Ariel - Volume 3 Number 2

Editors Richard J. Bonanno Robin A. Edwards Associate Editors Steven Ager Stephen Flynn Tom Williams Lay-out Editor Eugenia Miller Contributing Editors Paul Bialas Milton Packer Robert Breckenridge Lynne Porter Mark Pearlman Terry Burt Mike Leo Editors Emeritus Delvyn C. Case, Jr. Paul M. Fernhof

The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: A cohort study in Indonesia Health systems and services in low and middle income settings

Background: For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization's service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls. Methods: This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only. Results: 167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a "wheelie". The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019). Conclusions: Wheelchair provision according to World Health Organization's 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages

The Community Authorization Service: Status and Future

Virtual organizations (VOs) are communities of resource providers and users distributed over multiple policy domains. These VOs often wish to define and enforce consistent policies in addition to the policies of their underlying domains. This is challenging, not only because of the problems in distributing the policy to the domains, but also because of the fact that those domains may each have different capabilities for enforcing the policy. The Community Authorization Service (CAS) solves this problem by allowing resource providers to delegate some policy authority to the VO while maintaining ultimate control over their resources. In this paper we describe CAS and our past and current implementations of CAS, and we discuss our plans for CAS-related research.Comment: Talk from the 2003 Computing in High Energy and Nuclear Physics (CHEP03), La Jolla, Ca, USA, March 2003. 9 Pages, PD

A conceptual framework to assess effectiveness in wheelchair provision

Background: Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities. Objectives: In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. Method: The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. Results: The three iterations of the conceptual framework are described in this manuscript. Conclusion: We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe

Enhancing image contrast using coherent states and photon number resolving detectors

We experimentally map the transverse profile of diffraction-limited beams using photon-number-resolving detectors. We observe strong compression of diffracted beam profiles for high detected photon number. This effect leads to higher contrast than a conventional irradiance profile between two Airy disk-beams separated by the Rayleigh criterion.Comment: 7 pages, 3 figures, accepted for publication in Optics Expres

Procedures to Improve Sensor Data Quality

The oceans play an important role in aspects of global sustainability, including climate change, food security and human health. Because of its vast dimensions, internal complexity, and limited accessibility, efficient monitoring and predicting of the ocean forms a collaborative effort of regional and global scale. A key requirement for ocean observing is the need to follow well-defined approaches. Summarized under “Ocean Best Practices” (OBP) are all aspects of ocean observing that require proper and agreed-on documentation, from manuals and standard operating procedures for sensors, strategies for structuring observing systems and associated products, to ethical and governance aspects when executing ocean observing. In Task 6.2 we have developed new tools, and organized workshops with outcomes of Best Practice manuals and scientific publications. The focus has been on improving accuracy of trace element measurements in seawater and also of marine omics analysis, and enhancing reliability, interoperability and quality of sensor measurements for dissolved oxygen, nutrients and carbonate chemistry measurements

National Geodetic Satellite Program, Part II: Smithsonian Astrophysical Observatory

A sequence of advances in the determination of geodetic parameters presented by the Smithsonian Astrophysical Observatory are described. A Baker-Nunn photographic system was used in addition to a ruby-laser ranging system to obtain data for refinement of geodetic parameters. A summary of the data employed to: (1) derive coordinates for the locations of various tracking stations; and (2) determine the gravitational potential of the earth, is presented

Incoming Interns Perceived Preparedness for Core Entrustable Professional Activities

© 2019, International Association of Medical Science Educators. Introduction: The AAMC described 13 core entrustable professional activities (EPAs) for which every graduating medical student should perform proficiently on day 1 of residency. We studied how prepared starting interns felt in the core EPAs. Methods: Interns from a diverse health system were surveyed on how well medical school prepared them in the 13 core EPAs. Data were collected on type of medical school, participation in an acting/sub-internship (AI/SI), knowledge of EPAs, and participation in an EPA experience. Results: We collected 224 surveys out of 384 (58%) interns. 61.2% attended allopathic, 14.6% attended osteopathic, and 24.2% attended international schools. 67% had not heard of EPAs. 29% had an EPA experience of which 82% were required. 80% or more felt prepared in all EPAs except orders (60.7%) and handovers (73%). Allopathic interns were significantly more likely to have heard of EPAs and participated in an EPA experience than international. Allopathic interns felt more prepared than international in oral presentations and evidence-based medicine. Interns who participated in an EPA experience felt more prepared for oral presentation and evidence-based medicine. There were small but significant differences in feeling prepared in certain EPAs and types of AI/SI taken. Conclusion: The majority of interns entering residency have not heard of EPAs with fewer than 1/3 of interns participating in an EPA experience. International graduates were less likely to be aware or have experience with EPAs and report being less prepared in oral presentation and evidence-based medicine compared to allopathic graduates

Antidepressant Effects of High and Low Frequency Repetitive Transcranial Magnetic Stimulation to the Dorsolateral Prefrontal Cortex

Repetitive transcranial magnetic stimulation(rTMS) has antidepressant effects in patients withmajor depressive disorder. The mechanisms of ac-tion and optimal stimulation parameters remainunclear. To test the hypothesis that rTMS exertsantidepressant effects either by enhancing left dor-solateral prefrontal cortex (DLPFC) excitability orby decreasing right DLPFC excitability, the au-thors studied 45 patients with unipolar recurrentmajor depressive disorder in a double-blind, ran-domized, parallel group, sham-controlled trial. Pa-tients were randomized to receive 1 Hz or 10 HzrTMS to the left DLPFC, 1 Hz to the rightDLPFC or sham TMS. Left 10 Hz and right 1 HzrTMS showed similar significant antidepressanteffects. Other parameters led to no significantantidepressant effectThis study was supported in part by grants from the Spanish Ministerio de Educacion y Cienca (DGICYT), the Milton Fund, the Stanley Vada NAMI Foundation, the National Alliance for Research in Schizophrenia and Depression, and NIMHMedicin