A Constitutional Perspective on the Indiana Medical Malpractice Act

Symposium: The 1975 Indiana Medical Malpractice Ac

SWIRP (Submm-Wave and Long Wave InfraRed Polarimeter); Development and Characterization of a Sub-Mm Polarimeter for Ice Cloud Investigations

A major source of uncertainty in climate models is the presence, shape and distribution of ice particles in the uppermost layers of the clouds. The effects of this component are poorly constrained, turning ice particles into an almost-free variable in many climate models.NASA-GSFC is developing a new instrument aimed at measuring the size and shape of ice particles. The instrument consists of two sub-mm polarimeters (at 220 and 670 GHz) coupled with a long-wave infrared polarimeter at 10 micron. Each polarimeter has identical V-pol and H-pol channels; the axes of polarization are defined geometrically by the orientation of the waveguide elements, and the purity has been measured in the lab. The instrument is configured as a conical scanner, suitable for deployment as a payload on a small satellite or on a high-altitude sub-orbital platform. From a 400 km orbit, the instrument has a 3dB spatial resolution of 20 (10) km at 220 (670) GHz and a swath of 600 km over 180 degrees of view.The BAPTA (Bearing And Power Transfer Assembly) carries heritage from the SSMIS design, now in its 22nd year of on-orbit operation, but with a much reduced SWaP (Size Weight and Power) footprint, suitable for a small satellite.The main components of the instrument have been fabricated and are undergoing final testing prior to their integration as a single unit. The sub-mm channels have dedicated secondary reflectors which illuminate a shared primary reflector. The receiving units are placed behind the focal point of the optical arrangement, so that all beams equally illuminate the primary reflector and are almost co-located on the ground (within a single 220 GHz footprint). Primary and secondary beam patterns have been measured and verified to match the as-designed expectations. A Zytex (TM) window is deployed to protect the secondary reflectors and the feed horns from debris and other contaminants, and to reduce the heat load from the active (hot) IR calibration unit. The insertion loss of Zytex has been measured and is accounted in the calibration equation of the sub-mm channels.The radiometric performance of the sub-mm receivers has been characterized in the lab and under operational conditions of temperature and pressure.This paper discusses the design constraints on the sub-mm components, details of the scientific goals and their flowdown, and describes the characterization of the polarimeters. Options to optimize the layout and distribution of the masses within the assembly, with the goal of making the instrument even more compact and fully-compatible with cubesat-class satellites will be presented

Senior Sway: Using a Mobile Application to Measure Fall Risk

Background and Purpose: The Senior Sway mobile application uses the iPhone/iPad gyroscope to assess postural sway and motion reaction time. Impairment in postural sway and motion reaction time have the potential to increase risk for future falls. Senior Sway thereby has the potential to provide a quick, easy to use, objective measure for predicting falls in older adults. The purpose of this study was to evaluate the feasibility of the Senior Sway mobile application and its associations with fall risk in community-dwelling older adults. Methods: Adults older than 62 years were recruited from senior centers and community events. Descriptive and bivariate statistics were used to examine feasibility on the basis of enrollment, time required, satisfaction with application, and association with fall risk. Results and Discussion: Fifty-seven adults were recruited. Use of the Senior Sway mobile application was feasible. Ninety-one percent said that they liked the application and reported length of time of assessment was “just right.” The average Senior Sway score was 64.0 (range: 47.8-84.0), which was signifi cantly associated with the 30-second sit-to-stand test. In addition, the motor reaction time score was associated with the Timed Up and Go. Conclusions: Senior Sway is a promising application to improve identifi cation of adults at risk for falls and need for rehabilitation but warrants further research

Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care Delivery: Approaches From 3 Prospective Studies

Introduction: Patient-reported outcome (PRO) measures used during cancer care delivery improve communication about symptoms between patients and clinicians and reduce service utilization for uncontrolled symptoms. However, uptake of PROs in routine cancer care has been slow. In this paper, we describe stakeholder engagement activities used to overcome barriers to implementing PROs. Implementation occurred in 2 study settings: PROs completed in the waiting room and reviewed during clinical visits to guide symptom management for multiple myeloma (visit-based PROs); and weekly PROs completed by cancer patients between chemotherapy visits to monitor symptoms at home (remote PROs). Methods: PRO implementation steps across studies included: (1) clinician and patient input on key symptoms, PRO measures, and identifying which PRO responses are clinically concerning to better target nursing actions; (2) developing PRO-based clinical decision support (CDS) for responding to concerning PROs; (3) training clinicians and clinical research assistants to interpret PROs and use software; and (4) describing implementation impact (frequency of concerning PRO responses and nursing actions). Discussion: Clinician and patient input was critical for identifying key symptoms, PRO measures, and clinically concerning response options. For the visit-based PRO observational study, all symptom scores appeared on a clinician dashboard, and those rated ≥1 by patients (on a 0–4 or 0–10 scale) had PRO-based CDS available for access. For the 2 remote PROs trials, stakeholders recommended that the 2 “worst” response options (eg, PRO responses of “often”/“always” or “severe”/“very severe”) would trigger an automated email alert to a nurse along with PRO-based CDS. In each study, PRO-based CDS was tailored based on clinician input. Across studies, the most common nursing response to concerning PROs was counseling patients on (or providing care plans for) self-management of symptoms. In the trials, the percentage of weekly remote PROs generating an alert to a nurse ranged from 13% at an academic center to 36% in community oncology practices. Key Points: Across 3 prospective studies, PROs implemented into cancer care enabled tailored care based on issues identified on PROs. Stakeholder engagement was critical for successful implementation. This paper assists in addressing important PRO implementation challenges by describing a stakeholder-driven approach

Exploring the future of tourism and quality of life

Few studies to date have examined the impact of tourism on quality of life (QoL) as conventional research has tended to focus, instead, on resident attitudes towards tourism and tourism ’s impacts in particular (Smith, 1977; 1989). Even less research has addressed whether tourism can drive or facilitate sustainable development (Miller and Twining-Ward, 2005) or whether tourism can contribute to the subjective wellbeing of those involved in travel and tourism. Impact studies generally ask residents to agree or disagree with statements regarding perceived impacts from tourism on their community. By contrast, QoL research aims to understand how these impacts are internalised and influence an individual’s overall life satisfaction (Andereck et al, 2007). With terms used interchangeably QoL, happiness and well-being refer to one’s satisfaction with life, and feelings of contentment or fulfilment with one’s experiences in the world (ibid.). Whether tourism as phenomena and practice may support the growing body of evidence that demonstrates a positive relationship between existential factors such as life purpose / meaning, personal growth and wellbeing (Vella-Brodrick, 2007) was the topic of intense debate during the 2008 Business Enterprises for Sustainable Travel Education Network (BEST EN) Think Tank VIII

Stability of Solid State Reaction Fronts

We analyze the stability of a planar solid-solid interface at which a chemical reaction occurs. Examples include oxidation, nitridation, or silicide formation. Using a continuum model, including a general formula for the stress-dependence of the reaction rate, we show that stress effects can render a planar interface dynamically unstable with respect to perturbations of intermediate wavelength

Summer 1967

Massachusetts Turf and Lawn Grass CouncilBetter Turf Through Research and Educatio

Psychosocial predictors of depression among older African American cancer patients

To determine whether psychosocial factors predict depression among older African American cancer patients

Pregnancy attempts among adolescent and young adult cancer survivors

Objective: To examine whether demographic and cancer-related characteristics and factors such as fertility discussion with a medical provider and fertility preservation use are associated with attempting pregnancy after adolescent and young adult cancer. Design: Cross-sectional online survey. Setting: Not applicable. Patient(s): Women with lymphoma, breast cancer, thyroid cancer, or gynecologic cancer diagnosed at 15–39 years from 2004 to 2016 were identified from the North Carolina Cancer Registry and the Kaiser Permanente Northern and Southern California health care systems and responded to an online survey addressing survivorship concerns, including fertility and reproductive outcomes. Exposures: Demographic characteristics, cancer characteristics, fertility discussion with a medical provider or fertility specialist between cancer diagnosis and starting cancer treatment, use of fertility preservation strategies (freezing embryos or oocytes) after cancer diagnosis. Main Outcome Measure(s): Pregnancy attempt after cancer diagnosis, defined by either a pregnancy or 12 months of trying to become pregnant without pregnancy. Result(s): Among 801 participants who had not reached their desired family size at diagnosis, 77% had a fertility discussion with any medical provider between cancer diagnosis and treatment initiation, and 8% used fertility preservation after cancer diagnosis. At survey (median =7 years after diagnosis; interquartile range, 4–10), 32% had attempted pregnancy. Neither fertility discussion with any medical provider nor fertility counseling with a fertility specialist was significantly associated with pregnancy attempts. However, the use of fertility preservation was significantly associated with attempting pregnancy (prevalence ratios = 1.74; 95% confidence interval: 1.31–2.32). Other characteristics positively associated with pregnancy attempts included younger age at diagnosis, longer time since diagnosis, having a partner (at diagnosis or at survey), and having a history of infertility before cancer diagnosis. Conclusion(s): Use of fertility preservation strategies was uncommon in our cohort but was associated with attempting pregnancy after cancer. Ensuring access to fertility preservation methods may help adolescent and young adult cancer survivors to plan and initiate future fertility

Double agents: gendered organizational culture, control and resistance

Author's pre-publication draft. Final version of the article published in Sociology; available online on http://online.sagepub.com/This article presents ethnographic data showing how recruitment consultants negotiate managerial attempts to control workforce culture. I suggest the values which senior managers encourage consultants to embody prioritize so-called`masculine' attributes over `feminine' ones. I attempt to demonstrate the limits of cultural control by outlining three ways in which the consultants engage with this imposed culture: defiance, parody and ritual. These activities contain gendered assumptions similar to those embedded in corporate culture. I discuss the potential such practices have for resisting corporate culture and the gender within it, suggesting that one source of ambiguity within workplace `control' and `resistance' practices is that they employ overlapping cultural resources and assumptions