2,303 research outputs found
When, how and why BRCA1 and BRCA2 genetic testing is offered to patients who do not meet standard criteria
Life cycle energy efficiency in building structures: A review of current developments and future outlooks based on BIM capabilities
The continuous developments of Building Information Modelling (BIM) in Architecture, Engineering and Construction (AEC) industry supported by the advancements in material resourcing and construction processes could offer engineers the essential decision-making procedures to leverage the raising demands for sustainable structural designs. This article brings together the theory of Life Cycle Assessment (LCA) and the capabilities of BIM to survey the current developments in the energy efficiency of structural systems. In addition, the article explores the engineering dimensions of common decision-making procedures within BIM systems including optimisation methods, buildability and safety constraints and code compliance limitations. The research presents critical expositions in both engineering and sustainable energy domains. The article then argues that future innovations in the sustainable decision-making of buildingsâ structures would require BIM-integrated workflows in order to facilitate the conflicting nature of both energy efficient and engineering performance indexes. Finally, the study puts forward a series of research guidelines for a consolidated decision paradigm that utilises the capabilities of BIM within the engineering and sustainable energy domains in a synergistic manner
A Hierarchical Task Analysis of Commercial Distribution Driving in the UK
At the heart of distribution operations is an essential influence in the success or failure of achieving the triple bottom line of safety, efficiency, and environmental friendliness: commercial vehicle drivers, and the increasingly complex technology with which they interact. To the authorsâ knowledge, no hierarchical task analysis exists for commercial distribution driving, and this gap suggests that the first step in clarifying these functional relationships is to fulfill the evident need for a HTA of the commercial driving task. Thus, relevant literature (e.g. the UK Driving Standards Agency; existing hierarchical task analysis of private vehicle driving) is consulted to review procedure and construct a hierarchical task analysis of commercial distribution driving, in accordance with UK standards for C, CE, C+1 and CE+1 licensed driving activities. Preliminary analysis indicates that successful completion of the commercial driving task is subject to a far more complex set of factors than that of private vehicle driving, many of which require input from actors across various contexts, and rely heavily on automated vehicle technology. At present there exists no comprehensive, standardized measure against which to evaluate the quality of content in commercial driver training, and much is left to the expertise and discretion of individual companies to determine content which will create and support an âeffectiveâ driver. This hierarchical task analysis provides a normative characterization of commercial driving which informs driver training needs and course content, and supports industry expertise with a functional structure. Furthermore, this analysis may also serve as an input to a wide range of human factors analyses for effective system design
Comparison of Three Methods for Sampling Fishes and Macroinvertebrates in a Vegetated Wetland
Three methods of sampling fishes, two seining methods and a drop trap method, were evaluated in heavily vegetated freshwater habitats. The portable drop trap method, which utilized a 1 x 1 m-sq. trap, collected significantly more macroinvertebrates and fish per unit area than did the seining methods. The meter square drop trap offered the additional advantages of a greater number of animals per unit effort and an integrated sample of vegetation, macroinvertebrates and fish in a given area. A 90% (s.d.= 7.4%) recovery of tagged fishes released into the traps in different habitats showed the m2 drop trap to be a highly reliable and effective sampling method for fish in vegetated wetlands
Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study)
Background: Although results of case series support the use of spinal cord stimulation in failed back surgery syndrome patients with predominant low back pain, no confirmatory randomized controlled trial has been undertaken in this patient group to date. PROMISE is a multicenter, prospective, randomized, open-label, parallel-group study designed to compare the clinical effectiveness of spinal cord stimulation plus optimal medical management with optimal medical management alone in patients with failed back surgery syndrome and predominant low back pain.
Method/Design: Patients will be recruited in approximately 30 centers across Canada, Europe, and the United States. Eligible patients with low back pain exceeding leg pain and an average Numeric Pain Rating Scale score >= 5 for low back pain will be randomized 1:1 to spinal cord stimulation plus optimal medical management or to optimal medical management alone. The investigators will tailor individual optimal medical management treatment plans to their patients. Excluded from study treatments are intrathecal drug delivery, peripheral nerve stimulation, back surgery related to the original back pain complaint, and experimental therapies. Patients randomized to the spinal cord stimulation group will undergo trial stimulation, and if they achieve adequate low back pain relief a neurostimulation system using the Specify (R) 5-6-5 multi-column lead (Medtronic Inc., Minneapolis, MN, USA) will be implanted to capture low back pain preferentially in these patients. Outcome assessment will occur at baseline (pre-randomization) and at 1, 3, 6, 9, 12, 18, and 24 months post randomization. After the 6-month visit, patients can change treatment to that received by the other randomized group. The primary outcome is the proportion of patients with >= 50% reduction in low back pain at the 6-month visit. Additional outcomes include changes in low back and leg pain, functional disability, health-related quality of life, return to work, healthcare utilization including medication usage, and patient satisfaction. Data on adverse events will be collected. The primary analysis will follow the intention-to-treat principle. Healthcare use data will be used to assess costs and long-term cost-effectiveness.
Discussion: Recruitment began in January 2013 and will continue until 2016
Single maintenance and reliever therapy (SMART) of asthma: a critical appraisal
The use of a combination inhaler containing budesonide and formoterol as both maintenance and quick relief therapy (SMART) has been recommended as an improved method of using inhaled corticosteroid/long-acting ÎČ agonist (ICS/LABA) therapy. Published double-blind trials show that budesonide/formoterol therapy delivered in SMART fashion achieves better asthma outcomes than budesonide monotherapy or lower doses of budesonide/formoterol therapy delivered in constant dosage. Attempts to compare budesonide/formoterol SMART therapy with regular combination ICS/LABA dosing using other compounds have been confounded by a lack of blinding and unspecified dose adjustment strategies. The asthma control outcomes in SMART-treated patients are poor; it has been reported that only 17.1% of SMART-treated patients are controlled. In seven trials of 6â12â
months duration, patients using SMART have used quick reliever daily (weighted average 0.92 inhalations/day), have awakened with asthma symptoms once every 7â10â
days (weighted average 11.5% of nights), have suffered asthma symptoms more than half of days (weighted average 54.0% of days) and have had a severe exacerbation rate of one in five patients per year (weighted average 0.22 severe exacerbations/patient/year). These poor outcomes may reflect the recruitment of a skewed patient population. Although improvement from baseline has been attributed to these patients receiving additional ICS therapy at pivotal times, electronic monitoring has not been used to test this hypothesis nor the equally plausible hypothesis that patients who are non-compliant with maintenance medication have used budesonide/formoterol as needed for self-treatment of exacerbations. Although the long-term consequences of SMART therapy have not been studied, its use over 1â
year has been associated with significant increases in sputum and biopsy eosinophilia. At present, there is no evidence that better asthma treatment outcomes can be obtained by moment-to-moment symptom-driven use of ICS/LABA therapy than conventional physician-monitored and adjusted ICS/LABA therapy
BIM enabled optimisation framework for environmentally responsible and structurally efficient design systems
The present research investigates the potential for reducing the environmental impacts of structural systems through a more efficient use of materials. The main objective of this research is to explore and to develop a holistic and integrated methodology that utilises Building Information Modelling's (BIM) capabilities combined with structural analysis and Life Cycle Assessment (LCA) as well as a two-staged structural optimisation solver that achieves efficient and environmentally responsible steel design solutions. The implemented workflow utilises Autodesk Revit-BIM, Tally-LCA and Autodesk Robot-Structural Analysis. RobOpt is the plug-in that has been established using the Application Programming Interface (API) of Robot and the .NET framework of C?, and it inherits several structural functionalities based on Robot Finite Element Method (FEM) engine. The proposed RobOpt application can be accessed via a graphic user interface (GUI) within the Robot software. The developed BIM-enabled optimisation methodology could be utilised as a design tool to inform early stage structural design solutions. A prototypical steel framed structural system under certain loads has been explored. The resulting bespoke I-beam sections from the custom genetic algorithm (GA) optimisation demonstrate that significant savings-up to 21%-can be achieved in all tested environmental indicators when compared to the standard UK catalogue of steel sections. Considering all, the proposed framework constitutes a useful and an intuitive workflow, which aims to quantify the environmental savings of structural systems by utilising, advanced computational analysis and common construction techniques
Bayesian aggregation versus majority vote in the characterization of non-specific arm pain based on quantitative needle electromyography
Moving from a Product-Based Economy to a Service-Based Economy for a More Sustainable Future
Traditionally, economic growth and prosperity have been linked with the availability, production and distribution of tangible goods as well as the ability of consumers to acquire such goods. Early evidence regarding this connection dates back to Adam Smith's Wealth of Nations (1776), in which any activity not resulting in the production of a tangible good is characterized as unproductive of any value." Since then, this coupling of economic value and material production has been prevalent in both developed and developing economies throughout the world. One unintended consequence of this coupling has been the exponential increase in the amount of solid waste being generated. The reason is that any production and consumption of material goods eventually generates the equivalent amount of (or even more) waste. Exacerbating this problem is the fact that, with today's manufacturing and supply chain management technologies, it has become cheaper to dispose and replace most products rather than to repair and reuse them. This has given rise to what some call a disposable society." To put things in perspective: In 2012 households in the U.K. generated approximately 22 thousand tons of waste, which amounted to 411 kg of waste generated per person (Department for Environment, Food & Rural Affairs, 2015). During the same time period, households in the U.S. generated 251 million tons of waste, which is equivalent to a person generating approximately 2 kg of waste every day (U.S. Environmental Protection Agency, 2012). Out of these 251 million tons of total waste generated, approximately 20% of the discarded items were categorized as durable goods. The disposal of durable goods is particularly worrisome because they are typically produced using material from non- renewable resources such as iron, minerals, and petroleum-based raw materials
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