Advanced Solar Power Systems

The Advanced Solar Power System (ASPS) concentrator uses a technically sophisticated design and extensive tooling to produce very efficient (80 to 90%) and versatile energy supply equipment which is inexpensive to manufacture and requires little maintenance. The advanced optical design has two 10th order, generalized aspheric surfaces in a Cassegrainian configuration which gives outstanding performance and is relatively insensitive to temperature changes and wind loading. Manufacturing tolerances also have been achieved. The key to the ASPS is the direct absorption of concentrated sunlight in the working fluid by radiative transfers in a black body cavity. The basic ASPS design concepts, efficiency, optical system, and tracking and focusing controls are described

I-95 A/K/A the Drug Trafficker\u27s Freeway and Its Impact on State Constitutional Law

This article argues that a criminal in a search and seizure case can expect disparate results in different state trial courts although identical factual situations exist. The good faith exception to the exclusionary rule adopted by the United States Supreme Court in United States v. Leon has not been applied with uniformity in state courts. Furthermore, this article finds that some state courts, relying on adequate and independent state grounds, have afforded criminal defendants greater protection under state constitutions and statutes than they would receive in other state courts or federal district courts. Finally, this article argues that state appellate courts must write their opinions with clarity

When Should a Trial Judge Intervene to Question a Witness?

North Carolina Appellate Courts on several occasions have ordered new trials in cases due to the improper questioning of witnesses by the trial judge. Nonetheless, other Appellate Court opinions hold that limited questioning by the trial judge is appropriate and even necessary to promote clarity and to expedite the trial. We should all agree that the underlying purpose of every trial is to arrive at truth in the case and thus attempt to do justice. Clarity promotes justice. If the judge recognizes confusion at trial, limited intervention and questioning is allowed. The question becomes how far and under what circumstances may the trial judge intervene? A trial judge may intervene in the situations listed below, as well as others, without being subject to reversal on appeal. As I discuss the problems and possible solutions to the question presented, one must keep in mind that, under North Carolina trial procedure, no judge is allowed to voice any opinion as to whether any fact is fully or sufficiently proven as that invades the province of the jury

When Should a Trial Judge Intervene to Question a Witness?

North Carolina Appellate Courts on several occasions have ordered new trials in cases due to the improper questioning of witnesses by the trial judge. Nonetheless, other Appellate Court opinions hold that limited questioning by the trial judge is appropriate and even necessary to promote clarity and to expedite the trial. We should all agree that the underlying purpose of every trial is to arrive at truth in the case and thus attempt to do justice. Clarity promotes justice. If the judge recognizes confusion at trial, limited intervention and questioning is allowed. The question becomes how far and under what circumstances may the trial judge intervene? A trial judge may intervene in the situations listed below, as well as others, without being subject to reversal on appeal. As I discuss the problems and possible solutions to the question presented, one must keep in mind that, under North Carolina trial procedure, no judge is allowed to voice any opinion as to whether any fact is fully or sufficiently proven as that invades the province of the jury

The Emergence of a Congo Church

In 1898 the Disciples of Christ took over the Equator station of the American Baptist Foreign Mission Union at Bolenge. From that time this mission has enjoyed a steady growth, both in missionary personnel and its influence on native life in the Equator District of the Colony of Congo Belge. Its influence has also reached parts of three of the districts bordering on Equator District. It is with the church that this mission has won from the surrounding heathenism and with the church that it is hoped may be built up in this section from this beginning that this thesis primarily deals

The Effects of Certain Precision Practices on the Efficiency of Cotton Production.

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Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study

<p>Abstract</p> <p>Background</p> <p>The scope of practice of paramedics in Canada has steadily evolved to include increasingly complex interventions in the prehospital setting, which likely have repercussions on clinical outcome and patient safety. Clinical decision making has been evaluated in several health professions, but there is a paucity of work in this area on paramedics. This study will utilize the Delphi technique to establish consensus on the most important instances of paramedic clinical decision making during high acuity emergency calls, as they relate to clinical outcome and patient safety.</p> <p>Methods and design</p> <p>Participants in this multi-round survey study will be paramedic leaders and emergency medical services medical directors/physicians from across Canada. In the first round, participants will identify instances of clinical decision making they feel are important for patient outcome and safety. On the second round, the panel will rank each instance of clinical decision making in terms of its importance. On the third and potentially fourth round, participants will have the opportunity to revise the ranking they assigned to each instance of clinical decision making. Consensus will be considered achieved for the most important instances if 80% of the panel ranks it as important or extremely important. The most important instances of clinical decision making will be plotted on a process analysis map.</p> <p>Discussion</p> <p>The process analysis map that results from this Delphi study will enable the gaps in research, knowledge and practice to be identified.</p

Does Cultural Competency Training of Health Professionals Improve Patient Outcomes? A Systematic Review and Proposed Algorithm for Future Research

BACKGROUND: Cultural competency training has been proposed as a way to improve patient outcomes. There is a need for evidence showing that these interventions reduce health disparities. OBJECTIVE: The objective was to conduct a systematic review addressing the effects of cultural competency training on patient-centered outcomes; assess quality of studies and strength of effect; and propose a framework for future research. DESIGN: The authors performed electronic searches in the MEDLINE/PubMed, ERIC, PsycINFO, CINAHL and Web of Science databases for original articles published in English between 1990 and 2010, and a bibliographic hand search. Studies that reported cultural competence educational interventions for health professionals and measured impact on patients and/or health care utilization as primary or secondary outcomes were included. MEASUREMENTS: Four authors independently rated studies for quality using validated criteria and assessed the training effect on patient outcomes. Due to study heterogeneity, data were not pooled; instead, qualitative synthesis and analysis were conducted. RESULTS: Seven studies met inclusion criteria. Three involved physicians, two involved mental health professionals and two involved multiple health professionals and students. Two were quasi-randomized, two were cluster randomized, and three were pre/post field studies. Study quality was low to moderate with none of high quality; most studies did not adequately control for potentially confounding variables. Effect size ranged from no effect to moderately beneficial (unable to assess in two studies). Three studies reported positive (beneficial) effects; none demonstrated a negative (harmful) effect. CONCLUSION: There is limited research showing a positive relationship between cultural competency training and improved patient outcomes, but there remains a paucity of high quality research. Future work should address challenges limiting quality. We propose an algorithm to guide educators in designing and evaluating curricula, to rigorously demonstrate the impact on patient outcomes and health disparities

What do family physicians consider an error? A comparison of definitions and physician perception

BACKGROUND: Physicians are being asked to report errors from primary care, but little is known about how they apply the term "error." This study qualitatively assesses the relationship between the variety of error definitions found in the medical literature and physicians' assessments of whether an error occurred in a series of clinical scenarios. METHODS: A systematic literature review and pilot survey results were analyzed qualitatively to search for insights into what may affect the use of the term error. The National Library of Medicine was systematically searched for medical error definitions. Survey participants were a random sample of active members of the American Academy of Family Physicians (AAFP) and a selected sample of family physician patient safety "experts." A survey consisting of 5 clinical scenarios with problems (wrong test performed, abnormal result not followed-up, abnormal result overlooked, blood tube broken and missing scan results) was sent by mail to AAFP members and by e-mail to the experts. Physicians were asked to judge if an error occurred. A qualitative analysis was performed via "immersion and crystallization" of emergent insights from the collected data. RESULTS: While one definition, that originated by James Reason, predominated the literature search, we found 25 different definitions for error in the medical literature. Surveys were returned by 28.5% of 1000 AAFP members and 92% of 25 experts. Of the 5 scenarios, 100% felt overlooking an abnormal result was an error. For other scenarios there was less agreement (experts and AAFP members, respectively agreeing an error occurred): 100 and 87% when the wrong test was performed, 96 and 87% when an abnormal test was not followed up, 74 and 62% when scan results were not available during a patient visit, and 57 and 47% when a blood tube was broken. Through qualitative analysis, we found that three areas may affect how physicians make decisions about error: the process that occurred vs. the outcome that occurred, rare vs. common occurrences and system vs. individual responsibility CONCLUSION: There is a lack of consensus about what constitutes an error both in the medical literature and in decision making by family physicians. These potential areas of confusion need further study

Experience Feedback Committee: a management tool to improve patient safety in mental health

BACKGROUND: A management tool, called the Experience Feedback Committee, has been applied for patient safety and successfully used in medical departments. The purpose of this study was to analyse the functioning of an Experience Feedback Committee in a psychiatric department and to explore its contribution to the particular issues of patient safety in mental health. METHODS: We conducted a descriptive study based on all the written documents produced by the Experience Feedback Committee between March 2010 and January 2013. The study was conducted in Grenoble University Hospital in France. We analysed all reported incidents, reports of meetings and event analysis reports. Adverse events were classified according to the Conceptual Framework for the International Classification for Patient Safety. RESULTS: A total of 30 meetings were attended by 22 professionals including seven physicians and 12 paramedical practitioners. We identified 475 incidents reported to the Experience Feedback Committee. Most of them (92 %) had no medical consequence for the patient. Eleven incidents were investigated with an analysis method inspired by civil aviation security systems. Twenty-one corrective actions were set up, including eight responses to the specific problems of a mental health unit, such as training to respond to situations of violence or management of suicide attempts. CONCLUSIONS: The Experience Feedback Committee makes it possible to involve mental healthcare professionals directly in safety management. This tool seems appropriate to manage specific patient safety issues in mental health. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12991-015-0062-2) contains supplementary material, which is available to authorized users