Fatigue of boron-aluminum composites bonds and joints

Study examines effects of boron filament diameter on bonds and joints in boron-aluminum composite. Data include static strength, fatigue, and dynamic moduli of elasticity. Manson-Coffin analyses and metallurgical and fracture surface evaluation were also performed

The Impact of Banking Service Quality on the Financial Performance of Saudi Commercial Banks

This study aims to identify the extent of application banking service dimensions in Saudi commercial banks and the impact of  this  application on their financial performance, with the identification of the adoption possibility of new marketing mechanism from these banks to improve performance and make it a competitive advantage for them compared to other banks , and the results of the study were as follows: There is a strong  statistically significance correlation between  the principles of  banking service quality on one hand and the indicators of financial performance in the Saudi  commercial banks on the other hand, except the credibility principle  , The strongest correlation relationship is for  responsiveness principle and the least one is for reliability principle on financial performance , the study indicated that there is a correlation ralationship between the principles of banking service quality on one hand and the indicators of financial performance in saudi commercial banks on the other hand, except liquidity indicator , as the study indicated that there isnot correlation relationship between the variables of service quality principles  , The strongest relationship is  for activity indicator and then for  profitability indicator ,  and the least one is  for liquidity indicator with the principles of banking service quality ,  depending on the study sample's  point of view

Resistance Diffusion Bonding Boron/Aluminum Composite to Titanium New joining process allows low cost incorporation of B/AI into titanium aircraft and missile components for applications at temperatures to 600 F

ABSTRACT. Resistance spotdiffusion produces sound joints between boron/aluminum and titanium using standard electrodes and production welding equipment. Mechanical properties of these joints were excellent over the temperature range of 70 to 600 F. Data presented includes static, fatigue, creep, and crippling strength. Resistance diffusion bonding has been applied primarily to joining B/AI "hat" stiffeners to titanium web panels. Single stiffener/web test components have been tested to failure over the 70 to 600 F temperature range without failure of the spot joints. Large, multiple-stiffener panels have been fabricated and tested. To date, no premature joint failure has occurred in any of the more than 4,000 spots produced. In addition to stiffener/panel joints, stiffener splices have been produced successfully. This new joining process allows low-cost incorporation of B/AI into titanium aircraft and missile components. The high modulus and light weight of the composite can be used in areas where its high cost is justified, without requiring its usage in less critical areas. The ability to withstand structural loads at 600 F allows application in areas heretofore considered out of the range of B/AI application

Current state of antimicrobial stewardship in children’s hospital emergency departments

BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation. RESULTS A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR. CONCLUSIONS Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children's hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support. Infect Control Hosp Epidemiol 2017;38:469-475

A stimulus to define informatics and health information technology

<p>Abstract</p> <p>Background</p> <p>Despite the growing interest by leaders, policy makers, and others, the terminology of health information technology as well as biomedical and health informatics is poorly understood and not even agreed upon by academics and professionals in the field.</p> <p>Discussion</p> <p>The paper, presented as a Debate to encourage further discussion and disagreement, provides definitions of the major terminology used in biomedical and health informatics and health information technology. For informatics, it focuses on the words that modify the term as well as individuals who practice the discipline. Other categories of related terms are covered as well, from the associated disciplines of computer science, information technolog and health information management to the major application categories of applications used. The discussion closes with a classification of individuals who work in the largest segment of the field, namely clinical informatics.</p> <p>Summary</p> <p>The goal of presenting in Debate format is to provide a starting point for discussion to reach a documented consensus on the definition and use of these terms.</p

Variability in Pediatric Infectious Disease Consultants' Recommendations for Management of Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) is a common childhood infection. CAP complications, such as parapneumonic empyema (PPE), are increasing and are frequently caused by antibiotic-resistant organisms. No clinical guidelines currently exist for management of pediatric CAP and no published data exist about variations in antibiotic prescribing patterns. Our objectives were to describe variation in CAP clinical management for hospitalized children by pediatric infectious disease consultants and to examine associations between recommended antibiotic regimens and local antibiotic resistance levels. (MRSA) in their community.e or clindamycin use and clindamycin resistance, however, respondents were more likely to recommend an anti-MRSA agent when MRSA prevalence increased.Substantial variability exists in recommendations for CAP management. Development of clinical guidelines via antimicrobial stewardship programs and dissemination of data about local antibiotic resistance patterns represent opportunities to improve care

Creating a novel approach to discourse treatment through coproduction with people with aphasia and speech and language therapists

Background: Although spoken discourse is an outcome prioritised by all stakeholders in aphasia rehabilitation, assessment and treatment of discourse are not routine clinical practice. The small evidence base, varied clinical expertise, multiple barriers in the workplace, and challenges for clients in understanding their altered language abilities all contribute to this situation. These factors need serious consideration when developing a new treatment. Involving intended stakeholders as partners in the development process is recommended. This assists with future implementation by ensuring assessment and treatment are practical, feasible, and acceptable to those who will deliver and undertake it. Aims: This paper reports on the coproduction phase of the Linguistic Underpinnings of Narrative in Aphasia (LUNA) research project and describes the levels of partners’ involvement, the outcomes and impact of coproduction, and the factors that influenced it. Methods and procedures: Four partners with aphasia and four speech and language therapists (SLTs) worked with academic team members across a 6-month period to create the LUNA assessment and treatment. Separate sessions were held with partners with aphasia (monthly) and SLTs (fortnightly). Coproduction methods included open discussion, the Someone Who Isn’t Me (SWIM) technique (thinking from others’ perspectives), low and high fidelity prototypes, flexible brainstorming, card sort, and active experimentation with assessment and treatment tasks. Verbal and written information was presented, shared and documented during each session in supportive formats, and each session summarised as accessible minutes. Outcomes and Results: Partners contributed at consultation, cooperation, and co-learning levels during the coproduction phase. Outcomes included joined-up thinking across assessment-goal setting-treatment-desired outcomes; agreed decisions and content for assessment protocol and treatment manual; clarity on personalised, meaningful, and relevant treatment; therapeutic alliance operationalised in treatment manual; and more. Impacts included increased confidence, self-knowledge, pride, validation, peer support, networking, and benefits to SLTs’ services. Coproduction was positively influenced by consistent session structure and conduct, group dynamics, accessible communication methods, active task experimentation, and SWIM technique. Although the process was time and labour intensive, all partners considered this worthwhile. Conclusions: LUNA has exemplified how an inclusive coproduction process can work well despite the language challenges of aphasia. Authors also believe that coproduction with intended users has resulted in products (assessment protocol, treatment manual) that are more practical, feasible, and acceptable to clinicians and clients than if designed by academics alone. This latter claim now needs testing on a wide scale

Ventricular function after coronary artery bypass grafting: Evaluation by magnetic resonance imaging and myocardial strain analysis

AbstractObjectiveMagnetic resonance imaging with radiofrequency tissue tagging permits quantitative assessment of regional systolic myocardial strain. We sought to investigate the utility of this imaging modality to quantitatively determine preoperative impairment and postoperative improvement in ventricular function in patients with ischemic heart disease.MethodsMagnetic resonance imaging with radiofrequency tissue tagging was performed on 6 patients (average age 60.2 ± 13.7 years) with coronary artery disease and 32 control subjects with no known heart disease. Patients with coronary artery disease underwent imaging before and 3 months after coronary artery bypass grafting. The ventricle was divided into 6 segments within a midventricular plane. Regional 2-dimensional left ventricular circumferential strain was calculated from tagged magnetic resonance images throughout systole. Circumferential strain results were compared in patients before and after and 3 months after coronary artery bypass grafting and also in control subjects.ResultsBefore the operation circumferential strain identified 100% (10/10) of all regional wall motion abnormalities seen by preoperative ventriculography. Postoperatively, improvements were demonstrated in 56% (20/36) of the regions, and these improvements agreed with viability testing by single-photon emission computed tomography when available. Additionally, preoperative global circumferential strain for the ischemic group was significantly depressed relative to that in control subjects (0.11 ± 0.05 vs 0.20 ± 0.03, P < .001). Global circumferential strain correlated with ejection fraction by ventriculography (r = 0.84, P < .01) and improved after coronary artery bypass grafting (0.14 ± 0.05 vs 0.11 ± 0.05, P < .01).ConclusionsMagnetic resonance imaging with radiofrequency tissue tagging permitted circumferential strain calculation. This technology quantitatively demonstrated improvements in left ventricular wall motion after coronary artery bypass grafting for both individual regions and the entire ventricle. This noninvasive method may prove useful in preoperative evaluation and postoperative serial assessment of left ventricular wall motion