Important synoptic features during INDOEX IFP-99

INDOEX IFP-99 was undertaken as part of the international experiment in the Indian Ocean to take observations pertaining to aerosols, radiation, cloud physics and other related meteorological parameters. The important-aim of the INDOEX was to quantify radiative forcing due to natural and anthropogenic aerosols and their feedback on regional and global climate systems. Since prevailing circulation features transports aerosols, it is essential that important synoptic patterns during the expedition phase, i.e. 20 January to 10 March 1999 be examined. Based on the synoptic features it was noticed that crossequatorial flow in lower levels from western Arabian Sea to southern Indian Ocean was significantly higher than the eastern Arabian Sea. Two cyclonic storms, one in the south Bay of Bengal during 1-3 February and another in the south Indian Ocean during 4-13 March were observed. Significant changes in the cross-equatorial flow in the lower/upper tropospheric levels and ITCZ locations were noticed

Developing the Occupational Self Assessment: the use of Rasch analysis to assure internal validity, sensitivity and reliability.

This paper reports the results of three studies that examined the internal validity, sensitivity and reliability of the Occupational Self Assessment (OSA), a self-report of Occupational Competence and Value for occupational performance and participation (Baron et al 2006). All three studies used a Rasch measurement approach to explore the psychometric properties of iterative versions of the OSA. The first study showed that the 'Myself' Occupational Competence and Values items constituted a unidimensional construct, but did not discriminate optimally between participants. The results also suggested that the two 'My Environment' scales did not contain enough items to exhibit adequate measurement properties. Next, the rating scales were changed from three-point to four-point categories. The second study examined these changes and provided evidence to support the use of a four-point Occupational Competence scale. The Values rating scale was further revised because sensitivity did not improve. The third study confirmed that the OSA items in combination have good internal validity and measure the unidimensional constructs of Occupational Competence and Values. Further, both four-point rating scales resulted in improved person separation, indicated increased sensitivity, and could be used in a consistent manner by 90% of participants with a range of disabilities from a variety of contexts. The College of Occupational Therapists Ltd.sch_occ72pub1336pub

Thermal postbuckling behavior of laminated composite plates

This article does not have an abstract

Risk Factors and Clinical Outcomes Associated With Augmented Renal Clearance in Trauma Patients

Augmented renal clearance (ARC; i.e., creatinine clearance [CL ] ≥ 130 mL/min) has an incidence of 14%-80% in critically ill patients and has been associated with therapy failures for renally cleared drugs. However, the clinical implications of ARC are poorly defined. We hypothesize that modifiable risk factors that contribute to ARC can be identified in severely injured trauma patients and that these risk factors influence clinical outcome. In 207 trauma intensive care unit patients, 24-h CL was correlated with clinical estimates of glomerular filtration rate (by Cockroft-Gault, modification of diet in renal disease, or chronic kidney disease epidemiology), and clinical outcomes (infection, venous thromboembolism [VTE], length of stay, and mortality). The population was 45 ± 20 y, 68% male, 77% blunt injury with injury severity score of 24 (17-30). Admission serum creatinine was 1.02 ± 0.35 mg/dL, CL was 154 ± 77 mL/min, VTE incidence was 15%, ARC incidence was 57%, and mortality was 11%. Clinical estimates of glomerular filtration rate by Cockroft-Gault, modification of diet in renal disease, chronic kidney disease epidemiology underestimated actual CL by 20%, 22%, or 15% (all P < 0.01). CL was higher in males and those who survived, and lower in those with hypertension, diabetes, positive cultures, receiving transfusions, or pressors (all P < 0.05). On multivariate analysis, male gender (odds ratio [OR] 2.9 [1.4-6.1]), age (OR 0.97 [0.95-0.99]), and packed red blood cells transfusion (OR 0.31 [0.15-0.66]) were the only independent predictors of ARC. ARC occurs in more than half of all high-risk trauma intensive care unit patients and is underestimated by standard clinical equations. ARC was not associated with increased incidence of VTE or infection but rather is associated with younger healthier males and reduced mortality. ARC seems to be a beneficial compensatory response to trauma

Ethics in Telehealth : Comparison between Guidelines and Field Experience -the Case for Learning Health Systems

OBJECTIVES:To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives. METHODS:We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth. RESULTS:Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts. CONCLUSIONS:Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth