Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

INTRODUCTION: There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing.  METHODS: This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made.  RESULTS: Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients.  CONCLUSIONS: By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence

Observations and a model of undertow over the inner continental shelf

Author Posting. © American Meteorological Society, 2008. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 38 (2008): 2341-2357, doi:10.1175/2008JPO3986.1.Onshore volume transport (Stokes drift) due to surface gravity waves propagating toward the beach can result in a compensating Eulerian offshore flow in the surf zone referred to as undertow. Observed offshore flows indicate that wave-driven undertow extends well offshore of the surf zone, over the inner shelves of Martha’s Vineyard, Massachusetts, and North Carolina. Theoretical estimates of the wave-driven offshore transport from linear wave theory and observed wave characteristics account for 50% or more of the observed offshore transport variance in water depths between 5 and 12 m, and reproduce the observed dependence on wave height and water depth. During weak winds, wave-driven cross-shelf velocity profiles over the inner shelf have maximum offshore flow (1–6 cm s−1) and vertical shear near the surface and weak flow and shear in the lower half of the water column. The observed offshore flow profiles do not resemble the parabolic profiles with maximum flow at middepth observed within the surf zone. Instead, the vertical structure is similar to the Stokes drift velocity profile but with the opposite direction. This vertical structure is consistent with a dynamical balance between the Coriolis force associated with the offshore flow and an along-shelf “Hasselmann wave stress” due to the influence of the earth’s rotation on surface gravity waves. The close agreement between the observed and modeled profiles provides compelling evidence for the importance of the Hasselmann wave stress in forcing oceanic flows. Summer profiles are more vertically sheared than either winter profiles or model profiles, for reasons that remain unclear.This research was funded by the Ocean Sciences Division of the National Science Foundation under Grants OCE-0241292 and OCE-0548961

Mixed debris interaction with obstacle array under extreme flood conditions

This investigation explores the interactions of different shaped debris with an array of obstacles under subcritical flow conditions, representative of a flood associated with a storm surge or tsunami. Panels, blocks and cylinders were used in a flow channel, as analogues for house panels, cars/containers and trees respectively, whilst some tests used a mix of debris. The backwater effect due to the blockage caused by the obstacles was most (least) significant for panels (cylinders). There was some evidence that smaller key log types and higher flow rates led to smaller dams. It was also evident that key logs formed at different depths depending on debris shape; debris shape also determined the vertical shape of the dam. Capture efficiency had a broadly negative (positive) correlation with the Froude number (permeability). Also, from video footage there were examples of the debris moving more quickly through partial dams. Finally, the drag force, deduced from only the water depths and the flow discharge, showed a clear relationship between drag force and Froude number, and a dependency of drag force on debris shape. There are some implications for the layout of building footprints in the inundation zones and the use of large, break-away panels

Numerical Investigation of a Fuselage Boundary Layer Ingestion Propulsion Concept

In the present study, a numerical assessment of the performance of fuselage boundary layer ingestion (BLI) propulsion techniques was conducted. This study is an initial investigation into coupling the aerodynamics of the fuselage with a BLI propulsion system to determine if there is sufficient potential to warrant further investigation of this concept. Numerical simulations of flow around baseline, Boundary Layer Controlled (BLC), and propelled boundary layer controlled airships were performed. Computed results showed good agreement with wind tunnel data and previous numerical studies. Numerical simulations and sensitivity analysis were then conducted on four BLI configurations. The two design variables selected for the parametric study of the new configurations were the inlet area and the inlet to exit area ratio. Current results show that BLI propulsors may offer power savings of up to 85% over the baseline configuration. These interim results include the simplifying assumption that inlet ram drag is negligible and therefore likely overstate the reduction in power. It has been found that inlet ram drag is not negligible and should be included in future analysis

A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse.

A randomized, multicentre, open-label, phase II study compared temozolomide (TMZ), an oral second-generation alkylating agent, and procarbazine (PCB) in 225 patients with glioblastoma multiforme at first relapse. Primary objectives were to determine progression-free survival (PFS) at 6 months and safety for TMZ and PCB in adult patients who failed conventional treatment. Secondary objectives were to assess overall survival and health-related quality of life (HRQL). TMZ was given orally at 200 mg/m(2)/day or 150 mg/m(2)/day (prior chemotherapy) for 5 days, repeated every 28 days. PCB was given orally at 150 mg/m(2)/day or 125 mg/m(2)/day (prior chemotherapy) for 28 days, repeated every 56 days. HRQL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 [+3]) and the Brain Cancer Module 20 (BCM20). The 6-month PFS rate for patients who received TMZ was 21%, which met the protocol objective. The 6-month PFS rate for those who received PCB was 8% (P = 0.008, for the comparison). Overall PFS significantly improved with TMZ, with a median PFS of 12.4 weeks in the TMZ group and 8.32 weeks in the PCB group (P = 0.0063). The 6-month overall survival rate for TMZ patients was 60% vs. 44% for PCB patients (P = 0.019). Freedom from disease progression was associated with maintenance of HRQL, regardless of treatment received. TMZ had an acceptable safety profile; most adverse events were mild or moderate in severity

Aircraft Conceptual Design Using Vehicle Sketch Pad

Vehicle Sketch Pad (VSP) is a parametric geometry modeling tool that is intended for use in the conceptual design of aircraft. The intent of this software is to rapidly model aircraft configurations without expending the expertise and time that is typically required for modeling with traditional Computer Aided Design (CAD) packages. VSP accomplishes this by using parametrically defined components, such as a wing that is defined by span, area, sweep, taper ratio, thickness to cord, and so on. During this phase of frequent design builds, changes to the model can be rapidly visualized along with the internal volumetric layout. Using this geometry-based approach, parameters such as wetted areas and cord lengths can be easily extracted for rapid external performance analyses, such as a parasite drag buildup. At the completion of the conceptual design phase, VSP can export its geometry to higher fidelity tools. This geometry tool was developed by NASA and is freely available to U.S. companies and universities. It has become integral to conceptual design in the Aeronautics Systems Analysis Branch (ASAB) here at NASA Langley Research Center and is currently being used at over 100 universities, aerospace companies, and other government agencies. This paper focuses on the use of VSP in recent NASA conceptual design studies to facilitate geometry-centered design methodology. Such a process is shown to promote greater levels of creativity, more rapid assessment of critical design issues, and improved ability to quickly interact with higher order analyses. A number of VSP vehicle model examples are compared to CAD-based conceptual design, from a designer perspective; comparisons are also made of the time and expertise required to build the geometry representations as well

Mapping Children's Discussions of Evidence in Science to Assess Collaboration and Argumentation

The research reported in this paper concerns the development of children's skills of interpreting and evaluating evidence in science. Previous studies have shown that school teaching often places limited emphasis on the development of these skills, which are necessary for children to engage in scientific debate and decision-making. The research, undertaken in the UK, involved four collaborative decision-making activities to stimulate group discussion, each was carried out with five groups of four children (10-11 years old). The research shows how the children evaluated evidence for possible choices and judged whether their evidence was sufficient to support a particular conclusion or the rejection of alternative conclusions. A mapping technique was developed to analyse the discussions and identify different "levels" of argumentation. The authors conclude that suitable collaborative activities that focus on the discussion of evidence can be developed to exercise children's ability to argue effectively in making decisions

Quantum corrections to the dynamics of interacting bosons: beyond the truncated Wigner approximation

We develop a consistent perturbation theory in quantum fluctuations around the classical evolution of a system of interacting bosons. The zero order approximation gives the classical Gross-Pitaevskii equations. In the next order we recover the truncated Wigner approximation, where the evolution is still classical but the initial conditions are distributed according to the Wigner transform of the initial density matrix. Further corrections can be characterized as quantum scattering events, which appear in the form of a nonlinear response of the observable to an infinitesimal displacement of the field along its classical evolution. At the end of the paper we give a few numerical examples to test the formalism.Comment: published versio