3,430 research outputs found

    The quality of medical advice in low-income countries

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    This paper provides an overview of recent work on quality measurement of medical care and its correlates in four low and middle-income countries-India, Indonesia, Tanzania, and Paraguay. The authors describe two methods-testing doctors and watching doctors-that are relatively easy to implement and yield important insights about the nature of medical care in these countries. The paper discusses the properties of these measures, their correlates, and how they may be used to evaluate policy changes. Finally, the authors outline an agenda for further research and measurement.Health Monitoring&Evaluation,Health Systems Development&Reform,Gender and Health,Health Economics&Finance,Disease Control&Prevention

    Metastatic Ewing's sarcoma to the right ventricle

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    Ewing's sarcoma is a round cell neoplasm derived from neural crest cells that is part of the primitive neuroectodermal tumor (PNET) family. It is a rare, aggressive malignancy that affects young people, most commonly in the second decade of life. The treatment of localized disease has improved greatly over the past four decades, but the prognosis for metastatic disease remains poor. Cardiac metastases of Ewing's sarcoma are exceedingly rare, with only a few reported cases. This article presents a case of a 22 year old man with a history of Ewing's sarcoma of the bone involving the right kneepeer-reviewe

    Sustainability Research in the CGIAR: Its Status and Future

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    Preliminary report of the CGIAR Committee on Sustainability of Agricultural Production Systems, prepared by World Wildlife Fund Vice President Jeffrey Leonard. The report offers an overview of sustainability issues addressed by IARC programs, and of the contributions of IARC work to understanding of the physical, biological, and socioeconomic determinants of sustainability. It also identifies seven areas considered to be gaps in the Group's attention to sustainability. Agenda document, CGIAR meeting May-June 1989

    UNSTEADY-STATE SPHERICAL FLOW WITH STORAGE AND SKIN.

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    This paper presents short-time interpretation methods for radial-spherical (or radial-hemispherical) flow in homogeneous and isotropic reservoirs inclusive of wellbore storage, wellbore phase redistribution, and damage skin effects. New dimensionless groups are introduced to facilitate the classic transformation from radial flow in the sphere to linear flow in the rod. Analytical expressions, type curves (in log-log and semi log format), and tabulated solutions are presented, both in terms of pressure and rate, for all flow problems considered. A new empirical equation to estimate the duration of wellbore and near-wellbore effects under spherical flow is also proposed

    To Find Or Not To Find: Public Accounting Auditors Versus Governmental Auditors

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    This study examines the impact that the type of auditor (OfficeOffice of the Auditor General (OAG auditor) or CPA firm auditor) has on the number of compliance audit findings reported for select state agencies in a major Midwestern state. In the state studied, The OAG is responsible for conducting compliance audits of government agencies on at least a biennial basis. These audits are either performed by the Auditor General’s state auditors or by Certified Public Accounting (CPA) firms under contract to the OAG. A sample of agencies with audits that were sometimes performed by CPA firms and sometimes by OAG auditors was chosen. A statistical analysis concluded the number of compliance audit findings reported by OAG auditors was significantly higher than the number of compliance audit findings reported by CPA firm auditors, for the same set of state agencies

    Information Sharing and Situational Awareness: Insights from the Cascadia Rising Exercise of June 2016

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    In a catastrophic incident gaining situational awareness (SA) is the foremost prerequisite that ena-bles responders to save and sustain lives, stabilize the incident, and protect the environment and property from further damage. However, catastrophes severely damage and disrupt critical infrastructures including response assets. Initially and for days and even weeks, essential information remains incomplete, unverified, and is changing as the catastrophic incident unfolds, all of which leads to a distorted common operating picture (COP). The lack of clear and comprehensive SA/COP prevents incident commanders from efficiently directing the response effort. This study reports on the challenges emergency responders faced with regard to situational awareness in a recent large-scale exercise under the name of Cascadia Rising 2016 (CR16) conducted in the Pacific Northwest of the United States. The exercise involved a total of 23,000 active participants. Over four days in June of 2016, CR16 simulated the coordinated response to a rupture of the 800-mile Cascadia Subduction Zone resulting in a magnitude-9 earthquake and tsunami similar to the catastrophic incident in Eastern Japan in 2011. Responders at all levels were severely challenged, and the exercise revealed major vulnerabilities in critical infrastructures. Situational awareness was very difficult to establish. The exercise demonstrated that the challenges to SA/COP and to response management, in general, during catastrophic incidents cannot be regarded as a linear extension of non-catastrophic emergency and disaster responses. It rather requires the rethinking and revising of practices and procedures when responding under the constraints of massively degraded critical information infrastructures and harshly decimated assets

    A Requirements-Driven Optimization Method for Acoustic Liners Using Analytic Derivatives

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    More than ever, there is flexibility and freedom in acoustic liner design. Subject to practical considerations, liner design variables may be manipulated to achieve a target attenuation spectrum. But characteristics of the ideal attenuation spectrum can be difficult to know. Many multidisciplinary system effects govern how engine noise sources contribute to community noise. Given a hardwall fan noise source to be suppressed, and using an analytical certification noise model to compute a community noise measure of merit, the optimal attenuation spectrum can be derived using multidisciplinary systems analysis methods. In a previous paper on this subject, a method deriving the ideal target attenuation spectrum that minimizes noise perceived by observers on the ground was described. A simple code-wrapping approach was used to evaluate a community noise objective function for an external optimizer. Gradients were evaluated using a finite difference formula. The subject of this paper is an application of analytic derivatives that supply precise gradients to an optimization process. Analytic derivatives improve the efficiency and accuracy of gradient-based optimization methods and allow consideration of more design variables. In addition, the benefit of variable impedance liners is explored using a multi-objective optimization
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