Russia as a factor of growing importance in the world economic structure

This item was digitized by the Internet Archive

The design and testing of a centrifugal controlled variable camshaft phasing device for small-block Chevrolet engines

One method of improving performance and efficiency of internal combustion engines is to vary the timing of the valve opening and closure while leaving the lift and duration constant. This is called variable camshaft phasing and, generally, the camshaft should be advanced at low engine RPM and retarded as engine speed increases. The purpose of this project was to design and test a mechanically variable camshaft phasing device that retards the camshaft continuously over a given engine speed range as a function of engine speed. It was desired to design a device that would fit on an unmodified engine block utilizing an unmodified camshaft that could fit under a slightly modified timing cover. A conceptual design was developed based on analysis of various geometries. Computer simulations were employed to search for the optimal kinematic configuration that would give the device a minimal torque dependency. Several different types of springs were then analyzed using both computer models and static testing that would allow the device to operate over the desired range of engine speeds. A prototype variable cam phasing device was built and tested in a 1970\u27s model Chevrolet small-block V8 driven by the Mechanical Engineering Department\u27s engine dynamometer. The device exhibited unacceptable wear and fatigue characteristics in some areas of the device. However, the data that was gathered is encouraging and indicates that the prototype device represents a viable design

Trach tubes designed to maximize safety may increase risk to ventilated patients

Dual-cannulae tracheostomy tubes with low-pressure cuffs, such as the Shiley LPC, are widely regarded as inherently safer than single lumen tubes with low-volume cuffs. For the patient who undergoes tracheostomy for failure to wean from mechanical ventilation, however, the insertion of a tube that occupies a large amount of space within the trachea can delay subsequent efforts to liberate him from the ventilator. With an aim to promote more timely rehabilitation of ventilated patients, London Ontario's University Hospital has been inserting the Bivona TTS, a single lumen tube with an elastic cuff, during tracheostomy. This allows caregivers to better exploit the benefits of a functional upper airway early during the weaning process, which may reduce complications associated with prolonged mechanical ventilation. We urge clinical studies to determine how the choice of initial tracheostomy tube can affect rehabilitation strategies and important patient outcomes

Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods

The distribution of progesterone in body fluids and tissues of the dairy cow

A careful study was carried out of the method of Short (1956a) and Rowlands and Short (1959) for the estimation of progesterone in plasma and in corpora lutea respectively. For bovine plasma it was found necessary to acetylate the first chromatogram eluate with an acetic anhydride/pyridine mixture and subject the residue to a further chromatography step. These additional steps in-creased the specificity of the method for progesterone and at the same time yielded a comparatively pure final product. In addition the incorporation of a radioactive marker to calculate individual recoveries was found to be an advantage in both plasma and luteal samples. Using the above method plasma- progesterone con-centration was measured throughout the oestrous cycle in six normal dairy cows. The general pattern consisted of a gradual rise in progesterone concentration from near zero levels on the day of oestrus (day 1) until day 5 when a more rapid rise occurred up to a level of about 1.0 ug/100 ml plasma on day 9. The level remained at about this value until day 16 when a decline occurred until near zero levels 213 were reached on the subsequent day of oestrus. There appeared to be a considerable variation in the maximum levels attained during mid-cycle in individual cows. The range of values at this time in the six animals used was 0.63 to 1.44 ug/100 ml plasma. The removal of the corpus luteum or ovaries during mid-cycle in the cow resulted in an initial rapid drop in plasma progesterone concentration followed by a more gradual decline, The fact that this occurred after the removal of either the corpus luteum or the ovaries indicated that the residual progesterone level did not originate from ovarian tissue other than the corpus luteum. It was tentatively suggested that the residual level could be duo to a contribution from either the adrenal gland or the body fat depots. The subsequent determination of comparatively high levels of progesterone in the body fat of cows at mid. cycle emphasised the latter as the more likely of the two sources, with the reservation that an adrenal contribution due to surgical stress could not be ruled out completely. The rapid disappearance of injected progesterone from the circulating blood of the cow was in keeping with the observations made in other species. There was evidence to show that this was partly due to catabolism of the progesterone molecule and partly due to uptake by the body tissues, probably the body fat. Furthermore it was shown that renal excretion of progesterone per se did not occur to any appreciable extent. The half life of progesterone in the blood of the cow appeared to be in the order of 6 minutes. Progesterone in the body fat of cows at mid-cycle sac found to be 5 to 10 times that in the plasma and the identification of the progesterone from this source wan confirmed by infra-red analysis and gas/liquid chromatography. In fat from coup early in the cycle, from ovari-atomised cows and from bullocks, progesterone was not present in any measurable quantity. Progesterone was also found in cows milk where it appeared to reflect the levels found in plasma. However, in spite of milk being more available than plasma, owing to its high fat content, it was not considered to be a better source of material for the study of progesterone metabolism in the cow. Plasma and luteal levels of progesterone were studied in a series of 40 cows at 16 and 26 days after 215 insemination. The levels of progesterone in the pregnant and non pregnant animals when slaughtered at 16 days were of the same order, while at 26 days the marked difference between the levels in pregnant and non-pregnant cows could be accounted for by evidence of a recent ovulation in all cows in the latter group. In this series of 40 cows there appeared to be a relationship between the plasma levels and both the luteal weight and progesterone content. The higher blood levels appeared to be associated with the heaviest glands which in general contained more progesterone. Conversely, low blood levels were observed with small glands which generally contained less progesterone. The absolute and relative amounts of 2093 hydroxyprogesterone did not vary significantly among the groups. Progesterone levels were investigated in certain clinical oases made available through the Veterinary Hospital, namely cases of hydrops allantois and oases of retained foetal membranes. However, progesterone levels in these animals did not appear to differ significantly from those found in normal cows

An assessment of the relative influence of pain coping, negative thoughts about pain, and pain acceptance on health-related quality of life among people with hemophilia

Many people with hemophilia are affected by chronic arthritic joint pain as well as acute bleeding pain. In this cross-sectional study, 209 men with hemophilia A or B completed the Hemophilia Pain Coping Questionnaire (HPCQ), the Chronic Pain Acceptance Questionnaire (CPAQ), and the RAND 36-item Health Survey (SF-36), a measure of health-related quality of life. Multiple regression was used to test the influence of active pain coping, passive adherence coping, and negative thoughts about pain (HPCQ scales), and activity engagement and pain willingness (CPAQ scales), on physical and mental components of quality of life (SF-36 PCS and MCS scales), taking account of age, hemophilia severity, use of clotting factor, and pain intensity. Pain intensity was the main influence on physical quality of life and negative thoughts was the main influence on mental quality of life. Activity engagement and pain willingness had small but significant influences on physical and mental quality of life. Pain willingness also moderated and partly mediated the influence of pain intensity on physical quality of life, and activity engagement and pain willingness mediated the influence of negative thoughts on mental quality of life. Negative thoughts moderated and partly mediated the influence of pain intensity on mental quality of life. There was no evidence that active pain coping influenced quality of life. The findings suggest that quality of life in hemophilia could potentially be improved by interventions to increase pain acceptance and reduce negative thoughts about pain, especially among those with less severe pain.Haemophilia Society UK; Institute for Health Policy and Research, London Metropolitan University

Carabid (Coleoptera) assemblages in the Scottish uplands: the influence of sheep grazing on ecological structure

As a result of the European Community Common Agricultural Policy reform in 2005 it is predicted that livestock grazing in the Scottish uplands will become less intensive. At each of two upland research centres, two large (>40ha) plots were established to investigate the relationship between grazing intensity in the Scottish uplands and biodiversity. One plot was grazed intensively by sheep while the otherwas grazed extensively. Ground beetleswere sampled by pitfall trapping to determine the influence of grazing pressure on the ecologicalmake-up of ground beetle assemblages. Grazing intensity did not significantly influence carabid diversity. However, grazing intensity, altitude and moisture did influence the carabid ecological assemblage structure at both locations. Large flightless Carabus species were more abundant in extensively managed plots than intensively managed plots at both locations. It is likely that these long-living, relatively immobile beetles were favoured by the greater stability of the vegetation structure in the extensively grazed plots. Monitoring the ecological assemblage structure provides a more sensitive approach than diversity indices when comparing the impact of grazing and agricultural management but is also robust enough to allow direct comparisons between different geographical locations

"Customer" knowledge management in healthcare

This paper reports on a work-in-progress project on the management of patient knowledge in a UK general hospital. Greater involvement of patients is generally seen as crucial to the effective provision of healthcare in the future. However, this presents many challenges, especially in the light of the ageing population in most developed countries and the consequent increasing demand for healthcare. In the UK, there have been many attempts to increase patient involvement by the systematisation of patient feedback, but typically they have not been open to academic scrutiny or formal evaluation, nor have they used any knowledge management principles. The theoretical foundations for this project come first from service management and thence from customer knowledge management. Service management stresses the importance of the customer perspective. Healthcare clearly meets the definitions of a service even though it may also include some tangible elements such as surgery and provision of medication. Although regarding hospital patients purely as "customers" is a viewpoint that needs to be used with care, application of the theory offers potential benefits in healthcare. The two main elements we propose to use from the theory are the type of customer knowledge and its relationship to attributes of the quality of the service provided. The project is concerned with investigating various knowledge management systems (KMS) that are currently in use (or proposed) to systematise patient feedback in an NHS Trust hospital, to manage knowledge from and to a lesser extent about patients. The study is a mixed methods (quantitative and qualitative) action research investigation intended to answer the following three research questions: • How can a KMS be used as a mechanism to capture and evaluate patient experiences to provoke patient service change • How can the KMS assist in providing a mechanism for systematising patient engagement? • How can patient feedback be used to stimulate improvements in care, quality and safety

Towards a science and practice of resilience in the face of pain

The primary objective of this paper is to discuss how a resilience approach to (chronic) pain may advance our current understanding of (mal)adaptation to pain. Different resilience perspectives are described, and future challenges for research, prevention and treatment of (chronic) pain are discussed. Literature searches were performed in Web of Science and PubMed to identify relevant literature on risk and resilience in the context of pain. Resilience can be best defined as the ability to restore and sustain living a fulfilling life in the presence of pain. The Psychological Flexibility Model, the Broaden-and-Build Theory, and Self-Determination Theory are described as theories that may provide insight into resilience within the context of (chronic) pain. We describe how a resilience paradigm shifts the outcomes to pursue in pain research and intervention and argue the need for including positive outcomes in addition to negative outcomes. Psychological flexibility, positive affect and basic psychological needs satisfaction are described as potentially important resilience mechanisms with the potential to target both sustainability and recovery from pain. A resilience approach to chronic pain may have important implications for the prevention and treatment of chronic pain problems, as it may give specific indications on how to empower patients to continue living a fulfilling life (in the presence of pain)