1,140 research outputs found

    Judicial Review of Findings of Fact in Florida

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    Floor vibration serviceability in a multistory factory building

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    ArticleExperimental and analytical modal analysis and in-operation vibration measurements were performed on the massive concrete structural floors of several structurally connected ‘units’ of a six-level, multitenant industrial complex with total floor usable area exceeding 0.1 km2. The aim of the systematic study was to characterize vibration sources and factors that affect vibration serviceability, which is a major concern when changing usage patterns lead to conflicting requirements for vibration generation and tolerance for different types of industrial/ commercial user. This was a rare investigation aiming to provide information on specific performance and relevant technologies for occupancy decisions by tenants and building management of similar structures. Floors evaluated were within different types of industrial singleoccupant unit stacked up to six levels and having multibay floors with spans up to 12 m with first vibration mode frequencies greater than 8 Hz. These “high-frequency floors” display typical transient response behavior to footfalls, with response levels controlled by modal mass. Units were studied in typical operational conditions including warehousing, instrument assembly and testing, light electronic/mechanical manufacturing, and machining. Vibration sources included internal and external vehicles, human footfalls, and machinery. The study showed the most onerous form of loading to be forklift trucks and that higher level floors of the same type were least serviceable. Experimental modal analysis showed a surprising range of modal properties for nominally identical floors of the same type and the relevance to performance of modal mass

    Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review

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    Objectives: The objective of this study was to conduct a systematic review of the literature to address the following clinical questions: In adult patients with acute and subacute complete or incomplete traumatic SCI, (1) does the time interval between injury and commencing rehabilitation affect outcome?; (2) what is the comparative effectiveness of different rehabilitation strategies, including different intensities and durations of treatment?; (3) are there patient or injury characteristics that affect the efficacy of rehabilitation?; and (4) what is the cost-effectiveness of various rehabilitation strategies? Methods: A systematic search was conducted for literature published through March 31, 2015 that evaluated rehabilitation strategies in adults with acute or subacute traumatic SCI at any level. Studies were critically appraised individually and the overall strength of evidence was evaluated using methods proposed by the GRADE (Grades of Recommendation Assessment, Development and Evaluation) working group. Results: The search strategy yielded 384 articles, 19 of which met our inclusion criteria. Based on our results, there was no difference between body weight–supported treadmill training and conventional rehabilitation with respect to improvements in Functional Independence Measure (FIM) Locomotor score, Lower Extremity Motor Scores, the distance walked in 6 minutes or gait velocity over 15.2 m. Functional electrical therapy resulted in slightly better FIM Motor, FIM Self-Care, and Spinal Cord Independence Measure Self-Care subscores compared with conventional occupational therapy. Comparisons using the Toronto Rehabilitation Institute Hand Function Test demonstrated no differences between groups in 7 of 9 domains. There were no clinically important differences in Maximal Lean Test, Maximal Sidewards Reach Test, T-shirt Test, or the Canadian Occupational Performance Measure between unsupported sitting training and standard in-patient rehabilitation. Conclusion: The current evidence base for rehabilitation following acute and subacute spinal cord injury is limited. Methodological challenges have contributed to this and further research is still needed. © 2017, © The Author(s) 2017

    A clinical practice guideline for the management of degenerative cervical myelopathy: introduction, rationale, and scope

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    Degenerative cervical myelopathy (DCM) is a progressive spine disease and the most common cause of spinal cord dysfunction in adults worldwide. Patients with DCM may present with common signs and symptoms of neurological dysfunction, such as paresthesia, abnormal gait, decreased hand dexterity, hyperreflexia, increased tone, and sensory dysfunction. Clinicians across several specialties encounter patients with DCM, including primary care physicians, rehabilitation specialists, therapists, rheumatologists, neurologists, and spinal surgeons. Currently, there are no guidelines that outline how to best manage patients with mild (defined as a modified Japanese Orthopedic Association (mJOA) score of 15-17), moderate (mJOA = 12-14), or severe (mJOA <= 11) myelopathy, or nonmyelopathic patients with evidence of cord compression. This guideline provides evidencebased recommendations to specify appropriate treatment strategies for these populations. The intent of our recommendations is to (1) help identify patients at high risk of neurological deterioration, (2) define the role of nonoperative and operative management in each patient population, and (3) determine which patients are most likely to benefit from surgical intervention. The ultimate goal of these guidelines is to improve outcomes and reduce morbidity in patients with DCM by promoting standardization of care and encouraging clinicians to make evidence-informed decisions

    Global Three-Dimensional Radiation Magnetohydrodynamic Simulations of Accretion onto a Stellar Mass Black Hole at Sub- and Near-critical Accretion Rates

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    We present global 3D radiation magnetohydrodynamical simulations of accretion onto a 6.62 solar mass black hole with quasi-steady state accretion rates reaching 0.016 to 0.9 times the critical accretion rate, which is defined as the accretion rate to power the Eddington luminosity assuming a 10% radiative efficiency, in different runs. The simulations show no sign of thermal instability over hundreds of thermal timescales at 10 rgr_{\rm g}. The energy dissipation happens close to the mid-plane in the near-critical runs and near the disk surface in the low accretion rate run. The total radiative luminosity inside ∌\sim20 rgr_{\rm g} is about 1% to 30% the Eddington limit, with a radiative efficiency of about 6% and 3%, respectively, in the sub- and near-critical accretion regimes. In both cases, self-consistent turbulence generated by the magnetorotational instability (MRI) leads to angular momentum transfer, and the disk is supported by magnetic pressure. Outflows from the central low-density funnel with a terminal velocity of ∌\sim0.1cc are seen only in the near-critical runs. We conclude that these magnetic pressure dominated disks are thermally stable and thicker than the α\alpha disk, and the effective temperature profiles are much flatter than that in the α\alpha disks. The magnetic pressure of these disks are comparable within an order of magnitude with the previous analytical magnetic pressure dominated disk model.Comment: 17 pages, 13 figures, 3 tables, accepted for publication in Ap

    Relationship between secondary health conditions and life satisfaction in persons with spinal cord injury:study across twenty-one countries

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    Purpose: To determine the relationships between impact of secondary health conditions (SHCs), treatment of SHCs, and life satisfaction (LS) following spinal cord injury (SCI) across 21 countries. Hypotheses were as follows: (1) Persons with SCI and fewer SHCs report higher LS and (2) Persons who receive treatment for SHCs report higher LS than those who do not receive treatment.Methods: Cross-sectional survey, including 10,499 persons with traumatic or non-traumatic SCI aged 18 years or older and living in the community. To assess SHCs, 14 items adapted from the SCI-Secondary Conditions Scale were used (range 1–5). SHCs index was calculated as the mean of all 14 items. LS was assessed using a selection of 5 items from the World Health Organization Quality of Life Assessment. LS index was calculated as the mean of these 5 items. Results: South Korea, Germany, and Poland exhibited the highest (2.40–2.93) and Brazil, China, and Thailand the lowest (1.79–1.90) impact of SHCs. Indexes for LS and SHCs were inversely correlated (– 0.418; p &lt; 0.001). Mixed Model Analysis showed that the fixed effect (key predictors of the study) of SHCs index (p &lt; 0.001) and the positive interaction between SHCs index and treatment (p = 0.002) were significant determinants of LS.Conclusion: Persons with SCI across the world are more likely to perceive better LS if they experience fewer SHCs and receive treatment for SHCs, in comparison to those who do not. Prevention and treatment of SHCs following SCI should be a high priority in order to improve the lived experience and enhance LS.</p

    Exploring implicit and explicit aspects of sense of agency.

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    Sense of agency refers to the sense of initiating and controlling actions in order to influence events in the outside world. Recently, a distinction between implicit and explicit aspects of sense of agency has been proposed, analogous to distinctions found in other areas of cognition, notably learning. However, there is yet no strong evidence supporting separable implicit and explicit components of sense of agency. The so-called 'Perruchet paradigm' offers one of the few convincing demonstrations of separable implicit and explicit learning systems. We adopted this approach to evaluate the implicit-explicit distinction in the context of a simple task in which outcomes were probabilistically caused by actions. In line with our initial predictions, we found evidence of a dissociation. We discuss the implications of this result for theories of sense of agency

    Enhancing our conceptual understanding of state and trait self-efficacy by correlational analysis of four self-efficacy scales in people with spinal cord injury

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    BACKGROUND: Self-efficacy is an important determinant of adjustment following spinal cord injury. Self-efficacy is defined as the belief that one can successfully execute behavior required to produce the desired outcomes. In its original conceptualization, self-efficacy refers to the confidence that people have in their ability to accomplish specific tasks and behaviors within a specific context. Over the years these situation specific aspects have been unconfined and multiple constructs of self-efficacy have been proposed. The most common is a division in trait and state self-efficacy. Another used division that is utilized is between general, domain-specific and task-specific self-efficacy. The scientific support for these constructs is to date still unclear. The objective of this study was to enhance the understanding of the self-efficacy construct by comparing four self-efficacy scales designed to measure three aspects of self-efficacy (general versus domain-specific versus task-specific) in people with spinal cord injury. METHODS: Dutch and Australian adults with spinal cord injury (N = 140) completed four frequently used self-efficacy scales; the Moorong Self-efficacy Scale, General Self-efficacy Scale, University of Washington Self-efficacy Scale and a Self-care Self-efficacy Scale approximately 6 months after their inpatient rehabilitation. Pearson correlations examined inter-relationships between the scales. RESULTS: Hypothesized strong correlations between scales measuring similar aspects of self-efficacy were found (correlations 0.50-0.65). However, the hypothesized weak to moderate correlations between scales measuring diverging aspects of self-efficacy were only partly found (correlations 0.31-0.74), with 7 out of 12 correlations being strong instead of moderate. CONCLUSIONS: The expected distinctions between the three aspects of self-efficacy was not demonstrated. All four scales measure a common latent construct, most likely general self-efficacy aspects. Further research is necessary to find ways to improve the measurement of domain-specific and task-specific aspects of SE, so that they are sensitive enough to capture change over time, and thus enhance clinical outcomes of people with SCI as they adjust to their disability

    The epidemiology of pre-hospital potential spinal cord injuries in Victoria, Australia: a six year retrospective cohort study

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    © 2016, The Author(s). Background: Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI. Methods: This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI. Data was extracted from the AV data warehouse, including demographic details, trauma aetiology, paramedic assessment, management and other event characteristics. Results: A total of 106,059cases were included in the study, representing 2.3 % of all emergency transports by AV. Subjects had a median age of 51 years (interquartile range; 29–78) and 52.4 % were males (95 % CI 52–52.7). Males were significantly younger than females (M: 43 years [26–65] vs. F: 64 years [36–84], p =0.001). Falls and traffic accidents were the leading causes of injuries, comprising 46.9 and 39.4 % of cases, respectively. Other causes included accidents due to sport, animals, industrial work and diving, as well as violence and hanging. 29.9 % of patients were transported to a Major Trauma Service (MTS). A proportion of 48.8 % of the study population met the Pre-hospital Major Trauma criteria. Conclusion: This is the first study to describe the epidemiology of potential TSCI in Australia and is based on a large, state-wide sample. It provides background knowledge and a baseline for future research, as well as a reference point for future in policy. Falling and traffic related injuries were the leading causes of potential SCI. Future research is required to identify the proportion of confirmed TSCI among the potentials and factors associated with TSCI in prehospital settings
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