Non-technical skills learning in healthcare through simulation education: Integrating the SECTORS learning model and Complexity theory

Background: Recent works have reported the SECTORS model for non-technical skills learning in healthcare. The TINSELS programme applied this model, together with complexity theory, to guide the design and piloting of a non-technical skills based simulation training programme in the context of medicines safety. Methods: The SECTORS model defined learning outcomes. Complexity Theory led to a simulation intervention that employed authentic multi-professional learner teams, included planned and unplanned disturbances from the norm and used a staged debrief to encourage peer observation and learning. Assessment videos of non-technical skills in each learning outcome were produced and viewed as part of a Non-Technical Skills Observation Test (NOTSOT) both pre and post intervention. Learner observations were assessed by two researchers and statistical difference investigated using a student’s t-test Results: The resultant intervention is described and available from the authors. 18 participants were recruited from a range of inter-professional groups and were split into two cohorts. There was a statistically significant improvement (P=0.0314) between the Mean (SD) scores for the NOTSOT pre course 13.9 (2.32) and post course 16.42 (3.45). Conclusions: An original, theoretically underpinned, multi-professional, simulation based training programme has been produced by the integration of the SECTORS model for non-technical skills learning the complexity theory. This pilot work suggests the resultant intervention can enhance nontechnical skills

Design for Wire + Arc Additive Manufacture: design rules and build orientation selection

Wire + Arc Additive Manufacture (WAAM) is an additive manufacturing technology that can produce near net-shape parts layer by layer in an automated manner using welding technology controlled by a robot or CNC machine. WAAM has been shown to produce parts with good structural integrity in a range of materials including titanium, steel and aluminium and has the potential to produce high value structural parts at lower cost with much less waste material and shorter lead times that conventional manufacturing processes. This paper provides an initial set of design rules for WAAM and presents a methodology for build orientation selection for WAAM parts. The paper begins with a comparison between the design requirements and capabilities of WAAM and other additive manufacturing technologies, design guidelines for WAAM are then presented based on experimental work. A methodology to select the most appropriate build orientation for WAAM parts is then presented using a multi attribute decision matrix approach to compare different design alternatives. Two aerospace case study parts are provided to illustrate the methodology

John Cole of Baltimore (1774-1855): his life and works

Thesis (M.A.)--Boston UniversityJohn Cole, the son of John and Ann Cole, was born in Tewkesbury, England, where he was baptized on June 24, 1774. At an early age, he emigrated to America, and settled in Baltimore, Maryland, the seat of all his later musical activities, until his death on August 17, 1855. Despite his early training, reputedly received from contact with the singing-schools of Andrew Law, Andrew Adgate and others, Cole considered himself basically a self-taught musician. At first a writer and bookseller as well as a band musician, he eventually concentrated mainly on the composition and editing of sacred music. Much of this music was intended for the use of the Protestant Episcopal Church in the United States of America, one of the earliest instances in this country of music composed for a particular denomination. His earliest activities in church music were in connection with St. Paul's and Christ Church in Baltimore, both Episcopal, and his concern with the production of music for the services of this church is reflected in numerous publications throughout his life. Among works including compositions adapted to the Episcopal liturgy are: Sacred Music of 1803, Episcopalian Harmony of 1811, The Seraph of 1821 and 1827, Primitive Psalmody of 1836, Parochial Psalmody of 1840, Laudate Dominum of 1842 and 1847, and a collection of Chants For the Use of the Protestant Enisconal Church which is undated. Cole had ample opportunity to foster the promulgation of his own works since he was not only a composer, but also a publisher of music which he could then distribute through his own music store. In later years he was joined in this venture by his son, George Frederick Handel Cole, who was born on May 7, 1803, of the union of John and Ann Brewer Cole. The firm of John Cole & Son remained in business until 1839, when it was sold to F. D. Benteen, who then continued as the publisher of some of Cole's later works. His son continued on his own for awhile but later moved to Charleston, South Carolina, where he eventually died in 1861. Cole's reputation in the Baltimore community as a musician of high standards is attested to by several factors. As early as A Collection of Psalm Tunes and Anthems composed in 1803, Cole published an anthem entitled "Mt. Vernon" which an annotation in his own handwriting describes as "sung at the Funeral Solemnities, on the death of Washington." Many of his publications of liturgical music were done under the patronage of the Bishops and Clergy of the Episcopal Church. In 1828, he was chosen to write "a Song for the Day" in honor of the Fourth of July and the commencement of the Baltimore and Ohio railroad. His most famous hymn-tune "Geneva" appeared in innumerable collections of church music until late in the nineteenth century. Finally, his association with the celebrated Lowell Mason on an apparently equal professional footing is reflected both by the presence of Cole's works in the Lowell Mason collection and the manuscript book of hymn-tunes sent by Cole to Mason with annotations discussing matters of musical import. A survey of Cole's publications reveals his significant position as a transitional figure between the native American composers like Billings and Holden and the advocates of the "better music" movement like Mason and Hastings, who in their zeal for "taste" turned away from the native tradition and toward foreign importations. Cole started out in the traditional way, teaching singing-schools and writing tunes that incorporated many features associated with the "Fuguing-tune" composers. His growing taste for European music led him to acorn the "village musicians of the past century" and to advocate the adoption of musical practices going back to Ravenscroft and other psalmodists, and extending to Handel, Bach, Mozart, Beethoven, and a group of lesser lights originating mainly in England in the later eighteenth century. He also admired greatly the German tradition of the chorale which he felt shbuld be emulated by American composers. Cole's later works reflect his concern for spreading the "newer" taste, and include, as a result, many compositions which would not be held in esteem today. Among these are several of a sentimental, "genteel" nature, a few adapted from secular pieces, and others which show a derivative acquaintance with the works of Handel and his followers. In his better compositions, however, Cole incorporates some of the vitality of the earlier American tradition, which he remembered throughout his life. He even goes back to the "sharpe-note" or "patent-note" tradition in his Union Harmony of 1829, decrying his previous prejudices against this system. He is also not averse to introduce sections of imitation in the best "fuguing-tune" tradition in a composition of a neo-Handelian cast like the anthem "O Be Joyful in the Lord" from Devotional Harmony. The dichotomy between old and new is seen clearly in the pages of The Rudiments of Music especially in the matter of performance practice. Proportional concepts of time-signatures and ornamentation practices of the early eighteenth century stand side by side with Romantic concern with text as the point of departure for musical interpretation, and the use of descriptive terminology for tempo, plus clear indication of the nuances and dynamics necessary for performance. In sum, John Cole will not take his place in American music history as an unsung genius or an extraordinarily gifted composer. Nevertheless many practices instituted by him take on new meaning when the struggle to establish these practices in the past is examined critically in the light of the present problems of church musicians. And no more objective clue to the daily musical life of a people can be found than in the analysis of the activities of an average, devoted practitioner of the art of music examined in the hum-drum exposition of his everyday commitments. The work of Cole, coupled with the sincere efforts of countless others, has contributed to the broad stream of musical culture which is the basis of our present-day achievements in this area, and for this reason alone, are these earlier efforts worthy of investigation

Alien Registration- Stewart, Helen (Caribou, Aroostook County)

https://digitalmaine.com/alien_docs/26501/thumbnail.jp

Growth factors and growth associated protein (GAP-43) in the peripheral nervous system

The factors required to stimulate short-term Schwann cell DNA synthesis in serum-free medium (containing insulin) are thoroughly analysed and compared with the growth factor requirements of long-term ''autocrine" Schwann cells. Evidence is presented to demonstrate the importance of cAMP in Schwann cell DNA synthesis. Measurements of intracellular cAMP levels by radioimmunoassay in both Schwann cell types is related to the differing mitogen requirements of these cells. Further tissue culture studies show that insulin-like growth factor-I (IGF-I) plays a role in Schwann cell DNA synthesis, and that cultured Schwann cells are IGF immunoreactive. Binding studies and Scatchard analysis using 125I-IGF-I provide evidence for a type 1 IGF receptor on cultured Schwann cells. An immunohistochemical analysis on the distribution of IGF in vivo in the rat sciatic nerve is reported. Dried cell preparations and and 2hr cultures are used to document the presence of IGF in the Schwann cells from embryonic to adult rats. Teased nerve preparations from postnatal rats are used to study the distribution of IGF in neurones. Results obtained suggest that IGF-I may be acting as an autocrine/paracrine Schwann cell mitogen in vivo. An immunohistochemical investigation reveals that the growth associated protein GAP-43, hitherto considered to be associated with neurones and certain CNS glia, is present in non-myelin-forming Schwann cells. Nerve sections and dried cell preparations are used to document the developmental distribution of GAP-43 in Schwann cells in vivo. Further analyses on the developmental regulation of GAP-43 expression in Schwann cells has been carried out in tissue culture. Gel electrophoresis and western blotting techniques are used to confirm the identity of Schwann cell GAP-43. Evidence that GAP-43 is widely distributed in the neurones of the adult peripheral nervous system (PNS) is provided. Immunohistochemical studies and western blotting demonstrate that GAP-43 is present in high amounts in all three sub divisions of the autonomic nervous system (ANS) of the adult rat. Taken together with known distribution of GAP-43 in areas of the CNS associated with plasticity, these findings suggest a role for GAP-43 in the plasticity of the ANS

Multilevel modelling of event history data: comparing methods appropriate for large datasets

Abstract When analysing medical or public health datasets, it may often be of interest to measure the time until a particular pre-defined event occurs, such as death from some disease. As it is known that the health status of individuals living within the same area tends to be more similar than for individuals from different areas, event times of individuals from the same area may be correlated. As a result, multilevel models must be used to account for the clustering of individuals within the same geographical location. When the outcome is time until some event, multilevel event history models must be used. Although software does exist for fitting multilevel event history models, such as MLwiN, computational requirements mean that the use of these models is limited for large datasets. For example, to fit the proportional hazards model (PHM), the most commonly used event history model for modelling the effect of risk factors on event times, in MLwiN a Poisson model is fitted to a person-period dataset. The person-period dataset is created by rearranging the original dataset so that each individual has a line of data corresponding to every risk set they survive until either censoring or the event of interest occurs. When time is treated as a continuous variable so that each risk set corresponds to a distinct event time, as is the case for the PHM, the size of the person-period dataset can be very large. This presents a problem for those working in public health as datasets used for measuring and monitoring public health are typically large. Furthermore, individuals may be followed-up for a long period of time and this can also contribute to a large person-period dataset. A further complication is that interest may be in modelling a rare event, resulting in a high proportion of censored observations. This can also be problematic when estimating multilevel event history models. Since multilevel event history models are important in public health, the aim of this thesis is to develop these models so they can be fitted to large datasets considering, in particular, datasets with long periods of follow-up and rare events. Two datasets are used throughout the thesis to investigate three possible alternatives to fitting the multilevel proportional hazards model in MLwiN in order to overcome the problems discussed. The first is a moderately-sized Scottish dataset, which will be the main focus of the thesis, and is used as a ‘training dataset’ to explore the limitations of existing software packages for fitting multilevel event history models and also for investigating alternative methods. The second dataset, from Sweden, is used to test the effectiveness of each alternative method when fitted to a much larger dataset. The adequacy of the alternative methods are assessed on the following criteria: how effective they are at reducing the size of the person-period dataset, how similar parameter estimates obtained from using methods are compared to the PHM and how easy they are to implement. The first alternative method involves defining discrete-time risk sets and then estimating discrete-time hazard models via multilevel logistic regression models fitted to a person-period dataset. The second alternative method involves aggregating the data of individuals within the same higher-level units who have the same values for the covariates in a particular model. Aggregating the data like this means that one line of data is used to represent all such individuals since these individuals are at risk of experiencing the event of interest at the same time. This method is termed ‘grouping according to covariates’. Both continuous-time and discrete-time event history models can be fitted to the aggregated person-period dataset. The ‘grouping according to covariates’ method and the first method, which involves defining discrete-time risk sets, are both implemented in MLwiN and pseudo-likelihood methods of estimation are used. The third and final method to be considered, however, involves fitting Bayesian event history (frailty) models and using Markov chain Monte Carlo (MCMC) methods of estimation. These models are fitted in WinBUGS, a software package specially designed to make practical MCMC methods available to applied statisticians. In WinBUGS, an additive frailty model is adopted and a Weibull distribution is assumed for the survivor function. Methodological findings were that the discrete-time method led to a successful reduction in the continuous-time person-period dataset; however, it was necessary to experiment with the length of time intervals in order to have the widest interval without influencing parameter estimates. The grouping according to covariates method worked best when there were, on average, a larger number of individuals per higher-level unit, there were few risk factors in the model and little or none of the risk factors were continuous. The Bayesian method could be favourable as no data expansion is required to fit the Weibull model in WinBUGS and time is treated as a continuous variable. However, models took a much longer time to run using MCMC methods of estimation as opposed to likelihood methods. This thesis showed that it was possible to use a re-parameterised version of the Weibull model, as well as a variance expansion technique, to overcome slow convergence by reducing correlation in the Markov chains. This may be a more efficient way to reduce computing time than running further iterations

Artificial Intelligence Research Branch future plans

This report contains information on the activities of the Artificial Intelligence Research Branch (FIA) at NASA Ames Research Center (ARC) in 1992, as well as planned work in 1993. These activities span a range from basic scientific research through engineering development to fielded NASA applications, particularly those applications that are enabled by basic research carried out in FIA. Work is conducted in-house and through collaborative partners in academia and industry. All of our work has research themes with a dual commitment to technical excellence and applicability to NASA short, medium, and long-term problems. FIA acts as the Agency's lead organization for research aspects of artificial intelligence, working closely with a second research laboratory at the Jet Propulsion Laboratory (JPL) and AI applications groups throughout all NASA centers. This report is organized along three major research themes: (1) Planning and Scheduling: deciding on a sequence of actions to achieve a set of complex goals and determining when to execute those actions and how to allocate resources to carry them out; (2) Machine Learning: techniques for forming theories about natural and man-made phenomena; and for improving the problem-solving performance of computational systems over time; and (3) Research on the acquisition, representation, and utilization of knowledge in support of diagnosis design of engineered systems and analysis of actual systems

A perceived gap between invasive species research and stakeholder priorities

Information from research has an important role to play in shaping policy and management responses to biological invasions but concern has been raised that research focuses more on furthering knowledge than on delivering practical solutions. We collated 449 priority areas for science and management from 160 stakeholders including practitioners, researchers and policy makers or advisors working with invasive species, and then compared them to the topics of 789 papers published in eight journals over the same time period (2009–2010). Whilst research papers addressed most of the priority areas identified by stakeholders, there was a difference in geographic and biological scales between the two, with individual studies addressing multiple priority areas but focusing on specific species and locations. We hypothesise that this difference in focal scales, combined with a lack of literature relating directly to management, contributes to the perception that invasive species research is not sufficiently geared towards delivering practical solutions. By emphasising the practical applications of applied research, and ensuring that pure research is translated or synthesised so that the implications are better understood, both the management of invasive species and the theoretical science of invasion biology can be enhanced