Automotive Stirling engine development program

The study of high power kinematic Stirling engines for transportation use, testing of Mod I and Mod II Stirling engines, and component development activities are summarized. Mod II development testing was performed to complete the development of the basic engine and begin characterization of performance. Mod I engines were used for Mod II component development and to obtain independent party (U.S. Air Force) evaluation of Stirling engine vehicle performance

Facilitators and Barriers to Nursing Surveillance of Instability in Hospitalized Pediatric Patients: A Grounded Theory Study

Identification of patients at risk for deterioration initially started with studies that focused predictors of cardiopulmonary and neurovascular demise. This spawned research to evaluate the utility of predictor models followed by the performance studies of early warning track and trigger systems in adults. Mandates to provide emergency services early in the course of instability in the 1990s fueled research to analyze the outcomes of rapid response systems and early warning systems in both adults and pediatrics. Recently studies have looked at system and human factors that impact failure to rescue. Given the dearth of systems research in early prevention of deterioration in pediatrics this study was designed to explore what nurses do during deterioration and the factors that impact their actions. Interview and observations of 13 pediatric nurses and 16 parents of pediatric patients admitted to a non ICU environment were conducted at one academic children’s hospital in the Northwest USA. Grounded theory methods were used to guide data collection and analysis. Findings describe nursing actions associated with nursing surveillance of instability as well as factors that facilitate or impede surveillance efficacy. We present a theoretical model for how nurses and parents integrate their roles in surveillance of pediatric patients. We also further developed a sociotechnical model of nursing surveillance

Opioid dependence treatment: options in pharmacotherapy.

The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist maintenance. Agonist maintenance therapy is currently the recommended treatment for opioid dependence due to its superior outcomes relative to detoxification. Detoxification protocols have limited long-term efficacy, and patient discomfort remains a significant therapy challenge. Buprenorphine\u27s effectiveness relative to methadone remains a controversy and may be most appropriate for patients in need of low doses of agonist treatment. Buprenorphine appears superior to alpha-2 agonists, however, and office-based treatment with buprenorphine in the USA is gaining support. Studies of sustained-release formulations of naltrexone suggest improved effectiveness for retention and sustained abstinence; however, randomized clinical trials are needed

Distributed-Pair Programming can work well and is not just Distributed Pair-Programming

Background: Distributed Pair Programming can be performed via screensharing or via a distributed IDE. The latter offers the freedom of concurrent editing (which may be helpful or damaging) and has even more awareness deficits than screen sharing. Objective: Characterize how competent distributed pair programmers may handle this additional freedom and these additional awareness deficits and characterize the impacts on the pair programming process. Method: A revelatory case study, based on direct observation of a single, highly competent distributed pair of industrial software developers during a 3-day collaboration. We use recordings of these sessions and conceptualize the phenomena seen. Results: 1. Skilled pairs may bridge the awareness deficits without visible obstruction of the overall process. 2. Skilled pairs may use the additional editing freedom in a useful limited fashion, resulting in potentially better fluency of the process than local pair programming. Conclusion: When applied skillfully in an appropriate context, distributed-pair programming can (not will!) work at least as well as local pair programming

A calculus for generic, QoS-aware component composition

Software QoS properties, such as response time, availability, bandwidth requirement, memory usage, among many others, play a major role in the processes of selecting and composing software components. This paper extends a component calculus to deal, in an effective way, with them. The calculus models components as generalised Mealy machines, i.e., state-based entities interacting along their life time through well defined interfaces of observers and actions. QoS is introduced through an algebraic structure specifying the relevant QoS domain and how its values are composed under different disciplines. A major effect of introducing QoS-awareness is that a number of equivalences holding in the plain calculus become refinement laws. The paper also introduces a prototyper for the calculus developed as a ‘proof-of-concept’ implementation.FCT -Fuel Cell Technologies Program(FCOMP-01-0124-FEDER-020537

Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs

Background. Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. Aims and objectives. The purpose of this paper is to examine the inter-rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs.Design. Survey was among pressure ulcer experts.Methods. Fifty-six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter-rater reliability was calculated.Results. The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001).Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers).Conclusions. The inter-rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear.Relevance to clinical practice. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning

A randomised controlled trial and cost-effectiveness evaluation of "booster" interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design: Study candidates (n = 1500) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600) will be randomised into the study. These participants will receive either a "mini booster" (n = 200), "full booster" (n = 200) or no booster (n = 200). The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities. A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10% sample.Discussion: The choice of study population, study interventions, brief intervention preceding the study, and outcome measure are discussed