We\u27re Still Here: Culturally Sensitive Design and Planning

“In the 1700’s it was impossible to visit what is now known as western North Carolina without encountering the Cherokee. For the well traveled, it still is.” In 2007, the above quote was used in a marketing campaign by the Eastern Band of Cherokee Indians to attract tourists to the town of Cherokee, NC. Beginning in the early 1900’s, Cherokee evolved into a tourist destination because of the beautiful location, the historical importance and the offering of authentic cultural attractions. Millions of people traveled to Cherokee throughout the 1900’s just to get a glimpse of Cherokee life and be exposed to the Cherokee people of today. However, over the past few years, most visitors are attracted to Cherokee for the chance of striking it rich at Harrah’s Cherokee Casino. The purpose of this thesis is to redevelop a strategic site in Cherokee that will serve as a central marketplace for the town. This area should be designed in a way that is respectful and reflective of the Cherokee people, their history and their culture. This site will serve as a hub to visitors and a location for local residents to utilize on a day-to-day basis. This site will serve as a template for future development and redevelopment in the town that in hopes will restore a very special “Sense of Place.

Simulating actuator energy consumption for trajectory optimisation

This work aims to construct a high-speed simulation tool which is used to quantify the dynamic actuator power consumption of an aircraft in flight, for use within trajectory optimisation packages. The purpose is to evaluate the energy penalties of the flight control actuation system as an aircraft manoeuvre along any arbitrary trajectory. The advantage is that the approximations include major transient properties which previous steady state techniques could not capture. The output can be used to provide feedback to a trajectory optimisation process to help it compute the aircraft level optimality of any given flight path. The tool features a six degree of freedom dynamic model of an aircraft which is combined with low frequency functional electro-mechanical actuator models in order to estimate the major transient power demands. The actuator models interact with the aircraft using an aerodynamic load estimator which generates load forces on the actuators that vary as a function of flight condition and control surface demands. A total energy control system is applied for longitudinal control and a total heading control system is implemented to manage the lateral motion. The outer loop is closed using a simple waypoint following guidance system with turn anticipation and variable turn radius control. To test the model, a simple trajectory analysis is undertaken which quantifies a heading change executed with four different turn rates. The tool shows that the actuation system requires 12.8 times more electrical energy when performing a 90° turn with a radius of 400 m compared to 1000 m. A second test is performed to verify the model’s ability to track a longer trajectory under windy conditions

Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears : an economic evaluation alongside the UKUFF trial

FUNDING & ACKNOWLEDGEMENTS This project was funded by the NIHR Health Technology Assessment programme (project number 05/47/02) and is published in full in Health Technology Assessment; Vol. 19, No. 80. Further information available at: http://www.nets.nihr.ac.uk/projects/hta/054702 This paper presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the HTA programme or the Department of Health. Due to the confidential nature of the trial data supporting this publication not all of the data can be made accessible to other researchers. Please contact the UKUFF study principal investigator Andrew Carr ([email protected]) for more information. The authors wish to thank the UKUFF trial collaborators for their contribution in managing the conduct of the trial, and for their comments on the interim economic results: Marion Campbell and Hannah Bruhn (Centre for Healthcare Randomised Trials, HSRU, University of Aberdeen), Jonathan Rees MD and David Beard (NDORMS, University of Oxford; NIHR Oxford Biomedical Research Centre), Jane Moser (NDORMS, University of Oxford), Raymond Fitzpatrick and Jill Dawson (NDPH, University of Oxford).Peer reviewedPublisher PD

Listening and using participant and observer perspectives following large group, team-based simulations : empowering many voices

Peer reviewedPostprin

Actic Law & Policy Year in Review: 2015

A review of significant legal developments affecting the Arctic, including treaties and other international agreements; actions by the U.S. Congress, President, and other federal agencies; developments from the European Union and ten foreign countries; and several international organizations. Also addressed are themes including arctic marine shipping; indigneous residents; marine resources; military activities; polar icebreakers; pollution prevention, response, and liability; and scientific research

Analysis of the use of systematic reviews to justify otolaryngology clinical trials - Is research being wasted?

Objective of Research: Avoiding poor research methodology such as research waste through duplicative research certainly provides a more cost effective approach to achieving high quality methodologic studies. The purpose of our study is to explore the level of adherence to guidelines and where a literature search was incorporated and documented SRs were used as justification for conducting a RCT and the amount of research waste as a consequence.Methods and Results: We performed a meta-epidemiological cross-sectional study of RCTs published in top peer reviewed otorhinolaryngological journals according to Google Scholar Metrics. Data points extracted whether or not a study cited a systematic review. We recorded whether or not that study used the cited systematic review as justification for conducting the trial. Of the 304 articles retrieved, 151 were included. Overall, only 58.3% (88/151) of studies referenced a SR while shockingly, 41.7% (63/151) articles did not reference at all a systematic review. Possibly even more alarming is the fact that only 27% (24/88) that did cite at least one SR mentioned the SR as justification for conducting the trial and only 17% (15/88) of studies cited verbatim that a SR implicated the need for a RCT to further gaps in knowledge.Conclusion: Based off of our findings, we recommend that efforts be taken to reduce research waste by using SRs and meta-analysis as justification for conducting RCTs

Justification of oromaxillofacial trials using systematic reviews

Aims: In 2017 alone, $12.7 billion was spent on clinical trial research, though basis for conducting these trials is often questionable, absent, or based in industry interest. Systematic reviews (SR's) provide summaries of existing research and can be used to formulate effective research questions that have not been answered. In this study, we analyzed the scientific bases of randomized controlled trials (RCT's) in Oromaxillofacial Surgery (OMFS) journals to determine if SR's formed the basis of the research question.Methods: This study analyzed RCT's in the top 10 ranked OMFS journals by h5 index as of October 10, 2018. It includes all manuscripts published January 1, 2015 - December 31, 2017. We screened each study to extract data relating to funding sources, presence of SR citations, and research methodology.Results: Nearly half of the RCTs cited at least one SR in the introduction of the paper, but less than half of those used the SR review as justification of the trial. 34.5% of the manuscripts did not report their funding, and 25.6% explicitly declared no funding. Self-funded manuscripts cited SR's at the lowest rates in this study. Interestingly, the highest incidence of SR justification occurred when funding was received from a combination of non-profits and industry. Nonprofit papers and those without funding had the lowest incidence of SRs justification.Conclusions: Proper justification for OMFS clinical trials most often occurs when both industry and nonprofit organizations are invested in the research. More effective research could be performed if journal editors required researchers to cite evidence that their studies were necessary.Significance: While a minority of manuscripts published in high-impact OMFS journals mention SR's as justification for conducting the trial, awareness of proper justification should be increased among the scientific community. This is most likely to occur when both the public and private sectors are invested in the research

Exploring the use of lung ultrasound in the cardiac surgery population: a scoping review.

Lung ultrasound (LUS) is a safe, quick, and portable diagnostic tool which can accurately detect respiratory complications post-surgery without radiation. The aim of this scoping review was to map the evidence base regarding the use of LUS within the cardiac surgery population. JBI methodology for scoping reviews. In total, 90 reports were identified: 73 research studies, 6 narrative reviews, and 11 narrative, opinion and text articles. Studies were predominantly observational cohort and aimed to determine or compare LUS diagnostic ability, prognostic ability or both. LUS methods were heterogenous and variably reported. Despite an increasing number of studies since 2014, standardised protocols for the use of LUS are yet to be widely adopted and remain an important area for further work. Future research should consider exploring perceptions and experiences of LUS, the use of LUS in treatment outcome measurement, and use by non-physician healthcare professionals

The price ain’t right? hospital prices and healthspending on the privately insured

We use insurance claims data for 27.6 percent of individuals with private employer-sponsored insurance in the US between 2007 and 2011 to examine the variation in health spending and in hospitals’ transaction prices. We document the variation in hospital prices within and across geographic areas, examine how hospital prices influence the variation in health spending on the privately insured, and analyze the factors associated with hospital price variation. Four key findings emerge. First, health care spending per privately insured beneficiary varies by a factor of three across the 306 Hospital Referral Regions (HRRs) in the US. Moreover, the correlation between total spending per privately insured beneficiary and total spending per Medicare beneficiary across HRRs is only 0.14. Second, variation in providers’ transaction prices across HRRs is the primary driver of spending variation for the privately insured, whereas variation in the quantity of care provided across HRRs is the primary driver of Medicare spending variation. Consequently, extrapolating lessons on health spending from Medicare to the privately insured must be done with caution. Third, we document large dispersion in overall inpatient hospital prices and in prices for seven relatively homogenous procedures. For example, hospital prices for lower-limb MRIs vary by a factor of twelve across the nation and, on average, two-fold within HRRs. Finally, hospital prices are positively associated with indicators of hospital market power. Even after conditioning on many demand and cost factors, hospital prices in monopoly markets are 15.3 percent higher than those in markets with four or more hospitals