A Primary Care Approach to the Diagnosis and Management of Peripheral Arterial Disease

The objectives of this work are: (1) Be able to recognize characteristic symptoms of intermittent claudication (2) Diagnose PAD on the basis of history, physical exam, and simple limb blood pressure measurements (3) Recognize the significance of peripheral artery disease as a marker for coronary or cerebrovascular atherosclerosis (4) Provide appropriate medical management of atherosclerosis risk factors-- including use of antiplatelet therapy to reduce risk of myocardial infarction, stroke and death (5) Manage symptoms of intermittent claudication with program of smoking cessation, exercise, and medication The diagnosis of intermittent claudication secondary to peripheral artery disease (PAD) can often be made on the basis of history and physical examination. Additional evaluation of PAD is multi-modal and the techniques used will vary depending on the nature and severity of the patient's presenting problem. Most patients can be appropriately managed without referral for specialized diagnostic services or interventions

The effects of various error messages and error types on program debugging time.

Using the Shneiderrnan model, programs were bugged with three classes of errors and then flagged with five classes of error messages both to test the the Shneiderman theory and to attempt to develop more useful messages for programmers. Forty subjects, all of whom passed a general selection quiz on the programming language BASIC, participated in the study. Each subject saw three versions of a BASIC statistics program listing, the versions represented the three different types of errors and all shared a common sort of error message. The error types strongly affected the time subjects required to find the bug in the printed listing and correct it. As predicted by the theory, the syntax error was found most quickly. However, the speed at which the flow error and misuse error were detected was reversed from the order predicted by the theory. Using the scores on the BASIC quiz as a covariate, the error messages were found to affect the time to debug a listing with knowing which line caused the error reducing the time most but having a greater effect on the syntax error over the flow error

Cognitive-Behavioural Therapy

Cognitive-behavioural therapy (CBT) is a generic term, encompassing both: (1) approaches underpinned by an assumption that presenting emotional and behavioural difficulties are cognitively mediated or moderated; and (2) atheoretical bricolages of cognitive and behavioural techniques. This latter category may include effective therapeutic packages (perhaps acting through mechanisms articulated in the first category) but, when theory is tacit, it becomes harder to make analytical generalisations or to extrapolate principles that could guide idiographic formulation and intervention. In contrast, the first category of approaches posits that presenting difficulties may be formulated from an assessment of individual cognitive content (thought processes and underlying beliefs) and implies that we can bring about change in presenting difficulties through change in associated cognitions. Within this chapter, we formulate the case of ‘Molly’, using the theoretical model of CBT articulated by A. T. Beck, to understand the client’s presentation, current difficulties, and potential areas for intervention

Quantification of Bronchial Circulation Perfusion in Rats

The bronchial circulation is thought to be the primary blood supply for pulmonary carcinomas. Thus, we have developed a method for imaging and quantifying changes in perfusion in the rat lung due to development of the bronchial circulation. A dual-modality micro-CT/SPECT system was used to detect change in perfusion in two groups of rats: controls and those with a surgically occluded left pulmonary artery. Both groups were imaged following injections on separate days i) 2mCi of Tc99m labeled macroaggregated albumin (MAA) into the left carotid artery (IA) and ii) a similar injection into the femoral vein (IV). The IA injection resulted in Tc99m accumulation in capillaries of the systemic circulation including the bronchial circulation, whereas the IV resulted in Tc99m accumulation in the pulmonary capillaries. Ordered subset expectation maximization (OSEM) was used to reconstruct the SPECT image volumes and a Feldkamp algorithm was used to reconstruct the micro-CT image volumes. The micro-CT and SPECT volumes were registered, the SPECT image volume was segmented using the right and left lung boundaries defined from the micro-CT volume, and the ratio of IA radioactivity accumulation in the left lung to IV radioactivity accumulation in both lungs was used as a measure of left lung flow via the bronchial circulation. This ratio was ~0.02 for the untreated rats compared to the treated animals that had an increased flow ratio of ~0.21 40 days after left pulmonary artery occlusion. This increase in flow to the occluded left lung via the bronchial circulation suggests this will be a useful model for further investigating antiangiogenic treatments

Quantification of Bronchial Circulation Perfusion in Rats

The bronchial circulation is thought to be the primary blood supply for pulmonary carcinomas. Thus, we have developed a method for imaging and quantifying changes in perfusion in the rat lung due to development of the bronchial circulation. A dual-modality micro-CT/SPECT system was used to detect change in perfusion in two groups of rats: controls and those with a surgically occluded left pulmonary artery. Both groups were imaged following injections on separate days i) 2mCi of Tc99m labeled macroaggregated albumin (MAA) into the left carotid artery (IA) and ii) a similar injection into the femoral vein (IV). The IA injection resulted in Tc99m accumulation in capillaries of the systemic circulation including the bronchial circulation, whereas the IV resulted in Tc99m accumulation in the pulmonary capillaries. Ordered subset expectation maximization (OSEM) was used to reconstruct the SPECT image volumes and a Feldkamp algorithm was used to reconstruct the micro-CT image volumes. The micro-CT and SPECT volumes were registered, the SPECT image volume was segmented using the right and left lung boundaries defined from the micro-CT volume, and the ratio of IA radioactivity accumulation in the left lung to IV radioactivity accumulation in both lungs was used as a measure of left lung flow via the bronchial circulation. This ratio was ~0.02 for the untreated rats compared to the treated animals that had an increased flow ratio of ~0.21 40 days after left pulmonary artery occlusion. This increase in flow to the occluded left lung via the bronchial circulation suggests this will be a useful model for further investigating antiangiogenic treatments

Experimental Validation of a Four-Way Outphasing Combiner for Microwave Power Amplification

This letter presents a 2.14 GHz, four-way power combining and outphasing system for high-power amplifiers such as those in radio basestations (RBS). The combiner is ideally lossless, and enables power control through load modulation of the power amplifiers (PAs). A discrete-component power combiner is designed and characterized, and combined with inverse Class-F PAs using GaN HEMT devices to develop a complete PA system. We demonstrate the effectiveness of the system over a range of outphasing control angles. This first-ever microwave implementation of the outphasing system has a peak CW drain efficiency of 68.9%, with efficiency greater than 55% over a 5.5 dB power range. It provides an average modulated efficiency of 57% for a W-CDMA signal with 3.47 dB peak to average power ratio (PAPR) at 42 dBm output power.Massachusetts Institute of Technology. Center for Integrated Circuits and System

The Rise of the Social in Entrepreneurial Activities in National and International Contexts: A Clarification of Terms in the Development of a New Conceptual Framework

In examining the ‘social’ in entrepreneurial activities in national and international contexts our focus is on social innovation and business enterprise. Attention is given to what we understand by ‘social’ in entrepreneurial behaviours, innovation and change and the importance of social capital and social networks to understanding the dynamics that drive social innovation within the enterprise. Our social focus takes us on a conceptual journey in examining the meaning and import of social innovation, social capital, social networks and social enterprise. The rise in the import and media attention to social business within the international arena and the growing call for a social-orientation among business practitioners from small to medium enterprises to larger multi-national enterprises has promoted dialogue and debate about social processes that have also brought in its wake a certain amount of confusion and obfuscation. We set out to clarify this growing range of socially-oriented terms and identify the relationships between these concepts with the aim of extending knowledge in this emergent field. A key objective is to build a robust conceptual framework that informs our understanding of these complex relationships and provides a platform for further debate and research

The Rise of the Social in Entrepreneurial Activities in National and International Contexts: A Clarification of Terms in the Development of a New Conceptual Framework

In examining the ‘social’ in entrepreneurial activities in national and international contexts our focus is on social innovation and business enterprise. Attention is given to what we understand by ‘social’ in entrepreneurial behaviours, innovation and change and the importance of social capital and social networks to understanding the dynamics that drive social innovation within the enterprise. Our social focus takes us on a conceptual journey in examining the meaning and import of social innovation, social capital, social networks and social enterprise. The rise in the import and media attention to social business within the international arena and the growing call for a social-orientation among business practitioners from small to medium enterprises to larger multi-national enterprises has promoted dialogue and debate about social processes that have also brought in its wake a certain amount of confusion and obfuscation. We set out to clarify this growing range of socially-oriented terms and identify the relationships between these concepts with the aim of extending knowledge in this emergent field. A key objective is to build a robust conceptual framework that informs our understanding of these complex relationships and provides a platform for further debate and research

The impact of receiving a diagnosis of Non-Epileptic Attack Disorder (NEAD): a systematic review

Background: Clinicians have reported observations of the immediate cessation of non-epileptic attacks after the diagnosis of NEAD is presented. Objective: The purpose of this systematic review was to examine the impact of receiving a diagnosis of NEAD. Search strategy: A literature search across the databases Medline, PsycINFO, EMBASE, and CINAHL, and additional hand searching, identified 6 original studies meeting criteria for the review. Selection Criteria: Included studies were original peer-reviewed articles investigating the impact of receiving a diagnosis of NEAD on adult populations with at least one outcome measured pre and post-diagnosis. Analysis: The studies were assessed for methodological quality, including biases. This assessment was developed to include criteria specific to research regarding NEAD and diagnosis. Results: Six identified studies, with a total of 153 NEAD participants, examined the impact of receiving a diagnosis on seizure frequency. Two of the six also examined the impact on health-related quality of life. The findings were inconsistent, with approximately half the participants experiencing seizure reduction or cessation post-diagnosis. Diagnosis appeared to have no significant impact on health-related quality of life. The overall evidence lacked quality, particularly in study design and statistical rigour. Conclusions: Mixed results and a lack of high quality evidence was found. Concerns are considered regarding the appropriateness of seizure frequency as the primary outcome measure and the use of epilepsy control groups. Indications for future research include: measuring more meaningful outcomes, using larger samples and power calculations, and ensuring consistent and standard methods for communicating the diagnosis and recording outcomes

The dynamics of innovation and social capital in social enterprises: a relational sense-making perspective

We develop a relational sense-making framework in order to understand the ways in which knowledge and information, when transferred across social networks, enable or inhibit the innovation process and its sustainability within social enterprises. Our model comprises four main elements: (i) Social capital, (ii) the Innovation, (iii) the Process, and (iv) Adoption and ongoing support (SIPA). Collective understanding through sense-making and sense-giving is fundamental to the successful management and sustainability of innovation projects. The social capital which emerges and develops may incorporate formal and/or informal group(s) linked by particular interests, common goals and/or shared agenda(s). Broadly speaking, the innovation may be directed towards either a problem or an opportunity for the collective. The ‘black box’ process through which different views and interests are presented, interpreted and collective sense-making occurs in the further development and uptake of innovation is by its nature: multifaceted, complex and non-linear. The temporal fragility of certain innovations necessitates ongoing support and acceptance in order to achieve longer-term sustainability. The iterative relations between these elements of social capital, innovation, process and adoption occur within a social, political and economic context in which sense-making and sense-giving of individuals and groups often compete. A key objective of our research is, therefore, to tease out the extent to which and the ways in which social relationships and networks, innovation intentions and technology development are influenced by social capital dynamics within organizations, social enterprises in particular