bluuebunny/crossref_metadata_2025 huggingface dataset:
Playing with Hyenas:Renovating Environmental Product Policy Strategy
Authors: de Vries Jan L. , te Riele Harry R. M.
Published: July 2006

The 1990s policy trend of intervening at the specification level over a broad range of products has ended. Today's environmental product policies focus, rather, on a few arbitrary product groups. Selectiveness should serve absolute environmental impact reduction, which asks for a rational product‐selection and target framework. The authors propose “life‐cycle impact per consumer expenditure” as a key criterion. This criterion helps to connect macro environmental impact reduction aims with product innovation targets, even under continuous economic growth, consumption pattern shifts, and rebound threats. The authors analyze the Dutch economy as an exercise. This results in 44 product groups, labeled “Hyenas” by the authors, that need to improve their ratio score drastically between now and 2040. Some magnitudes of desired change are given. Finally, intervention processes at the Hyena group level along the lines of sustainable transition management are proposed. Joint visioning, experimental portfolios, interaction between micro, meso, and macro change levels, and gradual pressure building are crucial elements in this concept of complex change management.
Environmental Impacts of Consumption in the European Union:High‐Resolution Input‐Output Tables with Detailed Environmental Extensions
Authors: Huppes Gjalt , de Koning Arjan , Suh Sangwon , Heijungs Reinout , van Oers Lauran , Nielsen Per , Guinée Jeroen B.
Published: July 2006

For developing product policy, insight into the environmental effects of products is required. But available life‐cycle assessment studies (LCAs) are hardly comparable between different products and do not cover total consumption. Input‐output analysis with environmental extensions (EEIOA) of full consumption is not available for the European Union. Available country studies have a low sector resolution and a limited number of environmental extensions. This study fills the gap between detailed LCA and low‐resolution EEIOA, specifying the environmental effects of household consumption in the European Union, discerning nearly 500 sectors, while specifying a large number of environmental extensions. Added to the production sectors are a number of consumption activities with direct emissions, such as automobile driving, cooking and heating, and a number of postconsumer waste management sectors. The data for Europe have been constructed by using the sparse available and coarse economic and environmental data on European countries and adding technological detail mainly based on data from the United States.

A small number of products score high on environmental impact per Euro and also have a substantial share of overall consumer expenditure. Several meat and dairy products, household heating, and car driving thus have a large share of the total environmental impact. Due to their sales volume, however, products with a medium or low environmental score per Euro may also have a substantial impact. This is the case with bars and restaurants, clothing, residential construction, and even a service such as telecommunications. The limitations in real European data made heroic assumptions necessary to operationalize the model. One conclusion, therefore, is that provision of data in Europe urgently needs to be improved, at least to the level of sector detail currently available for the United States and Japan.
Toward an Information Tool for Integrated Product Policy: Requirements for Data and Computation
Authors: Heijungs Reinout , de Koning Arjan , Suh Sangwon , Huppes Gjalt
Published: July 2006

Integrated product policy, according to the European Union, requires reliable data on the impact of consumer products along their life cycles. We argue that this necessarily requires the development of an information tool for hybrid analysis, combining aspects of life‐cycle assessment and input‐output analysis. A number of requirements in the development of such a hybrid information tool are identified, mainly concerning data and computational structure. For the former, some important points of attention are discussed, whereas for the latter, operational formulas are developed.
Setting Priorities within Product‐Oriented Environmental Policy
Authors: Weidema Bo P. , Suh Sangwon , Notten Philippa
Published: July 2006

To focus Danish product‐oriented environmental policy, a study applying extended input‐output analysis has been performed, identifying the most important product groups from an environmental perspective. The environmental impacts are analyzed from three different perspectives—the supply perspective, the consumption perspective, and the process perspective—differing primarily in their system delimitation. The top ten environmentally most important product groups (out of 138 industry products and 98 final consumption groups) are listed for each of the three perspectives, using both total environmental impact and environmental impact intensity as ranking principles. The study covers all substances that contribute significantly to the environmental impact categories of global warming, ozone depletion, acidification, nutrient enrichment, photochemical ozone formation, ecotoxicity, human toxicity, and nature occupation. The differences in results between the three perspectives are elaborated and their policy relevance discussed. The top ten product groups account for a surprisingly large share of the total environmental impact of Danish production and consumption (up to 45%, depending upon the perspective). This implies that product‐oriented environmental policy may achieve large improvements by focusing on a rather small number of product groups. Both imported products and products produced for export in general cause more environmental impact than products produced in Denmark for the Danish market. Especially noticeable are the export of meat and ship transport. This leads to the recommendation to include specific policy measures targeting both foreign producers and foreign markets. Because of its relatively large input of labor, public consumption is found to have a much smaller environmental impact intensity than private consumption. The results confirm results of other similar studies, but are more detailed and have lower uncertainty, due to a number of improvements in data and methodology. A short presentation of the methodology is provided as background information, although this is not the main focus of this article.
The Environmental Impacts of Consumption at a Subnational Level
Authors: Collins Andrea , Flynn Andrew , Wiedmann Thomas , Barrett John
Published: July 2006

This article analyzes the environmental effects of resource consumption at a subnational level (by Cardiff, the capital city of Wales), using the Ecological Footprint as a measure of impact assessment. The article begins by providing a short critique of the Footprint methodology and the limitations of methods traditionally used to calculate national Footprint accounts. We then describe the Footprint methodology developed by the Stockholm Environment Institute to overcome some of these problems and used as the basis of the Reducing Wales' Ecological Footprint project, of which the Cardiff study has been a part. The main portion of this article focuses on presenting and discussing the Footprint results for Cardiff. The Ecological Footprint of household consumption in Cardiff will be presented using the international Classification of Individual Consumption According to Purpose (COICOP). Based on the results, we found that the areas of consumption that are a priority for Cardiff in terms of reducing resource use are food and drink, passenger transport (car and aviation), domestic fuel consumption, waste, and tourism. We also discuss how these findings have been presented to the Cardiff Council. We report on the initial reactions of policy officers to the Footprint results and how the Council plans to use them to influence policy decisions relating to sustainability. Finally, in the Conclusions section, we briefly explain the value of applying the Ecological Footprint at a subnational level and its value as an evidence‐based tool for sustainability decision making.
‘A Cloud Turned Goose’
Authors: Bronner Yigal , Shulman David
Published: July 2006

A vast corpus of Sanskrit poetry (kāvya) was produced over the last thousand years; most of these works reveal a vital and organic relation to the crystallising regional traditions of the subcontinent and to emerging vernacular literatures. Thus we have, for example, the Sanskrit literatures of Kerala, of Bengal-Orissa, of Andhra, and so on. These works, often addressed primarily to local audiences, have remained largely unknown and mostly undervalued, despite their intrinsic merits and enormous importance for the cultural history of India. We explore the particular forms of complex expressivity, including rich temporal and spatial modalities, apparent in such poems, focusing in particular on Vedänta Deśika's Hamsasandeśa, a fourteenth-century messenger-poem modelled after Kālidāsa's Meghasandeśa. We hypothesise a principle: as localisation increases, what is lost in geographical range is made up for by increasing depth. Sanskrit poetry thus comes to play a critical, highly original role in the elaboration of regional cultural identities and the articulation of innovative cultural thematics; a re-conceptualised ecology of Sanskrit genres, including entirely new forms keyed to local experience, eventually appears in each of the regions. In short, rumours of the death of Sanskrit after 1000 A.D. are greatly exaggerated
House full
Authors: Hughes Stephen
Published: July 2006

This article explores how genre matters for the history of cinema audiences in south India. I focus on the development of silent film genre categories in south India during the 1920s as they were used according to the local conditions to help imagine, define and cultivate cinema audiences. I argue that from the late- 1910s, film genre classifications helped exhibitors and film critics to conceive of, calculate and socially differentiate the steadily growing audiences for cinema. Using material from archival sources and newspapers—advertisements, reviews and film criticism—this article documents how the emergence of film genre categories and their subsequent refinement through the 1920s addressed and articulated a stereotyped sociology of local film audiences in Madras. At the beginning of the 1920s there were three main classifications of films recognised in the local cinema market of Madras—serials, short dramas and Indian films. For almost a decade these three categories broadly covered the range of films available in Madras. Local exhibitors and film critics saw each type of film as part of a changing system of complementary and contrasting entertainment alternatives corresponding to definitive kinds of local audiences. As there are few sources and little scholarship which can help deal with early film audiences, the history of film genres offers unique insight into how those in Madras imagined the always indeterminant social reality of film audiences
Imagining communities–differently
Authors: Arunima G.
Published: July 2006

This article examines the questions of ethnicity, territoriality and history in Kerala through an examination of two interrelated themes: the emergent print media and its uses, and the problem of language. By looking at examples of primarily two different kinds of prose writing that became available in this period—religious tracts and literary journals (with some references to the more explicitly literary genres like the novel and the short story)—it addresses the problem of identity that underlies the changes of the nineteenth and twentieth centuries, and the differential claims that groups made on the public sphere
Letters, prison sketches and autobiographical literature
Authors: Malik Jamal
Published: July 2006

For a long time, the Indian revolt of 1857 was known as the ‘Sepoy Mutiny’. This of course was from the perspective of colonial historiography, which later was challenged by nationalist historians of various camps, who considered this event as a marker of the .first war of independence . in India against the British. It is, however, astonishing to note that in both major narratives of the history of 1857, the life and works of Fadl-e Haqq Khairabadi (1797–1861) gains no attention. He was one of the first political prisoners of colonial times, who not only resigned from the post of kutchery chief and is said to have issued a fatwa-e jihad against the British, but also drafted the first constitution of Independent India based on the .principles of democracy.. Besides being a scholar of Islamic studies and theology, he was also a literary personage, especially in Arabic literature. On account of his deep knowledge and erudition he was called .Allama and later was venerated as a great Sufi. Khairabadi was not a marginal character in the history of 1857, yet somehow his presence in history has been undermined, if not totally ignored, by mainstream historians. Though Khairabadi remains alive in Urdu and Persian literature, we hardly find vernacular voices being heard in historical accounts that are important to ascertain the nature of the 1857 revolt. In order to establish this argument, this article relies heavily upon sources such as letters, autobiographical notes, prison literature and vernacular literature as the basis for a reconstruction of history that assists us in understanding whether the revolt was aimed at restoring the old order, or whether traditional historiography follows .traditionalisation. that ultimately corresponds to the politics of colonial restoration. Indeed, it is important to mention here that the case of Khairabadi helps us in understanding mutual perception at the cross-section of European and non-European encounters.
Migrant narratives
Authors: Varghese V.J.
Published: July 2006

The population movements that have occurred within present-day Kerala should be seen in tandem with the history of the massive out-migration record of the state, which has earned for its people the image of being a robust community with a proclivity for migration. This article explores the fashioning of the figure of the kutiyettakkaran, a migrant, in the Malayalee unconscious by problematising the peasant migration from Travancore to Malabar during 1920–70. Reading across Malayalam literary representations, this article looks at the configuration of the migrant self as located within the problematic of capital and colonial modernity. These literary texts, simultaneously fashioned by and fashioning history, give a nuanced picture of the contradictions and compulsions that governed the migrants as well as the natives. The migrant identity of the Syrian Christian settler in Malabar is construed within a social imaginary regulated by a specific discourse of development. The fashioning and circulation of a modernising and heroic image endowed the migrant with a peculiar authority in the landscape and history of Malabar. However, such a mission is critiqued, often in absolute terms, by texts closer to our times. These contemporary texts, informed as much by the consequences of the migration, play an important role in reconfiguring the Syrian Christian migrant as a stooge of capital.
Numerical Investigation of Progressive Damage and the Effect of Layup in Notched Tensile Tests
Authors: Hallett Stephen R. , Wisnom Michael R.
Published: July 2006

This article presents results from a new approach to the finite element modeling of notched damage in composite materials using interface elements to model intra- and interply damage. The technique is used to examine and predict the failures observed in tensile, double edge-notched specimens using four different layups made up from glass/epoxy prepreg. Owing to the detailed modeling of the individual damage modes, their interaction is well characterized. The analytical results obtained compare well with detailed test observations, capturing delamination and intraply splitting. By including the subcritical damage that occurs at the notch tip in the model, the stress singularity is removed and failure criteria can be used to predict ultimate ply failures.
Experimental Characterization of the Thermophysical Properties of Composite Materials by an Inverse Heat Conduction Method
Authors: Plana Vincent , Reulet Philippe , Millan Pierre
Published: July 2006

This study deals with the simultaneous identification of the thermophysical properties of an orthotropic medium by an inverse heat conduction method. The use of a long heating time instead of a very short flash allows preserving the integrity of some composite materials. The experimental implementation of this process is exposed. Several measurements on homogeneous solids as well as on carbon/epoxy composites are presented.
Corrosion Behavior of an Artificially Aged (T6) Al–Si–Mg-based Metal Matrix Composite
Authors: Dikici B. , Gavgali M. , Tekmen C.
Published: July 2006

The influence of age hardening on the corrosion behavior of Al–Si–Mg-based metal matrix composites (MMCs) has been investigated in aerated and deaerated 3.5 wt% aqueous NaCl solutions. Silicon carbide particle (SiCp reinforced composites consisting of 10 and 20 vol% SiCp are produced by the compocasting technique. After the extrusion process, the composites are artificially aged (T6). The corrosion resistances of the aged composites are analyzed by measuring the cyclic potentiodynamic polarization. The surface morphology of the composites before and after the corrosion tests are determined by using metallographic methods and scanning electron microscopy (SEM). In addition, the X-ray diffraction technique (XRD) has been used to determine the phases that occur at the matrix–reinforcement interface. The results demonstrate that the Epit values of unreinforced matrix alloy and composites increase negatively with increasing aging time. It is also observed that corrosion preferentially starts at the interface of Al–Mg2Si and Al–SiCp.
A Model for Shape Control of Cross-ply Laminated Shells using a Piezoelectric Actuator
Authors: Ren Libo , Parvizi-Majidi Azar
Published: July 2006

This article investigates the technique of using a piezoelectric (P) material as the actuator to control the deformation of thin unsymmetric cross-ply laminated shells. A theoretical model is developed using the Rayleigh–Ritz principle to predict the effect of piezoelectric layer on laminated shell deformation. Several stacking sequences are investigated. Owing to the curvature of the shell, the position of the piezoelectric layer has a great effect on the deformation. The effect of the P-layer as the outer surface or inner surface is investigated. It is found that to achieve the same amount of deformation, different levels of electric fields have to be applied depending on the P-layer configuration. The efficiency of the P-layer on shells with various stacking sequences is also studied and it is observed that the efficiency is determined by the stacking sequence of the composite layers. This model can be used as a guide to design the piezocomposite laminated shell.
Utilization of Waste Silk Fabric as Reinforcement in Epoxy Phenol Cashew Nut Shell Liquid Toughened Epoxy Resin: Studies on Mechanical Properties
Authors: Priya S. Padma , Ramakrishna H. V. , Rai K. S.
Published: July 2006

The objective of this study was to investigate the properties of toughened resin composites with silk fabric as the reinforcement, and Epoxy Phenol Cashew Nut Shell Liquid (EPCNSL) toughened epoxy as the matrix system. Different blend matrices were prepared by incorporating varying weight fractions of EPCNSL (5, 10, 15, 20, and 25%) in epoxy, and these matrices were subjected to mechanical strength analysis. Among the combinations of the blend matrices studied, the blend matrix containing 20 wt% of EPCNSL in epoxy showed highest strength, which was chosen to prepare composites. The mechanical properties of the EPCNSL toughened epoxy composites reinforced with silk fabric were studied with respect to varying weight fractions of silk fabric loading. The mechanical properties were found to increase with the increase in weight fraction of the silk fabric. The interfacial bonding between the reinforcement and the matrix was examined using SEM micrographs. Finally, the properties of the toughened resin composites were compared to those of pure epoxy/silk composites.
Assessing Adolescent Defendants' Adjudicative Competence
Authors: Viljoen Jodi L. , Vincent Gina M. , Roesch Ronald
Published: July 2006

As a result of changing legal standards, forensic clinicians have a greater likelihood of being faced with the task of assessing adolescents' adjudicative competence. This study examines the reliability and factor structure of the Fitness Interview Test, Revised Edition (FIT-R), in 152 male and female defendants ages 11 to 17. The interrater reliability of items and sections on the FIT-R is good. Most intraclass correlation coefficients (ICCs) for items fall between .60 and .91, and ICCs for section summary scores range from .82 to .91. Consistent with the design of the FIT-R, confirmatory factor analysis supports a three-factor model, which includes understanding and reasoning about legal proceedings, appreciation of the charges and possible consequences of proceedings, and the ability to communicate with counsel. These factors are united by a dominant superordinate factor. Recommendations are made regarding the clinical use of the FIT-R in the assessment of adolescent competency.
Disconfirmation of the Predictive Validity of the Self-Appraisal Questionnaire in a Sample of High-Risk Drug Offenders
Authors: Mitchell Ojmarrh , Mackenzie Doris Layton
Published: July 2006

The psychometric properties of the Self-Appraisal Questionnaire (SAQ) are assessed in a sample of drug dealing offenders. Findings indicate the SAQ demonstrated adequate concurrent validity; however, the SAQ fails to predict recidivism. Furthermore, SAQ total scores exhibit high levels of reliability, yet half of the SAQ subscales exhibit substandard levels of reliability and all but one of the subscales are multidimensional. A comparative analysis reveals that two measures already commonly available to criminal agencies, age and number of prior arrests, predict recidivism more effectively than the SAQ.
Mexican American Intergenerational Caregiving Model
Authors: Escandón Socorro
Published: July 2006

This study employed grounded theory to formulate a conceptual model of intergenerational caregiving among Mexican American families. The sample consisted of 10 Mexican American caregivers of various generations older than 21 who provided at least one intermittent service (without pay at least once a month) to an elder, related through consanguinal or acquired kinship ties. The inductively generated theory of role acceptance is composed of four phases: (a) introduction—early caregiving experiences, (b) role reconciliation, (c) role imprint, and (d) providing or projecting care. This model can be used to study varied generations of Mexican American caregivers. It also provides a framework for comparison with other groups of caregivers. The results can help in designing nursing interventions to support caregivers based on understanding the issues, to create and design systems that address the varying and ever-changing needs of informal caregivers, and to assist in the formulation of policy that supports Mexican American caregivers.
Research as Spiritual Covenant
Authors: Salois Emily Matt , Holkup Patricia A. , Tripp-Reimer Toni , Weinert Clarann
Published: July 2006

Conducting research with Native American communities poses special challenges from misunderstandings that may arise from the interface of differing cultural worldviews held by the scientific and the Native communities. Although the community-based participatory research approach shows promise for conducting research that can maximize benefits and minimize the risks of harm to Native American people, there is little information related to the practical implementation of culturally appropriate research practices when working with Native American communities. Drawing on the authors’ research with three Native American communities in the Northwest, this article describes culturally appropriate processes for engaging Native American communities. The first section identifies and describes the principles that provide the foundation for the authors’ research activity as a spiritual covenant and guides the authors’ research with the three communities. The second section describes the project phase matrix that was used to organize the approaches employed in this work.
Doing Participatory Action Research in a Racist World
Authors: Varcoe Colleen
Published: July 2006

This exploration of the racial power dynamics in a participatory action research project with women who had experienced intimate partner violence discusses the challenges inherent in doing participatory action with antiracist intent and offers suggestions for overcoming these challenges. To engage in this type of research, explicit commitment to the goals of an antiracist intent needs to be shared as widely as possible. Fostering such shared commitment demands that the social locations of all involved be interrogated continuously. Such interrogation, however, needs to be prefaced with understanding that individuals are not representative of particular power positions or social identities or locations and with critical attention to how language and social structures shape racism and other forms of dominance. Being inclusive must be understood as complex and the influence of diverse agendas and perspectives acknowledged and taken into account. In the face of such complexity, “success” in research may need redefinition.
Re-Forming Schools and Cities: Placing Education on the Landscape of Planning History
Authors: Vitiello Domenic
Published: July 2006

Schools are among the most ubiquitous institutions shaping city and regional ecology, policy, and everyday experience. In recent decades, planning historians have come to define planning ever more broadly, focusing on a great diversity of urban activities. But the design, development, and administration of public and private schools, from the preschool to university level, have yet to be incorporated into our discipline's debates and discussions to a significant degree. This introductory article frames the articles that follow within the broader history of American education and posits a variety of opportunities and questions to explore as we incorporate the history of schools into planning history.
A role for BLyS in the activation of innate immune cells
Authors: Chang Sook Kyung , Arendt Bonnie K. , Darce Jaime R. , Wu Xiaosheng , Jelinek Diane F.
Published: July 2006

B-lymphocyte stimulator (BLyS) is a member of the tumor necrosis factor (TNF) ligand superfamily. Although BLyS costimulates adaptive immune cells, the ability of BLyS to stimulate innate immune cells has not been described. Here, we show that BLyS strongly induces human monocyte survival, and activation as measured by proinflammatory cytokine secretion and up-regulation of costimulatory molecule expression. In addition, monocytes cultured with BLyS differentiated into macrophage-like cells. Regarding BLyS receptor(s) expression, freshly isolated monocytes bound low levels of exogenous BLyS and expressed primarily intracellular TACI, and cell surface TACI levels increased following monocyte activation. Of interest, bone marrow monocytes from some multiple myeloma patients expressed significant levels of cell surface TACI at isolation. Our findings indicate that BLyS plays a role in activating innate immune cells. Moreover, this study may explain more clearly why high BLyS production is often correlated with certain inflammatory autoimmune diseases and B-lymphocyte malignancies.
High numbers of tumor-infiltrating FOXP3-positive regulatory T cells are associated with improved overall survival in follicular lymphoma
Authors: Carreras Joaquim , Lopez-Guillermo Armando , Fox Bridget C. , Colomo Lluis , Martinez Antonio , Roncador Giovanna , Montserrat Emili , Campo Elias , Banham Alison H.
Published: July 2006

The tumor microenvironment plays an important role in the biologic behavior of follicular lymphoma (FL), but the specific cell subsets involved in this regulation are unknown. To determine the impact of FOXP3-positive regulatory T cells (Tregs) in the progression and outcome of FL patients, we examined samples from 97 patients at diagnosis and 37 at first relapse with an anti-FOXP3 monoclonal antibody. Tregs were quantified using computerized image analysis. The median overall survival (OS) of the series was 9.9 years, and the FL International Prognostic Index (FLIPI) was prognostically significant. The median Treg percentage at diagnosis was 10.5%. Overall, 49 patients had more than 10% Tregs, 30 between 5% to 10%, and 19 less than 5%, with a 5-year OS of 80%, 74%, and 50%, respectively (P = .001). Patients with very low numbers of Tregs (< 5%) presented more frequently with refractory disease (P = .007). The prognostic significance of Treg numbers was independent of the FLIPI. Seven transformed diffuse large B-cell lymphomas (DLBCLs) had lower Treg percentages (mean: 3.3%) than FL grades 1,2 (mean: 12.1%) or 3 (mean: 9%) (P < .02). In conclusion, high Treg numbers predict improved survival of FL patients, while a marked reduction in Tregs is observed on transformation to DLBCL.
Sentinel surveillance for human enterovirus 71 in Sarawak, Malaysia: lessons from the first 7 years
Authors: Podin Yuwana , Gias Edna LM , Ong Flora , Leong Yee-Wei , Yee Siew-Fung , Yusof Mohd Apandi , Perera David , Teo Bibiana , Wee Thian-Yew , Yao Sik-Chi , Yao Sik-King , Kiyu Andrew , Arif Mohd Taha , Cardosa Mary Jane
Published: July 2006

Background

A major outbreak of human enterovirus 71-associated hand, foot and mouth disease in Sarawak in 1997 marked the beginning of a series of outbreaks in the Asia Pacific region. Some of these outbreaks had unusually high numbers of fatalities and this generated much fear and anxiety in the region.

Methods

We established a sentinel surveillance programme for hand, foot and mouth disease in Sarawak, Malaysia, in March 1998, and the observations of the first 7 years are described here. Virus isolation, serotyping and genotyping were performed on throat, rectal, vesicle and other swabs.

Results

During this period Sarawak had two outbreaks of human enterovirus 71, in 2000 and 2003. The predominant strains circulating in the outbreaks of 1997, 2000 and 2003 were all from genogroup B, but the strains isolated during each outbreak were genetically distinct from each other. Human enterovirus 71 outbreaks occurred in a cyclical pattern every three years and Coxsackievirus A16 co-circulated with human enterovirus 71. Although vesicles were most likely to yield an isolate, this sample was not generally available from most cases and obtaining throat swabs was thus found to be the most efficient way to obtain virological information.

Conclusion

Knowledge of the epidemiology of human enterovirus 71 transmission will allow public health personnel to predict when outbreaks might occur and to plan interventions in an effective manner in order to reduce the burden of disease.
A rational model for assessing and evaluating complex interventions in health care
Authors: May Carl
Published: July 2006

Background

Understanding how new clinical techniques, technologies and other complex interventions become normalized in practice is important to researchers, clinicians, health service managers and policy-makers. This paper presents a model of the normalization of complex interventions.

Methods

Between 1995 and 2005 multiple qualitative studies were undertaken. These examined: professional-patient relationships; changing patterns of care; the development, evaluation and implementation of telemedicine and related informatics systems; and the production and utilization of evidence for practice. Data from these studies were subjected to (i) formative re-analysis, leading to sets of analytic propositions; and to (ii) a summative analysis that aimed to build a robust conceptual model of the normalization of complex interventions in health care.

Results

A normalization process model that enables analysis of the conditions necessary to support the introduction of complex interventions is presented. The model is defined by four constructs: interactional workability; relational integration; skill set workability and contextual integration. This model can be used to understand the normalization potential of new techniques and technologies in healthcare settings

Conclusion

The normalization process model has face validity in (i) assessing the potential for complex interventions to become routinely embedded in everyday clinical work, and (ii) evaluating the factors that promote or inhibit their success and failure in practice.
Genetic context determines susceptibility to intraocular pressure elevation in a mouse pigmentary glaucoma
Authors: Anderson Michael G , Libby Richard T , Mao Mao , Cosma Ioan M , Wilson Larry A , Smith Richard S , John Simon WM
Published: July 2006

Background

DBA/2J (D2) mice develop an age-related form of glaucoma. Their eyes progressively develop iris pigment dispersion and iris atrophy followed by increased intraocular pressure (IOP) and glaucomatous optic nerve damage. Mutant alleles of the Gpnmb and Tyrp1 genes are necessary for the iris disease, but it is unknown whether alleles of other D2 gene(s) are necessary for the distinct later stages of disease. We initiated a study of congenic strains to further define the genetic requirements and disease mechanisms of the D2 glaucoma.

Results

To further understand D2 glaucoma, we created congenic strains of mice on the C57BL/6J (B6) genetic background. B6 double-congenic mice carrying D2-derived Gpnmb and Tyrp1 mutations develop a D2-like iris disease. B6 single-congenics with only the Gpnmb and Tyrp1 mutations develop milder forms of iris disease. Genetic epistasis experiments introducing a B6 tyrosinase mutation into the congenic strains demonstrated that both the single and double-congenic iris diseases are rescued by interruption of melanin synthesis. Importantly, our experiments analyzing mice at ages up to 27 months indicate that the B6 double-congenic mice are much less prone to IOP elevation and glaucoma than are D2 mice.

Conclusion

As demonstrated here, the Gpnmb and Tyrp1 iris phenotypes are both individually dependent on tyrosinase function. These results support involvement of abnormal melanosomal events in the diseases caused by each gene. In the context of the inbred D2 mouse strain, the glaucoma phenotype is clearly influenced by more genes than just Gpnmb and Tyrp1. Despite the outward similarity of pigment-dispersing iris disease between D2 and the B6 double-congenic mice, the congenic mice are much less susceptible to developing high IOP and glaucoma. These new congenic strains provide a valuable new resource for further studying the genetic and mechanistic complexity of this form of glaucoma.
Child and Provider Restraints in Ambulances: Knowledge, Opinions, and Behaviors of Emergency Medical Services Providers
Authors: Johnson Timothy D. , Lindholm Daniel , Dowd M. Denise
Published: July 2006

Background:
Approximately 16,000 children are transported by ambulances each day, and there are an estimated 4,500 ambulance crashes each year. Information about emergency medical services (EMS) provider knowledge, opinions, and behaviors regarding occupant restraint is lacking.

Objectives:
To measure the knowledge, opinions, and behaviors of EMS personnel regarding child and provider restraint use in ambulances.

Methods:
A survey was given to all EMS providers in two large ambulance‐service organizations and in a hospital‐based pediatric ambulance service in a midsized urban area.

Results:
A total of 302 EMS providers were surveyed, for a return rate of 67.7%. Nearly half were involved in an ambulance crash at least once; of those, 7.6% were injured and 1% had patients in their care injured. The majority (91%) reported some training in child‐restraint use in ambulances, and half reported that they know a lot or very much about securing a critically ill child for transport. However, 30% did not identify the correct method of transport for a stable 2‐year‐old, and 40% did not choose the correct method of securing a child seat to the ambulance cot. Securing a child seat to the cot was viewed by 81% to not take too much time from patient care, and 63% did not view caring for a child in a car seat as difficult. Although 80% of providers regularly transported children in a car seat, 23% transported them on an adult's lap at least sometimes. Specialized pediatric‐transport providers were more likely to report safe pediatric and occupant restraint practices than were community EMS providers. Pediatric restraint behaviors were not associated with years of service or history of a crash. Two thirds of respondents reported not wearing their seatbelt on the squad bench while treating patients, and half believe that wearing a seatbelt interferes with patient care. A total of 95% report wearing seatbelts in the front seat of the ambulance. Provider seatbelt use in the patient compartment was not associated with years of service, with number of crashes, or with reporting correct use of pediatric restraints.

Conclusions:
This study indicates that the frequency of crashes in ambulances, and therefore the potential for injury, may be underappreciated. Current restraint practices of some of the study group are outside recommendations and may be placing at risk some children who are being transported by ambulances. This problem is complicated by the relative infrequency of pediatric ambulance transports compared with adults. Improved equipment and education may help providers safely transport pediatric patients. In addition, providers are risking their own safety by not wearing seatbelts in the rear ambulance compartment. Improved equipment may help alleviate this risk and allow providers to take care of patients safely.
Systematic Delays in Antibiotic Administration in the Emergency Department for Adult Patients Admitted with Pneumonia
Authors: Pines Jesse M. , Morton Melinda J. , Datner Elizabeth M. , Hollander Judd E.
Published: July 2006

Objectives:
The authors sought to determine the contribution of delays in care on time to antibiotics for patients admitted from the emergency department (ED) with pneumonia and to identify patients at risk for delayed antibiotics.

Methods:
This was a retrospective cohort study of patients admitted to the Hospital of the University of Pennsylvania (HUP) and to Pennsylvania Presbyterian Hospital (Presbyterian) with an admission diagnosis of pneumonia in 2004.

Results:
A total of 393 patients were included. Ninety percent had antibiotics documented as given in the ED. Eighty‐three (43%) of 209 at HUP and 104 (64%) of 161 patients at Presbyterian received antibiotics within four hours. Patients who received antibiotics more than four hours after ED arrival experienced longer waits for radiograph orders (HUP, 54 min [95% confidence interval {CI} = 33 to 76 min]; Presbyterian, 43 min [95% CI = 29 to 58 min]), for radiograph performance (HUP, 21 min [95% CI = 4 to 39 min], Presbyterian, 24 min [95% CI = 8 to 47 min]), for antibiotic orders (HUP, 56 min [95% CI = 38 to 95 min]; Presbyterian, 67 min [95% CI = 33 to 103 min]), and for antibiotic administration (HUP, 28 min [95% CI = 17 to 39 min]; Presbyterian, 30 min [95% CI = 21 to 38 min]). Patients with lower severity scores (p = 0.005) and patients with nonclassic clinical presentations for pneumonia were at increased risk for delayed antibiotics (odds ratio, 2.2; 95% CI = 1.1 to 4.4).

Conclusions:
Antibiotic delays for patients admitted with pneumonia occur across multiple care processes. Less severely ill patients and patients with nonclassic presentations are at higher risk for delayed antibiotic administration. Hospitals should consider performing a similar analysis to evaluate hospital‐specific and patient‐specific care delays.
Commonly Used Imaging Techniques for Diagnosis and Staging
Authors: Barentsz Jelle , Takahashi Satoru , Oyen Wim , Mus Roel , De Mulder Pieter , Reznek Rodney , Oudkerk Matthijs , Mali Wim
Published: July 2006

Imaging plays a vital role in the management of patients with cancer. Not only is it important for diagnosis, indicating sites of abnormality, and guiding biopsies, but it is also crucial in assessing disease extent and thereby determining treatment. In this review, conventional imaging techniques such as ultrasound, computed tomography, magnetic resonance imaging, and [18F]fluorodeoxyglucose–positron emission tomography are described, with attention to their mechanisms of action, and their strengths and weaknesses in diagnosis and staging of tumors. New developments are addressed and radiation safety issues are highlighted. In addition, we describe current and expected future uses of imaging techniques in oncology. Given that each technique has its inherent strengths and weaknesses, the combination of the methods will result in improved diagnosis, staging, and treatment prediction and monitoring.
New Technologies and Directed Agents for Applications of Cancer Imaging
Authors: Atri Mostafa
Published: July 2006

Molecular imaging represents tissue-specific imaging and quantification of physiologic (functional) and molecular events in tumors utilizing new noninvasive imaging modalities, radioligands, and contrast agents. It combines anatomic, physiologic, and metabolic information in a single imaging session. Molecular imaging relies on the ability to target genes and proteins that are linked directly or indirectly to human disease. New imaging biomarkers are being developed. In addition, functional and molecular imaging can potentially replace anatomic longitudinal studies by assessing treatment response earlier. Vascular targeting agents can be evaluated by imaging of tumor angiogenesis using magnetic resonance imaging (MRI), computed tomography and ultrasound, and positron emission tomography (PET). Targeted contrast agents can accomplish site-directed imaging or therapy by a variety of active and passive mechanisms. Furthermore, there is the possibility of combining different modalities such as ultrasonic imaging and MRI or MRI and PET to increase the flexibility unachievable with either modality alone. However, there is a need to standardize these techniques so that longitudinal evaluation of tumor response to treatment is feasible.
Magnetic Resonance As a Cancer Imaging Biomarker
Authors: Sorensen A. Gregory
Published: July 2006

Cancer is a diverse disease with many manifestations. Magnetic resonance (MR) has a wide range of sensitivities, and therefore has often been used to study cancer in humans in numerous different ways, most typically with MR spectroscopy and MR imaging. This article is not an exhaustive catalog of the use of MR in cancer, but will briefly highlight some of the many promising MR methods that have been developed, proposed, or used to focus on the problem of detecting and characterizing cancer, its treatments, and adverse effects.
Dynamic Axle Loads on Tracks with and Without Ballast Mats: Numerical Results of Three-Dimensional Vehicle-Track-Soil Models
Authors: Auersch L
Published: July 2006

Ballast mats are an efficient measure to reduce the vibrations near railway lines. The vehicle-track system gets a low eigenfrequency due to the insertion of an elastic ballast mat under the ballast. For frequencies higher than this low vehicle-track eigenfrequency, the forces, which are generating the vibration of the soil, are considerably reduced. In this contribution, a combined finite-element boundary-matrix method is used to calculate a number of completely three-dimensional track models with and without ballast mats. The influence of the important parameters such as the stiffness of the ballast mat, the unsprung vehicle mass, the mass of the track, and the stiffness of the subsoil is investigated. The numerical results are presented as the transfer functions of the total force that is acting on the soil and generating the vibration of the environment. The effectiveness of ballast mats is achieved by division of two of these force functions. The general tendencies for this insertion loss are discussed and a comparison with measurements is given. To come to an improved practical tool for the design of ballast-mat tracks, the finite-element method results are approximated by a simple two-dimensional model of which the solution is given explicitly.
Optimization of Train Departure Times at an Interchange Considering Passenger Flows
Authors: Takagi R , Goodman C J , Roberts C
Published: July 2006

The authors of this paper present the results of the numerical optimization of departure times of trains at an interchange station when services are disrupted. The evaluation function is based on accumulated, or aggregated, passenger delays and the dynamic model of the interchange accounts for variations in passenger walking times. The authors have developed a passenger flow model using petri nets, which enables the representation of passenger flows inside a station to be made with sufficient accuracy and short calculation times. The evaluation function of aggregated passenger times is defined, and the optimization is carried out using the multi-dimensional downhill simplex method. The results show that the optimized train departure times essentially represent compromises between the benefit generated by the extended holding of trains to allow more passengers to catch an earlier service and the disbenefit generated by longer waiting times of passengers already on the train being held.

This paper concludes with recommendations for combining these techniques with other models and evaluation criteria in order to move towards a practical train controller. Examples of refinements are a model of passenger behaviour when guidance information is provided, variations in dwell times when different numbers of passengers get on or off a train, congestion inside trains, and the impact of holding a train on the overall operation of trains on the line.
Fuzzy-Reasoning-Based Approach to Qualitative Railway Risk Assessment
Authors: An M , Lin W , Stirling A
Published: July 2006

This article presents the development of a fuzzy-reasoning-based railway risk assessment system. The proposed method can evaluate qualitative and quantitative risk data in a uniform manner for railway risk assessment. It permits risk analysts to assess the risks associated with the failure modes directly using linguistic terms. The proposed railway risk assessment system is capable of assessing the risks at component level, subsystem level, and system level. The outcomes of the risk assessment are represented in two formats, risk score and risk category with a belief of percentage, which provide very useful risk information to railway designers, operators, engineers, and maintainers. A case study on rolling stock asset risk assessment is used to demonstrate the proposed railway risk assessment system. The results indicate that by using this system, risks associated with a railway system can be assessed effectively and efficiently.