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García-Pérez, Andrés. "Optimum preliminary design of ion thrusters in concurrent design facility." Concurrent Engineering 28, no. 3 (July 20, 2020): 189–97. http://dx.doi.org/10.1177/1063293x20938422.
Повний текст джерелаАнотація:
In recent years, the development of new satellites has accelerated, especially for small satellites like university-class Cubesats, due to low design and manufacturing costs. The preliminary design of these spacecraft requires the utilization of new tools that improve the interrelation among the different subsystems and optimize the design. One of the most suitable approaches is the concurrent design facility, which connects specialists of each subsystem in the same room to facilitate the communication among them. This method provides different preliminary designs for the complete system by an iterative process in a reduced time, taking into account the simultaneity with the designs of the subsystems. One of the main subsystems of a spacecraft is the propulsion system, which plays a key role in the success of a mission by allowing the spacecraft to reach the final destination. Electric propulsion has become an interesting option due to the high value of the specific impulse, which provides the necessary velocity increment with a lower propellant mass compared to the traditional chemical rockets. The purpose of this paper is to present the equations implemented in the propulsion module of the concurrent design facility to obtain optimum designs of ion thrusters, which supposes a novelty compared to the traditional design approach of these systems, where there is no interaction with the design of the rest of subsystems. The objective is to help the designer to select the best options in a fast and easy way and improve the efficiency of the iterative work of the concurrent design facility.
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Hassan, Noha M., Talal Al Maazmi, Ali Al Hadhrami, and Mohamed Al Hosani. "Discrete event simulation: a vital tool for a concurrent life cycle design." Construction Innovation 16, no. 1 (January 4, 2016): 67–80. http://dx.doi.org/10.1108/ci-11-2014-0054.
Повний текст джерелаАнотація:
Purpose – The purpose of this study is to examine whether discrete event simulation (DES) can be equally utilised in the design phase of the architecture, engineering and construction industry (AEC) projects to achieve a more efficient facility layout. Facility design is a complex process involving diverse disciplines, tasks, tools and events. Integrating key participants involved in the design generally leads to a more satisfied end-user. The AEC thoroughly examined different approaches to enhance this integration through improved communication, visualisation and coordination among the different project participants. DES has been used extensively as a tool for analysis and evaluation, especially during the construction process. Design/methodology/approach – A facility planning framework is illustrated that combines both qualitative and quantitative analysis to achieve a performance-driven design. An investigative qualitative research approach is used to determine the design criteria and performance metrics based on the end-user and authority requirements. This approach is achieved by conducting critical reviews, surveys, focus groups and interviews. The research findings and collected data are used to perform a quantitative analysis to determine the effectiveness of the proposed design if constructed using DES. The potential of the method is shown through a case study to design a mall parking facility. Findings – The case study illustrated the capability of DES to improve construction design by comparing the artificially designed facility following the proposed framework to an existing facility. Increasing customer satisfaction by enhancing safety, minimising waiting time and maximising parking spot availability were the performance metrics used to evaluate the designs. DES was used as a tool to measure these criteria. Utilising DES in facility design increased resource utilisation and resulted in a safer layout that satisfied the end-user, client and authority requirements. Originality/value – Previous studies focused on integrating other modules such as energy, HVAC, lighting, acoustics and life cycle analysis to achieve a performance-driven design. The overwhelming majority of the literature focused on the use of DES for improving construction operations. Research literature about integrating DES as a tool for concurrent life cycle design was scarce. This research demonstrated that DES is an effective method and a vital key for determining the facility’s operational efficiency after construction.
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Salas Cordero, S. K., C. Fortin, and R. Vingerhoeds. "CONCURRENT CONCEPTUAL DESIGN SEQUENCING FOR MBSE OF COMPLEX SYSTEMS THROUGH DESIGN STRUCTURE MATRICES." Proceedings of the Design Society: DESIGN Conference 1 (May 2020): 2375–84. http://dx.doi.org/10.1017/dsd.2020.96.
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AbstractWhilst Concurrent Conceptual Design (CCD) has been performed for many years at facilities such as: the Concurrent Design Facility at ESA and the Project Design Center at JPL-NASA, the sequencing know-how resides in their communities of practice. This paper strives to explain how a sequencing algorithm based on Design Structure Matrices can be used as an instrument to facilitate the interaction between disciplines during CCD studies for Model-Based systems exemplified with two case studies.
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Pambaguian, Laurent, Eleonie van Schreven, and Ilaria Roma. "Space Hardware Advanced Manufacturing Engineering: SHAME to miss out on a potential game changer?" Concurrent Engineering 26, no. 1 (February 12, 2018): 117–26. http://dx.doi.org/10.1177/1063293x17751831.
Повний текст джерелаАнотація:
Advanced Manufacturing is widely used with features and applications playing a game changing role in our daily life. The European Space Agency has initiated in April 2016 a multi-disciplinary approach exploring the impact of infusing Advanced Manufacturing into space practices. A Concurrent Design Facility study was performed investigating potential design methodology amendments produced by introducing Advanced Manufacturing techniques into the design space. Innovative materials and processes were added to the conventional design parameters usually populating the systems design trade-spaces. This enabled multifunctional solutions, previously inconceivable, with a redefinition of interfaces and related requirements, shifted from ‘discipline’ boundaries to ‘units’ or ‘assembly’ boundaries. The Concurrent Design Facility Study identified the core domains of expertise required in a ‘Design for Advanced Manufacturing’ frame, governed by a flexible, open-minded systems engineering coordination. Early involvement of material and process engineers in the design proved to be an essential ingredient of the ‘Design for Advanced Manufacturing’ recipe. The design freedom brought by Advanced Manufacturing calls for unconventional design solutions, creativity becomes a need and infusion from non-space is invaluable. Biomimicry and architecture principles enriched the concurrent design environment, which proved to be very well suited with the needs and objectives of the new design methodology. This article reports the Concurrent Design Facility study conduct, as first attempt to understand Advanced Manufacturing impact on design methodology, the study cases selected for analysis, the observations on the methodology and on the interactions among the specialists in the team. The study outcome is reported, including an overview of benefits, disadvantages and points for further investigation in relation to the study cases assessed. In addition, the paper proposes recommendations for injecting Advanced Manufacturing into the project life cycle, from early design up to procurement phases and ultimately to the assembly, integration and verification phases, indicating required modelling tools, technologies and redefined engineering roles and expertise.
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Fischer, Philipp Martin, Meenakshi Deshmukh, Volker Maiwald, Dominik Quantius, Antonio Martelo Gomez, and Andreas Gerndt. "Conceptual data model: A foundation for successful concurrent engineering." Concurrent Engineering 26, no. 1 (November 14, 2017): 55–76. http://dx.doi.org/10.1177/1063293x17734592.
Повний текст джерелаАнотація:
Today, phase A studies of future space systems are often conducted in special design facilities such as the Concurrent Engineering Facility at the German Aerospace Center (DLR). Within these facilities, the studies are performed following a defined process making use of a data model for information exchange. Quite often it remains unclear what exactly such a data model is and how it is implemented and applied. Nowadays, such a data model is usually a software using a formal specification describing its capabilities within a so-called meta-model. This meta-model, often referred as conceptual data model, is finally used and instantiated as system model during these concurrent engineering studies. Such software also provides a user interface for instantiating and sharing the system model within the design team and it provides capabilities to analyze the system model on the fly. This is possible due to the semantics of the underlying conceptual data model creating a common language used to exchange and process design information. This article explains the implementation of the data model at DLR and shows information how it is applied in the concurrent engineering process of the Concurrent Engineering Facility. It highlights important aspects concerning the modeling capabilities during a study and discusses how they can be implemented into a corresponding conceptual data model. Accordingly, the article presents important aspects such as rights management and data consistency and the implications of them to the software’s underlying technology. A special use case of the data model is depicted and shows the flexibility of the implementation proven by a study of a multi-module space station.
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Abdalla, H. S., and J. Knight. "An Expert System for Concurrent Product and Process Design of Mechanical Parts." Proceedings of the Institution of Mechanical Engineers, Part B: Journal of Engineering Manufacture 208, no. 3 (August 1994): 167–72. http://dx.doi.org/10.1243/pime_proc_1994_208_075_02.
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A new approach for concurrent product and process design of mechanical parts is presented in this paper. This approach enables designers to ensure that the product will be manufactured with the existing manufacturing facility at high quality and lowest cost. It is composed of an integrated expert and CAD (computer aided design) system that meets the requirements for accomplishing the concept of design for manufacturability or concurrent engineering. The system is based mainly on three tasks: firstly, developing a technique for automated feature recognition from the database of a solid modeller; secondly, interfacing the expert system tool-kit with the solid modelling system; finally, building an expert system that contains extensive information about both manufacturing facilities and product features. The expert system provides feedback about manufacturing concerns such as process limits or design inconsistencies. This work is part of the present extended research plan for developing a generic system suitable for various manufacturing practices based on design for manufacturability strategy.
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Kempf, Scott, Frank K. Schäfer, Tiziana Cardone, Ivo Ferreira, Sam Gerené, Roberto Destefanis, and Lilith Grassi. "Simplified spacecraft vulnerability assessments at component level in early design phase at the European Space Agency's Concurrent Design Facility." Acta Astronautica 129 (December 2016): 291–98. http://dx.doi.org/10.1016/j.actaastro.2016.08.014.
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McDonald, Robert A., Brian J. German, T. Takahashi, C. Bil, W. Anemaat, A. Chaput, R. Vos, and N. Harrison. "Future aircraft concepts and design methods." Aeronautical Journal 126, no. 1295 (December 6, 2021): 92–124. http://dx.doi.org/10.1017/aer.2021.110.
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AbstractWith an annual growth in travel demand of about 5% globally, managing the environmental impact is a challenge. In 2019, the International Civil Aviation Organisation (ICAO) issued emission reduction targets, including well-to-wake greenhouse gas (GHG) emissions reduced at least 50% from 2005 levels by 2050. This discusses several technologies from an aircraft design perspective that can contribute to achieving these targets. One thing is certain: aircraft will look different in the future. The Transonic Truss-Braced Wing and Flying V configurations are promising significant efficiency improvements over conventional configurations. Electric propulsion, in various architectures, is becoming a feasible option for general aviation and commuter aircraft. It will be a growing field of aviation with zero-emissions flight and opportunities for special missions. Lastly, this paper discusses methods and design processes that include all relevant disciplines to ensure that the aircraft is optimised as a complete system. While empirical methods are essential for initial design, Multidisciplinary Design Optimisation (MDO) incorporates models and simulations integrated in an optimisation environment to capture critical trade-offs. Concurrent design places domain experts in one site to facilitate collaboration, interaction, and joint decision-making, and to ensure all disciplines are equally considered. It is supported by a Collaborative Design Facility (CDF), an information technology facility with connected hardware and software tools for design analysis.
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Hibino, Hironori, Toru Sakuma, and Makoto Yamaguchi. "Evaluation System for Energy Consumption and Productivity in Manufacturing System Simulation." International Journal of Automation Technology 6, no. 3 (May 5, 2012): 279–88. http://dx.doi.org/10.20965/ijat.2012.p0279.
Повний текст джерелаАнотація:
Industries need to design and improve their manufacturing systems while considering energy consumption and productivity concurrently. Manufacturing system simulation is often used to evaluate productivity when manufacturing systems are designed or improved. However, it is difficult to use simulation to evaluate energy consumption when designing and improving manufacturing systems. The purpose of our research is to establish a system for the concurrent evaluation of energy consumption and productivity in manufacturing system simulation. In this paper, first, requirements for a simulation to evaluate energy consumption and productivity are analyzed. Second, an evaluation system is proposed in consideration of the requirements. A Unified Modeling Language (UML) model that defines facility state transitions and relationships between the facility state and energy consumption is proposed. A manufacturing system simulation implemented in the proposed UML model is also proposed and developed. The proposed simulation is also implemented in a function to concurrently generate information on production throughput and energy consumption along a time progression. A system that provides a function to visually evaluate dynamic changes in the energy consumption per unit of production throughput along a time progression is also proposed and developed. Finally, a case study for semiconductor manufacturing systems is carried out to confirm the efficiency of our proposed evaluation system.
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Hein, Cheryl M. "Driving Simulators: Six Years of Hands-On Experience at Hughes Aircraft Company." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 37, no. 9 (October 1993): 607–11. http://dx.doi.org/10.1177/154193129303700920.
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In 1987 Hughes Aircraft Company launched a fledgling driving simulation laboratory. For six years the facility has been actively used for human factors research, product design and engineering, market research and the development of simulation technology. Review this facility's brief history reveals a concurrent evolution in sophistication of technical capability and applications with some interesting lessons learned regarding the use of driving simulators. The implications for researchers and product developers considering the use of driver-in-the-loop simulation tools are discussed.
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Bufford, Daniel, and Khalid Hattar. "The Design and Implementation of a Single, Double, and Triple Concurrent Beam In Situ Ion Irradiation TEM Facility." Microscopy and Microanalysis 20, S3 (August 2014): 1562–63. http://dx.doi.org/10.1017/s1431927614009544.
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Neghabi, Hossein, and Farhad Ghassemi Tari. "A new concept of adjacency for concurrent consideration of economic and safety aspects in design of facility layout problems." Journal of Loss Prevention in the Process Industries 40 (March 2016): 603–14. http://dx.doi.org/10.1016/j.jlp.2016.02.010.
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Del Savio, Alexandre Almeida, José Francisco Vidal Quincot, Alvaro Daniel Bazán Montalto, Leonardo Antonio Rischmoller Delgado, and Martin Fischer. "Virtual Design and Construction (VDC) Framework: A Current Review, Update and Discussion." Applied Sciences 12, no. 23 (November 28, 2022): 12178. http://dx.doi.org/10.3390/app122312178.
Повний текст джерелаАнотація:
Compared with other industries, construction has maintained one of the lowest growth rates in productivity and innovation over the last decades. Moreover, low compliance with schedule targets has remained a common issue throughout projects. Therefore, although methodologies developed have benefited productivity in design, construction and operation, meeting client and project objectives becomes challenging without properly integrating organization, information, systems and processes. This perspective introduces the Virtual Design and Construction (VDC) framework. First, this paper studies and reviews VDC since its creation at the Center for Integrated Facility Engineering (CIFE) of Stanford University in 2001. After that, a comprehensive bibliographical review of the VDC framework is presented and updated with examples of its application in construction projects, delving into its elements: Client Objectives, Project Objectives, Production Objectives, Controllable Factors, Integrated Concurrent Engineering (ICE), Building Information Modeling (BIM) and Project Production Management (PPM). Finally, the main benefits and project outcomes when applying the VDC framework are presented and discussed, followed by the conclusions and recommendations for future research.
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Parfitt, Claire E., Adam G. McSweeney, Lisa De Backer, Csilla Orgel, Andrew J. Ball, Michael Khan, and Sanjay Vijendran. "Small Mars Mission Architecture Study." Advances in Astronomy 2021 (June 10, 2021): 1–12. http://dx.doi.org/10.1155/2021/5516892.
Повний текст джерелаАнотація:
While the vast majority of ESA’s funding for Mars exploration in the 2020s is planned to be invested in ExoMars and Mars Sample Return, there is an interest to assess the possibility of implementing a small mission to Mars in parallel with, or soon after, the completion of the MSR programme. A study was undertaken in the Concurrent Design Facility at ESA ESTEC to assess low-cost mission architectures for small satellite missions to Mars. Given strict programmatic constraints, the focus of the study was on a low-cost (<250MEuro Cost at Completion), short mission development schedule with a cost-driven spacecraft design and mission architecture. The study concluded that small, low-cost Mars missions are technically feasible for launch within the decade.
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Beck, Sanne Have, and Dorthe Susanne Nielsen. "Healthcare Professionals’ Perspectives on the Outgoing Geriatric Team: A Qualitative Explorative Study." Journal of Ageing and Longevity 2, no. 4 (December 9, 2022): 316–25. http://dx.doi.org/10.3390/jal2040026.
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The need for communication and collaboration increases when an older patient is discharged from the hospital, as the transition of care is complex for older patients living with multiple concurrent diseases. An intervention: The outgoing geriatric team was developed and initiated to address these patients’ complex needs. The outgoing geriatric team aimed to collaborate with healthcare professionals at a skilled nursing facility. This study explored how the intervention was experienced by the healthcare professionals from both the outgoing geriatric team and the skilled nursing facility. The study employed a qualitative explorative design using semi-structured interviews. Fourteen healthcare professionals participated in the interviews. Data were analyzed using Braun and Clark’s thematic analysis. Three themes emerged: (1) The need for personal contact and communication; (2) the need for competent care and sensitive observation; and (3) the need for clarification of responsibilities. The study emphasized the importance of meeting face-to-face during cross-sectoral collaboration when treating and caring for patients with complex care needs.
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Jaquith, Peter E., Richard M. Burns, Steve E. Dunbarr, B. J. Fontaine, Harry A. Nelson, John L. Silveira, and Tom D. Thompson. "Modular Engine Room Design and Construction for the Strategic Sealift Ships." Journal of Ship Production 12, no. 04 (November 1, 1996): 230–43. http://dx.doi.org/10.5957/jsp.1996.12.4.230.
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During the contract design phase of the Strategic Sealift New Construction Program at National Steel and Shipbuilding Company (NASSCO), an innovative Design and Build Strategy was developed to reduce the construction time and cost associated with complex engine rooms. A Concurrent Engineering team was assembled to develop the strategy, and to focus design, planning, material, and production efforts to achieve a highly modular design which allows the installation of the majority of outfit systems and equipment at the more effective Ground Outfit versus Onboard Stage. Due to facility and crane lifting constraints, a modular approach was taken in lieu of the conventional Block Outfit approach. The Design and Build Strategy resulted in rationalized system locations allowing reduced piping, electrical, and ventilation linear footage while supporting a high level of system completion at the module stage. To implement the Design and Build Strategy, a series of cross-functional teams was created to manage the project from contract design through production implementation. This paper describes the process and methods used by NASSCO to design, plan, and construct this modular Engine Room.
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Elwyn, Laura J., Nina Esaki, and Carolyn A. Smith. "Safety at a girls secure juvenile justice facility." Therapeutic Communities: The International Journal of Therapeutic Communities 36, no. 4 (December 14, 2015): 209–18. http://dx.doi.org/10.1108/tc-11-2014-0038.
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Purpose – Serious juvenile delinquency is a significant and costly problem in the society. However, custodial environments often exacerbate current problems and promote recidivism. Girls’ delinquency, in particular, may call for trauma-informed approaches within organizations that serve the most serious offenders. The purpose of this paper is to explore whether implementation of a trauma-informed intervention that aims to change the therapeutic stand of the organization, the Sanctuary Model®, corresponded with improved indicators of physical and psychological safety of staff and youth at a female secure juvenile justice facility. Design/methodology/approach – This study utilizes quantitative administrative and performance-based standards (PbS) data routinely collected at the facility. Findings – Findings suggest that the facility was a safer place for both residents and staff after implementation of the model. Its safety indicators also compare favorably to those of the juvenile justice correctional field in general. Research limitations/implications – This study was constrained by a number of limitations, including lack of some desirable detail on the PbS measures and on a comparable field group of girls’ facilities. It is also hard to assess the impact of other concurrent changes in the facility. Future research that addresses these issues would be useful in further determining the utility of the model. Originality/value – This study is the first to examine the impact of a structured trauma-informed organizational change intervention based on therapeutic communities principles, namely the Sanctuary Model, on staff and youth in a secure juvenile justice facility. Findings may be of value to practitioners, administrators, policy makers, and researchers in the corrections field.
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Emami, Nasir, Reza Sobhani, and Diego Rosso. "Diurnal variations of the energy intensity and associated greenhouse gas emissions for activated sludge processes." Water Science and Technology 77, no. 7 (February 9, 2018): 1838–50. http://dx.doi.org/10.2166/wst.2018.054.
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Abstract A model was developed for a water resources recovery facility (WRRF) activated sludge process (ASP) in Modified Ludzack-Ettinger (MLE) configuration. Amplification of air requirements and its associated energy consumptions were observed as a result of concurrent circadian variations in ASP influent flow and carbonaceous/nitrogenous constituent concentrations. The indirect carbon emissions associated with the ASP aeration were further amplified due to the simultaneous variations in carbon emissions intensity (kgCO2,eq(kWh)−1) and electricity consumption (kWh). The ratio of peak to minimum increased to 3.4 (for flow), 4.2 (for air flow and energy consumption), and 5.2 (for indirect CO2,eq emission), which is indicative of strong amplification. Similarly, the energy costs for ASP aeration were further increased due to the concurrency of peak energy consumptions and power demands with time of use peak electricity rates. A comparison between the results of the equilibrium model and observed data from the benchmark WRRF demonstrated under- and over-aeration attributed to the circadian variation in air requirements and limitations associated with the aeration system specification and design.
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D'Souza, Melroy E., and Joel S. Greenstein. "A Field Study of the Product Development Process as a First Step in the Design of a System to Support Concurrent Engineering." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 40, no. 15 (October 1996): 781–90. http://dx.doi.org/10.1177/154193129604001507.
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This paper reports the results of the first phase of an ongoing research study undertaken at a real-world production facility. The purpose of this phase was to use a context-based, ethnographic approach to understand and identify issues relevant to the design of a system to support the product development process. The results of this study yielded information that could not have been obtained by a formal, controlled study in a laboratory setting. In general, the results suggest a need for more efficient storage and retrieval of critical information, for increased communication of that information, and for alternative media to supplement paper-based communication. It appears that a computer-based system could be designed to support a more responsive, more collaborative approach to the product development process.
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Mwansa, Stephen, Junaid M. Shaikh, and Phillip MUBANGA. "Investing in the Lusaka South Multi Facility Economic Zone." Advances in Social Sciences Research Journal 7, no. 7 (August 8, 2020): 974–90. http://dx.doi.org/10.14738/assrj.77.8778.
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A Multi Facility Economic Zone (MFEZ) can be described as a Special Economic Zone which can be utilized for export and domestic production purposes by industries operating in the designated economic zone. The MFEZ is characterized by a mixture of several enticing attributes ranging from facilities such as export processing zones, Industrial parks, free trade zones and free ports, among others. Ideally, it is hoped that an MFEZ will kindle economic development in the selected location and consequently contribute to that country’s gross domestic product. It is not uncommon to set up an independent firm to oversee and run the entire administrative affairs of the economic zone on behalf of the owners of the facility. This article is based on a study that was undertaken to assess the performance of the Lusaka South Multi Facility Economic Zone (LS-MFEZ) in Zambia from the time it was established. The research was conducted over a period of eighteen months. This article focuses on two of the objectives of the study that assesses, the effectiveness of the economic zone management firm in stimulating investment in the zone, and the suitability of the economic zone infrastructure as a vehicle for attracting investment in the zone. The research adopted a mixed methods approach using a questionnaire, interviews, and focus group discussions. Interview respondents were selected using snowball sampling. Since the study adopted a mixed research approach with a concurrent triangulation design, data were analysed through a thematic approach for the qualitative component and using descriptive statistics from the Statistical Package for Social Sciences (SPSS) for the quantitative part. The findings show that the zone management firm appears to grapple with some key administrative issues of managing the zone, in addition to inadequate zone infrastructure.
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Busse, Theresa Sophie, Chantal Jux, Sven Kernebeck, Larissa Alice Dreier, Dorothee Meyer, Daniel Zenz, Boris Zernikow, and Jan Peter Ehlers. "Participatory Design of an Electronic Cross-Facility Health Record (ECHR) System for Pediatric Palliative Care: A Think-Aloud Study." Children 8, no. 10 (September 24, 2021): 839. http://dx.doi.org/10.3390/children8100839.
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Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.
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Agostini, P., H. Aksakal, S. Alekhin, P. P. Allport, N. Andari, K. D. J. Andre, D. Angal-Kalinin, et al. "The Large Hadron–Electron Collider at the HL-LHC." Journal of Physics G: Nuclear and Particle Physics 48, no. 11 (November 1, 2021): 110501. http://dx.doi.org/10.1088/1361-6471/abf3ba.
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Abstract The Large Hadron–Electron Collider (LHeC) is designed to move the field of deep inelastic scattering (DIS) to the energy and intensity frontier of particle physics. Exploiting energy-recovery technology, it collides a novel, intense electron beam with a proton or ion beam from the High-Luminosity Large Hadron Collider (HL-LHC). The accelerator and interaction region are designed for concurrent electron–proton and proton–proton operations. This report represents an update to the LHeC’s conceptual design report (CDR), published in 2012. It comprises new results on the parton structure of the proton and heavier nuclei, QCD dynamics, and electroweak and top-quark physics. It is shown how the LHeC will open a new chapter of nuclear particle physics by extending the accessible kinematic range of lepton–nucleus scattering by several orders of magnitude. Due to its enhanced luminosity and large energy and the cleanliness of the final hadronic states, the LHeC has a strong Higgs physics programme and its own discovery potential for new physics. Building on the 2012 CDR, this report contains a detailed updated design for the energy-recovery electron linac (ERL), including a new lattice, magnet and superconducting radio-frequency technology, and further components. Challenges of energy recovery are described, and the lower-energy, high-current, three-turn ERL facility, PERLE at Orsay, is presented, which uses the LHeC characteristics serving as a development facility for the design and operation of the LHeC. An updated detector design is presented corresponding to the acceptance, resolution, and calibration goals that arise from the Higgs and parton-density-function physics programmes. This paper also presents novel results for the Future Circular Collider in electron–hadron (FCC-eh) mode, which utilises the same ERL technology to further extend the reach of DIS to even higher centre-of-mass energies.
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Dwiana, Anna, and Lucky Herawaty. "FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU BUANG AIR BESAR PADA MASYARAKAT DI DESA BANDAR BATAUGA KECAMATAN BATAUGA KABUPATEN BUTON SELATAN." Berita Kedokteran Masyarakat 33, no. 6 (June 1, 2017): 273. http://dx.doi.org/10.22146/bkm.23539.
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Determinants of defecation behavior among coastal community in district of South ButonPurposeThe purpose of this study was to identify the factors associated with community attitudes toward defecation in Bandar Batauga village Batauga district South Buton Regency.MethodsThis study used mixed methods, with convergent/concurrent design to merge the results of the quantitative and qualitative data analysis, their combination and contributions to the problem from multiple angles and multiple perspectives. The total number of respondents for this study were 110, divided into 100 respondents and 10 informants.ResultsChi-square analysis showed associated knowledge p-value = 0.0117; PR = 0.635 and facility availability p-value = 0.0002; PR = 1.876 with open defecation behavior.ConclusionTo improve the cooperation between health workers, heads of the environment, and communities need to provide more health education in order to increase the knowledge of the community and support the program of toilet procurement to support basic sanitation facilities.
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Aziato, Lydia, and O. Adejumo. "PSYCHOSOCIAL FACTORS INFLUENCING GHANAIAN FAMILY CAREGIVERS IN THE POST-OPERATIVE CARE OF THEIR HOSPITALISED PATIENTS." Africa Journal of Nursing and Midwifery 16, no. 2 (January 21, 2015): 112–24. http://dx.doi.org/10.25159/2520-5293/40.
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This study explored the psychosocial factors influencing family caregivers during the care of patients who underwent surgery and are in pain. Family caregivers play key roles in the care of post-surgical patients in different cultures. However, research has not adequately explored family caregivers’ experiences within the post-operative context in Ghana.An exploratory qualitative design was employed. Data collection involved individual interviews. Concurrent content analysis was undertaken and saturation of data was achieved with 12 family caregivers and one key informant. The participants were recruited from the surgical department of a tertiary health facility in Accra, the capital city of Ghana.The study revealed six themes that influenced family caregivers in the care of post-surgical patients: faith, fear, feeling of relief, empathy, commitment and inadequate knowledge. Health professionals should meaningfully integrate and educate family caregivers on patient care and pain management within the post-surgical context.
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Haggerty, Brian, and Mark Hoffmann. "Floating and float-in LNG solutions for Australian and international locations." APPEA Journal 54, no. 2 (2014): 513. http://dx.doi.org/10.1071/aj13086.
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The costs of LNG projects have increased worldwide. FLNG and float-in near-shore facilities reduce the total amount of infrastructure required for an offshore gas field development. Woodside has developed a range of FLNG and float-in/near-shore facility concepts. In the process key lessons from more than a dozen potential applications were obtained. The optimisation of process efficiency and availability versus operability and maintainability ends up in a different balance to onshore LNG or FPSO. Knowledge of LNG and FPSO operations and maintenance is required to design FLNG. Quantitative risk assessment (QRA) does not fully define the safety of the facilities. The application of proven philosophies, simplicity, and management of concurrent operations drives inherent safety. The choice of refrigerants for the liquefaction process on an offshore facility is not straightforward (e.g. nitrogen does not necessarily offer as big a safety advantage as often assumed). The design-one-build-many strategy can offer significant advantages if a number of similar facilities can be sanctioned in quick succession; however, this is not generally available and a bespoke solution will generally be optimum. Concrete near-shore facilities have superior durability and potentially lower maintenance but require significant pre-FID decisions and investment for graving docks, etc. FLNG offers greater certainty of execution outcome because of the fabrication and construction in the controlled shipyard environment; however, experience and management processes are required to manage the novelty aspects. Earlier contracting and execution decisions are required for floating LNG than for onshore LNG or standard FPSOs.
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Eleme, Zinovia, and Et al. "Cross section measurement of 241Am(n,f) reaction at the Experimental Area 2 of the n_TOF facility at CERN: First Results." HNPS Proceedings 27 (April 17, 2020): 189. http://dx.doi.org/10.12681/hnps.3008.
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The condition for the safe design and operation of fast neutron reactors and energy boosters (Generation-IV reactors, ADS systems [1]) is the accuracy of nuclear data. The 241Am isotope (T1/2 = 433 years) is highly present in nuclear waste, accounting for about 1.8% of the actinide mass in PWR UOx nuclear reactors’ waste [2]. In addition, the 241Am isotope is further produced by the β decay of the 241Pu isotope (T1/2 = 14.3 years). Given the high production rate of 241Am isotope, its incineration with concurrent energy production is considered to be of utmost importance for the design and implementation of the recycling of existing nuclear waste. Sensitivity studies of the proposed systems for energy production showed that high-precision measurements of the cross section of the 241Am(n,f) reaction are required. In the present work, the 241Am(n,f) reaction cross section was measured in the Second Experimental Area of the n_TOF facility at CERN, using an array of Micromegas detectors. For the measurement, six targets of 241Am with average activity of 17 MBq per sample were coupled with an equal number of detectors in a common chamber. Additionally two 235U and two 238U samples were coupled with Micromegas detectors utilizing the neutron flux determination. Within this work, an overview of the experimental set-up and the adopted data analysis technique is presented along with preliminary results.
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Hopgood, Daniel A., Richard J. Czosek, Tamilyn Bakas, Nicole Garritano, and Gordon L. Gillespie. "The Capture Gap: Implantable Cardioverter–Defibrillator Quality of Life." Clinical Nursing Research 29, no. 2 (October 7, 2018): 97–107. http://dx.doi.org/10.1177/1054773818803741.
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We aimed to compare salient characteristics and antecedents of quality of life (QOL) in adolescents and young adults with implantable cardioverter–defibrillators (ICDs) from qualitative methods with quantitative measurement of QOL and correlations between QOL (PedsQL) and measured participant characteristics. Concurrent parallel mixed methods design was used to collect survey data from the PedsQL electronic health record, demographic questionnaire, and semistructured interview data. A convenience sample of 16 individuals with ICDs, aged 13 to 25 years, was obtained from a tertiary pediatric facility. Overall QOL and subdomains of physical, psychosocial, and academic/work were examined by PedsQL and visual analog scale. Select demographics were collected to develop a participant profile. Females with ICDs appear to be at risk of poor QOL given some unknown factors. Financial status of the individual and the family was positively related to QOL. For new ICD persons involved in physical activities that must be stopped, peer support appears to improve QOL.
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Laucka, Paul V., Will B. Webster, and Jeffrey Kuch. "Pharmacist Review to Simplify Medication Regimens in a VAMC Primary Care Clinic." Journal of Pharmacy Technology 12, no. 2 (March 1996): 62–66. http://dx.doi.org/10.1177/875512259601200206.
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Objective: To assess the effect of a clinical pharmacist's prospective medication review of patients receiving multiple drug therapy, using the pharmaceutical care process, as determined by the number of concurrent medications the patient is receiving before and after clinic visits. Design: Assigned groups. Setting: Outpatient primary care clinic of a tertiary healthcare Veterans Affairs (VA) medical facility. Patients: Seven hundred twenty-seven patients who had eight or more active medication orders were selected. Four hundred forty-one patients (aged 67.2 ± 10.4 y) were in the intervention group; 286 others (aged 66.6 ± 11.9 y), whose medical records were not available, were assigned to the control group and received no clinical pharmacist intervention. Intervention: Medication regimens of VA ambulatory patients with eight or more active medications were reviewed by a clinical pharmacist, and a written communication to the prescriber was attached to the medical record. Main Outcome Measures: The number of active concurrent medications before and after clinic visits was measured. Results: There was a decrease in the medications in the intervention group from an average of 12.1 ±4 to 11.5 ± 4.2 (p < 0.05). The medications in the control group rose from an average of 11.8 ± 4.44 to 12.2 ± 4 (p = NS). A decrease of 0.6 prescriptions per patient was highly significant (p < 0.05). During the study, 1,336 recommendations were made to practitioners. From this group, 41% of the recommendations were accepted, and 477 medications were discontinued, the quantity dispensed or dosage was reduced, or an alternative medication was prescribed. Conclusions: These data suggest that clinical pharmacist intervention in an ambulatory care setting can affect practitioner prescribing habits and significantly decrease the number of medications prescribed.
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Zamin, Monique T., Monique M. Pitre, and John M. Conly. "Development of an Intravenous-to-Oral Route Conversion Program for Antimicrobial Therapy at a Canadian Tertiary Care Health Facility." Annals of Pharmacotherapy 31, no. 5 (May 1997): 564–70. http://dx.doi.org/10.1177/106002809703100507.
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OBJECTIVE: To describe the effect of introducing a route conversion program on the prescribing of antimicrobials for the treatment of respiratory tract infections and skin/soft tissue infections in a sample population. DESIGN: Concurrent, pre- and postintervention study. SETTING: Four general internal medicine wards at The Toronto Hospital, a 1170-bed, tertiary care health center in Toronto, Ontario, Canada. PARTICIPANTS: Patients receiving antimicrobial therapy for respiratory tract infections and skin/soft tissue infections. INTERVENTION: Written guidelines and education sessions were presented to residents, interns, medical students, and pharmacists responsible for the care of patients admitted to four general internal medicine wards. MAIN OUTCOME MEASURES: Clinical and laboratory parameters related to the status of the infection were monitored prospectively and compared with the course of drug therapy, with consideration of the patient's ability to meet the criteria established in the guidelines. The number of days of intravenous therapy prescribed despite appropriateness of oral therapy was tallied. RESULTS: Twenty-seven patients (28 infections) were identified for inclusion in the 7-week preliminary audit, and 30 patients (32 infections) were included in the audit after the program, which continued for 5 weeks. Following implementation of the program, the number of days that intravenous therapy was continued despite the appropriateness of oral therapy was reduced from 41% to 26% of the total days of intravenous therapy prescribed. CONCLUSIONS: The program had a positive influence on antimicrobial prescribing behavior in the population studied. Strategies to ensure continued benefit from the program have been developed.
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Hirokawa, Catherine A., and David R. Gray. "Chlorpropamide-Induced Hyponatremia in the Veteran Population." Annals of Pharmacotherapy 26, no. 10 (October 1992): 1243–44. http://dx.doi.org/10.1177/106002809202601011.
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OBJECTIVE: To determine the incidence and possible risk factors associated with chlorpropamide (CPA)-induced hyponatremia in the veteran population. DESIGN: Retrospective cohort study. SETTING: Federal tertiary care medical center. PATIENTS: Veterans receiving CPA from our facility with at least one serum sodium concentration below 135 mmol/L within the past year were eligible. A randomly selected control group consisting of patients taking CPA with normal sodium concentrations was also chosen. One hundred forty-five of 799 patients who had received CPA were included in the study. RESULTS: The average daily dose of CPA was 425 ± 207 mg (± SD). The incidence of hyponatremia associated with CPA was 7.1 percent (57/799 patients). The majority of patients were mildly hyponatremic (48/57 patients, 84 percent) with serum sodium concentrations between 130 and 134 mmol/L. The incidence of CPA-induced syndrome of inappropriate antidiuretic hormone was 2.1 percent. Concurrent angiotensin-converting enzyme (ACE) inhibitor use was identified as a risk factor; thiazide diuretic use was not. CONCLUSIONS: The incidence of hyponatremia related to CPA use in elderly veterans is consistent with other reports in the literature. ACE inhibitors may be a predisposing factor for CPA-induced hyponatremia.
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Badea, Gabriela Elena, Cristina Hora, Ioana Maior, Anca Cojocaru, Calin Secui, Sanda Monica Filip, and Florin Ciprian Dan. "Sustainable Hydrogen Production from Seawater Electrolysis: Through Fundamental Electrochemical Principles to the Most Recent Development." Energies 15, no. 22 (November 16, 2022): 8560. http://dx.doi.org/10.3390/en15228560.
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Among the many potential future energy sources, hydrogen stands out as particularly promising. Because it is a green and renewable chemical process, water electrolysis has earned much interest among the different hydrogen production techniques. Seawater is the most abundant source of water and the ideal and cheapest electrolyte. The first part of this review includes the description of the general theoretical concepts: chemical, physical, and electrochemical, that stands on the basis of water electrolysis. Due to the rapid development of new electrode materials and cell technology, research has focused on specific seawater electrolysis parameters: the cathodic evolution of hydrogen; the concurrent anodic evolution of oxygen and chlorine; specific seawater catalyst electrodes; and analytical methods to describe their catalytic activity and seawater electrolyzer efficiency. Once the specific objectives of seawater electrolysis have been established through the design and energy performance of the electrolyzer, the study further describes the newest challenges that an accessible facility for the electrochemical production of hydrogen as fuel from seawater must respond to for sustainable development: capitalizing on known and emerging technologies; protecting the environment; utilizing green, renewable energies as sources of electricity; and above all, economic efficiency as a whole.
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Biswas, Swarnava, Chandranath Chakraborty, Riddhi Chawla, Dabosmita Paul, Debajit Sen, Niloy Sarkar, and Moumita Mukherjee. "A Pragmatic Approach for Detecting nCOVID-19 using Pervasive Computing Based on Dual Diagnostic Measures." International Journal of Statistics in Medical Research 10 (December 1, 2021): 183–93. http://dx.doi.org/10.6000/1929-6029.2021.10.17.
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Our regular way of life has been disrupted by the COVID-19, and we have been obliged to accept the procedures that are in place under the new normal regime. It is envisaged that the standard diagnostic technique will evolve throughout the course of the procedure. As a help to this type of diagnostic technique, our research group is developing a tool. In this article, the group discusses the importance of employing two diagnostic metrics that have proven to be pivotal in many diagnoses for doctors, and how they might be used to their advantage. Together, natural language processing-based symptoms measures and a machine learning-based strategy that takes into account medical vitals can help to minimise the error percentage of detection by as much as 50%. The technique suggested in this study is the first of its type, and the authors have obtained findings that are satisfactory in terms of accuracy. A further justification for suggesting such a strategy is the manner in which a fusion algorithm might arrive at the correct results from two concurrent algorithms performing the same task. One of the group's other objectives was to give the doctor a valuable opinion in the form of such an architectural design. The suggested design may be employed at any point of care facility without the need for any additional infrastructure or escalation of the current amenities to accommodate the proposed architecture.
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Ahmed, Rushdia, Nadia Farnaz, Bachera Aktar, Raafat Hassan, Sharid Bin Shafique, Pushpita Ray, Abdul Awal, et al. "Situation analysis for delivering integrated comprehensive sexual and reproductive health services in humanitarian crisis condition for Rohingya refugees in Cox’s Bazar, Bangladesh: protocol for a mixed-method study." BMJ Open 9, no. 7 (July 2019): e028340. http://dx.doi.org/10.1136/bmjopen-2018-028340.
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IntroductionRohingya diaspora are one of the most vulnerable groups seeking refuge in camps of Cox’s Bazar, Bangladesh, arising an acute humanitarian crisis. More than half of the Rohingya refugees are women and adolescent girls requiring quality sexual and reproductive health (SRH) services. Minimum initial service package of SRH are being rendered in the refugee camps; however, WHO is aiming to provide integrated comprehensive SRH services to meet the unmet needs of this most vulnerable group. For sustainable and successful implementation of such comprehensive SRH service packages, a critical first step is to undertake a situation analysis and understand the current dimensions and capture the lessons learnt on their SRH-specific needs and implementation challenges. This situation analysis is pertinent in current humanitarian condition and will provide an overview of the needs, availability and delivery of SRH services for adolescent girls and women, barriers in accessing and providing those services in Rohingya refugee camps in Cox’s Bazar, Bangladesh, and similar humanitarian contexts.Methods and analysisA concurrent mixed-methods design will be used in this study. A community-based household survey coupled with facility assessments as well as qualitative in-depth interviews, key informant interviews and focus group discussions will be conducted with community people of Rohingya refugee camps and relevant stakeholders providing SRH services to Rohingya population in Cox’s Bazar, Bangladesh. Survey data will be analysed using univariate, bivariate and multivariable regression statistics. Descriptive analysis will be done for facility assessment and thematic analysis will be conducted with qualitative data.Ethics and disseminationEthical approval from Institutional Review Board of BRAC James P Grant School of Public Health (2018-017-IR) has been obtained. Findings from this research will be disseminated through presentations in local, national and international conferences, workshops, peer-reviewed publications, policy briefs and interactive project report.
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Azanaw, Abrham, Melaku Birhanu Alemu, Mezgebu Yitayal, and Andualem Yalew Aschalew. "Evaluation of the pediatric antiretroviral therapy service in Gondar city public health facilities—A case study design with mixed methods." PLOS ONE 17, no. 12 (December 30, 2022): e0279890. http://dx.doi.org/10.1371/journal.pone.0279890.
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Background The pediatric antiretroviral therapy (ART) service is introduced to save lives, restore mental and physical functions, and improve the quality of life of children living with HIV/AIDS. This evaluation aimed to assess the implementation status of the pediatric ART service provision in Gondar city administration health facilities to promote evidence-based decision-making for program improvement. Methods An institutional-based single case-study design with concurrent mixed methods were applied. The service was evaluated by the availability of essential resources, compliance of health providers with the standard guideline, and caregivers’ satisfaction dimensions. Document review, key informant interviews, observations, and interviewer-administered exit-interview were conducted. The quantitative data were analyzed in descriptive and analytical, while the qualitative data were transcribed, translated, and thematically analyzed. A logistic regression analysis was performed to identify factors associated with caregivers’ satisfaction. Results The overall implementation of pediatric ART service was 75.32%. The availability, compliance, and satisfaction were 68.96%, 74.44%, and 84.64%, respectively. Trained healthcare professionals, essential ART drugs, registers, and basic laboratory diagnostic equipment were reasonably available. However, the lack of opportunistic infection medications and adequate rooms were significant gaps in service provision. Respondents noted a shortage of drugs and rooms for consultation and service provision. Short travel distance (AOR = 2.87), low viral load (AOR = 3.15), and sex of caregivers (AOR = 4.98) were significantly associated with good satisfaction. Conclusions The overall implementation of pediatric ART service is well based on the pre-determined judgment criteria. The health facilities and policymakers are advised to focus on availing medications to treat opportunistic infections and expanding the health facility to have enough space for consultation and service provision. Furthermore, particular emphasis should be given to caregivers who come from long distances and patients with a high viral load to increase caregivers’ satisfaction.
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Elshafey, Mohamed Abdelmoneim, and Tarek Said Ghoniemy. "The Development Of QMMS: A Case Study for Reliable Online Quiz Maker and Management System." Future Computing and Informatics Journal 6, no. 2 (November 24, 2021): 82–96. http://dx.doi.org/10.54623/fue.fcij.6.2.3.
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The e-learning and assessment systems became a dominant technology nowadays and distribute across the globe. With severe consequences of COVID19-like crises, the key importance of such technology appeared in which courses, quizzes and questionnaires have to be conducted remotely. Moreover, the use of Learning Management Systems (LMSs), such as blackboard, eCollege, and Moodle, has been sanctioned in all respects of education. This paper presents an open-source interactive Quiz Maker and Management System (QMMS) that suits the research, education (under-grad, grad, or post-grad), and industrial organizations to perform distant quizzes, training and questionnaires with an integration facility with other LMS tools such as Moodle. The proposed system supports three basic levels: 1) administration, 2) instructors, and 3) learners at the micro-level teaching. The proposed system is adopted using .Net framework integrated with SQL-Server database engine that compromise between performance, security and stability. The proposed QMMS is described through different phases of Software Development Life Cycle (SDLC) including detailed analysis, design, implementation, testing, verification, and maintenance in order to exploit the importance of the analysis and design of LMS from the software engineering point of view. A comparative analysis, among the proposed system and a recent list of challenging ones, is presented in different aspects that shows the effectiveness, reliability and validity of proposed tool. Moreover, the proposed QMMS shows an enhancement ratio of up to 42.19% in response time perspective as compared to Moodle system in the case of massive concurrent transactions.
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Nock, Oliver, Jonathan Starkey, and Constantinos Marios Angelopoulos. "Addressing the Security Gap in IoT: Towards an IoT Cyber Range." Sensors 20, no. 18 (September 22, 2020): 5439. http://dx.doi.org/10.3390/s20185439.
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The paradigm of Internet of Things has now reached a maturity level where the pertinent research goal is the successful application of IoT technologies in systems of high technological readiness level. However, while basic aspects of IoT connectivity and networking have been well studied and adequately addressed, this has not been the case for cyber security aspects of IoT. This is nicely demonstrated by the number of IoT testbeds focusing on networking aspects and the lack of IoT testbeds focusing on security aspects. Towards addressing the existing and growing skills-shortage in IoT cyber security, we present an IoT Cyber Range (IoT-CR); an IoT testbed designed for research and training in IoT security. The IoT-CR allows the user to specify and work on customisable IoT networks, both virtual and physical, and supports the concurrent execution of multiple scenarios in a scalable way following a modular architecture. We first provide an overview of existing, state of the art IoT testbeds and cyber security related initiatives. We then present the design and architecture of the IoT Cyber Range, also detailing the corresponding RESTful APIs that help de-associate the IoT-CR tiers and obfuscate underlying complexities. The design is focused around the end-user and is based on the four design principles for Cyber Range development discussed in the introduction. Finally, we demonstrate the use of the facility via a red/blue team scenario involving a variant of man-in-the-middle attack using IoT devices. Future work includes the use of the IoT-CR by cohorts of trainees in order to evaluate the effectiveness of specific scenarios in acquiring IoT-related cyber-security knowledge and skills, as well as the IoT-CR integration with a pan-European cyber-security competence network.
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Coe, Jon, and Julia Hoy. "Choice, Control and Computers: Empowering Wildlife in Human Care." Multimodal Technologies and Interaction 4, no. 4 (December 14, 2020): 92. http://dx.doi.org/10.3390/mti4040092.
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The purpose of this perspective paper and technology overview is to encourage collaboration between designers and animal carers in zoological institutions, sanctuaries, research facilities, and in soft-release scenarios for the benefit of all stakeholders, including animals, carers, managers, researchers, and visitors. We discuss the evolution of animal-centered technology (ACT), including more recent animal-centered computing to increase animal wellbeing by providing increased opportunities for choice and control for animals to gain greater self-regulation and independence. We believe this will increase animal welfare and relative freedom, while potentially improving conservation outcomes. Concurrent with the benefits to the animals, this technology may benefit human carers by increasing workplace efficiency and improving research data collection using automated animal monitoring systems. These benefits are balanced against cultural resistance to change, the imposition of greater staff training, a potential reduction in valuable animal-carer interaction, and the financial costs for technology design, acquisition, obsolescence, and maintenance. Successful applications will be discussed to demonstrate how animal-centered technology has evolved and, in some cases, to suggest future opportunities. We suggest that creative uses of animal-centered technology, based upon solid animal welfare science, has the potential for greatly increasing managed animal welfare, eventually growing from individual animal enrichment features to facility-wide integrated animal movement systems and transitions to wildlife release and rewilding strategies.
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Mukhopadhyay, Jaya, Gilbert Kalonde, and Loras O'Toole PE. "A Survey of O&M Practices for High Performance Buildings in the Building Industry." Journal of Facility Management Education and Research 4, no. 1 (January 1, 2020): 14–29. http://dx.doi.org/10.22361/2474-6630-4.1.29.
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ABSTRACT Purpose — The purpose of this paper is to document in part the study that was conducted for a research project ASHRAE RP-1650, which investigates the training requirements for sustainable high-performance building (HPB) operations and maintenance (O&M). This paper documents the intent, procedures and findings of a portion of the research project, which includes a survey of O&M practices for high performance buildings in the industry. The purpose of the survey as reported in this paper was to confirm and refine the level of understanding of KSCs for operating HPBs as perceived by O&M personnel in the industry. The details of the survey and the results are presented in this paper. The survey was sent out to facility managers in the industry who are involved with the O&M of HPB systems and equipment. 221 facility managers were surveyed in this study. Design/methodology/approach — This study utilizes a concurrent mixed-method research, which considers both qualitative and quantitative responses. Findings — The study found that while most technicians were ‘moderately well' to ‘very well' trained for the configuration and components as well as the installation, repair and replacement of different high performance equipment and systems, they lacked essential knowledge to address issues such as: controls; tracking of variables; programming and operation of modulation devices implemented in high-performance systems and equipment. This finding implied a lack of ‘Systems Thinking' approach, which the study found to be pertinent and essential for the O&M of HPB systems and equipment. Originality/value — The study is utilized to identify gaps between the training requirements for O&M of HPBs identified from the literature review of the research project and the current industry practices. The identified gaps are valuable to develop learning objectives for training programs that are aimed to train personnel responsible for the O&M of HPBs.
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Ghazizadeh, Shabnam, Kyasha Moore, Kianusch Kiai, and Abie H. Mendelsohn. "Drug-Induced Sleep Endoscopy Performed in the Endoscopy Suite: A Resource Utilization Analysis." Otolaryngology–Head and Neck Surgery 162, no. 3 (January 21, 2020): 386–91. http://dx.doi.org/10.1177/0194599820901516.
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Objectives To analyze the resource utilization of performing drug-induced sleep endoscopy (DISE) procedures in an endoscopy suite (ES) setting as compared with the operating room (OR). Study Design A retrospective review of DISE procedures performed by a single attending surgeon from 2016 to 2018. Setting Tertiary hospital. Subjects and Methods All patients undergoing sleep endoscopy without concurrent surgical procedures were included. No exclusion criteria were incorporated. Analysis assessed for differences in procedure-related expenditures, patient characteristics, anesthesia and surgeon time, and access to care. Results A total of 87 sleep endoscopies were included: 65 (74.7%) performed in the ES and 22 (25.3%) in the OR. Patient groups were similar in age and apnea-hypopnea index severity ( P > .05). Patient body mass index was significantly higher for the ES group ( P = .03). Total facility time, postoperative recovery time, anesthesia care time, and time in the surgical room were significantly decreased in the ES setting ( P < .01). Surgical time was similar between the groups ( P > .05). For ES procedures, total cost was reduced by 74% ( P < .01). DISE in the ES resulted in a mean $5080 less in health system charges versus the OR group ( P < .01). There were no treatment-related complications in either setting. Conclusion The resource utilization profile of performing DISE can be significantly improved by transferring these procedures from the OR to the ES setting.
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Kalolo, Albino, Julieth Lalashowi, Doreen Pamba, Pendomartha Joseph Shayo, Catherine Gitige, Happiness Mvungi, Webhale Ntagazwa, et al. "Implementation of the ‘Removed Injectable modified Short-course regimens for EXpert Multidrug Resistant Tuberculosis’ (RISE study) in Tanzania: a protocol for a mixed-methods process evaluation." BMJ Open 12, no. 5 (May 2022): e054434. http://dx.doi.org/10.1136/bmjopen-2021-054434.
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IntroductionTanzania is adapting a shortened injectable-free multidrug resistant tuberculosis (MDR-TB) regimen, comprising new drugs such as bedaquiline and delamanid and repurposed drugs such as clofazimine and linezolid. The regimen is implemented using a pragmatic prospective cohort study within the National TB and Leprosy Programme and is accompanied by a process evaluation. The process evaluation aims to unpack the implementation processes, their outcomes and the moderating factors in order to understand the clinical effectiveness of the regimen. This protocol describes the methods employed in understanding the implementation processes of the new MDR-TB regimen in 15 regions of Tanzania.MethodsThis study adopts a concurrent mixed-methods design. Using multiple data collection tools, we capture information on: implementation outcomes, stakeholder response to the intervention and the influence of contextual factors. Data will be collected from the 22 health facilities categorised as dispensaries, health centres, district hospitals and referral hospitals. Health workers (n=132) and patients (n=220) will fill a structured questionnaire. For each category of health facility, we will conduct five focus group discussions and in-depth interviews (n=45) for health workers. Participant observations (n=9) and review documents (n=22) will be conducted using structured checklists. Data will be collected at two points over a period of 1 year. We will analyse quantitative data using descriptive and inferential statistical methods. Thematic analysis will be used for qualitative data.Ethics and disseminationThis study received ethical approval from National Institute of Medical research (NIMR), Ref. NIMR/HQ/R.8a/Vol.IX/3269 and from the Mbeya Medical Research and Ethics Review Committee, Ref. SZEC-2439/R.A/V.I/38. Our findings are expected to inform the wider implementation of the new MDR-TB regimen as it is rolled out countrywide. Dissemination of findings will be through publications, conferences, workshops and implementation manuals for scaling up MDR-TB treatments.
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Mossberg, Kurt A., and Elizabeth Fortini. "Responsiveness and Validity of the Six-Minute Walk Test in Individuals With Traumatic Brain Injury." Physical Therapy 92, no. 5 (May 1, 2012): 726–33. http://dx.doi.org/10.2522/ptj.20110157.
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Background A simple test of aerobic fitness for patients with traumatic brain injury (TBI) that is valid, reliable, and responsive to change is needed to provide clinicians a functional measure of cardiorespiratory capacity. Objective The purpose of this study was to examine the validity and responsiveness to change of the Six-Minute Walk Test (6MWT) in individuals with TBI. Design A cohort, pretest-posttest, comparison study was conducted. Methods Twenty-one patients performed the 6MWT upon admission to and prior to discharge from a postacute rehabilitation facility. Heart rate and distance traveled were recorded. A physiologic cost index (PCI) (beats per meter) was calculated based on steady-state heart rate. At discharge, all participants were able to perform a graded treadmill exercise test to exhaustion during which peak oxygen consumption (V̇o2) was measured. Results Between admission and discharge, mean total distance increased from 342.6 m (SD=127.0) to 408.9 m (SD=124.2), and work increased from 27,185 kg·m (SD=10,528) to 34,114 kg·m (SD=12,057). The effect size indexes were 1.10 and 1.12 for distance and work, respectively. Correlations (r) between the discharge peak V̇o2 and the discharge 6MWT distance, PCI, and work were .58, −.61, and .47, respectively. Limitations Stratification by gait speed may have improved responsiveness, especially for the slow ambulators. Conclusions All measures correlated well with peak V̇o2, establishing an acceptable level of criterion-related (concurrent) validity. The addition of heart rate and calculating the PCI was only slightly better at predicting peak V̇o2, albeit nonsignificant, than a simple measure of total distance. The 6MWT provides a good estimate of peak aerobic capacity, and some measures are more responsive to change than others in patients recovering from TBI.
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Nurislaminingsih, Rizki, and Partini Partini. "Persepsi Pemustaka dari Latar Belakang Sosial yang Berbeda terhadap Fungsi Perpustakaan (Studi di Perpustakaan Kota Yogyakarta)." Berkala Ilmu Perpustakaan dan Informasi 12, no. 2 (December 22, 2016): 159. http://dx.doi.org/10.22146/bip.17296.
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Nowadays, the existence of technology in the middle of the society does not only give the abundant information, but also causes confusion and boredom in searching for the information. Such situation also has influenced the society's demand with different social stratifications in their easiness of accessing the information. Yogyakarta City Library, which in fact is an information center for the whole society layers, is expected to be able to be a bridge for the impacts of technology existence in information searching process. This study aimed at finding out the influence of social environment in building perceptions towards the library functions and how the library functions were viewed by readers with different social stratifications. The method used in this study was the combination of quantitative and qualitative approaches with Concurrent Triangulation design, in which two approaches were used simultaneously. However, data gathering and data analysis processes were done separately. The respondents were fifty users selected through random sampling. The in-depth interview was done towards ten informants. The result of the study indicated that social environment was not only influential in building the society's perceptions towards the library functions, but also motivated the readers to visit the library. Besides, it was found out that there was the change regarding to the society's perceptions with different social backgrounds towards the library functions. Recently, a library has not only been viewed as a book storage or solely an information provider, but has also been viewed as a rare collections preserver, an amusement place, simply a spot for hanging out with friends, and a positive game facility among children and parents. In addition, a library has also been viewed as a successor of the education missions and as a medium for channeling the society's talent and creativity.
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Asumadu, Obed Kwaku Duah, Sandra Esi Effrim, Beatrice Ennin, Angela Owusuah Amoabeng, Rosina Darcha, Akwasi Boakye-Yiadom, Wisdom Peprah, Joel Afram Saah, and Richard Opoku Asare. "PRECONCEPTION KNOWLEDGE AND PRACTICES AMONG WOMEN IN FERTILITY AGE IN THE TAMALE TEACHING HOSPITAL OF GHANA." European Journal of Health Sciences 5, no. 2 (September 16, 2020): 1. http://dx.doi.org/10.47672/ejhs.568.
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Purpose: The aim of this study was to assess preconception knowledge and practices and its effect on birth outcomes among puerperal women in the Tamale Teaching Hospital.Methodology: The study employed analytic cross-sectional study design with a quantitative approach. A semi-structured questionnaire was used where questions on knowledge of preconception were adopted from Southampton Women’s Survey, 2006. Puerperal women in the postnatal unit of the Tamale Teaching Hospital, who were yet to be discharged, including referred cases, were selected as target population for this study. The exclusion criteria were women who have never delivered and menopausal women. The sample size was 363 puerperal women. Purposive sampling method was used to attain the required sample. Data was analyzed using SPSS version 25. In the analyses, a p-value<0.05 was considered statistically significant when variables were cross-tabulated.Findings: The results of the study revealed a high proportion of puerperal women 161 (44.3%) were above 30 years. The mean age was 30.56±6.44 years. The study found that 37.2% women had knowledge on preconception care. There was a significant association between folic acid intake and postpartum haemorrhage (r=-0.183, p<0.0001). There was no statistical association between birth outcomes and concurrent loss of pregnancy and number of pregnancies lost except for birth weight (r=0.202, p=0.000). Albeit preconception care knowledge was low among puerperal women, it significantly influenced postpartum haemorrhage and pregnancy induced hypertension but not antepartum hemorrhage and birth weight.Recommendation: At the community level the study recommended to the Ghana Health Service that a mother-to-mother support group be formed among women in their reproductive age and this could help encourage one another to discuss about their health before pregnancy and share success stories on birth outcomes and report to the facility in case of any problems.
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Benowitz, Isaac, Joseph Perz, and Julia Marders. "Detection of Possible Medical Product-Related Infection or Pathogen Transmission—United States, 2015–2019." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s30—s31. http://dx.doi.org/10.1017/ice.2020.508.
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Background: Medications, medical devices, biological products, and other medical products can cause healthcare-associated infections related to contamination in production or transportation (intrinsic contamination) or contamination at the point of use (extrinsic contamination). Rapid identification of contaminated medical products can lead to actions to decrease further patient harm. We sought to describe events that prompted public health investigations of contaminated medical products in healthcare facilities. Methods: We reviewed records of CDC consultations with health departments and healthcare facilities from January 2015 through August 2019 to identify public health investigations in which medical products were identified as a likely source of patient infection or pathogen transmission to at least 1 patient. We collected data on products, contamination type, pathogens, route of patient exposure, healthcare setting where exposure occurred, and resulting actions. Results: There were 34 investigations involving medications (n = 15, 44%), medical devices (n = 12, 35%), biological products (n = 3, 9%), and other medical products (n = 4, 12%). Intrinsic contamination was suspected in 15 investigations (44%), with 13 (87%) based on isolation of a pathogen from unopened products and 2 (13%) based on isolation of similar pathogens from patients in contact with a medical product at multiple facilities. Extrinsic contamination was suspected in 19 investigations (56%) based on evidence of pathogen transmission at a single healthcare facility and concurrent infection control gaps at that facility supporting a mechanism of contamination. The most common pathogens prompting investigation were nontuberculous mycobacteria (n = 9, 26%), Burkholderia spp (n = 7, 21%), Klebsiella spp (n = 3, 9%), Serratia spp (n = 2, 6%), and other environmental and commensal organisms. Patients were most commonly exposed in hospitals (n = 19, 56%) and outpatient settings (n = 9, 26%). The most common patient exposures that resulted in transmission of the pathogen were infusions and injections (n = 15, 44%), diagnostic and therapeutic procedures (n = 9, 26%), and surgery (n = 5, 15%). Patient were notified and offered testing in at least 6 investigations (18%) . Interventions included product removal, healthcare provider alerts, patient notification and testing, modification of injection safety practices and other general infection control practices, correction of improper storage and handling, and changes in product design, manufacturing processes, or instructions for use. Conclusions: Public health investigations identified intrinsic and extrinsic contamination of medications, devices, and other products as a cause of healthcare-associated infections. Healthcare facilities should consider contaminated products in investigations of healthcare-associated infections, take steps to identify local infection control concerns, and alert public health authorities to events that could suggest widespread contamination.Funding: NoneDisclosures: None
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Aberese-Ako, Matilda, Mustapha Immurana, Maxwell Ayindenaba Dalaba, Fidelis E. Y. Anumu, Anthony Ofosu, and Margaret Gyapong. "The socio-economic and health effects of COVID-19 among rural and urban-slum dwellers in Ghana: A mixed methods approach." PLOS ONE 17, no. 7 (July 15, 2022): e0271551. http://dx.doi.org/10.1371/journal.pone.0271551.
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Background Vulnerable populations such as rural and urban-slum dwellers are more likely to suffer greatly from the deleterious effects of the novel Coronavirus disease 2019 (COVID-19). However, in Ghana, most COVID-19 mitigating packages are not focused on vulnerable populations. Methods Concurrent mixed methods design was used to examine the socio-economic and health effects of COVID-19 among rural and urban-slum dwellers in Ghana. Four hundred respondents were sampled for the quantitative arm of the study, while 46 In-depth Interviews (IDIs) were conducted with community members and government officials. Sixty-four community members participated in Focus Group Discussions (FGDs) and non-participant observation was carried out for three months. Quantitative data were analysed using frequencies, percentages, Pearson Chi2 and ordered logistic regression. Interviews were recorded using digital recorders and later transcribed. Transcribed data (IDIs, FGDs) and observation notes were uploaded onto a computer and transferred to qualitative software NVivo 12 to support thematic coding and analysis. Results Majority of the respondents confirmed the deleterious socio-economic and health effects of COVID-19 on jobs and prices of food. Other effects were fear of visiting a health facility even when unwell, depression and anxiety. Young people (18–32 years), males, urban-slum dwellers, married individuals, the employed and low-income earners (those who earn GHC10/$1.7 to GHC100/ $17), were more likely to suffer from the socio-economic and health effects of COVID-19. Urban-slum dwellers coped by relying on family and social networks for food and other basic necessities, while rural dwellers created locally appropriate washing aids to facilitate hand washing in the rural communities. Conclusion COVID-19 and the government’s mitigation measures had negative socio-economic and health effects on vulnerable communities. While vulnerable populations should be targeted for the government’s COVID-19 mitigating packages, special attention should be given to young people (18–32 years), males, urban-slum dwellers, married individuals and low-income earners. Communities should be encouraged to maintain coping strategies adopted even after COVID-19.
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Bird, Brian H., Jane W. K. Githinji, Joseph M. Macharia, Jacqueline L. Kasiiti, Rees M. Muriithi, Stephen G. Gacheru, Joseph O. Musaa, et al. "Multiple Virus Lineages Sharing Recent Common Ancestry Were Associated with a Large Rift Valley Fever Outbreak among Livestock in Kenya during 2006-2007." Journal of Virology 82, no. 22 (September 10, 2008): 11152–66. http://dx.doi.org/10.1128/jvi.01519-08.
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ABSTRACT Rift Valley fever (RVF) virus historically has caused widespread and extensive outbreaks of severe human and livestock disease throughout Africa, Madagascar, and the Arabian Peninsula. Following unusually heavy rainfall during the late autumn of 2006, reports of human and animal illness consistent with RVF virus infection emerged across semiarid regions of the Garissa District of northeastern Kenya and southern Somalia. Following initial RVF virus laboratory confirmation, a high-throughput RVF diagnostic facility was established at the Kenyan Central Veterinary Laboratories in Kabete, Kenya, to support the real-time identification of infected livestock and to facilitate outbreak response and control activities. A total of 3,250 specimens from a variety of animal species, including domesticated livestock (cattle, sheep, goats, and camels) and wildlife collected from a total of 55 of 71 Kenyan administrative districts, were tested by molecular and serologic assays. Evidence of RVF infection was found in 9.2% of animals tested and across 23 districts of Kenya, reflecting the large number of affected livestock and the geographic extent of the outbreak. The complete S, M, and/or L genome segment sequence was obtained from a total of 31 RVF virus specimens spanning the entire known outbreak period (December-May) and geographic areas affected by RVF virus activity. Extensive genomic analyses demonstrated the concurrent circulation of multiple virus lineages, gene segment reassortment, and the common ancestry of the 2006/2007 outbreak viruses with those from the 1997-1998 east African RVF outbreak. Evidence of recent increases in genomic diversity and effective population size 2 to 4 years prior to the 2006-2007 outbreak also was found, indicating ongoing RVF virus activity and evolution during the interepizootic/epidemic period. These findings have implications for further studies of basic RVF virus ecology and the design of future surveillance/diagnostic activities, and they highlight the critical need for safe and effective vaccines and antiviral compounds to combat this significant veterinary and public health threat.
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Omale, Ugwu I., Osarhiemen Iyare, Richard L. Ewah, Chidinma I. Amuzie, Onyinyechukwu U. Oka, Victor U. Uduma, Azuka S. Adeke, et al. "COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants." BMJ Open 12, no. 12 (December 2022): e061732. http://dx.doi.org/10.1136/bmjopen-2022-061732.
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IntroductionThe COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria.Methods and analysesThe study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach.Ethics and disseminationEthical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022–02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021–17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate.Trial registration numberISRCTN16735844.
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Costigan, Jennifer, Sue S. Feldman, and Mark Lemak. "Assessment of Patient Satisfaction With Dermatology Clinics According to Clinic Type: Mixed Methods Study." JMIR Dermatology 3, no. 1 (May 12, 2020): e17171. http://dx.doi.org/10.2196/17171.
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Background Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses are considered significant indicators of the quality of care and patient satisfaction. There is a pressing need to improve patient satisfaction rates as CAHPS survey responses are considered when determining the amount a facility will be reimbursed by the Centers of Medicare and Medicaid each year. Low overall CAHPS scores for an academic medical center’s dermatology clinics were anecdotally attributed to clinic type. However, it was unclear whether clinic type was contributing to the low scores or whether there were other factors. Objective This study aimed to determine where the efforts of patient satisfaction improvement should be focused for two different types of dermatology clinics (private and rapid access clinics). Methods This study used a concurrent mixed methods design. Secondary data derived from the University of Alabama at Birmingham Hospital’s Press Ganey website were analyzed for clinic type comparisons and unstructured data were qualitatively analyzed to further enrich the quantitative findings. The University of Alabama at Birmingham Hospital is an academic medical center. The data were analyzed to determine the contributors responsible for each clinic not meeting national benchmarks. Thereafter, a review of these contributing factors was further performed to assess the difference in CAHPS scores between the private and rapid access clinics to determine if clinic type was a contributing factor to the overall scores. Results The data sample included 821 responses from May 2017 to May 2018. Overall, when both private clinics and rapid access clinics were viewed collectively, majority of the patients reported stewardship of patient resources as the most poorly rated factor (367/549, 66.8%) and physician communication quality as the most positively rated factor (581/638, 91.0%). However, when private clinics and rapid access clinics were viewed individually, rapid access clinics contributed slightly to the overall lower dermatology scores at the academic medical center. Conclusions This study determined that different factors were responsible for lower CAHPS scores for the two different dermatology clinics. Some of the contributing factors were associated with the mission of the clinic. It was suspected that the mission had not been properly communicated to patients, leading to misaligned expectations of care at each clinic.
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Balazs, George C., Harry G. Greditzer, Dean Wang, Niv Marom, Hollis G. Potter, Robert G. Marx, Scott A. Rodeo, and Riley J. Williams. "Ramp Lesions of the Medial Meniscus in Patients Undergoing Primary and Revision ACL Reconstruction: Prevalence and Risk Factors." Orthopaedic Journal of Sports Medicine 7, no. 5 (May 1, 2019): 232596711984350. http://dx.doi.org/10.1177/2325967119843509.
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Background: Ramp lesions are peripheral tears of the posterior horn of the medial meniscus that involve the meniscocapsular attachments or red-red zone and typically occur in conjunction with anterior cruciate ligament (ACL) ruptures. Purpose: To identify the prevalence of, and risk factors for, ramp lesions in a large cohort of patients undergoing primary and revision ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We queried our institutional registry of patients who underwent primary or revision surgical treatment for an ACL injury. Those who underwent preoperative magnetic resonance imaging (MRI) at our facility were included in the study. Clinical details were extracted and verified using electronic records. All preoperative MRI scans were reviewed by a musculoskeletal radiologist for the presence of a ramp lesion. Stable ramp lesions were defined as a peripheral posterior horn medial meniscal tear identified on MRI but either not identifiable with viewing and probing from the anterior portals or, if identified, not displaceable with anteriorly directed probing. Unstable ramp lesions were defined as peripheral posterior horn medial meniscal tears at the meniscocapsular junction that were identifiable at the time of surgery and displaced into the medial compartment with probing. The prevalence of stable and unstable ramp lesions was calculated. Demographic, injury, and imaging parameters were determined using univariate statistics. Results: A total of 372 patients were included. The overall prevalence of ramp lesions was 42% (155/372). Unstable ramp lesions were present in 73 (20%) patients, and stable ramp lesions were present in 82 (22%) patients. The presence of any ramp lesion (stable or unstable) was associated with bone marrow edema of the posteromedial tibia on MRI (odds ratio [OR], 3.0; P < .0001), a contact injury mechanism (OR, 1.8; P = .02), and a concurrent lateral meniscal tear (OR, 1.7; P = .02). No demographic, injury, surgical, or radiological variable was associated with a stable versus unstable ramp lesion. Conclusion: The overall prevalence of a ramp lesion in patients treated for ACL ruptures at our institution was 42%. The presence of bone marrow edema of the posteromedial tibia, a contact injury mechanism, or a lateral meniscal tear should alert surgeons to the potential presence of a medial meniscal ramp lesion.
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Dorff, Tanya B., Suzette Blanchard, Hripsime Martirosyan, Lauren Adkins, Gaurav Dhapola, Aidan Moriarty, Jamie R. Wagner, et al. "Phase 1 study of PSCA-targeted chimeric antigen receptor (CAR) T cell therapy for metastatic castration-resistant prostate cancer (mCRPC)." Journal of Clinical Oncology 40, no. 6_suppl (February 20, 2022): 91. http://dx.doi.org/10.1200/jco.2022.40.6_suppl.091.
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91 Background: Chimeric antigen receptor (CAR)-engineered T cell therapies are being pursued for the treatment of mCRPC. Prostate Stem Cell Antigen (PSCA) is highly expressed on the surface membrane in mCRPC and with limited expression on normal tissues. We undertook a phase 1, first-in-human study of a PSCA-targeted 4-1BB-co-stimulated CAR T cell therapy in mCRPC. Methods: CAR T cells were manufactured at City of Hope’s cGMP facility. The trial followed the Target equivalence range design with an equivalence range of.20-.35 and too toxic level of 0.51 following participants in cohorts of 3. The plan was to begin at a dose of 100 million (M) without lymphodepletion (LD) chemotherapy consisting of fludarabine and cyclophosphamide, then add LD to 100M prior to dose escalation to maximum 600M. Patients (pts) were required to have disease progression after at least 1 androgen receptor targeted therapy but there was no limit on prior chemotherapy or other treatments. Primary objective is to define the dose limiting toxicity (DLT) and recommended phase 2 dose as well as to describe preliminary bioactivity and efficacy. Correlative studies include MRI for target bone lesion response, CAR T cell persistence, circulating tumor cells, and serum cytokines. Results: 12 pts have been treated to date, median age 68 (42-72). Three pts were treated at the 100M dose with no DLTs. In the 100M plus LD dose level there 2 pts experienced DLT of grade 3 cystitis non-infective and fatigue. The protocol was amended to reduce the LD dose to 300 mg/m2 cyclophosphamide D1-3 and intensify monitoring with early intervention for cystitis. No DLT occurred in 3 pts treated in the modified LD 100M cohort. Cytokine release syndrome (CRS), DLTs and best response by RECIST are presented by dose level in the table. PSA declines (one >90%) were seen as well as radiographic improvement, though RECIST response was limited to stable disease (SD) by concurrent bone metastases. Correlative studies indicated bioactivity of PSCA-CAR T cells. Conclusions: PSCA-CAR T cell therapy is feasible in pts with mCRPC with DLT of cystitis, and shows preliminary anti-tumor effect at a dose of 100M plus LD. Dose escalation to 300M may proceed. Clinical trial information: NCT03873805. [Table: see text]