INTRODUCTION: Asthma is the most prevalent chronic disease in children, disproportionately affecting children from racial or ethnic minority groups and low-income families. Boston Medical Center’s Pediatric Primary Care Center serves these patient populations predominantly from the surrounding neighborhoods. It has been found that there are gaps in asthma care including diagnosing asthma in infants and young children, under-prescribing of preventive medication in all age groups, and variable management of children with poorly controlled asthma. In alignment with the accountable care organization model, health care professionals at BMC are using evidence-based care and population-based approaches to reduce asthma morbidity and thus improve the quality of life for patients with asthma and their families. METHODS: A quality improvement initiative was conducted at BMC’s Pediatric Primary Care Center. The aim was to develop routine surveillance of asthma control for the clinic population in order to identify and intervene on patients who have poorly controlled asthma. The Asthma Control Test (ACT) and the Test for Respiratory and Asthma Control in Kids (TRACK) were adapted into practice as validated patient-parent-reported tools to use to assess asthma control at all primary care office visits. Process measure included the percentage of visits with a documented asthma control testing in the electronic medical record. Outcome measures included (1) percentage of patients with poorly controlled asthma presenting to the clinic, as indicated by low ACT/TRACK scores, and (2) percentage of visits with a documented provider action in response to low ACT/TRACK scores. Iterative Plan, Do, Study, Act (PDSA) cycles optimized results; process and outcome measures were analyzed on run charts for trends. RESULTS AND CONCLUSIONS: Patient-centered strategies for visits and population-based systems to analyze outcomes are effective at delivering quality care for BMC’s pediatric asthma patient population. Following the implementation of routine asthma control screening in primary care, the percentage of visits with documented ACT/TRACK scores went from a baseline of 8% to 86%. Week to week variation was mostly attributed to higher patient visit volume beginning in the Fall season when epidemiologically there is a substantially increased frequency of asthma exacerbations in children. A median of 23% of patients report poorly controlled asthma during their visit. The percent of visits with documented provider action increased from 87% to 95% during this quality improvement initiative, indicating that patients were receiving targeted care needs including medication management and asthma education in response to low ACT/TRACK scores. However, consistent and timely delivery of preventive care services continues to be a challenge, particularly for a clinic serving high-risk, underserved, and culturally diverse patient populations. / 2020-06-17T00:00:00Z

In order to reduce the unnecessary radiation exposure for the clinical personnel, the optimization of procedures in the quality control test of gamma camera was investigated. A significant component of the radiation dose in performing the quality control testing is handling phantoms of radioactivity, especially the mixing to get a uniform activity concentration. Improving the phantom mixing techniques appeared to be a means of reducing radiation dose to personnel. However, this is difficult to perform without a continuous dynamic tomographic acquisition system to study mixing the phantom. In the first part of this study a computational fluid dynamics model was investigated to simulate the mixing procedure. Mixing techniques of shaking and spinning were simulated using the computational fluid dynamics tool FLUENT. In the second part of this study a Siemens E.Cam gamma camera was simulated using the Monte Carlo software SIMIND. A series of validation experiments demonstrated the reliability of the Monte Carlo simulation. In the third part of this study the simulated the mixing data from FLUENT was used as the source distribution in SIMIND to simulate a tomographic acquisition of the phantom. The planar data from the simulation was reconstructed using filtered back projection to produce a tomographic data set for the activity distribution in the phantom. This completed the simulation routine for phantom mixing and verified the Proof-in-Concept that the phantom mixing problem can be studied using a combination of computational fluid dynamics and nuclear medicine radiation transport simulations.

Submitted by Amanda Leoncini Carvalho Barros (amanda_leoncini@yahoo.com.br) on 2018-11-09T16:08:38Z No. of bitstreams: 1 Dissertação Amanda Barros.pdf: 17724737 bytes, checksum: aea0eba26a241617041802312cfe28db (MD5) / Approved for entry into archive by Lucilene Cordeiro da Silva Messias null (lubiblio@bauru.unesp.br) on 2018-11-09T16:42:13Z (GMT) No. of bitstreams: 1 barros_alc_me_bauru.pdf: 17724737 bytes, checksum: aea0eba26a241617041802312cfe28db (MD5) / Made available in DSpace on 2018-11-09T16:42:13Z (GMT). No. of bitstreams: 1 barros_alc_me_bauru.pdf: 17724737 bytes, checksum: aea0eba26a241617041802312cfe28db (MD5) Previous issue date: 2018-09-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Países com clima tropical sofrem frequentemente com o fenômeno da erosão. Devido às condições climáticas, que variam entre longos períodos de seca e chuvas intensas, em conjunto com a ação antrópica, este fenômeno tem seu efeito acelerado e pode causar graves consequências para o meio ambiente. Apesar do grande número de trabalhos publicados sobre o fenômeno erosivo, pouco deles aborda esse assunto sobre uma perspectiva da Mecânica dos Solos Não Saturados, muito comum nas regiões de clima tropical. Esta dissertação apresenta uma caracterização hidromecânica de um solo não saturado coletado de uma microbacia da cidade de Bauru-SP afetada por um processo erosivo hídrico e, conjuntamente, avalia o mecanismo de erodibilidade ocorrido na área. Os parâmetros hidráulicos foram obtidos pelos de retenção da água no solo e permeabilidade. Os parâmetros mecânicos foram obtidos pelos ensaios de compressão triaxial e edométricos, ambos com sucção controlada. Os resultados desses ensaios mostraram a influência da sucção tanto nos parâmetros de resistência ao cisalhamento do solo quanto nos de compressibilidade. A avaliação do mecanismo de erodibilidade foi realizada com base nos resultados encontrados nos ensaios de compressão triaxial e Inderbitzen, sendo esse último disponível no histórico de informações da microbacia. Essa avaliação constatou que o aumento da sucção pode contribuir contra o efeito da erosão uma vez que interfere na sua resistência através do intercepto de coesão. Entretanto, caso haja uma chuva intensa na área, essa contribuição pode durar poucos minutos, pois a microbacia não possui um sistema de drenagem eficiente e a camada superficial se saturada rapidamente e, consequentemente, perde o intercepto de coesão que estava disponível antes da chuva. O trabalho realizado evidencia um severo processo erosivo na microbacia Água Comprida e ainda permite um avanço nos estudos desse solo em termos do conceito da Mecânica dos Solos Não Saturados. / Countries with tropical climate often suffer from the erosion phenomenon. Due to the climatic conditions, which vary between long periods of drought and intense rains, together with the anthropic action, this phenomenon has its effect accelerated and can cause serious consequences for the environment. In spite of the great number of published works on the erosive phenomenon, few of them approach this subject on a perspective of the Mechanics of Unsaturated Soils, very common in the regions of tropical climate. This dissertation presents a hydromechanical characterization of an unsaturated soil collected from a microbasin of Bauru-SP city affected by an erosive water process and, together, evaluates the mechanism of erodibility occurred in the area. The hydraulic parameters were obtained by the soil-water retention and permeability. The mechanical parameters were obtained by triaxial and edometric compression tests, both with controlled suction. The results of these tests showed the influence of suction on both the shear strength and the compressibility parameters. The evaluation of the erodibility mechanism was carried out based on the results found in the triaxial and Inderbitzen tests, the latter being available in the history of the microbasin information. This evaluation found that increased suction may contribute to the erosion effect since it interferes with its resistance through the cohesion parameter. However, if there is heavy rainfall in the area, this contribution may last for a few minutes because the microbasin does not have an efficient drainage system and the surface layer is rapidly saturated and consequently loses the cohesion intercept that was available before the rain. The work carried out evidences a severe erosive process in the Água Comprida microbasin and still allows an advance in the studies of this soil in terms of the concept of the Mechanics of Unsaturated Soils.

BACKGROUND: Asthma is a chronic inflammatory disease of the airways that disproportionately affects low-income and minority children in the United States. Some studies have found a clear link between poor housing quality and exposure to allergen triggers associated with increased risk of asthma. Other studies have evaluated the relationship between stressful circumstances due to chronic illness, premature birth or violence on asthma outcomes. Psychological stress is thought to weaken the immune and neuroendocrine response making the body more vulnerable to environmental allergens. Studies have been done to assess the impact of psychological stress due to violence or the care of long term-critically ill children on increased asthma morbidity. However, asthma morbidity is not equal in all low-income and minority communities. It is possible that a form of stress - housing stress - which results from living in substandard housing conditions, may in fact provide more insight into the pathways linking indoor home exposures and stress in a way that leads to greater asthma susceptibility. Few studies have been done to assess the impact of stress due to substandard housing conditions. OBJECTIVE: To determine the impact of severe housing stress due to dilapidation, mold and a lack of housing control on child asthma control and on caregiver asthma-related quality of life. METHODS: A total of 143 children with asthma living in Boston, Massachusetts and between the ages of 4 and 18 were enrolled in the Boston Allergen Sampling Study between 2008 and 2011. Home visits were conducted to measure the levels of common allergens in the home and assess child asthma control, housing stress, perceived stress, and caregiver asthma-related quality of life. Housing stress was assessed based on resident perceptions of dilapidation, mold, and a lack of housing control; perceived stress for the caregiver was assessed using the Perceived-Stress Scale (PSS); child asthma control was assessed using Asthma Control Test (ACT) scores; and caregiver asthma-related quality of life was assessed using the Pediatric Asthma Caregiver Quality of Life (PACQOL) questionnaires. RESULTS: In a multivariate logistic regression severe housing stress was associated with 7.5 times increased odds of poor asthma control (OR = 7.51, 95%CI 2.7 to 20.79, p<0.0001) for the child and 3.0 times increased odds of poor caregiver asthma-related quality of life (OR = 3.02, 95%CI 1.37 to 6.63, p<0.006). This association was significant after adjusting for potential confounders. CONCLUSIONS: Independent of allergen exposure, the association between severe housing stress and asthma health outcomes for both the child and caregiver indicate that there is an emotional stress-based pathway directly tied to poor housing quality that poses increased risk for worse asthma health outcomes.

This thesis presents the design of Kalman filter based attitude determination algorithms for a hypothetical LEO satellite and for a satellite attitude control test setup. For the hypothetical LEO satellite, an Extended Kalman Filter based attitude determination algorithms are formed with a multi-mode structure that employs the different sensor combinations and as well as online switching between these combinations depending on the sensor availability. The performance of these different attitude determination modes are investigated through Monte Carlo simulations. New attitude determination algorithms are prepared for the satellite attitude control test setup by considering the constraints on the selection of the suitable sensors. Here, performances of the Extended Kalman Filter and Unscented Kalman Filter are investigated. It is shown that robust and sufficiently accurate attitude estimation for the test setup is achievable by using the Unscented Kalman Filter.

Darbo tikslas – nustatyti kompiuterizuoto inhibicinio kontrolės testo (IKT), IL-6, amoniako bei įprastinių kraujo rodiklių vertę diagnozuojant kognityvinius sutrikimus sergantiems lėtinėmis kepenų ligomis. Darbo uždaviniai: nustatyti kognityvinių sutrikimų dažnį, galimus rizikos veiksnius, palyginti IKT ir kraujo testų rezultatus lėtinio hepatito ir kepenų cirozės grupėse; nustatyti IKT bei IL-6, įprastinių kraujo testų vertę minimaliai hepatinei encefalopatijai (MHE). Iki šiol netirta ar pacientai, sergantys lėtiniu hepatitu ir kognityviniais sutrikimais, neturi analogiškų IKT rodiklių pakitimų, IL-6 koncentracijos padidėjimo kaip sergantieji kepenų ciroze ir MHE. Netirta kokie kraujo ar IKT rodikliai kognityvinius sutrikimus prognozuoja geriausia. Į tyrimą įtraukti 62 sergantieji kepenų ciroze be hepatinės encefalopatijos, 73 lėtiniu hepatitu bei 53 sveiki asmenys. Tą pačią dieną buvo atliekami kraujo tyrimai, psichometriniai testai ir IKT. Lėtinio hepatito grupėje kognityviniai sutrikimai nustatyti 54,8 %, о kepenų cirozės grupėje MHE ¬ 71,0 % tiriamųjų asmenų. Kognityvinius sutrikimus predisponuoja trumpesnė mokymosi trukmė, fibrozės laipsnis, dvigubas etiologinis veiksnys, amžius ir lytis įtakos neturi. Lėtinio hepatito grupėje kognityviniai sutrikimai koreliuoja su IKT rodikliais ir kepenų fermentų koncentracijos padidėjimu, o kepenų cirozių grupėje su IKT rodikliais ir IL-6 koncentracija kraujyje. Išvados: Kognityvinius sutrikimus sergant lėtiniu hepatitu ar... [toliau žr. visą tekstą] / The aim of the study was to ascertain a value of computerized inhibitory control test (ICT), routine blood tests, peripheral blood ammonia and IL-6 concentration for diagnosis of cognitive disorders in patients with chronic liver diseases. Tasks: to assess a frequency of cognitive impairments and associated risk factors and to compare ICT and blood tests results in chronic hepatitis and cirrhotic patients; to ascertain ICT, IL-6 and routine blood tests values for diagnosis of minimal hepatic encephalopathy (MHE). Until now there were no studies performed whether chronic hepatitis patients with cognitive disorders have analogous ICT, IL-6 and other tests abnormalities as cirrhotic patients with MHE. It has not been studied which ICT and other tests results predict best the cognitive disorders in such patients. 62 cirrhotic patients without overt hepatic encephalopathy, 73 chronic hepatitis and 53 healthy individuals were enrolled. On the same day blood tests, psychometric and ICT tests were performed by every participant. Cognitive disorders were detected in 54,8% of chronic hepatitis patients. In cirrhotic patients MHE was found in 71,0%. Cognitive disorders predispose shorter study time, the fibrosis score, double etiologic factor, while age and gender has no influence. In chronic hepatitis patients the cognitive impairments correlate with ICT and elevated liver enzymes. In cirrhotic patients cognitive disorders correlate with ICT and IL-6 concentration. Conclusion: the... [to full text]

The aim of the study was to ascertain a value of computerized inhibitory control test (ICT), routine blood tests, peripheral blood ammonia and IL-6 concentration for diagnosis of cognitive disorders in patients with chronic liver diseases. Tasks: to assess a frequency of cognitive impairments and associated risk factors and to compare ICT and blood tests results in chronic hepatitis and cirrhotic patients; to ascertain ICT, IL-6 and routine blood tests values for diagnosis of minimal hepatic encephalopathy (MHE). Until now there were no studies performed whether chronic hepatitis patients with cognitive disorders have analogous ICT, IL-6 and other tests abnormalities as cirrhotic patients with MHE. It has not been studied which ICT and other tests results predict best the cognitive disorders in such patients. 62 cirrhotic patients without overt hepatic encephalopathy, 73 chronic hepatitis and 53 healthy individuals were enrolled. On the same day blood tests, psychometric and ICT tests were performed by every participant. Cognitive disorders were detected in 54,8% of chronic hepatitis patients. In cirrhotic patients MHE was found in 71,0%. Cognitive disorders predispose shorter study time, the fibrosis score, double etiologic factor, while age and gender has no influence. In chronic hepatitis patients the cognitive impairments correlate with ICT and elevated liver enzymes. In cirrhotic patients cognitive disorders correlate with ICT and IL-6 concentration. Conclusion: the... [to full text] / Darbo tikslas – nustatyti kompiuterizuoto inhibicinio kontrolės testo (IKT), IL-6, amoniako bei įprastinių kraujo rodiklių vertę diagnozuojant kognityvinius sutrikimus sergantiems lėtinėmis kepenų ligomis. Darbo uždaviniai: nustatyti kognityvinių sutrikimų dažnį, galimus rizikos veiksnius, palyginti IKT ir kraujo testų rezultatus lėtinio hepatito ir kepenų cirozės grupėse; nustatyti IKT bei IL-6, įprastinių kraujo testų vertę minimaliai hepatinei encefalopatijai (MHE). Iki šiol netirta ar pacientai, sergantys lėtiniu hepatitu ir kognityviniais sutrikimais, neturi analogiškų IKT rodiklių pakitimų, IL-6 koncentracijos padidėjimo kaip sergantieji kepenų ciroze ir MHE. Netirta kokie kraujo ar IKT rodikliai kognityvinius sutrikimus prognozuoja geriausia. Į tyrimą įtraukti 62 sergantieji kepenų ciroze be hepatinės encefalopatijos, 73 lėtiniu hepatitu bei 53 sveiki asmenys. Tą pačią dieną buvo atliekami kraujo tyrimai, psichometriniai testai ir IKT. Lėtinio hepatito grupėje kognityviniai sutrikimai nustatyti 54,8 %, о kepenų cirozės grupėje MHE ¬ 71,0 % tiriamųjų asmenų. Kognityvinius sutrikimus predisponuoja trumpesnė mokymosi trukmė, fibrozės laipsnis, dvigubas etiologinis veiksnys, amžius ir lytis įtakos neturi. Lėtinio hepatito grupėje kognityviniai sutrikimai koreliuoja su IKT rodikliais ir kepenų fermentų koncentracijos padidėjimu, o kepenų cirozių grupėje su IKT rodikliais ir IL-6 koncentracija kraujyje. Išvados: Kognityvinius sutrikimus sergant lėtiniu hepatitu ar... [toliau žr. visą tekstą]

The aim of the thesis is to solve selected parts of the construction technology project for the building of the multifunctional complex Rudiny II, Žilina - building block D. The content of the thesis is a technical report to the construction technology project, studies of the implementation of the main technological stages of the building. technological regulation for horizontal and vertical monolithic structures, quality control and testing plan for the production of vertical and horizontal monolithic structures, OSH plan. In the appendix of my diploma thesis I processed drawings of construction equipment, itemized budget of the building, object budget according to THU, time plan of construction, dimensions of construction machines, laying plan for system formwork on standardized floor of multifunctional house.

`Organ of state' as a constitutional concept was first introduced by the 1993 Constitution, in which it was defined as including any statutory body or functionary. In their interpretation of this notion, the courts and academic writers invoked the tests developed at common law in order to determine its meaning. The commentators, on the one hand, used a variety of tests. The courts, on the other hand, subscribed to what has come to be known as the `control test'. The 1996 Constitution followed with a comprehensive definition of `organ of state'. This notion is also employed in other laws by direct reference or incorporation of the definition in section 239 with slight adjustments. Regrettably, the limited approach developed by the court in their interpretation of the notion of `organ of state' for the purposes of the 1993 Constitution has spilled over to the interpretation of the concept under the 1996 Constitution. The question is whether this is justifiable. The constitutional definition of `organ of state' makes it clear that other institutions and functionaries are organs of state on the basis of what they are and others by virtue of the functions they are engaged in. Therefore strict adherence to the control test or any other test could unjustifiably limit the application of the Constitution. / Jurisprudence / LL.M.

`Organ of state' as a constitutional concept was first introduced by the 1993 Constitution, in which it was defined as including any statutory body or functionary. In their interpretation of this notion, the courts and academic writers invoked the tests developed at common law in order to determine its meaning. The commentators, on the one hand, used a variety of tests. The courts, on the other hand, subscribed to what has come to be known as the `control test'. The 1996 Constitution followed with a comprehensive definition of `organ of state'. This notion is also employed in other laws by direct reference or incorporation of the definition in section 239 with slight adjustments. Regrettably, the limited approach developed by the court in their interpretation of the notion of `organ of state' for the purposes of the 1993 Constitution has spilled over to the interpretation of the concept under the 1996 Constitution. The question is whether this is justifiable. The constitutional definition of `organ of state' makes it clear that other institutions and functionaries are organs of state on the basis of what they are and others by virtue of the functions they are engaged in. Therefore strict adherence to the control test or any other test could unjustifiably limit the application of the Constitution. / Jurisprudence / LL.M.