Abstract Aim: This study protocol aims to examine the effectiveness and preconditions of a self-management program—named REducing Delay through edUcation on eXacerbations (REDUX)—in China. Background: The high disease burden in people with chronic lung disease is mainly due to exacerbations. There is a need for effective exacerbation-management interventions. A nurse-led program, REDUX, helped patients self-manage exacerbations. Design: A single-arm pre-post study. Methods: Fifty-four patients and 24 healthcare professionals (HCPs) in Chinese primary care will be included. The core element of the program is a personalized action plan. HCPs will receive training in using the action plan to help patients manage exacerbations. The intervention will start when a patient is referred to the nurse for a post-exacerbation consultation and ends when the patient presents for the second post-exacerbation consultation. During the first post-exacerbation consultation, the patient and nurse will create the action plan. The primary outcomes in patients will include the delays between the onset of exacerbation and recognition, between exacerbation recognition and action, between exacerbation recognition and consultation with a doctor, and when the patients feel better after receiving medical help from HCPs. The secondary outcomes will include preconditions of the program. The ethics approval was obtained in September 2021. Discussion: This study will discuss a culturally adapted nurse-led self-management intervention for people with chronic lung disease in China. The intervention could help Chinese HCPs provide efficient care and reduce their workload. Furthermore, it will inform future research on tailoring nurse-led self-management interventions in different contexts. Impact: The study will contribute to the evidence on the effectiveness and preconditions of REDUX in China. If effective, the result will assist the nursing of people with chronic lung disease. Trial registration: Registered in the Chinese clinical trial registry (ID: 2100051782).
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Background: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. Aims: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. Methods & Procedures: A database of 11,450 children was analysed consisting of data on children, aged 2–7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono‐ and bilingualism, nature of the language delay, and language profile of the children. Outcomes & Results:Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. Conclusions & Implications: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children.
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REducing Delay through edUcation on eXacerbations (REDUX) shows promise in reducing exacerbation recognition and action delays for chronic lung diseases in the Netherlands. However, factors influencing its successful implementation in China remain unclear. To identify the perceived factors influencing nurse-led self-management implementation of REDUX in China, stakeholder analysis using qualitative and quantitative approaches was conducted. A qualitative approach assessed support for REDUX, perceived influencing factors, and referred intervention delivery mode among patients, healthcare professionals, and policymakers. A quantitative approach identified necessary conditions for developing and implementing a digital-version intervention, involving app developers and cyber-security officers. The study followed COREQ and stakeholder analysis guidelines. Thirty-five patients, healthcare professionals, and policymakers highly supported REDUX. Perceived influencing factors included facilitators (e.g., easy-to-use design, perceived benefits) and barriers (e.g., patients’ affordability, lack of policy support). Preferred intervention delivery modes varied among stakeholders. Eighty-seven app developers and cyber-security officers completed quantitative surveys. The quantitative data showed that the work process of developing the health apps and protecting the users’ security and privacy mostly aligned with the related international guideline recommendations. The study identified key interdependent factors that were perceived as crucial for REDUX implementation success. Healthcare policies should prioritize self-management intervention, and minor action plan adjustments are needed.
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Mexico City airport is located close to the center ofthe city and is Mexico’s busiest airport which is consideredcongested. One of the consequences of airport congestion areflight delays which in turn decrease costumer’s satisfaction. Airtraffic control has been using a ground delay program as a toolfor alleviating the congestion problems, particularly in the mostcongested slots of the airport. This paper uses a model-basedapproach for analyzing the effectiveness of the ground delayprogram and rules. The results show that however the rulesapplied seem efficient, there is still room for improvement inorder to make the traffic management more efficient.
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Airport management is frequently faced with a problem of assigning flights to available stands and parking positions in the most economical way that would comply with airline policies and suffer minimum changes due to any operational disruptions. This work presents a novel approach to the most common airport problem – efficient stand assignment. The described algorithm combines benefits of data-mining and metaheuristic approaches and generates qualitative solutions, aware of delay trends and airport performance perturbations. The presented work provides promising solutions from the starting moments of computation, in addition, it delivers to the airport stakeholders delay-aware stand assignment, and facilitates the estimation of risk and consequences of any operational disruptions on the slot adherence.
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The present study was to further the understanding of the conceptual relationship between narrative absorption, that is the intense engagement with a story world, and felt suspense, that is the anticipation of a narrative outcome event. To this end, a media comparative online experiment was conducted with a 2 (Media format: film vs. Literature) × 2 (Suspense structure: diegetic vs. Non-diegetic delay) × 2 (Stories) between subject design. Results revealed a complex relationship among felt suspense, attention, emotional engagement, and transportation, showing the high importance of attention in felt suspense, and the moderating effect of media format and gender. Findings indicate that non-diegetic suspense delay unlike diegetic suspense decreases felt suspense and narrative absorption independently of media format.
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This longitudinal study compared the development of oral language and more specifically narrative skills (storytelling and story retelling) in children with specific language impairment (SLI) with and without literacy delay. Therefore, 18 children with SLI and 18 matched controls with normal literacy were followed from the last year of kindergarten (mean age = 5 years 5 months) until the beginning of grade 3 (mean age = 8 years 1 month). Oral language tests measuring vocabulary, morphology, sentence and text comprehension and narrative skills were administered yearly. Based on first and third grade reading and spelling achievement, both groups were divided into a group with and a group without literacy problems. Results showed that the children with SLI and literacy delay had persistent oral language problems across all assessed language domains. The children with SLI and normal literacy skills scored also persistently low on vocabulary, morphology and story retelling skills. Only on listening comprehension and storytelling, they evolved towards the level of the control group. In conclusion, oral language skills in children with SLI and normal literacy skills remained in general poor, despite their intact literacy development during the first years of literacy instruction. Only for listening comprehension and storytelling, they improved, probably as a result of more print exposure.
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Analyse van twee gedichten van Mary Szybist over de bijbelse annunciatie. De gedichten maken gebruik van het performatieve aspect van lyrische poëzie om de besloten, fatalistische uitkomst die typisch geassocieerd wordt met de annunciatie uit te dagen en op te schorten. De verdeling en toekenning van agency in de annunciatiescène kan daardoor heroverwogen worden. Bovendien stelt het de lezer in staat om na te denken over hoe vooraf bepaalde en feestelijke verklaringen ongepast of ongegrond kunnen zijn. Verschenen in het jubilieumnummer van Frame: Journal of Literary Studies over het thema feest: de vele vormen, rituelen en emoties van vieren en herdenken. Hoe (de)construeren of versterken literaire teksten wat wij als feestelijk beschouwen? Welke perspectieven bestendigen we met de tradities en rituelen die we in ere houden en waarover we schrijven? De auteurs onderzoeken hoe praktijken van viering worden verbeeld in de literatuur, hoe literaire teksten kunnen fungeren als kritische voertuigen die onderzoeken wat het betekent om het ene ding te vieren boven het andere, en hoe kunst en literatuur circuleren binnen specifieke feestelijke sociale contexten.
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BackgroundOcclusions of intravenous (IV) tubing can prevent vital and time-critical medication or solutions from being delivered into the bloodstream of patients receiving IV therapy. At low flow rates (≤ 1 ml/h) the alarm delay (time to an alert to the user) can be up to 2 h using conventional pressure threshold algorithms. In order to reduce alarm delays we developed and evaluated the performance of two new real-time occlusion detection algorithms and one co-occlusion detector that determines the correlation in trends in pressure changes for multiple pumps.MethodsBench-tested experimental runs were recorded in triplicate at rates of 1, 2, 4, 8, 16, and 32 ml/h. Each run consisted of 10 min of non-occluded infusion followed by a period of occluded infusion of 10 min or until a conventional occlusion alarm at 400 mmHg occurred. The first algorithm based on binary logistic regression attempts to detect occlusions based on the pump’s administration rate Q(t) and pressure sensor readings P(t). The second algorithm continuously monitored whether the actual variation in the pressure exceeded a threshold of 2 standard deviations (SD) above the baseline pressure. When a pump detected an occlusion using the SD algorithm, a third algorithm correlated the pressures of multiple pumps to detect the presence of a shared occlusion. The algorithms were evaluated using 6 bench-tested baseline single-pump occlusion scenarios, 9 single-pump validation scenarios and 7 multi-pump co-occlusion scenarios (i.e. with flow rates of 1 + 1, 1 + 2, 1 + 4, 1 + 8, 1 + 16, and 1 + 32 ml/h respectively). Alarm delay was the primary performance measure.ResultsIn the baseline single-pump occlusion scenarios, the overall mean ± SD alarm delay of the regression and SD algorithms were 1.8 ± 0.8 min and 0.4 ± 0.2 min, respectively. Compared to the delay of the conventional alarm this corresponds to a mean time reduction of 76% (P = 0.003) and 95% (P = 0.001), respectively. In the validation scenarios the overall mean ± SD alarm delay of the regression and SD algorithms were respectively 1.8 ± 1.6 min and 0.3 ± 0.2 min, corresponding to a mean time reduction of 77% and 95%. In the multi-pump scenarios a correlation > 0.8 between multiple pump pressures after initial occlusion detection by the SD algorithm had a mean ± SD alarm delay of 0.4 ± 0.2 min. In 2 out of the 9 validation scenarios an occlusion was not detected by the regression algorithm before a conventional occlusion alarm occurred. Otherwise no occlusions were missed.ConclusionsIn single pumps, both the regression and SD algorithm considerably reduced alarm delay compared to conventional pressure limit-based detection. The SD algorithm appeared to be more robust than the regression algorithm. For multiple pumps the correlation algorithm reliably detected co-occlusions. The latter may be used to localize the segment of tubing in which the occlusion occurs.
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Airport management is regularly challenged by the task of assigning flights to existing parking positions in the most efficient way while complying with existing policies, restrictions and capacity limitations. However, such process is frequently disrupted by various events, affecting punctuality of airline operations. This paper describes an innovative approach for obtaining an efficient stand assignment considering the stochastic nature of airport environment. Furthermore, the presented methodology combines benefits of Bayesian modelling and metaheuristics for generating solutions that are more robust to airport flight schedule perturbations. In addition, this paper illustrates that the application of the presented methodology combined with simulation provides a valuable tool for assessing the robustness of the developed stand assignment to flight delays.
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