General practitioners' perceptions of effective health care

Objectives: To explore general practitioners' perceptions of effective health care and its application in their own practice; to examine how these perceptions relate to assumptions about clinicians' values and behaviour implicit in the evidence based medicine approach. Design: A qualitative study using semistructured interviews. Setting: Eight general practices in North Thames region that were part of the Medical Research Council General Practice Research Framework. Participants: 24 general practitioners, three from each practice. Main outcome measures: Respondents' definitions of effective health care, reasons for not practising effectively according to their own criteria, sources of information used to answer clinical questions about patients, reasons for making changes in clinical practice. Results: Three categories of definitions emerged: clinical, patient related, and resource related. Patient factors were the main reason given for not practising effectively; others were lack of time, doctors' lack of knowledge and skills, lack of resources, and "human failings." Main sources of information used in situations of clinical uncertainty were general practitioner partners and hospital doctors. Contact with hospital doctors and observation of hospital practice were just as likely as information from medical and scientific literature to bring about changes in clinical practice. Conclusions: The findings suggest that the central assumptions of the evidence based medicine paradigm may not be shared by many general practitioners, making its application in general practice problematic. The promotion of effective care in general practice requires a broader vision and a more pragmatic approach which takes account of practitioners' concerns and is compatible with the complex nature of their work

The dynamic phenomena of a tethered satellite: NASA's first Tethered Satellite Mission, TSS-1

The tethered satellite system (TSS) was envisioned as a means of extending a satellite from its base (space shuttle, space station, space platform) into a lower or higher altitude in order to more efficiently acquire data and perform science experiments. This is accomplished by attaching the satellite to a tether, deploying it, then reeling it in. When its mission is completed, the satellite can be returned to its base for reuse. If the tether contains a conductor, it can also be used as a means to generate and flow current to and from the satellite to the base. When current is flowed, the tether interacts with the Earth's magnetic field, deflecting the tether. When the current flows in one direction, the system becomes a propulsive system that can be used to boost the orbiting system. In the other direction, it is a power generating system. Pulsing the current sets up a dynamic oscillation in the tether, which can upset the satellite attitude and preclude docking. A basic problem occurs around 400-m tether length, during satellite retrieval when the satellite's pendulous (rotational) mode gets in resonance with the first lateral tether string mode. The problem's magnitude is determined by the amount of skiprope present coming into this resonance condition. This paper deals with the tethered satellite, its dynamic phenomena, and how the resulting problems were solved for the first tethered satellite mission (TSS-1). Proposals for improvements for future tethered satellite missions are included. Results from the first tethered satellite flight are summarized

An Analytical Study for Subsonic Oblique Wing Transport Concept

The oblique wing concept has been investigated for subsonic transport application for a cruise Mach number of 0.95. Three different mission applications were considered and the concept analyzed against the selected mission requirements. Configuration studies determined the best area of applicability to be a commercial passenger transport mission. The critical parameter for the oblique wing concept was found to be aspect ratio which was limited to a value of 6.0 due to aeroelastic divergence. Comparison of the concept final configuration was made with fixed winged configurations designed to cruise at Mach 0.85 and 0.95. The crossover Mach number for the oblique wing concept was found to be Mach 0.91 for takeoff gross weight and direct operating cost. Benefits include reduced takeoff distance, installed thrust and mission block fuel and improved community noise characteristics. The variable geometry feature enables the final configuration to increase range by 10% at Mach 0.712 and to increase endurance by as much as 44%

On the anomalous afterglow seen in a chameleon afterglow search

We present data from our investigation of the anomalous orange-colored afterglow that was seen in the GammeV Chameleon Afterglow Search (CHASE). These data includes information about the broad band color of the observed glow, the relationship between the glow and the temperature of the apparatus, and other data taken prior to and during the science operations of CHASE. While differing in several details, the generic properties of the afterglow from CHASE are similar to luminescence seen in some vacuum compounds. Contamination from this, or similar, luminescent signatures will likely impact the design of implementation of future experiments involving single photon detectors and high intensity light sources in a cryogenic environment.Comment: 6 pages, 5 figures, submitted to PR

Ground state magnetic dipole moment of 35K

The ground state magnetic moment of 35K has been measured using the technique of nuclear magnetic resonance on beta-emitting nuclei. The short-lived 35K nuclei were produced following the reaction of a 36Ar primary beam of energy 150 MeV/nucleon incident on a Be target. The spin polarization of the 35K nuclei produced at 2 degrees relative to the normal primary beam axis was confirmed. Together with the mirror nucleus 35S, the measurement represents the heaviest T = 3/2 mirror pair for which the spin expectation value has been obtained. A linear behavior of gp vs. gn has been demonstrated for the T = 3/2 known mirror moments and the slope and intercept are consistent with the previous analysis of T = 1/2 mirror pairs.Comment: 14 pages, 5 figure

A New Simulation Metric to Determine Safe Environments and Controllers for Systems with Unknown Dynamics

We consider the problem of extracting safe environments and controllers for reach-avoid objectives for systems with known state and control spaces, but unknown dynamics. In a given environment, a common approach is to synthesize a controller from an abstraction or a model of the system (potentially learned from data). However, in many situations, the relationship between the dynamics of the model and the \textit{actual system} is not known; and hence it is difficult to provide safety guarantees for the system. In such cases, the Standard Simulation Metric (SSM), defined as the worst-case norm distance between the model and the system output trajectories, can be used to modify a reach-avoid specification for the system into a more stringent specification for the abstraction. Nevertheless, the obtained distance, and hence the modified specification, can be quite conservative. This limits the set of environments for which a safe controller can be obtained. We propose SPEC, a specification-centric simulation metric, which overcomes these limitations by computing the distance using only the trajectories that violate the specification for the system. We show that modifying a reach-avoid specification with SPEC allows us to synthesize a safe controller for a larger set of environments compared to SSM. We also propose a probabilistic method to compute SPEC for a general class of systems. Case studies using simulators for quadrotors and autonomous cars illustrate the advantages of the proposed metric for determining safe environment sets and controllers.Comment: 22nd ACM International Conference on Hybrid Systems: Computation and Control (2019