Central Design Research Articles

Detailed Design of Special-Shaped Steel Structures Based on DfMA: The BIM-FEM Model Conversion Method

(1) This paper, based on the characteristics of complex steel structures as well as difficult points in the process of their detailed design, introduces the product design concept of DfMA (Design for Manufacturing and Assembly) from the manufacturing industry and studies the detailed design method of BIM-FEM model conversion. The BIM software Revit (2020) is used as the basis for the BIM detailed design of the project, which achieves the purpose of rapid modeling and provides a detailed design model basis for finite element analysis. (2) Utilizing the Revit API and C# for secondary development as the technical means, this approach involves converting the geometric entity model described by CSG-Brep into an APDL stream. This creates an interface with the finite element analysis software ANSYS (12.0) to implement the detailed design of BIM-FEM model conversion, optimizing the algorithm for converting complex analysis models that require high precision for special-shaped steel structures. (3) This research addresses issues such as the disconnection between the design, manufacturing, and construction of special-shaped steel structures, providing support for design decisions. Moreover, it enhances the detailed design method by improving the standardization of special-shaped components under the condition of design diversity. (4) These studies provide sustainability for engineering design, manufacturing, and construction projects, enabling the maximization of benefits and product lifecycle management (PLM) through these projects. (5) Finally, a case study analysis was conducted on the Wuhan City New Generation Weather Radar Construction Project, designed by the Central South Architectural Design Institute (CSADI), to verify the detailed design of BIM-FEM model conversion. This proved the scientific validity, practicality, and necessity of this research.

Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis.

To quantify the association between insurance and hospital admission following minor isolated extremity firearm injury. The association between insurance and injury admission has not been examined. This was an observational retrospective cohort study of minor isolated extremity firearm injury captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases in 6 states (New York, Arkansas, Wisconsin, Massachusetts, Florida, and Maryland) from 2016 to 2017 among patients aged 16 years or older. The primary exposure was insurance. Admitted patients were propensity score matched to nonadmitted patients on age, extremity Abbreviated Injury Score, and Elixhauser Comorbidity Index with exact matching within hospital to adjust for selection bias. A general estimating equation logistic regression estimated the association between insurance and odds of admission in the matched cohort while controlling for sex, race, injury intent, injury type, hospital profit type, and trauma center designation with observations clustered by propensity score-matched pairs within hospital. A total of 8151 patients presented to hospital with a minor isolated extremity firearm injury between 2016 and 2017 in 6 states. Patients were 88.0% male, 56.6% Black, and 71.7% aged 16 to 36 years old, and 22.1% were admitted. A total of 2090 patients were matched on propensity for admission. Privately insured matched patients had 1.70 higher adjusted odds of admission and 95% confidence interval of 1.30 to 2.22, compared with uninsured after adjusting for patient and hospital characteristics. Insurance was associated with hospital admission for minor isolated extremity firearm injury.

Ten-year follow-up of posterior chamber phakic intraocular lens with central port design in patients with low and normal vault.

To assess the clinical outcomes and postoperative complications of the implantable collamer lens (ICL) with a central port throughout 10 years of follow-up in patients with low and normal vault. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Retrospective and comparative case series. This study included eyes that underwent a V4c ICL implantation with 10 years of follow-up. The eyes were divided into 2 groups according to the vault at 1 year postoperatively: vault <250 μm and between 250 μm and 800 μm. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), vault, complications, and secondary surgeries were analyzed. 37 and 90 eyes were enrolled in the low and normal-vault groups, respectively. No differences in UDVA, CDVA, and refraction were found between the groups over 10 years of follow-up. No cases developed ICL-induced anterior subcapsular opacity over the follow-up period. 2 (5.4%) and 8 (8.9%) eyes in the low and normal-vault groups, respectively, required ICL exchange. 1 (2.8%) and 2 (2.2%) eyes in the low and normal-vault groups, respectively, required excimer laser to correct residual refractive error. The IOP remained stable throughout the 10-year follow-up. The loss in ECD from that preoperatively to 10 years postoperatively was 3.8% and 4.5% in the low and normal-vault groups, respectively ( P = .4). No pigment dispersion glaucoma or other vision-threatening complications were reported. This study shows good long-term outcomes of the V4c ICL, supporting that the central hole provides safety to the procedure and prevents the potential risk associated with low vault.

Human-centered design in the development of innovative technology for the food processing medium, small and micro enterprises (MSMEs) in Uganda

Taking account of end-user perspectives is crucial in the design and development process to ensure successful technology adoption considering the evolving customer demands. This study utilized the user-centric Human Center Design (HCD) framework to re-develop food processing equipment, specifically pulpers and pasteurizers, previously developed by the Department of Agricultural and Biosystems Engineering (DABE) of Makerere University. The study implemented several interventions to augment the adoption of processing equipment among MSME agro-processors in Uganda. This included development of modified pasteurizers (biomass and electrical) and pulpers, development of user manuals, and training of processors on the use of equipment. All interventions were designed with a focus on the needs and preferences of the end users. This study demonstrates how HCD can be used to develop food processing equipment that addresses the dynamic needs of micro, small, and medium-scale agro-processors in form of production capacity and cost of ownership. The study findings can influence large-scale research and policy toward the production and adoption of user-centric food processing equipment, which in turn can provide agro-processors with increased livelihoods and reduce the major challenge of post-harvest losses.

Impacts of hospitals users’ characteristics on perceptions of the physical environment

Recently hospital managers and designers become more interested in ‘patient centered design’ (PCD) through the integration of patients' perceptions and expectations of the hospitals' physical environment. This increased interest in PCD indicates the improved understanding of the impacts of hospital's physical environment on all users including patients, families and hospital staff. Literature shows that incorporating users' perceptions of the physical environment during the design process is very important to produce PCD. The current study is aimed at assessing the impacts of four demographic factors namely: age, sex, education level and area of residence on users' perceptions of hospitals' physical environment. Five principal design factors were identified: views, safety &comfort, facilities &way finding, architectural & hygiene and sensory. For the questionnaire survey, the statistical analysis has been conducted with IBM SPSS Statistics version 27.0. Demographic data was analyzed descriptively by computing frequencies and percentages. Then the descriptive statistics for the items i.e. frequencies, percentages, means and standard deviations (SD) were computed. Non-parametric tests were applied to assess variances in constructed principal dimensions concerning users' demographic factors. The users of two hospitals: Nekemte specialized hospital & Paulos comprehensive hospital participated in the survey. A total of 480 respondents were participated in ranking the importance of 21 questionnaire items on 5-point Likert scale. The result reveals that education level has a significance role (p-value = 00.001,00.002,0.032) for the difference between perceptions of three out of five summated design factors namely; views, facilities & way finding and architectural& hygiene respectively. Similarly, residence area has significantly contributed for the difference in users' perceptions (P-value = 00.001, 00.001, 0.025) on three summated design factors; views, safety &comfort and architectural & hygiene respectively. Based on the analysis, the study suggests that identifying perceptions of all users is very important to help designers to design PCD based on empirical evidence.

DESIGN THINKING

Design and design thinking have been identified as making valuable contributions to business and management, and the number of higher education programs that teach design thinking to business students, managers, and executives are growing. However multiple definitions of design thinking and the range of perspectives have created some confusion about potential pathways. This paper examines notions of design and design thinking and uses these definitions to identify themes in higher educational programs. We present the findings from an initial exploratory investigation of design and design thinking in higher education business programs and define four distinct educational approaches around human centred innovation, integrative thinking, design management and design as strategy. Potential directions for management education programs are presented.

A BaTiO3@polyacrylonitrile/poly(vinylidene fluoride) nanofibrous composite membrane with high piezoelectricity based on the central combination design method and cross-electrospinning technology

The rapid development of piezoelectric sensors has been studied extensively, owing to their good flexibility, wearability, high sensitivity and low cost. However, some inorganic materials with good piezoelectricity cannot make sensors flexible, and the organic materials with good flexibility have a weak output electrical signal and low strength. In order to explore and optimize the preparation technology of piezoelectric sensors, a BaTiO3@polyacrylonitrile (PAN)/poly(vinylidene fluoride) (PVDF) nanofibrous composite membrane (NCM) was prepared by cross-electrospinning technology and the central combination design (CCD) method. The morphology, structure, hydrophobicity, mechanical properties and piezoelectricity of the BaTiO3@PAN/PVDF NCMs were investigated. The BaTiO3@PAN/PVDF NCMs had the better hydrophobicity and mechanical properties compared with the pure PAN/PVDF NCM. The 5BaTiO3@PAN/PVDF NCM designed by CCD had a more uniform fiber diameter, and a more stable output voltage with a 46% improvement. With the help of cross-electrospinning technology and the CCD method, the NCM will be outstanding for the development of fabricating flexible wearable piezoelectric sensors.

Function generation with planar four-bar mechanisms as a mixed problem of correlation of crank angles and dead center design

Function generation with planar four-bar mechanisms as a mixed problem of correlation of crank angles and dead center design

Harmony as an Aesthetic Approach for Meditation Centers

In recent years, meditation centres have become increasingly popular among individuals seeking solace, tranquillity, and respite from the pressures of contemporary life. This research paper seeks to explore the significance of harmony as an aesthetic approach in designing and organizing meditation centres, with the aim of enhancing the overall meditative experience for practitioners. By conducting an interdisciplinary examination of architecture, interior design, and psychological well-being, this study aims to investigate the role of harmonious aesthetics in facilitating a more effective and fulfilling meditation experience. The study emphasizes the importance of harmonious aesthetics in shaping the design of meditation centres. The pursuit of visual appeal extends beyond mere aesthetics to encompass a multisensory experience that evokes a sense of calmness and promotes mindfulness. The interplay of colours, textures, and spatial arrangements come together to create a serene atmosphere that guides practitioners on a journey inward. The paper underscores the significance of interior design in fostering harmony in meditation centres. Interior spaces that incorporate calming colour palettes, natural materials, and minimalist aesthetics create an environment that is conducive to meditation. Researchers examine the psychological impact of these design choices on practitioners, exploring how a harmonious interior can facilitate a deeper sense of mindfulness and focus during meditation sessions. Furthermore, the study analyses case studies of existing meditation centres that are renowned for their aesthetic excellence. By identifying commonalities in their design philosophies and best practices, the paper aims to inform architects, designers, and meditation practitioners alike. The goal is to foster a deeper understanding of the role of intentional aesthetics in enhancing the meditative journey and contributing to holistic well-being. In conclusion, this research paper emphasizes the significance of harmony as a key aesthetic principle in meditation centre design. By focusing on harmonious aesthetics, architects, designers, and meditation practitioners can create an environment that promotes inner peace, mindfulness, and overall well-being. The findings of this study contribute to the evolving discourse on meditation centre design and have practical implications for those involved in the design and construction of such spaces. Keywords: harmonious aesthetics, design of meditation centres, multisensory experience, harmony principle

Analisis Keterbacaan dan Efisiensi Pada Logo HUT 76 Lombok Tengah

The quality of the 76-year-old Central Lombok logo is considered to lack good readability and efficiency. This can affect the quality of the audience’s readability in understanding the visuals. Moreover, Central Lombok is a mirror reflection of Indonesia at international scale MotoGP events and is required to develop regional branding. The aim of this research is to analyze the level of readability and efficiency through analyzing the use of color and the application of typography in the logo. The method used in this research uses quantitative methods with research stages including the data collection process through digital observation on the diskominfoloteng Instagram. In the research results, the error in choosing colors in the 76 Central Lombok logo by using red and white in the logo, where the two colors have very different color intensities and different levels of legibility, readability and visibility, gives rise to poor readability. Due to the addition of a script font to the 76 Years of Central Lombok logo design. The results show that the choice of color intensity can influence the application of media to dark or light backgrounds. The author provides a solution in the form of using one color in one logo structure and the author also recommends that designers do not use script fonts in a logo so that typographic principles can be maximally applied in all media applications.

Reducing vibration and noise in honeycomb structure applied to automobile integrated water tank

This work uses modal acoustic transfer vector (MATV) technology in conjunction with vibration response analysis to determine optimal target optimization parameters for automobile integrated water tanks. The effects of square and hexagonal reinforcement honeycomb structures on the vibration damping performance of water tanks are analyzed, using an untreated smooth plane as a reference object. The study investigates the effects of honeycomb height, honeycomb length, and honeycomb thickness on the tank’s vibration damping performance. The results indicate that a hexagonal structure is more effective than a square structure in improving structural stiffness and reducing structural vibration. The height of the honeycomb structure is particularly effective in suppressing normal vibration of the structural surface, especially when the height exceeds 8 mm. A response surface model is developed based on the edge length, wall thickness, and height of the honeycomb, following the Box-Behnken central combinatorial test design principle. Considering the effect of interference of additional parts, the noise reduction is found to be most effective with a honeycomb side length L = 12 mm, height H = 4.91 mm, and wall thickness T = 2.5 mm. These parameters can be a guide for creating a new honeycomb reinforcement structure to better achieve vibration and noise reduction in automobile water tanks.

Centering healthcare workers in digital health design: Usability and acceptability of two-way texting to improve retention in antiretroviral therapy in a public HIV clinic in Lilongwe, Malawi.

New initiates on antiretroviral therapy (ART) are at high risk of treatment discontinuation, putting their health at risk. In low- and middle-income countries, like Malawi, appropriate digital health applications (apps) must fit into local clinic, connectivity and resource constraints. We describe the human centered design (HCD) and development process of an open-source, hybrid, two-way texting (2wT) system to improve ART retention. We detail the critical role of diverse healthcare workers (HCWs) in the HCD process to inform app usability, create buy-in, and ensure appropriate optimization for the local context. We optimized 2wT usability and acceptability over three HCD phases: 1) informal feedback sessions with diverse 2wT stakeholders, 2) a small pilot, and 3) key informant interviews. Phase one included four sessions with diverse HCWs, including "expert ART clients", clinical, technical, supervisory, and evaluation teams to inform 2wT design. In phase 2, a small pilot with 50 participating ART clients aimed to inform implementation improvement. Phase three included interviews with ten HCWs to deepen understanding of 2wT acceptability and usability, documenting strengths and weaknesses to inform optimization. Multi-phase feedback sessions with HCWs helped refine 2wT language and message timing for both weekly and tailored client-specific visit reminders. The pilot led to improvements in educational materials to guide client responses and ease interaction with HCWs. In interviews, the HCWs appreciated the HCD co-creation process, suggested ways to increase access for low-literacy clients or those without consistent phone access, and felt integrating 2wT with other eHealth platforms would improve scalability. Inclusion of HCWs across phases of HCD design, adaption, and optimization increased 2wT usability and acceptability among HCWs in this setting. Engaging HCWs into 2wT co-ownership from inception appears successful in co-creation of an app that will meet HCW needs, and therefore, enhance support for 2wT clients to attend visits and remain in care.

Exploring the Impact of Some Types of Virtual Tours on Data Center Design Proficiency

The use of virtual tours has garnered attention as a promising method to enhance skills in various domains, including data center design. This research delves into the influence of different virtual tour modalities on the enhancement of data center design proficiency among both students and professionals. Through a comprehensive series of experiments and surveys, we investigate the efficacy of panoramic and video-based virtual tours in augmenting participants' comprehension of data center design principles, their capacity to apply these principles practically, and their overall competency in crafting efficient and reliable data centers. Our findings demonstrate a significant enhancement in data center design proficiency facilitated by virtual tours, particularly immersive and interactive formats surpassing traditional methods. Furthermore, our study uncovers the role of individual variances, such as prior expertise and experience in data center design, in modulating the effectiveness of virtual tours. These insights carry substantial implications for the evolution of pedagogical strategies in data center design education and training, advocating for the integration of virtual tour technologies into established curricula.

User Interface Optimization Using Human Centered Design Method to Improve Website Usability (Case Study: Entrance Cilacap)

A good user interface design on a website will make users feel at home using the website. On the contrary, a bad user interface will make users quickly leave the site or bounce rate. User involvement in the system development process will have a positive and significant impact on satisfaction with a system. The objective of this study is to obtain a new user interface that can overcome the usability problems in the web design of the Cilacap Entrance. To meet user needs, this study uses the human centered design (HCD) method for web redesign. User identification and interviews were conducted to obtain user context data. While user personas are used to determine user needs. In addition, A/B testing was used by applying the results of heatmap analysis and data from Google Analytics and Google Web Console to compare the results before and after the interface redesign. The results showed an increase in the number of users, longer visits, more content exploration, and high activity on the site. This means that the redesigned interface was successful in improving user experience, increasing user activity, and maintaining user interest in the Cilacap Entrance website.

Systematization of public centers design methodology

The article deals with the issue of systematization of the development of project solutions of public complexes based on the analysis of their functional and planning structure and constituent elements. The author systematizes his long-term scientific research and project practice using theoretical sources, in the part of the formation of the architecture of public centers of large cities; conclusions are drawn regarding promising models for optimizing their structure.The nature of the interaction of elements in the modular system of the layout of public complexes is highlighted. A promising methodology for designing multifunctional complexes in an integrated modular system has been formulated. Conclusions were made regarding the possibility of the influence of such methods on the practice of designing public complexes.In this article, provision of "end-to-end" unification and "open" typification of block modules allows to expand the possibilities of alternative search for the most rational project solutions of large multi-functional complexes - public centers. This makes it possible to significantly facilitate the process of designing such objects, shifts the emphasis of creative searches from the layout of the internal structure and technology to the solution of architectural plastic and artistic tasks of the formation of urban ensembles of the center.The nomenclature of residential and public centers of large cities, as the main structural nodes of the city in unity with the adjacent system of settlements, is given. Conclusions are drawn on possible directions of unification and modular coordination of the constituent elements of multifunctional complexes - public centers.

Technological and textural properties of gluten-free quinoa-based pasta (Chenopodium quinoa Wild)

Quinoa (Chenopodium quinoa Willd.) is an Andean grain with a perfect nutritional composition that, by diversifying its transformation, becomes an attractive alternative for consumers looking for a high-quality, healthy diet with a source of vegetable proteins. The objective of this work was to elaborate and evaluate the technological and textural properties of quinoa paste in its entirety through the Star-Shaped Composite Central Design (CCD) of 5 process variables: Water Temperature (°C), Water Quality (ml), Mixing Time (min), Drying Temperature (°C), and Drying Time (min), with 5 levels each. At the same time, the yield and good cooking quality were studied to optimize the process. In the model of the equation for the cooking time response, a negative and significant influence of drying temperature was shown. On the other hand, for cooking loss, dough gain, a* and b* values, and texture had high values if the drying time was increased. On the contrary, the L-value decreases, which is positively significant. Meanwhile, the swelling index was only significantly positive within the technological properties. In addition, it was found that the optimal conditions for producing quality pasta were 25 °C: 1150 ml: 30 min: 70 °C and 80 min, respectively, with a desirability of 0.883. When the pasta was prepared with quinoa, the cooking time was 7 min, the cooking loss was 2.46 g/g, the mass gain was 23.6 g/g, the cooking yield was 7.99%, the swelling index was 2.9%, water absorption was 135%, and protein was 12.71 g and 0. 21 Pa in texture, these results being consistent with cited research. Likewise, the whiteness was 51.97 for the values a* 2.41 and b* 12.45; all this analysis is reflected in the final yield of the process at 78%. In conclusion, the results indicated that, by optimizing the conditions in the production of gluten-free quinoa pasta, it is possible to obtain a gluten-free product with high added value, excellent cooking quality, adequate technological properties, texture, and color acceptable to the consumer.

From service design thinking to the third generation of activity theory: a new model for designing AI-based decision-support systems.

The rise of Artificial Intelligence (AI), particularly machine learning, has brought a significant transformation in decision-making (DM) processes within organizations, with AI gradually assuming responsibilities that were traditionally performed by humans. However, as shown by recent findings, the acceptance of AI-based solutions in DM remains a concern as individuals still strongly prefer human intervention. This resistance can be attributed to psychological factors and other trust-related issues. To address these challenges, recent studies show that practical guidelines for user-centered design of AI are needed to promote justified trust in AI-based systems. To this aim, our study bridges Service Design Thinking and the third generation of Activity Theory to create a model which serves as a set of practical guidelines for the user centered design of Multi-Actor AI-based DSS. This model is created through the qualitative study of human activity as a unit of analysis. Nevertheless, it holds the potential for further enhancement through the application of quantitative methods to explore its diverse dimensions more extensively. As an illustrative example, we used a case study in the field of human capital investments, with a particular focus on organizational development, which involves managers, professionals, coaches and other significant actors. As a result, the qualitative methodology employed in our study can be characterized as a "pre-quantitative" investigation. This framework aims at locating the contribution of AI in complex human activity and identifying the potential role of quantitative data in it.

The analysis of operation and failures of a power plant on high-speed vessels with semi-submersible propellers

Over the past century, shipbuilding has been closely linked to solving the most acute problem of increasing the speed of ships. Builders of high-speed vessels habitually justify this struggle for speed in connection with the requirements of the modern market. In Russia, as well as all over the world, there is a need for modern, high-speed, maneuverable and economical vessels. To meet this need, Almaz Central Design Bureau has developed, the Rybinsk Vimpel Plant has launched a high-speed vessel with semi-submersible propellers of project 12150 "Mongoose". Currently, about 75 ships have been launched [1]. This article analyzes the work of foreign and domestic engines accumulated during the operation of high-speed engines MTU 10V2000M93 (manufactured in Germany), ZVEZDA M470MK-M3 (manufactured in Russia) installed on high-speed vessels of project 12150. In particular, information on the most characteristic failures of the components of the main power plants and the propulsion system as a whole, as well as on the possible causes of the occurrence and development of typical engine failures installed on these high-speed vessels, which allow us to assess the advantages and disadvantages of the power plant used.

The Role of Hospital Characteristics in Clinical and Quality Outcomes for Gastrointestinal Bleeding in a National Cohort.

There is substantial variability in patient outcomes for gastrointestinal bleeding (GIB) across hospitals. This study aimed to identify hospital factors associated with GIB outcomes. This was a retrospective cohort study of Medicare fee-for-service beneficiaries hospitalized for GIB from 2016 to 2018. These data were merged with the American Hospital Association Annual Survey data to incorporate hospital characteristics. We used generalized linear mixed-effect models to estimate the effect of hospital-level characteristics on patient outcomes after adjusting for patient risk factors including anticoagulant and antiplatelet use, recent GIB, and comorbidities. The primary outcome was 30-day mortality, and secondary outcomes included length of stay and a composite outcome of 30-day readmission or mortality. Factors associated with improved GIB 30-day mortality included large hospital size (defined as beds >400, odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90-0.97), greater case volume (OR 0.97, 95% CI 0.96-0.98), increased resident and nurse staffing (OR 0.88, 95% CI 0.83-0.94), and blood donor center designation (OR 0.93, 95% CI 0.88-0.99). Patients treated at a hospital with multiple advanced capabilities, such as availability of advanced endoscopy, advanced intensive care unit (ICU) capabilities (both a medical-surgical ICU and cardiac ICU), blood donor center, and liver transplant center, had a 22% reduction in 30-day mortality risk, compared with those hospitalized in a hospital with none of these services (OR 0.78, 95% CI 0.68-0.91). However, length of stay increased with additional services. Patients hospitalized for GIB at hospitals with multiple advanced specialized capabilities have lower mortality but longer lengths of stay. Further research should examine the processes of care linked to these services that contribute to improved mortality in GIB.

Heterogeneity of State Stroke Center Certification and Designation Processes.

Stroke centers are critical for the timely diagnosis and treatment of acute stroke and have been associated with improved treatment and outcomes; however, variability exists in the definitions and processes used to certify and designate these centers. Our study categorizes state stroke center certification and designation processes and provides examples of state processes across the United States, specifically in states with independent designation processes that do not rely on national certification. In this cross-sectional study from September 2022 to April 2023, we used peer-reviewed literature, primary source documents from states, and communication with state officials in all 50 states to capture each state's process for stroke center certification and designation. We categorized this information and outlined examples of processes in each category. Our cross-sectional study of state-level stroke center certification and designation processes across states reveals significant heterogeneity in the terminology used to describe state processes and the processes themselves. We identify 3 main categories of state processes: No State Certification or Designation Process (category A; n=12), State Designation Reliant on National Certification Only (category B; n=24), and State Has Option for Self-Certification or Independent Designation (category C; n=14). Furthermore, we describe 3 subcategories of self-certification or independent state designation processes: State Relies on Self-Certification or Independent Designation for Acute Stroke Ready Hospital or Equivalent (category C1; n=3), State Has Hybrid Model for Acute Stroke Ready Hospital or Equivalent (category C2; n=5), and State Has Hybrid Model for Primary Stroke Center and Above (category C3; n=6). Our study found significant heterogeneity in state-level processes. A better understanding of how these differences may impact the rigor of each process and clinical performance of stroke centers is worthy of further investigation.