Reluctance Research Articles

When Medicine Is Powerless

An 1897 painting by the 16-year-old Pablo Picasso—Reason and Charity—illustrates the oft-perceived epistemological divide between comforting patients and treating them. In the corner stands a nun holding a child in one arm and offering the patient a drink; in the foreground sits a doctor taking the patient’s pulse and looking at his watch. Physiology is the domain of reason; care the domain of charity. Of course the contrast is overblown, but by then it had already been commonly felt for some time.

Detecting Liver Fibrosis: a Non-Invasive Era

Liver fibrosis is a dynamic process, which occurs due to exposures of various substances or organisms that may result in chronic inflammation process in the liver. The exposures may include viral infection, particularly by hepatitis B virus (HBV), hepatitis C virus (HCV) or substances such as alcohol, etc. Determining the presence or absence of liver fibrosis is a very important issue in order to evaluate deterioration phase of advanced inflammation process in the liver and to decide when to provide appropriate treatment. Liver biopsy is the gold standard procedure to identify the severity of fibrosis since it has extra advantage, i.e. its ability to identify other abnormalities in the liver in addition to fibrosis problem. However, as a main diagnostic procedure, liver biopsy is not a perfect major option. Drawbacks often mentioned include problems on sampling error, inability to demonstrateliver fibrosis globally and complication risk at biopsy procedure, which causes reluctance to perform biopsy; however, the risk of complication rarely occurs in experienced hand. Further developments demonstrate that various techniques of detecting liver fibrosis through noninvasive methods have emerged, i.e. by performing examination of transient elastography, by using various scoring system such as aspartate aminotransferase to platelet ratio index (APRI), Hepascore, Fib-4 and blood test using FibroTest, which actually aim to detect the presence or absence of significant liver fibrosis with high accuracy level. By using such techniques, the determination of liver fibrosis severity does not have to be performed using liver biopsy and it can be used by general physician; however, the techniques are still not able to determine when treatment of chronic hepatitis B and C should be given. This issue contains a study conducted by Tarigan et al, about utilization of parameters for detecting non-invasive fibrosis in the form of a scoring system, which is called as the S-index. The index has enriched the numerous available scoring systems, which are the blood-based markers, with at least of 12 non-invasive methods for detecting liver fibrosis based on the examinations of blood marker.1 Previous study on the S-index conducted by Zhou et al in 386 patients who were hepatitis B carrier and compared to liver biopsy demonstrated a high level of accuracy, sensitivity and specificity over 80% to detect significant liver fibrosis and the index is superior than the other six scoring systems.2 A study of S-index conducted by Tarigan et al had smaller sample size (40 patients) than the study conducted by Zhou et al and used FibroScan as the control, which is not the gold standard of procedure in the context of research, which usually make a comparison to liver biopsy.2 When previous studies were taken into consideration, FibroScan was also only able to detect moderate and advanced liver fibrosis.3 Body mass index, which has frequently become the confounding factor of FibroScan, was also not mentioned in this study. However, the study results show a high level of accuracy for S-index in the case of hepatitis B infection and chronic hepatitis C, which was made into one sample. Those preliminary studies should be appreciated for guiding further measures in order to discover the standard method on detecting liver fibrosis in Indonesian population and therefore, further studies with large sample size are necessary and improvements of should be made on drawbacks of the available studies.

Investigation of Non Linear Dynamic Characteristics of 8/6 Switched Reluctance Motor Drive for Variable Speed Applications - Modeling and Implementation

In this paper the mathematical modeling of an 8/6 switched reluctance machine (SRM) is carried out and the performance in motoring mode operation is studied in Matlab/Simulink environment. SRM is a highly nonlinear machine due to variable inductance and frequent switching of phase current so to study the non linear dynamic behaviors in SRM is important to improve the performance. For the variable speed conditions the reference speed is tuned for attaining the required speed. Due to that in 8/6 SRM hardware circuit is designed at close loop condition, with various reference speeds and the corresponding performance is investigated

A phenomenological study on lack of motivation

The aim of this research is to point out the underlying reasons about the lack of motivation at academic activities concerning Attribution Theory. Attribution Theory trys to understand how the people answer ‘why’ question and how they do casual explanations. This research is a qualitative based research. It is used the phenomenological design. The subject, one undergraduate student, for the study was selected via critical case study method. The data was gathered with the use of one-on-one interviews. The data analysis is done by the four stages. The first stage, the verbal interview conversation is decoded and the despose in writing is read from begining to end. At the second stage, the static themes and literals are determined. For the third stage, the analysis is shown at the chart. And at the last stage, the main experience is put forward. The results of the data analysis revealed that the main reasons for the lack of motivation for undergraduate students were weakness of willpower, lack of ambition and purpose, a feeling of pessimizim for the future, reluctance of faculty members, and lack of motivating activities. Key words: Attribution theory, fenomenology, critical case study, motivation

Current situation related to antiretroviral therapy and related influential factors on HIV infected injection drug users in the methadone maintenance treatment clinics

To find out the current coverage of antiretroviral therapy (ART) among HIV positive subjects and to identify the major influential factors associated with the participation in ART among them. 291 HIV positive subjects from 6 methadone maintenance treatment (MMT) clinics in Guangxi and Yunnan province were surveyed by questionnaires. 217 males (74.6%) and 74 females (25.4%) were under investigation, with the average age of 38.4 +/- 5.9. Most of them received less than senior high school education, married and unemployed. Results from the single factor logistic regression analysis showed that: working status, living alone, self-reported history of drinking alcohol in the last month, negative attitude towards MMT among family members,poor self-reported compliance to MMT in the last month,lack of incentives in the MMT clinics, reluctance on disclosure of their own HIV status, good self-perception on their health status, lack of communication on ART related topics among family members in the last 6 months, lack of correct attitude and knowledge on ART etc. appeared as the main factors that influencing the participation in ART program among the patients. Data from the multivariate logistic regression analysis showed that factors as: living alone, unwilling to tell others about the status of HIV infection, poor self-perception on HIV infection, lack of discussion of ART related topics within family members in the last 6 months and poor awareness towards ART among the family members etc., were associated with the low participation rate of ART. Conclusion Strengthening the publicity and education programs on HIV positive patients and their family members at the MMT clinics seemed to be effective in extending the ART coverage. Attention should also be paid to increase the family support to the patients.

Hot Resistance Estimation for 8/6 Switched Reluctance Machine Using Artificial Intelligence

To design energy saving electrical machines, a new trend has come out to determine the temperature rise of rotating electrical machine. Rise in the winding temperature was determined from the estimated values of winding resistance, both cold and hot. The estimation of hot resistance was modeled using soft computing techniques such as ANFIS which stands for Adaptive Neuro Fuzzy Inference system. This technique estimates hot resistance of the winding using the input variables as cold resistance, ambient temperature and temperature rise. Heat run test was conducted on 8/6 Switched Reluctance Machine of 2 H.P at various Ambient temperature .The estimated values of hot resistance show a good agreement between the measured and computed values obtained using ANFIS. Hence this model proves to be well suited for the estimation of hot resistance.

Success through Failure: Wittgenstein and the Romantic Preface

I argue that the Preface to Wittgenstein’s Philosophical Investigations represents a form of preface found in several other major works of Romanticism. In essence, this kind of preface says: ‘I have tried very hard to write a work of the following conventional type … . I failed, and have thus been compelled to publish, with some reluctance, the following fragmentary, eccentric, unfinished or otherwise unsatisfactory work.’ It sometimes transpires, however, that a work which appeared unfinished and unsatisfactory to the author and his contemporaries, later comes to be seen as both complete and startlingly original. Indeed, not initially recognizing what you have achieved is sometimes a mark of the greatness-through-originality so highly prized by Romantic writers. Besides the Investigations, I concentrate on Coleridge’s Preface to ‘Kubla Khan’, and the first 269 lines of Wordsworth’s Prelude (in both the 1805 and 1850 versions), discussing exactly why all three authors found their projects so recalcitrant, why their solutions were so original, and why the magnitude of their achievements was not appreciated from the first. I end with some reflections on why Wittgenstein’s work on aesthetics, the aesthetic impact of his work, and the cognitive impact of his work should not be separated.

A Novel and Low Cost Sensorless Controller for SRM Utilizing Linear Equations: Analysis, Design and Construction

A new low cost sensorless controller for Switched Reluctance Motor (SRM) is designed and constructed in this paper. In the presented novel technique, the rotor position is obtained from the linear equations of the SRM phase current, flux and rotor position. In other similar strategies, the detection of rotor position requires an expensive, high speed controller component since a complex process and calculations have to be performed. Because of using linear equations in the presented technique, the program used by of the controller is less complex and simpler which causes a low cost, medium frequency controller can drive the SRM easily. A new configuration of MOSFET driving is also introduced in this paper which solves a typical problem of usual converters. In this paper, one phase mathematical model of SRM is explained at the beginning. Then 50 watts 12 by 8 SRM is selected and analyzed by Finite Element Method (FEM) in order to obtain the necessary motor parameters. After that the novel sensorless technique is introduced and designed for the motor. The controller circuit is then constructed and tested in the laboratory. Finally operational results are presented for the motor and controller circuit under different load conditions

Partnering for More Than the Survival of a Catholic Presence in Healthcare

One of the contributions to the Catholic healthcare ministry made by the late Cardinal Bernardin is a set of criteria for Catholic healthcare systems to use in choosing partners for joint ventures and affiliations (Bernardin, 1994). He based his criteria on the premise that appropriate partners are those who will ultimately strengthen and enhance the Catholic presence in healthcare in general, and the Catholic identity of the Catholic facility in particular. Hence, the preferred partner is another Catholic party. A second option is another not-for-profit system or facility that shares “in a substantive way our Catholic vision and values.” This choice of partner can be problematic in that, even if common vision and values are affirmed, the Catholic identity of the Catholic partner may be diluted. This situation could occur, for example, as a result of the shift from an exclusive Catholic sponsorship to an arrangement of co-sponsorship. It could also result from the need, in some cases at least, for material cooperation by the Catholic system in some prohibited procedures. The growing reluctance in some quarters to approve material cooperation even for the sake of a continued Catholic presence in healthcare (e.g., Smith, 1996) makes such partnerships especially troublesome. In addition to diluting the identity of the Catholic partner, choosing non-Catholic partners may, in some instances, damage the presence of Catholic healthcare by putting other Catholic facilities in the same service area at financial risk. A third partner option is a for-profit system. For-profit healthcare had been judged by the Cardinal to be inimical to Catholic identity, and is ruled out (Bernardin, 1995; Place, 1998). These criteria have proven to be helpful. They are helpful, however, only within the limited context of their grounding premise: the need to preserve and promote Catholic healthcare’s ministry. The “healthcare” ministry is not the only public ministry of the Church. Nor does the healing ministry of the Church need to be viewed solely as an end, sought for its own sake. It is also possible and legitimate to view the healthcare ministry as a vehicle through which to pursue or fulfill another Church ministry. The criteria for choosing partners in healthcare can also be premised on a desire to strengthen and preserve a different public ministry of the Church. At the very least, this could allow choices of partners being made with more enthusiasm and creativity

The reimbursement system is not the dominant factor influencing reluctance to perform single-fraction radiotherapy for painful bone metastases.

Numerous prospective randomized controlled trials (RCTs) have demonstrated the equivalence of single-fraction (SF) and multi-fraction (MF) radiotherapy (RT) for the palliation of painful bone metastases (1-9). Recent practice guidelines support the use of SF-RT (10-13).

La gestion du risque en douane : premières leçons tirées de l'expérience de quelques pays d'Afrique de l'Ouest

ResumeEn raison de l’accroissement des flux commerciaux et donc de leur charge de travail, les administrations douanieres les plus modernes developpent depuis plusieurs annees des approches structurees pour analyser le risque, seul moyen efficace pour limiter les controles intrusifs, repondre aux besoins des operateurs prives et securiser leurs operations. Peu de pays en developpement se sont engages dans cette voie en raison de reticences fortes, tant au niveau des agents de controle qui ne souhaitent pas forcement changer leur facon de travailler, que des autorites qui craignent des pertes de recettes fiscales. L’article presente l’experience de cinq pays d’Afrique de l’Ouest qui, dans le cadre de la modernisation de leur administration douaniere, developpent des systemes d’analyse et de gestion du risque qui reposent notamment sur une exploitation exhaustive et systematique de l’information statistique disponible. Les premieres lecons tirees de ces experiences sont encourageantes et d’autres pays devraient logiquement suivre. Actuellement reservees aux administrations douanieres, ces methodes pourraient aussi etre developpees au sein des administrations des impots.Classification JEL : H26, H39, O24

Norms, Repeated Games, and the Role of Law

In drawing on the theory of repeated games, norms scholars have devoted much attention to the so-called “third-party enforcement problem:” the seemingly inevitable reluctance of members of a community to carry out their implicit threat to punish deviators. We argue that the third-party enforcement problem—as currently represented in the literature—is illusory. To be sure, third party enforcement is always a problem for “titfor-tat,” the norms literature’s canonical example of a cooperation-sustaining strategy. The problem is not, however, endemic to strategies that support cooperation. Thus, we propose re-focusing on an alternative strategy, which we call “def-for-dev” (“defect-for-deviate”). Under def-for-dev third parties find it in their interest to punish deviators lest they themselves be labeled as deviators in future rounds. Although the third-party enforcement problem as conceived of in the literature is illusory, there is still reason for skepticism about the application of mainstream repeated game theory to law and norms. We highlight the “counterfactual problem:” the fact that the theory of games requires that players continue to believe that other players have adopted a particular equilibrium strategy even “off the equilibrium path,” when it is evident that this belief is false. The counterfactual problem opens up avenues for law that the literature has not yet identified. We contend, for example, that law does not enter simply to help players arrive at the cooperative equilibrium, but is required to sustain that equilibrium. This observation has the virtue of consistency with actual patterns of law enforcement. * Brokaw Professor of Corporate Law, Albert C. BeVier Research Professor, University of Virginia School of Law, pgm9h@virginia.edu. ** Associate Professor, University of Virginia School of Law, csanchirico@law.virginia.edu.

Les métiers de risk management au sein de la banque : un enjeu RH

Résumé Alors que la crise financière de 2008 a mis en évidence le rôle fondamental de la maîtrise des risques pour l’activité bancaire et le système financier mondial, les métiers de la filière Risque souffrent à ce jour en France d’un déficit d’attractivité. La recherche montre que les principales réticences sont la perte en « bonus » et en employabilité externe, ce qui pourrait témoigner d’une évolution vers des contrats psychologiques davantage transactionnels que dans le passé.

Resistance to Change: Hephzibah and Clifford in Nathaniel Hawthorne’s The House of the Seven Gables as Two Case Studies

It is argued that change is a necessity, that it’s connected with time, that it is either for the better or the worse, and that some people of whom Hepzibah and Clifford in Hawthorne’s The House of the Seven Gables are ones who sometimes resist change for certain reasons. The discussion demonstrates that Hepzibah and Clifford resist change in defi ance of time and reality. They both imprison themselves in the past and refuse to live in the real world. This refusal to change occurs due to identity-related reasons, the loss of certain interests, fear of the unknown, the threat to their security and survival, and its being imposed upon them. This paper shows that change is a fact of life and that it occurs daily in subtle ways whether we like it or not. In line with this contention, people should cope with it, and come to terms with the past and the present whose disregard is a sign of folly. Key Words : Resistance ; Reluctance ; Necessity ; Imprison ; Reality ; Imposed ; Collapse

ANALYTICAL DESIGN OF DIMENSIONAL AT SUBMERSIBLE PUMP-TYPE SWITCHED RELUCTANCE MOTOR WITH 8/6 POLES

Manufacturing pre-calculations to determine the dimensions of a machine is of great importance. In this study, submersible pump-type Switched Reluctance Motor with 8/6 poles (SRM), how to mathematically calculate the dimensions are given in detail. B-H curve modeling of silicon sheet was infused into account at calculation of machine dimensions. Programs are required for calculations written using MATLAB 7.04.

Reluctance to Lengthen Pap Testing Intervals

The optimal interval for Pap screening is in flux as new human papillomavirus (HPV) data and testing methods emerge. The American College of

Respite Care for Mental Health Carers: Carers’ Views on Respite Care for Adults with Mental Disorders

This study examined informal mental health carers' perceptions of respite care. Participants were 106 carers caring for an adult with mental illness recruited through carer support organizations. Carers provided written responses to open-ended questions covering four areas: barriers, positive and negative aspects, and improvements associated with respite care. A total of 36% had accessed respite care and 64% had never accessed respite care. The most frequently reported respite themes for both users and non-users in each of the four areas relevant to carers and care recipients were: barriers - care-recipient's reluctance to use respite (e.g., refusal, psychiatric symptoms hamper access, denial of mental disorder; carer positives - caregiving relief (e.g., opportunity to relax, break from caring role); care recipient positives - socializing and participation in activities; carer negatives - problematic characteristics of the service (e.g., irregular or inflexible services, staffing problems); care recipient negatives - lack of suitable activities; carer improvements - increased access and availability of services; care recipient improvements - greater support and understanding of mental health issues. Findings indicate that respite care services should be tailored to the demands of mental health caregiving providing flexibility in options across factors such as frequency, duration, location, transport access, support levels, staff training, activities and routines, graduated entry, type of respite (e.g., in-home, hospital, drop-in centre), and crisis/acute respite.

Empowering patients during insulin initiation: a real-world approach.

Glycemic control is suboptimal in many patients with type 2 diabetes mellitus (T2DM). Despite documented benefits of insulin therapy, initiation of insulin is delayed in many cases because of the reluctance of patients and physicians to use this important treatment. A review of the literature revealed that educating patients about the role of insulin in managing T2DM and the advantages of using insulin analogs and insulin delivery devices may help alleviate some patients' concerns regarding insulin therapy. Compared with standard clinic-directed approaches, patient-driven algorithms that empower patients to initiate and titrate basal insulin therapy have been shown to improve glycemic control. Additional research is needed to confirm the importance of patient empowerment programs in T2DM management.

Analysis of Two-phase E-core Switched Reluctance Machines Using Magnetic Equivalent Circuit Technique

The modification of magnetic structures for an E-core switched reluctance machine (SRM) comprising two segmented stator cores or a monolithic stator core is presented for ease of assembly, good manufacturability, mechanical robustness, and electromagnetic performance improvement. The E-core stator has four small poles with phase windings and two or four large poles (hereafter referred to as common poles), in between. The common poles are shared by both phases for positive torque generation during the entire operation. The E-core SRMs are compared to a conventional two-phase SRM. The comparison includes cost savings, torque, copper and core losses, and efficiency in order to validate the distinct features of the E-core SRMs. Magnetic equivalent circuit (MEC) technique is employed for proving the benefits of the E-core common-pole structure.

Analysis on Dynamic Characteristic and Circuit Parameter of Linear Switched Reluctance Motor by Electromagnetic Analytical Method

This paper deals with analysis on dynamic characteristic and circuit parameter of linear switched reluctance motor by electromagnetic analytical method. Above all, using space harmonic method, which is electromagnetic method, the air-gap flux density is analyzed in the both align and unaign positions, and the inductance profile, force characteristic and resistance per phase are calculated by means of the process. The validity of the analyzed results are demonstrated by the finite element method(FEM) and manufacture of the prototype machine. Second, the dynamic simulation is analyzed by the use of circuit parameters derived from analytical method, and the operating system of the prototype machine is manufactured to demonstrated the validity of simulation analysis. As a result, it is considered that the characteristic equation suggested in this paper will contribute to the design, analysis and application of LSRM.