Terminal Course Research Articles

A Preliminary Report on Students’ Reflections about Their Learning in an Active Learning Classroom

In the past decades, College Algebra has become a big hurdle for students to graduate or further pursue STEM or related careers. For most of the student population, College Algebra is a terminal course and only a small portion of students take it for further mathematics courses. The traditional content of College Algebra does not serve either group of students well (Mathematical Association of America, 2004; Mathematical Association of America & National Council of Teachers of Mathematics, 2012). In recent years, at a large Hispanic-serving university, the course design for liberal arts students has been changed. An active-learning curriculum has been implemented, namely Quantitative Reasoning. This curriculum engages students with opportunities to learn math concepts from relevant everyday sources and even their own personally collected data. Students build their own understanding of mathematics by relevant data-based situations experienced through preview activities designed to prepare students for class, collaboration in class discussion and discovery through relevant problem situations, and practice activities extending learning after each lesson. The purpose of this study was to investigate student perceptions of their learning outcomes from an active-learning structured course. That is, what impact does a course design with pre-assignment tasks, authentic problem solving through collaboration in class, and practice assignments after lessons have on diverse student populations in a quantitative reasoning course?

Research on Unmanned Surface Vessel Aggregation Formation Based on Improved A* and Dynamic Window Approach Fusion Algorithm

The traditional A* and DWA fusion algorithm has three problems in the task of aggregation formation: one is the lack of meeting coordination strategy, the other is the inability to unify the terminal course, and the third is too many turning points in the global path. To solve the above problems, an improved algorithm is proposed. Firstly, by smoothing the global planning path, the stability of a USV heading in the navigation is improved. Then, by adding the key points of the global path, a guide path is formed to unify the terminal heading range. Finally, by adding an encounter coordination strategy, aggregation efficiency is improved. Simulation experiments were carried out in the Python environment based on this algorithm. The results show that the improved algorithm can improve the navigation obstacle avoidance ability of USVs and guide multiple USVs to finish the task of aggregation formation.

Coverage, Placement and Impact of Quality Control and Assurance on Quality of Products in Zimbabwean Polytechnic Clothing and Textile Production Units

This study sought to establish the coverage, placement and impact of Quality Control and Assurance on Quality of Products in Zimbabwean Polytechnic Clothing and Textile Production Units, using the qualitative approach. The population comprised of 103 Clothing and Textiles National Diploma students and 27 lecturers from three polytechnics. Stratified sampling was used to select 32 ND students and 6 lecturers who participated in the study. The study used a questionnaire, FGD and interviews as sources of data. Data was analyzed through the thematic approach. The study established that the component of Quality Control and Assurance contained very important aspects of quality management issues. The quality control component had a positive impact on the quality of products produced in the polytechnic CTPUs as it equipped participants with skills and competences required to produce high quality products that satisfy customers. One of recommendations is that the Ministry of Higher and Tertiary Education, Innovation Science and Technology through the Higher Education Examination Council should reconsider the course structure and placement of Quality Control and Assurance component in the Clothing and Textile curriculum. The fundamentals of quality control in garment industry should be taught at National Certificate level as it can be a terminal course for those who do not wish to advance to National Diploma level.

Chikungunya and COVID‐19 in Brazil: The danger of an overlapping crises

It is already widely known that the COVID-19 pandemic has added a heavy burden to the health care system in different parts of the world. In Brazil, the situation was no different. The uncontrolled increase in the contagion curve of the disease has tested the limits of the country's health system. This situation is aggravated by the coexistence of an outbreak of Chikungunya, which affects mainly the most vulnerable groups in the country. The overlap of these two crises can be a dangerous combination if urgent measures are not taken. This article is protected by copyright. All rights reserved.

Development and validation of the Terminal Delirium-Related Distress Scale to assess irreversible terminal delirium.

There is no tool to appropriately assess terminal delirium, including the natural terminal course. The objective of this study was to develop an evaluation scale to assess distress from irreversible terminal delirium and to examine the validity of the scale. Based on previous qualitative analysis and systematic literature searches, we carried out a survey regarding the views of bereaved families and developed a questionnaire. We extracted items that bereaved families regarded as important and constructed an evaluation scale of terminal delirium. Then, we applied the questionnaire in a cross-sectional questionnaire survey of bereaved relatives of cancer patients who were admitted to a hospice or a palliative care unit. We developed the Terminal Delirium-Related Distress Scale (TDDS), a 24 item questionnaire consisting of five subscales (support for families and respect for a patient, ability to communicate, hallucinations and delusions, adequate information about the treatment of delirium, and agitation and restlessness). Two hundred and eighty-one bereaved relatives participated in the validation phase. The construct validity was shown to be good by repeated factor analysis. Convergent validity, confirmed by the correlation between the TDDS and the Care Evaluation Scale (r = 0.651, P < 0.001), was also good. The TDDS had good internal consistency (Cronbach's alpha coefficient for all 24 items = 0.84). This study showed that the TDDS is a valid and feasible measure of irreversible terminal delirium.

Stackelberg Model of Anti-terrorism Resource Allocation in Express Transportation Security Checks

The problem of anti-terrorism security checks of express transportation becomes more and more severe under the Internet shopping model. In this paper, a Stackelberg game model of anti-terrorism resource allocation in express transportation security checks is built to discuss, in terms of single and multiple routes, the optimal resource allocation of express company (defender) including physical security measures, in-box sensor technology, non-intrusive security measures at terminal distribution sites and handover course. It shows that, for the single route, express company should trade off the security costs among the first, second and third level security measures, and should allocate the same security costs of physical security measures for every distribution site. For the multiple routes, the transportation route that terrorists insert the hazardous materials has the lowest probability of physical security measures, and therefore is utilized by terrorists. Thus, the optimal allocation plan of security resources should be the same security costs of non-intrusive security measures at the final distribution sites (the third level security measure) among each transportation routes.

Hypercalcemia with invasive pulmonary papillomatosis and microinvasive squamous carcinoma

Juvenile respiratory papillomatosis is a rare pediatric disease in which benign papillomata develop in the respiratory tract, most commonly involving the larynx and tracheobronchial tree. Invasive pulmonary papillomatosis is an aggressive form in which the papillomata extend into the lung parenchyma. We report a case of a 22-year-old man with a long-standing juvenile respiratory tract papillomatosis, initially diagnosed at age 2, who subsequently developed invasive pulmonary papillomatosis and underwent partial surgical resection for his pulmonary disease. Hypercalcemia complicated the patient’s final hospitalizations. HPV typing performed on a laryngeal papilloma was positive for HPV 6/11. The lobectomy specimen revealed malignant transformation of invasive pulmonary papillomatosis characterized by the presence of microinvasive nests of squamous carcinoma. Immunohistochemical stain for parathyroid hormone on the invasive component was negative. Eventually, the patient succumbed to his disease and while the family refused post-mortem examination, Positron Emission Tomography (PET) performed during the patient’s terminal course suggested the possibility of metastasis to liver and periaortic lymph nodes. There was no evidence of bony metastasis.

Cispatá Bay and Mestizos Evolution as Reconstructed from Old Documents and Maps (16th–20th Century)

Historical cartography is increasingly being used for the study of coastal evolution, but less considered are coeval descriptive sources as well as exploration reports that accompany the construction of maps. Herein, these issues are considered when analyzing the chronological model of the Rio Sinú mouth and Cispatá bay evolution before the Tinajones delta formed (around 1942–1943) as it is established in the literature. This study is based on the examination of about 500 manuscripts or printed maps produced from the 16th century to 1937 (the last one before the Tinajones delta was formed) in which the Morrosquillo Gulf, the Rio Sinú terminal course, the Mestizos headland and Cispatá bay are represented. These maps were compared with coeval descriptive sources. Several maps are not based on new topographic surveys but are more recent elaborations of the original documents, while others include updates of only limited portions of the area and simply replicate or mix a drawn coastline, at best, tens of years before or, at worst, centuries before. A synchronic and diachronic comparative analysis of these documents was performed, and, out of these maps, only three were found to be reliable for the morphological reconstruction of the area. Many of the remaining maps turned out to be full or partial copies of the originals, so they attribute the wrong date to the described coastlines and water depths. These findings led to a new model for Cispatá bay evolution with respect to that proposed by previous scholars using some of these maps. In particular, some river mouths and coastal morphologies were backdated, and bay infilling proved to be far faster than described before. Written documents demonstrate that this process was triggered by inland slope deforestation.

Research on Sliding Mode Method about Three-Dimensional Integrated Guidance and Control for Air-to-Ground Missile

Based on adaptive sliding mode-control and back-stepping design method, an integrated guidance and control method with less calculation is proposed, which is designed for air-to-ground missile during the terminal course in threedimensional space. The model of the control system with nonlinear and coupling is simplified, then the integrated guidance and control model in pitch and yaw channel is established. The coupling terms and modeling error between channels is considered as unknown bounded disturbance. An extended state observer is developed to estimate and compensate the unknown disturbance. In the design process, the block dynamic surface method is adopted, and the first order low pass filter is introduced to avoid the problem of differential explosion present in the traditional back-stepping design method during the process of differentiating virtual control variable. The Lyapunov stability theory is used to prove the stability of the system. Finally, in the case of nominal and positive and negative perturbations of model parameters, the simulation experiments are carried outto verify the effectiveness of the proposed IGC algorithm.

Lattice dissections: plainer and less fancy

The title of this Article pays homage to Greg Frederickson's widelyknown book on geometrical dissections, Dissections: Plane &amp; Fancy [1]. I enjoyed the book so much, I built an honours geometry course around it − a terminal mathematics course for honours students needing a mathematics credit for their general education requirements. Not only is there significant geometry involved, but there is a fair amount of number theory relevant to finding infinite families of dissections of, for example, m squares to n squares.However, although many dissections from one regular polygon to another are quite elegant, the mathematics involved in specifying the dissections is often formidable.

End of Life, Withdrawal, and Palliative Care Utilization among Patients Receiving Maintenance Hemodialysis Therapy.

Withdrawal from maintenance hemodialysis before death has become more common because of high disease and treatment burden. The study objective was to identify patient factors and examine the terminal course associated with hemodialysis withdrawal, and assess patterns of palliative care involvement before death among patients on maintenance hemodialysis. We designed an observational cohort study of adult patients on incident hemodialysis in a midwestern United States tertiary center, from January 2001 to November 2013, with death events through to November 2015. Logistic regression models evaluated associations between patient characteristics and withdrawal status and palliative care service utilization. Among 1226 patients, 536 died and 262 (49% of 536) withdrew. A random sample (10%; 52 out of 536) review of Death Notification Forms revealed 73% sensitivity for withdrawal. Risk factors for withdrawal before death included older age, white race, palliative care consultation within 6 months, hospitalization within 30 days, cerebrovascular disease, and no coronary artery disease. Most withdrawal decisions were made by patients (60%) or a family member (33%; surrogates). The majority withdrew either because of acute medical complications (51%) or failure to thrive/frailty (22%). After withdrawal, median time to death was 7 days (interquartile range, 4-11). In-hospital deaths were less common in the withdrawal group (34% versus 46% nonwithdrawal, P=0.003). A third (34%; 90 out of 262) of those that withdrew received palliative care services. Palliative care consultation in the withdrawal group was associated with longer hemodialysis duration (odds ratio, 1.19 per year; 95% confidence interval, 1.10 to 1.3; P<0.001), hospitalization within 30 days of death (odds ratio, 5.78; 95% confidence interval, 2.62 to 12.73; P<0.001), and death in hospital (odds ratio, 1.92; 95% confidence interval, 1.13 to 3.27; P=0.02). In this single-center study, the rate of hemodialysis withdrawals were twice the frequency previously described. Acute medical complications and frailty appeared to be driving factors. However, palliative care services were used in only a minority of patients.

The anatomy and physiology of the terminal thoracic duct and ostial valve in health and disease: potential implications for intervention.

The thoracic duct (TD) transports lymph drained from the body to the venous system in the neck via the lymphovenous junction. There has been increased interest in the TD lymph (including gut lymph) because of its putative role in the promotion of systemic inflammation and organ dysfunction during acute and critical illness. Minimally invasive TD cannulation has recently been described as a potential method to access TD lymph for investigation. However, marked anatomical variability exists in the terminal segment and the physiology regarding the ostial valve and terminal TD is poorly understood. A systematic review was conducted using three databases from 1909 until May 2017. Human and animal studies were included and data from surgical, radiological and cadaveric studies were retrieved. Sixty-three articles from the last 108years were included in the analysis. The terminal TD exists as a single duct in its terminal course in 72% of cases and 13% have multiple terminations: double (8.5%), triple (1.8%) and quadruple (2.2%). The ostial valve functions to regulate flow in relation to the respiratory cycle. The patency of this valve found at the lymphovenous junction opening, is determined by venous wall tension. During inspiration, central venous pressure (CVP) falls and the valve cusps collapse to allow antegrade flow of lymph into the vein. During early expiration when CVP and venous wall tension rises, the ostial valve leaflets cover the opening of the lymphovenous junction preventing antegrade lymph flow. During chronic disease states associated with an elevated mean CVP (e.g. in heart failure or cirrhosis), there is a limitation of flow across the lymphovenous junction. Although lymph production is increased in both heart failure and cirrhosis, TD lymph outflow across the lymphovenous junction is unable to compensate for this increase. In conclusion the terminal TD shows marked anatomical variability and TD lymph flow is controlled at the ostial valve, which responds to changes in CVP. This information is relevant to techniques for cannulating the TD, with the aid of minimally invasive methods and high resolution ultrasonography, to enable longitudinal physiology and lymph composition studies in awake patients with both acute and chronic disease.

A joint mid-course and terminal course cooperative guidance law for multi-missile salvo attack

Salvo attacking a surface target by multiple missiles is an effective tactic to enhance the lethality and penetrate the defense system. However, existing cooperative guidance laws in the mid-course or terminal course are not suitable for long- and medium-range missiles or stand-off attacking. Because the initial conditions of cooperative terminal guidance that are generally generated from the mid-course flight may not lead to a successful cooperative terminal guidance without proper mid-course flight adjustment. Meanwhile, cooperative guidance in the mid-course cannot solely guarantee the accuracy of a simultaneous arrival of multiple missiles. Therefore, a joint mid-course and terminal course cooperative guidance law is developed. By building a distinct leader-follower framework, this paper proposes an efficient coordinated Dubins path planning method to synchronize the arrival time of all engaged missiles in the mid-course flight. The planned flight can generate proper initial conditions for cooperative terminal guidance, and also benefit an earliest simultaneous arrival. In the terminal course, an existing cooperative proportional navigation guidance law guides all the engaged missiles to arrive at a target accurately and simultaneously. The integrated guidance law for an intuitive application is summarized. Simulations demonstrate that the proposed method can generate fast and accurate salvo attack.

Promoting Quantitative Literacy in an Online College Algebra Course

This article reports on a US-based study that examined a traditional, lecture-based college algebra section versus an online, quantitative literacy focused section; the latter included weekly news discussions as well as problem-based learning projects requiring data analysis. College algebra fulfills the quantitative literacy requirement of many colleges' general education programs and is a terminal course for most who take it. An online problem-based learning environment provides a unique means of engaging students in quantitative discussions and research.

Promoting Numeracy in an Online College Algebra Course through Projects and Discussions

This research stems from efforts to infuse quantitative literacy (QL) in an online version of college algebra. College algebra fulfills the QL requirement of many college’s general education programs, and is a terminal course for most who take it. In light of the course’s traditional content and teaching methods, students often leave with few QL gains. An online problem-based learning environment provides a unique means of engaging students in quantitative discussions and research, yet little research exists on online courses in the context of QL. This study examined a lecture-based college algebra course versus an online, QL-focused section.Students in each section took the QLRA and responded to an open-ended prompt regarding their mathematical disposition during the first and final weeks of the fall 2014 semester. There were statistically significant gains in the online students’ QLRA performance but none for the face-to-face students. Qualitative analysis of the responses revealed drastic differences in students’ attitudes and their outlook on what utility mathematics has to offer. Implications include that project-based learning in an online environment is a promising strategy for fostering QL in terminal math courses; the study also highlights the need for accountability of QL outcomes in math departments nationwide.

Integrated Guidance and Control Design for the Near Space Interceptor

Considering the guidance and control problem of the near space interceptor (NSI) during the terminal course, this paper proposes a three-channel independent integrated guidance and control (IGC) scheme based on the backstepping sliding mode and finite time disturbance observer (FTDO). Initially, the three-channel independent IGC model is constructed based on the interceptor-target relative motion and nonlinear dynamic model of the interceptor, in which the channel coupling term and external disturbance are regarded as the total disturbances of the corresponding channel. Then, the FTDO is introduced to estimate the target acceleration and control system loop disturbances, and the feed-forward compensation term based on the estimated values is employed to effectively remove the effect of disturbances in finite time. Subsequently, the IGC algorithm based on the backstepping sliding mode is also given to obtain the virtual control moment. Furthermore, a robust least-squares weighted control allocation (RLSWCA) algorithm is employed to distribute the previous virtual control moment among the corresponding aerodynamic fins and reaction jets, which also takes into account the uncertainty in the control effectiveness matrix. Finally, simulation results show that the proposed IGC method can obtain the small miss distance and smooth interceptor trajectories.

Prevalence, incidence and clinical impact of cachexia: facts and numbers-update 2014.

Cachexia is a serious but underrecognised consequence of many chronic diseases. Its prevalence ranges from 5–15 % in end-stage chronic heart failure to 50–80 % in advanced cancer. Cachexia is also part of the terminal course of many patients with chronic kidney disease, chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis. Mortality rates of patients with cachexia range from 10–15 % per year in COPD through 20–30 % per year in chronic heart failure and chronic kidney disease to 80 % in cancer. The condition is also associated with poor quality of life. In the industrialised world, the overall prevalence of cachexia (due to any disease and not necessarily associated with hospital admission) is growing and it currently affects around 1 % of the patient population, i.e. around 9 million people. It is also a significant health problem in other parts of the globe. Recently there have been advances in our understanding of the multifactorial nature of the condition, and particularly of the role of inflammatory mediators and the imbalance of anabolism and catabolism. Several promising approaches to treatment have failed to live up to the challenge of phase III clinical trials, but the ghrelin receptor agonist anamorelin seems to have fulfilled at least some early promise. Further advances are urgently needed.

KLRG1+ NK Cells Protect T-bet–Deficient Mice from Pulmonary Metastatic Colorectal Carcinoma

We studied the developmental and functional mechanisms behind NK cell-mediated antitumor responses against metastatic colorectal carcinoma (CRC) in mice. In particular, we focused on investigating the significance of T-box transcription factors and the immunotherapeutic relevance of IL-15 in the development and function of tumor-reactive NK cells. Pulmonary CRC metastases were experimentally seeded via an adoptive i.v. transfer of luciferase-expressing CT26 CRC cells that form viewable masses via an in vivo imaging device; genetically deficient mice were used to dissect the antitumor effects of developmentally different NK cell subsets. IL-15 precomplexed to IL-15 receptor-α was used in immunotherapy experiments. We found that mice deficient for the T-box transcription factor T-bet lack terminally differentiated antitumor CD27(low)KLRG1(+) NK cells, leading to a terminal course of rapid-onset pulmonary CRC metastases. The importance of this NK cell subset for effective antitumor immunity was shown by adoptively transferring purified CD27(low)KLRG1(+) NK cells into T-bet-deficient mice and, thereby, restoring immunity against lung metastasis formation. Importantly, immunity to metastasis formation could also be restored in T-bet-deficient recipients by treating mice with IL-15 precomplexed to IL-15 receptor-α, which induced the development of eomesodermin(+)KLRG1(+) NK cells from existing NK cell populations. Thus, contingent upon their T-bet-dependent development and activation status, NK cells can control metastatic CRC in mice, which is highly relevant for the development of immunotherapeutic approaches in the clinic.

Variation of the subscapularis tendon at the fetal glenohumeral joint

We examined the topohistology of the subscapularis tendon at the glenohumeral joint in 10 mid-term (15-16 weeks of gestation) and 10 late-stage (27-32 weeks) human fetuses. At both stages, there were two patterns of terminal course of the subscapularis tendon: 1) the tendon was tightly attached to the medial part of the joint capsule and extended anterosuperiorly along the capsule to the lesser tubercle (7/10 mid-term fetuses; 5/10 late-stage fetuses); 2) the tendon passed superiorly through the joint cavity for a long distance in combination with the subcoracoid bursa opening widely to the joint cavity (3/10 mid-term fetuses; 5/10 late-stage fetuses). The lower glenoid labrum tended to be well developed in the former pattern because the subscapularis tendon did not interfere with the superior extension of the labrum. With only one exception (late stage), the capsule-attaching tendon was seen in fetuses in which the coracoid process was located on the superior side of the lesser tubercle, whereas the intra-articular tendon accompanied the coracoid process at the same supero-inferior level of the tubercle. Thus, the topographical relationship between the coracoid process and lesser tubercle in fetuses seemed to determine the courses of the subscapularis tendon at the glenohumeral joint. The present variation in the subscapularis tendon was likely connected with the adult morphologies of the middle and inferior glenohumeral ligaments or folds, whose variations are well known.

Evaluation of Quality of Life in Complete Locked-In Syndrome Patients

There are few studies where quality of life (QOL) and contributive factors are assessed in locked-in syndrome (LIS) patients with complete physical and functional disability and dependence on caregivers. The study's objective was evaluation of QOL in LIS patients. We have compared QOL in LIS patients with QOL in healthy controls (control group). We have included 19 LIS patients, most of them with vascular etiologies or terminal course of ALS, and 20 healthy controls comparable with LIS patients for age; none of them was in a caregiving position. Administered to patients and controls were the McGill Quality of Life Single Item Scale (MQOL-SIS) Part A; Short Form survey (SF-36), Mental Component Summary (MCS) and Physical Component Summary (PCS); Beck Depression Inventory-II (BDI-II); and Toronto Alexithymia Scale (TAS). Mean MQOL-SIS and MCS SF-36 were not significantly different between the LIS group and healthy controls. PCS SF-36 score was significantly higher in controls. There were no significant differences between the two groups for TAS scores. Frequency of depressive symptoms was significantly higher in LIS patients than in controls. In our study, QOL in LIS patients was not significantly altered compared to control subjects in MQOL-SIS and in the MCS SF-36 scale; these results match previous studies published in the literature. Several factors may have an impact on QOL in LIS patients, such as family support and patient-computer communication devices; these may have contributed to improve QOL in LIS patients in this study.