Top Of Pyramid Research Articles

Eight ways to support faculty with Entrustable Professional Activities.

Competency Based Medical Education (CBME) is pushing the medical profession to be more accountable in our standards of assessment. This has led us to focus our efforts at the top of Miller's pyramid, where we aim to see what the trainee 'does' in the clinical environment. In Canadian Royal College specialty training, this has come in the form of workplace-based supervision of trainees performing Entrustable Professional Activities (EPAs). This is unfamiliar territory for many residents and faculty, and implementation of an additional assessment process into already busy clinical practice has been particularly challenging. Because EPA assessments serve as significant contributors in new programs of assessment, failure to collect high quality EPA assessments threaten the validity of this new system. Understanding the barriers to and enablers of EPA acquisition can inform faculty development initiatives to ensure success. Based on our previous work studying early experiences of EPA assessment acquisition in Emergency Medicine, we have identified eight key concepts to guide faculty development initiatives, namely: the rationale for CBME, the 'behind the scenes' of CBME, how to construct rich narrative comments, effective use of supervision scales, the tension of EPA assessments being both formative and summative, the importance of a shared responsibility between residents and faculty for EPA assessment completion, familiarity with the suite of EPAs, and tips and tricks for incorporating EPA assessment completion into busy clinical practice. These key concepts can be integrated into an overall faculty development strategy for building this now essential skill set.

Red Emission of Well‐Ordered InGaN/GaN Nanocolumn Arrays on Si (111) Substrates Grown via Nanotemplate Selective‐Area Growth

Herein, triangular‐lattice nanopillar templates are fabricated on sputter‐deposited AlN/Si (111) substrates. Nanotemplate selective‐area growth via radiofrequency‐plasma‐assisted molecular beam epitaxy is employed to grow GaN nanocolumns on the nanopillars. Well‐ordered uniform GaN nanocolumn arrays are obtained by inserting a migration‐enhanced‐epitaxy grown AlN/AlGaN buffer layer, thereby aligning the polarity of GaN to Ga‐polar. Subsequently, bulk InGaN active layers are grown on top of the GaN nanocolumns with increasing growth time (tg = 10–20 min). In the initial stage of growth (tg = 10 min), low‐In‐content InGaN grows on the edges of the six‐sided pyramidal top of the GaN nanocolumns. As the growth progresses, low‐In‐composition InGaN fills the sides between InGaN on the edges, while high‐In‐composition InGaN rapidly grows on the top of the c‐plane nanocolumns. High‐angle annular dark‐field scanning transmission electron microscopy reveals the formation of an InGaN core, covered with a low‐In‐composition InGaN shell, on the top of the nanocolumns. At tg = 20 min, the photoluminescence spectrum exhibits a peak at 669 nm with a full width at half maximum value of 51.7 nm. Thus, the proposed method is suitable for growing red‐light‐emitting well‐ordered InGaN/GaN nanocolumn arrays on Si.

Resource Depletion Risk for Medical Equipment: Embracing the Circular Economy.

Resource Depletion Risk for Medical Equipment: Embracing the Circular Economy.

Conceptualization of the species problem

The species problem is understood as a result of the contradiction between aspiration and inability to reduce diversity of species conceptions (SCs) to a single one. Any SC represents the natural spe-cies phenomenon in a certain cognitive situation and serves as a heuristic model of this phenomenon in the latter. SCs of various levels of generality emerge as a result of sequential multiple reduction cascade; the more reduction steps lead to a particular SC, the less it is adequate to the natural species phenomenon. The entire array of SCs can be represented by a conceptual pyramid, within which various SCs occur as particular interpretations of more general (inclusive) concepts and have no sense without contexts imposed by them. It is suggested that, in order to define natural “species in general,” a certain concept of biota should be fixed at the top of conceptual pyramid allowing to dis-tinguish between species and non-species (such as life form, syntaxa, guilds) phenomena. The on-tology of the natural species phenomenon is presumably determined by its essence, viz. species-hood. The latter is a part of the entire natural history of organisms, so its manifestations are group-specific and evolve with the evolutionary development of the structure of biota.

An Alternate Approach to Eliminate Poverty

Poverty elimination in India has remained a great challenge. Since independence, several policies have been adopted in this direction. Yet, no such visible improvement is witnessed in the standard of living of the people at the bottom of the income pyramid. The argument is not that all the government policies have failed to address the problem. But, there is certainly need of an alternate approach to supplement the government programs for poverty reduction. The present piece tries to see an alternative analytical approach in the form of marginal voluntary sacrifices by people themselves without government policy interventions. It finds that a smaller sacrifice from the people at the top of income pyramid can help in achieving progressivity in income distribution and poverty reduction.

Supporting evidence for geropsychiatric nursing as a subspecialty of gerontological advanced practice nursing

Advanced practice nurses (APRNs) make significant contributions to the mental health of older adults. Despite the surge in the number of older adults, the number of APRNs choosing educational preparation for geropsychiatric nursing (GPN) is limited. The purpose of the GAPNA GPN Position Statement is to sustain a new vision for the nursing profession that will improve the care of older adults with psychiatric and mental health disorders. This position paper was written by a diverse group of APRNs with the collective intent to reflect respect, decrease stigma, remove controversy, and uphold a positive, person-centered approach to mental disorders among older adults and their families. The GAPNA GPN Position Statement was written to advance excellence in the GPN subspecialty, provide holistic care for older adults and make recommendations for practice. Blending gerontological and psychiatric nursing results in a subspecialty at the top of the APRN Consensus Model pyramid.

Caminhos da Reprodução da Colonialidade: Experiência desenvolvimentista e reação conservadora sob a tensão colonialidade/decolonialidade

This communication aims to verify how the recent process of precarious medianization occurred in Brazil. This is part of the question whether the second Brazilian developmental experience promoted changes in the intermediate strata of the class structure in Brazil. Through a consistent bibliographic review, derived from doctorate research, we make use of decolonial thought as a knowledge that confronts neoliberal and financial rhetoric. Here we outline the tension between coloniality/decoloniality that makes it possible to locate normative references called social markers of the tension between coloniality/decoloniality. The markers then try to analyze the development, especially the Brazilian heterodox model of the PT governments, and possible changes in the class structure. It is identified, then, a process of precarious medianization in which social mobility occurs in a limited way inflating the intermediate strata and not producing a middle class society. This produces conservative and far-rigth reactions in order to ensure the maintenance of an unequal social order, based on strong privileges at the top of the socioeconomic pyramid, not breaking with the colonization of social life

Nitrogen-Enriched Cr1-xAlxN Multilayer-Like Coatings Manufactured by Dynamic Glancing Angle Direct Current Magnetron Sputtering.

Multilayer-like CrN and Cr1−xAlxN coatings with different Al contents were deposited onto a stainless steel substrate using dynamic glancing angle deposition direct current magnetron sputtering (DGLAD dcMS) in a N rich atmosphere to understand the role of Al on the growth of the films and mechanical properties of the nitrides with a multilayer architecture. Chemical analysis by means of energy dispersive analysis (EDS) and glow discharge optical emission spectroscopy (GDOES) depth profiling revealed that while CrN samples were close to stoichiometric, the Cr1−xAlxN coatings presented excess N between 70 and 80% at. An expressive change in texture was observed as the CrN coating changed its preferred orientation from (111) to (200) with the addition of Al, followed by a modification in morphology from grains with faceted pyramidal tops in CrN to dome-shaped grains in Cr1−xAlxN coatings. Multilayer-like nanostructures of corrugated grains were produced with a periodicity of approximately 30 nm using dynamic glancing angle deposition. The deposition rate was drastically reduced with an increase of Al, meanwhile, the best mechanical performance was achieved for the coating with a higher content of Al, with hardness up to 27 GPa and a higher value of maximum resistance to plastic deformation.

Ekonomske tendencije, kapital i nejednakosti

Inequalities in: capital, property, income; the regulations are contemporary and global society. The rate income on capital surpasses rate the economic growth. Implement is enormous concentration of capital. Large is number a rich mans and extreme wealthy. On other side enormous majority is smaller the well-off and poor. Increase and the layer global plutocrats. Project is decelerate dynamics growth. The future is foggy uncertainty, as and full risky. Target of the work is perceive growth sociable a inequalities as the urgent contemporary the problem. Apply is various the methodology (historical, deductive-inductive, structural, comparative, statistical and other analysis). The problem it is concentration of capital and possibility reduce the social divide. Similarly swear, the problem is it and long-term the decelerate dynamics of the economic growth. Conclude is that beneficial influence powers of the convergence and (or) of the divergence, as and mixed of the efficiencies whose a resultant to be able in the direction reduce a global inequalities. Development individually a regions to be able and to dynamism of the economic growth. Philosophical and economic, rate the return of capital surpass the rate economic growth (p>g). This the trend anticipate is and in 21. century. "the first basic law of capitalism": a participation income of capital in national income (a) increase is rate the return (r) on capital and relation capital and income (b) that is a = r x b. "Other basic law of capitalism": relation capital and income (b) quotient is rate of saving (s) and rate growth of national income (g) that is b = s/g. "Law cumulative growth": rather small annual rate the return in long a deadline cause powerful growth, initial, of capital. "Law behavior": money and profit are motor activities! Richest the layer make one percentage of people (1%) on highest top of pyramid! Plutocracy create of the world politics.

Mass Gymnastics: A Playlist

Mass Gymnastics: A Playlist Kimberly Jannarone (bio) My essay in Theatre Journal’s March 2019 issue analyzes gymnastic displays of nineteenth- and twentieth-century Czechoslovaks and Germans through the lens of mass performance. The essay argues that gymnastic training and performance techniques parallel shifts in the socio-political conception of the people in the age of mass politics. I demonstrate how small groups of dispersed people seeking unity through synchronized movement end up forming units of power ultimately adopted and adapted by totalitarian political leaders. The essay draws on research for my upcoming book, Mass Performance: Systems and Citizens. The book creates a category of thought for mass performance, which I define as a thousand or more people performing the same activity at the same time. I focus on how the power of synchronized mass movement has been recognized and systematized by ruling powers in the era of nationalization. German and Czechoslovak gymnastic movements, called the Turners and the Sokols, respectively, serve as paradigmatic examples of a vast modern phenomenon that, while largely forgotten today, was wildly popular from the early nineteenth to the mid-twentieth centuries. Thousands of citizens would train for months or years to perform physical and vocal actions together, in synchrony, on a field for sequences that lasted an average of twenty minutes. The following images and videos provide further contexts for the mass gymnastics craze, and hopefully help to convey—however distantly and inadequately—their contagious dynamism. [End Page E-1] 1. German Mass Gymnastics, 1811–1945 LINKS: https://www.youtube.com/watch?v=PVM6voEWKiw https://www.youtube.com/watch?v=g7u5Knj5Uj4 https://www.vintag.es/2013/01/1938-reich-party-congress-third-reichs.html Click for larger view View full resolution National Socialist Gymnastic Festival. Stuttgart, 1933. Germany developed mass gymnastics from Jahn’s Turnverein (1811) on through the National Socialist displays of the 1930s and 40s. Looked at alongside images of mass gymnastic displays such as those of the Sokols, the lines of influence are clear, in both technique and type. One distinct feature of mass performance in totalitarian regimes is the focus on a single leader appreciating the performance, something not emphasized in pre-totalitarian displays of Czechoslovak or Turner mass gymnastics. [End Page E-2] 2. Sokol Slets in Czechoslovakia, 1882–1948 LINK: https://www.youtube.com/watch?v=ylDm0C-iHqo Click for larger view View full resolution Sokol Slet. Masaryk Stadium. Prague, 1938 Sokol Slets (mass displays) contained many different elements, including parades, dances, performances of regional dances, and, of course, mass gymnastic routines. A certain inexactness of movement and playfulness among the performers can be seen in videos of Sokols, qualities that disappear in the later communist-led Spartakiads. [End Page E-3] 3. Mass Gymnastics in the Soviet Union, c.1928–91 LINK: https://www.youtube.com/watch?v=MSZ2RW4etFA Click for larger view View full resolution Collage of footage from a mass physical culture display, Leningrad, c.1948. Mass gymnastics spread to the Soviet Union, first inspired by the Czechoslovak gymnastics, then adopted into the Soviet Union’s own mass performance system. In this footage, Stalin and Beria can be seen watching the display. [End Page E-4] 4. Spartakiads in communist Czechoslovakia, 1955–90 LINK: https://www.youtube.com/watch?v=wrwmFNK9tLg Click for larger view View full resolution Six thousand girls and boys perform in a sequence at the Spartakiad. Strahov Stadium, Prague, 1955. Spartakiads developed challenging routines for children, which became a staple of all subsequent mass gymnastic performances. [End Page E-5] LINK: https://www.youtube.com/watch?v=KCK1wpg8ao8 Click for larger view View full resolution The “Fireworks” sequence of the communist Spartakiad, 1980. Strahov Stadium. Prague, 1980. Thousands of young men throw themselves from the top of human pyramids, so that, from the stands, their combined leaps resemble the dynamic and dangerous bursts of a fireworks display. This sequence was in fact perilous, and confidential reports detailing that year’s injuries (concussions, broken bones, spinal fractures, damage to inner ears) circulated among officials after the Spartakiad. [End Page E-6] 5. Mass Performance in North Korea LINK: https://www.youtube.com/watch?v=qd3H9X-Yl2k Click for larger view View full...

Hexagonal Nanopyramidal Prisms of Nearly Intrinsic InN on Patterned GaN Nanowire Arrays

By using multiple growth steps that separate the nucleation and growth processes, we show that nearly intrinsic InN single nanocrystals of high optical quality can be formed on patterned GaN nanowire arrays by molecular beam epitaxy. The InN nanostructures form into well-defined hexagonal prisms with pyramidal tops. Micro-photoluminescence (μ-PL) is carried out at low temperature (LT: 28.2 K) and room temperature (RT: 285 K) to gauge the relative material quality of the InN nanostructures. Nanopyramidal prisms grown using a three-step growth method are found to show superior quantum efficiency. Excitation and temperature dependent μ-PL demonstrates the very high quality and nearly intrinsic nature of the ordered InN nanostructure arrays.

Артефакт в историческом пространстве Нового Эрмитажа. Пирамида с камеями и витрины-пирамиды для гемм

The article is devoted to the history of the Hermitage museum interiors, its collections, showcases and historical ties between them. From the very beginning of the Hermitage history its museum space reflected the public policy. In its collection the Hermitage holds unique showcases shaped as pyramids. No such example is to be found elsewhere in museum collections. We have no documents about the reason for their appearance, but some facts give us possibility to suggest their connection with the memory of Catherine II.The article is devoted to the history of the Hermitage museum interiors, its collections, showcases and historical ties between them. From the very beginning of the Hermitage history its museum space reflected the public policy. In its collection the Hermitage holds unique showcases shaped as pyramids. No such example is to be found elsewhere in museum collections. We have no documents about the reason for their appearance, but some facts give us possibility to suggest their connection with the memory of Catherine II.In 1811 the unique item was made for the Hermitage — a wooden pyramid made by Heinrich Daniel Gambs. There were cornelian cameos with portraits of Ancient Roman emperors and Holy Roman emperors, the so-called “Kaiser-Suiten”, placed on its facet. The pyramid top was decorated by a Minerva figure, as Catherine II loved to be represented in art works. Wolf figures were the symbol of Rome. The whole complex was an allegorical representation of Catherine’s wise rule based on the Ancient Rome and West-European tradition.In 1816 the pyramid was placed in the hall together with the loveliest Catherine’s cameos collection. In 1854 a new Cameos hall in the New Hermitage building was arranged. The Gambs pyramid surrounded with showcases in pyramid shape for which the old pyramid became the prototype was placed in its center. This hall with pyramid and showcases became the peculiar symbol of memory about Catherine the Great. In 1854 it was pictured by Ed. Hau.

Collaborative Governance in Senior Health Care: Actor Structure and its Dynamic Mechanism

China’s aging policy aims at promoting healthy aging and active aging, guaranteeing the economic independence in the elderly and mobilizing social participation so as to promoting the health and the quality of service for the elderly through cooperative governance. Its goal is to build senior health care system characterized by a pyramid structure with a narrow top and a wide bottom. First, the basement should be wide and preferred, which means that the health care system should be based on the family and community, involving the participation of the elderly themselves, caregivers and local governments and being characterized by self-supporting and family support. Second, the middle of the structure plays a role of conversion and cohesion, linking the top and the bottom. It aims to realize the community-based nursing home, resulting that the elderly needed for some kinds of service can get access to low care or high care in their own homes. Third, the top of the structure should be minimized. The top of the pyramid involves care services from facilities and emergency services from hospitals, including the low care and high care from the nursing institutions. The base, middle, top of this pyramid structure for senior health care should be a complete system, interrelating and cooperating with each other. With the deepening of China’s aging population, policy makers should explore effective ways to provide heal care for the aged. This paper will focus on the government, market, individual and family as different actors in the senior health care system, together with a commitment to the future development and policy practice.

Komparativna analiza sadržaja savremenih strategija bezbednosti

State security strategy is the top of legislative pyramid of documents in the sphere of national security and the source for all special and individual strategies in this sphere. The end of the Cold War, globalization and the need for transparency of the armed forces in order to reduce mutual perception of threats have imposed the trend of publishing security strategies. Security strategy is one of the instruments that ensures commitment of a state to respond to all threats in a comprehensive manner, to increase the level of effectiveness of security sector by optimization and coordination of all contributing entities, as well as to increase regional and international collaboration and trust. Not taking into consideration the issue of the level of practical application of published strategies, their availability and number have enabled comparative analysis, insight into national values, interests and objectives of other states, their special and individual strategies, system and national security policy.

Investigations on the Nature of Ceramic Deposits in Plasma Spray–Physical Vapor Deposition

In Plasma Spray–Physical Vapor Deposition (PS-PVD) process, major fractions of the feedstock powder can be evaporated so that coatings are deposited mainly from the vapor phase. In this work, Computational Fluid Dynamics (CFD) results indicate that such evaporation occurs significantly in the plasma torch nozzle and even nucleation and condensation of zirconia is highly possible there. Experimental work has been performed to investigate the nature of the deposits in the PS-PVD process, in particular coatings from condensate vapor and nano-sized clusters produced at two spraying distances of 1000 mm and 400 mm. At long spraying distance, columns in the coatings have pyramidal tops and very sharp faceted microstructures. When the spraying distance is reduced to 400 mm, the tops of columns become relatively flat and a faceted structure is not recognizable. XRD patterns show obvious preferred orientations of (110) and (002) in the coatings sprayed at 400 mm but only limited texture in the coatings sprayed at 1000 mm. Meanwhile, a non-line of sight coating was also investigated, which gives an example for pure vapor deposition. Based on these analyses, a vapor and cluster depositions are suggested to further explain the formation mechanisms of high-quality columnar-structured PS-PVD thermal barrier coatings which have already shown excellent performance in cyclic lifetime test.

Philips Lifeline CareSage Analytics Engine: Retrospective Evaluation on Patients of Partners Healthcare at Home

Background: The most common cause of emergency transports/admissions in the aging population is deterioration in their health status due to multiple chronic conditions. To meet the needs of this population, healthcare systems are seeking cost-effective ways to monitor, diagnose, and treat patients, based on connected solutions that seamlessly integrate data and provide actionable insights. The Philips Lifeline’s CareSage program for elderly and frail people utilizes a Personal Emergency Response Service (PERS) to detect medical emergencies and to promote independent living. The system tracks the types and outcomes of incidents, in particular the emergency transport-related events. Their timely detection is critical in optimizing clinical and financial outcomes. Objective: The study objectives are to evaluate (1) healthcare utilization and expenditure and (2) the CareSage predictive model on patients of Partners Healthcare at Home who have been using the Philips Lifeline service. This study is unique in utilizing PERS connected technology as a source of data to identify patients at risk of emergency transports or admissions that cause high healthcare expenditure. Methods: We identified 3335 patients with in-/out-patient encounters in 5 Partners Healthcare-affiliated hospitals through cross-reference of Philips Lifeline and Partners Healthcare at Home (PLL/PHH) data. The patients’ demographics, clinical outcomes, and healthcare expenditure for fiscal years 2011-2015 were extracted from Enterprise Data Warehouse (EDW) of Partners Healthcare. The medical alert data related to PERS utilization were extracted from the Philips Lifeline database. Retrospective statistical analysis of hospital utilization and healthcare cost was performed. Further, the CareSage logistic regression model that uses only PERS data to predict emergency room (ER) transport was validated on PHH patients. A new model predicting ER admissions was developed using boosted regression trees on a combination of PERS and electronic health record (EHR) data. Model performance was evaluated by the area under the receiver operator characteristic curve (AUC) and the positive predictive value (PPV). Results: Patients in the top (5%), middle (6-50%), and bottom (51-100%) segments of the cost acuity pyramid account for 40%, 55%, and 5% of the total healthcare expenditure, respectively, and these percentages stay stable across fiscal years 2011-2015. Increasing trends in total cost and average cost per patient and per encounter were detected through 2011-2015 based on linear regression analysis. The current CareSage predictive model that identifies patients at high risk of emergency transport in the coming 30 days has AUC=0.74 on the PHH population, whilst the new model that identifies patients at high risk of emergency admission in the coming 30 days has AUC=0.82. For prediction windows of one year, the PPV in the top 5% was also good: 63% and 67% for emergency transport and admission, respectively. Conclusions: Predictive models based on PERS and EHR data can identify patients at risk of emergency transports and admissions that account for high healthcare cost. Healthcare organizations can use the outcome of the predictive models to design relevant interventions targeting their high risk patients.

The Effects of National Cultural Traits on BOP Consumer Behavior

Scholars who aim to solve problems with poverty and a lack of resources often focus on bottom of pyramid (BOP) consumer groups. They propose that the traditional TOP (top of pyramid) business strategies are not suitable for BOP populations, and that it is crucial to determine and satisfy BOP consumption demands. The purpose of this study is to find out which factors influence BOP consumption, and to explore BOP integrated products. The concepts of “national cultural traits” and sustainable product design are also used. The findings will help enterprises learn how to make profits in BOP markets (addressing economic goals), while helping the poor get out of poverty (addressing social goals). Two different areas concerning BOP consumers are used to illustrate the results.

Pattern transfer to GaAs substrates and epitaxial growth of GaAs nanostructures using self-organized porous templates

GaAs nanostructures were grown on patterned GaAs (111) B substrates with molecular beam epitaxy. Nanopatterns were achieved by patterning a thin film of silicon dioxide (SiO2) grown on the substrate surface with a self-organized porous alumina template. Growth of patterned nanostructures took place through the holes in the SiO2 film. The authors obtained two kinds of nanostructures: nanopillars and nanodots. The majority of nanopillars had two kinds of tops, i.e., hexagonal flat top and pyramidal top, as observed with a scanning electron microscope. High resolution transmission electron microscopy studies showed epitaxial relationships between the nanostructures and the substrates. Photoluminescence measurements of nanopillars showed the photoluminescence peak shifted to a higher energy compared to films grown under the same condition.

Microscopic and Isotope Tracer Study on the Growth of Spherical ZnO Particles in Water–Ethylene Glycol Solvent

ZnO spherical powder with hierarchical structure was synthesized from zinc acetate anhydride and hexamethylenetetramine in a solvent of water and ethylene glycol (EG), and its time evolution was investigated by microscopic and isotope tracer studies. Initially, spherical ZnO particles made of nanocrystallites were precipitated. From the early growth stage, crystallites were radially aligned along the c-axis. With aging, the nanoparticles transformed into hexagonal prism-like particles with pyramidal tops, which showed clear radial alignment. Subsequently, the ZnO spheres became cracked and broke into wedge-shaped pieces of the pyramid-like particles. The microscopic studies suggested that the spherical particles grew through oriented attachment of small particles during the early growth stage, while Ostwald ripening through dissolution–recrystallization changed the component particles to a pyramidal shape in the later stage. In order to investigate the growth process, we attempted a novel isotope tracer study, where H218O was used for the solvent and the distribution of 18O in the spherical particles was analyzed by a secondary ion mass spectrometer. The concentric 18O distribution in the ZnO spherical powder aided the mechanism of continuous concentric-oriented attachment of nanoparticles to form spherical ZnO particles. The difference in the 18O distribution before and after transformation into the pyramid shape was small, which implies that this change was a local reaction. The oxygen isotope tracer study in water–EG solvent was proven effective in determining the history of the particles and the development of their inner structures.

Phase and structure development of spontaneously ambient-grown ZnO·xH2O and TiO2·xH2O nanostructures towards oxide single crystals

Stress-induced spontaneously ambient-grown orthorhombic ZnO·xH2O and monoclinic TiO2·xH2O nanostructures transform into single-crystalline wurtzite ZnO and polycrystalline brookite TiO2.