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Background: We previously introduced the concept of “two-stage” (or “just-in-time”) informed consent for randomized trials with usual care control. We argued that conducting consent in two stages—splitting information about research procedures from information about the experimental intervention—would reduce the decisional anxiety, confusion, and information overload commonly associated with informed consent. We implemented two-stage consent in a low-stakes randomized trial of a mindfulness meditation intervention for procedural distress in patients undergoing prostate biopsy. Here, we report accrual rates and patient understanding of the consent process. Methods: Patients approached for consent for the biopsy trial were asked to complete the standard “Quality of Informed Consent” questionnaire to assess their knowledge and understanding of the trial. Results: Accrual was excellent with 108 of 110 (98%) patients approached for consent signing first-stage consent. All 51 patients randomized to the experimental arm and who later presented for biopsy signed second-stage consent and received the mindfulness intervention. Quality of Informed Consent data were available for 48 patients assigned to the mindfulness treatment arm and 44 controls. The mean Quality of Informed Consent score was similar in the meditation and control arms with and overall mean of 75 (95% confidence interval = 74–76) for the knowledge section and 86 (95% confidence interval = 81–90) for understanding, comparable to the normative scores of 80 and 88. On further analysis and patient interview, two of the Quality of Informed Consent questions were found to be misleading in the context of a two-stage consent study for a mindfulness intervention. Excluding these questions increased knowledge scores to 88 (95% confidence interval = 87–90). Conclusion: We found promising data that two-stage consent facilitated accrual without compromising patient understanding of randomized trials or compliance with allocated treatment. Further research is needed incorporating randomized comparison of two-stage consent to standard consent approaches, measuring patient anxiety and distress as an outcome, using suitable modifications to the Quality of Informed Consent questionnaire and trials with higher stakes.

Conductive elastomeric nanocomposites (CEMs) were prepared in two stages to control the precision of pressure sensors. Carbon-based nanofillers such as multi-walled carbon nanotubes (MWCNT) or graphene (GR) were added to the rubber matrix. For Rubber/MWCNT composites, unfunctionalized (U-MWCNT) and –COOH functionalized MWCNT (F-MWCNT) fillers were synthesized. The properties of the CEMs and the synergistic improvements between the fillers and rubber matrix in composites were also investigated. SEM images show that F-MWCNT fillers were dispersed homogeneously in the composites and they interacted with rubber better than other carbon fillers. The piezoresistivity properties of the CEMs before and after compression were determined using the four-probe method by cyclic loading in 1 mm increments between 1.5 mm and 3.5 mm. F-MWCNT filled composites had higher strength than others when they were compressed by 2.5 mm. The F-MWCNT and GR filled nanocomposites possessed the best resistivity for pressure sensors when compressed at 2.5 mm (for F-MWCNT 1.1E + 08 Ω, GR 5.28E + 06 Ω). These nanocomposites are promising pressures sensors for air suspension systems.

This paper proposes a hybrid aperiodic sampled-data mechanism for the control of interconnected subsystems with time-delay. The proposed aperiodic sampled-data mechanism comprises of two stages. In the first stage, the next sampling instant for each subsystem is computed using self-triggering strategy. Thereafter, in the second stage, an event-triggering condition is checked at these sampling instants for each subsystem and signal is transmitted to the controller only if the event-triggering condition is violated. Further, to reduce the computational complexity involved in the proposed triggering mechanism, another triggering mechanism with integrated event-triggering and self-triggering is developed. Also, an upper bound on delay for each subsystem is computed to ensure the stability of distributed networked control system. The results proposed are validated using a simulation example. A comparison of the proposed technique with other triggering mechanisms in terms of sampling instants, number of transmissions to the controller, maximum delay bound and other performance measures is drawn through simulation example.

A novel approach for modeling and simulation of cutting force and power consumption in relation to chip geometry has been proposed in end milling‌ of AISI D2 steel. It is carried out in two stages: experimental work and finite element method based numerical simulation. In the first stage, experiments are conducted on the AISI D2 steel at two levels of spindle rotational speed, axial depth of cuts and four levels of feed per tooth using 10 mm and 8 mm diameter mill cutters. Cutting forces and amplitude of cutter vibration are measured in X and Y directions. Mechanistic models in terms of chip geometry and cutting force coefficients are developed to predict cutting forces and power consumption relative to chip geometry at 30°, 60° and 90° of cutter rotation. In the second stage, numerical simulation is carried out to predict cutting forces and power consumption relative to chip geometry at 30°, 60° and 90° of cutter rotation and compared with estimated values of cutting forces and power consumption. The maximum error between the two approaches for the cutting forces in X and Y directions and power consumption is estimated as 10.80%, 8.33% and 7.70% respectively. At spindle rotational speed of 2000 rpm, 0.3 mm of axial depth of cut and 50 µm of feed per tooth, the cutting forces and cutting power consumption are found minimum.

The ‘6-week check’ is a head-to-toe assessment that forms part of the newborn and infant physical examination (NIPE). This NHS screening programme comprises two stages: the neonatal component takes place within 72 hours of birth, usually before discharge home, and the infant examination is performed between 6 and 8 weeks of age, typically in the community by the GP. The NIPE aims to detect abnormalities of the eyes, heart, hips and testes, and to ensure appropriate follow up of positive findings. It also presents an opportunity for care providers to monitor a child’s general health and development, and to provide information, health promotion, and support to parents and carers. This article seeks to describe in more detail the background and purpose of the infant check, to provide a systematic approach for performing the examination with a focus on four key conditions and to recommend referral pathways for positive findings.

Background Bilateral carotid artery stenting (BCAS) is often performed in two stages (staged BCAS) but it is also an option to be performed in one stage (simultaneous BCAS). To confirm the safety of simultaneous BCAS, we retrospectively analyzed perioperative and postoperative course of simultaneous BCAS compared with staged BCAS. Materials and methods Patients with symptomatic stenosis of ≥50% or asymptomatic stenosis of ≥80% of bilateral carotid arteries underwent BCAS. Procedure time, symptomatic ischemic complications, presence/absence of high-intensity spots on postoperative diffusion-weighted image, duration of postoperative hospital stays and 30 days outcome of patients performed with simultaneous BCAS (group A, 8 patients with 16 stenotic lesions (8 procedures)) were compared with those of staged BCAS (group B, 4 patients with 8 stenotic lesions (8 procedures)). Results In groups A and B, procedure time was 146.0 ± 53.8 and 103.5 ± 39.4 min; intraoperative hypotension was observed in 62.5% and 50.0%; postoperative hypotension occurred in 37.5% and 50.0%; diffusion-weighted image showed high-intensity spots in 37.5% and 12.5%; and duration of postoperative hospital stays was 5.1 ± 1.8 and 5.3 ± 2.3 days. No patients suffered symptomatic ischemic complications. In simultaneous BCAS, there was a tendency that procedure time was longer and high-intensity spots on postoperative diffusion-weighted image was more frequent, but there was no increase in symptomatic ischemic complications and duration of hospital stays compared to staged BCAS. Conclusions Safety of simultaneous BCAS may not be inferior to staged BCAS. In terms of duration of hospital stays, simultaneous BCAS can be superior to staged BCAS for patients with bilateral carotid artery stenosis.

Poland’s local governments, introduced into the public administration system in two stages in 1989 and 1999, have become important actors in the development policy conducted at the national and local levels. Setting up voivodeships—the third-level units of local government—was particularly significant for building strong foundations for a comprehensive regional policy in Poland. Voivodeships create the conditions needed for the long-term economic and social development of their territories. That is why voivodeships should be governed by visionaries rather than administrators. The direct responsibility for regional development planning and programming positions their leaders as the coordinators of development activities in the region and the wise investors of EU funds. Their role must be reflected in the appropriate coordination of development activities at the local level and the ability to offer territorially sensitive financial tools to local communities.

This visual essay uses photographs to present the changes undergone by labour in a typical village of Romania. The images were captured in two stages, in 2004 and in 2017, when the authors attempted re-photographing the same frames representing the pursuit of several occupations. The essay reveals some household chores which did not undergo any change at all, as well as others that disappeared altogether. The essay also reveals the major changes undergone by specialized labour during this 13-year period.

Causal mediation analysis seeks to decompose the effect of a treatment or exposure among multiple possible paths and provide casually interpretable path-specific effect estimates. Recent advances have extended causal mediation analysis to situations with a sequence of mediators or multiple contemporaneous mediators. However, available methods still have limitations, and computational and other challenges remain. The present paper provides an extended causal mediation and path analysis methodology. The new method, implemented in the new R package, gmediation (described in a companion paper), accommodates both a sequence (two stages) of mediators and multiple mediators at each stage, and allows for multiple types of outcomes following generalized linear models. The methodology can also handle unsaturated models and clustered data. Addressing other practical issues, we provide new guidelines for the choice of a decomposition, and for the choice of a reference group multiplier for the reduction of Monte Carlo error in mediation formula computations. The new method is applied to data from a cohort study to illuminate the contribution of alternative biological and behavioral paths in the effect of socioeconomic status on dental caries in adolescence.

Structural integrity assessment procedures to assess the effect of interaction between multiple adjacent flaws normally consist of two stages. First, alignment rules categorize non-coplanar flaws as aligned or non-aligned. Second, combination rules classify aligned flaws as interacting or non-interacting. Although these criteria are applied to different failure modes like brittle fracture, elastic–plastic fracture and plastic collapse, most of them were developed based on linear elastic fracture mechanics for the sake of simplicity. However, there are very limited references available for the technical background of these criteria. This lack of justifying backgrounds becomes more critical when applying these procedures to any other failure modes other than brittle fracture. This article studies the interaction between non-coplanar edge notches in scenarios of large deformation. Hereto, strain patterns are studied through full-field deformation measurements utilizing both experimental and numerical tools. Digital image correlation is used to measure strain during experiments and to verify the finite element analyses. The results show that in addition to the crack driving force, which represents a local response of notches, the global strain distribution within the specimen in terms of strain patterns can be used to probe the interaction between non-coplanar flaws. The authors suggest a novel criterion based on the trajectory of maximum equivalent strain to distinguish between aligned and non-aligned flaws. This study is based on double-edge notched tension specimens and gives a fundamental insight into flaw interaction in failure modes other than brittle fracture.

The paper describes a novel computational approach to refine continuum models for penetration calculations which involves two stages. At the first stage, a trial continuum model is used to model penetration into a concrete target. Model parameters are chosen to match experimental data on penetration depth. Deformation histories are recorded at few locations in the target around the penetrator. In the second stage, these histories are applied to the boundaries of a representative volume comparable to the element size in large scale penetration simulation. Discrete-continuum approach is used to model the deformation and failure of the material within the representative volume. The same deformation histories are applied to a single element which uses the model to be improved. Continuum model may include multiple parameters or functions which cannot be easily found using experimental data. We propose using mesoscale response to constrain such parameters and functions. Such tuning of the continuum model using typical deformation histories experienced by the target material during the penetration allows us to minimize the parameter space and build better models for penetration problems which are based on physics of penetration rather than intuition and ad hoc assumptions.

This descriptive, cross-sectional study investigated problems experienced by patients after undergoing a thyroidectomy. The study included 60 first-time, post-thyroidectomy patients diagnosed with benign thyroid disease from a university hospital’s general surgery clinic in Ankara, Turkey. The data were collected in two stages: interviews with patients on the first day following surgery and postoperative follow-up telephone interviews in each of the first 4 weeks following surgery. The follow-ups revealed that patients principally experienced varying degrees of pain and difficulties in connection with work and recreation, communication, body image, and movement, for up to 4 weeks after surgery. These results showed that patients were particularly prone to problems on the first day and during the first week of the postoperative period; therefore, patients should be provided with follow-up telephone interviews to facilitate easier recovery and to help them overcome any problems experienced during the postoperative period.

Smartphones have penetrated rapidly and mobile shopping provides promising market opportunities for retailers. However, little is known about mobile shopping patterns and inferring these patterns from online shopping may provide misleading insights. We combine mobile log data and a mobile panel survey, and examine two stages in mobile shopping: the possession of shopping applications (hereafter, apps) and the purchase via shopping apps. Our exploratory investigation of mobile data and its empirical analyses provide three substantive findings. First, online experience and mobile experience both positively relate to the possession of shopping apps. Second, browsing behavior for non-shopping apps helps understand the possession of shopping apps as it reflects user preferences for acquiring more apps. Third, purchasing decisions are explained by digital experience (i.e., online experience and mobile experience) and browsing information from shopping apps, with other factors being of little predictive value. The implications for mobile retailing research and practice are discussed.

Five successive stages are identified that characterize the process of explanatory model building in economics. Moving across the first three from an initial image, to the model’s preliminary formalization, and then to its operationalization, requires the successive introduction of assumptions that remove the model farther and farther from the reality on the basis of which the initial image was created. It is argued that by ignoring the first two stages, important implications of the Stage 3 assumptions may be hidden. The revelation of these implications may lead to the reconsideration or rejection of the model.

The primary aim of micro and small enterprises in a developing economy is creation of employment opportunities and eradication of poverty. The present study is to examines the performance of female owned micro and small enterprises (MSEs) in North Gondar Zone, Ethiopia. To reach out the stated objective, data were collected through survey questionnaire from the population of 14,571 MSEs operating in the Zone, using two stages of sampling; purposive and simple random. The result depicts that gender of the operator has no significant relationship with the performance of MSEs in the study area. While common factors are hindering the performance of male and female owned MSEs, specifically, female owned MSEs’ performance was positively affected by completion of secondary education and formal business skills training. It also observed that female owned enterprises, operating and merchandising, have shown significantly positive performance.

The kinetics of extraction of dibutyl sebacinate by different grades of motor fuel from rubberised fabric based on a blend of nitrile rubbers SKN-26M and SKN-40M was investigated. The kinetics was determined according to the GOST 9.030-74 standard from the change in weight of the specimen after holding in fuel at 50°C and drying. The change in quality of the fuel after contact with the fabric was recorded from the change in the content of existent gum in fuel according to GOST 1567-97 (ISO 6246-95) and its acidity according to GOST 5985-79 before and after contact with the rubberised fabric. It was shown that the process of extraction proceeds in two stages, the time of the first of which under experimental conditions is not dependent on the type of fuel. The rate of the first stage is much higher than the rate of the second stage. The relation of rates and proportion of extracted fuel at the first and second stages depends on the type of fuel. It can be asserted that the surplus amount of extracted substances is made up of impurities, which include residual monomer or its derivatives and substances used in the synthesis of the rubber. The mechanism of extraction with extractant counterflow into the vulcanisate and its dependence on the grade of petrol is proposed, based on allowance for the diffusion processes in the system.

Ecological momentary assessment (EMA) was used in 24 adults with mild-to-moderate hearing loss who were seeking first hearing-aid (HA) fitting or HA renewal. At two stages in the aural rehabilitation process, just before HA fitting and after an average 3-month HA adjustment period, the participants used a smartphone-based EMA system for 3 to 4 days. A questionnaire app allowed for the description of the environmental context as well as assessments of various hearing-related dimensions and of well-being. In total, 2,042 surveys were collected. The main objectives of the analysis were threefold: First, describing the “auditory reality” of future and experienced HA users; second, examining the effects of HA fitting for individual participants, as well as for the subgroup of first-time HA-users; and third, reviewing whether the EMA data collected in the unaided condition predicted who ultimately decided for or against permanent HA use. The participants reported hearing-related disabilities across the full range of daily listening tasks, but communication events took the largest share. The effect of the HA intervention was small in experienced HA users. Generally, much larger changes and larger interindividual differences were observed in first-time compared with experienced HA users in all hearing-related dimensions. Changes were not correlated with hearing loss or with the duration of the HA adjustment period. EMA data collected in the unaided condition did not predict the cancelation of HA fitting. The study showed that EMA is feasible in a general population of HA candidates for establishing individual and multidimensional profiles of real-life hearing experiences.

This paper highlights a new method for the detection of ischaemic episodes using statistical features derived from ST segment deviations in electrocardiogram (ECG) signal. Firstly, ECG records are pre-processed for the removal of artifacts followed by the delineation process. Then region of interest (ROI) is defined for ST segment and isoelectric reference to compute the ST segment deviation. The mean thresholds for ST segment deviations are used to differentiate the ischaemic beats from normal beats in two stages. The window characterization algorithm is developed for filtration of spurious beats in ischaemic episodes. The ischaemic episode detection is made through the coefficient of variation (COV), kurtosis and form factor. A bell-shaped normal distribution graph is generated for normal and ischaemic ST segments. The results show average sensitivity (Se) 97.71% and positive predictivity (+P) 96.89% for 90 records of the annotated European ST-T database (EDB) after validation. These results are significantly better than those of the available methods reported in the literature. The simplicity and automatic discarding of irrelevant beats makes this method feasible for use in clinical systems.

Background: Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses’ reaction to dilemma such as moral distress is relatively less noticed. Objective: This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses. Research design: This study applied Q methodology to explore the perspectives of nurses regarding moral distress. Data were collected in two stages. First, in-depth interviews were conducted to collect nurses’ opinions. Sentences that best fit the concepts of moral distress were extracted for the construction of Q statements. Second, nurses subjectively ranked these Q statements so that the relevant severity of moral distress could be determined using Q sorts. The study participants were nurses at a regional teaching hospital in northeast Taiwan. A total of 60 participants were invited to rank 40 moral distress Q statements. Ethical considerations: The study protocol was approved by the institutional review board of National Yang-Ming University Hospital. Only the participants who signed an informed consent form participated in the study. The respondents’ right to withdraw from the study was respected. Findings: Five types of responses were identified regarding the nurses’ perspectives. These types were “conflict with personal values,” “excessive of workload,” “curbing of autonomy,” “constraint engendered by organizational norms,” and “self-expectation frustration.” Conclusion: The findings regarding nurses’ experiences of moral distress can be used to construct multifaceted policies and solutions and to incorporate ethical education in training programs.

Railway vehicle homologation with respect to running dynamics is addressed via dedicated norms that require the knowledge of the accelerations and wheel–rail contact forces obtained from experimental computational testing. Multibody dynamics allows the modelling of railway vehicles and their simulation on realistic operations conditions. However, the representativeness of the multibody models, and the results of their use in railway dynamics are greatly influenced by the modelling assumptions and their ability to represent the operational conditions. In this paper, two alternative multibody models of a railway vehicle are presented and simulated in a realistic railway track scenarios to appraise the consequences of different modelling assumptions on the railway dynamic analysis outcome. A vehicle–track interaction compatibility analysis is performed afterwards according to norm EN 14363. The analysis consists of two stages: the use of a simplified method, described in the norm for the identification of the different performance indexes from the railway vehicle dynamic analysis outcome; and the visual inspection of the vehicle motion with respect to the track via dedicated visualization tools. The results of the virtual vehicle homologation tests are presented and discussed in face of the modelling assumptions used, being significant differences identified between the railway vehicle modelled with cylindrical joints with clearances or with equivalent force elements. It is also concluded that the use of clearance joints prevents the need to use modelling assumptions on the equivalent force elements that have limited or no physical meaning, thus reducing the number of modelling parameters for which a high level of abstraction has to be exercised.

Drawing on fieldwork – a set of observations carried out over several years in the presence of conductors and musicians during rehearsals, concerts, and recording sessions, and in-depth interviews with conductors such as Claudio Abbado, Laurence Equilbey, and Claire Gibault – this article seeks to answer, from a sociomusicological perspective, the following question: How is a musical interpretation constructed within a collective body made up of a conductor and musicians? The central hypothesis leading to observation of music-being-made is that it is a collective creative activity. This is what we shall discover in two stages: first, by examining how the authority of the conductor is negotiated in the course of such a collective effort; then, by setting forth various facets by which it is possible to comprehend a process of shared creativity. We shall then approach the role of relays in the orchestra, phenomena of self-regulation, spontaneous interventions of musicians, as well as the process of cooperation. At least, the observation shows how the conductor plays a crucial but not solitary role. This is indeed a collaborative sort of work in multiple dimensions, in which the participation and role of each player is incessantly renegotiated, and in which in fine the meaning given to the musical entity is knit together. Creativity abounds in the heart of initiatives borne by each of the participants and takes form in their synergy.

This study explored issues, paradoxes, concerns, and practices regarding issues of interpretation and translation in qualitative research, which concern scholars in cross-cultural/cross-language studies. This study focused on two stages of research work. In the first, a bilingual dissertation was rewritten as a play and installation, and performed in three different venues, with the purpose of introducing audiences to the political crises in South America surrounding desaparecidos, the thousands of citizens who disappeared into the prisons of dictators. The second round of research was carried out through interviews with Spanish and Chinese doctoral students who conducted research and presented it bilingually. The conclusions can be applied to any cross-language study, but especially dissertation studies conducted by PhD students, and such bilingual studies, which address social problems in the international students’ home countries, have broad implications for enhancing and strengthening social justice beyond the boundaries of the United States.

The article provides new empirical evidence on the impact of economic globalization on the efficiency of the banking sector. The analysis is confined into two stages. In the first stage, we employ the bias corrected data envelopment analysis method to compute the efficiency of individual banks during the period 1999–2008. We then use bootstrap regressions to examine the impact of economic globalization on bank efficiency, while controlling for the potential impacts of contextual variables. The empirical findings indicate that liberalization (restrictions) of the trade and capital account exerts positive (negative) influence on the efficiency of Malaysian banks. Likewise, the impacts of better personal contacts and information flows seem to work in favor of Malaysian banks’ efficiency. The empirical findings also bring forth the importance of cultural proximity in determining the efficiency of banks operating in the Malaysian banking sector.

Drop-the-losers designs have been discussed extensively in the past decades, mostly focusing on two-stage models. The designs with more than two stages have recently received increasing attention due to their improved efficiency over the corresponding two-stage designs. In this paper, we consider the problem of estimating and testing the effect of selected treatment under the setting of three-stage drop-the-losers designs. A conservative interval estimator is proposed, which is proved to have at least the specified coverage probability using a stochastic ordering approach. The proposed interval estimator is also demonstrated numerically to have narrower interval width but higher coverage rate than the bootstrap method proposed by Bowden and Glimm (Biometrical Journal, vol. 56, pp. 332–349) in most cases. It is also a straightforward derivation from the stochastic ordering result that the family-wise error rate is strongly controlled with the maximum achieved at the global null hypothesis.

This study measured the durations of Japanese obstruent geminates/singletons and their adjacent vowels (V1 and V2) embedded in words repeatedly spoken by four intermediate-level Taiwanese learners of Japanese. The results indicated that the four learners were more or less at a native-like level in terms of geminate lengthening, but not in terms of the V1/V2 duration ratio. These findings suggest that for Chinese learners of Japanese, the learning of Japanese geminates consists of two stages: geminate/singleton phonemic contrast learning, followed by V1/V2 phonetic contrast learning. It is suggested that explicit instruction may be effective at the second stage.

A new method for exploiting natural gas from methane hydrates, which combines carbon dioxide replacement and depressurization, was investigated in a 288-ml high-pressure vessel of 288 ml. Experimental results with and without depressurization were compared to reveal the effects of depressurization on the final replacement percentage. Results showed that the CH4–CO2 replacement reaction could be divided into two stages. The first stage lasts for about 4 h and can be described as the surface reaction stage; the reaction in this stage is rapid, and the results fit the Avrami model. In the second stage, the rate of the reaction is slow due to hydrates blocking the diffusion pathways. As the replacement reaction is restricted by the diffusion and transportation of CO2, partial melting of methane hydrates through depressurization enhances the second stage. This is because the melting of methane hydrates provides pathways for CO2 to penetrate into the inner layer of the hydrates. The combined method improves the replacement percentage. However, the effects of depressurization on the stability of the sediments remain to be explored.

In 2005, the Illinois Tollway staff rehabilitated a 33-mi-long segment of Interstate Highway 88 in Illinois by rubblizing deteriorated jointed plain concrete pavement (JPCP) and placing a hot-mix asphalt (HMA) overlay on the rubblized JPCP. The pavement design called for the ultimate pavement structure to be constructed in two stages: the first at the time of rubblization, when at least 6.0 in. of HMA would be placed, and the second 10 years later, when 2.0 in. of HMA would be cold milled and 6.0 in. of HMA placed back. The pavement design called on the tollway staff’s experience with rubblization and research surrounding the fatigue endurance limit to develop a staged construction strategy. The strategy would reduce up-front construction costs by placing a minimum of 6.0 in. of HMA at initial construction. The tollway staff was confident that the strategy would work, but the pavement performance was monitored annually for verification. Annual monitoring included pavement distress condition surveys, deflection testing and deflection data analysis, and pavement coring. In particular, the tollway staff desired confirmation that the staged construction strategy would yield a perpetual asphalt pavement by controlling the amount of bottom-up fatigue cracking that would develop in the asphalt mat. After 9 years of observations and data analysis, the staff has confirmed the pavement is exhibiting the properties of a perpetual pavement and the staged construction strategy should ultimately prove successful.

Background: The coronary no-reflow (NR) phenomenon, which is associated with poor clinical outcomes, is usually referred to as a post-percutaneous coronary intervention (PCI) state. NR can occur in different stages of the PCI procedure, not only including the post-stenting stage, but from balloon pre-dilation to pre-stenting. The clinical significance of NR in the different stages of the PCI procedure is unclear. The purpose of the current study was to analyze the clinical and angiographic characteristics, the prognosis for NR patients in the aforementioned two stages and to determine the predictors of NR in the early stage. Methods: Between January 2009 and December 2013, a total of 420 consecutive patients with ST-segment elevation myocardial infarction (STEMI) underwent primary PCI. Sixty-three patients (15%) with NR constituted the study population. The patients were divided into an early NR group and a subsequent NR group. The clinical and angiographic findings were compared between the two groups. Multivariate logistic regression was used to determine the predictors for early NR. The long-term clinical outcomes after PCI were analyzed. Results: Regarding the baseline characteristics, we identified that the early NR group had statistically significant effects on the higher percentage of diabetes mellitus (42.9% vs. 20%), lower admission systolic blood pressure (SBP) (102.2±8.3 mmHg vs. 110.5±7.6 mmHg), higher percentage of Killip classification III (71.4% vs. 45.7%,) and longer reperfusion time (7.1±2.3 h vs. 5.88±2.2 h) compared to the subsequent NR group. There were significant differences between the two groups with respect to the percentage of initial thrombolysis in myocardial infarction (TIMI) flow 0/1 (64.3% vs. 37.1%), target lesion length (31.4±13.6 mm vs. 20.5±17.3 mm) and thrombus score ⩾4 (67.9% vs. 42.9%; pConclusion: Early NR patients during primary PCI have more severe baseline clinical and angiographic characteristics, as well as a poorer long-term prognosis.

As part of a broader industrial project, the first two stages of a Cognitive Work Analysis (CWA, Work Domain Analysis [WDA] and Control Task Analysis [ConTA]) were completed for Long Haul Commercial Road Transport. To support the potential uptake of CWA by different stakeholders within the industrial organization, parts of the ConTA Contextual Activity Template (CAT) were truncated. The goal of the current, exploratory study, was to identify which stakeholders within the industrial organization could benefit from using the WDA or CAT for either their Strategic (Research) or Product (Development) planning, and over what time horizon. We observed differences in the perceived usefulness of the WDA and the CAT between the different stakeholders. Innovative solutions to the issues raised should significantly enhance the industrial use of Cognitive Work Analysis.

Although research on synaesthesia has blossomed in the last decades, few things are known about inherited sound-colour synaesthesia and processes underlying synaesthetic perception. In this study we investigated how the auditory pitch, the frequency range, the complexity, as well as the structure of the sound affected the synaesthetic visual attributes of chroma, colour brightness, colour plurality and density. A distinct mapping was observed between sound features and visual characteristics, which suggests that visual stimulation requires sensory auditory processing. We propose that congenital synaesthetic perception involves two stages of processing: initially the sensory auditory information is processed by the primary auditory cortex, and then it is distributed to the secondary and extrastriate visual brain areas, generating visual stimulation. This process does not necessarily involve the participation of brain areas responsible for associative thinking.

Based on the conceptual analysis, the study examines the features of cognitive barriers and their impact on information seeking. The study resulted in a typology specifying six sub-types of cognitive barriers: unwillingness to see one’s needs as information needs, inability to articulate one’s information needs, unawareness of information sources, low self-efficacy, poor search skills and inability to deal with information overload. The sub-types were reviewed at two stages of the information-seeking process: identifying and articulating information needs; and selecting and accessing information sources. The impact of cognitive barriers is mainly negative because they block, limit or hamper information seeking, or give rise to negative reactions such as frustration. Cognitive barriers can also impact positively by helping the individual to concentrate on a few, good enough sources of information.

Nonradiographic axial spondyloarthritis (SpA) and radiographic SpA (also known as ankylosing spondylitis) are currently considered as two stages or forms of one disease (axial SpA). The treatment with tumor necrosis factor-α (TNFα) inhibitors has been authorized for years for ankylosing spondylitis. In recent years, most of the anti-TNFα agents have also been approved for the treatment of nonradiographic axial SpA by the European Medicines Agency (EMA) and similar authorities in many countries around the world (but not in the US), increasing the number of possible therapies for this indication. Data from several clinical trials have demonstrated the good efficacy and safety profiles from those anti-TNFα agents. Presently, a large number of patients achieve a satisfactory clinical control with the current therapies, however, there remains a percentage refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) and TNFα inhibitors; therefore, several new drugs are currently under investigation. In 2015, the first representative of a new class of biologics [an interleukin (IL)-17 inhibitor] secukinumab, was approved for the treatment of ankylosing spondylitis; a clinical trial in nonradiographic axial SpA is currently underway. In this review, we discuss the recent data on efficacy and safety of TNFα-inhibitors focusing on the treatment of nonradiographic axial SpA.

This study examines support for climate adaptation planning and the role of perceived risk, uncertainty, and trust on adaptation of U.S. coastal communities. This assessment is based on the analysis of web-based questionnaires ( n = 137) among state, local, and non-government organization (NGO) planners in Alaska, Florida, and Maryland. Ordinal regression and correlation analysis were used to assess which factors are related to support for adaptation during two planning stages. Findings from this study suggest the influence of perceived risk, uncertainty, and trust on support for climate change adaptation (CCA) varies across two stages of adaptation planning (support for the development of plans and willingness to allocate human and financial resources to implement plans). The disaggregation of planning entities into different study areas and levels of management revealed significant differences in the relationship between perceived risk, uncertainty, and trust and support for CCA planning. These findings have implications for the design of communication and engagement strategies.

This article examines the relationships between prison structure, researcher access to prisons, and scholarship about prisons. Drawing on the author’s own work over more than 10 years as a prison educator, legal advocate, and prison researcher, as well as on the scholarship of other prison researchers throughout the social sciences, the article argues that prisons resist scrutiny at two stages. First, prisons are structurally and bureaucratically closed off from research; second, prison researchers are emotionally disconnected from their work. These two layers of obfuscation maintain the prison as a social “black site”: physically located outside of our communities, invisible to the public and the researcher alike. In an effort to overcome these barriers, this article outlines a mixed method, collaborative approach to prison research and discusses the ethical and emotional challenges of this approach. By identifying the major obstacles to meaningful prison research, as well as some possible strategies to overcoming these obstacles, this article seeks to make such work more feasible for investigators in many disciplines.

The aim of this study was to develop a children's version of the Cantonese Hearing in Noise Test (CHINT-C). This was accomplished in two stages. First, a total of 120 sentences understood by children aged 6-7 years were selected from the original pool of CHINT sentences and were grouped into 12 lists, each containing 10 sentences composed of 10 characters. Following this, 260 primary and secondary school children, with ages ranging from 6 to 17 years, and 21 adults of age 18 or older were administered the CHINT-C to determine its reliability/validity, normative data, and age-specific correction factors. The result showed good interlist reliability, and test–retest reliability for the CHINT-C. The speech perception skills assessed using the CHINT-C do not reach adult level until after 11-13 years of age. Correction factors were established that could be used to determine age-specific norms for the evaluation of speech intelligibility of children in various sound fields.

IN THIS PAPER I provide a critical commentary of Elmer Thiessen's The Ethics of Evangelism. Following an overview of the book's project and strategies, I discuss two stages of the project in detail. The first is Thiessen's analysis of ‘religious proselytism’; the second is Thiessen's arguments that evangelizing can be a good thing to do in itself. Finally, I summarize what I think are the chief merits of the book and suggest for whom it will be of particular interest.

Previous research has demonstrated that persons with early to moderate stage dementia are capable of leading small group activities for persons with more advanced dementia. In this study, we built upon this previous work by training residents in long-term care facilities to fill the role of group activity leaders using a Resident-Assisted Programming (RAP) training regimen. There were two stages to the program. In the first stage, RAP training was provided by researchers. In the second stage, RAP training was provided to residents by activities staff members of long-term care facilities who had been trained by researchers. We examine the effects of RAP implemented by researchers and by activities staff member on long-term care resident with dementia who took part in these RAP activities. We also examined effects produced by two types of small group activities: two Montessori-based activities and an activity which focuses on persons with more advanced dementia, based on the work of Jitka Zgola. Results demonstrate that levels of positive engagement seen in players during RAP (resident-led activities) were typically higher than those observed during standard activities programming led by site staff. In general, Montessori-Based Dementia Programming® produced more constructive engagement than Zgola-based programming (ZBP), though ZBP did increase a positive form of engagement involving observing activities with interest. In addition, RAP implemented by activities staff members produced effects that were, on the whole, similar to those produced when RAP was implemented by researchers. Implications of these findings for providing meaningful social roles for persons with dementia residing in long-term care, and suggestions for further research in this area, are discussed.

The wear of a model metal-on-metal ball-and-socket total disc arthroplasty was measured in a simulator. The ball had a radius of 10 mm, and there was a radial clearance between ball and socket of 0.015 mm. The model was subjected to simultaneous flexion–extension, lateral bending, axial rotation (frequency: 1 Hz) and compression (frequency: 2 Hz, maximum load: 2 kN). Throughout the tests, the models were immersed in calf serum diluted to a concentration of 15 g protein per litre, at a controlled temperature of 37 °C. Tests were performed on three models. At regular intervals (0, 0.5, 1, 2, 3, 4 and 5 million cycles), mass and surface roughness were determined; mass measurements were converted into the volume lost as a result of wear. All measurements were repeated six times. Wear occurred in two stages. In the first stage (duration about 1 million cycles), there was a linear wear rate of 2.01 ± 0.04 mm3 per million cycles; in the second stage, there was a linear wear rate of 0.76 ± 0.02 mm3 per million cycles. Surface roughness increased linearly in the first million cycles and then continued to increase linearly but more slowly.

Two important issues in the analysis of association among financial markets are the degree of dependence and the underlying shape commanding the cross-market dependencies, so that any model used to describe this association must cope with both the issues. In the study presented in this article, we approach the modelling of dependence in two stages. The first stage is based on modelling the dependence between the returns of two assets by means of a single Archimedean copula, whereas the second one takes advantage of the mixture between copulas to gain the necessary flexibility to capture different tail dependence patterns. Both stages have been followed in modelling the dependence among the daily returns of seven Latin American country indices, a regional index and a worldwide index. Our findings have important implications for portfolio risk management. JEL Classification: G11, G15

The aim of this article is to show how a suspect’s statement travels through two stages of the criminal law process: the police interrogation and the trial, exhibited by two modes of production: talk and writing. I first discuss how the suspect’s statement is elicited and written down by the police in the police report; next I consider how the police report is made to form part of a legally adequate case-file; and finally I investigate the ways in which the judge quotes and refers to the police report in his questioning of the suspect during the trial. This step-by-step inspection of the trajectory of the suspect’s statement shows processes of de- and recontextualization. The suspect’s statement is written down so as to enable it to be taken out of one context (the police interrogation) and inserted into another (the trial). This means that old meanings are removed from the suspect’s statement and new meanings are added. In the courtroom, however, the judge treats the suspect’s written statement as his own individual production, irrespective of the interactional environment in which it was elicited. The suspect’s statement is taken out of one context, inserted into another context and treated as independent of context.

In the UK there is no Diet Quality Index (DQI) that enables estimates of diet quality to be made for children of different age groups. This paper discusses the methodological complexities of designing an appropriate DQI for children aged 10 years and under, using dietary data in the National Diet and Nutrition Survey (NDNS) in relation to UK dietary guidelines. Two stages of the process of developing this score are described. The final score was employed as an outcome measure in secondary analysis of the NDNS and as a means of sampling 48 case study children from the NDNS. This DQI, like all composite measures, produces a summary of overall dietary quality. This may mask individual components important for understanding the health impacts of children’s diets. However, DQIs are methodologically advantageous over ‘data driven’ dietary pattern approaches because they are based on existing knowledge of optimal dietary patterns and provide clear nutritional benchmarks for comparing dietary quality for population sub-groups. Our innovative scoring system enables children’s diets to be compared for different age groups relative to UK dietary guidelines and is appropriate for use in quantitative analysis and for assessing diet quality more qualitatively for small groups of children.

Fabric-based strain sensors have been developed using different technologies, among which flat knitting is one of the most effective and economical methods. However, knitted strain sensors are not often used in practical applications because the sensors usually exhibit large elastic hysteresis when they are deformed and subjected to stress during application. One possible approach to overcome these shortcomings is to introduce elastic properties at the yarn level by combining the conductive materials with elastic materials. In this paper, we demostrate a hybrid yarn made of a conductive yarn that winds around an elastic core yarn in a direct twisting device. The electro-mechanical properties of strain sensors knitted from the hybrid yarns were tested in order to characterize the sensors. This study consisted of two stages: the yarn preparation and the sensor characterization. In the first stage, two kinds of elastic core components (polyamide/Lycra and polyamide) and two kinds of conductive winding yarns (Bekinox BK50/1 and Bekinox BK50/2) were selected for twisting. The twisting was done with a constant twisting speed and four different numbers of twists. Mechanical properties, that is, the tenacity, force at break and elongation at break, were tested in order to determine the optimal parameters for producing the hybrid yarns. The results indicated that among the tested yarns those with a polyamide core and Bekinox BK50/1 winding yarns at 450 twist/meter and with a polyamide/Lycra core and Bekinox BK 50/2 winding yarns at 600 twist/meter had the best properties. These were thus selected as the materials for producing knitted strain sensors. In the second stage, electro-mechanical properties of the knitted strain sensors were determined under tensile stress and multi-cyclic tensile stress. The results show that the hybrid yarns can effectively enhance the electro-mechanical properties of the knitted strain sensors without compromising processiablity and comfortability.

In this study, chemically treated Alcell lignin was used as a compatibilizer in the preparation of polypropylene–oil palm empty fruit bunch (PP-EFB) composites. Basically, this study was divided into two stages. In the first stage, glycidyl methacrylate (GMA) and allyl glycidyl ether (AGE) were used to treat Alcell lignin in different ratios (1:1, 1:2 and 1:3) based on equivalent weight. Then, the treated lignin was used as a compatibilizer at different percentages (1%, 3% and 5%, based on the weight of EFB filler) in the preparation of lignocellulosic–thermoplastic composites. The size of the EFB filler used for this study was 53–180 µm and the ratio of PP to EFB filler was fixed at 40%:60% (based on weight). The results showed that the incorporation of GMA- and AGE-treated lignin had enhanced the mechanical properties and increased the hydrophobicity of lignocellulosic–thermoplastic composites. By comparison, those with the GMA-treated lignin exhibited better enhancement in mechanical properties as compared to those with AGE-treated lignin.

Cognitive work analysis is a widely applied method within Human Factors. To date, applications have mainly focused on the first two stages of the method - Work Domain Analysis and Control Task Analysis. The latter stages have been neglected and are consequently not as well developed methodologically. This paper proposes an approach for strategies analysis, the third phase, which builds upon the output of the earlier phases and provides a structured, repeatable method for identifying potential strategies for completing control tasks. An Apple iPod is used to exemplify and evaluate the proposed approach. Future directions include validation of the approach with more complex systems. Language: en

The results of an experimental investigation for the retrofitting of shear-damaged RC beams using diagonal CFRP strips are presented in this article. The experimental study consisted of seven shear-deficient, T-cross-sectioned, ½-scale, simply supported beam specimens. One beam is used as the reference specimen. The remaining six specimens are tested in two stages. At the first stage, specimens are shear damaged severely and the shear-damaged RC beams are retrofitted using diagonal CFRP strips by wrapping them around the beam in the shape of a ‘U’. Then, retrofitted beams are tested to failure. In this study, 50 mm wide CFRP strips are used with three different spacings such as sf = 125, 150, and 200 mm. One of the two specimens with the same spacing is tested with anchorages at the ends of the CFRP strips. Although the strips without anchorages improved the shear strength of the shear-damaged beam, they could not prevent the shear failure. Shear-damaged specimens that are retrofitted with anchoraged CFRP strips showed to improve the shear strength, and ductile flexural behavior was observed in them. When the CFRP strains of the strips with and without anchorages are compared, maximum strains at anchoraged strips are approximately 1.55 times larger than those without anchorages. Calculated shear load carrying capacity of the specimens, according to ACI 440 and FIB regulations, are approximately 2% larger than the experimental one.

The Community Coalition Action Theory (CCAT) blends practice wisdom with empirical data to explain how community coalitions achieve community change and community capacity outcomes. The current study uses data from an evaluation of 20 California Healthy Cities and Communities coalitions to test relationships between coalition factors and outcomes as predicted by CCAT in two stages of coalition development. Data are from two rounds of coalition member surveys, interviews with local coalition coordinators, and semiannual progress reports. Consistent with CCAT predictions and prior research, shared decision making and leadership were correlated with participation; staff competence, task focus, and cohesion were correlated with member satisfaction. Coalition size was associated with participation and dollars leveraged. Also, consistent with CCAT, diversity of funding sources was associated with new leadership opportunities and program expansion; dollars leveraged was correlated with new leadership opportunities and new partners. Findings provide preliminary support for many, but not all, of the relationships predicted by CCAT.

An adequate overview of the historical background and theoretical framework of Feminist Biblical Hermeneutics (FBH) discourse(s), especially in the last three centuries, requires a differentiation of two stages. First, a description of the historical background out of which an epistemological space for feminist discourse(s) is identified; and second, a description of the development in the theoretical articulation of the FBH discourse(s) per se once this space was established. An overview that addresses these two stages allows those who are interested in engaging feminist discourse(s) to appreciate and appropriate the key epistemological elements on which feminist discourse(s) are based.

Influenced by governmental policy, school psychological services in the Chinese mainland are a recent phenomenon with a history of only about 20 years, which can be divided into two stages: exploration and development. To give a comprehensive account of the development of school psychological services in the Chinese mainland, this article reviews their developmental history, analyses their status quo and features, identifies some contemporary problems, and suggests possible directions for the future development.

This article explores the concept of dispute systems design for workplace disputes, focusing particularly on the first two stages: organizational diagnosis and design. It argues that dispute systems should be designed in light of the conflict-related motivations and behaviors of personnel under existing conditions, as well as the likely consequences of each design choice on their future motivations and behaviors, including incentives to participate in the new system.These assertions are illustrated with an in-depth case study of Resolve Employment Disputes, Reach Equitable Solutions Swiftly (REDRESS®), the U.S. Postal Service (USPS) employment mediation program. The case study shows that the organizational diagnosis stage was critical to the successful design of the USPS program in that it provided important information about the dispute behaviors of personnel in the existing system. In turn, this information helped the USPS understand how various design choices would affect individual incentives to participate the future REDRESS® system.

In Alzheimer’s disease (AD), the presence of amyloid-β peptide may impair cell energy formation by altering both anaerobic and aerobic metabolism. This study aimed to estimate possible alterations in circulating energy substrates. In 54 community-dwelling AD subjects, fasting peripheral venous blood samples were drawn in the morning to determine the energy substrates lactate, pyruvate and ketone bodies (KBs, β-hydroxybutyrate and acetoacetate). Plasma lactate levels in the entire AD population were significantly lower than in healthy controls ( P 5 years. Moreover, both plasma lactate and pyruvate were lower in subjects with AD >5 years than in subjects with AD ⩽5 years ( P