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- typically explores specific and clearly defined questions that examine the relationship between events/occurrences
- Data could be gathered through surveys and questionnaires that are carefully developed and structured to provide you with numerical data that can be explored statistically and yield a result that can be generalised to some larger population

Quantitative research

- Exploratory and seeks to explain the ‘how’ and ‘why’ of a particular phenomenon

- Ex: Investigation of the ff:
*local knowledge and understanding of a given issue or programme
*people’s experiences, meanings and relationships
*social processes and contextual factors

Qualitative Research

Type of knowledge: subjective
Aim: Exploratory and observational
Characteristics: Flexible, Contextual portrayal, Dynamic, continuous view of change
Sampling: Purposeful

Qualitative Research

Data collection: semi-stuctured or unstructured
Nature of Data: Narratives, quotations, descriptions, value of uniqueness, particularity
Analysis: Thematic

Qualitative Research

Type of knowledge: Objective
Aim: Generalizable and testing
- Fixed and Controlled
- Independent and dependent variable
- pre- and post- treatment of change
Sampling: Random

Quantitative research

Data collection: Structured
Nature of Data: Numbers and Statistics
Analysis: Statistical

Quantitative research

Data can be classified into two broad categories:

Qualitative Data: Characteristics or traits for which numerical value can not be assigned e.g. motivation, confidence, honesty integrity etc.

Quantitative Data: Characteristics or traits for which numerical value can be assigned, are called variables, e.g. Achievement Intelligence Aptitude, Height, Weight etc

1. They should be collected through standardized tests
*If self-made test is used it should be reliable and valid

2. They are highly reliable and valid
*Therefore, generalization an conclusions can be made easily with certain level of accuracy

3. They can be easily interpreted with scientific accuracy

- The level of significance can also be determined
- The scoring system of this type of data is highly objective
- Its use is always based upon the purpose of the study
- Inferential statistics can be used

Four different levels of measurement namely:

- Nominal scale
- Ordinal scale
- Interval scale
- Ratio scale

- Least precise or crude of the four basic scales of measurement
- These are qualitative data which are mutually exclusive and exhaustive and do not mean hierarchy
- Numerals represent category or classification labels only

Nominal scale

- There is no particular order assigned to them
- The frequency or numbers are used to give a name to something that may be used for determining percent, mode
- Example: sex (male does not mean being better than female); boys and girls; pass and fail; rural and urban

Nominal scale

- More precise scale than the nominal scale
- Allows the assignment of values by arranging the observations in relative rank order
- No value is assigned to the distances to the positions of ranking
- Example: Economic class (low, middle, upper), scale of severity (none, mild, moderate, severe, very severe).

Ordinal scale

- More precise and refined scale than nominal and ordinal scales
- Has all the characteristics and relationship of the ordinal scale, besides which distances between any two numbers on the scale are known

Interval Measures

- The intervals between numbers are equal but not related to true zero
- They do not represent true quantity
- Example temperature, calendar years

Interval Measures

- Has the properties of interval scale plus two additional characteristics:
*This scale has a true, rather than arbitrary ‘zero’. It is possible to indicate the complete absence of property
*Ex: The zero point on a centimeter scale indicates the absence of height

Ratio scale

- Has the properties of interval scale plus two additional characteristics:
*The ratio scale numerals have the qualities of real numbers, and can be added, subtracted, multiplied; or divided

Ratio scale

Reporting of Quantitative Data

- Units - Ex: number of staff that have been trained; number of children enrolled in school for the first time
- Prices - Ex: amount of money spent on a building, or the additional revenue of farmers following a seed distribution programme
- Proportions/percentages - Ex: proportion of the community that has access to a service

Reporting of Quantitative Data (2)

- Rates of change - Ex: percentage change in average household income over a reporting period
- Ratios - Ex: ratio of midwives or traditional birth attendants to families in a region
- Scoring and ranking - Ex: scores given out of ten by project participants to rate the quality of service they have received

Quantitative Data Collection

- Surveys and questionnaires
- Biophysical measurements (Ex: height and weight of a child)
- Project records (Ex: the number of training events held and the number of participants attending)
- Service provider of facility data

- Measurement instrument for assessing individual’s attitudes, beliefs, behavior or attributes
- Before constructing your questionnaire be clear about its purpose and the information you want to get

Design of the questionnaire can be split in to three elements:

- Determine the questions to be asked
- Select the question type for each question and specify the wording
- Design the question sequence and overall questionnaire layout

- A key link needs to be established between the research aims and the individual questions via the research issues
- Issues and questions can be determined through a combined process of exploring the literature and thinking creatively

Determine the Questions to be Asked

- limit the responses and the information to be collected to the available choices
- Advantage is that coding and analyses are often easy
- To avoid losing information it is best for close-ended questions to include all possible answers
*If this is not possible include “others and specify” as one of the choices

Close- Ended Questions

- Allow the researcher to obtain greater information especially on attitudes and opinions
- Coding and analyses are often difficult
- Ex: What do you usually use as guide for managing your patients?

Open- Ended Questions

The most appropriate questionnaire will probably be a combination of __

both open and close-ended questions

Some general rules can be stated on question wording:

- Be concise and unambiguous
- Avoid double questions
- Avoid questions involving negatives
- Ask for precise answers
- Avoid leading questions

- Avoid jargon
- Ex:
“Kayo po ba ay naniniwala na lahat ng bata ay nararapat na ma-immunize?”
“Kayo po ba ay naniniwala na lahat ng bata ay nararapat na mabakunahan?”

Be Concise and unambiguous

- Check for ambiguity and make sure that the answer may be competently answered
- Ex:
Kayo po ba ay nagkalagnat ng mga nakaraan araw?
Kayo po ba nagkalagnat ng mga nakaraang isang linggo?

Be Concise and unambiguous

- Ex:
Do you eat a balanced diet and exercise regulary__ Yes _NO
Do you eat a balanced diet? __ Yes _NO
Do you exercise regularly? __ Yes _NO

Avoid Double Questions

- Ex:
“Kayo po ba ay hindi naniniwala na lahat ng bata ay nararapat na mabakunahan?”

Avoid questions involving negatives

- Leading questions such as “Do you agree with the majority of people that the health service is failing?” should be avoided for obvious reasons that any right-minded individual can see. Don’t you agree?

Avoid leading questions

- Designed to elicit the interviewee’s knowledge or perspective on a topic
- Individual interviews, which can include key informant interviews, are useful for exploring an individual’s beliefs, values, understandings, feelings, experiences and perspectives of an issue
- Allow the researcher to ask about a complex issue, learning more about the contextual factors that govern individual experiences.

Interviews: Advantages

- Usually yield richest data, details, new insights
- Permit face-to-face contact with respondents
- Provide opportunity to explore topics in depth
- Allow interviewer to experience the affective as well as cognitive aspects of responses
- Allow interviewer to explain or help clarify questions, increasing the likelihood of useful responses
- Allow interviewer to be flexible in administering interview toparticular individuals or in particular circumstances

Interviews: Disadvantages

- Expensive and time-consuming
- Need well-qualified, highly trained interviewers
- Interviewee may distort information through recall error, selective perceptions, desire to please interviewer
- Flexibility can result in inconsistencies across interviews
- Volume of information very large; may be difficult to transcribe and reduce data

- Organised discussion between 6 to 8 people
- Provide participants with a space to discuss a particular topic, in a context where people are allowed to agree or disagree with each other
- Allow you to explore how a group thinks about an issue, the range of opinions and ideas, and the inconsistencies and variations that exist in a particular community in terms of beliefs and their experiences and practices
- Recruit participants for whom the issue is relevant (purposive recruitment)

Focus Groups

- defined as a group of people with a common characteristic such as place of residence, religion, gender, age, use of hospital services, or life event (such as giving birth)

Types of Population based on permanency of membership

- Fixed population
- Dynamic or open population

- Population whose membership is permanent
- Membership is always defined by a life event
- Ex: the people who were in Hiroshima, Japan, when the atomic bomb exploded at the end of World War II are members of a fixed population.
*This population will never gain any new members because only people who were at this historical event can be members

Fixed population

- Membership is defined by a changeable state or condition, and so is transient
- A person is a member of a dynamic population only as long as he or she has the defining state or condition
- Ex: Population of the city of Manila is dynamic because people are members only while they reside within the city limits

Dynamic or open population

- Turnover is always occurring because people enter the city by moving in or by birth, and people leave the city by moving away or by death
- include groups defined by geographic and hospital catchment areas, religious groups, and occupations

Dynamic or open population

- describes a situation in which the number of people entering the population is equal to the number leaving

Steady state

- is usually based on a combination of physical and pathological examinations, diagnostic test results, and signs and symptoms
- Which and how many criteria are used to define a “case” (a person who meets the disease definition) has important implications for accurately determining who has the disease

definition of a disease

Measuring Disease Occurrence: Three factors to consider

- Number of people that are affected by the disease
- Size of the population from which the cases of disease arise
- Length of time that the population is followed

*Failure to consider all three components will give a false impression about the impact of the disease on a population.

Three types of calculations are used to describe and compare measures of disease occurrence:

- Ratios
- Proportions
- rates

- simply one number divided by another
- Entities represented by the two numbers are not required to be related to one another
- Individuals in the numerator can be different from those in the denominator.
- Ex: “sex ratio” - ratio of two unrelated numbers; the number of males divided by the number of females, usually expressed as the number of males per 100 female

- One number divided by another, but the entities represented by these numbers are related to one another
- The numerator of a proportion is always a subset of the denominator
- Also known as fractions, are often expressed as percentages and range from 0 to or 0% to 100%.
- Ex: the proportion of U.S. residents who are black is the number of black residents divided by the total number of U.S. residents of all races

- one number divided by another, but time is an integral part of the denominator
- Ex: speed rate

Two basic measures of disease frequency

- Incidence
- Prevalence

- defined as the occurrence of new cases of disease that develop in a candidate population (population at risk) over a specified time period
- deals with the transition from health to disease

Two types of Incidence

- Cumulative incidence
- Incidence rate

- May also be called as Incidence proportion
- the proportion of a candidate population that becomes diseased over a specified period of time
- Possible value ranges from 0 to 1 or, if expressed as a percentage, from 0 to 100%

Cumulative Incidence/ Cumulative risk

Number of new cases of disease / Number in candidate population over a period of time

Cumulative Incidence/ Cumulative risk

- Time is not an integral part of this proportion but rather is expressed by the words that accompany the numbers of the cumulative incidence measure
- Can be thought of as the average risk of getting a disease over a certain period of time
- Generally, the cumulative incidence over a long period of time (such as a lifetime) will be higher than that over a few years
- is usually reserved for fixed populations

Cumulative Incidence/Cumulative risk

- the occurrence of new cases of disease that arise during person-time of observation
- The incidence rate’s denominator integrates time (t), and so it is a true rate

Incidence Rate

Incidence Rate

Number of new cases of disease/Person-time of observation in candidate population

- its dimension is 1/t or t-1
- possible values range from zero to infinity
- Person-time is accrued only among candidates for the disease.
- A person contributes time to the denominator of an incidence rate only up until he or she is diagnosed with the disease of interest

Incidence Rate

- It is not based upon the assumption that everyone in the candidate population has been followed for a specified time period
- Person-time is accrued only while the candidate is being followed
- Accrual of person-time stops when the person dies or is lost to follow-up

Incidence Rate

Relationship Between Cumulative Incidence and Incidence Rate

CI = IRi x Ti
where CI is cumulative incidence, IRi is incidence rate, and Ti is the specified period of time.

- measures the frequency of existing disease
defined as the proportion of the total population that is diseased
- Two types
*point prevalence
*period prevalence

- refers to the proportion of the population that is diseased at a single point in time
- can be thought of as a single snapshot of the population
point can be either a particular calendar date such as December 1, 2005 or a point in someone’s life such as college graduation

Point Prevalence

Point Prevalence

Number of existing cases of disease/Number in total population at a point in time

- refers to the proportion of the population that is diseased during a specified duration of time, such as during the year 2005
- includes the number of cases that were present at the start of the period (for example, January 1, 2005) as well as the number that developed during the period (for example, January 2 through December 31, 2005).

Period Prevalence

Period Prevalence

Number of existing cases of disease/Number in total population during a period in time

- Unlike the numerator for the two incidence measures, the prevalence numerator includes all currently living cases regardless of when they first developed
- The denominator includes everyone in the population— sick, healthy, at risk, and not at risk
- Because prevalence is a proportion, it is dimensionless and its possible values range from zero to one, or 0 to 100%

This equation assumes that the population is in steady state (that is, inflow equals outflow) and that the incidence rate and duration do not change over time.

P (1-P) = IR x D

If the frequency of disease is rare (that is, less than 10%), the equation simplifies to:

P = IR x D

Uses of Incidence

- Evaluation of the effectiveness of programs that try to prevent disease from occurring in the first place
- Researchers who study the causes of disease prefer to study new cases over existing ones because they are usually interested in exposures that lead to developing the disease
- Many researchers prefer to use incidence because the timing of exposures in relation to disease occurrence can be determined more accurately

Uses of Prevalence

- useful for estimating the needs of medical facilities and for allocating resources for treating people who already have a disease
- Researchers who study diseases such as birth defects (where it is difficult to gather information on defects present in miscarried and aborted fetuses) and chronic conditions such as arthritis (whose beginnings are difficult to pinpoint) have no choice but to use prevalence

- Total number of deaths from all causes per 100,000 population per year

Crude mortality (or death) rate

- Number of deaths from a specific cause per 100,000 population per year

Cause-specific mortality (or death) rate

- Total number of deaths from all causes among individuals in a specific age category per 100,000 population per year in the age category

Age-specific mortality (or death) rate

- Number of existing or new cases of a particular disease or condition per 100 population

Morbidity rate

- Number of deaths per number of cases of disease.

Case fatality rate

Experimental Studies in Humans – Clinical Trials
(Purpose of Experiments)

- To draw conclusions about a procedure or treatment
- To determine whether there is a difference between the different groups

- Experimental drug or procedure is compared with another drug or procedure (placebo or another drug)

Controlled Trials

- Studies in which the investigator’s experience with a drug or treatment is described
- No comparison with another group

Uncontrolled Trials

- The direct comparison of two or more treatment modalities in human groups
- A method of evaluating treatment
- Uses the experimental design

Clinical Trials

- Subjects exposed to the treatment and to a comparator (placebo or standard treatment)
- Subjects and Researchers “blinded” to the actual exposure
- Specific outcomes are measures and compared using statistical analysis to determine significant effects

Clinical Trials

Risk of Disease With Drug A (Rt)

Rt = A / A+B

Risk of Disease w/out Drug A (Rc)

Rc = C / C+D

Relative Risk

Rt / Rc = Relative Risk

*Risk of Disease with tx relative to control

Absolute Risk Reduction

Absolute Risk Reduction = ARR = Rc – Rt

Relative Risk Reduction (RRR)

RRR = ARR / Rc

*Decreased Risk of Developing Disease due to Tx

Number Needed To Treat

NNT = Number Needed To Treat = 1/ARR

- The clinical decision making process is based on probabilities.
- The purpose is to increase the probability of disease towards 100%.
- may affect treatment plans or subsequent diagnostic tests.
- When the estimated likelihood of a disease is close to 100%, the disease is confirmed

Diagnostic Testing

Diagnostic Testing

1. History taking
2. Physical Examination
3. Tests are usually ordered to confirm a clinical impression
4. Tests may also be ordered to assess the severity of the illness, to predict disease outcome, or to monitor response to therapy.

The most definitive diagnostic method is referred to as the __.

“gold standard”

Characteristics of Diagnostic Tests

Screening Tests – must be sensitive
Confirmatory Tests – must be specific
Cutoff point – the point at which a test changes from negative to positive
Accuracy: Sensitivity, Specificity
Estimates of Probability: PPV, NPV, LR

- is defined as the percentage of persons with the disease of interest who have positive test results

Sensitivity of a test

Sensitivity = A / A+C x 100

- is defined as the percentage of persons without
the disease of interest who have negative test results

Specificity = D / B+D x 100

Tests with a high sensitivity are useful clinically to __.

rule out a disease

Tests with a high specificity are used to __.

confirm the presence of disease

- is defined as the percentage of persons with positive test results who actually have the disease of interest

Positive Predictive Value

Positive Predictive Value

+ Predictive Value = A / A+B x 100

- is defined as the percentage of patients with a negative
test result and do not have the disease of interest

Negative Predictive Value

Negative Predictive Value

- Predictive Value = D / C+D x 100

- is the probability of that test result in patients with disease………
- probability of that test result in patients without the disease

Likelihood Ratio of a positive test

Likelihood Ratio of a positive test

= sensit / 1 – specif
= A/A+C divided by B/B+D

Types of Clinical Studies

Case Series
Cross-sectional Survey

Case-Control Study Cohort Study

Experimental: Clinical Trials

- CLINICAL QUESTION: What happened?
- Rare diseases
- Illnesses with long latency periods
- Evaluation of a wide range of potential etiologic exposure

Case-Control Study

- means a group of subjects followed over a period of time
Main Objectives :
- To describe the incidence of certain outcomes over time (DESCRIPTIVE)
- To analyze associations between risk factors and those outcomes (ANALYTICAL)

Cohort Study

- CLINICAL QUESTION: What will happen?
- Sample of subjects without the outcome of interest
- Predictor variables measured
- Subjects followed over a period of time
- Most effective way to establish the temporal sequence of predictor and outcome variables

Prospective Cohort Study

- Sample of subjects with the outcome of interest
similar to the prospective cohort study except that baseline measurements, follow-up, and outcomes all happened in the past
- Only possible if there is adequate data on the risk factors and outcome

Retrospective Cohort Study

- Exposure status and Disease status are measured at one point in time
- Useful for chronic illnesses (gradual onset, long duration)
- Prevalence studies
- Less costly than cohort studies

Cross-Sectional Studies

Why do we order Laboratory Examinations?

- Plan an intervention
- Monitor response to therapy
- Estimate risk of future events
- Determine prognosis in patients with a known disease.
- To diagnose the presence or absence of a particular condition

In articles regarding diagnostic tests, the diagnostic modality o f interest is usually compared with a reference standard to check its accuracy

Reference Standard

- Yardstick with which the performance of the test is measured
- Ideally
*test that gives the information nearest to the “truth”
*test that can unequivocally establish presence or absence of the disease in question

Reference Standard

- proportion of persons with disease who correctly have a positive test, i.e. a/(a+c);

Sensitivity (sn)

- proportion of persons with no disease who correctly have a negative test, i.e. d/(b+d).

Specificity (sp)

- measure of how much the likelihood of disease changes given a test result
- Could be computed from sensitivity and specificity
LR (+) = Sn/1‐Sp
LR (-) = 1‐Sn/Sp

Likelihood ratio (LR)

Strength of test by likelihood ratio

LRs >10 or

- Have very few false negatives, therefore virtually all negative tests must occur in non-diseased people
- It is Negative in Health (NIH)
- A sensitive test rules out disease – and the mnemonic is SnOut (Sensitive = ruled Out)
- For screening especially for serious diseases that are easily treated, we want to do a sensitive test

Highly sensitive test

- Have very few false positives, therefore any positive tests must occur in diseased people
- It is Positive in Disease (PID)
- A specific test rules in disease – and the mnemonic is SpIn (Specificity = ruled In).
- For detection of disease not easily treated or for which the treatment is potentially dangerous, we want a highly specific test
- For confirmation of disease

Highly specific tests

- larger group to which the study results are to be generalized
- Ex: If one is studying a new drug for the treatment of hypertension, the target population is all the hypertensive patients in the world

Target Population

- representative group from the target population

Study or sample population

- Any inferences from a sample refer only to the defined population from which the sample has been properly selected
- Ex: If a sample of doctors in the Philippines was found to follow guidelines only 30 % of the time, can we say that all doctors all over the world are follow guidelines only 30 % of the time?

Study Population

For the study population to be clearly defined, we should be guided by the following questions:

- What or who should be the study population?
- When and where should the study population be recruited?
- How should the study population be selected?

- Exact characteristics of the study population must be defined
- Should correspond to the characteristics of the target population
- This is usually stated as an inclusion and exclusion criteria

What and who should be the study population

- A statement indicating when and where the study population will be recruited is oftentimes necessary
- Ex: “Patients consulting for low back pain at the Family Medicine Clinic of the Manila Doctors Hospital between the period January 1 to December 31, 2017 will be recruited for the study”.

When and where the study population be recruited

- method of selecting the study/sample population

Two categories of Sampling

- Probability sampling /Random Sampling
- Non-probability sampling

- Also called Random sampling
- When random sampling is used, each element in the population has an equal chance of being selected (simple random sampling) or a known probability of being selected (stratified random sampling)

Probability Sampling

- The sample is representative because the characteristics of a properly drawn sample represent the parent population in all ways
*Remember: To make accurate inferences, the sample has to be representative

Probability Sampling

- made by non-random methods
- target population is difficult to identify
- This may not be a limitation when generalization of results is not intended
*The results would be valid for the sample itself (internal validity)

Non-probability sampling

- Another limitation of non-random samples is that statistical inferences such as confidence intervals and tests of significance cannot be estimated from non-random samples

Non-probability sampling

Examples of Probability Sampling

- Simple random sampling
- Systematic sampling
- Cluster sampling
- Multi-stage sampling
- Stratified sampling
- Disproportional Sampling

- Every individual in the population being sampled has an equal likelihood of being include.
- Basis of all good sampling techniques
- Disallows any method of selection based on volunteering or the choice of groups of people known to be cooperative

Simple random sampling

- Identify all individuals from whom the selection will be made
- Assign a number to each individual in the list
- Select certain numbers by reference to random number tables which are published in standard statistical textbooks or generated by statistical software such as EPI INFO, Excel

Simple random sampling

- Identify all individuals from whom the selection will be made
- The total number in the list is divided by the sample size to get the sampling interval.
- Randomly select a starting point in the list and include the subject in the list at every sampling interval.

Systematic Random Sampling

This is equal to simple random sampling as long as the list is not arranged in a particular order

Systematic Random Sampling

- Studies may be carried out on large populations which may be geographically quite dispersed
- In such cases, clusters may be identified and random samples of clusters will be included in the study
- Every member of the cluster will also be part of the study.

Cluster Sampling

- This introduces two types of variations in the data – between clusters and within clusters – and this will have to be taken into account when analyzing data
- Cluster sampling may produce misleading results when the disease under study itself is distributed in a clustered fashion in an area.

Cluster Sampling

- Strict random sample may be difficult to obtain and it may be more feasible to draw the required number of subjects in a series of stages
- In this type of sampling primary sample units are inclusive groups and secondary units are sub-groups within these ultimate units to be selected which belong to one and only one group

Multi-stage Sampling

- The accessible population is first divided into nonoverlapping strata such as range of age, sex, economic status etc
- In each strata subjects are randomly selected either by simple or systematic random sampling

Stratified Random Sampling

- If different strata have different size, sampling can be done whose size is proportional to the size of the strata that may lead to different sizes between different strata.

Disproportional Sampling

Examples of Non-Probability Sampling

- Convenience Sampling
- Purposive Sampling
- Snowball Sampling
- Quota Sampling

- simply use participants who are available at the moment
- quick, inexpensive, and convenient
- Ex:
In shopping malls or airports, individuals are selected as they pass a certain location and interviewed concerning issues, candidates, or other matters.
Phone surveys may be based on anyone answering the phone between the hours of 9 A.M. and 5 P.M.

Convenience Sampling

- Researcher selects a certain subject because they fulfill some specific criteria
- Pick out the sample is picked out in relation to some criterion, which are considered important for the particular study.

Purposive sampling

- Subject who was already included are asked to identify others who also have the same requisite characteristics

Snowball Sampling

- This technique is often used by market researchers and those taking political polls
- The intent is to select a sample whose frequency distribution of characteristics reflects that of the population of interest

Quota Sampling

- Decide the group interest
*Dictated by the nature of the problem being investigated
For issues of national interest, frequently used subsets are age, race, sex, socioeconomic level, and religion.

- Know the percentage of individuals making up each subset of the population

- Match these percentages in the sample.
*For example, if you were interested in ethnic groups, and knew their population percentages, you would select your sample so as to obtain these percentages

- Choose within each subgroup
*Often individuals are selected in the sample on the basis of availability
*Quotas could be selected through knocking on doors, telephoning numbers, or sending mailings until the sample percen tages for subsets match those of the population

Quota Sampling

- Process in which each subject is given the same chance of being assigned to the different study groups.
- Purpose is to make the groups comparable with respect to known and unknown variables that might affect the outcome of the study

- One method to do this is through toss of a coin.
*If the coin turns up heads the subject is assigned to A, if the coin turns up tails the subject is assigned to B
- Another simple randomization procedure can be done using the table of random numbers

Simple Randomization

- Blocked randomization is used to avoid imbalance in the number of subjects assigned to each group
- If 20 subjects will be randomized to two groups using simple randomization might result to 12 subjects being assign to one group and 8 to the other

Block Randomization

- In blocked randomization each block, say 4, is designed to have equal number of A and B by enumerating the possible combinations of 2 A’s and 2 B’s (AABB, ABAB, ABBA, BAAB, BABA, BBAA).
- The combinations are then selected at random until all 20 subjects are randomized

Block Randomization

- prognostic factors that may affect the outcome such as age, severity of illness etc. are identified.
- They are then divided into different strata such as less than 20 as the first strata, 20-50 as the second strata, and greater than 50 as the last strata.
- The subjects in each strata are then randomized (simple or blocked) to their group assignment

stratified randomization

The formula to be used for estimating the sample size may depend on:

- Type of the study
- Outcome to be measured

The __ describes the purpose of the study, the importance of the research question, the methodology and justifies the feasibility of the project

Purposes of Research Proposal

- Represents the synthesis of the researcher’s critical thinking and the scientific literature to ensure that the research question is refined enough to be studied
- Serves as an application for review by peers, administrative committees or funding agencies
- Enhance communication among colleagues who may be co-investigators
- Serves as guide throughout the study to ensure that the researchers follow the outlined rules of conducting the study

General Rules (Research Proposal): Word of Choice

- Words chosen should be simple, precise, necessary and familiar
*Highly technical and scientific terms should be used less often and only when necessary
*Avoid jargon or inventing new words by adding suffixes or prefixes to familiar words.

- Use few abbreviatons as least as possible

General Rules (Research Proposal): Sentence Structure

- Use simple and direct sentences.
*This can be done if the core or the message is conveyed in a simple sentence structure

- Avoid piling of nouns into noun cluster

- Avoid putting too many ideas in one sentence.
*A sentence should only talk about one thing at a time.

- Aim for a mean sentence length of no more than 20 words per sentence.

General Rules (Research Proposal): Paragraph Structure

- Should convey an organized idea
- Continuity of these ideas must be clear.
*Paragraph should have a definite structure.
*It should be started with a topic sentence followed by a series of logically arranged supporting sentences

- Contains key words found in the study objectives or the research question
- Describes the main idea of the project
- Serves to orient the reviewer as to what he or she is about to read
- Should be not so brief that it says nothing or leaves some things hanging, but it should not be so long that a reviewer has to think hard to figure out what it means

- Name of investigators (main investigator first and not the most senior), their institution and addresses
- Limit authors who will actively participate in the study from planning, conduct of the study, analysis and writing the final paper.

List of investigators

- Should not exceed 300 words, single spaced and following standard structure:
- Objectives – state the main question of the study
- Study design – describe design as to the appropriate use of randomization, blinding and temporal direction
- Setting – indicate the study setting (hospital, clinic, community)
- Patients/participants – state selection procedures, entry criteria and numbers participants entering and completing the study

Protocol abstract

- Interventions – describe the essential features of any intervention including their method and duration of administration
- Main outcome measures – primary outcome measures should be indicated as planned before data collection begins
- Data analysis
*state sample size and considerations for its calculation and exact level of significance
*State specific statistical methods to test difference or association
- Conclusion – state expected primary conclusions according to study objective along with the clinical application

Protocol abstract

- Should awaken the interest of the reader and prepare him or her to understand the paper.
- Should be direct to the point, specific rather than vague and general.
- Its structure is like a “funnel”.
*The broader mouth of the funnel represents topics known about the subject This is followed by topics not yet known. What is not yet known usually leads to the research question

- Research design or strategy
*state the design (randomized controlled trial, cohort or case-control, etc.)

- Sample population
*Define target population, demographic area, and how they will be selected
*Describe randomization if it will be done

- Describe how intervention will be given
- Describe the process of blinding if it will be done, how to encourage compliance and other co-intervention

Experimental intervention

- Specify outcome attributes being measured, how they will be measured, and ways of minimizing bias in its measurement

Outcome measurement

Analysis – specify the statistical analysis to be undertaken
Pilot study – describe how and to whom it will be done
Ethics – emphasize informed consent, confidentiality, insurance policy if any

- Should be designed according to ethical standards (amended Helsinki declaration)
- The form should be written in understandable language

Informed Consent

Informed Consent contains the following: (1-5)

1. A statement of the purpose of the study
2. Description of procedures both experimental and routine
3. Duration of the subject’s involvement in the study
4. Whom to contact in terms of adverse events or additional questions
5. Risks and discomfort associated with participation in the study

Informed Consent contains the following: (6-10)

6. Alternative appropriate treatment available in place of experimental treatment
7. Benefits the subject may expect from participation in the study
8. A statement that participation is voluntary
9. A statement guaranteeing confidentiality
10. A statement regarding compensation due to adverse events

Risks, Burdens and Benefits

Privacy and Confidentiality

- Participation by individuals capable of giving informed consent as subjects in medical research must be voluntary

Informed Consent

- an attribute or agent that is suspected to be related to the occurrence of a particular disease

Risk Factor

- The probability of developing the outcome without the exposure

Baseline Risk

HARM Studies

Particular Exposure > Undesirable Outcome

Harmful Exposures:

Behaviours (tobacco, alcohol, coffee)
Treatments (medications, radiation)
Patient characteristics (obesity, lifestyle)

Clinical Questions on Harm:

P : patient population at risk
E : exposure
O : outcome

Risk Factors / HARM

Genetic susceptibility / Race
Environment, Geographic location
Age, Sex
Personal lifestyle (hygiene, diet)
Medical Conditions
Medications, Household Items
Food and Drinks

- Essential for understanding the different approaches to prevention and control
- Useful in the formulation of hypothesis regarding the etiology of a disease

Natural History of Disease

(Stages in the natural history of disease)
- The disease has not developed but the groundwork has been laid by the presence of factors which affect its occurrence

1. Stage of susceptibility

(Stages in the natural history of disease)
- No manifest disease but pathogenic changes have started to occur

2. Stage of presymptomatic disease

(Stages in the natural history of disease)

- Sufficient anatomic or functional changes have occurred so that there are recognizable signs and symptoms of disease

3. Stage of clinical disease

(Stages in the natural history of disease)

- Residual defects of short or long duration leave the patient disabled to a greater or less extent

4. Stage of disability

Study Designs for HARM

- Randomized Controlled Trials
- Cohort Study
- Case-control study

Studies designed to test the likelihood of a cause-and-effect relationship between a risk factor and a disease are termed __.

hypothesis-testing studies

RCT for Harm:

- Highest Validity
- Low feasibiliy
- May be unethical to randomize to harmful exposures

Cohort Studies on HARM:

- Midway in validity because baseline characteristics rarely similar
- Statistical adjustments needed
- Big sample, long follow-up

Case-control studies on HARM

- Highest feasibility
- Good for rare outcomes
- No need for follow-up
- Need to ascertain past exposures

Validity Criteria in Harm Studies:

- Similarity in baseline characteristics
- Statistical adjustment for differences
- Unbiased criteria to determine exposure (recall bias?)
- Unbiased outcome measurement

Case Exposure Probability

Case Exposure Probability = Exposed cases/All cases
= A / A+B

Odds of case exposure

= A/A+B / B/A+B or = A/B

Odds of control exposure

Odds of control exposure = C/D

Odds Ratio (OR)

Odds Ratio (OR) = A/B ÷ C/D = AD / CB

How precise is the estimate of risk? Use 95% Confidence Interval

- When interval ends are on the side of benefit (1), exposure increases the odds of the outcome
- When one end is 1, the study in inconclusive. Exposure has no effect on the outcome when ends show small unimportant reductions.

Issues affecting applicability

Biological Issues
- Sex
- Co-morbidities
- Race
- Age
- Pathology

Socio-economic Issues

Estimating impact of a harmful exposure on individual patients

Step 1: Estimate baseline risk or pre-exposure risk in percent
Step 2 : Convert the baseline risk to baseline odds (Assume 2% risk)
Step 3: Multiply baseline odds by the Odds Ratio to get the post-exposure odds
Step 4: Convert post-exposure odds to post-exposure risk in percent


Why Can't We Figure Out How to Be Happy?

It shouldn't be this hard, but, yeah, it is.

Practice makes perfect—T-ball wisdom for the ages.

Happiness, as far as anyone can tell, is no exception.

The New York Times ran an op-ed this Sunday arguing that advising someone to be his or her most authentic self is kind of bullshit. "Just be yourself"—what if your "self" isn't all that great? Do you still give being better a hard pass? As the piece notes, studies have found that the most authentic, true-to-themselves people often don't advance in their careers, and when they express authentic emotions, it can be seen as signs of weakness, especially for women.

Advertisement - Continue Reading Below

The author suggests sincerity, not authenticity, is the best policy. Sincerely, only you know yourself, so it's your business if you want to be a happier, more successful self. Sincerely, you can learn from imitating others. Sincerely, you can practice exceeding your own expectations.

A second piece in the same section floated the idea that teaching ourselves to experience "emotional granularity" to deal with the bad stuff keeps us from spiraling into sadness. Basically, the brain physically reacts to feeling anguish, distress, and righteousness better than it does to just feeling "general badness," as the author found through his lab work. Complicated emotions are a better brain workout.

Just like recognizing our authentic self isn't always our best self, we have to recognize our authentic feelings are complex. We practice improving ourselves to do better in our careers and relationships—we try to change. We practice registering all emotions to make our brains stronger—again, we try to change.

But, since practice takes time to make perfect, here are five strategies to make yourself happy, right now, today:

1. Sit under a tree.

2. Check in with a friend.

3. Listen to this song.

4. Straighten your shoulders.

5. Smile. Simple as that.

Advertisement - Continue Reading Below
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Biomes Lesson Plan AnalysisAssessment

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¶ … thematic unit about Biomes. It is in summary an assessment for special education high school students who are capable of reading and writing. The thematic unit that needs to be investigated in this paper will be identified as Learning Target. A description of the thematic unit as well as the course objectives for this particular topic will be given. A summary/conclusion is given at the end.

Thematic Unit: Learning Target

Lesson Title: Biological elements

What are Biomes?

Biomes are defined as "the earth's major ecological communities." Biomes are classified according to the most common vegetation found in the area and characterized based on the adaptations of organisms to that specific geographical environment. The significance of biomes in the world should be estimated (The Worlds Biomes). In the history of life in the world, biomes have changed and moved numerous times, lately, human activities have significantly altered the composition and location of biomes. Therefore, the conservation of biomes should be an important concern to all.

Unit Description:

In this particular lesson students name or rather identify the major biomes in the world and study one biome and its characteristics. Students will also create a map showing the location and major characteristics of all the major biomes as part of their learning experience. Students will also have to write a paragraph describing the temperature and climate of each biome (Elements of Biology: Biomes).

Materials required:

A large world map

Multiple colored pencils and markers

An internet connected computer

Print resources such as encyclopedias and atlases

Elements of Biology: Biomes video

The lesson should begin by playing to the students the video titled: Elements of Biology: Biomes. The students should be told to focus and take notes of the following segments of the video "The Temperate Zone," "Tundra and Taiga," and "Deserts and Tropics." Upon the end of the video, a brief discussion should be held with the students concerning biomes. It is important to make sure that the students understand that a biome is basically a major ecological community that is characterized by its organisms defined by the prevailing climatic conditions. A class list should then be made with the participation of the students detailing the major biomes in the world. The students should then be separated in groups of five or six and each group should be assigned one biome on the class list. The groups should then be tasked to draw a map of the assigned biomes and include the following components in the map (Elements of Biology: Biomes):

The location of the biome

To code using different colors the climate and vegetation of the biome

To draw a representation of the animals that live in that particular biome

Enough time should be allowed to the students to work on the maps. The students should also be informed that they can find outline maps on this website: http://www.eduplace.com/ss/maps/. They should also be informed that there are numerous reference books such as atlases and encyclopedias that also have this information and that they should refer to such authentic material, too. After the groups of students have drawn the biome maps, each group should be told to write a paragraph that describes the biome and include information such as its temperature, climate and unique characteristics. In the next class, each group of students should share its map with the class through a presentation (Elements of Biology; Biomes). At the end of the presentations, the maps should be posted on the bulletin board so that students can have a visual display of the biomes and their diversity. This lesson should then be concluded by asking the students what they learned about biomes after completing the map-drawing activity. Questions such as, what do they understand now that they didn't understand before and if they now appreciate the diversity of the major regions of the world, should be asked. The students should also be asked to ponder on how geography affects the living conditions of people around the world. Finally, the students should be asked to write a report on the biome that they drew about.

The written reports should then be assessed in the following manner utilizing three-point rubric to examine their understanding during the lesson (Elements of Biology; Biomes).

3 points: For students, who identified all the seven biomes; created an accurate and informative map for their group and significantly contributed to the group's descriptive paragraph.

2 points: for students who identified at least five of the seven biomes; created an adequate map for their group; and contributed to the group's adequate/satisfactory paragraph.

1 point: for students who identified less than four of the seven biomes; did not contribute to the group for the creation of the map; and did not make any contributions to the group's paragraph.

Vocabulary To Be Included (Elements of Biology: Biomes):

Biome: A major ecological community that is characterized by its organisms and climate.

Desert: This is the driest biome; it is composed of arid lands often with sparse vegetation and not more than 10 inches of rainfall per year.

Deciduous forests: A biome found in North America, Western Europe, Australia, and Asia, it often features a moist, temperate climate.

Grasslands: A biome often found in temperate climates such as the American Midwest, steppes in Eurasia and the pampas of South America.

Savannah: A biome found in tropical latitudes featuring long dry seasons, grass, and shrubs.

Taiga: A biome that is located immediately south of the tundra featuring very low temperatures during winter, short seasons for vegetation growth and forests made of coniferous trees.

Tropical forest: A biome that is located near the equator characterized by a hot and wet climate.

Tundra: A biome found on the northernmost area of the globe featuring long and cold winters and very short summers.

Oceans: This is the largest biome in the world and it is comprised of extremely large water bodies that dominate two thirds of the surface of the Earth.

Other vocabulary to be covered should include rivers, mountains, and plains.

Instructional Objective:

2 CCL's that the unit is aligned to are (New York State P-12 Common Core):

Determine the context/meaning of the terms used in the text, including their connotative and figurative meanings; study the additive impact of word choices used in meaning and tone; for example how the language used brings out a sense of time and location, how it sets a friendly or formal tone)

1. The development of word knowledge is a slow and cumulative process that requires multiple exposures to those particular words. This does not just entail repeating the word and its definition or synonym many times but rather, it involves the students seeing and hearing the word in a variety of contexts. Students should have the ability to demonstrate their understanding by using the vocabulary in different contexts.

2. Students will have to have the capability of using the vocabulary learned in this unit and applying them when writing the descriptive paragraph on their maps.

3. Students will also have to demonstrate an understanding of the video (visual media) and specific words used within the context of the video as they are applied in this unit.

4. Finally, students will also have to demonstrate a comprehension or understanding of the vocabulary in their final written report describing the biome, they had been assigned.

Strong and thorough text-based evidence should be cited to support analysis of the meaning of the text both explicitly and in terms of inferences, and a determination of instances where the text leaves things uncertain.

1. A discussion should be done on the biome report regarding the effects of human activity on the biome and the factors that are contributing to the destruction of that particular biome (if any) and its populations (ALEX Lesson Plan). Students should have the capability of showing the impacts of humans on the biomes.

2. Students should also prove that they can properly cite texts they use in their reports.

3. If a text leaves matters uncertain students should have the ability to make proper inferences on what that could be the case.

4. Students should go through their notes during the lesson because these would form important parts of the report they are going to write. They should also be able to cite the materials shown in class.

1. The amount of detail given to students leaves very little room for "education." It does not allow sufficient participation of the students to draw out their unique skills or talents. There is not enough time or space for teachers to prepare a thorough curriculum or to accommodate for the students' varying developmental capabilities (Ravitch, 2012). In this lesson, for instance, there is a lot of use of prescribed media and not enough space for the teacher to say or teach what he or she personally knows about the subject.

2. Practically, preparations for examinations on common core standards will soon become the sole agenda or mission for school (Ravitch, 2012).… [END OF PREVIEW]

Lesson Plan Primary Sources Basic Information: This

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An unexpected contraction in the U.S. economy in the fourth quarter sent stocks in Europe and the U.S. lower on Wednesday, but helped keep the euro close to a 14-month high on expectations that the U.S. central bank will continue its easy monetary policy.

The Federal Reserve is expected to maintain asset buying at $85 billion a month when it concludes its meeting later in the day and stick to its commitment to hold interest rates near zero until unemployment falls to at least 6.5 percent from the current 7.8 percent.


Innovators Under 35 General Information

What is the difference between the regional lists of young innovators and the global list?

We believe that innovation can happen anywhere in the world. Since 2010, we have expanded our search for the most promising innovators by organizing regional editions of the Innovators Under 35 list. There are regional versions in Latin America, Europe, China, India, and Southeast Asia/Oceania.

MIT Technology Review celebrates the winners of these regional lists through editorial stories and events in their native country or region. Regional winners are also automatically considered for the global list.

Where do all the lists reside?

How is the list chosen?

Once all the nominations are in, the editors of MIT Technology Review winnow the group down to fewer than 100 finalists. The editors will solicit specific information from each finalist. This means that most nominees will not be asked for more information.

Do I have to participate in a regional competition to be selected for the global list?

No, that is not necessary.

Information for Nomination

I nominated someone for the Innovators Under 35 list and have not heard back from MIT Technology Review yet. What should I do?

You do not need to do anything. We will be in touch with the candidate directly if he or she becomes a finalist.

What are you looking for in the nominee description?

This should be a brief capsule summary of the technical work for which you believe the nominee deserves recognition, including an explanation of its impact, both within the nominee's field and in the wider world. Don't tell us that someone is innovative or accomplished in general. Point to something in particular that we can write about.

What is the age qualification?

The nominee must be under 35 by September 30 of the year of the award. For instance, if you are nominating someone now for the 2018 global list, he or she should turn 35 no earlier than October 1, 2018.

What do you mean by "affiliation(s)"?

This is simply the nominee's place of work or study. We provide multiple fields in case a nominee is both working professionally and studying for an advanced degree and in case a student or professor is founding a company. Please do not list professional memberships or the schools where a nominee has previously earned degrees. Past winners have come from startups, large companies, government agencies, and nonprofits, as well as from universities around the world. We encourage nominations from institutions of all types.

Whom should I list as references?

These should be advisors, supervisors, coworkers, or colleagues at other institutions who are familiar with the nominee's work and able to describe the work and its importance. These people should be willing and able to provide a short (approximately one-page) letter in support of the nominee, within two weeks of being asked.

Can a nominator be listed as a reference?

Yes! However, we might request a separate letter of support for the nominee.

Can I nominate candidates jointly—for example, a group of three cofounders?

Please submit a separate nomination for each individual.

Information Required from Finalists

How will MIT Technology Review contact finalists for additional information?

If you are selected as a finalist, you will be contacted by e-mail in mid- to late February. You will then have two weeks to submit all required materials and to ensure that reference letters have been submitted.

What information is required from finalists?

A current CV or résumé; a personal statement; date of birth (winners must be under 35 on September 30 of the year of the award); and the names of three individuals who can write brief reference letters, along with their contact information (email addresses and phone numbers).

What information should I include in my personal statement?

The statement should be a brief (300- to 500-word) first-person description of your work, including some technical detail about your innovation and how it could affect the world at large. It is also helpful to include links to media articles, peer-reviewed papers, company websites, etc.

What information is required for a reference letter?

Reference letters should be approximately one page long and should contain several paragraphs explaining how the writer knows the candidate and why he or she believes the candidate has done exceptional work.

In what form should a reference letter be submitted?

A reference can be completed and mailed on official letterhead or sent as an e-mail reply to the e-mail message that we will send.

What is the deadline to submit all required materials?

All materials, including reference letters, are due two weeks from the time finalists are notified.

Information for Existing Innovators Under 35ers

How do I provide more information for my profile?

We recognize that as time goes by, you may have updates and want to keep your profile current with the latest developments. We love hearing from our innovators! Please e-mail with any news, and let us know if you’ve moved organizations so that we can keep in touch.

Other Questions?

If you have any questions regarding the nomination process, please e-mail If you have any questions regarding the Innovators Under 35 community, email


1. Healthy  barefoot hooves start on the inside of the horse. If your horse has poor hoof quality or balance, look at what and how they are being fed. Excessive growth can be caused by an abundance of the wrong foods creating inflammation in the hooves and an accelerated rate of growth as the hoof tries to compensate and repair itself. Only it cannot grow a healthy hoof without the right balance if key nutrients . Trace minerals, Copper, Zinc, selenium, Vitamins E & A and Biotin, amino acids Lysine and Methionine are all critical to good hoof health.
  2. After doing extensive testing on the available forage in Southwest Washington with www.equi-analyitical.com , I have found the best supplement for hooves is www.californiatrace.com . There has not been a single sample of hay from east or west of the mountains to have adequate levels of Copper and Zinc to provide for growth of a healthy hoof !! California trace fed along with plain white salt on your choice of hay pellets with the addition of ground flaxseed or whole Chia seeds for an omega 3 fat source will improve the hoof.  (The photo above is a hay sampling probe that I carry in my truck should you want to send a sample of your hay to get tested. Please tell me  before the appointment if you want a hay test so I remember to bring the drill, lol)
  3. Feeding Hay from slow feed Bags or boxes to slow down the rate of consumption so the horse never goes without an almost constant stream of fiber in it's digestive tract. Equines are trickle feeders, they have a relatively small stomach but a large cecum, their fermentation vat for all that fiber !
  4. When the temperature drops in the winter, resist the urge to feed grain to "keep the horse warm". Feed additional hay and use water tank heaters or add warm water to encourage water consumption. The fermentation of fiber is what keeps a horse warm.Fermentation takes lots of water so the need for water goes up as the consumption of hay increases.
  5. The water source needs to be high quality. If you filter or treat your well water for your household needs, the horse needs the water to go through the same filtering/treatment process. High Iron levels can interfere with the absorption of key minerals in the body making all the time and money spent on a feed program could be going to waist.
  6. Restriction of fresh grazing to the early morning hours and use of a track system (often called a Paddock Paradise, a management system developed by Jamie Jackson) to encourage natural movement. Preserving the health of your available pasture for limited grazing increases the good nutrients and lessens the overall NSC% ( the measure of sugar and starch) in the grass plants. Then during the grazing season your horse will enjoy and get the benefits of healthy grass. Healthy grass is an excellent source of Omega 3 fatty acids , vitamin E& Vitamin A .
  7. call 360-880-3264 and talk with me about your feed management challenges and set up an appointment


Merseyside is one of the areas where sex offenders are most likely to live.

Figures show there were 1,658 registered sex offenders in the Merseyside police force area in March 2017, a rate of 133.4 per 100,000 people aged 10 and over - which is one of the highest rates in England and Wales.

This is the equivalent of one sex offender for every 750 people aged 10 and over, with the rate 24 per cent higher than the England and Wales average.

The number of sex offenders in Merseyside has risen by 8 per cent compared to 2016, and is 54 per cent higher than in 2010/11, when there were 1,079registered sex offenders.

The figures, released by the Home Office, cover offenders managed by Multi-Agency Public Protection Arrangements (MAPPA) aimed at preventing further offences.

Sex offenders are required to notify the police of certain details, with further notification required if any of those details change (sometimes referred to as ‘being on the sex offenders register’).

A legal challenge in 2010 means offenders can apply for a review of lifetime notification requirements, after at least 15 years for adults and 8 years for juveniles. Twelve offenders had these requirements revoked in 2016/17.

In 2016/17, 110 sex offenders in Merseyside were cautioned or convicted of a breach of notification requirements.

As well as this, one more serious sex offender was returned to prison for breaching their licence conditions.

Across England and Wales, there were 108 sex offenders per 100,000 of the population aged 10 and over on in March 2017. This is an increase
from 104 in March 2016 and continues a trend of successive annual increases.

The number of registered sex offenders per head of population has risen by more than two thirds (69 per cent) over the past 10 years, from 64 per 100,000 people aged 10 and over in 2006/07.

The increase in the number of sex offenders is influenced by sentencing trends, in which the number of people convicted of sexual offences is increasing.

Additionally, many sexual offenders are required to register for long periods of time, with some registering for life. This has a cumulative effect on the total number of offenders required to register at any one time.

MAPPA are a set of statutory arrangements to assess and manage the risk posed by certain sexual and violent offenders. The aim is to protect the public and prevent offenders from committing further offences.

MAPPA brings together the police, probation and prison services, as the responsible authority, working with other organisations such as social services, health trusts and local authorities.

Offenders eligible for MAPPA are identified and information is gathered and shared about them across relevant agencies. The nature and level of the risk of harm they pose is assessed and a coordinated risk management plan is implemented to protect the public.


Managing Technological Innovation unit 7

Unit 7 Assignment

Utilizing your Final Project's organization, answer the following questions in a one- to two-page paper (according to 'Paper Submissions' found within the Online Communications Guidelines within Course Home):

For your selected organization, identify and discuss the size and structural dimensions. Is this organization utilizing a mechanistic or organic structure?

Would you consider this organization to be ambidextrous?

Can you identify any project champions in this organization? What is the importance of the role they play in fostering innovation?

How does this organization involve customers and suppliers in the technology development process? What are the benefits of utilizing customers and suppliers in this manner?

Assignment Checklist:

Discuss the culture of an organization and compare it to size, structure, and other measurable attributes.

Describe culture of a selected organization and how it impacts innovation.

Compare internal culture to a culture of business partners, customers, and suppliers.

Beceriler: Araştırma Yazarlığı

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American Flag around Lyman SC 29365

The American Revolutionary War
How the American Flag happened

The history of the United States is substantial and also complicated, yet can be broken down right into milestones and periods that split, linked, and also altered the United States into the country it is today. The American flag really did not look like it does now. Other than that, it went through a lot of modifications and alterations.

The American Revolutionary War

Enter the American Revolution. Occasionally described as the American War of Independence, or the Revolutionary War, it was a war which lasted from 1775-1783 and permitted the initial 13 colonies to stay independent from Great Britain. Starting in Great Britain in the late 1790s, the Industrial Revolution at some point made its way to the United States as well as altered the emphasis of the nation’s economy and also the method it produces products.

For more than 10 years prior to the outbreak of the revolution in 1775, tensions had been developing in between colonists as well as the British authorities. These stress emerged from growing tensions between residents of Great Britain’s 13 North American colonies and the colonial government (which stood for the British crown). Efforts by the British government to increase income by collecting tax from the colonies (notably the Stamp Act of 1765, the Townshend Tariffs of 1767 and the Tea Act of 1773) met violent demonstration amongst lots of colonists, who disliked their lack of representation in Parliament and also demanded the very same civil liberties as other British people. Colonial resistance caused violence in 1770, when British soldiers opened fire on a crowd of colonists, killing 5 men in exactly what was called the Boston Massacre. After December 1773, when a band of Bostonians impersonated Mohawk Indians boarded British ships and unloaded 342 containers of tea right into Boston Harbor, an outraged Parliament passed a series of measures (known as the Intolerable, or Coercive Acts) created to reassert royal authority in Massachusetts.

via Wikimedia Commons

George Washington was made its commander in chief. Congress hoped they can require the British to discuss yet George III declined to compromise. Rather, in August 1775 he proclaimed that all the American colonies were in a state of disobedience.

By June 1776, with the Revolutionary War in full swing, a growing bulk of the colonists had actually pertained to favor freedom from Britain. That very same year Richard Henry Lee of the Virginia Assembly presented Congress with resolutions stating the independence of the colonies, asking for a confederation and revealed the need to discover foreign allies for a battle against Britain. On July 4th, the Continental Congress elected to take on the Declaration of Independence, prepared by a five-man committee including Franklin and John Adams but written generally by Jefferson. By the fall of 1781, the American army had managed to compel the adversary to retreat to Virginia’s Yorktown peninsula, near where the York River clears into Chesapeake Bay. Backed up by a French military led by General Jean Baptiste de Rochambeau, Washington moved against Yorktown with a total of around 14,000 soldiers, while a fleet of 36 French warships offshore stopped British reinforcement or evacuation. Entrapped and overpowered, the opponent was compelled to surrender their entire army. Stating disease, the British general sent his deputy, Charles O’Hara, to surrender; after O’Hara approached Rochambeau to surrender his sword (the Frenchman deferred to Washington), Washington gave the nod to his own deputy, Benjamin Lincoln, who approved it. After French support aided the Continental Army force the British surrender at Yorktown, Virginia, in 1781, the Americans had efficiently won their independence, though the battle would certainly not officially end til 1783.

The motion for American independence properly triumphed at Yorktown, contemporary historians did not see that as the crucial success. British armies remained stationed around Charleston, and the effective main army still stayed in New York. The British removal of their soldiers from Charleston and Savannah in late 1782 lastly pointed to the end of the conflict. British and also American mediators in Paris authorized initial peace terms in Paris late that November, as well as on September 3, 1783, Great Britain formally recognized the freedom of the United States in the Treaty of Paris. At the same time, Britain signed separate peace treaties with France and also Spain (which had entered the conflict in 1779), bringing the American Revolution to a close after 8 long years.

Exactly how the American Flag happened

The American flag was designed to represent the brand-new union of the thirteen original states: it would certainly have thirteen stripes, alternating red and also white, as well as thirteen stars, white on a blue field. Among the very first flags had actually the stars arranged in a circle, based upon the idea that colonies were equal. The thirteen stripes, laid out side-by-side, stood for the battle for independence; red stood for valor, white signified pureness and also blue represented commitment.

In 1818, after a few design adjustments, the United States Congress made a decision to preserve the flag’s original thirteen stripes and add new stars to reflect each brand-new state that got in the union.

While there is no question that the real Betsy Ross deserved interest in her very own right, it is the legend of Betsy sewing the initial stars and stripes that has made her a remarkable historical number. The Betsy Ross tale was brought to public attention in 1870 by her grandson, William Canby, in a speech he made to the Historical Society of Pennsylvania. Canby and various other participants of Betsy’s family authorized sworn testimonies specifying that they listened to the tale of the making of the first flag from Betsy’s very own mouth.

According to the narrative history, in 1776, 3 men – George Washington, Robert Morris, and also George Ross, went to Betsy Ross in her upholstery shop. She escorted them to her parlor, where they could have a private meeting. Right here, Washington pulled a folded up paper from his inside coat pocket. On it, was a sketch of a flag with thirteen red and also white stripes and thirteen 6-pointed stars.

Washington asked if Betsy can make a flag from the layout. Betsy responded: “I do not know, however I will attempt.” This line was made use of in the vouched statements of most of Betsy’s family members, recommending that it is a straight quote from Betsy. As the tale goes, Betsy recommended transforming the stars to 5 points as opposed to six. She showed them ways to do it with just one snip of her scissors. They all accepted to change the layout to have stars with five points.

Some people believe that it was Francis Hopkisnon who provided birth to the concept of the Stars and Stripes. Francis Hopkinson was a popular patriot, an attorney, a Congressman from New Jersey, an endorser of the Declaration of Independence, poet, artist, as well as identified civil servant.

He was designated to the Continental Navy Board on November 6,1776. It was while serving on the Continental Navy Board that he turned his attention to making the flag of the United States. Using stars in that layout is thought to have been the result of an experience in the war directly pertaining to his propriety.

A publication in Hopkinson’s library at his residence in Bordentown was taken by a Hessian soldier in December 1776, a dark year of the war. The soldier, an I. Ewald, wrote on the within cover that he had actually seen the author near Philadelphia as well as that he, Ewald, had taken the publication from a fine nation seat near Philadelphia. The soldier had composed over and also below Hopkinson’s bookplate, which had three 6 pointed stars and his family motto, “Semper Paratus”, or “Always Ready”.

In a letter to the Board of Admiralty in 1780 Hopkinson insisted that he had actually designed “the flag of the United States of America” as well as a number of ornaments, devices, and checks appearing on bills of exchange, ship papers, the seals of the boards of Admiralty as well as Treasury, as well as the Great Seal of the United States. Hopkinson had actually received nothing for this work, and also now he submitted a bill as well as asked “whether a Quarter Cask of the public wine” would certainly not be a practical and appropriate reward for his labors.

Even so, no one could be so sure that created the American flag. The American flag is the sacred symbol of the country. As you see the flag silhouetted in front of the calm skies of the nation, you are reminded that the American flag stands for exactly what you are – no more, no less.

Top American Flags near state of South Carolina

As taken from the Star Spangled Banner:

O say can you see, by the dawn’s early light,
What so proudly we hailed at the twilight’s last gleaming,
Whose broad stripes and bright stars through the perilous fight,
O’er the ramparts we watched, were so gallantly streaming?
And the rockets’ red glare, the bombs bursting in air,
Gave proof through the night that our flag was still there;
O say does that star-spangled banner yet wave
O’er the land of the free and the home of the brave?

ZIP codes in Lyman we serve: 29365


Center for Technological Pain (CTP) has been doing research on relieving pain caused by technology since 2017. CTP has been developing various DIY methods of eliminating health problems that can arise from handheld technology, such as smartphones and laptops. Some of the methods are devices such as glasses with shades that prevent eyestrain, educational workshops and self-defense classes from technology. The CEO Dasha Ilina believes that humans should be able to abuse technology, but not the other way around.


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Rotary Dryer

STEP 1 : In this step the pressure is the input and the temperatures are the output which are virtually calculated.

STEP 2 :The next step is the calculation part where by using the input values of step 1 and some suitable formulas the user has to calculate the volumetric flow rate , mass flow rate and the air mass velocity. All this calculated values are to be inserted in the space provided with a pink background.

STEP 3 : In this step the user has to calculate the overall heat transfer co-effecient using the virtual temperature data which he got in step 1.

STEP 4 : This step basically includes comparison between the the calculated user's data and the virtual data.

STEP 5 : This is the final step which concludes tthe experiment by giving marks on the user's capability to perform the calculations correctly.

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