Building and Sustaining a Thriving Leadership Culture Essential to every healthy church is a biblical model of leadership. In the New Testament, church leadership is built around a team of elders ...working together, each bringing his own unique skills and gifts to the cause of shepherding the flock God entrusted to them. However, in many churches today the principle of plurality in leadership is often misunderstood, mistakenly applied, or completely ignored. Dave Harvey encourages church leaders to prioritize plurality for the surprising ways that it helps churches to flourish. This book not only builds a compelling case for churches to adopt and maintain biblical elder pluralities guided by solid leadership but also supplies practical tools to help elders work together for transformation.
The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures ...such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system.
We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes. Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4-0.6), good (κ > 0.6-0.8) and very good (κ > 0.8-1.0).
Agreement between the two pediatric radiologists was very good (κ = 0.83, 95% CI 0.65-1.00) and between the two adult radiologists was good (κ = 0.75, 95% CI 0.57-0. 93). Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56). Agreement between clinicians was good-to-very good (pediatrician vs. physician:κ = 0.85; vs. pediatric resident:κ = 0.81; vs. medicine resident:κ = 0.76; vs. research nurse:κ = 0.75; vs. medical students:κ = 0.63 and 0.66). Following review of discrepant CXR report scores by clinician pairs, κ values for radiologist-clinician agreement ranged from 0.59 to 0.70 and for clinician-clinician agreement from 0.97 to 0.99.
This five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity. The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.
Thermal spray aluminum, TSA, offshore, marine, corrosion rate, seawater INTRODUCTION A joint industry project, titled "Improved Splash and Tidal Zone Coatings for 40-Year Design Life" was undertaken ...by TWI from 2010-2012 on behalf of a group of oil and gas production companies.1 A review of more than fifty technical publications relating to the performance of thermally sprayed aluminum (TSA) and similar sacrificial coatings in marine conditions was performed and a technology gap analysis undertaken to formulate a detailed study into the behavior of TSA and similar coatings in conditions simulating alternate immersion in warm seawater. By 1997 more than 400,000m2 of steel surface had been coated with TSA in the Norwegian offshore industry alone.2 Most recently, TSA has been employed as the primary corrosion protection system on the submerged sections of 65 offshore wind turbine foundations installed in the Baltic Sea in 2017 with a total surface area approaching 100,000m2.3 These coatings mitigate corrosion by acting both as a barrier and, when submerged, as a form of cathodic protection. A long-term AWS study (American Welding Society) evaluated the effects of coating thickness, surface preparation, and sealer coatings in long-term exposures in several environments, including total immersion and mean tide seawater, marine atmosphere and industrial atmosphere.6 After 19 years, it was reported that sealed TSA-coated panels tested in mean tide at Wrightsville Beach, North Carolina showed no damage to the underlying steel, and vinyl sealed panels exposed to total immersion were in good condition, showing only a few, small, unbroken blisters. After 34-years exposure at the LaQue Centre test site at Kure Beach, North Carolina it was reported that, although zinc and high zinc containing coatings performed well, those with high Al content displayed the best performance.7 After six years of immersion with little visible degradation in the English Channel, TSA-coated panels were removed and 3mm wide, vertical and horizontal, scribes were cut into the coatings to expose the steel substrate.8 After four years' further exposure, no rust or coating breakdown associated with the scribes was observed.
Can you expand on some of the changes your customers and travelers will see or are already seeing with the evolution of Southwest Business? DAVE HARVEY: Since beginning service in 1971, we've ...maintained our own booking experience so that we can control the entire customer journey from start to finish. Because of our robust point-to-point network, we can quickly move goods across our network with ease for both shippers and customers. Besides technology, what trends do you see as being most influential on the entirety of the airline industry? DAVE HARVEY:
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