#multicomplexs

[punkitt-is-here]

LEAVE RAMSHACKLE ALONE, I KNOW WHAT THAT RETWEET WAS DIRECTED AT!!!

listen I know not everyone can be a Breaking Bad writer level bigshot but some people have to make it somewhere in this world ALRIGHT!!! I was just about to watch it this morning for breakfast until I saw your retweet of that post that may or may not have been true, listen here, the artsyle is good, too good to fail okay, it can't end it up as another Hazbin Hotel or Lackadaisy, IT CAN'T!!!

And mind I ask!!! I ask are you implying that artists can't be writers, sure the Ramshackle artists may or may not be fully accomplished writers but we don't know!!! Well I don't but who knows they might be!!!

& May I remind you that Atla started out as just characters being silly but ended up as one of the best cricily acclaimed series of all time.

Also- ALSO!!! this is just a pilot, we have no idea how much different it'll be when fully released, why it could have a multicomplex plot structure with a ludofaceted narrative overlapping different plot structures. YOU DON'T KNOW & NEITHER DO I!!!!!!!!!!

this is extremely funny. for context this is what i retweeted:

[jamelalatise]

Stumbled upon a chapel yesterday in Awaji Island’s multicomplex building, that was of course designed by Tadao Ando.

[bds123]

Top 5 dự án cho thuê chung cư làm văn phòng Cầu Giấy

Xin lưu ý! Thông tin về giá thuê của các chung cư quận Cầu Giấy sau đây sẽ chỉ mang tính chất tham khảo và không hoàn toàn chính xác. Giá thuê thực tế sẽ liên tục thay đổi tùy theo các biến động của thị trường. Hãy liên hệ trực tiếp với người cho thuê hoặc chủ đầu tư dự án chung cư để biết thêm thông tin mới nhất.

1: Dự án chung cư Tràng An Complex

2: Dự án chung cư Green Park Tower

3: Dự án chung cư Eurowindow Multicomplex

4: Dự án chung cư Vimeco Tower

5: Dự án chung cư N05 Hoàng Đạo Thúy

Xem thông tin ở bài viết:

[actiasdara]

DNA Repair and Recombination

DNA Maintenance

DNA replication → inheritance

DNA repair → genome stability and integrity

DNA recombination → variety in organism

Why are DNA lesions lethal

Structural damage → prevent replication/transcription stalling of replication fork

Harmful mutations → impair survival of organism mutation in tumor suppressor gene (gene that prevent proliferation wildly, pro cell survival)

If unrepaired:

Senescence (cellular aging)

Apoptosis

Aberrant cell division cancer

Not all DNA lesions create cell death, but in some part they do

Culprits

Endogenous

Replication error

Reactive oxygen species

Defective repair system

Exogenous

Radiation

Interchelating agent

Carcinogen

Viruses (integrate genome to host)

Types of DNA Lesions

Single base changes

Damages on nucleobases or nucleotide

Examples:

Cytosine hydrolysis and become uracil (deamination)

Guanine methylation (add methyl group to guanine)

Guanine oxidation (may only create 2 hydrogen bond with C)

Depurination (lost of purin)

alkylation/methylation (protecting nucleotide)/oxidation

Repair:

Base excision repair

recognition of damage base and remove it (DNA glycosylase)

AP (area that don’t have nucleobase)

AP endonuclease (remove nucleotide of AP)

DNA Polymerase and ligase will fill the gap (divided into short and long “up to 10 nucleotides”)

Structural distortion

Bulky DNA lesions (include covalent bond “T dimer” triggered commonly by UV radiation)

Repair:

Nucleotide excision repair

Multicomplex nuclease (recognize and cut the bulky section)

DNA Helicase (the cut strand)

DNA polymerase and ligase (fill the gap)

DNA Mismatch

Repair

Mismatch excision repair

MutSalpha (MSH2-MSH6 heterodimer) recognize and recruit other protein

PCNA clamp, RFC, and Exo1 (cut the mismatch area)

Fill the gap

ligation

DNA backbone damage

Can occur when single strand break is not fixed

Strategies:

Homologous recombination (HR)

Active only in S-G2 phase

Require homologous chromosomes

Less efficient repair

Lead to faithful repair outcomes

Protein

MRN complex (cut and create ssDNA “overhang”)

Exo1 exonuclease (expose the overhang)

Rad51 Bind to 3’ ssDNA overhangs and help migrate

BRCA1 aids Rad51 search and invade homologous sequence

DNA polymerase

May end with crossover

Non-homologous end joining (NHEJ)

JUST JOIN THE END

Active throughout the cell cycle (last choice)

Could create small mutation (change DNA sequence, frame shift)

Ku protein (Ku70-Ku80), recognize and binds to DNA DSB ends

Protect and stabilize DNA ends

Recruit additional protein

Bring to ends together

Artemis (additional DNA end processing)

DNA-PK (kinase, add phosphate) and DNA ligase

Alternative End Joining

PARP1 → Recognize, binds, and match

Match with 2-20 nucleotide base pairing

PolQ (polymerase)

DNA Lesion Comes from Different Forms

Base pair mismatch (you get the idea, single base changes, most common)

Repair with mismatch repair

Single strand break (break of the phosphodiester bond on one strand, DNA backbone damage)

Single strand break repair

Structural base pair distortion (match with its own strand

Nucleotide excision repair (removal of entire nucleotide)

Nucleotide alteration (can change the helical structure)

Base excision repair

Double strand break

Homologous recombination

Non-homologous end joining

Genetic Recombination - Cross overs

Often happen in fertilization process

Morgan & Sturtevant

Types of Mutation

Silent mutation (mutation but same product, except when it create splicing region)

Missense mutation (produce different product, but same function)

Nonsense mutation (produce stop codon)

Frameshift (shift of translation frame)

Variation = Polymorphism

Single nucleotide polymorphism

Variation at single position in DNA sequence among individual

Single nucleotide variation

More than 1% of the population carries this sequence

Copy number variations

Variation in copy number of particular DNA sequence among individual

Structural Variation

[jivandeepartlife-blog]

Water based flavored drink Mix, Mix Fruit Kissel (Sea buckthorn – blueberry) • kissel you can support your immune system every day ‼️ • As a complex of vitamins, sea buckthorn and blueberry, it is a rich source of energy, power and spiritual vitality ‼️ • The Sea buckthorn is a natural antioxidant, and the blueberry helps keep your eyesight sharp and fight against colds.‼️ • #blueberry #seabuckthorn #kissal #energy #mixfruit #flavored #drinks #researchedinrussia #multicomplexs #formulatedinrussia #richnessofsiberia #juice #energyjuice #artlife #artlife_moscow #artliferussia #indiaartlife #artlifeindia #suratartlife #gujratartlife #jivandeepartlifewellness (at Jivandeep Artlife Wellness) https://www.instagram.com/p/BxHEulyHmlu/?igshid=6lreg6wd4zgu

[nutresul]

E hoje é dia de falar desse super combo da Body Action que vem recheado com os melhores suplementos da marca, é o Combo Black Friday Body Action! Com ele você tem o que precisa para turbinar seu desempenho durante os treinos, além de garantir um desenvolvimento acelerado e saudável de sua estrutura muscular. Quer conhecer melhor? Então clica no link abaixo e aproveite para garantir o seu que a promoção é só nesta semana! https://www.nutresul.com.br/produto/combo-black-friday/2452325  #suplementosbaratos #promodesuplementos #blackfriday #blackweek #combodesuplementos #hipertrofia #combobodyaction #wheymusclehammer #wheyprotein #multicomplex #polivitaminico #creatina #nutresul https://www.instagram.com/p/CIEdVy_At89/?igshid=bp3mbj1st2fz

[djalmaaquino]

Reposted from @pointfitsuplementos Resumo de um dia de treino NOGI, sem kimono #suplementosbaratos #promodesuplementos #blackfriday #blackweek #combodesuplementos #hipertrofia #combobodyaction #wheymusclehammer #wheyprotein #multicomplex #polivitaminico #creatina #bariatricos #academia #musculacao #grampeados #treinofocado #mma #obesidade #perderpeso #qualidadedevida #bariatricosquemalham #fitness #boaforma #pretreino #treinopesado #jiujitsu #lutas #boxe #academia #nogi (em D.Aquino Estacionamento Ltda) https://www.instagram.com/p/CIDTO6HH7lh/?igshid=1go8xulrxdq85

[sunofficevn]

Tòa Eurowindow 27 Trần Duy Hưng, Quận Cầu Giấy, Hà Nội

Eurowindow MultiComplex là tổ hợp căn hộ cao cấp và 5 sàn trung tâm thương mại văn phòng tiêu chuẩn hạng B. Tòa nhà có vị trí đắc địa, dễ dàng kết nối với các khu vực. Thiết kế tòa nhà độc đáo. chất lượng tốt và nhiều ti���n ích dịch vụ.

Giá cho thuê văn phòng hợp lý các diện tích cho thuê linh hoạt từ 90m2 đối với văn phòng truyền thống, và từ 10m2 đến 30m2 đối với văn phòng trọn gói, corworking space cung cấp nhiều sự lựa chọn và giải pháp thuê văn phòng đa dạng cho khách hàng.

https://timvanphong.com.vn/eurowindow-multicomplex/

[amrpackaging]

Thermal Expansion in the field of Packaging Engineering

Alia Rind December 2, 2018 Professor Nayder Copty PHYS 250-01x

Abstract

The following paper provides insight on the physical knowledge application of temperature and heat in the production of packaged goods. Moreover, the thermal expansion of common household plastic polyethylene terephthalate, PET. The physical laws of thermal expansion learned in PHYS-250 are applied in the major field of Packaging Engineering to further understand material qualities.

Introduction

Plastic production has been reaching a steady incline over the past few decades. The man-made material is low in production cost, simple to manufacture and readily transferable for shipments. America produced 50 billion plastic bottles last year alone and the consumption of plastic doesn’t seem to be approaching a halt at any time soon. Many of the plastics are purposed for single use and disposed of in landfills. The bottles that don’t make it in to a trash can can end up riding waves in the ocean. As the current global issue of plastic consumption rises, I wonder how this affects our environment. The most common plastic used for packaging purposes is polyethylene terephthalate, PET. The polymer resin is made up of ethylene glycol and purified terephthalic acid1. Appeal of the durable, nontoxic, transparent material is noticed by suppliers and utilized in the market for its versatility. PET is recognized by the number 1 on their materials and for being one hundred percent recyclable (1). In an ideal society, engineers would practice a closed loop vision for packages with the end result in mind. Recycling is a multicomplex process for engineers. The career of a packaging engineer includes the consideration and experimentation of material expansion and strength in various environments to further investigate the recyclable properties.

Thermal Expansion on PET

The thermal expansion of an object is a consequence of the change in the average separation between its constituent atoms or molecules. Molecules vibrate with a small amplitude at ordinary temperatures. As temperature increases so does the amplitude of the molecule’s vibrations causing the overall object to expand (3). The small molecules are fueled with energy as they warm up and are excited to move around, trying to take up as much space as they can. Thermal expansion in solids could occur in three forms. There is linear expansion, whereas a very thin wire is exposed to heat, the expansion of cross-sectional area on a rod is negligible, but the length has noticeably increased. In this example, the expansion being considered is only the length of the material.

Additionally, when a solid is exposed to heat and there is an increase in the length, width and height we can consider it to have undergone volumetric expansion. 

Finally, there is superficial expansion, where only the expansion of surface area in being considered (4).

Initially we will observe the laws of linear thermal expansion as learned in PHYS 250. Such laws state that the change in the material length, L, under thermal expansion is dependent on the initial length of the material, Li, the change in temperature, T, and the coefficient of linear expansion, , which is dependent of the material exposed. The relationship is expressed by the following, ∆L=L_i α∆T (3). L is equal to the difference between the final length, Lf, and the initial length of the material, Li. Thus, ∆L=L_f-L_i. 

The coefficient of thermal expansion (x10-6 K-1) for PET is 59.4 (2). Other materials such as lead have a coefficient of thermal expansion equal to 29. With this knowledge I would believe that plastics like PET would expand faster than lead if the change in temperature and initial length were the same. Interesting enough, polymer composites tend to decrease the coefficient of expansion in asphalt (5). Asphalt is a common material used in pavement construction, and in a study done by the College of New York it was discovered that increases in the amount of PET, by weight, in the asphalt would decrease the overall coefficient of thermal expansion of the composite. The coefficient of thermal expansion is dependent on the materials crystallization and size as well. Linear expansion of metals is practical and used daily in fields of civil engineering. In packaging engineering, it is more common to see the introduction of natural fibers as composites alongside polymers though it would be interesting to study how these composites can alter the strength and length expansion of a material in my future field of study.

Secondly, in class we briefly discussed the volumetric expansion of a material. The volumetric expansion of an object occurs when a material is exposed to a positive change in temperature and can be defined as ∆V=V_(i ) β∆T (3) , where Vi is the initial volume, β is the coefficient of volumetric expansion (by material), T is the change in temperature, and V is the change in volume. Thus, ∆V=V_f-V_i. The thermal expansion is important in packaging to understand the tolerances of polymers. For example, a closure may have a different expansion than the finish of a bottle in a hot fill application. Additionally, a foam cushion may contract in a shipper when temperatures drop and the product will sit loosely in the container.

Finally, I’ll mention surface expansion, though never discussed in class. Surface expansion is ΔA  =  A0 2αΔT (4). Where the change in area is equal to the original area, the coefficient of linear expansion, change in temperature multiplied by two. The equation describes what occurs to a thin sheet of material when exposed to a temperature change. Packing engineers utilize this law in the blow molding process of a polymer. The material will go through a system where the plastic is melted down and then injected into a mold. In order for the plastic to expand into the mold there is compressed air that blows the heated plastic into the molds. Without the superficial expansion of the thin films of plastics, we wouldn’t have plastic bags. 

Conclusion

In conclusion, the application of thermal expansion in polymer packaging is expanding in the field. Research in the field is either in process or put at a cost to the general public. Well regarded research has been compiled in the past on the thermal expansion of polymer composites for civil use. The application of thermal expansion knowledge can further aid in the closed loop vision for packaged goods. 

Acknowledgments

Thank you Nayder Copty for providing a lifetime of physics knowledge in a single college semester.

References

1 Goldmeier HE. Polyethylene terephthalate. Salem Press Encyclopedia of Science. 2016. https://ezp.raritanval.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ers&AN=87323287&site=eds-live. Accessed December 2, 2018.

2 Engineering ToolBox, (2003). Coefficients of Linear Thermal Expansion. [online] Available at: https://www.engineeringtoolbox.com/linear-expansion-coefficients-d_95.html [Accessed Day Mo. Year

3 Chapter 18 Mechanics Lecture Slides by Dr. Nayder Copty

4 Thermal Expansion - Summary – The Physics Hypertextbook https://physics.info/expansion/summary.shtml

5 LEDESMA, RAMONA. EFFECTS OF POLYETHYLENE TEREPHTHALATE (PET) FROM PLASTICS WASTE ON THE THERMAL PROPERTIES OF ASPRALT, The City College of CUNY Dept. of Chemical Engineering New York, N.Y. https://web.anl.gov/PCS/acsfuel/preprint%20archive/Files/36_3_NEW%20YORK_08-91_1119.pdf. Scholarly Article.

[vpn]

Ultra Rich Multicomplex Nourish+Protect Moisture Veil and its just vaseline and its my holy grail

these skincare companies need to white label some aquaphor, add a weird "natural" fragrance, and profit. just my two cents

[babyawacs]

#peculiar #dangerous #tricky #housing @potus .@potus .@vp @vp @theeconomi st  @chathamhouse https://www.bloomberg.com/news/articles/2021-05-26/housi ng-market-biden-wants-to-fix-eviction-crisis-spiraling-home-prices? housing is a multicomplex prob lem of facettes from value valuegeneration bankproduct ecology upgrade big businessmarket its distor tions from waytoomuchmoney around the population squeeezedoutofit speculation objects society mixes o r compartmentalisation rural/urban educated/uneducated withtheir richpoor effects andthe weakest are theones that must pay the hyperinflation effects *********** stop all housevalue increases that do n ot meet certain ecological standards this may takesomepressure out  push for modernisation of those that can so ofthe new houseproducts from banking  and subsidise the retrofit of homes to ecological standards as build new ones with special mortgages where your offer competes with markets sets some standards as steering function. latter is dangerous s tuff but can dampen pricing inflation your coreproblem ************ th is is an onthefly strafethought analysis idonotknwothe us housing sector ind etail a good rule to optimise it is 20percent downpay 3percent fixed rate 30yr mortgage paidoff as 13month when12needed, this two weekly. where all is a quarter ofthe income takehomepay monthly the i dealtypical line  I am Christian KISS BabyAWACS – Raw Independent Sophistication #THINKTANK + #INTEL #HELLHOLE #BLOG https://www.BabyAWACS.com/ Inqui ry@BabyAWACS.com PHONE / FAX +493212 611 34 64 Helpful? Pay. Support. Donnate. paypal.me/ChristianKiss

#peculiar #dangerous #tricky #housing @potus .@potus .@vp @vp @theeconomi st  @chathamhouse https://www.bloomberg.com/news/articles/2021-05-26/housi ng-market-biden-wants-to-fix-eviction-crisis-spiraling-home-prices? housing is a multicomplex prob lem of facettes from value valuegeneration bankproduct ecology upgrade big businessmarket its distor tions from waytoomuchmoney around the population squeeezedoutofit speculation objects society mixes o r compartmentalisation rural/urban educated/uneducated withtheir richpoor effects andthe weakest are theones that must pay the hyperinflation effects *********** stop all housevalue increases that do n ot meet certain ecological standards this may takesomepressure out  push for modernisation of those that can so ofthe new houseproducts from banking  and subsidise the retrofit of homes to ecological standards as build new ones with special mortgages where your offer competes with markets sets some standards as steering function. latter is dangerous s tuff but can dampen pricing inflation your coreproblem ************ th is is an onthefly strafethought analysis idonotknwothe us housing sector ind etail a good rule to optimise it is 20percent downpay 3percent fixed rate 30yr mortgage paidoff as 13month when12needed, this two weekly. where all is a quarter ofthe income takehomepay monthly the i dealtypical line  I am Christian KISS BabyAWACS – Raw Independent Sophistication #THINKTANK + #INTEL #HELLHOLE #BLOG https://www.BabyAWACS.com/ Inqui ry@BabyAWACS.com PHONE / FAX +493212 611 34 64 Helpful? Pay. Support. Donnate. paypal.me/ChristianKiss

#peculiar #dangerous #tricky #housing @potus .@potus .@vp @vp @theeconomist @chathamhouse https://www.bloomberg.com/news/articles/2021-05-26/housing-market-biden-wants-to-fix-eviction-crisis-spiraling-home-prices? housing is a multicomplex problem of facettes from value valuegeneration bankproduct ecology upgrade big businessmarket its distortions from waytoomuchmoney around the population…

[olevetti]

Я не знаю, что такого волшебного в этой сыворотке 😱🪄 Но я уже открыла вторую баночку, так что давно пора вам рассказать о ней! 👌🏼 И, скажу по секрету, она точно не последняя 😅😂 #Сывороткадлялица «Она-Иная» Multicomplex Anti-Aging от Мастерской Олеси Мустаевой @masterskaya_olesi_mustaevoi меня покорила 🙏🏼 Приятная, нежная, комфортная 💙 По обещаниям 💙 замедляет стресс-индуцированное старение кожи 💙 глубоко увлажняет (однозначно подтверждаю!) 💙 повышает эластичность и тонус кожи (есть такое 😉) 💙 восстанавливает защитный барьер (и снова да 👍🏼 видимо за это так и полюбила 😍😂) 💙 уменьшает UV и IR повреждения (хз что такое 🤔😅) 💙 стимулирует синтез коллагена 💙 улучшает обновление клеток эпидермиса 💙 выравнивает микрорельеф Аромат специфический, но мне нравится, одного неполного нажатия на дозатор достаточно на лицо и шею 👌🏼 Люблю и утром, и вечером! Под крем, но можно и сольно - думаю, летом опробую 😉 30 мл хватило мне на 2 месяца регулярного использования 👌🏼 Если использовать ежедневно вечером, например, должно хватить месяца на 3 - как раз на весь срок годности после вскрытия 👌🏼 Сыворотка настолько хорошо вписалась в мой уход и «дружит» со всеми средствами, что чую мы и правда с ней надолго вместе 🙏🏼😍 #мастерскаяОлесиМустаевой #натуральнаякосметика #olevetti_лицо #olevetti_musthave #olevetti_beauty #уходзалицом #уходзакожей #бьютиотзыв #facecare (at Saransk) https://www.instagram.com/p/CLWcJ2Rn2HP/?igshid=103hlqrcsizmb

[ceetheacademicstuff]

The Role of Parents and Families in Teen Pregnancy Prevention: An Analysis of Programs and Policies.

Silk, Jessica, and Diana, Romero. 2014. “The Role of Parents and Families in Teen Pregnancy Prevention: An Analysis of Programs and Policies. Journal of Family Issues 35(10): 1339-1362. 

Method: Evaluations that look into the multicomplex factors that go into preventing pregnancies. Parental involvement, family values and access to resources. 

Participants: Multi purpose parental involvement groups that participated in evaluating each group of parental involvement that participated. The scope of programs include wide-scale strategies, such as national observances (e.g., Let’s Talk Month) or media campaigns; parent-only or parent–child community-, school-, clinic-, work-, and home-based programs; and dissemination of videos or written materials for families to use at home (Silk, 2014). Thus, evaluating the effectiveness of learning the material. 

Design: Used evaluations after going through educational steps in order to test the effectiveness. 

Results: Parental involvement is highly important because it does have an impact on reducing teen pregnancy or educating young teens in time before they are in a situation where they are in a position of having sexual relations. 

Discussion: The findings of the study were depending on the relationship between the teen and their parent really decided the outcome about speaking openly on issues like pregnancy. Another fact was the inclusion of parent discussion about reproductive health. If the teen could speak freely and openly around their parent it provided for access for more of a discussion about contraceptives and condom usage within their sexual encounters. 

[bdscuatui]

Hà Nội nở rộ việc biến tầng kỹ thuật chung cư thành căn hộ để bán Cư dân chung cư Eurowindow Multicomplex (27 Trần Duy Hưng, Trung Hoà, Cầu Giấy (Hà Nội) vừa phản ánh đến cơ quan chức năng việc chủ đầu tư là Công ty CP đầu tư xây dựng và phát triển công nghệ cao trong quá trình xây dựng dự án đã tự ý ngăn 2 tầng kỹ thuật (tầng 6 và tầng 27 – PV) thành 19 căn hộ trái phép.Theo đó, tại tầng 6 có tổng diện tích sàn xây dựng 1.767m2 được chủ đầu tư ngăn thành 15 căn có diện tích khác nhau từ 76-123m2; Tầng 27 tổng diện tích xây dựng 1.767m2 chia làm 4 căn với diện tích 119 đến 200m2."Việc chủ đầu tư tự ý biến 2 tầng kỹ thuật thành các căn hộ để bán cho khách hàng không chỉ vi phạm giấy phép xây dựng, thiết kế của tòa nhà, hệ thống PCCC mà còn ảnh hưởng trực tiếp tới cuộc sống cư dân trong tòa nhà. Do mua phải căn hộ trái phép ở tầng kỹ thuật, đến nay tôi vẫn chưa thể làm được sổ đỏ", chủ một căn hộ tầng 27 bức xúc. Chủ đầu tư tòa nhà Eurowindow Multicomplex biến 2 tầng kỹ thuật thành căn hộ trái phépTrước những sai phạm trên, Thanh tra Sở Xây dựng Hà Nội đã lập biên bản vi phạm hành chính chủ đầu tư về hành vi "tổ chức thi công xây dựng sai nội dung giấy phép xây dựng được cấp". Đồng thời, cơ quan thanh tra đã ra quyết định xử phạt hành chính số tiền 40 triệu đồng và yêu cầu Công ty CP đầu tư xây dựng và phát triển công nghệ cao buộc phải khắc phục hậu quả.Tuy nhiên, đã 5 năm trôi qua những sai phạm tại tòa nhà Eurowindow Multicomplex vẫn chưa được xử lý, gây bức xúc cho cư dân. Trong khi đó, chủ đầu tư lại tìm cách để "hợp thức hoá" hai tầng sai phạm trên.Trao đổi với PV, ông Nguyễn Việt Hà, Tổng Giám đốc Công ty CP đầu tư xây dựng và phát triển công nghệ cao thừa nhận việc chuyển đổi công năng 2 tầng kỹ thuật của toà nhà Eurowindow Multicomplex thành 19 căn hộ để bán, cho thuê.“Chúng tôi đã gửi hồ sơ tới các cơ quan chức năng để làm thủ tục xin chuyển đổi công năng hai tầng kỹ thuật và đang trong quá trình tính thuế và chờ quyết định hướng dẫn của thành phố. Sau đó, chúng tôi sẽ hoàn thiện hồ sơ cấp sổ đỏ cho cư dân", ông Hà nói. 5 năm qua, những sai phạm tại dự án vẫn tồn tại. Trong khi đó, chủ đầu tư đang tìm cách để "hợp thức hoá"sai phạm trên.Được biết, toà nhà Eurowindow Multicomplex xây dựng trên ô đất 4.000 m2; Tổng diện tích sàn xây dựng 45,6 nghìn m2; Công trình gồm có 3 tầng hầm, 28 tầng nổi gồm: 25 tầng văn phòng, căn hộ, trung tâm thương mại,... và 2 tầng kỹ thuật cộng 1 tầng mái với tổng số vốn lên tới hơn 51 triệu USD.Trước đó, Thanh tra Bộ Xây dựng đã vào cuộc thanh tra dự án Eurowindow Multicomplex sau phản ánh của khách hàng liên quan đến việc chủ đầu thay đổi công năng công trình từ văn phòng kinh doanh thành căn hộ để bán.Tình trạng chủ đầu tư các dự án chung cư, tòa nhà văn phòng… tự ý thay đổi công năng tòa nhà diễn ra khá phổ biến, trong đó có dự án chủ đầu tư tự ý “biến” tầng kỹ thuật, tầng tum thang thành căn hộ để bán hay "cắt xén" tầng thương mại của tòa nhà để xây thêm căn hộ khiến cư dân vô cùng bức xúc.Có thể kể đến như chung cư Sakura Tower (47 Vũ Trọng Phụng, quận Thanh Xuân). Theo kết luận thanh tra của Thanh tra Chính phủ, Công ty cổ phần Hùng Tiến Kim Sơn là chủ đầu tư chung cư Sakura Tower đã xây dựng 2 tầng kỹ thuật không đúng quy hoạch được phê duyệt và đã tự ý chuyển đổi công năng tầng kỹ thuật. Cụ thể, tầng kỹ thuật giữa tầng 2 và tầng 3 cao 4,5 m, hiện cho thuê làm văn phòng; tầng kỹ thuật giữa tầng 11 và tầng 12 cao 3 m, đã chia thành 14 căn hộ....Trước thực trạng trên, mới đây Bộ Xây dựng ban hành Thông tư số 07/2019/TT-BXD có hiệu lực từ ngày 1/1/2020, đưa ra những hướng dẫn, quy định cụ thể các hạng mục này nhằm 'siết' chủ đầu tư chung cư chuyển đổi công năng tùm lum.[ad_2] Nguồn CafeF

[juniperpublishersjcmah]

An Instrument for Dimensional Diagnosis of a Child Constitution (ICC) Individualizing the Care for Children with Developmental Disorders- Juniper Publishers

Abstract

Objectives: Developmental disorders present themselves with complex problems that may threaten the child’s development. In every child a disorder shows itself in a unique way, which makes it necessary to individualize. The objective of this study is to develop an instrument that provides a dimensional diagnosis by mapping the degree of (dis) balance on three domains of child development. The instrument is based on an anthroposophic anthropology and typology. Materials and methods: The typology of the child’s constitution is operationalized using concept mapping en consensus building with experts. In a pilot study the psychometric properties of the instrument were preliminary tested on children with developmental disorders in Dutch institutions.

Results: The Instrument for diagnosis of a Child Constitution (ICC) consists of two parts. Part I contains 36 polar items in three subscales of 12 items, and is completed by healthcare professionals. Part II consists of three Visual analogue scales (VAS-scales and is completed by a practitioner. The outcome (the scores of Part I and II) is a profile of the child’s constitution, showing the (dis)balance on three domains of child development. A pilot study with 38 children demonstrates positive face validity, and moderate internal consistency and inter-rater reliability of the ICC.

Conclusion: The ICC has been developed as a diagnostic instrument to assess individualized dimensional diagnosis of children with a developmental disorder. Future studies will focus on validation of the instrument.

Keywords:Dimensional Diagnosis; Child Constitution; Developmental Disorders; Anthroposophic anthropology; Typology; ICC; Tacit knowledge

Abbrevations: ASD: Autism Spectrum Disorder; ADHD: Attention Deficit Hyperactivity Disorder; COSMIN: Consensus-based Standards for selection of health Measurement Instruments; McDD: Multicomplex Developmental Disorder

    Introduction

Developmental disorders

Developmental disorders include a broad range of psychological and physical symptoms through which children differ from what is generally considered as normal. These neurodevelopmental disorders [1] have a pervasive effect on the child’s development; they may affect it permanently in multiple developmental domains. The following disorders are mostly included: language/speech, learning and motoric disorders, Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder, Conduct Disorder and tic disorders. Also, intellectual disabilities and genetic syndromes, like Down’s syndrome. There are clinicians who also consider early traumatic experiences that affect the development of the child’s capacity to build attachments with others as a developmental disorder [2].

The prevalence of developmental disorders seems to be increasing. In American research amongst children between the ages of 3 and 17, Boyle et al. [3] found an increase in the prevalence from 12.84% to 15.04% between the periods 1997/1999 to 2006/2008. In this study ADHD, ASD, learning disorders, sensory disorders, intellectual disabilities, epilepsy and motoric disorders were included. The prevalence of ASD increased from 0.19% to 0.74% in the aforementioned period, ADHD from 5.69% to 7.57% [3].

Developmental disorders rarely occur in isolation. Often there is comorbidity, such learning disorders and ASD [4]. More than 70% of the children with ASD have at least one comorbid disorder [5] and 40% have two or more [6].

Kaplan [7] considers the term ‘comorbidity’ of limited value in relation to developmental disorders; they are atypical and neurological dysfunctions that lead to a continuum of disorders. In each child a developmental disorder has an unique presentation. In the DSM-5 [8], the categorical structure does not always fit the realities of clinical practice and scientific research. Therefore, steps in a more dimensional approach and individualization in diagnosis is to be preferred.

Diagnostics

Theories relating to developmental disorders are multidisciplinary, with contributions from the field of developmental psychology [9] and medicine [10]. This links well with an interdisciplinary approach in the examination and diagnosing of children with a possible developmental disorder [11]. This way of diagnosing consists of the classification of the disorder and mapping out the child’s individual functioning.

Classifying disorders in well-defined categories has led to the development of protocol and evidence-based treatments for similar problems [12]. A disadvantage of the categorical classification is the often all-or-nothing threshold concerning the number of criteria that must be adhered to in order to establish the presence of a disorder [13]. Developmental disorders manifest themselves in varying degrees in different developmental domains [14]. The alignment with the individual’s situation is achieved more effectively in a dimensional approach [15,16].

Constitutional diagnostics

In the anthroposophical inspired care for children with a developmental disorder determining the constitution is a method to map out the child’s individual situation [17]. This method in health care has derived from a typology of the constitution, which has its basis in the anthroposophic anthropology [18-20].

The concept of ‘type’ used here can be characterized as a dynamic and plastic complex of ways to constitute similar but not identical living organisms [21]. The type functions as the active designer, which expresses itself in form and function of an organism and organs. For living nature the type is what laws of nature, like gravity, are for the dead nature. As such, the type is invisible to the physical senses. It does apply to the individual organisms that are manifestations of a type. Every living organ(ism) is an unique manifestation of a type. In the typology of the constitution three organs as domains of development in the child’s functioning are distinguished, a cognitive, an affective and a conative domain. In these domains the typology focuses on a designer, a type. This type constitutes in each domain biopsychosocial processes of development, with on both extremes of a continuum a polar pair of one-sidedness. In the constitutional diagnostics of a child the degree of (im-)balance on the continuum in these domains is identified [19].

On the continuum in the domain of cognitive functioning the quality of perception and thinking are central. On the one hand, this consists of the capacity to bring form and congruency in perceptions, as well as in thoughts and memories. On the other hand, it consists of the capacity to let go of these thoughts and to forget them. The domain of affective functioning is concerned with the experience and expression of feelings and emotions and the ability to pull back and close oneself off from the environment. The domain of conative functioning is centered on movement and mobility. The capacity to slow down and be passive and on the other hand to move and be active.

The child’s functioning can be registered on a continuum for each of these domains, with sidedness on either sides of a healthy middle area. In the three developmental domains, the six constitutional images represent that sidedness. The names that characterise the six images consist of a verb and a noun:

a) Densifying/Obsessive versus Dissolving/Forgetful for the cognitive developmental domain

b) Closing/Clenched versus Opening/Outflowing for the affective developmental domain

c) Decelerating/Heavy versus Accelerating/Light for the conative developmental domain

Each child has its own degree of (im-)balance in the continuums of the three developmental domains, which defines its constitution.

Theoretical framework

The child’s development occurs as a transactional process [9] in a continuous exchange between the organism and the environment; both of which are continuously changing [22,23]. A developmental disorder intervenes in this interaction. For adaptation and recovering of balance in functioning, the child’s organism uses self-regulating capacities, such as resilience [24].

Recognising these capacities is linked to attitudes regarding health as a dynamic phenomenon, as the capacity to adapt and maintain autonomy in light of physical, emotional and social challenges [25]. The typology of the constitution is built on this concept of health. The three developmental domains that are used in this typology - the cognitive, affective and conative domains - are known from psychology [26,27] and psychiatric research [28,29].

The term ‘constitution typology’ refers to the basis of constitutional characteristics. In the literature, the term ‘constitution’ is used as a reference to predisposition, the genetic constitution of the child. The genetic constitution is responsible for the development of structure and functions of an organism [30]. In this meaning, constitution is usually an immutable, static fact of the child’s predisposition. However, in the constitution typology, the constitution is a dynamic phenomena. The child’s constitution changes during lifetime under the influence of the environment and the child’s own personality. As a result, this meaning of constitution is influencable through treatment.

As an indicator of the coherence between predisposition and bio-psychosocial phenomena the term constitution seems to be losing its meaning, in favour of the term ‘temperament’. This appears from the description of temperament as predispositionbased individual differences in behaviour [31]. Temperament consists of personality characteristics that have a genetic and neurobiological foundation [32]. There are similarities and differences between the meaning and role of ‘constitution’ and ‘temperament’ in the literature. A similarity is that in the constitutional images, constitution refers to coherence in predisposition and bio-psychosocial processes; comparable to temperament [18,19,33]. A difference is the relation to developmental disorders. Temperament is considered to be a personality factor that protects the child, or constitutes a risk factor for the development of disorders [34]. The used meaning of constitution here consists of the actual bio-psychosocial functioning of the child, including a possible developmental disorder.

Aim and research questions

The aim of this study is developing a measuring instrument to determine the degree of (im-)balance in the child’s constitution. This study supports the scientific basis of Integrative Healthcare [35] and in particular, anthroposophical inspired healthcare [36]. The study is societally relevant because it contributes to the further development of an anthroposophic healthcare that is focused on the situation of the individual child and its environment. Previous steps in the scientific justification are a methodical description of the healthcare [17] and the typology of the constitution [19,20,37].

The questions of this study are:

a) Which bio-psychosocial phenomena should be included in the instrument?

b) Which design of the instrument fits best the constitutional typology?

c) What are the outcomes of the investigation into internal consistancy, inter- and intra-rater

d) reliability?

    Methods

To answer the first question, concept mapping has been used in a group of experienced professionals. We used consensus building to determine which items should be included and how the instrument should be designed. For the third question, a pilot study was conducted with the cooperation of practitioners. A questionnaire was filled out to determine instrumental usability.

Concept mapping

Concept mapping is used for the operationalisation of concepts in (healthcare-based) research [38]. It entails the generation, prioritisation and clustering of phenomena, which, through a cluster analysis, leads to an overview of the attitudes of the group of people in question [39]. In this study, we worked with the written variant of concept mapping [40] in order to generate, prioritise and cluster the concerning characterising bio-psychosocial phenomena for the first research question. For this analysis we used the Ariadne programme1, which combines statistical techniques, Principal Components Analysis and Hierarchical cluster analysis.

Experienced professionals: Experienced professionals can be considered the carriers of ‘tacit knowledge’ [41]. A total of 42 people were asked to participate in this study (12 professional supervisors, six artistic therapists, 11 remedial educationalists/ psychologists and 13 doctors). Of these 42, 14 people opted out of the study (ill, no time) and six people did not response. The remaining group of 22 experienced professionals consists of three professional supervisors, four therapists, eight remedial educationalist/psychologists and seven doctors. Their average number of years of experience in healthcare was 16.2 years (range: 6.4 - 21.3).

Two rounds of questionnaires: The 22 participants received a questionnaire in two rounds. All of the participants (100%) responded to the first questionnaire; the second questionnaire had a response rate of 63.6% (14 participants). In the first round the participants were asked which bio-psychosocial phenomena they consider typical for each constitutional domain on the basis of their expertise. In the second round, the participants were asked to prioritise the gathered phenomena from the first round. In addition, they were asked to categorise the connected phenomena in clusters. Prioritisation could be given on a fivepoint scale, ranging from low (1) to high (5)2. The phenomena with an average prioritisation higher than 3.5 were considered important for the diagnostics of the constitution.

Consensus building

Consensus is the agreement regarding a matter by experts, in light of the actual situation of the empirical study and their shared professional experience, and in words that mean the same to the discussion partners [42].

In three meetings with the experienced professionals and researchers, consensus building took place between the professionals and researchers to answer the second and third question, relating to the composition and design of the instrument.

Design of the instrument

In the consensus group, the researchers put forward a proposition for the construction of the instrument. In this proposal, the principle of polarity was applied and the constitution was made measurable in two ways. We chose to use measuring scales, through which the degree of (im-) balance in a system could be scored.

The first way of measuring the constitution consists of judging polar-formulated phenomena on a seven-point Likert scale, with a range from -3 to +3. With this, it is indicated whether there is a balance, and if so/or not, to what extent there is or is not a balance disruption in each of the polar-formulated items. The score 0 points towards a balance; all other scores indicate a greater or lesser deviation from this balance. This way of measuring has an analytical character; the child’s scores are determined on the basis of separate phenomena.

The second way of measuring consists of the clinical evaluation by the practitioner, regarding the degree of balance, or one-sidedness, in each of the three pairs of the polar phenomena. By comparing the image of the child as it appeared in the diagnostic investigation with a characterising description of the three pairs of polar phenomena, an experienced professional can determine how the image that she/he developed of the child relates to this. In the instrument he can indicate this assessment on three Visual Analogue Scales (VAS scales). The measuring of VAS scales appeals to the practitioner’s tacit knowledge [41] and the capacity to recognise a pattern or ‘Gestalt’ [43] and is connected to the method of ‘pattern recognition’ [17,44].

Pilot study

To answer the third question, through a pilot study with 38 children, the instrument was investigated in terms of internal consistency, inter-rater reliability and instrumental usefulness. Fifteen practitioners, six doctors and nine remedial educationalists/psychologists cooperated in this pilot study. For each of the 38 children, the instrument was filled out; the polar-formulated items separately by two professional supervisors and the VAS scale separately by two practitioners, a remedial educationalists/psychologist and a doctor. The child’s practitioner filled out the requested personal information: initials, date of birth and gender, the actual DSM classification and determined level of functioning through an intelligence investigation of the child, the date of entry and the practitioner’s own name and job position.

The internal consistency of the instrument of the three subscales was determined by establishing Cronbach’s alpha. The inter-rater reliability was determined by calculating the Pearson correlations of unweighted sum scores, between pairs of evaluators for each of the three subscales in Part I and the three VAS scales in Part II. The Consensus-based Standards for selection of health Measurement Instruments (COSMIN) [45], gave as a criterion for the quality of the internal consistency a Cronbach’s alpha of >.70 and a Pearson correlation of >.70 for the inter-rated reliability. The instrumental usefulness was investigated with an inventory of the experience of respondents using the instrument, and through the determination of the missing values, whereby a maximum percentage of 5% was established [46].

    Results

Concept mapping

Creation the inventory and prioritization: The number of phenomena, which were generated by the experience experts in the first questionnaire and received an average prioritisation equal to or greater than 3.5 on the five-point scale in the second round, were the following for the polar phenomena:

a) Densifying/Obsessive - Dissolving/Forgetful: in the first round: 38 and 36; and in the second round: (46.6% of the number generated in the first round) and 17 (47.2%);

b) Closing/Clenched - Opening/Outflowing: 60 and 59 in the first round; in the second round: 34 (56.6%) and 26 (44.1%);

c) Decelerating/Heavy - Accelerating/Light: 40 and 60 in the first round; in the second round: 17 (42.5%) and 29 (48.3%).

Clustering: The phenomena, which were clustered and prioritised by the separate participants, were processed into an average clustering in the Ariadne programme, using the Principal Components Analysis and Hierarchical cluster analysis. The choice for two clusters presented the best options for interpretation, and with that, an organising principle for the selection of the items to be included in the instrument. The first cluster contains psychological phenomena and the second cluster consists of biological/physiological phenomena in their related developmental domains.

Consensus building

In the consensus discussions with the experience experts, an agreement was reached regarding the researchers’ proposition relating to the construction and design of the instrument, as described in the section Methods. The Instrument for the determination of the Child’s Constitution (ICC) consists of two parts. Part I contains 36 polar-formulated items, for the assessment on a seven-point Likert scale. Part II contains three VAS scales, which indicate the degree of balance or imbalance in the developmental domains. For Part I of the ICC, the number of items for each of the three developmental domains is maximised at 12. Items have been selected from the two clusters of phenomena, with a minimum of two items per cluster. The selection of the items took place on the basis of the ranking according to the prioritisation. For Densifying/ Obsessive versus Dissolving/Forgetful, ten items from the first cluster were selected, and two items from the second cluster. For both the Closing/Clenched versus Opening/Outflowing and the Decelerating/Heavy versus Accelerating/Light polarities, nine items were selected from the first cluster and three items from the second cluster.

In the explanation with the ICC it is indicated that for the filling out of the child’s functioning, the month prior to the moment of entry should be considered leading. Part I of the ICC is filled out by people who are professionally involved in the care of the child. Part II is filled out by the diagnostically responsible practitioner. For the filling out of Part II of the ICC, a characterising description of the three constitutional types have been formulated in clarifying notes, as a support for the filling out of the VAS scales.

Pilot study

Composition study group: The ICC was used for the diagnostics of 38 children/adolescents; 10 girls and 28 boys. Their average age was 10.0 years (range: 7 - 16). Of these children, 14 were classified as having a disorder in the Autistic Spectrum, six had Multicomplex Developmental Disorder (McDD), five ADHD, three an Attachment disorder and one child had Down’s syndrome. The nine other children were diagnosed with an intellectual disability.

The children’s level of functioning varied from averagely gifted (five children) to severely mentally disabled (one child); 17 children functioned at a moderately mentally retarded level, 11 children had a slight mental disability and four children had a moderate mental disability. Of the children and adolescents, seven were in day-care treatment; the remaining 31 were receiving clinical treatment.

Internal consistency: Cronbach’s alpha for Part I in its entirety is .79. For the three subscales of Part I, Cronbach’s alpha is .64 (Closing/Clenched-Opening/Outflowing); .67 (Densifying/ Obsessive-Dissolving/Forgetful); and .76 (Decelerating/Heavy- Accelerating/Light).

Inter-rater reliability

The Pearson correlations for the subscales of Part I was significant: **p<.01:

a) Densifying/Obsessive - Dissolving/Forgetful .66**

b) Closing/Clenched - Opening/Outflowing .69**

c) Decelerating/Heavy - Accelerating/Light .82**

The Pearson correlations for the three VAS scales of Part II:

a) Densifying/Obsessive - Dissolving/Forgetful .44**

b) Closing/Clenched - Opening/Outflowing .25

c) Decelerating/Heavy - Accelerating/Light .47

Instrumental usefulness: The number of missing values in the 76 filled-out instruments was 45. In Part I of the instrument, 42 missing values were counted, spread over 19 of the 36 items. In Part II, the VAS scales, there were 3 missing values. In total, there were 45 missing values for 76 (number of filled out instruments: 38 children x 2) x 39 (number of items: 36 in Part I + 3 in Part II) = 2.964 items; a percentage of 1.51%.

The practitioners and supervisors indicated that the seven-point Likert scale in Part I provided sufficient room for nuancing in the answering of the questions. A few questions could not be responded to by all supervisors on the basis of their personal experience. This applied to questions regarding physical functioning, which were intended for the supervisors working in the day care treatment and artistic therapists. None of the practitioners added any remarks in the characterising description of the types in the Clarification of Part II of the instrument.

The following modifications were made to the instrument following the findings relating to the instrumental usefulness: four body-oriented items in Part I of the instrument, which had not been filled out by all supervisors, were made optional.

    Discussion

This study concerns the development of the Instrument for the determination of the Child’s Constitution (ICC) for the dimensional diagnostics of children with a developmental disorder. The selection of items for the instrument was established through concept mapping and consensus building with 22 experience experts with an average of 16.2 years of working experience in healthcare. This has resulted in an instrument that consists of three developmental domains and two sections. Part I contains 12 polar-formulated items for each of the three domains and is filled out by professional supervisors. Part II has a VAS scale for each of the three domains and displays the clinical evaluation of the practitioner responsible for the child’s diagnosis. In a pilot study with 38 children/ adolescents, the internal consistency, the inter-rater reliability and instrumental usefulness were exploratively investigated. Cronbach’s alpha is good for the entire instrument (.79) and ‘mediocre’ to ‘good’ for the three subscales of Part I (.64 - . 76). The Pearson correlation for the inter-rated reliability of the three subscales of Part I ranges between .66 and .82; all three are significant (p<.01). For the three VAS scales in Part II, the correlations are low; in the .25 to .47 range. Except the subscale Closing/Clenched - Opening/Outflowing, these are statistically significant (p<.01). Investigation into the instrumental usability has led to modification of the instrument: four items in Part I of the instrument were made optional. These are body-oriented biological/physiological items, which cannot be filled out by all supervisors, as shown by the number of missing values per item. The number of missing values remains far below the set maximum of 5% with a percentage of 1.51%. All 36 items of Section I are maintained.

A first limitation of the study is that the constitutional approach is founded on the anthroposophic anthropology, of which the philosophical and empirical justification of the theoretical framework are still developing [39]. A second limitation concerns the quality of the pilot study into the validity and reliability of the developed instrument. The study group is small and not randomly composed, nor have all aspects of validity and reliability been tested.

    Conclusion

Nonetheless, the ICC in this phase of its development is already of importance to anthroposophic daily practice. It provides handles for the individualisation of the diagnostics and for individual choices in child-oriented treatments. Additionally, it contributes to the explication and operationalisation of anthroposophic concepts, and by doing so, to further scientific support base of anthroposophic-inspired healthcare. Generally speaking, the construction of the ICC with the polar-formulated items is an example of a questionnaire which is based on a dynamic healthcare concept.

Subsequent steps that will be taken in the developmental process of the instrument are:

improvement of the manual of the use of the instrument, research into the reliability, validity and respon

siveness of the instrument, and further theoretical justification of the constitutional approach towards healthcare.

For more Open access journals please visit our site: Juniper Publishers  

For more articles please click on Journal of Complementary Medicine & Alternative Healthcare