Aims:To Study the religious and ideological views and practice of PalliativeCare physician towards Euthanasia.Materials and Methods:An...Full Text Available
Goals of workThe goal of this study was to evaluate, at a population level, the association between specialized palliativecare services (SPCS) and short- and long-term caregiver...Full Text Available
This article is a story of networking of palliativecare at the corporate level. This gives an insight that if you have will and dedication then you can imagine and make it true that networking can...Full Text Available
Paediatric palliativecare is a holistic approach aimed at addressing the complex issues related to the care of children and families facing chronic life limiting illnesses. The needs of children are...Full Text Available
The purpose of this study was to evaluate the safety and efficacy of TACE with microspheres preloaded with doxorubicin in unresectable intrahepatic cholangiocarcinoma (UCH). Twenty patients with UCH were observed; 9 refused, preferring other palliativecare or chemotherapy, and 11 agreed to be treated with one or more cycles of DC beads loaded with doxorubicin (100-150 mg) in a TACE procedure between February 2006 and September 2007. A total of 29 individual TACE procedures were performed. Follow-up imaging was performed on all patients before, immediately after, and 4 weeks after each TACE procedure to evaluate the response and need for further treatment. Each patient received i.v hydration, antibiotics, and medications against nausea and pain before TACE. Survival rate was calculated using Kaplan-Meier survival curve. A response rate of 100% followed RECIST criteria was observed. Eight of eleven patients are alive, with a ...
BackgroundLung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently,...Full Text Available
Caring for a child with a potentially fatal medical condition is a challenge for parents or caregivers. The ability to measure parental self-efficacy in pediatric palliativecare may be an important component of targeting supportive services that address individual needs of families. Therefore, the goal was to develop a Pediatric PalliativeCare Parental Self-Efficacy Measure (PCPEM). First, a list of questions were generated that asked parents their level of confidence in carrying out tasks involved in caring for a child with a potentially fatal medical condition in 6 palliativecare domains: 1) medical discussion/decisions; 2) symptom management/medication; 3) daily activities; 4) feelings/concerns; 5) spirituality; and 6) end-of-life care. The PCPEM was narrowed to 58 questions after expert ...
A 67-year-old man presented with gastrointestinal bleeding resulting from a fistula between the aortic stump and the fourth part of the duodenum 14 months after an axillobifemoral bypass, graft excision, and aortic stump closure for aortic graft infection. The patient initially refused any attempt at definitive surgical treatment so coil embolization of the aortic stump was performed via a brachial approach. Coil embolization may be a useful adjunct in the management of such difficult problems. This approach may buy time and allow careful planning of a definitive treatment or may serve as a palliative procedure in inoperable patients. PMID:15947052
Oral mucositis associated with head and neck radiotherapy can substantially hinder completion of cancer therapy. Alleviation of this often severe stomatitis can provide enhanced patient comfort and facilitate appropriate care. A double-blind format was used in a pilot project to measure, against a control rinse, the effectiveness of an oral rinse consisting of hydrocortisone, nystatin, tetracycline, and diphenhydramine in controlling radiation-related mucositis. A combination of clinical evaluation and patient responses to a questionnaire was used to judge the results of the topical medications. Patients using the experimental medication developed less mucositis than did patients in the control group.
BackgroundExisting studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary...Full Text Available
BackgroundDepression is a common illness, often treated in primary care. Many studies have reported undertreatment with antidepressants in primary care. Recently, some studies also...Full Text Available
BackgroundLittle is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced...Full Text Available
The Northwest Foster Care Alumni Study examined the relation between experiences in foster care and depression among young adults who spent at least a year in foster care as adolescents. Results indicate that preparation for leaving foster care, nurturing supports from the foster family, school stability, access to tutoring, access to therapeutic service and support, and a shorter and more stable placement history were associated with a lower probability of depression in young adulthood. Results provide evidence that suggest ways to improve practice to decrease rates of depression among alumni of care. (Contains 2 tables.)
AbstractObjective: This study examined the effectiveness of a telephone-based referral-care management (TBR-CM) intervention on psychiatric health...Full Text Available
OBJECTIVETo evaluate trends in costs of ambulatory care related to female pelvic floor disorders (PFD) in the United States.STUDY DESIGNFull Text Available
OBJECTIVE AND DESIGNThis study used qualitative and quantitative methods to examine the reasons primary care physicians and nurses offered for their inability to initiate guideline-concordant...Full Text Available
BackgroundUntil now only limited research has been done on the prevalence of chronic pain in primary care. The aim of this investigation was to study the health care utilisation...Full Text Available
OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary...Full Text Available
BackgroundMost studies on children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) have been undertaken in tertiary care and little is known about their management...Full Text Available
To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were ...
The study examines the question of whether or not civilian marketing practices and principles can be applied in the military care setting. Using the NRMC Great Lakes as a basis, the answer is yes--consumers of military medical care are ready to be the rec...
BackgroundInternationally, there is increasing use of telephone consultations, particularly for triaging requests for acute care. However, little is known about how this mode of...Full Text Available
BackgroundWith a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing...Full Text Available
Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections.Design...Full Text Available
The objective of this study was to evaluate the effect of pregabalin in painful cervical or lumbosacral radiculopathy treated in Primary Care settings under routine clinical practice. An observational,...Full Text Available
Background Little is known about how migrants adapt to first-world public health systems. In Norway, patients are assigned a registered general practitioner (RGP) to provide basic care...Full Text Available
BackgroundIntegration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in...Full Text Available
IntroductionThe aim of the study was to assess and classify incidents of electromagnetic interference (EMI) by second-generation and third-generation mobile phones on critical care...Full Text Available
PURPOSE This study was designed to evaluate the impact of electronic medical record (EMR) implementation on quality of diabetes care.METHODS We conducted a 5-year longitudinal...Full Text Available
OBJECTIVE--To review findings from studies of the influence of desktop computers on primary care consultations. DESIGN--Systematic review of world reports from 1984 to 1994. SETTING--The computerised...Full Text Available
Despite an accumulating body of literature addressing racial/ethnic disparities in children’s health and health care, there have been few published studies of interventions that have...Full Text Available
The aim of this retrospective study was to determine the safety and efficacy of chemoembolization (TACE) as palliative treatment for patients with unresectable intrahepatic cholangiocarcinoma (CCA) and to compare the results with those in the literature. Fifteen patients with histology-proven CCA (5 men, 10 women) had received palliative treatment with TACE over a 6-year period. The treatment protocol comprised repeated TACE at a minimum of 8-week intervals. TACE was performed with a mixture of 10 ml Lipiodol and 10 mg mitomycin C injected into the tumor-supplying vessels. Follow-up investigations after 8-10 weeks comprised contrast-enhanced multislice spiral CT and laboratory control. Statistical evaluation included survival analysis using the Kaplan-Meier method. During the investigation period 58 TACEs (3.9 #+-# 3.8; 1-15) were performed in 15 patients. Mean tumor size was 10.8 #+-# 4.6 cm (range, 2.0-18.0 cm). Unifocal ...
The paper discusses a number of recent studies investigating into the energy conservation and environmental impacts of electric heating systems (off-peak storage systems). In future, i.e. in and after 1993, off-peak storage systems will be evaluated through comparative analyses of oil-fired heating systems, pollutant emission analyses, the eventual success of pollution abatement measures designed for power plant emissions to keep within the legal limiting values, and the possible abandonment of pollution abatement measures abroad. Opposing the electric heating studies submitted by the electric power industry the author refutes their favourable results referring to the palliative selection of inadequate or vague parameters. Assuming average power plant pollutant emissions of 180 mg/standard/sup 3/ the nitrogen oxide emissions of oil-fired heating systems (134.1 kg/Tj) are found to be below those of off-peak storage systems ...
Abstract An increase in chronic disease prevalence is contributing to health care cost growth and decreased quality of life in industrialized nations worldwide. Inadequate management of chronic diseases is a leading cause of hospitalizations and, thus, avoidable expenditures. In this study, we evaluated the impact of nurse-delivered care calls, the primary intervention of a proactive chronic care management (CCM) program, in a population aged 65 and older in Germany. In this analysis, hospital admission rates were evaluated among program enrollees who were diagnosed with diabetes, heart failure, coronary heart disease, or chronic obstructive pulmonary disease. The Intervention group comprised those members who participated in care calls (n?=?13,486), whereas the Comparison group included e...
The incidence of hilar cholangiocarcinoma is very rare worldwide. Radical resection is the only prognostic factor for long survival in patients with hilar cholangiocarcinoma. Postoperative radiation therapy can improve local control and survival rates for patients with palliative resection, but it remains controversial in patients with radical resection. Biliary drainage can effectively release bile duct obstruction for the majority of patients with locally advanced disease, and may even prolong survival when combined with radiation therapy. Radiation therapy includes extrernal beam therapy alone, external beam therapy with intraluminal brachytheapy and new radiation technique, such as three dimentional conformal therapy and intensity modulated radiation therapy. The propective randomized clinical study is needed for further investigation in the role of combined modality therapy especially for hilar cholangiocarcinoma. (authors)
Objective To report the clinical response to image-guided percutaneous cryotherapy (IPC) for the palliative management of localized metastases in patients with gynecologic malignancies. Methods Institutional review board approval and patient consent were obtained. Gynecologic oncology patients were identified from our institution's cryotherapy database from August 2003 to August 2007. Cryotherapy was performed with 2.4?mm diameter probes (Endocare, Irvine, CA) with ultrasound or computerized tomography (CT) guidance under conscious sedation and local anesthesia. Follow-up was conducted by imaging studies and clinical encounters, using Response Evaluation Criteria in Solid Tumors (RECIST criteria). Results Twenty-eight ablation sessions were performed for 41 metastatic foci in 15 patients w...
In contrast to the increasing availability of information pertaining to the care of children with chronic kidney disease (CKD) from large-scale observational and interventional studies, epidemiological...Full Text Available
OBJECTIVE: To evaluate the effectiveness of a program to improve hypertension control practices in primary care. DESIGN: Retrospective quasi-experimental study. SETTING: Three hospital-based family...Full Text Available
ERDMANN A.L., DE ANDRADE S.R., FERREIRA DE MELLO A.L., KLOCK P., DO NASCIMENTO K.C., SANTOS KOERICH M. & STEIN BACKES D. (2011) Practices for caring in nursing: Brazilian research groups. International Nursing Review58, 379-385 Background:- The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. Aim:- To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. Methods:- The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south-east of Brazil, distri...
We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50 80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2 81 weeks). Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of ...
Summary Objective To evaluate the cost-effectiveness of an educational outreach intervention to improve primary respiratory care by South African nurses. Methods Cost-effectiveness analysis alongside a pragmatic cluster randomised controlled trial, with individual patient data. The intervention, the Practical Approach to Lung Health in South Africa (PALSA), comprised educational outreach based on syndromic clinical practice guidelines for tuberculosis, asthma, chronic obstructive pulmonary disease, pneumonia and other respiratory diseases. The study included 1999 patients aged 15 or over with cough or difficult breathing, attending 40 primary care clinics staffed by nurses in the Free State province. They were interviewed at first presentation, and 1856 (93%) were interviewed 3 months late...
Over 30 months 9292 consecutive patients admitted to nine coronary care units with suspected myocardial infarction were considered for admission to a randomised double blind study comparing the effect...Full Text Available
IntroductionTransfusion is a common treatment in pediatric intensive care units (PICUs). Studies in adults suggest that prolonged storage of red blood cell units is associated with...Full Text Available
Objectives Vietnamese patients? views on healthcare are changing as surgical interventions become more commonplace, but their views on perioperative care have remained largely unstudied during this period of rapid change. This study assesses Vietnamese patients? impression of anesthesia safety and postoperative pain in relation to clinical outcomes with the aim of improving patient-centered perioperative care. Methods The study cohort consisted of 180 hospitalized patients who were followed for 24?h following abdominal surgery. The assessments of these patients on the use of anesthesia and postoperative pain were measured by means of a 5-point Likert scale survey. Perioperative events were recorded on standardized forms by medical staff. The relationship between relevant factors affecting ...
Reliable exposure information for cosmetic and other personal care products and ingredients is needed in order to conduct safety assessments. Essential information includes both the amount of product applied, and the frequency of use. To obtain current data, studies to assess consumer use practices were undertaken. Six widely used personal care product types were included in the studies. Five of the products were cosmetics (spray perfume, hairspray, liquid foundation, shampoo, body wash) and one product was a cosmetic/over-the-counter drug product (solid antiperspirant). Three hundred and sixty women, ages 19-65 years, who regularly use the products of interest, were recruited at 10 different geographical locations within the US. The number of recruits was chosen to ensure a minimum of thr...
This document presents the results of a review of publicly available information on energy use in health care facilities. The information contained in this document and in the sources cited herein provides the background and context for efforts to reduce energy use and costs in health care. Recognizing the breadth and diversity of relevant information, the author acknowledges that the report is likely not comprehensive. It is intended only to present a broad picture of what is currently known about health care energy use. This review was conducted as part of a 'High Performance Health Care Buildings' research study funded by the California Energy Commission. The study was motivated by the recognition that health care facilities collectively account for a substantial fraction of total commercial building energy use, due in ...
Rapid corrosion of PWR steam generator carbon steel support structures and consequential denting of steam generator tubes led to considerable investigation of the mechanism of corrosion and for palliatives. The basic mechanism is now fairly well understood. Chloride present in the boiler feedwater from condenser leakage is concentrated in the support plate crevice as a result of the superheat present. This leads to the formation of a low pH acid ferrous chloride environment either through the hydrolysis of a weak base chloride such as MgCl_2 or the combined action of a neutral chloride with an oxidizing agent. Rapid attack of the carbon steel ensues with the Fe_3O_4 corrosion product forming at the metal/oxide interface. This oxide has a volume approximately twice that of the steel consumed and thus eventually fills the crevice between the tube and the support plate. Oxide growth continues leading to compression of the Alloy 600 primary tube and to distortion and ...
BackgroundHow socio-demographic factors influence women's autonomy in decision making on health care including purchasing goods and visiting family and relatives are very poorly...Full Text Available
Objective To establish current practice in the use of Read codes for diabetes.Design Cross sectional study.Setting 17 practices in the Battersea...Full Text Available
BackgroundThe link between maternal factors and birth outcomes is well established. Substantial changes in society and medical care over time have influenced women's reproductive...Full Text Available
BACKGROUND:Reports indicate that characteristics of older adults with chronic pain may be different than those of younger persons.OBJECTIVE:To study...Full Text Available
BackgroundOral cancer is as prevalent as cervical and testicular cancer in the United Kingdom. Nursing staff provide the oral health care for the patient population in hospital....Full Text Available
Out of nearly 900 women in a research study of human immunodeficiency virus infection in pregnancy, 8 were subsequently found not to be infected. Misdiagnoses could have resulted from (a) laboratory...Full Text Available
BackgroundMany interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services...Full Text Available
ObjectiveThe study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central...Full Text Available
Background:The minimum hemoglobin cutoff for blood donation in India is 12.5 gm% for both male and female donors and the minimum donation interval is 3 months. Donation...Full Text Available
BackgroundMany health care professionals use spinal palpatory exams as a primary and well-accepted part of the evaluation of spinal pathology. However, few studies have explored...Full Text Available
ContextWhile opioids are increasingly used for chronic non-cancer pain (CNCP), we know little about opioid dosing patterns among individuals with CNCP in usual care...Full Text Available
This study describes instructions for after-hours care offered by family physicians' offices when patients telephone the practice. Randomly selected (n=1,680) Ontario family physicians and general practitioners...Full Text Available
Acute kidney injury (AKI) is a common clinical problem with significant clinical and economic consequences. A number of studies point to a rising incidence of AKI in the hospital and in the intensive...Full Text Available
Objective. Preterm neonates are susceptible to infection due to a combination of sub-optimal immunity and increased exposure to invasive organisms. Invasive fungal infections are associated with significant morbidity and mortality among preterm infants cared for in the neonatal intensive care unit (NICU). Mannose-binding lectin (MBL) is a component of the innate immune system, which may be especially important in the neonatal setting. The objective of this study was to investigate the presence of any association between MBL gene polymorphism and nosocomial invasive fungal infection in preterm neonates. Methods. Codon 54 (B allele) polymorphism in exon 1 of the MBL gene was investigated in 31 patients diagnosed as nosocomial invasive fungal infection and 30 control preterm neonates. Results...
The objective of this study was to evaluate the association between the number of blood cultures collected and the appropriateness of care for suspected bacteremic community-acquired urinary tract infection (UTI) in the elderly. We retrospectively evaluated the medical records of 129 patients with UTI >65?years old admitted to a large community-based training hospital in Japan from 1 January 2006 to 31 December 2009. We assessed the association between the number of blood cultures collected and the appropriateness of care received, as well as other factors. Two-thirds of the patients were women, and patients >85?years old accounted for 45.0% of the cases. Most of the organisms isolated from the urine and blood were Escherichia coli (65.4?67.0%). More than two blood cultures were collected ...
Background ?Guidelines for safe and effective management and use of point of care testing? have been recently launched in Ireland. Aims To survey point of care testing (POCT) services in the Republic of Ireland. Methods A questionnaire covering accreditation status, existence of POCT committees, quality management systems, and staff resources was distributed by the Irish External Quality Assessment Scheme (IEQAS). Results Of those that returned completed questionnaires, 56% had assigned specific POCT responsibilities to designated staff. Most support was for blood gases and glucose analysis. Compared with other published studies, Irish laboratories gave similar support for blood gases, less for glucose and much less for urinalysis. Conclusions This survey demonstrated poor IT support for P...
To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression. Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used. Thirty of 31 attempted ...
A ten week old girl who had previously undergone a palliative procedure for the hypoplastic left heart syndrome had unrelieved aortic coarctation that did not respond to standard balloon dilatation....Full Text Available
Incidence of esophageal cancer (EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy, more than 50% of patients have incurable disease at the time...Full Text Available
AIM: To evaluate the efficacy of self expandable metallic stents (SEMS) in patients with malignant esophageal obstruction and fistulas.METHODS: SEMS were implanted in the presence of fluoroscopic...Full Text Available
The heterogeneity of metastatic breast cancer mandates the need to select therapies taking into account tumor and patient characteristics. Chemotherapy is indicated in the palliative setting especially...Full Text Available
ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific ...
PURPOSE We wanted to examine how coordinated care is implemented in primary care practices to address patients' health behavior change needs. METHODS Site visit notes, documents, interviews, and online implementation diaries were collected from July 2005 to September 2007 from practice-based research networks (PBRNs) participating in Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks (P4H). An iterative group process was used to conduct a cross-case comparative analysis of 9 interventions. Published patient outcomes reports from P4H interventions were referenced to provide information on intervention effectiveness. RESULTS In-practice health risk assessment (HRA) and brief counseling, coupled with referral and outreach to a valued and known counseling resource, emerged as the best way to consistently coordinate and encourage follow-through for health behavior counseling. Findings from ...
Abstract Background: This study involves a multicentre surveillance of tigecycline and tetracycline activity against Gram-negative and Gram-positive bacteria from primary care centres (PCCs), general hospital wards (GHWs) and intensive care units (ICUs) in Denmark (n == 9), Finland (n == 10), Norway (n == 7) and Sweden (n == 19). Methods: The hospitals were each asked to test 30 consecutive Gram-positive and 30 Gram-negative clinical isolates. Supportive information accompanying each isolate included the study centre, ward level (PCC, GHW, or ICU), patient identification and source of the isolate. Minimum inhibitory concentrations (MICs) for tetracycline and tigecycline were determined with the Etest. Results: The isolates collected comprised 1610 Gram-negative and 1767 Gram-positive clini...
ObjectiveTo evaluate the primary care communications initiative, which introduced NHSnet to primary care in Scotland.DesignSemi-structured telephone...Full Text Available
PurposeDescription and analysis of the effects and side-effects of integrated mental health care in the Netherlands.Context of caseDue...Full Text Available
Purpose Skilled placement of peripherally inserted central catheters (PICC) has a profound impact on patient well-being and costs of care. The use of ultrasound-guided methods and prescribed training for cannulation skills are evidence-based practice recommendations. The purpose of this study was to compare two methods of PICC instruction on the acquisition of applied skills. Methods Residents were randomly assigned to one of two groups (N?=?16/16) of this blind-rater study and were trained to perform ultrasound-guided PICC cannulation using either simulation or apprenticeship methods. All residents were assessed placing a PICC in applied clinical patient care. Results Residents who completed simulation training had significantly better transfer of skills to applied clinical practice than ...
Background/Purpose: Peripherally inserted central venous catheters (PICCs) are commonly used for neonatal vascular access. The aim of this study was to look at PICC line complication rates and possible predictors of PICC infection in a neonatal intensive care unit. Method: This was a prospective study of 226 neonates who had PICCs on our neonatal intensive care unit between January 2006 and June 2009. Complete data was available on 218 neonates who had 294 PICC lines. Criteria for catheter-related sepsis was positive blood cultures (peripheral/central) and/or a positive catheter tip culture after removal in the presence of a clinical suspicion of line sepsis. Results: Of 218 neonates, 132 (169 lines) were medical, and 86 (125 lines) were surgical. Our PICC line infection rate was 17 infect...
This paper describes how a computerized MIS is used to assist HMO management to conduct utilization and quality of care review activities in a prepaid medical care network. The HMO is a ‘network’...Full Text Available
BackgroundWe examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.MethodsSecondary analyses...Full Text Available
Objective: Results of reliability and agreement studies are intended to provide information about the amount of error inherent in any diagnosis, score, or measurement. The level of reliability and agreement among users of scales, instruments, or classifications is widely unknown. Therefore, there is a need for rigorously conducted interrater and intrarater reliability and agreement studies. Information about sample selection, study design, and statistical analysis is often incomplete. Because of inadequate reporting, interpretation and synthesis of study results are often difficult. Widely accepted criteria, standards, or guidelines for reporting reliability and agreement in the health care and medical field are lacking. The objective was to develop guidelines for reporting reliability and...
The urine test strip is the most common test used to detect ketones in veterinary patients, but it can underestimate the degree of ketonuria and hence, ketonemia. Additionally, adequate urine samples for analysis may be difficult to obtain from dehydrated animals. The standard method used to detect and monitor ketonemia in human medicine is measurement of serum or whole blood beta-hydroxybutyrate (?HOB). A point-of-care (POC) analyzer has been validated for this purpose in humans. This study compared the accuracy of the POC device to an enzymatic reaction laboratory method for measurement of ?HOB in dogs. Although the POC sensor tended to overestimate ?HOB concentrations, there was good correlation (R(2) = 0.96) and good agreement between the 2 methods with a bias +/- precision of 0.0860 +/- 0.3410 mmol/L ?HOB. The POC ?HOB sensor can be useful for assessing ketonemia in dogs. PMID:21119867
Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinic...
We analyzed the effects of the Colorado Medicaid Capitation Program on the duration and services of over 21,000 outpatient mental health episodes for young children. The study spanned a three year period before and after capitation was implemented, and compared episodes of outpatient care for children from 14 capitated Community Mental Health Centers (CMHCs) with those from three CMHCs that remained fee-for-service. Proportional hazards regressions revealed that capitation resulted in an increase in outpatient episode duration, over and above similar effects for the comparison fee-for-service episodes. The hypothesis that there were longer capitated episodes for children who were hospitalized was not supported. Children with behavioral and anxiety disorders had longer capitated episodes. Service intensity decreased over time in the managed care sites. Changes in case mix may have had an impact on changes in episode duration ...
The aims of the study were to develop and test the psychometric properties of the Thai Family Health Routines (TFHR) scale, a 70-item self-report questionnaire used to measure the health of Thai families through their routine behaviors in daily life. Development of the TFHR was based on the structural domains of Denham's Family Health Model. The TFHR scale was initially composed of 85 items and tested on 1,040 families living in the central region of Thailand. The confirmatory factor analysis, with an acceptable factor structure model, yielded 70 items aligned with six factors: self-care, safety and prevention, mental health behavior, family care, family caregiving, and illness care routines. The preliminary psychometric properties demonstrated that the TFHR scale had satisfactory internal consistency, criterion validity, and construct validity. The test results suggested that the TFHR scale has ...
To investigate the problems of the Hanaro stent (Solco Intermed, Seoul, Korea) when used in the palliative treatment of patients with inoperable malignant biliary obstruction. Between January 2000 and May 2001, the treatment of 46 patients with malignant biliary obstruction involved percutaneous placement of the Hanaro stent. Five patients encountered problems during removal of the stent's introduction system. The causes of obstruction were pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), and gastric carcinoma with biliary invasion (n=1). In one patient, percutaneous transhepatic cholangiography and stent insertion were performed as a one-step procedure, while the others underwent conventional percutaneous transhepatic biliary drainage for at least two days prior to stent insertion. A self-expandable Hanaro stent, 8-10 mm in deameter and 50-100 mm in lengh, and made from a strand of nitinol wire, was used in all cases. Among the five patients who ...
... 03/08/2011 Professor named Chair at Epworth Hospital Professor Nilmini Wickramasinghe from the College of Business at RMIT University has been named Epworth Chair, Health Information Management , by Epworth HealthCare. 26/07/2011 Study investigates drug-free relief for tension headaches As Australia marks its first National Pain Week ...
BackgroundIntermittent preventive treatment of malaria during pregnancy (IPTp) is a key intervention in the national strategy for malaria control in Tanzania. SP, the current drug...Full Text Available
BackgroundGeneralized anxiety disorder (GAD) is the most frequent anxiety disorder in primary care patients. It is known that painful physical symptoms (PPS) are associated with...Full Text Available
The objectives of this project to interface the site-specific real-time radiological dose assessment system FADAS(Following Accident Dose Assessment System) to CARE. In this study, the results of the field tracer experiments conducted on the Younggwang site have been analysed. And the experimental procedure on Ulchin site has been introduced. The environmental characteristics on Ulchin and Wolsung has been investigated.
The utilization of health care services in children and adolescents with chronic benign pain was studied in a Dutch population sample of 254 chronic pain sufferers aged 0-18 years. Children and adolescents who had reported chronic pain (continuous or recurrent pain >3 months) in our previous prevalence study were asked to keep a 3-week diary on their pain and to fill out questionnaires on background factors, health care use and the impact of pain. Parent ratings were used for children aged 0-11 years, self-report was used in adolescents (12-18 years). In a 3-month period, in 53.4% of the cases medication was used for pain, and general practitioners and specialists were consulted for pain in 31.1% and 13.9% of subjects, respectively. Physiotherapists, psychologists and alternative health providers were visited by 11.5, 2.8, and 4.0%, respectively. In the preceding year, 6.4% had been hospitalized due ...
Objective: To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: 7 biliary metallic stents were placed in 7 patients with recurrent jaundice after T-tube drainage in cholangiocarcinoma cases. Results: Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment. Conclusions: Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma-induced obstructive jaundice
Background The Norwood procedure consists of three palliative operations, performed in neonates with hypoplastic left heart syndrome. Especially the first stage (Norwood I) is associated with the highest mortality rates in paediatric cardiac surgery (up to 25%). During surgery, the aorta is reconstructed and a systemic-to-pulmonary shunt is applied. Originally the modified Blalock-Taussig shunt was used, but recently the right-ventricle-to-pulmonary-artery shunt is increasingly being employed. We reviewed the results of our operative strategy, where an individualised choice of shunt is made. Furthermore, attempts to reduce interstage mortality (between Norwood I and II) were assessed. Methods All neonates who underwent Norwood stage I palliation from August 2004 until November 2010 were in...
The present research has been made to develop and review critically the functional requirements of the specific safety systems of CANDU such as SDS-1, SDS2, ECCS, and containment. Based on R documents for this, a systematic study was made to develop the domestic regulation statements. Also, the conventional laws are carefully reviewed to see the compatibility to CANDU. Also, the safety assessment method for CANDU was studied by reviewing C documents and recommendation of IAEA. Through the present works, the vague policy in the CANDU safety regulation is cleaning up in a systematic form and a new frame to measure the objective risk of nuclear power plants was developed.
The present research has been made to develop and review critically the functional requirements of the specific safety systems of CANDU such as SOS-1, SOS-2, ECCS and containment. Based on R documents for this, a systematic study was made to develop the domestic regulation statements. Also, the conventional laws are carefully reviewed to see the compatibility to CANDU. Also, the safety assessment method for CANDU was studied by reviewing C documents and recommendation of IAEA. Through the present works, the vague policy in the CANDU safety regulation is cleaning up in a systematic form and a new frame to measure the objective risk of nuclear power plants was developed.
Purpose - The article discusses how care programmes and integrated care pathways can be linked, finding ways to improve healthcare process professional and logistical quality from a supply chain and a network point-of-view. Design/methodology/approach - The authors argue that owing to cost containment goals and increasing healthcare demand, healthcare services systems are challenged to improve service quality, whilst at the same time finding ways to improve delivery processes. It explores if the combination of two instruments, care programmes and integrated care pathways, can meet both goals. This combination is illustrated by an example from the Institute of Mental Health Care Eindhoven en de Kempen. Findings - Analysis suggests that care programmes can be combined with integrated care pa...
"Correctional Health Care: Implications for Public Health Policy" is the first in a series of articles that examines the special health care needs of persons who are incarcerated in America's correctional...Full Text Available
Six patient assessment systems that have explicit decision rules for replicating team judgments on level of care patient placement were selected for analysis. The six were selected because of their...Full Text Available
BackgroundThe Emergency Care Summary (ECS) was introduced in 2006 to allow aspects of the general practitioner (GP; family doctor, equivalent to primary care physician) medical record...Full Text Available
Aim: Compounds such "9"9"mTc-MDP and "9"9"mTc-HEDP are used regularly in bone scintigraphy for metastasis detection. The therapeutics properties of beta emitter radionuclides like "1"5"3Sm, "1"6"6Ho and "1"7"7Lu has been widely reported in literature being "1"7"7Lu the less developed for medical applications. With the purpose of study different radiopharmaceuticals alternatives, for metastasis bone palliation, we have evaluated, on a comparative basis, the labeling of "1"5"3Sm-MDP, "1"5"3Sm-HEDP, "1"6"6Ho-MDP, "1"6"6Ho-HEDP, "1"7"7Lu-MDP and "1"7"7Lu-HEDP from the exhibited radionuclidic purity and biological distribution point of view. Material and Methods: The radionuclides were produced at La Reina Research Reactor, Chilean Nuclear Energy Commission. The radionuclidic purity was determined by gamma-Ray spectrometry. The labeling was accomplished with MDP (Plenum) and HEDP synthesized in-house. The in-vitro affinity of labeled compounds to ...
OBJECTIVETo examine psychometric properties of the Confidence in Diabetes Self-Care (CIDS) scale, a newly developed instrument assessing diabetes-specific self-efficacy...Full Text Available
... Harbor Township Vineland Voorhees Pediatric Partner Hospitals AtlantiCare Regional Medical Center- City Campus, Atlantic City AtlantiCare Regional Medical Center - ...
This study aimed to reveal that severe disturbance of attachment relationship with primary care-giver can affect functional and anatomical brain development by measuring cerebral perfusion on "9"9"mTc-ECD brain SPECT and correlative MRI. We included 18 children aged 31 to 76 months who met the diagnostic criteria of RAD as defined in DSM-IV and ICD-10 and SSP and CARS. "9"9"mTc-ECD SPECT was performed using CERASPECT. MRI was performed in all patients. SPECT data were visually assessed. 15 of 18 children had abnormal perfusion on SPECT, revealing decreased perfusion of Lt.thalamus (7/15) and Rt.thalamus (3/15), and bilateral thalami (5/15). Perfusion of basal ganglia was decreased in 8 children. Decreased perfusion of Lt. parietal area was seen in 2. Whereas, all patients had normal MR findings. Perfusion abnormalities involving thalamus, BG in most children with RAD were found in this study. These results suggest that ...
We summarize our lattice QCD study of the form factor at zero recoil in the decay {bar B} {yields} D*{ell}{bar {nu}}. After careful consideration of all sources of systematic uncertainty, we find, h{sub A{sub 1}}(1) = 0.913{sub -17-30}{sup +24+17}, where the first uncertainty is from statistics and fitting while the second combined uncertainty is from all other systematic effects.
The role of natural enemies in the regulation of populations is one of the major questions facing population ecologists. Simplification have led to two theoretical ways of incorporating the role of natural enemies in single ecological models: diffusion models and patch-type models. The predictions of the models are different because of the way variability is incorporated. Three equations are presented for diffusion models and one for patch models. Since the two types of models apply at different combinations of spatial and temporal scales, the right model(s) to choose for a particular study requires careful assessment. A continuing dialogue between experimentalists and theoreticians will lead to a better understanding of natural systems such as those that occur in biological control.
Fifty patients scheduled to undergo IVF received a standard anesthetic of fentanyl and propofol for induction, followed by propofol infusion, with Bispectral index values and modified Ramsey sedation scores recorded at 5-minute intervals for the duration of anesthesia care. Moderate sedation was found only transiently during the first 5-10 minutes of the oocyte retrieval, but thereafter the level of sedation increased, with deep sedation and general anesthesia measured in all patients as determined by both the Bispectral index scores and lack of response to painful stimulation.
Kaluza-Klein higher derivative induced gravity is studied for its application in the inflationary universe. The stability of an inflationary solution in a $D+4$-dimensional anisotropic space is analyzed carefully. We show that there is two nontrivial constraints derived from the static assumptions on the $D$-dimensional scale factor $d$ and scalar field $\\psi$. We find that a physical inflationary solution is consistent with the above constraints. In addition, a compact formula for the non-redundant $4+D$ dimensional Friedmann equation is also derived for convenience. Possible implications are also discussed in this paper.
Hope is an essential dimension of life. Hope, according to Marcel?s thinking, is the act by which the temptation to despair is actively overcome. Hope comes alive when confronting life?s trials, darkness, illness and separation. Marcel differentiates ?I hope? from ?I hope that?. Hope as a central construct for nursing has been analysed, defined, and studied by the nursing theorist Jean Watson in her Theory of Human Caring, and Kaye Herth with her strategies (Herth Hope Index). These strategies are based on Marcel?s existential notion that human beings have an endless possibility of improving their own being.
The objectives of the project were to develop operational techniques for promoting contaminant hideout return from tube support crevices and to identify the effect of chemical inhibitor application on corrodent transport. The implementation of routine procedures for promoting the return of sequestered corrodents could retard the progression of denting or other corrosion processes and improve steam generator availability. Tests also quantified the effect of inhibitor application on crevice hideout and hideout return processes, with the intention of developing a better understanding of the inhibition mechanism. By carefully monitoring the hideout and hideout return inventories, the program also has provided the opportunity to study steam generator concentration processes in general.
In this work, the right management procedure for hydraulic power oil will be discussed and suggested. A thermal power plant turbine should respond to the change of load status. However, to satisfy the frequency of alternating current, the revolution per minute should be kept constant. Therefore, by controlling the flow rate of the steam to the turbine, the governor satisfies the load variation without alternating the revolution per minutes of the turbine. To protect the governor, the hydraulic power unit should be managed carefully by controlling the quality and the flow rate of the oil.
The gastrointestinal transit was studied in 20 patients with loop transverse colostomies and previously normal colons. This analysis was performed through radiological observation of progression of 20 radiopaque pellets and measurements of its transit time in the various segments of the digestive tract. An evaluation of other related clinical and radiological events was carried out sentimentality's. In order to better understand the influence of the surgical procedure, the study was performed under similar dietary and supportive care conditions and standard radiological studies before and after the re-establishment of transit, thus enabling a comparison with the same individual. (author)
SummaryA laboratory-based surveillance study was conducted from January 2007 to May 2010 in San Martino Tertiary Referral Hospital in Genoa, Italy in which the molecular epidemiology of multidrug-resistant Acinetobacter baumannii was investigated in the five intensive care units (ICUs). A total of 53 A. baumannii strains were isolated from patients admitted to ICUs (69.8%) and to other epidemiologically linked hospital wards (30.2%) and were genotyped by repetitive extragenic palindromic polymerase chain reaction (REP-PCR), multilocus sequence typing (MLST) and adeB sequence typing. REP-PCR fingerprinting analysis, MLST and adeB typing results were well correlated and allowed us to classify strains causing epidemic events into three major epidemic clones: A (REP-I/ST4, adeB-STII genotype) ...
Sodium monofluoroacetate (1080) is a vertebrate pesticide widely used for possum control in New Zealand. Fluoroacetate is also a toxic component of poisonous plants found in Australia, South Africa, South America, and India. Because of its importance and effectiveness in pest control and the highly toxic nature of this compound, its acute sub-lethal and target organ toxicity have been extensively studied. In relation to its use as a pesticide its environmental fate, persistence, non-target impacts and general toxicology have been and continue to be extensively studied. Toxic baits must be prepared and used with extreme care, otherwise humans, livestock, and non-target wildlife will be put at risk. The high risk of secondary poisoning of dogs is a cause for concern. 1080 acts by interfering with cellular energy production. Possums die from heart failure, usually within 6-18 h of eating baits. Long-term exposure to sub-lethal ...
Women treated of localised stages of cervix cancer have a very good prognosis. But do health care professionals have a tendency to underestimate the potential need for rehabilitation of this group? To be able to answer this question this study aimed to develop knowledge concerning these women's own perception of their health during a long period after surgical cancer treatment. A total of 398 women who underwent radical hysterectomy in the period from the 1 January 1983 to 31 December 2000 participated in the study at Aarhus University Hospital, Skejby in Denmark 2001-2003. All patients initially filled in an internally validated questionnaire. Subsequently a sample of 100 women filled in the questionnaires Short Form -36 and Sense of Coherence to evaluate their self-reported health. Analy...
PURPOSE.- The study aims to clinically validate the defining characteristics (DCs) of the nursing diagnosis (ND) of Activity Intolerance for patients with ischemic heart disease and refractory angina. METHODS.- Cross-sectional study was used, involving 22 patients with ND of Activity Intolerance. The Fehring method was used to validate the ND. FINDINGS.- Most DCs presented reliability indexes between 0.5 and 0.79. Three DCs presented reliability indexes - 0.8. CONCLUSION.- All DCs were validated, and electrocardiographic changes indicating ischemia, verbal report of fatigue, and abnormal rate response to activity were considered as DC major. IMPLICATIONS FOR NURSING PRACTICE.- This study is relevant in daily nursing practice for guidance in establishing the care plan and describing the ass...
The required minimum 30-year post-closure care period for municipal solid waste (MSW) landfills can be shortened by reducing or eliminating of MSW components with long-terms effect in gas and leachate. The objectives of this study were to evaluate the relative persistence of landfill gas, leachate quantity, and selected leachate parameters using post-closure monitoring data from a case study landfill in south Florida. The relative persistence of selected decomposition byproducts in leachate were evaluated by both zero order and first order models based on monitoring data from the case study landfill. The analyses show that although gas and leachate production rates diminish very quickly, some contaminants remain in leachate as the decomposition process continues at a slower rate. For the c...
The incidence of hepatocellular carcinoma (HCC) is increasing in developed countries and the general status of HCC patients is now by far better than a few years ago, allowing physicians to propose some different treatments of these patients. Among these treatments, intra-arterial injection of 131-iodine-labelled Lipiodol could be used in palliative, curative or adjuvant settings. After a brief summary of the modalities of this treatment, requiring the collaboration of Gastro-enterologists, Oncologists, Radiologists and Nuclear Medicine physicians, the different possibilities of therapeutic uses of this new approach are described and an outlook of these developments is proposed. (author)
Carcinoma en cuirasse of the breast, which invades the skin via lymphatics and may encase the entire thorax and abdomen, is poorly controlled by surgery, chemotherapy, or conventional irradiation. Palliation of patients with breast carcinoma en cuirasse is a difficult clinical problem which must be effectively managed over extended periods due to the indolent nature of this disease. The management of three cases is reported, and the new technique of rotational subtotal skin electron-beam therapy (SSEBT) is presented. (author).
Self-expanding metallic stent insertion has been widely applied for the palliative treatment of malignant esophageal strictures. Although it is known as an easy, safe, and effective procedure, complications are well known and include things such as stent migration and esophageal stent occlusion caused by tumor in growth. However, metallic stent fractures have been rarely reported in the esophagus, especially for nitinol stents. We report a case of a stent fracture associated with migration in a patient with a malignant esophageal stricture near the gastroesophageal junction. It is highly probable that the stent fracture was due to chemical erosion of the stent caused by gastric juice
To evaluate repeated hepatic intraarterial chemotherapy (HIC) as a palliative treatment option for unresectable cholangiocarcinoma and liver metastases of various origins that were progressive under systemic chemotherapy. Between 2002 and 2006, 55 patients were treated in 4-week intervals (mean five sessions). Combined gemcitabine/mitomycin was administered intraarterially within 1 h. Tumor response was evaluated after the third session according to RECIST. Treated tumor entities were colorectal carcinoma (CRC) (n = 12), breast cancer (BC) (n = 12), cholangiocarcinoma (CCC) (n = 10), pancreatic (n = 4), ovarian (n = 3), gastric, cervical, papillary (each n = 2), prostate, esophageal carcinoma, leiomyosarcoma (each n = 1), cancer of unknown primacy (CUP) (n = 5). All patients tolerated the treatment well without any major side effects or complications. In total, there were 1 complete response (CR), 19 partial responses (PR), 19 stable (SD) and 16 progressive ...
To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ...
This longitudinal study examined a model of early school achievement in reading and math, as it varies by socioeconomic context, using data from the NICHD Study of Early Child Care and Youth Development. A conceptual model was tested that included features of family stress, early parenting, and school readiness, through both a single-group analysis and also a multiple-group analysis. Latent profile analysis was used to identify subgroups of more advantaged and less advantaged families. Family stress and parenting were shown to operate differently depending on the socioeconomic context, whereas child-based school readiness characteristics were shown to operate similarly across socieodemographic contexts. Implications for intervention are discussed.
This research project is to develop a technical basis for flexible piping designs which will improve piping reliability and minimize the use of pipe supports, snubbers, and pipe whip restraints. This study indicated that piping design can be made more reliable by some reduction of rigid supports and/or snubbers. This study also confirmed that the malfunction of pipe whip restraints introduced higher thermal stresses and tended to reduce the overall piping reliability. Finally, our results indicated that supports in a flexible piping design may need to be reevaluated and that the elimination of pipe supports which are close to components should be done with care in order to minimize the impact on the component reliability.
Background/Objectives: Cardiotoxic drug poisoning can lead to severe cardiac shock (CS) and death. B-type natriuretic peptide (BNP) is a well-established diagnostic and prognostic marker in heart failure but has never been assessed in patients with cardiotoxic drug poisoning. The aim of the study was to determine whether BNP could be useful for early stratification of patients admitted to intensive care unit. Methods: 30 consecutive patients experiencing shock and cardiotoxic drug exposure were enrolled in a prospective monocentric study and underwent at least two BNP measurements within the first 24 h after admission. Results: While BNP values on admission were poorly informative, subsequent BNP measurements (11 +- 6 h after admission) were significantly increased in patients with CS comp...
Background Trauma centers are designated to provide systematized multidisciplinary care to injured patients. Effective trauma systems reduce patient mortality by facilitating the treatment of injured patients at appropriately resourced hospitals. Several U.S. studies report reduced mortality among patients admitted directly to a level I trauma center compared with those admitted to hospitals with less resources. It has yet to be shown whether there is an outcome benefit associated with the ?level of hospital? initially treating severely injured trauma patients in Australia. This study was designed to determine whether the level of trauma center providing treatment impacts mortality and/or hospital length of stay. Methods Outcomes were evaluated for severely injured trauma patients with an ...
Background: As the global population ages, support for family caregivers who provide the bulk of care to community-dwelling older people is becoming ever more important. However, in many countries, homecare-service practitioners currently do not follow a systematic approach to assessing and responding to caregiver needs. Objectives: The aim of this study was to explore the experiences of caregivers and practitioners who took part in a field test of the Family Caregivers Support Agreement (FCSA) tool, a modified version of the Carers Outcome Agreement Tool (COAT) initially developed as the result of an Anglo-Swedish study. Both the COAT and the FCSA are designed to facilitate partnerships between caregivers and practitioners so that needs assessment and subsequent support services are negot...
Background and aims. The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia. We aimed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination, as compared to usual care, in 4- to 12-year-old children. Methods. In all, 239 children were enroled by 25 family practitioners in an open-label study. After a pseudo-randomization, usual pain management (n = 132) was compared to a multifactorial strategy (n = 107) associating preliminary application of an anesthesic patch, preferential use of specified vaccines, child education by the parents and the doctor, parental accompaniment...
Background: Anxiety disorders are known to be common in the general population. Previous studies with adults with intellectual disabilities (IDs) report a prevalence of general anxiety disorder ranging from less than 2% to 17.4%. Little is known about associated factors in this population. This study investigates point prevalence of anxiety disorders and determines the factors independently associated with them. Methods: Information was collected with 1023 adults with IDs who participated in a large-scale, population-based study. All had a comprehensive physical and mental health assessment. The point prevalence of anxiety disorders according to different diagnostic criteria was determined, as were independently associated factors by using logistic regression analysis. Results: Three point eight per cent (95% CI = 2.7-5.2%) of the cohort had an anxiety disorder at the time of assessment. Generalised anxiety disorder was the ...
Aim.- To identify what determinants influence the prevalence and accuracy of nursing diagnosis documentation in clinical practice. Background.- Nursing diagnoses guide and direct nursing care. They are the foundation for goal setting and provide the basis for interventions. The literature mentions several factors that influences nurses- documentation of diagnoses, such as a nurse-s level of education, patient-s condition and the ward environment. Design.- Systematic review. Method.- MEDLINE and CINAHL databases were searched using the following headings and keywords: nursing diagnosis, nursing documentation, hospitals, influence, utilisation, quality, implementation and accuracy. The search was limited to articles published between 1995-October 2009. Studies were only selected if they were...
A transient-enhanced diffusion has been observed during the furnace or rapid thermal annealing of ion-implanted silicon. We have studied this transient in detail and show that, for doses of Group V dopants sufficient to amorphize the silicon, it arises from the trapping of interstitials by dopant atoms during implantation. These are retained during solidphase-epitaxial (SPE) growth, but can be released by additional thermal processing to cause the observed transient and the formation of a band of extended defects. We have measured the enhanced diffusion coefficients and the duration of the transient for Sb-implanted Si by careful furnace annealing experiments. We obtain general expressions which predict the effects of the transient during any thermal processing based on SPE growth (furnace, CW laser, or rapid thermal annealing). We show that there is no analogous mechanism of vacancy trapping by Group III elements.
A transient-enhanced diffusion has been observed during the furnace or rapid thermal annealing of ion-implanted silicon. We have studied this transient in detail and show that, for doses of Group V dopants sufficient to amorphize the silicon, it arises from the trapping of interstitials by dopant atoms during implantation. These are retained during solidphase-epitaxial (SPE) growth, but can be released by additional thermal processing to cause the observed transient and the formation of a band of extended defects. We have measured the enhanced diffusion coefficients and the duration of the transient for Sb-implanted Si by careful furnace annealing experiments. We obtain general expressions which predict the effects of the transient during any thermal processing based on SPE growth (furnace, CW laser, or rapid thermal annealing). We show that there is no analogous mechanism of vacancy trapping by Group III elements.
Due to deregulation, the electrical power industry is undergoing deep changes, moving towards an open market. Two kinds of parties are active in the new environment: the economical agents (producers, consumers, brokers) and the power system operator, the former interested in power exchanges and their economic value, the latter in bus injections and their threat to the security of the transmission network. The variables used to model the transmission network operation have to be meaningful to the power system operator as well as to the economical parties; the action rules followed by the power system operator to enforce network security have to be carefully designed to be equitable and non-discriminatory. In this paper, a modeling of the power exchanges is proposed in the form of multilateral trades, and some rules for the action of the power system operator are proposed and discussed. The results obtained on a simple study case are discussed. ...
As care shifts from institutional to home- and community-based settings, consumer health information technology (IT) must be designed to support patients' new health information management responsibilities. We developed and piloted a new methodology grounded in social network analysis and human factors engineering to explore two often overlooked aspects of this phenomenon: the task of health information communication with members of the social network and the context of culture. Such knowledge is necessary to inform the appropriate design of consumer health IT. We asked a culturally diverse sample of participants to describe what, to whom, why, and how they communicate health information and to provide direct feedback about the methodology. The methodology was acceptable to all participants and able to capture similarities and differences in their health information communication practices. Prior to the main study we will need to refine the ...
The Bragg-curve detector of the parallel plate ionization chamber type generates a signal that is a distorted replica of the original Bragg-curve. In result of this distortion, the signal peak height is not only a function of the atomic number of the heavy ion, as it is often stated, but also of the particle mass. This mass effect was studied with the aid of computer simulation, and it was found to be dependent on the Frisch grid to anode gap width and on the detector gas. The charge resolution of the detector is affected very significantly by this mass dependence of the signal peak height. Therefore, a careful selection of the detector gas and the grid to anode gap width is necessary, if good charge resolution over a wide range of heavy ions is required. (orig.).
As the ground state potential curve is strongly related to spectral line shapes, the minumum position of the ground state potential is obtained from the experiemental absorption profile k({delta}{nu}, T) at high density of the radiating atoms. The temperature dependence of the absorption processes of Hg and Cd lines 253.65 and 326.1 nm, respectively perturbed by inert gases (Xe, Kr, Ar and Ne) had been carefullystudied over a wide spectral range. Using the point of the maximum temperature dependence {delta}{nu} {sub m} in each case, we are able to calculate the position of the ground state potential R {sub m} using a simple formula.
A new evaluation (UKFY2) has been prepared of the independent and cumulative yields of the products of fission induced by thermal, fast, and 14 MeV neutrons in nuclides important for reactor design and operation and for fuel and waste management. Three spontaneously fissioning nuclides were also considered. The evaluation used a database that is considered to be complete up to early 1989. Carefulstudy was made of experimental uncertainties and discrepancies, emphasizing the need for further measurements. Gaps in the data were filled by interpolation and extrapolation, using fits to empirical models. The yields were subsequently adjusted to fit physical constraints of the fissioning process. This paper describes the evaluation, which was submitted and accepted for inclusion in the JEF2 file. The file was produced in January 1990 and a revision of cumulative yield uncertainties distributed in January 1991.
The aims of this study were to identify risk factors and evaluate the association with clinical outcomes of postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Data from 2488 consecutive adult patients were analyzed. Patients were classified as having CSA-AKI based on the risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria using peak postoperative creatinine in the postoperative intensive care unit (ICU). Multiple stepwise logistic regression analysis was used to identify independent risk factors for CSA-AKI. CSA-AKI occurred in 584 patients (23.5%). CSA-AKI patients had significantly longer aortic cross-clamp and cardiopulmonary bypass times. Furthermore, CSA-AKI patients had higher hospital mortality (5.5% vs 1.5%, PCopyright2...
The Bragg-curve detector of the parallel plate ionization chamber type generates a signal that is a distorted replica of the original Bragg-curve. In result of this distortion, the signal peak height is not only a function of the atomic number of the heavy ion, as it is often stated, but also of the particle mass. This mass effect was studied with the aid of computer simulation, and it was found to be dependent on the Frisch grid to anode gap width and on the detector gas. The charge resolution of the detector is affected very significantly by this mass dependence of the signal peak height. Therefore, a careful selection of the detector gas and the grid to anode gap width is necessary, if good charge resolution over a wide range of heavy ions is required.
The clinical use of "1"8F-fluorodeoxyglucose (FDG) positron emission tomography in monitoring anticancer treatment is expanding. At the same time a number of radiotracers aiming to image different aspects of tumour biology such as proliferation and apoptosis are being developed. However, the factors determining changes of radiotracer uptake parameters in response to treatment are not well understood. In many cases, cellularity may be the primary determinant of changes of FDG uptake and may confound the interpretation of metabolic changes. Early imaging assessments have in some cases showed transient increases of uptake parameters, commonly termed 'flares', which are likely to be unaffected by cellularity and directly reflect pharmacodynamics at a cellular level. In this review a number of settings where molecular imaging 'flares' have been described are discussed. Such changes may often be clinically informative and warrant carefulstudy as ...
In this work, we present results of a systematic study of optical properties of Er{sup 3+} ions in 6H SiC. The role of N-donors played in activation of photoluminescence (PL) of erbium at 1.5 {mu}m was investigated. We have confirmed that N-donors are necessary for activation of the Er PL on one hand, whereas on the other we present evidence that N-donors compete for excitation with Er centres. The high-resolution measurements of the Er{sup 3+} PL were performed aiming at determination of crystal field split levels of the {sup 4}I{sub 15/2} ground and {sup 4}I{sub 13/2} first excited multiplet of Er{sup 3+} ions. Careful analysis of temperature evolution of individual PL lines allowed proposing energy level schemes for the ground and first excited states.
In this work, we present results of a systematic study of optical properties of Er"3"+ ions in 6H SiC. The role of N-donors played in activation of photoluminescence (PL) of erbium at 1.5 #mu#m was investigated. We have confirmed that N-donors are necessary for activation of the Er PL on one hand, whereas on the other we present evidence that N-donors compete for excitation with Er centres. The high-resolution measurements of the Er"3"+ PL were performed aiming at determination of crystal field split levels of the "4I_1_5_/_2 ground and "4I_1_3_/_2 first excited multiplet of Er"3"+ ions. Careful analysis of temperature evolution of individual PL lines allowed proposing energy level schemes for the ground and first excited states.
Parents who contacted 1 of 15 children?s mental health agencies in Ontario, Canada reported on where and why they were seeking mental health services for their 4- to 17-year-old children. Parents contacted?an average of four agencies (?1.7; range?=?1?14) in the previous year. Approximately one-half of parents were looking for either multiple types of treatment, or help for different problems, across agencies. The complex pattern of help-seeking evidenced in our study likely increases the burden on the mental health care system and on families, and may reduce the likelihood that families will connect with the most appropriate treatment.
Fragranced consumer products are pervasive in society. Relatively little is known about the composition of these products, due to lack of prior study, complexity of formulations, and limitations and protections on ingredient disclosure in the U.S. We investigated volatile organic compounds (VOCs) emitted from 25 common fragranced consumer products-laundry products, personal care products, cleaning supplies, and air fresheners-using headspace analysis with gas chromatography/mass spectrometry (GC/MS). Our analysis found 133 different VOCs emitted from the 25 products, with an average of 17 VOCs per product. Of these 133 VOCs, 24 are classified as toxic or hazardous under U.S. federal laws, and each product emitted at least one of these compounds. For ''green'' products, emissions of these c...
The optimization of the safety characteristics of electrical installations in industrial plants with explosion or fire hazards can be obtained only through a careful interdisciplinary study and analysis carried out at the onset of the plant project design phase. The least complex and costly and safest solutions are those which are born from plant designs which take into account the typology of the industrial process or technology, or which incorporate pollution abatement measures and adequate safety measures for the electrical installations. This paper provides examples to illustrate how the global plant economy is fundamentally dependant upon a multi-disciplinary initial effort in design analyses. Comments are made relevant to the adequacy of the safety requirements established by existing and planned Italian norms in dealing with safety and fire protection for high-tech industrial plant electrical installations.
Abstract Background Atopic dermatitis (AD) affects health and quality of life and it has great impact on both health-care costs and costs to the society. Objectives The objective of this study was to develop a model to analyse the cost-effectiveness of a barrier-strengthening moisturizing cream as maintenance therapy compared with no treatment after initial treatment with betamethasone valerate in adult patients with AD in Sweden. A further aim was to apply a similar health-economic analysis for Denmark, Norway and Finland. Methods A Markov simulation model was developed including data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate AD treated with either a moisturizing cream or no treatment, (ii) resource utilization and quality of...
Abstract The fit of patient coping style and psychotherapy focus has been suggested as improving treatment outcome. This article reviews the definitions, measures, and previous research surrounding this hypothesis. An original meta-analysis of 12 carefully selected studies (N = 1,291 patients) resulted in a weighted, mean effect size (d) of .55 in favor of a fit between externalizing patients and symptom-focused treatment or, alternatively, internalizing patients and insight-focused treatment. This medium-size effect indicates that nondiagnostic patient factors, like coping style, are important considerations in the selection of effective therapies. Clinical examples and clinical recommendations are provided. 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:176-183, 2011.
BackgroundAlthough self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. ObjectiveTo identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. DesignRetrospective chart review. SettingA tertiary-care academic medical center in South Korea. PatientsThis study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. InterventionPlacement of colonic SEMSs. Main Outcome MeasurementsTechnical success and immediate and long-term clinical success rates. ResultsTechnical...
The Fast Flux Test Facility (FFTF) core loading during its ninth operating cycle was significantly different from that of previous cycles because of the presence of the Core Demonstration Experiment (CDE). The CDE consists of a number of axially blanketed fuel assemblies and internal blankets prototypic of advanced oxide cores in Liquid Metal Reactors (LMR). In preparation for the Cycle 9 reload design effort, a careful assessment of control rod worth and reactivity calculations for Cycles 1 through 8 was made. The goal of this study was to establish calculational biases and reduce uncertainties factored into the reload design calculations. These analyses helped assure that the operational objectives for Cycle 9 were met.
The Fast Flux Test Facility (FFTF) core loading during its ninth operating cycle was significantly different from that of previous cycles because of the presence of the Core Demonstration Experiment (CDE). The CDE consists of a number of axially blanketed fuel assemblies and internal blankets prototypic of advanced oxide cores in Liquid Metal Reactors (LMR). In preparation for the Cycle 9 reload design effort, a careful assessment of control rod worth and reactivity calculations for Cycles 1 through 8 was made. The goal of this study was to establish calculational biases and reduce uncertainties factored into the reload design calculations. These analyses helped assure that the operational objectives for Cycle 9 were met.
The interscalenic block technique is widely used for ambulatory shoulder surgery despite a substantial number of failures and adverse effects. We prospectively evaluated satisfaction in 40 consecutive patients who underwent open Bankart repair under a single general anesthesic performed in an ambulatory care unit. The mean age of the patients was 23 years. There were 29 men and 11 women. Patients were evaluated postoperatively with a visual analog scale of pain (in the recovery room, at the time of discharge, and the day after and 1 week after surgery) via a home assessment questionnaire that included the following: effectiveness of oral pain medication, ability to perform activities of daily life, and overall satisfaction. One patient failed to be discharged because of a feeling of faintn...
The {rvec n} + p {yields} d + {gamma} experiment under construction at LANSCE studies the weak interaction between neutrons and protons. The experiments will measure the directional dependence of the parity-violating {gamma}-ray asymmetry, A{sub {gamma}}, in the polarized cold neutron capture by para-hydrogen. The goal is to measure A{sub {gamma}} with uncertainty of 0.5 x 10{sup -8}, 10% of its predicted value. A{sub {gamma}} primarily isolates the {Delta}I = 1 component of the hadronic weak interaction and thus will determine the long-range weak pion-nucleon coupling constant H{sub {pi}}{sup 1}. The experiment is carefully designed for the LANSCE pulsed spallation neutron source to achieve the proposed statistical precision and to control systematic errors. We discuss the experiment and its status.
The paper describes the possibilities of using data warehousing and OLAP technologies in public health care in general and then our own experience with these technologies gained during the implementation...Full Text Available
By analyzing the data of 459 patients who completed the Supportive Care Needs Survey (SCNS), the prevalence, medical and non-medical predictors of unmet needs were investigated. Breast cancer patients...Full Text Available
Fresh blood has many potential advantages over older blood, but there is no evidence that these properties translate into clinical benefit for intensive care patients. The observational multicenter...Full Text Available
Digital information flow within the intensive care unit (ICU) continues to grow, with advances in technology and computational biology. Recent developments in the integration and archiving of these...Full Text Available
BackgroundNew Zealand's Primary Health Care Strategy (NZPHCS) was introduced in 2002. Its features are substantial increases in government funding delivered as capitation payments,...Full Text Available
Psychology as both a science and a profession has been closely identified with other disciplines in the broad field of health since the turn of the present century. Recent advances in health care have...Full Text Available
OBJECTIVES:To investigate the prevalence of potential drug interactions at the intensive care unit of a university hospital in Brazil and to analyze their clinical significance.METHODS:This...Full Text Available
ObjectiveTo identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients.Full Text Available
The outcome of patients admitted to intensive care units is known to be influenced by such factors as age, previous health status, severity of disease, and diagnosis. To estimate the outcome of such...Full Text Available
ObjectiveTo report the outcome of children with life-threatening asthma (LTA) admitted to a university Pediatric Intensive Care Unit (PICU).MethodsRetrospective...Full Text Available
This article explores the effects of reimbursement and utilization control policies on utilization patterns and spending for physician and hospital outpatient services under state Medicaid programs....Full Text Available
OBJECTIVE: To examine primary care physicians' management of rheumatoid arthritis, ascertain the determinants of management and compare management with that recommended by a current practice panel....Full Text Available
This paper summarizes the findings for the African Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview...Full Text Available
Electronic personal health records (ePHRs) can potentially maximize access and coordination of health information and improve patient/clinician collaboration, patient self-management, and health outcomes....Full Text Available
BackgroundThe Government has invested £7 million (approx. $11.5 million) to connect all Primary Care Practices in Scotland to the National Health Service...Full Text Available
Objectives:Despite its impact on health policy, the relationship between geographical proximity and health care seeking has received scant attention in the medical literature. This...Full Text Available
Emergency Departments (ED) are fast-paced, information-intensive environments where patient care team members must address their information needs quickly and accurately. We conducted a qualitative...Full Text Available
The method of linear analogue self-assessment (LASA) was used to quantify the views concerning day care which were held by patients attending a geriatric day hospital. The results suggest that day hospitals...Full Text Available
ObjectivesTo assess Croatian community pharmacists' patient care competencies using the General Level Framework (GLF).MethodsThe competencies of...Full Text Available
PURPOSE We wanted to assess computer capabilities in a primary care practice-based research network and to understand how receptive the practices were to new ideas for automation of practice...Full Text Available
Quality research, requiring large numbers of participants, in the intensive care unit (ICU) population requires multicentre collaboration. Although logistically challenging, this methodology reduces...Full Text Available
BACKGROUND. Diabetes can be effectively treated and monitored in general practice. Postgraduate medical education at a local level is required to support this strategic shift of medical care from hospital...Full Text Available
Will the aging of Canada's population bankrupt the health care system? In this issue (see pages 1555 to 1560) Dr. Marie Demers reports that the increase in physician service costs for elderly people...Full Text Available
PURPOSE The Wells rule is widely used for clinical assessment of patients with suspected deep vein thrombosis (DVT), especially in the secondary care setting. Recently a new clinical decision...Full Text Available
The overarching goal of medical training is to nurture the growth of knowledgeable, caring and insightful clinicians guided by the ideals of medical professionalism. Recent definitions of professional...Full Text Available
BackgroundThe Canadian Emergency Department Triage and Acuity Scale (CTAS) is a well recognized and validated triage system that prioritizes patient care by severity of illness....Full Text Available
Patients do considerable information work. Technologies that help patients manage health information so they can play active roles in their health-care, such as personal health records, provide...Full Text Available
Very few areas of medical science have experienced more rapid development of new and beneficial treatment approaches during the past two decades than the disciplines required for total care of patients...Full Text Available
This article compared conceptual and empirical strengths of alternative methods for estimating racial disparities using non-linear models of health care access. Three methods were presented...Full Text Available
ObjectiveTo estimate the joint effect of a multifaceted access intervention on primary care physician (PCP) productivity in a large, integrated prepaid group practice.Data...Full Text Available
OBJECTIVE: To increase cost-efficiency while maintaining the standard of medical care, an accelerated surgical stay program for patients having breast surgery was instituted. SUMMARY BACKGROUND DATA:...Full Text Available
...dates of the implementation of the standard unique health identifier for health care providers. 162.404 Section 162.404 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA...
... Title : Mental Health and Resilience: Soldiers' Perceptions about Psychotherapy, Medications, and Barriers to Care in the United States Military. ...
Studies on the multivariate autoregressive (MAR) analysis are carried out for the choice of the parameters for modelling the data obtained from various sensors optimally. Accordingly, the roles of the parameters on the analysis results are identified and the related ambiguities are reduced. Experimental investigations are carried out by means of synthesized reactor noise-like data obtained from a digital simulator providing simulated stochastic signals of an operating nuclear reactor so that the simulator constitutes a favourable tool for the present studies aimed. As the system is well defined with its known structure, precise comparison of the MAR analysis results with the true values is performed. With the help of the information gained through the studies carried out, conditions to be taken care of for optimal signal processing in MAR modelling are determined. Although the parameters involved are ...
The Sultanate of Oman has a relatively young national health care system that could demonstrate its high performance at an international level. Emergency medicine as a specialty has developed rapidly in the country over the last decade. This has involved the parallel development of local emergency residency training, prehospital emergency care, and emergency nursing programs. This article reviews the progress of emergency care practice in this country from a general primary care system toward becoming an established specialty in hospital, prehospital, and private emergency care settings. It also describes aspects of undergraduate, postgraduate, and continuous emergency medicine education in the country. Further, a glimpse into academic emergency medicine and emergency nursing is provided. ...
This study examined whether cognitive behavioural therapy (CBT) could prevent the development or worsening of panic-spectrum psychopathology and anxiety symptoms in chronic obstructive pulmonary disease (COPD). 41 patients with COPD, who had undergone pulmonary rehabilitation, were randomised to either a four-session CBT intervention condition (n = 21) or a routine care condition (n = 20). Assessments were at baseline, post-intervention, and at 6-, 12- and 18-month follow-ups. Primary outcomes were the rates of panic attacks, panic disorder and anxiety symptoms. Secondary outcomes were depressive symptoms, catastrophic cognitions about breathing difficulties, disease-specific quality of life and hospital admission rates. There were no significant differences between the groups on outcome measures at baseline. By the 18-month follow-up assessment, 12 (60%) routine care group participants had experienced at least one panic ...
Numerical studies are performed to identify an optimal range of geometric parameters in connection with the design of an impingement-conditioned small direct-injection diesel engine. The parametric studies were made in a pressure chamber with a circular protrusion on to which sprays are directed to impinge. Computational runs were made for 24 cases carefully chosen to allow examination of the effects on post-impingement spray characteristics of the following parameters: (a) the nozzle-plate distance and (b) the size and geometry pattern of the protrusion. An optimal range of these parameters has been identified through an analysis of the calculated results in terms of vapour concentration, the Sauter mean diameter of the wall spray and the dispersed wall spray volume. The results obtained also reveals that, by just changing the size of the impingement surface and the impingement distance, local fuel vaporization efficiency ...
The key to the future for electric utilities will not be found in legislation or regulation. Title VII of the Energy Policy Act of 1992 will prove to be just as ineffectual in improving the industry's position as was the Public Utility Regulatory Policies Act of 1978. These legislative palliatives, which produced so much commotion and so many reams of heated commentary, are largely irrelevant to a successful future for electric utilities. The key will be found in economics, not in law, and the future will lie in completing Thomas A. Edison's century-old vision for the industry, half of which the industry has heretofore ignored. The industry must embrace the complete vision and evolve from electric utilities into [open quotes]end-use energy utilities.[close quotes
A 21-year-old woman developed midesophageal stricture two weeks after ingestion of aluminium phosphide (AlP) tablets. Aluminium phosphide is a lethal protoplasmic toxin and is also the most common cause of suicidal poisoning in northern India. Upper gastrointestinal endoscopy (UGIE) showed a tight esophageal stricture 29?cm from the incisors with a circumferential ulcer. Dilatation up to 17?mm was done using Savary-Gilliard dilators. She had repeated dilatations three times at nearly two-week intervals. In view of the resistant stricture, a silicone Polyflex stent was placed across the stricture and removed after 3?months; there was no recurrence of stricture even after three months of follow-up. Patients with recurrent esophageal stricture and those with fistula may benefit from silicone ...
BACKGROUND: The urgent need for patient safety education for healthcare students has been recognised by many accreditation bodies, but to date there has been sporadic attention to undergraduate/graduate medical programmes. Medical students themselves have identified quality and safety of care as an important area of instruction; as future doctors and healthcare leaders, they must be prepared to practise safe healthcare. Medical education has yet to fully embrace patient safety concepts and principles into existing medical curricula. Universities are continuing to produce graduate doctors lacking in the patient safety knowledge, skills and behaviours thought necessary to deliver safe care. A significant challenge is that patient safety is still a relatively new concept and area of study; thus, many medical educators are unfamiliar with the literature and unsure how to integrate patient safety learning into existing ...
BACKGROUND: The urgent need for patient safety education for healthcare students has been recognised by many accreditation bodies, but to date there has been sporadic attention to undergraduate/graduate medical programmes. Medical students themselves have identified quality and safety of care as an important area of instruction; as future doctors and healthcare leaders, they must be prepared to practise safe healthcare. Medical education has yet to fully embrace patient safety concepts and principles into existing medical curricula. Universities are continuing to produce graduate doctors lacking in the patient safety knowledge, skills and behaviours thought necessary to deliver safe care. A significant challenge is that patient safety is still a relatively new concept and area of study; thus, many medical educators are unfamiliar with the literature and unsure how to integrate patient safety learning into existing ...
Most of the petroleum fields in the Norwegian sector of the North Sea are sandstone reservoirs; the oil and gas are trapped in different species of sandstone. But the Ekofisk Field is a chalk reservoir, which really challenges the operator companies. When oil is produced from chalk reservoirs, water usually gets in and the reservoir subsides. The subsidence may be expensive for the oil companies or be used to advantage by increasing the recovery rate. Since 60 per cent of the world's petroleum reserves are located in carbonate reservoirs, it is important to understand what happens as oil and gas are pumped out. Comprehensive studies at the Department of Petroleum Technology and Applied Geophysics at Stavanger University College in Norway show that the mechanical properties of chalk are considerably altered when the pores in the rock become saturated with oil/gas or water under different stress conditions. The processes are extremely complex. The article also ...
Abuzakuk T, Coward P, Shenava Y, Kumar VS, Skinner JA. The management of wounds following primary lower limb arthroplasty: a prospective, randomised study comparing hydrofibre and central pad dressings. Abstract Wound care following lower limb arthroplasty has not been subject to in-depth clinical research, primarily because such wounds usually heal without complication. However, when prosthetic implants are used, serious wound problems can be disastrous (Whitehouse et al. Infect Control Hosp Epidemiol 2002;23:183-9; Lindwell OM. Clin Orthop Relat Res 1986;211:91-103). We report the results of a prospective, randomised, controlled trial comparing a hydrofibre (Aquacel) and central pad (Mepore) dressing in the management of acute wounds following primary total hip or knee arthroplasty left ...
The use of ionising radiation for the preservation of food has been under investigation for many years but has yet to receive worldwide acceptance. Although irradiation can be carefully controlled, it is generally accepted that the development of a test or tests for the detection of irradiated food would enhance consumer confidence and might help to enforce labelling regulations. The 2-alkylcyclobutanones are reported to be the only cyclic compounds formed as the products of the radiolysis of saturated and unsaturated triglycerides. The synthesis of 2-dodecylcyclobutanone (DCB) and 2-tetradecylcyclobutanone (TCB), which are formed from palmitic and stearic acid respectively following irradiation, has been carried out and using irradiated chicken meat as the model for a high-lipid containing food, both cyclobutanones have been extracted with hexane and then identified using gas chromatography/mass spectrometry (GC/MS). DCB and TCB have been detected in chicken meat ...
In this paper we apply stochastic programming modelling and solution techniques to planning problems for a consortium of oil companies. A multiperiod supply, transformation and distribution scheduling problem - the Depot and Refinery Optimization Problem (DROP) - is formulated for strategic or tactical level planning of the consortium's activities. This deterministic model is used as a basis for implementing a stochastic programming formulation with uncertainty in the product demands and spot supply costs (DROPS), whose solution process utilizes the deterministic equivalent linear programming problem. We employ our STOCHGEN general purpose stochastic problem generator to 'recreate' the decision (scenario) tree for the unfolding future as this deterministic equivalent. To project random demands for oil products at different spatial locations into the future and to generate random fluctuations in their future prices/costs a stochastic input data simulator is developed and calibrated to ...
The main challenges for PMOS ultra shallow junction formation remain the transient enhanced diffusion (TED) and the solid solubility limit of boron in silicon. It has been demonstrated that low energy boron implantation and spike annealing are key in meeting the 90nm technology node ITRS requirements. To meet the 65nm technology requirements many studies have used fluorine co-implantation with boron and Si"+ or Ge"+ pre-amorphization (PAI) and spike annealing. Although using BF_2"+ can be attractive for its high throughput, self-amorphization and the presence of fluorine, many studies have shown that the fluorine successfully reduce TED, its energy needs to be well optimized with respect to the boron's, therefore BF_2"+ does not present the right fluorine/boron energy ratio for the optimum junction formation. In this work we optimize the fluorine energy for boron energies down to 200eV. We show the dependence of optimized junction on Ge"+ ...
It is well known that the lightning protection of transmission lines is exclusively relying on their correct initial design. Although detailed engineering studies are usually performed by electric power utilities for the design of new transmission lines, there are reported cases where the design is based simply on tradition or on utilities' standardization policy. In this paper, the lightning protection of high-voltage transmission lines is faced as an optimization problem where optimum design parameters are calculated for the lines, relating their cost with the lightning failures' cost, aiming to reduce or even eliminate lightning failures. The optimization method considers all the available protection means, i.e. ground wires and surge arresters. In order to validate the effectiveness of the proposed method, it is applied on several operating Hellenic transmission lines of 150 kV carefully selected among others due to their ...
A cohort of singleton black human females exposed to diagnostic x-ray in utero and controls matched by parity, hospital of birth and birthdate have been followed to ages 25 to 30 years in Baltimore, Maryland. The search for possible effects of prenatal irradiation has focused on health, growth, development, and reproductive experience of exposed and control women. This paper reports findings related to reproductive experience. From an original data set of 1458 matched exposed-control pairs of women, questionnaire responses were received from 1109 exposed and 1124 control women including 852 each from pairs in which both the exposed and control woman responded. After careful search for alternative explanations of the findings, the authors concluded that females exposed in utero to low doses of x-ray (probably 1 to 5 rads) had significant increases in their rates of early onset of menses, births at age 15 years or less, numbers of living children, stillbirths, and ...
Supermetal with critical characteristics is under advanced investigation for further improvement of metal materials. Although iron is most frequently used as structural material among various metals, it should be used more carefully and effectively because of resource limitation and global environmental problem. It is essential to draw various excellent properties much more from iron and to improve recyclability. In particular, the best way to meet these requirements is achievement of more fine structure and higher purity. Since the lowest crystalline grain size is now limited to nearly 10{mu}m, metallic structure composed of grains below 1{mu}m is expected by mesoscopic control. Various methods have been studied to achieve ultra-fine crystalline structure, and study of precise heat treatment control and ultra-strength metallurgy is required. Heat treatment in magnetic field and layered structure by mechanical alloying are ...
Substantial thermal performance improvement in ice-on-tube cold thermal energy storage systems (TES) is possible by making use of porous copper mesh as a Heat Conducting Enhancement Device (HCED). HCEDs are inexpensive heat transfer augmentation devices that can result in faster rate of ice growth and larger final steady state ice build volume by reducing the controlling thermal conduction resistance of the ice layer. This improves the competitiveness of external ice-on-tube systems as compared to other TES systems, such as dynamic ice harvesters and static internal melt systems. In this study the amount of ice growth enhancement is predicted theoretically, by performing simplified 1-D calculations, and is then validated in the laboratory through carefully controlled experiments. This study shows that ice volume increase between 50 and 90% is possible by using HCEDs of the type tested. (author)
There is a plethora of new silver-containing dressings on the market today. Various manufacturers attempt to show that their dressings are the most efficacious and therefore should be preferentially employed by health care workers based on the results of their in vitro tests. However, there have been no studies that clearly identify which tests are appropriate for comparison purposes. The purpose of this study was to determine which in vitro test is most appropriate for evaluating the antimicrobial efficacy of silver-containing dressings. This was done by testing seven silver-containing dressings and two non-silver-containing topical agents against 17 clinically relevant microorganisms using zone of inhibition assays and time-kill kinetic assays in complex media. The results for the two assays were then correlated to determine whether the methods generated similar results. It was determined that the two methods do not ...
Background 2009 pandemic influenza A(H1N1) has led to a global increase in severe respiratory illness. Little is known about kidney outcomes and dialytic requirements in critically ill patients infected with pandemic H1N1. Study Design Prospective observational study. Setting & Participants 50 patients with pandemic H1N1 admitted to any of 7 intensive care units in Manitoba, Canada, were prospectively followed. Outcome & Measurements Outcomes were kidney injury and kidney failure defined using RIFLE (risk, injury, failure, loss, end-stage disease) criteria or need for dialysis therapy. Results The pandemic H1N1 group was composed of 50 critically ill patients with pandemic H1N1 with severe respiratory syndrome (47 confirmed cases, 3 probable). Kidney injury, kidney failure, a...
We wanted to determine the technical and clinical efficacy of placing a self-expandable PTFE-covered nitinol stent for the management of inoperable malignant biliary obstruction. Thirty six patients with inoperable malignant biliary obstructions were treated by placement of self-expandable PTFE-covered nitinol stents (S and G Biotech Corporation, Seongnam, Korea). Clinical evaluation was done with assessment of the serum bilirubin and alkaline phosphatase levels, which were measured before and after stent placement within 1 week, at 1 month and at 3 months. The patient survival rate and stent patency rate were calculated with performing Kaplan-Meier survival analysis. Successful stent placement was achieved in all the patients without procedure-related complication. Pancreatitis as an early complication occurred in two cases. The serum bilirubin and alkaline phosphatase levels were significantly decreased after the procedure. During the follow-up, recurrent obstructive jaundice ...
Inferior vena cava (IVC) obstruction is a well-described clinical entity. Most IVC obstructions from malignant neoplasms are a direct result of tumor compression [Oviedo J, Cerda S. Vascular invasion by hepatocellular carcinoma. Arch Pathol Lab Med 2001;125: 454-5; Furui S, Sawada S, et al. Gianturco stent placement in malignant caval obstruction: analysis of factors for predicting the outcome. Radiology 1995;195:147-52; Fletcher WS, Lakin PC, et al. Results of treatment of inferior vena cava syndrome with expandable metallic stents. Arch Surg 1998;133:935-8]. The symptoms of IVC obstruction include progressive ascites, scrotal edema and lower body edema. These constellations of symptoms are described as IVC syndrome and are devastating to a patient with end-stage cancer. We describe a palliative therapy utilizing Luminexx nitinol self-expanding stents to treat intracaval hepatoma thrombus obstructing the IVC. The procedure is rapidly performed, technically ...
We wanted to evaluate the long-term results of a dual expandable nitinol stent for the palliative treatment of malignant gastroduodenal strictures. The dual stent consists of two stents; an outer partially nylon covered stent and an inner bare nitinol stent. The outer stent was placed into the stricture and this was followed by coaxial placement of the inner bare stent. Using fluoroscopic guidance, dual expandable stents were placed in 86 patients with inoperable malignant gastroduodenal strictures. The technical and clinical success, the complication, survival and the stent patency were evaluated during the follow-up period. Stent placement was technically successful in 83 of the 86 patients. After stent placement, 74 of the 85 patients showed improvement of their symptoms. During the mean follow-up period of 133 days, 24 patients (28%) developed recurrent symptoms due to incomplete expansion (n=1), stent migration (n=4), food impaction (n=2), granulation tissue ...
AbstractOBJECTIVETo provide an overview of the 2009 edition of the Rourke Baby Record (RBR), which incorporates recent research in the literature relating to preventive health care for children aged 0 to 5 years.QUALITY OF EVIDENCERecommendations are identified as supported by good, fair, or consensus evidence, according to the classification of the Canadian Task Force on Preventive Health Care.MAIN MESSAGENew information and recommendations are given for growth monitoring, nutrition, developmental surveillance, physical examination maneuvers, immunization schedules, and advice for parents. Anticipatory guidance updates relate to injury prevention, infant swaddling, literacy facilitation, nonparental child care, parenting skills programs, serum lead levels, over-the-counter cough and cold medications, pacifiers, antipyretics, insect repellents, and dental care and oral health. The 2009 RBR is available ...
The health politics and policy communities are still struggling with the question of "what went wrong" in the 1993-94 health care reform effort. Here I identify which Americans were politically active and inactive during the health care reform debate to explore the role political participation may have had in determining the outcome of the debate. Using data from a national and California random-sample telephone surveys, and controlling for other demographic attributes, I found that those who engaged in political activity specifically related to health care reform were disproportionately more likely to be self-identified conservatives, less likely to favor an employer mandate plan, more likely to be fifty to sixty-four years old, more likely to be men, and more likely to have greater interest in and knowledge of the health care issue. Even in California, where a single-payer proposal was on the November ...
The objectives of this paper are to: quickly outline the extent of the care gap in osteoporosis; define T-2 (knowledge) translation and its relationship to quality improvement; discuss the barriers to best practice in osteoporosis care after a fracture; convey the importance of rigor in design and evaluation of translational interventions by drawing upon examples from the broader literature; describe in some detail a series of post-fracture intervention trials conducted in Alberta, Canada; and make some conclusions specifically about osteoporosis interventions and more generally about T-2 translational research.
... Ashton WS, Puntel RA, Wiswell TE. A rapid and readily available repair of the peripherally inserted central catheter in the nursery. NEONATAL INTENSIVE CARE 11 ...
Patients rely on their primary care physician to manage multiple, often chronic medical conditions that require prescription medications. Balancing the risk to benefit of treatments can be challenging...Full Text Available
During an outbreak of Flavobacterium meningosepticum septicaemia in a neonatal intensive care unit 9 infants were treated with intravenous trimethoprim sulphamethoxazole. Bacteriological cure was achieved...Full Text Available
A questionnaire on the development of specialist clinics was distributed to the members of the Association of British Neurologists and completed by 104 members (85 consultants). Half of the respondents...Full Text Available
ObjectiveTo investigate the prevalence of complicating and concurrent morbidities in older diabetic patients and to evaluate to what extent their occurrence affects the burden of...Full Text Available
Sepsis has continuously been a leading cause of neonatal morbidity and mortality despite current advances in chemotherapy and patient intensive care facilities. Neonates are at high risk for...Full Text Available
BackgroundAs long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors...Full Text Available
A Health Care Establishment (HCE) is an establishment where medical services are rendered. The above services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. Previously, IT equipment consisted solely of stand-alone systems, whereas in recent years, the trend has been towards computer networks and distributed systems in HCEs. The spread of distributed information technology in HCEs have necessitated the implementation of Security in HCISs, to assure confidentiality, integrity and availability of HCE information. This paper discusses the issues of Security and Network Security in Health Care Information Systems (HCISs). It also suggests a method in establishing Network Security Guidelines and describes Principles for the provision of Network Security in HCEs. PMID:10163736
... 82 Ibid, 200. 83 Ibid, 200. 84 Ibid, 201. 43 Page 49. care to hunt down and execute all that claimed to be from the house of David. They considered ...
A Health Care Establishment (HCE) is an establishment where medical services are rendered. These services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. The spread of distributed information technology in HCEs have necessitated the implementation of Network Security in Health Care Information System (HCISs), to assure confidentiality, integrity and availability of HC information being transmitted across HC networks. This paper presents a road map in implementing Network Security guidelines for the provision of Network Security in HCEs, work carried out within the Secure Environment for Information Systems in Medicine (SEISMED) project under the Advanced Informatics in Medicine (AIM) programme. PMID:8591295
... dressing changes and site care, mid-line placement, placement of peripherally inserted central catheters, heparin locks, and patient education. ...
PurposeHealth information technology (HIT) and physician career satisfaction are associated with higher-quality medical care. However, the link between HIT and physician...Full Text Available
The economics of medical computer networks are presented in context with the patient care and administrative goals of medical networks. Design alternatives and network topologies are discussed with...Full Text Available
BackgroundAlthough advances in rehydration therapy have made cholera a treatable disease with low case-fatality in settings with appropriate medical care, cholera continues...Full Text Available
Brief admission of the new diabetic child and of a parent to an enlightened hospital for stabilisation, preliminary education, and familiarisation with hospital and community staff is well worth while....Full Text Available
Background Increasing numbers of cancer patients are using the Internet, but little is known about their attitudes toward online health care.Full Text Available
of injuries, disabilities, and deaths; and 3. Encourage professionals from a wide spectrum of disciplines such as engineering, bioengineering, medicine, health care, public...
This bibliography of nonserial publications consists of 610 annotations. It is intended as a guide to the development of a collection for librarians and for health professionals in research and education....Full Text Available
Purpose: To assess the prevalence, significance and practical value of two recently described CT signs of instable aneurysm: the crescent sign and the periluminal halo (a low-attenuating internal layer of the thrombus around the patent lumen). Material and methods: Among the CT examination performed in the last 5 years, they retrospectively selected the nonruptured aneurysms with a diameter exceeding 4 cm (no. = 93 average diameter 5.1 cm, unenhanced images in 28 cases and enhanced in 84) and the ruptured aneurysms (no. = 16, average diameter 6.7 cm, unenhanced images in 9 cases and enhanced in 9). They studied the prevalence of the crescent and halo sing, their relationship with the aneurysm diameter, and the effect of contrast enhancement. Results: The crescent sign was identified with a statistically significant prevalence in ruptured ( 37.5 % or cases) over asymptomatic aneurysms (5.5 %); the halo had the same frequency in the 2 groups (12.5 % and 9.5 %). Both ...
Soils and groundwater beneath an abandoned Process sewer line in the A/M Area of the Savannah River Site (SRS) contain elevated levels of volatile organic compounds, specifically trichloroethylene (TCE) and tetrachloroethylene (PCE), two common chlorinated solvents. These compounds have low aqueous solubilities, thus when released to the subsurface in sufficient quantity, tend to exist as immiscible fluids or nonaqueous phase liquids (NAPLs). Because chlorinated solvents are also denser than water, they are referred to by the acronym DNAPLS, or dense non aqueous Phase liquids. Technologies targeted at the efficient characterization or removal of DNAPL are not currently proven. For example, most DNAPL studies rely on traditional soil and water sampling and the fortuitous observation of immiscible solvent. Once DNAPL is identified, soil excavation (which is only applicable to small contained spill sites) is the only ``proven`` cleanup method. New cleanup approaches ...
Silicon nitride-based ceramics behavior is strongly influenced by microstructural parameters, which, in turn are determined by chosen densification method. Highly covalent Si-N bond hind are the silicon nitride densification. Therefore, metal oxides are used in order to get high density. However, such oxides must be carefully selected, because they affect the general macroscopic properties of sintered bodies. In the present work, the viability of rare earth concentrate use to produce #beta#--Si_6_-_xAl_xO_xN_8_-_x and its effect on mechanical properties of the sintering ceramics are studied. Additive composition, heating rate, soaking time and sintering temperature were took as variables. Hardness, fracture toughness, Young's modulus and flexural strength were investigated. Lattice parameter compositional dependence and secondary phases crystallized after past-sintering heat treatment were also determined. The results show that rare earth ...
The International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO) was launched in the year 2000, based on a resolution by the IAEA General Conference (GC(44)/RES/21). INPRO intends to help to ensure that nuclear energy is available in the 21st century in a sustainable manner, and seeks to bring together all interested Member States, both technology holders and technology users, to consider, jointly, actions to achieve desired innovations. INPRO is taking care of the specific needs of developing countries. This IAEA publication is part of Phase 1 of INPRO. It intends to provide an overview on history, present situation and future perspectives of nuclear fuel cycle technologies. While this overview focuses on technical issues, nevertheless, the aspects of economics, environment, and safety and proliferation resistance are important background issues for this study. After a brief description about the INPRO project and an evaluation ...
In this updated second edition, the order of contents of the textbook has been reorganized. It has been divided into main parts: Basic Science and Clinical Nuclear Medicine. Basic Science, Part I, encompasses basic physics, radiation protection, interaction of radiation with matter and radiation detection, imaging, nuclear pharmacy, and radiation biology. Part II, Clinical Nuclear Medicine, covers the central nervous system, bone, gastroenterology (liver/spleen), cardiovascular system, pulmonary system, genitourinary system, thyroid and endocrine systems, gallium studies, radioassay, hematology, and therapy. The total number of pages of the current edition is increased to 250 from the 213 of the first edition but there are fewer questions because those in the basic science area have been carefully selected to 60 of the original 98 questions. Compared with the previous edition, there are two advantages in the current one: (1) the addition of ...
A 1984 American Association of the Academy of Sciences study of more than 150 successful science in-service programs developed a list of their characteristics, which included: Strong academic component in mathematics, science, and communications, focused on enrichment rather than remediation; academic subjects taught by teachers who are highly competent in the subject matter and believe that students can learn the materials; heavy emphasis on the applications of science and mathematics and careers in these fields; integrative approach to teaching that incorporates all subject areas, hands-on opportunities, and computers; multiyear involvement with students; recruitment of participants from all relevant target populations; opportunities for in-school and out-of-school learning experiences; parental involvement and development of base of community support; specific attention to removing educational inequalities related to race and gender; involvement of professionals ...
A 1984 American Association of the Academy of Sciences study of more than 150 successful science in-service programs developed a list of their characteristics, which included: Strong academic component in mathematics, science, and communications, focused on enrichment rather than remediation; academic subjects taught by teachers who are highly competent in the subject matter and believe that students can learn the materials; heavy emphasis on the applications of science and mathematics and careers in these fields; integrative approach to teaching that incorporates all subject areas, hands-on opportunities, and computers; multiyear involvement with students; recruitment of participants from all relevant target populations; opportunities for in-school and out-of-school learning experiences; parental involvement and development of base of community support; specific attention to removing educational inequalities related to race and gender; involvement of professionals ...
We exhibit static solutions of multi-flavour QCD in two dimensions that have the quantum numbers of baryons and mesons, constructed out of quark and anti-quark solitons. In isolation the latter solitons have infinite energy, corresponding to the presence of a string carrying the non-singlet colour flux off to spatial infinity. When $N_c$ solitons of this type are combined, a static, finite-energy, colour singlet solution is formed, corresponding to a baryon. Similarly, static meson solutions are formed out of a soliton and an anti-soliton of different flavours. The stability of the mesons against annihilation is ensured by flavour conservation. The static solutions exist only when the fundamental fields of the bosonized Lagrangian belong to $U(N_c{\\times}N_f)$ rather than to $SU(N_c) \\times U(N_f)$. Discussion of flavour symmetry breaking requires a careful treatment of the normal ordering ambiguity. Our results can be viewed as a derivation of the constituent ...
Artificial bone cements (BCs) based on poly(methyl methacrylate) (PMMA) powders and methyl methacrylate (MMA) liquid monomer also present in their formulation small amounts of other substances, including a chemical initiator compound and radiopaque agents. Because inadequate mixing of the recipe components during the manufacture of the bone cement may compromise the mechanical properties of the final pieces, new techniques to incorporate the fillers into the BC and their effect upon the mechanical properties of BC pieces were investigated in the present study. PMMA powder composites were produced in situ in the reaction vessel by addition of X-ray contrasts to the reacting MMA mixture. It is shown that this can lead to much better mechanical properties of test pieces, when compared to standard bone cement formulations, because enhanced dispersion of the radiopaque agents can be achieved. Moreover, it is shown that the addition of hydroxyapatite (HA) and acrylic ...
A new performance model of the externally fired combined cycle (EFCC) is implemented in ASPEN (Advanced System for Process ENgineering), a chemical process simulator. The model accounts for interactions within and between approximately a dozen major process areas. The new model is applied to case studies to evaluate the sensitivity of process performance to the ranges of uncertainty in key model inputs such as heat losses, carbon conversion, and air leakage rates, and to illustrate how alternative designs, including steam injection and flue gas desulfurization (FGD), can affect plant thermal efficiency and net power output. The model results suggest that careful attention to the design of the FGD system is needed, especially with respect to reheat, and that steam injection may offer cost savings associated with reducing the size of the steam turbine with little or no penalty on plant output or plant efficiency. Uncertainties in the slagging ...
High-quality solar cells have been fabricated by utilizing localized argon-ion laser decomposition of silver neodecanoate spun onto diffused silicon substrates and subsequent electroplating. Early adhesion problems during electroplating have been carefullystudied and finally solved using a novel coating procedure. The laser-metallized solar cells have been characterized using lighted and dark current-voltage measurements and compared with baseline cells metallized using standard photolithographic procedures. Non-AR-coated cell efficiencies ranging from 10 to over 11% have been obtained for the laser-metallized cells, comparable with the best baseline cells. The laser-metallized cells have 30 to 40% lower series resistance than the unsintered baseline cells, indicating that in-situ sintering takes place during laser writing. A dramatic new and simpler laser metallization process on which patent protection is currently being sought has yielded ...
A programme has been initiated by the Coordinating Office for Monitoring of enhanced natural radioactivity of the Federal Office for Radiation Protection to investigate different kinds of sample materials with enhanced naturally occurring radioactivity (NORM) such as scales from oilfield and naturally gasfield pipes, blast furnace sludge and sinter dust from the production of pig iron, as well as bauxit and red mud from the production of aluminium oxide. The aim of these investigations is to find proper preparation and measuring methods which allow, in particular, a sample treatment with optimised effort combined with a reliable determination of the specific activities of the dominating radionuclides. Of particular interest is the method of gamma-ray spectrometry, since this method has been used for most of our studies of sample materials. Due to different compositions of calibration and NORM-samples, e.g. different densities, and the analysis of low-energy ...
Using a facility named SPHINX, which can accommodate a heat transfer test with CO{sub 2} at supercritical pressure, a series of tests was performed. The test geometries include tubes with the inner diameter of 4.4, 6.32 and 9 mm. a concentric annular passages with 8 x 10 mm, and an eccentric annular passages with 9.5 x 12.5 mm. Based on the test results, heat transfer correlations were developed and compared with the existing correlations. The heat transfer deterioration which may occur at certain conditions of heat and mass flux, were carefullystudied and the published criteria were reviewed against our test results. Numerical calculation by using commercial CFD code, Fluent, were performed in order to provide the pre-test information for the heat transfer tests. Various turbulence models were evaluated and reliable models were suggested for each case
Due to the improvement of algorithm and the advancement of calculation performance, the imaging by depth migration before stacking is being put into practice from the viewpoint of both calculation cost and accuracy. A lot of imaging examples have been already reported from the survey areas with complicated velocity structures, such as the North Sea and the Gulf of Mexico. Effectiveness of the method has been confirmed. For imaging techniques in Japan National Oil Corporation and Japan Petroleum Exploration Co., Ltd., high-speed depth migration before stacking and high efficiency velocity structure estimation technique have been investigated. This paper describes necessary care to be taken when using depth focusing analysis (DFA) for correcting a velocity model, as an interim stage of case study. The results of depth migration before stacking using dip moveout (DMO) velocity were further inferior to the section obtained by the migration after ...
We compare N-body simulations of isolated galaxies performed in both frameworks of modified Newtonian dynamics (MOND) and Newtonian gravity with dark matter (DM). We have developed a multigrid code able to efficiently solve the modified Poisson equation derived from the Lagrangian formalism AQUAL. We take particular care of the boundary conditions that are a crucial point in MOND. The 3-dimensional dynamics of initially identical stellar discs is studied in both models. In Newtonian gravity the live DM halo is chosen to fit the rotation curve of the MOND galaxy. For the same value of the Toomre parameter (Q_T), galactic discs in MOND develop a bar instability sooner than in the DM model. In a second phase the MOND bars weaken while the DM bars continue to grow by exchanging angular momentum with the halo. The bar pattern speed evolves quite differently in the two models: there is no dynamical friction on the MOND bars so they keep a constant ...
Longitudinal compression of space-charge dominated beams can be achieved by imposing a head-to-tail velocity tilt on the beam. This tilt has to be carefully tailored, such that it is removed by the longitudinal space-charge repulsion by the time the beam reaches the end of the drift compression section. The transverse focusing lattice should be designed such that all parts of the beam stay approximately matched, while the beam smoothly expands transversely to the larger beam radius needed in the final focus system following drift compression. In this thesis, several drift compression systems were designed within these constraints, based on a given desired pulse shape at the end of drift compression systems were designed within these constraints, based on a given desired pulse shape at the end of drift compression. The occurrence of mismatches due to a rapidly increasing current was analyzed. In addition, the sensitivity of drift compression to errors in the initial ...
The image quality of digital luminescent radiography (DLR) is sufficient for routine biplane chest radiography and for follow-up studies of heart size, pulmonary congestion, coin lesions, infiltrations, atelectasis, pleural effusions, and mediastinal and hilar lymph node enlargement. Chest radiography in the intensive care unit may in most cases be performed using the DLR technique. there is no need for repeat shots because of incorrect exposure, and the position of catheters, tubes, pacemakers, drains and artificial heart valves, the mediastinum, and the retrocardiac areas of the left lung are more confidently assessed on the edge-enhanced DLR films than on conventional films. Nevertheless, DLR is somewhat inferior to conventional film-screen radiography of the chest as it can demonstrate or rule out subtle pulmonary interstitial disease less confidently. There is no reduction of radiation exposure of the chest in DLR compared with modern ...
A new N-body and hydrodynamical code, called RAMSES, is presented. It has been designed to study structure formation in the universe with high spatial resolution. The code is based on Adaptive Mesh Refinement (AMR) technique, with a tree based data structure allowing recursive grid refinements on a cell-by-cell basis. The N-body solver is very similar to the one developed for the ART code (Kravtsov et al. 97), with minor differences in the exact implementation. The hydrodynamical solver is based on a second-order Godunov method, a modern shock-capturing scheme known to compute accurately the thermal history of the fluid component. The accuracy of the code is carefully estimated using various test cases, from pure gas dynamical tests to cosmological ones. The specific refinement strategy used in cosmological simulations is described, and potential spurious effects associated to shock waves propagation in the resulting AMR grid are discussed and ...
Computed tomography (CT) of the thorax shows early promise of important diagnostic advances. We believe that CT often provides information superior to that provided by standard roentgenographic techniques, is capable of significantly influencing patient management, and in selected instances, offers unique information not available by other methods. Computed tomography permits the imaging of mediastinal structures not possible with conventional roentgenographic methods and can diagnose with certainty benign mediastinal conditions such as pericardial cysts and focal or diffuse accumulations of fat. It is ideal for detecting pleural abnormalities and for displaying underlying parenchymal disease in patients with complex pleuroparenchymal shadows on conventional films. Pulmonary metastases unseen on the plain chest film can be detected with greater sensitivity than by any other method. Future applications of CT include the staging of mediastinal lymph nodes in bronchogenic carcinoma, the ...
Computed tomography (CT) of the thorax shows early promise of important diagnostic advances. We believe that CT often provides information superior to that provided by standard roentgenographic techniques, is capable of significantly influencing patient management, and in selected instances, offers unique information not available by other methods. Computed tomography permits the imaging of mediastinal structures not possible with conventional roentgenographic methods and can diagnose with certainty benign mediastinal conditions such as pericardial cysts and focal or diffuse accumulations of fat. It is ideal for detecting pleural abnormalities and for displaying underlying parenchymal disease in patients with complex pleuroparenchymal shadows on conventional films. Pulmonary metastases unseen on the plain chest film can be detected with greater sensitivity than by any other method. Future applications of CT include the staging of mediastinal lymph nodes in bronchogenic carcinoma, the ...
Behavioral economics has captured the interest of scholars and the general public by demonstrating ways in which individuals make decisions that appear irrational. While increasing attention is being focused on the implications of this research for the design of risk-reducing policies, less attention has been paid to how it affects the economic valuation of policy consequences. This article considers the latter issue, reviewing the behavioral economics literature and discussing its implications for the conduct of benefit-cost analysis, particularly in the context of environmental, health, and safety regulations. We explore three concerns: using estimates of willingness to pay or willingness to accept compensation for valuation, considering the psychological aspects of risk when valuing mortality-risk reductions, and discounting future consequences. In each case, we take the perspective that analysts should avoid making judgments about whether values are "rational" or "irrational." ...
This paper presents a method for the optimal design of high voltage transmission lines taking into consideration shielding and backflashover failure rates. The minimization of suitably defined performance indices, which relate the failures caused by lightning in a transmission line to both line insulation level and tower footing resistance, is aimed. Optimum values for both line insulation level and tower footing resistance are calculated. The method is applied on several operating Hellenic transmission lines of 150 and 400kV, respectively, carefully selected among others, due to their high failure rates during lightning thunderstorms. Special attention has been paid on open loop lines, where a possible failure could bring the system out of service causing significant problems. The obtained design parameters, which reduce the failure rates caused by lightning, are compared with the existing design parameters of the transmission lines leading up to useful ...
Objective: To assess the efficacy, prospects and future of conservative management of beta thalassemia major patients in a developing country. Design: Patients registered at IHBTS were studied over a period of three years. They consented to being managed on moderate transfusion regimen, aiming to maintain a pre-transfusion haemoglobin(Hgb) level of 9.0 plus minus 1.0 g per dL. We studied their transfusion requirements, status for transfusion transmitted infections (TTls), serum ferritin levels and complications developing as a result of iron overload. Subjects: Initially all registered patients were included in this study. Sporadic patients as well as dropouts occurring due to any reason, (patients concurrently seeking treatment at other centres as well, or complying poorly to advised chelation therapy) were excluded from the study. The data presented here conforms to a cohort of 60 regular patients who ...
Diethyl phthalate (DEP) and di-n-butyl phthalate (DnBP) are used extensively in personal care products, including fragrances (DEP) and nail polish (DnBP). Between May 2003 and...Full Text Available
Implementing a successful local area network for a publications work-group isn't as simple as the scarcity of information on the subject would suggest. Making a network work for your requires careful planning, developing and acquiring network expertise, transforming your group's patterns of working together, and carefully managing the human and technological resources.
Implementing a successful local area network for a publications work-group isn`t as simple as the scarcity of information on the subject would suggest. Making a network work for your requires careful planning, developing and acquiring network expertise, transforming your group`s patterns of working together, and carefully managing the human and technological resources.
BackgroundInformal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the...Full Text Available
Comprehensive geriatric care should receive nation-wide attention in order to realize its objectives. An analysis of patient problems at the Geriatirc Clinic, Tygerberg Hospital and Goodwood Aftercare Hospital is presented. The training of personnel, with full motivation of the community, to render health services to the aged is discussed. PMID:7368010
BackgroundEffectiveness of services for patients diagnosed with severe mental illness (SMI) may improve when treatment plans are needs based. A regional Cumulative Needs for Care...Full Text Available
As part of the work scope set in the French law on high level long lived waste R&D passed in 1991, CEA is conducting a research program to establish the scientific basis and assess the feasibility of long term storage as an option for the safe management of nuclear waste for periods as long as centuries. This goal is a significant departure from the current industrial practice where storage facilities are usually built to last only a few decades. From a technical viewpoint such an extension in time seems feasible provided care and maintenance is exercised. Considering such long periods of time, the risk for Society of loosing oversight and control of such a facility is real, which triggers the question of whether and how long term storage safety can be actually achieved. Therefore CEA commissioned a study (1) in which MUTADIS Consultants (2) and CEPN (3) were both involved. The case study looks into several past and ...
We conducted a retrospective review of the North American Renal Transplant Cooperative Study (NAPRTCS) Registry transplant and dialysis arms to assess anemia and growth patterns in children who returned to dialysis after a failed renal transplant from January 1, 1992 to February 3, 2004. Of the 1807 potential study subjects, 1451 had transplant removal data (TxIn vs. TxOut) available for analysis. Four hundred and twenty-one of 1451 patients (29%) had a transplant nephrectomy at the time of entry into the NAPRTCS Registry Dialysis arm. Anemia rates steadily decreased from 72.2% at 30 days after dialysis initiation to 59.5% at 12 months after dialysis initiation. Factors associated with anemia at 30 days after dialysis initiation included hemodialysis, lack of Epo use, and patients who comprised earlier study era cohorts. At one yr after return to dialysis, earlier study cohort era was the only factor ...
Material related to routine as well as sensitive aspects of parent/day care center relationships is presented in this training module, one of a series providing staff development information for programs operated for dependents of military personnel. The module offers a brief discussion of ways caregivers can help parents feel at ease about leaving their children in child care and presents a set of multiple-choice skill-building exercises for effectively working with parents. Exercises focus on various topics, including how parents can be approached when their child may have a health problem, when child abuse or neglect is suspected, and when parental cooperation is needed to stop a child's undesirable or disruptive behavior. Exercises are also devoted to the questions of whether or not caregivers should act as advisors to parents or tell parents about their child's behavior at the center. Concluding exercises indicate how caregivers can ...
The purpose of this thesis is to study the behaviour of the simultaneous flow of oil and water in horizontal pipes. In this connection, two test facilities are used. Both facilities have horizontal test sections with inner pipe diameters equal to 2 inches. The largest facility, called the model oil facility, has reservoirs of 1 m{sub 3} of each medium enabling flow rates as high as 30 m{sub 3}/h, which corresponds to mixture velocities as high as 3.35 m/s. The flow rates of oil and water can be varied individually producing different flow patterns according to variations in mixture velocity and input water cut. Two main classes of flows are seen, stratified and dispersed. In this facility, the main focus has been on stratified flows. Pressure drops and local phase fractions are measured for a large number of flow conditions. Among the instruments used are differential pressure transmitters and a traversing gamma densitometer, respectively. The flow patterns that ...
Objective: To explore the interventional treatment for biliary re-stenosis after metallic stents placement in patients due to cholangiocarcinoma and evaluate its therapeutic effect. Methods: Percutaneous metallic stents placement or combined with continuously infusion arterial chemotherapeutic and chemotherapeutic embolization were performed in 12 patients with biliary re-stenosis using 12 metallic stents. Results: Once stent placement was 100% successful in all 12 cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that in preoperation. Jaundice was reduced satisfactorily in 12 patients. 3 patients were undergone continuously arterial chemotherapeutics infusion and chemotherapeutic embolization 4 weeks after stents placement. Conclusions: Percutaneous replacement of biliary metallic stents was effective and safe for palliation of malignant biliary re-stenosis and would be much better when combined with continuously arterial ...
The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that ...
The Zollinger-Ellison syndrome (ZES) is taken as an example of the diagnostic and therapeutic strategy in gastro-entero-pancreatic endocrine tumours, given the standard characteristics of this procedure, whatever the nature of the primitive tumour. Management of ZES includes: anatomical localization of gastrinoma and of possible metastases, in 60 % of cases this step conditioning therapeutic indications and chances of cure; search of a type 1-multiple endocrine neoplasia (MEN A), in 25 % of cases; therapeutic indications: ablative surgery with curative intent in case of gastrinoma and of resectable liver metastases, palliative treatment otherwise: anti-secretory drugs, somatostatin analogues, chemotherapy and interferon {alpha}; long-term follow-up of patients with resected tumour. At each step, somatostatin receptor scintigraphy with indium 111-pentetreotide does play a pivotal role. (author). 110 refs.
MRI provides a non-invasive diagnostic tool complementing echocardiography on one hand, and showing advantages over echocardiography, on the other hand, especially after corrective procedures. The multiple different MRI sequences need to be adapted to examinations of children and patients with congenital heart disease (CHD), and can be used to detect morphologic changes, blood-flow in the heart and thoracic vessels and diastolic or systolic function of myocardium. Several factors determine the success of the examination of a complex congenital heart disease or a postoperative situs. Pediatric radiologists and radiologists experienced in congenital heart diseases have to work in close cooperation. Echocardiography should be performed before MRI. The results of prior examinations and the clinical history of the patients, including possible palliative or reconstructive operations, must be available before MRI to guide the planning of the examination. With a systematic ...
Assessment of the roles of the carboxyl-terminal #beta#146 histidyl residues in the alkaline Bohr effect in human and normal adult hemoglobin by high-resolution proton nuclear magnetic resonance spectroscopy requires assignment of the resonances corresponding to these residues. By a careful spectroscopic study of human normal adult hemoglobin, enzymatically prepared des(His146#beta#)-hemoglobin, and the mutant hemoglobins Cowtown (#beta#146His #-># Leu) and York (#beta#146His #-># Pro), the authors have resolved some of these conflicting results. By a close incremental variation of pH over a wide range in chloride-free 0.1 M N-(2-hydroxyethyl)piperazine-N'-2-ethanesulfonic acid buffer, a single resonance has been found to be consistently missing in the proton nuclear magnetic resonance spectra of these hemoglobin variants. The results indicate that the contribution of the #beta#146 histidyl residues is 0.52 H"+/hemoglobin tetramer at pH ...
Spin-polarized liquid helium-3 is prepared by laser optical pumping in low magnetic field and at room temperature, prior to fast liquefaction of the polarized sample. The use of a new helium-3 cryostat enabled us to obtain liquid helium-3 with polarization rates up to 25 % at well-stabilized temperatures (around 0.5 K). We could thereby study the effect of nuclear polarization on liquid-vapour equilibrium, and particularly on the saturated vapour pressure. Very sensitive capacitive gauges were developed. We estimated (to first order in M{sup 2}) the expected effects when the polarization M is suddenly destroyed. These effects were experimentally observed in helium-3/helium-4 mixtures, in pure helium-3, only a transient increase in pressure has been recorded. We then describe in a third part a preliminary experiment which aimed at determining the longitudinal relaxation time T1 in mixtures. Relaxation on the walls is efficiently reduced by a cesium coating and T1s ...
Objectives This paper examines the determinants of the insureds decision to use their health insurance card when seeking outpatient and inpatient health care in Vietnam. Methods Uses Vietnams latest Household Living Standard Survey data and random-intercept logistic regression to assess the influence of the observed individual, household and commune/ward factors on the insureds decision to access health insurance benefits while controlling for the unobserved commune/ward-specific factors. Results Compared to the compulsory enrollees, the voluntary enrollees and the beneficiaries of the Health Care Fund for the Poor are less likely to use their card when seeking inpatient care. An individuals likelihood of accessing insurance benefits varies inversely with income and the level of education,...
Given the concern over the potential for health risks associated with certain ingredients (e.g., phthalates) in personal care products, usage patterns of 30 types of personal care products (e.g., shampoo, sunscreen, fragrance, etc.) were collected in 604 California households through a telephone interview. Preferences in selecting products, e.g., scented or unscented, aerosol, and brand loyalty, were also investigated. Participants were recruited in three age groups, children (mostly preschoolers), their parents, and adults age 55 or older. Use frequencies of various product types varied by sex, age group, race, education, and climatic region. Product use by parent and child from the same household were correlated. Use frequencies of products in the same class (e.g., skincare) were moderat...
Participants in the conference selected to attend two different working group sessions. The working groups discussed different perspectives of system-based approaches to osteoporosis and fracture care. The group on postfracture case management recommended that nurse case managers be used to improve communication among patients, orthopaedic surgeons, and those providing ongoing clinical care. The hospital working group discussed the impact of and barriers to improved postfracture management in the hospital setting. The health systems group emphasized the difference between a closed system in which long-term benefits of interventions were more likely to be appreciated than in fee for service systems. The health information technology group discussed the advantages and challenges of electroni...
Opinion statement Because a minority of patients with D-transposition of the great arteries are diagnosed in utero by ultrasound, most present after delivery with cyanosis. In the absence of apparent lung disease, cyanotic neonates suspected of having a cardiac lesion should be immediately transferred to an intensive care unit at a pediatric tertiary care center for monitoring, resuscitation, and to define the cardiac anatomy and physiology. A prostaglandin E-1 infusion is usually initiated to maintain ductal patency and promote intra-cardiac mixing. In the past, balloon atrial septostomy (BAS) was routinely performed to enlarge the atrial septal defect and improve intra-cardiac mixing while the infants awaited surgery. Recent literature has reported an increase risk of stroke in neonates ...
To determine the proportion of rheumatoid arthritis (RA) patients receiving preventive health care according to US Preventive Services Task Force recommendations compared with a community-based population sample, with emphasis on dyslipidemia testing, given the increased risk of cardiovascular disease (CVD) in RA patients. Patients with RA (ICD-9 code 714.0 at ?2 office visits with a rheumatologist) and a primary care physician (PCP) at the Geisinger Health System (GHS) were identified through electronic health records. The records were searched back from 3/31/08 for the length of time required to satisfy each outcome measure. Percentages were compared with population testing rates using the Pearson Chi-square test. Eight hundred and thirty-one RA patients were compared to 169,476 subjects...
Despite the many advances in scientific research over the last several decades, cutting edge technologies and therapeutics often take many years to find their way into widespread use. The dissemination and uptake of best practices into clinical care is sometimes a neglected component of research that is essential to improve the population?s health. Type 2 translational research, sometimes called ?Proof in Practice Research,? seeks to maximize the yield of what has been learned from the bench and from carefully controlled clinical trials and to extend those benefits to a larger population. One aspect of type 2 translational research, sometimes called evidence implementation or implementation science, applies what has been learned about clinical medicine to achieve best practices across prov...
AbstractBACKGROUND: Disparities in treatment and mortality for colorectal cancer (CRC) may reflect differences in access to specialized care or other characteristics of the area where an individual lives. METHODS: Surveillance, Epidemiology and End Results Program-Medicare data for seniors diagnosed with CRC were linked to area measures of the sociodemographic characteristics and the capacity of surgeons, medical oncologists, and radiation oncologists. Outcomes included receipt of stage-appropriate CRC care and mortality. RESULTS: After adjustment, blacks and Hispanics were less likely than whites to undergo surgery (odds ratio [OR] 0.57, 95% confidence interval (CI) 0.52-0.63 and OR 0.82, 95% CI 0.70-0.95, respectively). Individuals who lived in areas with the highest tertile of surgeon c...
This case study, conducted from an interpretive paradigm, illuminates contextual factors related to the tutor experience when senior undergraduate dental hygiene students served as tutors for beginning undergraduate dental hygiene students, or sophomores, in a 1-semester, 2-hour long problem-based learning (PBL) course in a Baccalaureate Dental Hygiene (BDH) curriculum during the spring semester of 2008. Data were collected using various sources and methods. Six tutors and three administrators were interviewed, tutees completed an anonymous questionnaire, the tutorial process and tutor training sessions were observed, and related documents were examined. Data analysis included open and axial coding, creation of tutor profiles, and identification of patterns. Tutor behaviors varied with respect to the nature of intervention (e.g., telling, asking, clarifying, acknowledging), emphasis (process, content, social), and facilitation style (directive, suggestive, ...
Perspectives from industry, academe, and the NRC are brought together in this report and used to develop a logical framework that links management and organization factors and safety in nuclear power plant performance. The framework focuses on intermediate outcomes which can be predicted by organizational and management factors, and which are subsequently linked to safety. The intermediate outcomes are efficiency, compliance, quality, and innovation. The organization and management factors can be classified in terms of environment, context, organizational governance, organizational design, and emergent processes. Initial empirical analyses were conducted on a limited set of hypotheses derived from the framework. One set of hypotheses concerned the relationships between one of the intermediate outcome variables, efficiency, as measured by critical hours and outage rate, and safety, as measured by 5 NRC indicators. Results of the analysis suggest that critical hours and outage rates and ...
The main aim of any food irradiation treatment is to guarantee the best safe quality of the products, reducing the spreading risk ("cross-contamination") for several food-associated diseases. Actually, over 40 countries provide clearances for the treatment of about 45 different types of foodstuffs. EU has to homogenise the situation within the associated States. With the European directive 1999/2/EC Italy, as other EU countries, already has brought into force their regulations to comply. The current Italian regulation on irradiation treatment of foodstuffs is referred since 1996 as follows: a) potatoes, onions and garlic; b) spices, herbs and condiments microbial. The new (April 2001) Italian law allows the possibility to ask for special permission of treatment for other foodstuff which is possible to treat in other E.U. countries. Large majority of foods are submitted to irradiation treatment after they have been packaged. In Dutch cases the study of radiation ...
Nano materials are usually difficult to prepare. This work presents a simple way of preparing LiMn{sub 2}O{sub 4} nano powders using the high-energy ball milling method. This method has the advantage of producing pure, single-phase and crystalline nano powders. The milling method is carefully controlled to avoid unwanted chemical reactions that may change the stoichiometry of the material. Nano powders of between 30 and 50 nm are obtained. Structural studies of the nano powders, as well as the more conventional micron-sized LiMn{sub 2}O{sub 4}, are made using X-ray diffraction and neutron diffraction methods. Electrochemical evaluation of the materials is undertaken with a three-probe cyclic voltammetry technique and galvanostatic charge-discharge measurements. Structural studies reveal that not only are the crystallites of the nano powders much reduced in size from the normal powders, but their cell parameters are also ...
Parenting programmes are effective interventions for preventing and treating conduct problems in young children. Up to 20% of children in disadvantaged areas have conduct disorder. Recent government initiatives such as targeting early years services to designated disadvantaged Flying Start areas in Wales have resulted in increased nursery-care provision for pre-schoolers, yet little has been done to equip nursery staff with effective child behaviour management strategies. The purpose of this non-randomised trial platform study was to establish the feasibility of delivery and the effectiveness of the new Incredible Years Toddler Parent Programme in supporting nursery staff in managing difficult behaviour in the nursery. The Parent Programme is a 12-session (a two-hour session/week) course for carers/parents of children aged one to three years old, which encourages carers to: establish positive relationships with children through play and ...
The use of aqueous methyldiethanolamine (MDEA) for selective removal of hydrogen sulfide from acid gas streams has been studied in a 2 inch column packed with 1/4 inch ceramic Intalox saddles. The column was operated in a counter-current, steady state fashion. The feed gas composition varied between 1 and 5 mole % hydrogen sulfide and between 0 and 50 mole % carbon dioxide. In order to assist the development of packed column absorption models, the rate at which pure carbon dioxide absorbs into 2 M MDEA was measured as a function of pressure, liquid flow rate and packed bed length. The importance of end effects was carefully evaluated. In addition, draining and tracer methods were used to estimate the amount of static holdup present in the column. Using classical draining methods, as much as 50 % of the total holdup was found to be static. However, according to the step decrease in tracer method, less than 5 % of the total holdup was static. ...
In this paper, we evaluate the performance of the 1- and 5-site models of methane on the description of adsorption on graphite surfaces and in graphitic slit pores. These models have been known to perform well in the description of the fluid-phase behavior and vapor-liquid equilibria. Their performance in adsorption is evaluated in this work for nonporous graphitized thermal carbon black, and simulation results are compared with the experimental data of Avgul and Kiselev (Chemistry and Physics of Carbon; Dekker: New York, 1970; Vol. 6, p 1). On this nonporous surface, it is found that these models perform as well on isotherms at various temperatures as they do on the experimental isosteric heat for adsorption on a graphite surface. They are then tested for their performance in predicting the adsorption isotherms in graphitic slit pores, in which we would like to explore the effect of confinement on the molecule packing. Pore widths of 10 and 20 A are chosen in this investigation, and ...
A public health emergency such as an influenza pandemic will lead to shortages of mechanical ventilators, critical care beds, and other potentially life saving treatments. This will raise difficult...Full Text Available
... be able to watch the many intricate steps Dr. Richard Alexander must accomplish to remove the cancer. ... door to informed medical care. Now let's join Dr. Richard Alexander at the University of Maryland Medical ...
Patient decision support systems have a promising role in the delivery of health care. However, the best approach for further development of these systems is a matter of speculation. To help chart a...Full Text Available
BackgroundStrategies to accurately identify the occurrence of specific health care events in administrative data is central to many quality improvement and research efforts. Many...Full Text Available
Patients who fail to attend initial appointments reduce clinic efficiency. To maximize attendance by newly referred outpatients, we introduced a mandatory group orientation clinic for all new patients...Full Text Available
Personal Health Records (PHRs) are increasingly recognized as a strategy to improve patient-provider communication, availability of health information, and quality of care, by making the delivery of...Full Text Available
Albeit the considerable progress that has been made both in our understanding of the pathophysiology of acute renal failure (ARF) and in its treatment (continuous renal replacement therapies), the morbidity...Full Text Available
Femur fractures typically affect elderly patients with multiple co-morbidities. Pain control can be difficult, requiring intensive nursing and physician care as elderly patients may manifest cardiovascular...Full Text Available
OBJECTIVE: The objective was to define and characterize the costs associated with trauma care at a level I trauma center. Once the costs were identified, attending physician-led teams were designed...Full Text Available
BackgroundThere has been substantial research on psychosocial and health care determinants of health disparities in the United States (US) but less on the role of modifiable risk...Full Text Available
BackgroundDespite having the largest population in Africa, Nigeria has no accurate population based data to plan and evaluate eye care services. A national survey was undertaken...Full Text Available
The Joint Commission on Accreditation of Hospitals (JCAH) has continuously emphasized improvement in the quality of care provided in hospitals as the central purpose of the accreditation process. In...Full Text Available
Patient-centered interdisciplinary health care for children with chronic medical disorders represents an evolution from the traditional “stop and go” treatment for acute illnesses. This...Full Text Available
This Mini-Computer-Assisted Nursing Management System allows nursing to control staffing costs and more effectively relate staffing to patient care requirements. Nursing resources are prospectively...Full Text Available
BackgroundPatients’ general tendency to adhere to health care provider-recommended treatments is associated with a number of health outcomes, but whether it influences pain...Full Text Available
Although the demand for use of information technology within the healthcare industry is intensifying, relatively little has been written about guidelines to optimize IT investments. A technology architecture...Full Text Available
Abstract The Read Thesaurus (Version 3 of the Read Codes) is a controlled medical vocabulary produced during the Clinical Terms Projects with the involvement of over 2,000 health care...Full Text Available
BackgroundAdolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes...Full Text Available
Skin cancers in skin of color often present atypically or with advanced stage in comparison to Caucasian patients. Health care providers must maintain a high index of suspicion when examining...Full Text Available
Dental caries continues to be a common chronic disease among various population groups. Patient care can be improved with detection at the earliest stage. However, current techniques do not...Full Text Available
BackgroundSeverely disabling chronic pain in the adult population is strongly associated with a range of negative health consequences for individuals and high health care costs,...Full Text Available
ObjectiveTo implement a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing...Full Text Available
Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic...Full Text Available
BackgroundInternet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of...Full Text Available
ObjectiveTo test whether a disclosure intervention improves subjective health and reduces medical consumption and sick leave in somatising patients in general practice.DesignNon-blind...Full Text Available
Background In May 2000, AstraZeneca launched a Web service for asthma patients and health-care providers called LinkMedica, which includes an asthma diary for...Full Text Available
Continuing Medical Education (CME) is a requirement among practicing physicians to promote continuous enhancement of clinical knowledge to reflect new developments in medical care. Previous research...Full Text Available
ObjectiveThe authors present an Electronic Healthcare Record (EHR) server, designed and developed as a proof of concept of the revised prEN13606:2005 European standard concerning...Full Text Available
The current obesity pandemic is expected to result in considerable downstream morbidity, mortality and incremental costs to health care systems around the world. The major metabolic complications of...Full Text Available
BackgroundMefloquine has historically been considered safe and well-tolerated for long-term malaria chemoprophylaxis, but its prescribing requires careful attention to rule out contraindications...Full Text Available
ObjectiveComputerized physician order entry with clinical decision support has been shown to improve medication safety in adult inpatients, but few data are available regarding its...Full Text Available
ObjectivesPericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome...Full Text Available
This program focused on practice-level service change as a means of improving patient care and developing leadership skills of 19 general practitioners (GPs) and aimed to: promote and support change...Full Text Available
AimsTo describe nurse burnout, job dissatisfaction, and quality of care in Japanese hospitals, and to determine how these outcomes are associated with work environment...Full Text Available
In terms of managing thrombotic disorders, genotype-based individualized patient care emerged as early as 1994 when the association of factor V Leiden (G1691A), and later, prothrombin (G20210A),...Full Text Available
An outbreak with a multiresistant Klebsiella pneumoniae (MRKP) strain among seven patients admitted to the adult intensive care unit (ICU) of a regional teaching hospital in The Netherlands...Full Text Available
BackgroundNorway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric...Full Text Available
...Programme Manager Interests Multilevel Statistical Modelling Geography of Health and Health Care Geographical Data Analysis Census Data Analysis Health Services Research (in particular Research Design, Statistical Analysis and Epidemiology) people/mgould.html Homepage | Contacts | Site Map | Privacy Statement | Webmaster | ...
...research and publications and some who are accredited by the British Association of Sport and Exercise Sciences (BASES), which enables them to work with high performance athletes . We care about your progress and welfare. As our recent QAA review noted \\
Laparoscopic colon surgery for select cancers is slowly evolving as the standard of care but minimally invasive approaches for rectal cancer have been viewed with significant skepticism. This procedure...Full Text Available
We report on the presentation and management of a patient with herniation of the rectum following a coccygectomy. We used an abdominal approach and careful pelvic dissection to define the defect in...Full Text Available
The needs of hospitalized geriatric patients differ from the needs of hospitalized younger adults. In an attempt to improve systems of care for the older adult, the Centers for Medicare and Medicaid...Full Text Available
... the nest with young when the female left (male meadow voles were in the nest with young too infrequently ... prairie voles, whereas the number of checks that male meadow voles were in the nest increased s...
PurposeTo assess the prevalence and the dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck (HN) cancer who underwent...Full Text Available
Background and ObjectiveCervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It...Full Text Available
ObjectiveTo investigate possible differences in operative delivery rate among low-risk women, randomised to an alongside midwifery-led unit or to standard obstetric units within...Full Text Available
ObjectivesIn 2003, the Omani Ministry of Health Child Health Care Program initiated a national Birth Defects (BD) Register. This paper reviews the magnitude and risk factors of birth...Full Text Available
BackgroundThe prevalence of tobacco use among individuals with mental illness remains a serious public health concern. Tobacco control has received little attention in community...Full Text Available
The Clinical Summary is a Web-based application for accessing the clinical database at the Massachusetts General Hospital. The application has been developed to give physicians in our health care community...Full Text Available
Policies and regulations in the current health care environment have impacted the manner in which patient data - especially protected health information (PHI) - are handled in the clinical and...Full Text Available
ObjectiveMany hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness...Full Text Available
PURPOSE We wanted to assess the impact of an electronic health record–based diabetes clinical decision support system on control of hemoglobin A1c (glycated hemoglobin),...Full Text Available
We previously demonstrated the ability to create engineered arteries by carefully controlling the mechanical environment of intact arteries perfused ex vivo, yielding engineered arteries...Full Text Available
Giardiasis is recognized as a worldwide public health problem. Seroprevalence data from both the developing and developed world show high rates of carriage in populations at risk for fecal-oral transmission,...Full Text Available
BackgroundSarcoma encompasses an uncommon group of cancer and the data is insufficient from Pakistan. We report our four years experience of Sarcoma of soft tissues and bones.MethodsThis...Full Text Available
ObjectiveWhile essential for patient care, information related to medication is often written as free text in clinical records and, therefore, difficult to use in computerized systems....Full Text Available
Ever-changing audio technology requires that National Library Service NLS always be aware of developments and prepare carefully for any systematic changes that may be desired or required. Usefulness, cost effectiveness, thoughtful stewardship, and educate...
Total health care expenditure in 2006 was $2.1 trillion. This figure is estimated to double within the next few years as the cost of treating diabetes and other chronic conditions continues to rise....Full Text Available
It is usually very complex to design an Integrated Information System in a hospital that includes both in-patient and out-patient medical care data. The difficulty appears because each department...Full Text Available
PurposeTo develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery.Full Text Available
BackgroundChina has had no effective and systematic information system to provide guidance for strengthening PHC (Primary Health Care) or account to citizens on progress. We report...Full Text Available
BACKGROUND AND AIMS:In view of increasing therapeutic efficacy, the delivery of hepatitis C virus (HCV) antiviral treatment is expected to increase. Yet practical experience reveals...Full Text Available
BackgroundEffective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening...Full Text Available
The purpose of the meeting reported here was to develop a set of national evidence-based standards for assessing and managing patients with potentially resectable rectal cancer. This report represents...Full Text Available
ObjectivesTo see whether there are age variations in the relationships between having a close companion friend at church, health, and outpatient physician visits.Full Text Available
You receive an annuity if eligible -- requires 18 months service for FERS; and 60 ... You may use up to 104 hours of your accrued sick leave to care for sick family ...
Social support is a critical, yet underutilized resource when undergoing cancer care. Underutilization occurs in two conditions: (a) when patients fail to seek out information, material assistance,...Full Text Available
... yourself to call 911 until you have performed CPR for about 2 minutes. 3. Carefully place the ... more breaths. The chest should rise. 9. Continue CPR (30 chest compressions followed by 2 breaths, then ...
... and retrieve an AED until you have performed CPR for about 2 minutes. 3. Carefully place the ... more breaths. The chest should rise. 9. Continue CPR (30 chest compressions followed by 2 breaths, then ...
home when you are sick helps everyone you care about Questions & Answers Flu Vaccine: Q&A Vaccine Dosage & Administration Vaccine Supply for 2011-12 Season Vaccine Supply and...
home when you are sick helps everyone you care about Questions & Answers Flu Vaccine: Q&A Vaccine Dosage & Administration Vaccine Supply for 2011-12 Season Vaccine Supply and...
home when you are sick helps everyone you care about Questions & Answers Flu Vaccine: Q&A Vaccine Dosage & Administration Vaccine Supply for 2011-12 Season Vaccine Supply and...
Drownings in Recreational Water Settings - United States, 2001-2002 While immediate CPR can save someone's life, often medical care in the hospital cannot prevent serious...
Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)–infected subjects. Initiation of antiretroviral therapy is associated with a 2%–6% decrease...Full Text Available
The aim of the overview is to give a perspective of global biobank development is given in a view of positioning biobanking as a key resource for healthcare to identify new potential markers that can...Full Text Available
The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic...Full Text Available
Abstract This paper focuses on the basic principles of information technology (IT) organization within health sciences centers. The paper considers the placement of the leader of the...Full Text Available
BACKGROUND:The value of other health care professionals is increasingly being recognized to compensate for the shortage of physicians in Canada. Chronic cough is one of the most...Full Text Available
BackgroundComputer-based health-risk assessments are electronic surveys which can be completed by patients privately, for example during their waiting time...Full Text Available
Validation of body-mass relationships requires a careful statistical analysis of data of normal weight individuals. BMI (ratio between body mass and square of body height) and BSI values (ratio between...Full Text Available
Careful measurements do not confirm an anomalous anisotropy in the angular distribution of fission fragments from the fast neutron fission of Americium 242. The energy range covered was 1.60-3.15 MeV. (AIP)
Information needs that arise when clinicians use clinical information systems often go unresolved, forcing clinicians to defer decisions or make them with incomplete knowledge. My research characterizes...Full Text Available
Alton Ochsner was a giant of American surgery. His career encompassed patient care, teaching, and research as symbolized on the original seal of the Ochsner Clinic. His ideas were innovative and groundbreaking...Full Text Available
Platelet reactivity plays a pivotal role in the pathogenesis of ischemic adverse events during and after acute coronary syndromes (ACS), and percutaneous coronary intervention (PCI). Glycoprotein (GP)...Full Text Available
BackgroundErrors have been the concern of providers and consumers of health care services. However, consumers' perception of medical errors in developing countries is rarely explored....Full Text Available
BackgroundIntrapartum fetal hypoxia remains an important cause of death and permanent handicap and in a significant proportion of cases there is evidence of suboptimal care related...Full Text Available
BackgroundParents of chronically ill children are at risk for a lower Health Related Quality of Life (HRQoL). Insight in the dynamics of factors influencing parental HRQoL is necessary...Full Text Available
BackgroundTraffic injuries can cause physical, psychological, and economical impairment, and affected individuals may also experience shortcomings in their post-accident care and...Full Text Available
Recent health care policies and regulations have impacted the manner in which patient data – especially protected health information (PHI) – are handled in both the clinical...Full Text Available
...2010-10-01 false Special rules relating to group health plans. 146.145 Section 146.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH...
...discrimination against participants and beneficiaries based on a health factor. 146.121 Section 146.121 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH...
...named Chair at Epworth Hospital Professor Nilmini Wickramasinghe has been named Chair, Health Information Management , at Epworth HealthCare. Related links School of Business ...the College of Business at RMIT University has been named Epworth Chair, Health Information Management , by Epworth HealthCare. Professor Wickramasinghe has more than ... Professor Wickramasinghersquo;s appointment as Epworth Chair, Health Information Management , will help to further strengthen this clinical academic alliance, with RMIT now ...
Aim.- To describe the clinical aspects of implantable cardioverter defibrillators care in Sweden with focus on organisation, the role and education of nurses, patient information and education and areas in need of improvement. Background.- Implantable cardioverter defibrillators implantations have developed rapidly in recent years and are now an established arrhythmia treatment. The expanding indication for implantable cardioverter defibrillators implantation demands new competencies and resources in the implantable cardioverter defibrillators team members. Methods.- Participants were recruited among physicians and nurses in all of the hospitals implanting implantable cardioverter defibrillators (n-=-16). Data were collected by a questionnaire. Additionally, all written educational materia...
For the performance assessment of radioactive and hazardous waste disposal sites, risk assessments are usually performed for the long term, i.e., over an interval in space and time for which one can predict movement and behavior of toxic agents in the environment. This approach is based on at least three implicit assumptions: One, that the engineering layout will take care of the immediate endangerment of potential receptors; two, that one has carefully evaluated just how far out in space and time the models can be extrapolated, and three, that one can evaluate potential health effects for very low exposures. A few of these aspects will be discussed here in the framework of the scientific method.
This study attempts to elucidate some of the effects of adding argon, neon and hydrogen to low pressure thermionically supported discharges used for plasma nitriding AISI M2 steel substrates. Four runs were performed at the same substrate temperature (550 C) and bias voltage (500 V), using the following gas mixtures: 8% N{sub 2} in Ar, 8% N{sub 2} in Ne, N{sub 2}+H{sub 2} in equal proportions, and N{sub 2} only. By careful control of the discharge parameters, most of the bombardment energy was transported to the substrates by 500 eV ions in all cases; these were mainly Ar{sup +} ions in the N{sub 2}+Ar run and N{sub 2}{sup +} ions in the other runs, notably by the action of Penning ionization in the N{sub 2}+Ne run. We found that the surface hardness was not significantly influenced by the type of ion delivering the bombardment energy, although we suggest that ions would need sufficient mass to cause (for example) sputtering, if the substrate ...
Purpose: To assess the prevalence, significance and practical value of two recently described CT signs of instable aneurysm: the crescent sign and the periluminal halo (a low-attenuating internal layer of the thrombus around the patent lumen). Material and methods: Among the CT examination performed in the last 5 years, they retrospectively selected the nonruptured aneurysms with a diameter exceeding 4 cm (no. = 93 average diameter 5.1 cm, unenhanced images in 28 cases and enhanced in 84) and the ruptured aneurysms (no. = 16, average diameter 6.7 cm, unenhanced images in 9 cases and enhanced in 9). They studied the prevalence of the crescent and halo sing, their relationship with the aneurysm diameter, and the effect of contrast enhancement. Results: The crescent sign was identified with a statistically significant prevalence in ruptured ( 37.5 % or cases) over asymptomatic aneurysms (5.5 %); the halo had the same frequency in the 2 groups (12.5 % and 9.5 %). Both ...
Turret moored Floating Production Storage and Offloading (FPSO) systems are considered suitable for a wide range of environmental conditions but experience of designing moorings for these units in harsh environments is limited. Furthermore, each floating production system has its own requirements as to the way the riser system is operated because of its dependence on both reservoir and site specific conditions. The current mooring codes do not have a consistent set of requirements; for example, the intact mooring system safety factors range from 1.5 to 2.3. Such vastly differing requirements result in wide variability in the intrinsic safety, reliability and cost. This paper describes a reliability analysis carried out for the first North Atlantic FPSO (Foinaven), to address the acceptance criteria for moorings by returning to the fundamentals. Although the analysis deals with FPSO`s, the approach is applicable to any catenary moored unit. One primary purpose of the mooring system is ...
Lipase catalyzed esterification reactions between lactic acid and several fatty acids have been studied. Difficulties arise in esterifying lactic acid because of the potential for this substance to act both as an acyl donor and as a nucleophile. These difficulties were minimized via strategies which greatly increased the yield of the desired ester. Use of the companion fatty acid in excess with respect to lactic acid in an apolar solvent (n-hexane) in which the lactic is not completely dissolved has been employed to minimize the potential for lactic acid to act as an acyl donor in a self-polymerization reaction.Beneficial and sinergistic effects of both silica gel and molecular sieves on conversion to the desired product are described. However, careful control of the amount of molecular sieves used is required. This fact is a consequence of two opposing effects of this material: i.e. adsorption of both lactic acid and water from the reaction ...
This paper is dedicated to the numerical study of natural ventilation in a room through a large external opening using the CFD code Fluent. Bidimensional numerical simulations are performed for wind speeds up to 5.55 m-s{sup -1} (20 km-h{sup -1}). We propose a two-step solution procedure with grid refinement. When combined with appropriate thermal boundary conditions, this technique appears very efficient at limiting local convergence problems. Through an analysis of the flow pattern in the cavity, we qualitatively explain those results and define a critical Archimedes number. Calculated air change rates are compared to values deduced from empirical correlations of the literature. Agreement is in general poor, which can be explained by the differences between the conditions of our simulations and those of the experiments that lead to those correlations. However, from our simulations, we derived very clear correlations between the air change coefficient and the ...
Nuclear material is either a product of technological processing of natural source material or it is entirely of anthropogenic origin. Consequently, nuclear material carries 'tool-marks' or 'fingerprints' of the process it was subjected to. Uranium fuels are examples of the first category, while plutonium belongs to the second category. The nature of these production processes is reflected in the elemental and isotopic composition of the material as well as in its microscopic and macroscopic appearance. All of these parameters can be determined using appropriate analytical techniques and they may result in important conclusions on the history and on the origin of the material. Therefore, they provide the most essential contribution to the prevention of future diversions of nuclear material from the same source. So far, essentially metallic impurities or light elements have been investigated for their potential in providing clues either on the type of process they originate from or on ...
The aim of this work is to account for the effects of the high temperature oxidation of metals on their microstructure and their mechanical properties. 'Model' materials like pure nickel, pure iron and the Ni-20Cr alloy are studied. Nickel foils have been oxidised at 1000 C on one side only in laboratory air, the other side being protected from oxidation by a reducing atmosphere. After the oxidation treatment, the unoxidized face was carefully examined by using an Atomic Force Microscope (AFM). Grain boundaries grooves were characterised and their depth were compared to the ones obtained on the same sample heat treated in the reducing atmosphere during the same time. They are found to be much deeper in the case of the single side oxidised samples. It is shown that this additional grooving is directly linked to the growth of the oxide scale on the opposite side and that it can be explained by the diffusion of the vacancies ...
Nonevaporable getters (NEGs) have been extensively studied in the last several years for their sorption properties toward many gases. In particular, an innovative alloy as a thin film by magnetron sputtering was developed and characterized at the European Organization for Nuclear Research. It is composed of Ti-Zr-V and protected by an overlayer of palladium (Pd), according to a technology for which the authors got the licence. NEG-Pd thin films used in combination with ion getter pumps is a simple, easy way to handle pumping devices for ultrahigh and extremely high vacuum applications. To show how to apply this coating technology to the internal surface of different types of ion pumps, the authors carried out several tests on pumps of various shapes, sizes (in terms of nominal pumping speed), and types (diode, noble diode, and triode). Special care was taken during the thermal cycle of baking and activation of the pumps to preserve the internal ...
An absorption method of elimination of liquid radioactive wastes (LRW) of low and intermediate activity level by decreasing their contamination up to the level permitting their discharge into the environment is proposed in the paper. The LRW decontamination is accompanied with efficient compacting the resulting secondary solid wastes. The method is based on the use of a new very efficient, chitin containing natural fiber bio-sorbent, Mycoton, which is manufactured commercially in Ukraine. The chemical composition of the sorbent and its highly developed surface provide practically unrestricted opportunities for producing its modifications having any necessary absorption and operational characteristics. The effects of pH, the presence of various salts and complexing agents, as well as of some other factors to the distribution coefficients of the most important radionuclides have been carefullystudied in experiments with Mycoton and its ...
A general criterion has been suggested for deep geological repositories containing spent fuel - the repositories should impose no greater radiological risk than due to naturally occurring uranium deposits. The following analysis investigates the rationale of that suggestion and determines whether current expectations of spent-fuel repository performance are consistent with such a criterion. In this study, reference spent-fuel repositories were compared to natural uranium-ore deposits. Comparisons were based on intrinsic characteristics, such as radionuclide inventory, depth, proximity to aquifers, and regional distribution, and actual and potential radiological consequences that are now occurring from some ore deposits and that may eventually occur from repositories and other ore deposits. The comparison results show that the repositories are quite comparable to the natural ore deposits and, in some cases, present less radiological hazard than their natural ...
(1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion. CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular ...
This article is a case study of an Internet chat room outreach project in Perth, Western Australia. The CyberReach project sought to adapt current peer based health promotion outreach, training and supervision frameworks to an online outreach setting in a way that was effective and supported by the online community. It targeted marginalised groups to trial the provision of online mental and sexual health promotion incorporating a participatory action research model into its development and implementation. Three 6-week trial periods were conducted and significant changes were made in response to changes in the online environment and to improve sustainability and effectiveness of the protocols. Four themes arose from CyberReach's experience: online group processes are unique due to the creation of extensive personal networks and occurrence of disclosure without face-to-face contact across potentially large geographic barriers; flexibility is required to adapt to ...
Background and purpose: To assess the effectiveness of radiotherapy in preventing tumour seeding after chest drain or pleural biopsy in patients with malignant mesothelioma and to determine, if tract metastases appear, whether they are tender or troublesome to patients. Patients and methods: Patients with a histological diagnosis of pleural mesothelioma and an invasive procedure within the preceding 21 days were stratified by age, performance status and treatment centre. Randomisation was performed between immediate drain site radiotherapy 21 Gy in three fractions (XRT arm) or best supportive care (BSC) with follow-up to 12 months. Patients were asked to complete questionnaires on treatment toxicity and on symptoms from any tract metastases detected. Results: Sixty-one patients were recruited from two centres between 1998 and 2004; 56 men, 5 women, median age 70. 31 were allocated to drain site radiotherapy. Seven patients developed tract metastases associated with ...
Abstract Anesthetics affect outcomes from central nervous system (CNS) injuries differently. This is the first study to show how two commonly used anesthetics affect continuously recorded hemodynamic parameters and locomotor recovery during a 2-week period after two levels of contusion spinal cord injury (SCI) in rats. We hypothesized that the level of cardiovascular depression and recovery of locomotor function would be dependent upon the anesthetic used during SCI. Thirty-two adult female rats were subjected to a sham, 25-mm or 50-mm SCI at T3-4 under pentobarbital or isoflurane anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were telemetrically recorded before, during, and after SCI. Locomotor function recovered best in the 25-mm-injured isoflurane-anesthetized animals. There was no significant difference in locomotor recovery between the 25-mm-injured pentobarbital-anesthetized animals and the 50-mm-injured isoflurane-anesthetized animals. White ...
Purpose: To assess the role of CT in the evaluation of traumatic and spontaneous oesophageal perforation. Materials and methods: From March 2001 to May 2003, we studied 12 patients (7 males and 5 females; age range: 25-66 years, mean age: 43.5 years) with suspected oesophageal perforation due to motor-vehicle accidents (4 cases), stab wound (one case), post-intubation (2 cases), foreign body ingestion (2 cases) and spontaneous (3 cases). Five patients underwent standard chest and cervical radiography; two patients with suspected foreign body ingestion also underwent a gastrografin swallow study; all of the 12 patients underwent CT of the neck, chest and abdomen before and after intravenous, and in four cases oral, administration of contrast material. Results: In 5 patients with cervical, thoracic and abdominal trauma, the CT examination showed the presence of pleuroparenchymal injury (pneumothorax, pleural effusion and subcutaneous emphysema) ...
Site studies for CANDU type NPP began in a careful manner since 1982 as a first part of the Nuclear Power Plant Romanian Program adopted by political and governmental authorities at the time. A team was charged to develop all packages of the necessary main studies. The first Romanian NPP CANDU 6 type reactor gone to erection on Cernavoda site, planned to have 5 units and, like Wolsong NPP, applied the same design for the nuclear island. For the BOP parts the ANSALDO-GE project was applied with a thorough concern about requirements raised by connection to NSP. The first mission of design and research multi-branch team was to adapt the NPP Cernavoda project having an open water cooling circuit 'once-through' to the new parameters of a close recirculation water cooling circuit. Also, the structural design was re-evaluated for the case of soft foundation strata instead of hard rock ones. The close recirculation water cooling ...
Biodiesel is produced from vegetable oils that have been chemically modified by esterification; an example is rapeseed oil methyl ester (RME), made by treating rapeseed oil with methanol. Biodiesel can be burned directly in diesel engines. Oil from the rapeseed variety known as 00 was the first type of vegetable oil used for transesterification to produce biodiesel. Many other oils have been used successfully as biodiesel feedstock including sunflower oil in Southern France and Italy, soybean oil in the USA, and palm oil in Malaysia. Biodiesel can be made from a wide range of feedstock and multi-feedstock blends. Compared to conventional diesel biodiesel has some environmentally friendly advantages, e.g. biodiesel is reported to release fewer solid particles. Potentially even more important is the low level of carbon dioxide generation associated with biodiesel, at a time when CO{sub 2} emissions are falling in every industrial sector except transport. Life-cycle ...
Some hypo-stoichiometric Zr-based Laves phase alloys were prepared and studied from a viewpoint of discharge capacity for electrochemical application. After careful alloy design of ZrMn{sub 2}-based hydrogen storage alloys through changing their stoichiometry while substituting or adding some alloying elements, the Zr(Mn{sub 0.2}V{sub 0.2}Ni{sub 0.6}){sub 1.8} alloy reveals relatively good properties with regard to hydrogen storage capacity, hydrogen equilibrium pressure and electrochemical discharge capacity. In order to improve the discharge capacity and rate-capability, Zr is partially replaced by Ti. The discharge capacity of Zr{sub 1-x}Ti{sub x}(Mn{sub 0.2}V{sub 0.2}Ni{sub 0.6}){sub 1.8} (x=0.0, 0.2, 0.3, 0.4, 0.6) alloy electrodes at 30 C reaches a maximum value and decreases as the Ti fraction increases. In view of electrochemical and thermodynamic characteristics, the occurrence of a maximal phenomenon of the electrochemical discharge ...
We wanted to evaluate the usefulness of a new type of a complex expandable nitinol stent that was designed to reduce the stent's propensity to migration during the treatment of malignant gastroduodenal obstructions. Two types of expandable nitinol stent were constructed by weaving a single thread of 0.2mm nitinol wire in a tubular configuration: an uncovered stent 18mm in diameter and a covered stent 16mm in diameter. Both ends of the covered stent were fabricated by coaxially inserting the covered stent into the tubular uncovered stent and then attaching the two stents together with using nylon monofilament. Under fluoroscopic guidance, the stent was placed in 29 consecutive patients (20 men and 9 women, mean age: 65 years) who were suffering with malignant gastric outlet obstruction (n=20), duodenal obstruction (n=6) or combined obstruction (n=3). Clinical improvement was assessed by comparing the food intake capacity before and after the procedure. The complications were ...
Total skin electron beam therapy (TSEB) was used in the treatment of 33 patients with lymphoma and 13 patients with leukemia involving extensive segments of the skin surface. Twenty-two of 23 had lesions as a primary manifestation of lymphoma (primary cutaneous lymphoma-PCL) and 11 developed cutaneous lesions following disseminated nodal lymphoma (secondary cutaneous lymphoma-SCL). A once weekly fractionation scheme was employed to irradiate the entire skin surface with 3.5 to 4 MeV electron beam from a 6 MeV linear accelerator. During each weekly session, 400 rad were delivered to the entire skin and a complete course consisted of 4-6 consecutive weekly sessions. The majority of patients have been previously treated elsewhere for various periods and all patients have been at risk for a median of 12 months, range from 12-117 months following TSEB. Striking predominance of the diffuse pattern (76%) was demonstrated in both the PCL and SCL. There was extracutaneous involvement in 63% ...
This paper reports the characteristics and local management of 826 acute wounds identified during an audit across all health care providers serving the population of Bradford, UK. Of the wounds encountered 303 were traumatic wounds and 237 primary closures with smaller numbers of other acute wound types. Of the 303 traumatic wounds 174 occurred in women (57.4%). Men predominated in the under 45s (65M:26F), this being largely accounted for by hand and finger trauma (n=62) particularly in patients of working age (M32:F12). Women predominated in the over 65s (50M:130F), this being largely accounted for by lower limb traumatic wounds (M24:F91), the majority of these being in patients 65 and over (M14:F82). In this sub-group of 96 patients 25 had wounds of 6 weeks or longer duration, only 3 had...
National efforts to improve the quality and safety of health care present challenges for medical education and training. Today's doctors need to be skilled communicators who know how to identify, prevent and manage adverse events and near misses, how to use evidence and information, how to work safely in a team, how to practise ethically, and how to be workplace teachers and learners. These competencies (knowledge, skills and attitudes) are set out in the National Patient Safety Education Framework (NPSF) of the Australian Council for Safety and Quality in Health Care. The NPSF is designed to help medical schools, vocational colleges, health organisations and private practitioners develop curricula to enable health professionals to work safely. The NPSF describes what doctors (depending on their level of knowledge and experience) can do to demonstrate competencies in a range of quality and safety activities. Medical schools, vocational ...
Following the February 2011 earthquake in Christchurch, New Zealand (NZ), the authors participated in counselling local residents, and debriefing and supervising support teams. Indications were that risk for mental health disorders, including Post-Traumatic Stress Disorder (PTSD), may be elevated in residents, and that this risk may continue for some time. Patients may be de-prioritising their mental health issues when these become normalised throughout the city's population. The authors recommend that primary care patients are assessed using a brief, comprehensive tool (for example, the Case-finding and Help Assessment Tool) that targets many health and behavioural issues identified as increasing in the city following the earthquake. Anxiety and mood disorder symptoms may indicate assessment is appropriate to reduce harm arising from increased risk for PTSD. Concern also is raised for primary health care providers who may have experienced the ...
This paper contributes to an understanding of pharmacogenomics-in-the-making by foregrounding a regulatory setting in which these technologies must be situated: decision-making about pharmaceutical reimbursement. Health care assessment organizations have been introduced in many countries to systematically address the issue of health care coverage. Using the example of Sweden, the process of deciding reimbursement status is shown to hinge on the creation of stable and clinically feasible categories of patients, diseases and drug responses. Through a series of analogous examples concerning conventional pharmaceuticals, it is argued that current mechanisms for categorizing reimbursable drugs could be upset when pharmacogenomic advances provide a means of making patients more specific objects ...
Summary This third paper, in a three-part CE series on the preventions of infection in patients with chronic kidney disease, focuses on surveillance and auditing of healthcare-associated infections within the renal care environment. The last decade has seen an increased awareness of the threat to patient safety from healthcare-associated infection (HCAI) and the emergence of multi-drug resistance organisms. Effective HCAI prevention strategies include adequate governance structures, access to expert advice, adherence to standard and transmission-based precautions, minimising the use of invasive medical devices, and surveillance. Surveillance data can be collected using outcome (e.g. infection) and/or process (e.g. hand hygiene compliance audit) measures. Establishing a surveillance program...
Purpose - The purpose of this paper is to explain some tax management complications for onshore and offshore hedge funds posed by US FIN 48, Uncertain Tax Positions, and to emphasize the hedge fund manager's responsibility for careful tax planning and compliance. Design/methodology/approach - The paper discusses a hedge fund's objective to deliver tax-efficient results to investors, explains the background of FIN 48, and illustrates five types of situations in which conservative auditors following FIN 48 may raise "red flags." Findings - With the advent of FIN 48's standards careful tax planning and compliance are more important than ever for a hedge fund. Significant complications may arise from unwise, tardy, or missed tax elections; filing an IRS Form 8275, Disclosure Statement, stating...
Available from UMI in association with The British Library. Requires signed TDF. Design of time and correlation windows for non -parametric frequency response estimates. The thesis deals with problems that arise in the field of spectral analysis due to finite observations of input and output records. In particular, it is concerned with the method of applying time and correlation windows in spectral analysis procedures to obtain non-parametric frequency response estimates of open-loop time invariant systems. The thesis reviews and develops the sources of error that arise when frequency response techniques are applied directly to windowed records of input and output data to estimate the frequency response of open loop systems. Having identified the cause of these errors, methods of eliminating or reducing them are studied. The techniques introduced involve the use of differing time windows for the input and output data records. It is shown that windows can be ...
Physico-chemical characterizations performed on samples of 100Cr6 steel implanted both with boron and nitrogen revealed the formation of boron nitride along with the following new phases: Fe{sub 1-x}(B, N), Fe{sub 2-x}(B, N) and Fe{sub 3-x}(B, N). A thorough analysis of boron NITRIDE (5BN) indicates that a low ion current density (3 {mu}A.cm{sup -2}) in the case of the boron plus nitrogen sequence favours the formation of sp{sup 2} bonds (hexagonal-BN) while a higher ion current density (6{mu}A.cm{sup -2}) promotes sp{sup 3} bonds (cubic-BN) in the opposite sequence. Tribological tests carried out on these samples revealed that nitrogen and boron implantations do not lead to any significant improvement of friction and wear at variance with the results obtained by others authors. However, on a set samples accidentally contaminated with carbon during implantation, we noticed a considerable improvement of these tribological parameters. As this pollution is commonly encountered in surface ...
For evaporation crystallization of extremely corrosive FGD scrubber solutions which - depending on the process - can lead all the way to a product suitable for depositing, an economic equipment concept based on metallic construction materials was to be investigated. In a parameter study, electrochemical test methods were used to determine the influence of the pH value, the Fe{sup 3+}, F and So{sub 2} contents in a solution containing 200 g/l CaCl{sub 2}+30 g/l NaCl at 80deg C on the resistance to pitting corrosion of stainless steels and NiCrMo alloys. In addition, electrochemical and wet corrosion tests (e.g. crevice corrosion) were conducted using original FGD scrubber solutions with 43-50% dry substance from the power plants Reuter-West, Oberhavel and Rudow of the BEWAG, Berlin. The results were compared to those of standardized and non-standardized short-term tests for determining the critical pitting corrosion and crevice corrosion temperatures for the various ...
As waste disposal methods and long-term precautionary care of the environment are closely related, disposal of non-avoidable and intractable residual products is to be viewed primarily from a safety angle. Also, thermal processes airm mainly at treatment, not utilization. 'Safety' in this context addresses both the environmental compatibility of the products and the process itself. In other words, only mature techniques (i.e., safe, proven ones) are employed. (orig.)
Atopic eczema is a chronic skin condition affecting between 5% and 20% of children aged up to 11 years at one time or other. Research suggests that prevalence is increasing and various environmental...Full Text Available
BackgroundMany emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital...Full Text Available
In the past decade, a new technique has been developed for measuring tensile stresses in solids. This ultrasonic technique has been used thus far primarily for measuring fastener tension. The precision of measurement is routinely to 2-3% and, with special care, to approx. 1%. The method is insensitive to the frictional losses which plague tensioning by torque wrench. Though the approach is relatively new, it promises a wide range of applicability.
On the basis of legally provided area dose measurements and time records of fluoroscopic examinations during the operation, radiation doses to medical personnel and patients are evaluated. Adequate radiation protection measures and a careful behaviour in the operating room keep the radiation exposure to the personnel below the maximum permissible exposure. Taking into account the continuous personnel radiation monitoring and medical supervision, radiation hazards in the operating room can be considered low.
Military working dogs are rapidly becoming integral to military operations. While they bring many valuable capabilities to the battlefield, it is important that Special Operations leaders consider canine team capabilities and requirements when planning missions. Careful logistical and operational planning can optimize the health, performance, and readiness of the working dog while protecting the safety and well-being of the team members working with them. We also offer recommendations for medical treatment of dog bites. PMID:19813342
A filter for extracting solids and liquids from gaseous combustion exhausts comprises a textile filter element formed of polyacrylonitrile fibers oxidized by careful heat treatment and comprising approximately 61% carbon after treatment. The filter may be woven, knitted or formed as a batting of randomly-oriented fibers. Abrasion resistant coatings and lubricants for the fibers are disclosed. The filter material is especially useful as a filter bag.
To optimize the emergency care of patients with multiple injuries, a special emergency room with integrated radiological equipment has been developed. It consists of a linear array of a computed tomography system, a mobile C-arm with an integrated scattered radiation grid for conventional films and a C-arm fluorographic system. The intent is to avoid delay caused by transport and repositioning of the patient. It enables all necessary diagnostic procedures to be performed within a minimal amount of time. (orig./MG).
The "1"3"1I-labelled monoclonal antibodies 791T/36 and 79IT/36 Fab fragments have been evaluated in the imaging of patients with colorectal cancer, with benign colorectal tumours, and with malignant tumours of other parts of the gastrointestinal tract. The results of clinical imaging have been carefully correlated with clinical findings and direct measurement of the preferential uptake of antibody by the tumours. (UK).
In the 21st century, eighty years after William Baer presented his groundbreaking work treating bone and soft tissue infections with live maggots, thousands of therapists around the globe have rediscovered...Full Text Available
The author furnishes a review of incidents of major damage to high-output steam turbines. At the same time, he thereby underlines the call for an improvement in the exchange of experience on such damage and its causes at international level. Only the careful observance of past damage experience - including that of foreign manufacturers and operators - complete and modern monitoring equipment and the painstaking evaluation of all data furnished by such equipment can keep the risk of new technical development within economically tolerable limits. (orig.).
Decision-making is strongly based on modelling in two of our water supply projects concerning artificial ground water. The model used is a 2-dimensional flow and transport model using the element method. Due to sharp variations in Finnish soils, the modelling process is based on careful and detailed evaluation of basic hydrogeological data before and during model calibration.
BackgroundThe frequency of transfer of genes encoding resistance to antimicrobial agents was determined by conjugation in ESBL-producing and/or fluoroquinolone or aminoglycoside...Full Text Available
CTX-M-type extended-spectrum β-lactamases (ESBLs) have become increasingly common worldwide, with the notable exception of the United States, where TEM- and SHV-type ESBLs have appeared to predominate....Full Text Available
BackgroundResistance to third generation cephalosporins due to acquisition and expression of extended spectrum β-lactamase (ESBL) enzymes among Gram-negative bacteria is...Full Text Available
The implementation of information technology will continue to have important effects on the practice of emergency medicine. Patient registration and tracking systems, telemedicine electronic order entry systems, and the advent of electronic health records are some examples of applications that influence patient care in emergency departments. We review the literature regarding information technology advances in emergency medicine and outline the important role that emergency physicians play in developing and implementing a national health information technology strategy. PMID:16712540
Since many years, people take care of hazardous consequences of a non controlled economic growth and the sustainable development concept gains on one. This situation leads to consequences in the building industry and in the energy policy: buildings insulation in consideration, demand of consultants. In this framework, the partnership between Gaz De France and CICF has to be built. (A.L.B.)
A team of physicians, pharmacists, and informatics professionals developed a CDSS added to a commercial electronic medical record system to provide prescribers with patient-specific maximum dosing recommendations...Full Text Available
Niger is the second poorest country in the world but it has natural resources underground in the form of uranium ores deposits. This uranium is currently mined by two companies incorporated under Nigerian law: Somair and Cominak, operated by the principal shareholder Areva (through its subsidiary Cogema). After a presentation of Somair and Cominak key figures, this document details the working conditions and radiological protection, the environmentally friendly operations, the production traceability, the local economic development, the strengthening of the health care system and the development of the infrastructure. (A.L.B.)
A laser spectrometer for the ethylenediaminetetra-acetic acid (EDTA) titration of magnesium or calcium ions that is designed around a handheld laser pointer as the source and a photoresistor as the detector is developed. Findings show that the use of the spectrometer reduces the degree of uncertainty and error in one part of the EDTA titrations, however overall standard deviations depend on the skill of the student and their willingness to be careful and precise.
In the context of safety assessment of radioactive waste repositories, complex radionuclide transport models covering key safety-relevant processes play a major role. In recent Swiss safety assessments, such as Kristallin-I, an important drawback was the limitation in geosphere modelling capability to account for geosphere heterogeneities. In marked contrast to this limitation in modelling capabilities, great effort has been put into investigating the heterogeneity of the geosphere as it impacts on hydrology. Structural geological methods have been used to look at the geometry of the flow paths on a small scale and the diffusion and sorption properties of different rock materials have been investigated. This huge amount of information could however be only partially applied in geosphere transport modelling. To make use of these investigations the 'PICNIC project' was established as a joint cooperation of PSI/Nagra and QuantiSci to provide a new geosphere transport ...
In the treatment of prostatic cancer using a newly proposed intermittent multiportal therapy (DIMT), acute reactions, change in tumor marker levels, and complications more than 6 months after treatment were evaluated. From June 1989 to September 1990, 26 patients with prostatic cancer (stage A2, 3 patients; B, 9; C, 2; D, 10; recurrence, 2) were treated. Fifteen patients were followed up for more than one year, with a mean period of 11.6 months. The treatment schedule is 52.5 Gy in 16 fractions in 4 weeks for radical treatment, and 30.0 Gy in 8 fractions in 2 weeks for palliative treatment. The 360 degree rotation about the patient was divided into 16 fractions, and 2 opposing fractions were used in one day as parallel opposed portals to treat the target volume. The fractions were serially treated one per day, so that 8 treatment days produced a total dose of distribution similar to that for conventional conformational therapy. The size of the irradiation field ...
Objective: To evaluate the effect of PTBD in treating malignant biliary obstruction caused by hilar cholangiocarcinoma. Methods: We retrospectively analyzed the data of 103 patients(M:62,F:41)with malignant obstructive jaundice caused by hilar cholangiocarcinoma. After taking percutaneous transhepatic cholangiography, metallic stent or plastic external catheter or external-internal catheter for drainage was deployed and then followed up was undertaken with clinical and radiographic evaluation and laboratory. examination. Results: All patients went though PTBD successfully (100%). According to Bismuth classification, all 103 cases consisted of I type(N=30), II type (N=30), III type (N=26) and IV type (N=17). Thirty-nine cases were placed with 47 stents and 64 eases with drainage tubes. 4 cases installed two stems for bilateral drainage, 2 cases installed two stents because of long segmental strictures with stent in stent, 1 case was placed with three stents, and 3 cases installed stent ...
Purpose: To determine the value of MRI in the postoperativ evaluation of a singular ventricle compared to echocardiography and cardiac catheterization. Materials and methods: Thirty-one patients (range: 6 months to 30 years) with a functional single ventricle following palliative corrective operations. Five patients had a Blalock-Taussig-Shunt, 8 patients a Glenn-Anastomosis and 18 a cavopulmonary shunt (6 with classic Fontan-Circulation, 12 with modified cavopulmonary anastomosis). The results in terms of postoperative morphologic changes were compared to percutaneous echocardiography (31/31) and cardiac catheterization (6/31). Results: Echocardiography, which was performed on all patients, could not visualize the entire length of the tunnel, the Glenn-Anastomosis or the central pulmonary arteries in 70% of the patients due to an inadequate acoustic window. MRI was able to show the entire tunnel in 11/12 patients and the central pulmonary arteries in 30/31 ...
The groundwater flow and transport model of the Faultless underground nuclear test conducted at the Central Nevada Test Area (CNTA) was accepted by the state regulator and the environmental remediation efforts at the site have progressed to the stages of model validation and long-term monitoring design. This report discusses the long-term monitoring strategy developed for CNTA. Subsurface monitoring is an expensive and time-consuming process, and the design approach should be based on a solid foundation. As such, a thorough literature review of monitoring network design is first presented. Monitoring well networks can be designed for a number of objectives including aquifer characterization, parameter estimation, compliance monitoring, detection monitoring, ambient monitoring, and research monitoring, to name a few. Design methodologies also range from simple hydrogeologic intuition-based tools to sophisticated statistical- and optimization-based tools. When designing the long-term ...
The accuracy of dose computation within the lungs depends strongly on the performance of the calculation algorithm in regions of electronic disequilibrium that arise near tissue inhomogeneities with large density variations. There is a lack of data evaluating the performance of highly developed analytical dose calculation algorithms compared to Monte Carlo computations in a clinical setting. We compared full Monte Carlo calculations (performed by our Monte Carlo dose engine MCDE) with two different commercial convolution/superposition (CS) implementations (Pinnacle-CS and Helax-TMS's collapsed cone model Helax-CC) and one pencil beam algorithm (Helax-TMS's pencil beam model Helax-PB) for 10 intensity modulated radiation therapy (IMRT) lung cancer patients. Treatment plans were created for two photon beam qualities (6 and 18 MV). For each dose calculation algorithm, patient, and beam quality, the following set of clinically relevant dose-volume values was reported: (i) minimal, median, ...
The family of natriuretic peptides consists of the atria natriuretic peptide (ANP), the cerebral natriuretic peptide (BNP), the type C natriuretic peptide (CNP) and the peptide isolated from the dendroaspis snakes' poison (DNP), whose presence in humans has not been confirmed. The physiological function of ANP is in the control of arterial blood pressure by regulation of systemic vascular resistance of blood vessels. BNP is produced as one of the factors in the acute response to inflammatory tissue damage, mainly in coronary vessels. Increased serum concentrations of natriuretic peptides have been found in stress situations, such as trauma or major surgery, systemic hypotension, and in intrinsic myocardial dysfunction. High concentrations of natriuretic peptides were observed in severe sepsis, septic shock and in multiple organ failure, probably due to increased secretion by mediators of the inflammatory process.The highest concentrations of ANP and BNP were found in lethal conditions. ...
Data fusion techniques are based on the premise that two or more carefully designed NDE tests are potentially capable of offering additional information concerning the test object relative to what can be garnered from a single test. However, information from a heterogeneous set of transducers cannot be fused unless the data is mapped onto a common `format'. The eddy current method cannot, for example, provide time-of-flight information that can be combined from estimates derived from ultrasonic tests. This paper presents a simple solution to address the problem by employing the so-called Q-transform to relate diffusive fields, such as those generated by eddy current probes, and propagating wave fields generated by ultrasonic NDT sensors. The paper illustrates how the distance between a defect and a source can be extracted from eddy current data generated using carefully selected excitation signals. Numerical results and comparisons with ...
An attempt was made to minimize the channeling tail by implantation along a random equivalent direction following a careful alignment of the target. In order to analytically determine the random equivalent directions, critical angles for channeling were mapped on a stereogram. Boron ions with energies of 17 and 45 keV are implanted along specified directions determined from the map. The depth distribution of the dopant is profiled by SIMS and the effects of water orientation upon the channeling tail are noted. Industrial common use of a 7/sup 0/ tilt is not optimum. However, implantation with the wafer tilted at 5.5 +/- 0.5/sup 0/ from the surface normal and rotated at 7.0 +/- 0.5/sup 0/ from a (100) plane shows the least channel-tail compared to implantation along other directions. Rapid thermal annealing (RTA) is a promising annealing method for shallow junction formation. Transient enhanced diffusion of implanted boron is observed. Two different mechanisms for ...
An attempt was made to minimize the channeling tail by implantation along a random equivalent direction following a careful alignment of the target. In order to analytically determine the random equivalent directions, critical angles for channeling were mapped on a stereogram. Boron ions with energies of 17 and 45 keV are implanted along specified directions determined from the map. The depth distribution of the dopant is profiled by SIMS and the effects of water orientation upon the channeling tail are noted. Industrial common use of a 7"0 tilt is not optimum. However, implantation with the wafer tilted at 5.5 +/- 0.5"0 from the surface normal and rotated at 7.0 +/- 0.5"0 from a (100) plane shows the least channel-tail compared to implantation along other directions. Rapid thermal annealing (RTA) is a promising annealing method for shallow junction formation. Transient enhanced diffusion of implanted boron is observed. Two different mechanisms for the boron ...
Clinical-HINTS (Health Intelligence System) is a horizontally integrated decision support system (DSS) designed to meet the requirements for intelligent real-time clinical information management in critical care medical environments and to lay the foundation for the development of the next generation of intelligent medical instrumentation. The system presented was developed to refine and complement the information yielded by clinical laboratory investigations, thereby benefiting the management of the intensive care unit (ICU) patient. More specifically, Clinical-HINTS was developed to provide computer-based assistance with the acquisition, organisation and display, storage and retrieval, communication and generation of real-time patient-specific clinical information in an ICU. Clinical-HINTS is an object-oriented system developed in C+2 to run under Microsoft Windows as an embryo intelligent agent. Current generic reasoning skills include ...
The Belgian Malinois dog was introduced into the Department of Defense Military Working Dog Program in 1984. All dogs are purchased in Europe and have adapted well to the rigorous training requirements of the program. Most veterinary problems seen in this breed are related to kennel confinement and include traumatic dental disease, tail lesions, a variety of dermatologic conditions, and an inability to gain weight. Epilepsy is a breed problem and has been seen in this population, as has gastric dilatation/volvulus. Both elbow and hip dysplasia exist in the Malinois breed. PMID:1900116
In recent years the feedstock base of the coking plants in the South has been significantly degraded: the charges contain an increased quantity of gas coal and coal from coalfields in the East are being included. Certain plants in the Ukraine receive coal from the Kuznetsk, Pechora and Karaganda coalfields. Addition of these coal types in the charges of plants in the South is expected to continue in the future. Their efficient utilization requires careful investigation of the new charges in order to determine the optimal composition and to produce blast furnace coke meeting modern specifications.
We numerically demonstrate selective near-field localization determined by the polarization state of a single emitter coupled to plasmonic nano-cluster. Seven gold nanospheres are carefully arranged such that up to ten polarization states of the single emitter, including linear, circular, and elliptical polarizations, can be distinguished via the distinct field localization in four gaps. The ability to transform polarization state into field spatial localization may find application for single emitter polarization analysis.
Power System Stabilizers (PSS) have broad application throughout the world. PSS application requires careful tuning which is usually accomplished in the field with the generator and power system in an abnormal condition. Recently developed equipment which combines fast Fourier transform capability with digital computer technique provides a means of PSS tuning which is faster and more accurate than was previously obtainable. This paper describes a PSS tuning test conducted using the new technique. The advantages will be apparent to the reader. The described test is very poignant as evidenced by two unexpected occurrences of instability.
In the last 40 years, significant advances have been made in the understanding of the neurophysiologic processes involved in the experience of trauma and pain. This knowledge, together with the rapid growth and understanding in the behavioral health sciences, has expanded to include a much better appreciation of how these fields are converging and contribute to a process called neuroplasticity. These basic mechanisms common to all patients have important implications for clinical outcome and for improving clinical practice. This article is written for clinicians who manage patients with sacroiliac joint dysfunction, a specific type of nonspecific low back pain.
Periosteal Ewing's sarcoma is an uncommon, but well documented origin of this malignant condition with radiography signs, different from intramedullary growing tumours. Imaging modalities like CT or MRI supply proof of macroscopically intact endosteal cortical surface and free medullary cavity in long bones affected by this periosteal type of malignancy. Definite confirmation is valid after a careful microscopic investigation of the resected specimen. The prognosis of this type of Ewing's sarcoma may be favourable than that of the central type. Early diagnosis and therapy are thus essential. A clinical survey of six observations is given. (orig.).
Nonlinear distortion added by the loudspeaker in a hearing aid lowers the signal-to-noise ratio and may degrade the hearing aid user's ability to understand speech. The balancedarmature- type loudspeakers, predominantly used in hearing aids, are inherently nonlinear devices, as any displacement of the loudspeaker diaphragm inevitably changes the magnetic and electrical characteristics of the loudspeaker. A numerical time-domain model capable of describing these nonlinearities is presented. By simulation it is demonstrated how the output distortion could potentially be reduced significantly through careful design of the mechanical properties of the armature.
Cross-sectional imaging has revolutionised the radiological diagnosis of pleural collections. Not only can the precise location and volume of a pleural effusion be established, but also features specific for the aetiology of the effusion can be demonstrated. Increasingly, radiologists are called upon to perform image-guided biopsies, aspirations and small bore chest drain placement, all of which have been shown to be safe and efficacious. Pneumothoraces occurring due to acute trauma and in an intensive care setting can also benefit from radiological input, both in terms of diagnosis and image-guided treatment. (orig.)
Most of the essays gathered in this volume were first presented at a conference, Justice and the Human Genome, in Chicago in early November, 1991. The goal of the, conference was to consider questions of justice as they are and will be raised by the Human Genome Project. To achieve its goal of identifying and elucidating the challenges of justice inherent in genomic research and its social applications the conference drew together in one forum members from academia, medicine, and industry with interests divergent as rate-setting for insurance, the care of newborns, and the history of ethics. The essays in this volume address a number of theoretical and practical concerns relative to the meaning of genomic research.
Measurements of the humeral cortical thickness demonstrate that generalised osteoporosis in female Bantu commences in the fifth decade and gradually increases until, in the ninth decade, all subjects are osteoporotic. The combined cortical thickness (CCT) of the humerus in young adults is very similar to that found previously in a white London population and the loss of cortex with age is very similar. It is concluded that the known low incidence of femoral neck fracture in Bantu is not due to a lower incidence of generalised osteoporosis but to environmental factors. The chief environmental factor postulated is the greater amount of physical work performed by the Bantu. A more careful mode of walking is suggested as a subsidiary cause. (orig.).
This article examines the interplay between globalising and localising forces occurring in a child welfare reform project in South Korea. Focusing especially on care and education services for children and families provided by the Korean 'Dream Start' programme, which provides comprehensive health, parental involvement and welfare services to low-income children and their families, I discuss its involvement in the process of 'glocalisation'. Drawing on Foucaultian ideas, I conducted a critical discourse analysis of the policy documents of Dream Start. The article concludes by discussing local resistance to the creation of a cosmopolitan child and the dual qualities of inclusion/exclusion inscribed in the Dream Start project.
A zinc/air battery is claimed whose performance is improved by omitting separating elements such as diaphragms etc. The cathode and anode spaces are separated by a collector with holes big enough to permit the electrons to pass freely while restraining the anode material. Further, the active material consists of a spherical care of inert material with a zinc coating. Under the zinc coating, the spherical particles have another thin coating of an electropositive material, e.g. nickel. The cell also contains means for circulating the anode suspension.
The paper presents an integrated approach to the problem of electron temperature diagnostics of the plasma in a reversed field pinch. Three different methods, sampling different portions of the electron distribution function, are adopted, namely Thomson scattering, soft X-ray spectroscopy by pulse-height analysis and filtered soft X-ray intensity ratio. A careful analysis of the different sources of systematic errors is performed and a novel statistical approach is adopted to mutually validate the three independent measurements. A satisfactory agreement is obtained over a large range of experimental conditions, indicating that in the plasma core the energy distribution function is well represented by a maxwellian. (author)
The electromagnetic properties of a prototype gravitational wave detector, based on two coupled superconducting microwave cavities, were tested. The radio-frequency (rf) detection system was carefully analysed. With the use of piezoelectric crystals small harmonic displacements of the cavity walls were induced and the parametric conversion of the electromagnetic field inside the cavities explored. Experimental results of bandwidth and sensitivity of the parametric converter versus stored energy and voltage applied to the piezoelectric crystal are reported. A rf control loop, developed to stabilize phase changes on signal paths, gave a 125 dBc rejection of the drive mode on a time scale of 1 h.
Optimization is a powerful paradigm for expressing and solving problems in a wide range of areas, and has been successfully applied to many vision problems. Discrete optimization techniques are especially interesting since, by carefully exploiting problem structure, they often provide nontrivial guarantees concerning solution quality. In this paper, we review dynamic programming and graph algorithms, and discuss representative examples of how these discrete optimization techniques have been applied to some classical vision problems. We focus on the low-level vision problem of stereo, the mid-level problem of interactive object segmentation, and the high-level problem of model-based recognition. PMID:20660950
Delayed cerebral necroses after irradiation are to be divided into hemispheric and midline lesions, as they differ from each other in several aspects. Apart from the symptoms, they are differing in the duration of latency, in the course and prognosis, and also with regard to morphology. Though there is no doubt that radiation tolerance of cerebral midline structures is relatively limited, on biological grounds, evidence of a difference between the tolerated doses could not be given from the existent inhomogeneous radiation data, with the help of the NSD-concept. Radiation planning for the region of the head, nevertheless, carefully should avoid in every case to involve the structures of the cerebral midline.
The main purpose of this paper is to stress the importance of CT depiction of the mandibular incisive canal. This anatomical structure contains a major neurovascular bundle and is thus very important in the planning of mandibular implants in the canine-incisive area. The importance of careful assessment of the mandibular canal course before implantology is now widely recognized. The same holds true for the canine-incisive region in the jaw, to detect the incisive canal if present and prevent any complications from its accidental damage. CT with a dedicated software showed the incisive canal in a large number of patients, which calls for precise reporting of its presence, course, and relationships with teeth.
This book constitutes the thoroughly refereed post proceedings of the international workshop Computer Vision Approaches to Medical Image Analysis, CVAMIA 2006, held in Graz, Austria in May 2006 as a satellite event of the 9th European Conference on Computer Vision, EECV 2006. The 10 revised full papers and 11 revised poster papers presented together with 1 invited talk were carefully reviewed and selected from 38 submissions. The papers are organized in topical sections on clinical applications, image registration, image segmentation and analysis, and the poster session. (orig.)
As an application of ART2 neural networks, computer aided monitoring of pump efficiency is successfully examined for an industrial waste-liquid treatment process with measured data of valve openness and liquid flow rates. By running the neural networks in parallel, we confirm that accuracy to detect system changes is good, and the adjustment of classifier parameters is relatively easy. Investigating the resulting classes carefully, frequency of each class is correlated with pump efficiency. The relative amount of variables are also related to the classes. (author)
In recent years, several groups, including the physician assistant, health information management, ophthalmic medical technician/technologist, and athletic training review committees, have left the Commission on Accreditation of Allied Health Education Programs (CAAHEP) system to form their own, profession-specific accrediting bodies. Their motivation was typically a desire for greater professional visibility and autonomy. Combined, these professions represented one third of the CAAHEP's programs. This article reviews the history of allied health and examines current attempts to bring cohesion and identity to this increasingly fractured segment of the U.S. health care system. PMID:18444439
Close coupled expressions for phenomenological cross sections which describe transport properties of atom--diatom mixtures are obtained in the total-J coupling scheme and are related to the bracket integrals of kinetic theory. Coupled states and infinite order sudden expressions for the generalized phenomenological cross sections using initial, final, and average l-labeling are also given. Particular care is taken to use a phase convention for the CS and IOS approximations which is consistent with the Arthurs--Dalgarno formalism and which gives the correct behavior of degeneracy averaged differential cross sections.
Excessive irradiation due to unexpected leakage was found on a patient receiving electron beam therapy. The cause of this leakage was analyzed and the amount of leakage was measured for different electron beam energies. The highest leakage occurred with a 6 x 6 cm cone using a 12 MeV electron beam. The leakage dose measured along the side of the cone could be as great as 40%. Until the cones are modified or redesigned, it is advised that all patient setups be carefully reviewed to assure that no significant patient areas are in the side scatter region.
...Advances in Chronic Kidney Disease-The purpose of Advances Chronic Kidney Disease is to provide in-depth, scholarly review articles about the care and mana ... Advances in Chronic Kidney Disease - Elsevier Home Products User Resources About Us Support & Contact Elsevier Websites Advanced Product ...Search Browse Journals Advances in Chronic Kidney Disease Advances in Chronic Kidney Disease Additional Information Related Publications Editorial Board Journal Online e- Alert Readers ...year: 6 Tips Title This is my tip content Visit Advances in Chronic Kidney Disease Online! The purpose of Advances Chronic Kidney Disease is ...
There is increasing pressure to operate laboratory facilities in environmentally and financially sustainable ways. A key factor in achieving this goal is careful consideration of how energy is used by the buildings' ventilation system, both for conditioning air supplied to the laboratories and the energy used moving air through the building. Traditionally, laboratory energy use is treated as an engineering concern within the scope of the building's overall design and operation. However, this approach limits the involvement of key stakeholders in many important decisions and can lead to unexpected safety concerns for the laboratory's users. We believe that a broad view of the parties affected by a laboratory building's operations is necessary to avoid having the various stakeholders working...
Recent rapid growth in mobile computing technologies enables telemedicine applications to operate on mobile devices. Our focus is on the design of an integrated electrocardiogram (ECG) beat detector on a Personal Digital Assistant (PDA) platform for the health screening process. The ECG beat detector module will be supported by the PDA version of Personal Health Information Management System (PHIMS) and Facilitated Accurate Referral Management System (FARMS) through wireless network infrastructure as a home-based mobile cardiac monitoring solution. PMID:17282192
MRI provides a non-invasive diagnostic tool complementing echocardiography on one hand, and showing advantages over echocardiography, on the other hand, especially after corrective procedures. The multiple different MRI sequences need to be adapted to examinations of children and patients with congenital heart disease (CHD), and can be used to detect morphologic changes, blood-flow in the heart and thoracic vessels and diastolic or systolic function of myocardium. Several factors determine the success of the examination of a complex congenital heart disease or a postoperative situs. Pediatric radiologists and radiologists experienced in congenital heart diseases have to work in close cooperation. Echocardiography should be performed before MRI. The results of prior examinations and the clinical history of the patients, including possible palliative or reconstructive operations, must be available before MRI to guide the planning of the examination. With a systematic ...
Nuclear medicine and magnetic resonance imaging (MRI) are widely used in cardiac diagnostics. Both techniques have been carefully evaluated and are equivalent for the assessment of regional and global wall motion as well as the evaluation of ejection fraction and cardiac volumes, though MRI is herein currently seen as gold standard. For evaluation of myocardial perfusion, extensive data exist for nuclear imaging, that, next to high diagnostic accuracy for evaluation of coronary artery disease, show incremental prognostic information and allow for independent risk stratification. Because of rapid technical advance, myocardial perfusion imaging has also become feasible with cardiac MRI. Results of recent studies are promising, but the data are few compared to perfusion scintigraphy. For viability assessment in patients with ischemic cardiomyopathy, positron emission tomography (PET) with FDG is currently seen as gold standard. However, single ...
When biomass is used as fuel for thermal conversion plants, minerals from the fuel can be responsible for major problems. Generally, these problems are associated with the existence and development of low melting compounds or eutectics, which form sticky layers. In a fluidised bed, this can result in bed-agglomeration and defluidisation. This causes local high temperature, which often accelerates the process. It ultimately can lead to a completely sintered bed content with a glassy phase gluing the bed particles together and shut-down of the plant. The main objective of the title project is to develop a methodology to predict ash/bed agglomeration and sintering problems, to indicate related problems and, furthermore, to identify solution methods to make different types of biomass streams more viable for energy production. Within the present study, selected fuels are subjected to different existing methods together with some new ones, in order to determine the ...
The paper analyses the advantages and disadvantages of the second generation improved technologies and third generation technologies mainly developed in China in terms of safety and economy. The paper also discusses the maturity of the second generation improved technologies and the sophistication of the third generation technologies respectively. Meanwhile, the paper proposes that the advantage and disadvantage of second generation improved technologies and third generation technologies should be carefully taken into consideration and the relationship between the maturity and sophistication should be properly dealt with in the current stage. A two-step strategy shall be taken as a solution to solve the problem of insufficient capacity of nuclear power, trace and develop the third generation technologies, so as to ensure the sound and fast development of nuclear power. (authors)
By means of an analogous simulator, which can simulate a power supply system, a method to determine the transfer function of a Power System Stabilizer (PSS) is developed. The purpose of the PSS is to damp unwanted electro-mechanical oscillations. The method is very systematic and there is no need for specified values of the parameters used in the system. It is assumed that the power generator system is linear for small variations. The system can be considered to be a black box. Measurements executed by means of this method are completely controlled by the person who enforces the measurement. By applying this method carefully, irregularities are almost out of the question. The equipment necessary are a PC with two AD-ports and an adjustable sinus-generator. A comparison is made with a more traditional method, in which a spectrum analyzer is used. 4 figs., 7 refs.
This guide accompanies the following article: Gabrielle Poeschl, `What Family Organization Tells Us about Fairness and Power in Marital Relationships', Social and Personality Compass 1/1 (2007): 557-571, 10.1111/j.1751-9004.2007.00026.x Author's Introduction One thing that often strikes me, when I talk with people, is the human capacity to accept and defend surprising aspects of the social life. Thus, we have some feeling that the separation between the domestic and the public spheres has not always existed, but we are ready to assume that in the first human groups, men went out hunting to feed their family, while women stayed in the camp to take care of the children. Even in the face of evidence to the contrary, we are reluctant to question the opinion that men and women differ in persona...
The somatic and genetic radiation exposure of patients undergoing Digital Subtraction Angiography (DSA) and traditional Film Arteriography (FA) of cranial, cervical, thoracic and abdominal vascular territories are compared. The radiation doses absorbed within the critical organs - red bone marrow, lung, thyroid gland and female breast - and in the gonads were measured using an anthropomorphic Alderson phantom. A Somatic Dose Index was calculated in order to estimate the somatic radiation risk. The somatic radiation exposure depends upon the location of the critical organs with respect to the entrance site of the x-ray beam, and can be reduced by an appropriate choice of the angiographic projection. Under this condition, the radiation exposure of the patient during DSA can be lower than during FA. For renal DSA an a.p. projection, the use of an abdominal compression device and careful caudal shielding of the field are advocated. (orig.).
... The drop in pay, with mounting medical bills and a curve ball in their personal life, led Mr. Flake and his wife, Amy, to exhaust their savings. As they shifted spending to credit cards their debt mounted, and conversations about retirement ... In October 2008, they learned that a relative of hers with an 8-month-old son was going to prison. If the Flakes could not take the baby, he would be placed in foster care. The Flakes did some soul searching and decided to seek custody of ...) 1 2 Next Page »A version of this article appeared in print on March 24, 2011, on page F4 of the New York edition. Sign In to E-Mail Print Single Page Reprints Connect with The New York Times on Facebook. Get Free E-mail Alerts on These Topics Retirement Personal ...
The physical foundations of a variety of emerging technologies --- ranging from the applications of quantum entanglement in quantum information to the applications of nonequilibrium bulk and interface phenomena in microfluidics, biology, materials science, energy engineering, etc. --- require understanding thermodynamic entropy beyond the equilibrium realm of its traditional definition. This paper presents a rigorous logical scheme that provides a generalized definition of entropy free of the usual unnecessary assumptions which constrain the theory to the equilibrium domain. The scheme is based on carefully worded operative definitions for all the fundamental concepts employed, including those of system, property, state, isolated system, environment, process, separable system, system uncorrelated from its environment, and parameters of a system. The treatment considers also systems with movable internal walls and/or semipermeable walls, with chemical reactions ...
Even though the currently intensive research efforts on high- temperature superconducting materials have not yet converged on a well specified practical material, the indications are that such a material may be quite brittle, anisotropic, and may contain many flaws such as microcracks and voids at grain boundaries. Consequently, practical applications of high temperature superconducting materials will require a very careful strength analysis based on fracture mechanics considerations. Because of the high sensitivity of the strength of such materials to the presence of defects, methods of quantitative non-destructive evaluation may be expected to play an important role in strength determinations. This proposal is concerned with the use of ultrasonic methods to detect and characterize isolated cracks, clusters of microcracks and microcracks distributed throughout the material. Particular attention has been, and will continue to be devoted to relating ultrasonic ...
The invention refers a procedure of radiation dose control in irradiated tissues during electron-beam therapy. It aims at meeting the planned radiation dose for diseased tissues and taking care of the healthy ones. Therefore, the dose distribution required is determined before irradiation in consideration of such factors as energy-dependence of detector sensitivity, self-absorption within the tissue, and relative biological effectiveness. Furthermore, the expected intensity distribution of secondary quantum radiation excited in the irradiated tissue is calculated. A radiation detector for local resolution is used for registration. During irradiation the calculated intensity distribution is compared with the measured one. The invention is applicable in radiation therapy with monoenergetic electron beams.
A prerequisite for a sensible estimate of moisture induced stresses in timber members is an accurate prediction of the members' moisture states during their service life. There are, however, an infinite number of possible moisture states for an arbitrary timber member in a natural varying climate. The naturally varying humidity is possible to describe as harmonic cycles, with different periods, superimposed. This work presents realizations of envelop curves over the possible moisture states in a timber member for some carefully chosen harmonic humidity variations. The calculations, on which the realizations were made, are based on a fully coupled transport model including a model for the influential sorption hysteresis of wood. A format containing required information suitable for assessin...
We report the fabrication of p"+/n junctions using Ge"+, C"+, and B"+ co-implantation and a spike anneal. The best junction exhibits a depth of 26 nm, vertical abruptness of 3 nm/decade, and sheet resistance of 520 Ohm/square. The junction location is defined by where the boron concentration drops to 10"1"8 cm"-"3. These junctions are close to the International Technology Roadmap specifications for the 65 nm technology node and are achieved by careful engineering of amorphization, stresses, and point defects. Advanced simulation of boron diffusion is used to understand and optimize the process window. The simulations show that the optimum process completely suppresses the transient-enhanced diffusion of boron and the formation of boron-interstitial clusters. This increases the boron solubility to 20% above the equilibrium solid-state solubility.
The recent literature in the field of supply chain management emphasizes the role of inter-organizational networks and the integration of vertical reproduction networks (supply chains) in particular as a key factor for value creation. However, the literature includes little empirical evidence. This situation suggests the need to appraise investments in such networks or supply chains carefully. How can a decision maker reliably assess the effect of investing in inter-organizational network arrangements on firm value? This article takes up this issue and suggests a framework consisting of five components to help answer the question. The task of the framework is to support the structuring and revelation of the causal chain between investments in the network on the one hand and the effect of t...
To discuss and share knowledge around advances in the care of patients with thrombotic disorders, the Third International Symposium of Thrombosis and Anticoagulation was held in S?o Paulo, Brazil, from October 14?16, 2010. This scientific program was developed by clinicians for clinicians, and was promoted by four major clinical research institutes: the Brazilian Clinical Research Institute, the Duke Clinical Research Institute of the Duke University School of Medicine, the Canadian VIGOUR Centre, and the Uppsala Clinical Research Center. Comprising 3?days of academic presentations and open discussion, the symposium had as its primary goal to educate, motivate, and inspire internists, cardiologists, hematologists, and other physicians by convening national and international visionaries, th...
Explosives have rarely been used in decommissioning of nuclear reactors. Nevertheless, controlled blasting can be used advantageously during careful destruction of nuclear power plants for removal of concrete, pipe systems, and other components. Experiments performed within a former nuclear power plant demonstrate the feasibility of this method, employing explosive masses up to 15 kg per blast. The loadings of the components and the total plant structure were measured and compared with code predictions. The experiments show a response of the containment predominantly in frequency ranges above 100 Hz, thus keeping the building and components below German regulation limits for shock excitation. The blast wave pressures are reduced drastically within short distances in the building. Dust and debris can be contained with simple methods such as curtains. Use of this method seems to be applicable to actual dismantling projects.
Among pharmaceuticals and personal care products released into the aquatic environment, antibiotics are of particular concern, because of their ubiquity and health effects. Although scientists have recently paid more attention to the threat of antibiotics to coastal ecosystems, researchers have often focused on relatively few antibiotics, because of the absence of suitable analytical methods. We have therefore developed a method for the rapid detection of 36 antibiotic residues in coastal waters, including tetracyclines (TCs), sulfanilamides (SAs), and quinolones (QLs). The method consists of solid-phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis, using electrospray ionization (ESI) in positive mode. The SPE was performed with Oasis HLB and Oasi...
A data analysis based on an artificial neural network classifier is proposed to identify cosmic ray antiprotons detected with the CAPRICE silicon-tungsten imaging calorimeter against electron background in the energy range 1.2-4.0 GeV. A set of new physical variables, describing the events inside the calorimeter on the base of their different patterns, are introduced in order to discriminate between hadronic and electromagnetic showers. The ability of the artificial neural network classifier to perform a careful multidimensional analysis gives the possibility to identify antiprotons with an electron rejection 408{+-}85 (stat) at 95.0{+-}0.2 (stat)% of signal detection efficiency. The high accuracy achieved by this method improves substantially the efficiency in the evaluation of the cosmic ray antiproton spectrum. (orig.).
Summary Objectives To describe the pattern of incident illness in children after initiation of antiretroviral therapy (ART) in a large public health sector programme in Lusaka, Zambia. Methods Systematic chart review to retrospectively extract data from medical records of children (i.e. <15 years) initiating ART in the Lusaka, Zambia public sector. Incident conditions were listed separately and then grouped according to broad categories. Predictors for incident diagnoses were determined using univariate and multivariable analysis. Results Between May 2004 and June 2006, 1705 HIV-infected children initiated ART. Of these, 1235 (72%) had their medical records reviewed. Median age at ART initiation was 77 months and 554 (45%) were females. Eight hundred and forty-one (68%) children had an inc...
We show that the HACCP system is not fully applicable at the primary production level, and that food safety is obtained through the careful implementation of good hygiene practice (GHP) at the farm. Guides to GHP intended at primary productions cover one activity, such as cattle rearing or corn production. Yet most farms have more than one activity. Hazards from one activity can be transferred to another activity, and in general this is not considered in one-activity guides. There is a need therefore for farmers to be able to detect and control such transfers. We suggest a horizontal complement to the Guides to GHP that would consider only the application of the Step 6 and Principle 1 of the HACCP system amended as follows: ''List all potential hazards transferred from one activity to anot...
...com: Chicken Soup for the Soul: Power Moms - 101 Stories Celebrating the Power of Choice for Stay-at-Home and Work-from-Home Moms (9781935096313)...com: Chicken Soup for the Soul: Power Moms - 101 Stories Celebrating the Power of Choice for Stay-at-Home and Work-from-Home Moms (9781935096313)...Victor Hansen, Wendy Walker: Books Jack Canfield, Mark Victor Hansen, Wendy Walker,Chicken Soup for the Soul: Power Moms - 101 Stories Celebrating ...the Power of Choice for Stay-at-Home and Work- from-Home Moms,Chicken Soup for the Soul,1935096311,I9781935096313,Child Care/Parenting,Employment,Literary collections,Motherhood,...
Understanding Center for Medicare and Medicaid Services (CMS) documentation and coding rules is challenging for most physicians. To accurately bill for clinical services, physicians must learn a system that may initially seem daunting, but is in fact governed by a small number of straightforward rules. The Evaluation and Management (E/M) guidelines for all service codes specify 3 components: history, examination, and medical decision-making, each with a defined set of elements or characteristics. Service coding is based on the level of care supported by the number of history and examination elements and the complexity of decision-making. This article will clarify the guidelines for outpatient clinical services and suggest a practical method of selecting appropriate E/M codes. Because physicians must often choose between billing codes 99213 and 99214 for a visit by an established patient, it will particularly focus on the minimum documentation needed to bill a 99214 ...