WorldWideScience

Sample records for center observational case

  1. Shiitake dermatitis recorded by French Poison Control Centers - new case series with clinical observations.

    Boels, D; Landreau, A; Bruneau, C; Garnier, R; Pulce, C; Labadie, M; de Haro, L; Harry, P

    2014-07-01

    Shiitake (Lentinula edodes) is an edible mushroom which was initially grown in Japan and China and is now sold on the European market. Flagellate erythema may arise following shiitake consumption and was first described in Japan in 1974. This paper reports a French shiitake dermatitis case series. The findings of retrospective study of shiitake dermatitis cases, reported to French Poison Control Centres (PCC) from January 2000 to December 2013, are reported. Among 32 exposed patients, 15 presented flagellate urticarial lesions after raw shiitake consumption. The first case of this series was reported in 2006 and the last nine cases were reported as of 2012. After shared meals, no symptoms were reported among guests, who preferred cooked shiitake to the raw mushroom. In this series, rashes appeared 12 h to 5 days (median: 24 h) after raw shiitake ingestion. Linear and itchy urticarial lesions formed on the trunk, arms, and legs within a few hours and persisted for 3-21 days. In four cases, rash and pruritus were either triggered or worsened by sun exposure. Eleven patients received corticosteroids, antihistamines, or both. All patients completely recovered. Due to the rapidly increasing consumption of exotic food in Western countries, it is no surprise that cases of shiitake dermatitis are now appearing in Europe. The mechanism of shiitake dermatitis is thought to be toxic and due to lentinan, a polysaccharide component of the mushroom. There is no specific validated treatment for shiitake dermatitis. Health professionals and the general population should be aware of both the risk associated with raw shiitake consumption and of the good prognosis of this very spectacular and uncomfortable toxic dermatitis.

  2. Far infrared observations of the galactic center

    Gatley, I.

    1977-01-01

    Maps of a region 10' in diameter around the galactic center made simultaneously in three wavelength bands at 30 μm, 50 μm, and 100 μm with approximately 1' resolution are presented, and the distribution of far infrared luminosity and color temperature across this region is derived. The position of highest far infrared surface brightness coincides with the peak of the late-type stellar distribution and with the H II region Sgr A West. The high spatial and temperature resolution of the data is used to identify features of the far infrared maps with known sources of near infrared, radio continuum, and molecular emission. The emission mechanism and energy sources for the far infrared radiation are anslyzed qualitatively, and it is concluded that all of the observed far infrared radiation from the galactic center region can be attributed to thermal emission from dust heated both by the late-type stars and by the ultraviolet sources which ionize the H II regions. A self-consistent model for the far infrared emission from the galactic center region is presented. It is found that the visual extinction across the central 10 pc of the galaxy is only about 3 magnitudes, and that the dust density is fairly uniform in this region. An upper limit of 10 7 L/sub mass/ is set on the luminosity of any presently unidentified source of 0.1 to 1 μm radiation at the galactic center. Additional maps in the vicinity of the source Sgr B2 and observations of Sgr C bring the total number of H II regions within 1 0 of the galactic center studied by the present experiment to nine. The far infrared luminosity, color temperature and optical depth of these regions and the ratio of infrared flux to radio continuum flux lie in the range characteristic of spiral arm H II regions. The far infrared results are therefore consistent with the data that the galactic center H II regions are ionized by luminous, early type stars

  3. Microvascular Outcomes of Pediatric-Onset Type 1 Diabetes Mellitus: A Single-Center Observational Case Reviews in Sana’a, Yemen

    Abdallah Ahmed Gunaid

    2018-01-01

    Full Text Available Microvascular complications of pediatric-onset type 1 diabetes are common in low-income countries. In this study, we aimed at reviewing microvascular outcomes in 6 cases with type 1 diabetes over 14 to 31 years of follow-up. Severe proliferative diabetic retinopathy (PDR and/or diabetic macular edema (maculopathy (DME and overt diabetic nephropathy (macroalbuminuria were seen among 4 of 6 patients, whereas severe diabetic peripheral neuropathy with Charcot neuroarthropathy was seen in 1 patient only, who had the longest duration of follow-up. The weighted mean (SD (95% confidence interval hemoglobin A 1c was 8.9 (1.6 (8.4-9.4% [74 (17 (68-80 mmol/mol] for PDR/DME and 8.6 (1.7 (8.0-9.0% [71 (19 (65-77 mmol/mol] for macroalbuminuria. Thyroid autoimmunity was positive in 3 patients with overt hypothyroidism in 2 of them. Worse microvascular outcomes among these cases might be attributed to poor glycemic control, lack of knowledge, and limited financial resources.

  4. Off-center observers versus supernovae in inhomogeneous pressure universes

    Balcerzak, Adam; Dabrowski, Mariusz P.; Denkiewicz, Tomasz

    2013-01-01

    Exact luminosity distance and apparent magnitude formulas are applied to Union2 557 supernovae sample in order to constrain possible position of an observer outside of the center of symmetry in spherically symmetric inhomogeneous pressure Stephani universes which are complementary to inhomogeneous density Lema\\^itre-Tolman-Bondi (LTB) void models. Two specific models are investigated. The first which allows a barotropic equation of state at the center of symmetry with no scale factor function...

  5. The Universe Observation Center: an educational center devoted to Astronomy in Catalonia

    Fernández, D.

    The Universe Observation Center (in Catalan language, Centre d'Observació de l'Univers, COU) is located in close proximity to the Montsec Astronomical Observatory (Observatori Astronòmic del Montsec, OAM), in eastern Catalonia (Spain). Both centers comprise the Montsec Astronomical Park (Parc Astronòmic Montsec, PAM), managed by the Consorci del Montsec. Montsec Mountain remains the finest location for astronomical observation in Catalonia, as demonstrated by a site-testing campaign conducted by the Astronomy and Meteorology Department of the University of Barcelona. The COU consists of a Central Building (including a permanent exhibition and three classrooms possessing broadband Internet access), the Telescope Park (two astronomical domes equipped with medium-size telescopes, a coelostat for solar observation, and a portable telescope park), the Eye of Montsec (a digital planetarium and, at the same time, an extremely innovative platform for sky observation) and the Garden of the Universe (a tour of the land surrounding the COU, visiting several areas within it). The COU will offer to the Spanish academic community a host of fascinating and unique activities in the fields of astronomy and geology. The Center is open not only to students (from primary school through university), but also to amateur astronomers, people interested in science and the general public.

  6. The Universe Observing Center a modern center to teach and communicate astronomy

    Ribas, Salvador J.

    2011-06-01

    The Universe Observing Center is one of the parts of the Parc Astronòmic Montsec (PAM). PAM is an initiative of the Catalan government, through the Consorci del Montsec (Montsec Consortium), to take advantage of the capabilities and potential of the Montsec region to develop scientific research, training and outreach activities, particularly in the field of Astronomy. The choice of the Montsec mountains to install the PAM was motivated by the magnificent conditions for observing the sky at night; the sky above Montsec is the best (natural sky free of light pollution) in Catalonia for astronomical observations. The PAM has two main parts: the Observatori Astronòmic del Montsec (OAdM) and the Universe Observing Center (COU). The OAdM is a professional observatory with an 80-cm catadioptric telescope (Joan Oró Telescope). This telescope is a robotic telescope that can be controlled from anywhere in the world via the Internet. The COU is a large multipurpose center which is intended to become an educational benchmark for teaching and communicate astronomy and other sciences in Catalonia. The management of the COU has three main goals: 1) Teach primary and secondary school students in our Educational Training Camp. 2) Teach university students housing the practical astronomy lectures of the universities. 3) Communicate astronomy to the general public. The COU comprises special areas for these purposes: the Telescopes Park with more than 20 telescopes, a coelostat for solar observations and two dome containing full-automated telescopes. The most special equipment is ``The Eye of Montsec'', with its 12m dome containing a multimedia digital planetarium and a platform for direct observation of the sky and the environment. During 2009 we expect around 10000 visitors in Montsec area to enjoy science with Montsec dark skies and an special natural environment.

  7. HERSCHEL OBSERVATIONS REVEAL ANOMALOUS MOLECULAR ABUNDANCES TOWARD THE GALACTIC CENTER

    Sonnentrucker, P. [Space Telescope Science Institute, Baltimore, MD 21218 (United States); Neufeld, D. A.; Indriolo, N. [Physics and Astronomy Department, Johns Hopkins University, Baltimore, MD 21218 (United States); Gerin, M.; De Luca, M. [LERMA-LRA, UMR 8112 du CNRS, Observatoire de Paris, Ecole Normale Superieure, UPMC and UCP, 24 rue Lhomond, F-75231, Paris Cedex 05 (France); Lis, D. C. [Astronomy Department, California Institute of Technology, Pasadena, CA 91125 (United States); Goicoechea, J. R., E-mail: sonnentr@stsci.edu [Centro de Astrobiologia, CSIC/INTA, E-28850, Madrid (Spain)

    2013-01-20

    We report the Herschel detections of hydrogen fluoride (HF) and para-water (p-H{sub 2}O) in gas intercepting the sight lines to two well-studied molecular clouds in the vicinity of the Sgr A complex: G-0.02-0.07 (the {sup +}50 km s{sup -1} cloud{sup )} and G-0.13-0.08 (the {sup +}20 km s{sup -1} cloud{sup )}. Toward both sight lines, HF and water absorption components are detected over a wide range of velocities covering {approx}250 km s{sup -1}. For all velocity components with V{sub LSR} > -85 km s{sup -1}, we find that the HF and water abundances are consistent with those measured toward other sight lines probing the Galactic disk gas. The velocity components with V{sub LSR} {<=} -85 km s{sup -1}, which are known to trace gas residing within {approx}200 pc of the Galactic center, however, exhibit water vapor abundances with respect to HF at least a factor three higher than those found in the Galactic disk gas. Comparison with CH data indicates that our observations are consistent with a picture where HF and a fraction of the H{sub 2}O absorption arise in diffuse molecular clouds showing Galactic disk-like abundances while the bulk of the water absorption arises in warmer (T {>=} 400 K) diffuse molecular gas for V{sub LSR} {<=} -85 km s{sup -1}. This diffuse Interstellar Medium (ISM) phase has also been recently revealed through observations of CO, HF, H{sup +}{sub 3}, and H{sub 3}O{sup +} absorption toward other sight lines probing the Galactic center inner region.

  8. Domestic Employment In Career Centered Families: A Case Study ...

    Domestic Employment In Career Centered Families: A Case Study Of Covenant University Ota, ... Gender and Behaviour ... However, eighty three (83) useable instruments were returned with the teaching staff having the highest response rate.

  9. Interoperable Access to Near Real Time Ocean Observations with the Observing System Monitoring Center

    O'Brien, K.; Hankin, S.; Mendelssohn, R.; Simons, R.; Smith, B.; Kern, K. J.

    2013-12-01

    The Observing System Monitoring Center (OSMC), a project funded by the National Oceanic and Atmospheric Administration's Climate Observations Division (COD), exists to join the discrete 'networks' of In Situ ocean observing platforms -- ships, surface floats, profiling floats, tide gauges, etc. - into a single, integrated system. The OSMC is addressing this goal through capabilities in three areas focusing on the needs of specific user groups: 1) it provides real time monitoring of the integrated observing system assets to assist management in optimizing the cost-effectiveness of the system for the assessment of climate variables; 2) it makes the stream of real time data coming from the observing system available to scientific end users into an easy-to-use form; and 3) in the future, it will unify the delayed-mode data from platform-focused data assembly centers into a standards- based distributed system that is readily accessible to interested users from the science and education communities. In this presentation, we will be focusing on the efforts of the OSMC to provide interoperable access to the near real time data stream that is available via the Global Telecommunications System (GTS). This is a very rich data source, and includes data from nearly all of the oceanographic platforms that are actively observing. We will discuss how the data is being served out using a number of widely used 'web services' (including OPeNDAP and SOS) and downloadable file formats (KML, csv, xls, netCDF), so that it can be accessed in web browsers and popular desktop analysis tools. We will also be discussing our use of the Environmental Research Division's Data Access Program (ERDDAP), available from NOAA/NMFS, which has allowed us to achieve our goals of serving the near real time data. From an interoperability perspective, it's important to note that access to the this stream of data is not just for humans, but also for machine-to-machine requests. We'll also delve into how we

  10. Triploidy--Observations in 154 Diandric Cases.

    Nanna Brink Scholz

    Full Text Available Hydatidiform moles (HMs are abnormal human pregnancies with vesicular chorionic villi, imposing two clinical challenges; miscarriage and a risk of gestational trophoblastic neoplasia (GTN. The parental type of most HMs are either diandric diploid (PP or diandric triploid (PPM. We consecutively collected 154 triploid or near-triploid samples from conceptuses with vesicular chorionic villi. We used analysis of DNA markers and/or methylation sensitive-MLPA and collected data from registries and patients records. We performed whole genome SNP analysis of one case of twinning (PP+PM.In all 154 triploids or near-triploids we found two different paternal contributions to the genome (P1P2M. The ratios between the sex chromosomal constitutions XXX, XXY, and XYY were 5.7: 6.9: 1.0. No cases of GTN were observed. Our results corroborate that all triploid human conceptuses with vesicular chorionic villi have the parental type P1P2M. The sex chromosomal ratios suggest approximately equal frequencies of meiosis I and meiosis II errors with selection against the XYY conceptuses or a combination of dispermy, non-disjunction in meiosis I and meiosis II and selection against XYY conceptuses. Although single cases of GTN after a triploid HM have been reported, the results of this study combined with data from previous prospective studies estimate the risk of GTN after a triploid mole to 0% (95% CI: 0-1,4%.

  11. Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers.

    Chang, Alex L; Kim, Young; Ertel, Audrey E; Hoehn, Richard S; Wima, Koffi; Abbott, Daniel E; Shah, Shimul A

    2017-05-01

    Efforts to regionalize surgery based on thresholds in procedure volume may have consequences on the cost of health care delivery. This study aims to delineate the relationship between hospital volume, case mix, and variability in the cost of operative intervention using colectomy as the model. All patients undergoing colectomy (n = 90,583) at 183 academic hospitals from 2009-2012 in The University HealthSystems Consortium Database were studied. Patient and procedure details were used to generate a case mix-adjusted predictive model of total direct costs. Observed to expected costs for each center were evaluated between centers based on overall procedure volume. Patient and procedure characteristics were significantly different between volume tertiles. Observed costs at high-volume centers were less than at middle- and low-volume centers. According to our predictive model, high-volume centers cared for a less expensive case mix than middle- and low-volume centers ($12,786 vs $13,236 and $14,497, P case mix at low-volume centers, which may lead to perceived poor performance at these centers. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Climate Prediction Center (CPC) U.S. Daily Precipitation Observations

    National Oceanic and Atmospheric Administration, Department of Commerce — Observational reports of daily precipitation (1200 UTC to 1200 UTC) are made by members of the NWS Automated Surface Observing Systems (ASOS) network; NWS...

  13. Brain fag: New perspectives from case observations.

    Ebigbo, Peter O; Lekwas, Elekwachi Chimezie; Chukwunenyem, Nweze Felix

    2015-06-01

    Brain fag was originally described as a culture-bound syndrome among West African students. The term "brain fag" literally means "brain fatigue." Available literature indicates that brain fag symptoms usually present in formal academic settings when African students are required to transit to a reliance on written literature (as opposed to more traditional oral forms of information transmission) and to adapt to westernized, individualistic systems of education that, at times, oppose the values of relatively collectivistic African societies. Based on detailed observation of two typical and two nontypical cases of brain fag, the authors suggest that the syndrome may not be solely related to tensions in the academic sphere, but may function more generally as an expression of psychological distress that results from societal pressures that exceed the coping capacity of the individual. The brain fag symptoms, including lack of concentration, sensations of internal heat in the head and body, heaviness, and multiple somatic complaints, may constitute a defensive process which helps prevent a full-fledged decompensation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  14. Stennis Space Center observes 2009 Safety and Health Day

    2009-01-01

    Sue Smith, a medical clinic employee at NASA's John C. Stennis Space Center, takes the temperature of colleague Karen Badon during 2009 Safety and Health Day activities Oct. 22. Safety Day activities included speakers, informational sessions and a number of displays on safety and health issues. Astronaut Dominic Gorie also visited the south Mississippi rocket engine testing facility during the day to address employees and present several Silver Snoopy awards for outstanding contributions to flight safety and mission success. The activities were part of an ongoing safety and health emphasis at Stennis.

  15. Climate Prediction Center (CPC) U.S. Pan Evaporation Observations

    National Oceanic and Atmospheric Administration, Department of Commerce — Observational reports of daily pan evaporation (1200 UTC to 1200 UTC) are made by members of the NWS Cooperative Network (COOP) or supplemental networks of NOAA's...

  16. Islam Observed: the Case of Contemporary Malaysia

    Metzger, Laurent

    1998-01-01

    The phenomenon of the rise of Islam in Malaysia does not attract much attention of observers when compared with the same phenomenon in the countries of the Middle East, North Africa, Central or South Asia. This paper attempted to review comprehensively the development of Islam in Malaysia since obtaining its independence from Britain in August 1957.Copyright (c) 2014 by SDI. All right reserved.DOI: 10.15408/sdi.v5i2.753

  17. Image changes of the cases with neuroblastoma observed without therapy

    Takeuchi, Maho; Aida, Noriko

    1999-01-01

    Fifteen cases (10 males and 5 females) of neuroblastoma diagnosed by mass screening from November 1993 to October 1997, were observed without therapy. The mean age was 7.9 months. There were tumors in para-aortic area in 4 cases, in adrenal parts in 7 cases, in mediastinum in 3 cases. The other case had tumors in mediastinum and adrenal parts, bilaterally. The observation was executed by the ultrasonography in cases with the abdominal tumor and by MRI in cases with the mediastinal tumor. CT, MRI and US were performed in the first examination by radiologist. MIBG scintigraphy was used mainly for the detection of distant metastases. Imaging was performed at every one or two months in the beginning of observation, and at every three or four months afterwards. Tumors reduced in 9 cases, unchanged in 1 case and increased in 5 cases (8 tumors). The change of tumor size could be evaluated accurately, but the prediction of benignity or malignancy was difficult. Pathological findings were obtained from 5 cases who underwent surgical resection. Four cases had increased tumor. Two of them had benign neuroblastoma or ganglioma, and 2 cases had malignant neuroblastoma of low differentiation. One case with decreased tumor had neuroblastoma and became benign. (K.H.)

  18. Inside the Black Box: The Case Review Process of an Elder Abuse Forensic Center.

    Navarro, Adria E; Wysong, Julia; DeLiema, Marguerite; Schwartz, Elizabeth L; Nichol, Michael B; Wilber, Kathleen H

    2016-08-01

    Preliminary evidence suggests that elder abuse forensic centers improve victim welfare by increasing necessary prosecutions and conservatorships and reducing the recurrence of protective service referrals. Center team members gather information and make decisions designed to protect clients and their assets, yet the collective process of how these case reviews are conducted remains unexamined. The purpose of this study is to present a model describing the interprofessional approach of investigation and response to financial exploitation (FE), a frequent and complex type of abuse of vulnerable adults. To develop an understanding of the case review process at the Los Angeles County Elder Abuse Forensic Center (Center), a quasi-Delphi field study approach was used involving direct observations of meetings, surveying team members, and review from the Center's Advisory Council. The goal of this iterative analysis was to understand the case review process for suspected FE in Los Angeles County. A process map of key forensic center elements was developed that may be useful for replication in other settings. The process map includes: (a) multidisciplinary data collection, (b) key decisions for consideration, and (c) strategic actions utilized by an interprofessional team focused on elder justice. Elder justice relies on a complex system of providers. Elder abuse forensic centers provide a process designed to efficiently address client safety, client welfare, and protection of assets. Study findings provide a process map that may help other communities replicate an established multidisciplinary team, one experienced with justice system outcomes designed to protect FE victims. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. A New Method to Directly Observe Tuberculosis Treatment: Skype Observed Therapy, a Patient-Centered Approach.

    Buchman, Tavora; Cabello, Celina

    Tuberculosis (TB) treatment completion is in part determined by patient's adherence to long-term drug regimens. To best ensure compliance, directly observed therapy (DOT) is considered the standard of practice. Nassau County Department of Health TB Control is responsible for providing DOT to patients with TB. Tuberculosis Control sought to use and evaluate Skype Observed Therapy (SOT) as an alternative to DOT for eligible patients. The evaluation included analysis of patient's acceptance and adherence to drug regimen using SOT. Tuberculosis Control assessed staff efficiency and cost savings for this program. Percentages of SOT of patients and successful SOT visits, mileage, and travel time savings. Twenty percent of the caseload used SOT and 100% of patients who were eligible opted in. Average SOT success was 79%. Total mileage savings and time saved were $9,929.07 and 614 hours. Because SOT saves cost and time and is a suitable alternative to DOT for patients, it should be considered as part of new policies and practices in TB control programs.

  20. Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus.

    Morgan, Sonya J; Pullon, Susan R H; Macdonald, Lindsay M; McKinlay, Eileen M; Gray, Ben V

    2017-06-01

    Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin's 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.

  1. Critical hand ischemia treatment via orbital atherectomy-A single center observational retrospective analysis.

    Bahro, Abdul; Igyarto, Zsuzsanna; Martinsen, Brad

    2017-03-01

    Critical hand ischemia (CHI) can be devastating and may result in amputation. Distal vessel calcification has been shown to be a major factor in causing CHI. Atherectomy in the upper extremities is not typically considered due to the small anatomy; however, the Diamondback 360° Peripheral Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc.) can access treatment areas with a reference vessel diameter of 1.5mm. A retrospective, observational, single center (Merit Health Center, Jackson, MS) analysis of 11 CHI patients with calcific disease of the radial artery treated with orbital atherectomy (OAS) was completed. Demographics and procedural to 30-day outcomes were assessed. All patients had good blood flow to the hand after intervention and none experienced complications during or immediately post-procedure. At 30-days the freedom from revascularization and amputation was 100%, and all the wounds were healed. The following important principles were followed during the use of OAS for CHI: (1) ACT was therapeutic (~250s); (2) Gentle wire manipulation; (3) Utilization of a small OAS crown (1.25mm); (4) Aggressive vasodilator use-given through the exchange catheter; (5) Angioplasty balloon was matched to the size of the vessel and long and low pressure inflations were completed. Critical hand ischemia can be treated with endovascular techniques. Obtaining good outflow to the fingers is critical for wound healing and preventing amputation. Orbital atherectomy is a useful tool in preparing vessels for balloon angioplasty; particularly in cases where calcification is present. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Tuberculosis in Sulaimaniyah, Iraqi Kurdistan: A Detailed Analysis of Cases Registered in Treatment Centers.

    Karadakhy, Kamaran; Othman, Nasih; Ibrahimm, Faredun; Saeed, Akam Ali; Amin, Ari Abdul-Adheem Hama

    2016-01-01

    Tuberculosis (TB) remains a major public health problem especially in low and middle-income countries. The current study was undertaken to estimate the incidence of the disease and describe its epidemiological characteristics in Iraqi Kurdistan. A retrospective study was carried out on cases registered in the directly observed treatment-short course (DOTS) centers in Sulaimaniyah province. Information was collected from the summary reports of all cases registered in 2010 and detailed information was obtained from 307 cases in the main center. During 2010, a total of 530 new and relapsed cases were registered in the DOTS centers amounting to an annual incidence of 31 per 100,000. Over 73% of cases were pulmonary TB and 45% of all cases had positive smear. Most common symptoms were cough (58%), sweating (49%) and fever (48). Almost 43% of patients were diagnosed by direct swab examination, 30% by biopsy and 23% through clinical and radiologic examination. In relation to outcome, 89% of patients were treated successfully, 7% died and 3% defaulted. Mortality rate was 8% in pulmonary infection and 4% in extrapulmonary infection. Old age (65 years and over) was significantly associated with higher odds of death compared to people aged 34 years and younger (OR 6.7, 95% CI 1.3-36.1, P=0.03). The incidence of TB is still high in the Iraqi Kurdistan. The DOTS has been successful in treating the majority of cases but there are areas needing improvement especially record-keeping and patient follow-up during and after treatment.

  3. Observations of Undergraduate Geoscience Instruction in the US: Measuring Student Centered Teaching

    Teasdale, R.; Manduca, C. A.; Mcconnell, D. A.; Bartley, J. K.; Bruckner, M. Z.; Farthing, D.; Iverson, E. A. R.; Viskupic, K. M.

    2014-12-01

    The Reformed Teaching Observation Protocol (RTOP; Swada, et al., 2002) has been used by a trained team of On the Cutting Edge (CE) observers to characterize the degree of student-centered teaching in US college and university geoscience classrooms. Total RTOP scores are derived from scores on 25 rubric items used to characterize teaching practices in categories of lesson design, content delivery, student-instructor and student-student interactions. More than 200 classroom observations have been completed by the RTOP team in undergraduate courses at a variety of US institution types (e.g., community colleges, research universities). A balanced mix of early career, mid-career, and veteran faculty are included, and the study examines class sizes ranging from small (80 students). Observations are limited to one class session and do not include laboratories or field activities. Data include RTOP scores determined by a trained observer during the classroom observation and an online survey in which the observed instructors report on their teaching practices. RTOP scores indicate that the observed geoscience classes feature varying degrees of student-centered teaching, with 30% of observed classes categorized as teacher-centered (RTOP scores ≤30), 45% of observed classes categorized as transitional classrooms (RTOP scores 31-49) and 25% are student-centered (RTOP scores ≥ 50). Instructor self-report survey data and RTOP scores indicate that geoscience faculty who have participated in one or more CE professional development event and use the CE website have an average RTOP score of 49, which is significantly higher (> 15 points) than the average score of faculty who have not participated in CE events and have not used the website. Approximately 60% of student-centered classes (those with high RTOP scores) use some traditional lecture nearly every day, but are also are likely to include an in-class activity or group discussion (e.g. Think-Pair-Share). More than 50% of

  4. [Poisoning with Jatropha curcas: 24 cases reported to Paris and Marseille Poisons Centers].

    Langrand, J; Médernach, C; Schmitt, C; Blanc-Brisset, I; Villa, A F; de Haro, L; Garnier, R

    2015-03-01

    Jatropha curcas L. is an inedible plant belonging to the Euphorbiaceae family that is growing in subtropical zones of all continents. We report a series of 24 cases of poisoning with J. curcas seeds or fruits reported to poison centers in Paris and Marseille between December 2000 and June 2014. Fifteen adults and 9 children ingested J. curcas seeds or fruits. All patients experienced gastrointestinal disorders, within the first hours following ingestion: nausea, vomiting, diarrhea and abdominal pain. Laboratory investigations performed in 10 patients revealed minor abnormalities: CK elevation (8 cases), dehydration (5 cases) with moderate elevation of serum creatinine levels (3 cases), and mildly increased serum bilirubin (8 cases). Complete remission of all clinical signs was observed within 48 hours in the 20 cases for which the outcome was known. Previously published cases of J. curcas poisoning were very similar to ours: As in our series, gastrointestinal disorders were always present. They were sometimes associated with neurological or cardiovascular signs, and hepatic or renal disorders; these were generally interpreted as complications of severe gastroenteritis, although direct toxic effects could not be formally excluded. In most cases, simple supportive measures were sufficient to ensure complete recovery within 24-48 hours. J Curcas poisoning incidence is certainly increasing because the plant is cultivated to produce biodiesel and is now largely present in most subtropical countries. As a consequence, local health professionals should be informed of the toxic properties of this plant.

  5. Patient-centered innovation in health care organizations: a conceptual framework and case study application.

    Hernandez, Susan E; Conrad, Douglas A; Marcus-Smith, Miriam S; Reed, Peter; Watts, Carolyn

    2013-01-01

    Patient-centered innovation is spreading at the federal and state levels. A conceptual framework can help frame real-world examples and extract systematic learning from an array of innovative applications currently underway. The statutory, economic, and political environment in Washington State offers a special contextual laboratory for observing the interplay of these factors. We propose a framework for understanding the process of initiating patient-centered innovations-particularly innovations addressing patient-centered goals of improved access, continuity, communication and coordination, cultural competency, and family- and person-focused care over time. The framework to a case study of a provider organization in Washington State actively engaged in such innovations was applied in this article. We conducted a selective review of peer-reviewed evidence and theory regarding determinants of organizational change. On the basis of the literature review and the particular examples of patient-centric innovation, we developed a conceptual framework. Semistructured key informant interviews were conducted to illustrate the framework with concrete examples of patient-centered innovation. The primary determinants of initiating patient-centered innovation are (a) effective leadership, with the necessary technical and professional expertise and creative skills; (b) strong internal and external motivation to change; (c) clear and internally consistent organizational mission; (d) aligned organizational strategy; (e) robust organizational capability; and (f) continuous feedback and organizational learning. The internal hierarchy of actors is important in shaping patient-centered innovation. External financial incentives and government regulations also significantly shape innovation. Patient-centered care innovation is a complex process. A general framework that could help managers and executives organize their thoughts around innovation within their organization is presented.

  6. Early failure analysis of machining centers: a case study

    Wang Yiqiang; Jia Yazhou; Jiang Weiwei

    2001-01-01

    To eliminate the early failures and improve the reliability, nine ex-factory machining centers are traced under field conditions in workshops. Their early failure information throughout the ex-factory run-in test is collected. The field early failure database is constructed based on the collection of field early failure data and the codification of data. Early failure mode and effects analysis is performed to indicate the weak subsystem of a machining center or the troublemaker. The distribution of the time between early failures is analyzed and the optimal ex-factory run-in test time for machining center that may expose sufficiently the early failures and cost minimum is discussed. Suggestions how to arrange ex-factory run-in test and how to take actions to reduce early failures for machining center is proposed

  7. TEV GAMMA-RAY OBSERVATIONS OF THE GALACTIC CENTER RIDGE BY VERITAS

    Archer, A.; Buckley, J. H.; Bugaev, V. [Department of Physics, Washington University, St. Louis, MO 63130 (United States); Benbow, W.; Cerruti, M. [Fred Lawrence Whipple Observatory, Harvard-Smithsonian Center for Astrophysics, Amado, AZ 85645 (United States); Bird, R.; Collins-Hughes, E. [School of Physics, University College Dublin, Belfield, Dublin 4 (Ireland); Buchovecky, M. [Department of Physics and Astronomy, University of California, Los Angeles, CA 90095 (United States); Byrum, K. [Argonne National Laboratory, 9700 S. Cass Avenue, Argonne, IL 60439 (United States); Cardenzana, J. V; Eisch, J. D. [Department of Physics and Astronomy, Iowa State University, Ames, IA 50011 (United States); Chen, X. [Institute of Physics and Astronomy, University of Potsdam, D-14476 Potsdam-Golm (Germany); Ciupik, L. [Astronomy Department, Adler Planetarium and Astronomy Museum, Chicago, IL 60605 (United States); Connolly, M. P. [School of Physics, National University of Ireland Galway, University Road, Galway (Ireland); Falcone, A. [Department of Astronomy and Astrophysics, 525 Davey Lab, Pennsylvania State University, University Park, PA 16802 (United States); Feng, Q.; Finley, J. P. [Department of Physics and Astronomy, Purdue University, West Lafayette, IN 47907 (United States); Fleischhack, H. [DESY, Platanenallee 6, D-15738 Zeuthen (Germany); Flinders, A. [Department of Physics and Astronomy, University of Utah, Salt Lake City, UT 84112 (United States); Fortson, L., E-mail: asmith44@umd.edu [School of Physics and Astronomy, University of Minnesota, Minneapolis, MN 55455 (United States); and others

    2016-04-20

    The Galactic Center ridge has been observed extensively in the past by both GeV and TeV gamma-ray instruments revealing a wealth of structure, including a diffuse component and the point sources G0.9+0.1 (a composite supernova remnant) and Sgr A* (believed to be associated with the supermassive black hole located at the center of our Galaxy). Previous very high energy (VHE) gamma-ray observations with the H.E.S.S. experiment have also detected an extended TeV gamma-ray component along the Galactic plane in the >300 GeV gamma-ray regime. Here we report on observations of the Galactic Center ridge from 2010 to 2014 by the VERITAS telescope array in the >2 TeV energy range. From these observations we (1) provide improved measurements of the differential energy spectrum for Sgr A* in the >2 TeV gamma-ray regime, (2) provide a detection in the >2 TeV gamma-ray emission from the composite SNR G0.9+0.1 and an improved determination of its multi-TeV gamma-ray energy spectrum, and (3) report on the detection of VER J1746-289, a localized enhancement of >2 TeV gamma-ray emission along the Galactic plane.

  8. Observing the effect of a policy: a maintenance case

    Rijsdijk, Chris; Tinga, Tiedo

    2016-01-01

    Purpose – The purpose of this paper is to show that maintenance performance is potentially better predictable from recording routines. Design/methodology/approach – An attempt is made to observe an effect of a policy. Maintenance cases seem exceptional because of the efficiently obtainable evidence

  9. ADVANCED COMPOSITES TECHNOLOGY CASE STUDY AT NASA LANGLEY RESEARCH CENTER

    This report summarizes work conducted at the National Aeronautics and Space Administration's Langley Research Center (NASA-LaRC) in Hampton, VA, under the U.S. Environmental Protection Agency’s (EPA) Waste Reduction Evaluations at Federal Sites (WREAFS) Program. Support for...

  10. The IRIS Data Management Center: Enabling Access to Observational Time Series Spanning Decades

    Ahern, T.; Benson, R.; Trabant, C.

    2009-04-01

    The Incorporated Research Institutions for Seismology (IRIS) is funded by the National Science Foundation (NSF) to operate the facilities to generate, archive, and distribute seismological data to research communities in the United States and internationally. The IRIS Data Management System (DMS) is responsible for the ingestion, archiving, curation and distribution of these data. The IRIS Data Management Center (DMC) manages data from more than 100 permanent seismic networks, hundreds of temporary seismic deployments as well as data from other geophysical observing networks such as magnetotelluric sensors, ocean bottom sensors, superconducting gravimeters, strainmeters, surface meteorological measurements, and in-situ atmospheric pressure measurements. The IRIS DMC has data from more than 20 different types of sensors. The IRIS DMC manages approximately 100 terabytes of primary observational data. These data are archived in multiple distributed storage systems that insure data availability independent of any single catastrophic failure. Storage systems include both RAID systems of greater than 100 terabytes as well as robotic tape robots of petabyte capacity. IRIS performs routine transcription of the data to new media and storage systems to insure the long-term viability of the scientific data. IRIS adheres to the OAIS Data Preservation Model in most cases. The IRIS data model requires the availability of metadata describing the characteristics and geographic location of sensors before data can be fully archived. IRIS works with the International Federation of Digital Seismographic Networks (FDSN) in the definition and evolution of the metadata. The metadata insures that the data remain useful to both current and future generations of earth scientists. Curation of the metadata and time series is one of the most important activities at the IRIS DMC. Data analysts and an automated quality assurance system monitor the quality of the incoming data. This insures data

  11. Case Descriptions and Observations About Cutis Marmorata From Hypobaric Decompressions

    Conkin, Johnny; Pilmanis, Andrew A.; Webb, James T.

    2002-01-01

    There is disagreement about the pathophysiology, classification, and treatment of cutis marmorata (CM), so there is disagreement about the disposition and medical status of a person that had CM. CM is rare, associated with stressful decompressions, and may be associated with serious signs and symptoms of decompression sickness (DCS). CM presents as purple or bluish-red skin mottling, often in the pectoral region, shoulders, chest, or upper abdomen. It is unethical to induce CM in humans so all information comes from retrospective analysis of case reports, or from animal models. A literature search, seven recent case reports from the Johnson Space Center and Brooks Air Force Base Hypobaric DCS Databases, interviews with DCS treatment experts, and responses to surveys provided the factual information used to arrive at our conclusions and recommendations. The "weight of evidence" indicates that CM is a local, not centrally mediated or systemic response to bubbles. It is unclear whether obstruction of arterial or venous blood flow is the primary insult since the lesion is reported under either condition. Any neurological or cardiovascular involvements are coincidental, developing along the same time course. The skin could be the source of the bubbles due to its mass, the associated layer of fat, and the variable nature of skin blood flow. CM should not be categorized as Type II DCS, should be included with other skin manifestations in a category called cutaneous DCS, and hyperbaric treatment is only needed if ground level oxygen is ineffective in the case of altitude-induced CM.

  12. Congenital Heart Surgery Case Mix Across North American Centers and Impact on Performance Assessment.

    Pasquali, Sara K; Wallace, Amelia S; Gaynor, J William; Jacobs, Marshall L; O'Brien, Sean M; Hill, Kevin D; Gaies, Michael G; Romano, Jennifer C; Shahian, David M; Mayer, John E; Jacobs, Jeffrey P

    2016-11-01

    Performance assessment in congenital heart surgery is challenging due to the wide heterogeneity of disease. We describe current case mix across centers, evaluate methodology inclusive of all cardiac operations versus the more homogeneous subset of Society of Thoracic Surgeons benchmark operations, and describe implications regarding performance assessment. Centers (n = 119) participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 through 2014) were included. Index operation type and frequency across centers were described. Center performance (risk-adjusted operative mortality) was evaluated and classified when including the benchmark versus all eligible operations. Overall, 207 types of operations were performed during the study period (112,140 total cases). Few operations were performed across all centers; only 25% were performed at least once by 75% or more of centers. There was 7.9-fold variation across centers in the proportion of total cases comprising high-complexity cases (STAT 5). In contrast, the benchmark operations made up 36% of cases, and all but 2 were performed by at least 90% of centers. When evaluating performance based on benchmark versus all operations, 15% of centers changed performance classification; 85% remained unchanged. Benchmark versus all operation methodology was associated with lower power, with 35% versus 78% of centers meeting sample size thresholds. There is wide variation in congenital heart surgery case mix across centers. Metrics based on benchmark versus all operations are associated with strengths (less heterogeneity) and weaknesses (lower power), and lead to differing performance classification for some centers. These findings have implications for ongoing efforts to optimize performance assessment, including choice of target population and appropriate interpretation of reported metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. High Temporal Resolution Tropospheric Wind Profile Observations at NASA Kennedy Space Center During Hurricane Irma

    Decker, Ryan K.; Barbre, Robert E., Jr.; Huddleston, Lisa; Brauer, Thomas; Wilfong, Timothy

    2018-01-01

    The NASA Kennedy Space Center (KSC) operates a 48-MHz Tropospheric/Stratospheric Doppler Radar Wind Profiler (TDRWP) on a continual basis generating wind profiles between 2-19 km in the support of space launch vehicle operations. A benefit of the continual operability of the system is the ability to provide unique observations of severe weather events such as hurricanes. Over the past two Atlantic Hurricane seasons the TDRWP has made high temporal resolution wind profile observations of Hurricane Irma in 2017 and Hurricane Matthew in 2016. Hurricane Irma was responsible for power outages to approximately 2/3 of Florida's population during its movement over the state(Stein,2017). An overview of the TDRWP system configuration, brief summary of Hurricanes Irma and Matthew storm track in proximity to KSC, characteristics of the tropospheric wind observations from the TDRWP during both events, and discussion of the dissemination of TDRWP data during the event will be presented.

  14. Model of Emergency and Observation Nursing Services at the Community Health Center in East Java

    Dwi Ananto Wibrata

    2017-07-01

    Full Text Available Public health centers as the spearhead of health services, also provide 'emergency and observation' nursing services, due to the high number of accidents in East Java. The purpose of this study was to develop the nurse's performance model in providing 'emergency and obeservation' nursing services at Puskesgadarsi ('Emergency and Observation' Community Health Center in East Java, using cross sectional design. The subjects of 120 nurses were selected by multi stage sampling technique. Data were collected through questionnaires and FGDs, and then analyzed using structural equation modeling to produce an model of ‘emergency and observation’ nursing service for nurses at Puskesgadarsi. Components of the model were reinforcing factors, personal factors, cognition factors, affection factors, commitment, interpersonal, reinforcement and nurse performance. Nurses can use this model in providing nursing services with due regard to their knowledge and skills, facilities and infrastructure, as well as interaction and self-reinforcement, so as to be able to perform nursing services 'emergency and observation' well.

  15. STATISTICAL ANALYSIS OF SPORT MOVEMENT OBSERVATIONS: THE CASE OF ORIENTEERING

    K. Amouzandeh

    2017-09-01

    Full Text Available Study of movement observations is becoming more popular in several applications. Particularly, analyzing sport movement time series has been considered as a demanding area. However, most of the attempts made on analyzing movement sport data have focused on spatial aspects of movement to extract some movement characteristics, such as spatial patterns and similarities. This paper proposes statistical analysis of sport movement observations, which refers to analyzing changes in the spatial movement attributes (e.g. distance, altitude and slope and non-spatial movement attributes (e.g. speed and heart rate of athletes. As the case study, an example dataset of movement observations acquired during the “orienteering” sport is presented and statistically analyzed.

  16. Statistical Analysis of Sport Movement Observations: the Case of Orienteering

    Amouzandeh, K.; Karimipour, F.

    2017-09-01

    Study of movement observations is becoming more popular in several applications. Particularly, analyzing sport movement time series has been considered as a demanding area. However, most of the attempts made on analyzing movement sport data have focused on spatial aspects of movement to extract some movement characteristics, such as spatial patterns and similarities. This paper proposes statistical analysis of sport movement observations, which refers to analyzing changes in the spatial movement attributes (e.g. distance, altitude and slope) and non-spatial movement attributes (e.g. speed and heart rate) of athletes. As the case study, an example dataset of movement observations acquired during the "orienteering" sport is presented and statistically analyzed.

  17. Hematological observations on two cases of acute radiation syndrome

    Jiang Benrong; Wang Guilin; Huang Shimin

    1990-01-01

    The hematological changes of two cases of acute radiation syndrome were observed. The physical doses of patients Liang and Yan were 3.5 Gy and 2.6 Gy respectively. According to the changes in WBC and platelet counts and the absolute count of lymphocytes and in comparison with the hematological data of the victims of Y-12 accident in USA in 1958 and those of previous accidents in China, Liang suffered from a moderate or moderate to severe degree, and Yan suffered from a moderate or moderate mild degree of hemopoietic form of acute radiation syndrome. This estimation was consistent with their clinical course and physical doses. Some blood cells appeared in the cytoplasm of megakaryocytes in bone marrow smears of those two cases. The mechanism of this phenomenon is discussed and its clinical significance remains to be studied

  18. Reliability centered maintenance : a case study of railway transit maintenance to achieve optimal performance.

    2010-12-01

    The purpose of this qualitative case study was to identify the types of obstacles and patterns experienced by a single heavy rail transit agency located in North America that embedded a Reliability Centered Maintenance (RCM) Process. The outcome of t...

  19. Case Series of Synthetic Cannabinoid Intoxication from One Toxicology Center

    Kenneth D. Katz

    2016-05-01

    Full Text Available Synthetic cannabinoid use has risen at alarming rates. This case series describes 11 patients exposed to the synthetic cannabinoid, MAB-CHMINACA who presented to an emergency department with life-threatening toxicity including obtundation, severe agitation, seizures and death. All patients required sedatives for agitation, nine required endotracheal intubation, three experienced seizures, and one developed hyperthermia. One developed anoxic brain injury, rhabdomyolysis and died. A significant number were pediatric patients. The mainstay of treatment was aggressive sedation and respiratory support. Synthetic cannabinoids pose a major public health risk. Emergency physicians must be aware of their clinical presentation, diagnosis and treatment.

  20. Mycetoma: experience of 482 cases in a single center in Mexico.

    Alexandro Bonifaz

    2014-08-01

    Full Text Available Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013. A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11% were actinomycetomas and 38 cases (7.88% were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years. The main affected localization was lower and upper limbs (70.74% and 14.52% respectively. Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported. The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%. Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21% and Actinomadura madurae (8.7%; meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

  1. Exploring interprofessional, interagency multimorbidity care: case study based observational research

    McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

    2017-01-01

    Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID

  2. Crop Production for Advanced Life Support Systems - Observations From the Kennedy Space Center Breadboard Project

    Wheeler, R. M.; Sager, J. C.; Prince, R. P.; Knott, W. M.; Mackowiak, C. L.; Stutte, G. W.; Yorio, N. C.; Ruffe, L. M.; Peterson, B. V.; Goins, G. D.

    2003-01-01

    The use of plants for bioregenerative life support for space missions was first studied by the US Air Force in the 1950s and 1960s. Extensive testing was also conducted from the 1960s through the 1980s by Russian researchers located at the Institute of Biophysics in Krasnoyarsk, Siberia, and the Institute for Biomedical Problems in Moscow. NASA initiated bioregenerative research in the 1960s (e.g., Hydrogenomonas) but this research did not include testing with plants until about 1980, with the start of the Controlled Ecological Life Support System (CELSS) Program. The NASA CELSS research was carried out at universities, private corporations, and NASA field centers, including Kennedy Space Center (KSC). The project at KSC began in 1985 and was called the CELSS Breadboard Project to indicate the capability for plugging in and testing various life support technologies; this name has since been dropped but bioregenerative testing at KSC has continued to the present under the NASA s Advanced Life Support (ALS) Program. A primary objective of the KSC testing was to conduct pre-integration tests with plants (crops) in a large, atmospherically closed test chamber called the Biomass Production Chamber (BPC). Test protocols for the BPC were based on observations and growing procedures developed by university investigators, as well as procedures developed in plant growth chamber studies at KSC. Growth chamber studies to support BPC testing focused on plant responses to different carbon dioxide (CO2) concentrations, different spectral qualities from various electric lamps, and nutrient film hydroponic culture techniques.

  3. Rhabdomyolysis in Ebola Virus Disease. Results of an Observational Study in a Treatment Center in Guinea.

    Cournac, Jean Marie; Karkowski, Ludovic; Bordes, Julien; Aletti, Marc; Duron, Sandrine; Janvier, Frédéric; Foissaud, Vincent; Savini, Hélène; de Greslan, Thierry; Rousseau, Claire; Billhot, Magali; Gagnon, Nicolas; Mac Nab, Christine; Dubrous, Philippe; Moroge, Sophie; Broto, Helene; Cotte, Jean; Maugey, Nancy; Cordier, Pierre-Yves; Sagui, Emmanuel; Merens, Audrey; Rapp, Christophe; Quentin, Benoit; Granier, Hervé; Carmoi, Thierry; Cellarier, Gilles

    2016-01-01

    The pathogenesis of Ebola virus disease (EVD) remains unclear. The sporadic nature of Ebola outbreaks and their occurrence in resource-limited settings have precluded the acquisition of extensive clinical and laboratory data. Rhabdomyolysis during EVD has been suggested to occur in previous studies showing increased aspartate aminotransferase-alanine aminotransferase ratios, but, to date, has not been confirmed with creatine kinase (CK) assays. We performed an observational study of 38 patients admitted to an Ebola treatment center from January to April 2015. CK values from patients with confirmed EVD were compared with those in patients without confirmed EVD. A panel of other analyses were also performed. In patients with EVD, characteristics were compared between survivors and nonsurvivors. High levels of CK were more frequent in patients with EVD than in those without (P = .002), and rhabdomyolysis was more frequent (59% vs 19%, respectively; P = .03). CK levels >5000 U/L were observed in 36% of patients with EVD. Also in patients with EVD, fatal outcome was significantly associated with higher creatinine and bilirubin levels, international normalized ratio, and viral load. Rhabdomyolysis is a frequent disorder in EVD and seems to be more common than in other viral infections. It may contribute to the renal failure observed in nonsurviving patients. More studies are needed to determine the impact of rhabdomyolysis on EVD outcome. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  4. Cosmological evolution of supermassive black holes in galactic centers unveiled by hard X-ray observations.

    Ueda, Yoshihiro

    2015-01-01

    We review the current understanding of the cosmological evolution of supermassive black holes in galactic centers elucidated by X-ray surveys of active galactic nuclei (AGNs). Hard X-ray observations at energies above 2 keV are the most efficient and complete tools to find "obscured" AGNs, which are dominant populations among all AGNs. Combinations of surveys with various flux limits and survey area have enabled us to determine the space number density and obscuration properties of AGNs as a function of luminosity and redshift. The results have essentially solved the origin of the X-ray background in the energy band below ∼10 keV. The downsizing (or anti-hierarchical) evolution that more luminous AGNs have the space-density peak at higher redshifts has been discovered, challenging theories of galaxy and black hole formation. Finally, we summarize unresolved issues on AGN evolution and prospects for future X-ray missions.

  5. Observations of the galactic center and search for exotic signals with H.E.S.S

    Vivier, M.

    2009-06-01

    Very high energy γ-ray astronomy is a new and young physics field which aims to study the origin of cosmic rays and their acceleration process inside various astrophysical objects such as pulsars, black holes or supernovae remnants. This is also a promising way to search for exotic high energy phenomena and unknown physics. This dissertation deals with three fundamental physics topics closely connected to very high energy γ-ray astronomy: particle acceleration in the vicinity of a supermassive black hole, primordial black holes evaporation, and indirect searches for (dark matter. Each of these topics is studied with data collected by the H.E.S.S (High Energy Stereoscopic System) instrument, an imaging Cherenkov array dedicated for the detection of very high energy γ-rays above 100 GeV. In the first part of the dissertation, we present a rapid overview of the field of very high energy γ-ray astronomy. A precise description of the H.E.S.S detector is then given as well as the data analysis techniques used to derive the results that are subsequently presented. The first subject is related to black hole astrophysics and concerns observations of the Galactic Center region with H.E.S.S. The source of the γ-ray emission discovered in 2004 toward this region is unidentified. A precise determination of the source energy spectrum and variability with new data is reported here. Results are then compared with models of particle acceleration in the vicinity of Sgr A * , the supermassive black hole located at the dynamical center of the Galaxy. In a second subject, the whole data collected with H.E.S.S is used to search for the signature o f primordial black holes evaporation through their emission of bursts of γ-rays. Primordial black holes are exotic objects that might have formed in the early stages of the Universe. As the bulk of the γ-ray emission is likely to originate from a standard astrophysical mechanism, the Galactic Center is not an ideal target for the

  6. KECK OBSERVATIONS OF THE GALACTIC CENTER SOURCE G2: GAS CLOUD OR STAR?

    Phifer, K.; Meyer, L.; Ghez, A. M.; Witzel, G.; Yelda, S.; Boehle, A.; Morris, M. R.; Becklin, E. E. [Department of Physics and Astronomy, University of California, Los Angeles, CA 90095 (United States); Do, T. [Dunlap Institute for Astronomy and Astrophysics, University of Toronto, Toronto, Ontario, M5S 3H4 (Canada); Lu, J. R. [Institute for Astronomy, University of Hawaii, Hilo, HI 96720 (United States); Matthews, K., E-mail: ghez@astro.ucla.edu [Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA 91125 (United States)

    2013-08-10

    We present new observations and analysis of G2-the intriguing red emission-line object which is quickly approaching the Galaxy's central black hole. The observations were obtained with the laser guide star adaptive optics systems on the W. M. Keck I and II telescopes (2006-2012) and include spectroscopy (R {approx} 3600) centered on the hydrogen Br{gamma} line as well as K' (2.1 {mu}m) and L' (3.8 {mu}m) imaging. Analysis of these observations shows the Br{gamma} line emission has a positional offset from the L' continuum. This offset is likely due to background source confusion at L'. We therefore present the first orbital solution derived from Br{gamma} line astrometry, which, when coupled with radial velocity measurements, results in a later time of closest approach (2014.21 {+-} 0.14), closer periastron (130 AU, 1600 R{sub s}), and higher eccentricity (0.9814 {+-} 0.0060) compared to a solution using L' astrometry. It is shown that G2 has no K' counterpart down to K' {approx} 20 mag. G2's L' continuum and the Br{gamma} line emission appears unresolved in almost all epochs, which implies that the bulk of the emission resides in a compact region. The observations altogether suggest that while G2 has a gaseous component that is tidally interacting with the central black hole, there is likely a central star providing the self-gravity necessary to sustain the compact nature of this object.

  7. Massive Young Stellar Objects in the Galactic Center. 1; Spectroscopic Identification from Spitzer/IRS Observations

    An, Deokkeun; Ramirez, Solange V.; Sellgren, Kris; Arendt, Richard G.; Boogert, A. C. Adwin; Robitaille, Thomas P.; Schultheis, Mathias; Cotera, Angela S.; Smith, Howard A.; Stolovy, Susan R.

    2011-01-01

    We present results from our spectroscopic study, using the Infrared Spectrograph (IRS) onboard the Spitzer Space Telescope, designed to identify massive young stellar objects (YSOs) in the Galactic Center (GC). Our sample of 107 YSO candidates was selected based on IRAC colors from the high spatial resolution, high sensitivity Spitzer/IRAC images in the Central Molecular Zone (CMZ), which spans the central approximately 300 pc region of the Milky Way Galaxy. We obtained IRS spectra over 5 micron to 35 micron using both high- and low-resolution IRS modules. We spectroscopically identify massive YSOs by the presence of a 15.4 micron shoulder on the absorption profile of 15 micron CO2 ice, suggestive of CO2 ice mixed with CH30H ice on grains. This 15.4 micron shoulder is clearly observed in 16 sources and possibly observed in an additional 19 sources. We show that 9 massive YSOs also reveal molecular gas-phase absorption from C02, C2H2, and/or HCN, which traces warm and dense gas in YSOs. Our results provide the first spectroscopic census of the massive YSO population in the GC. We fit YSO models to the observed spectral energy distributions and find YSO masses of 8 - 23 solar Mass, which generally agree with the masses derived from observed radio continuum emission. We find that about 50% of photometrically identified YSOs are confirmed with our spectroscopic study. This implies a preliminary star formation rate of approximately 0.07 solar mass/yr at the GC.

  8. SINGLE-PULSE RADIO OBSERVATIONS OF THE GALACTIC CENTER MAGNETAR PSR J1745–2900

    Yan, Zhen; Shen, Zhi-Qiang; Wu, Ya-Jun; Zhao, Rong-Bing; Fan, Qing-Yuan; Hong, Xiao-Yu; Jiang, Dong-Rong; Li, Bin; Liang, Shi-Guang; Ling, Quan-Bao; Liu, Qing-Hui; Qian, Zhi-Han; Zhang, Xiu-Zhong; Zhong, Wei-Ye; Ye, Shu-Hua [Shanghai Astronomical Observatory, Chinese Academy of Sciences, Shanghai 200030 (China); Wu, Xin-Ji [Department of Astronomy, Peking University, Beijing 100871 (China); Manchester, R. N. [CSIRO Astronomy and Space Science, P.O. Box 76, Epping, NSW 1710 (Australia); Weltevrede, P. [Jodrell Bank Centre for Astrophysics, School of Physics and Astronomy, University of Manchester, Manchester M13 9PL (United Kingdom); Yuan, Jian-Ping [Key Laboratory of Radio Astronomy, Chinese Academy of Sciences (China); Lee, Ke-Jia, E-mail: yanzhen@shao.ac.cn [Kavli Institute for Astronomy and Astrophysics, Peking University, Beijing 100871 (China)

    2015-11-20

    In this paper, we report radio observations of the Galactic Center magnetar PSR J1745–2900 at six epochs between 2014 June and October. These observations were carried out using the new Shanghai Tian Ma Radio Telescope at a frequency of 8.6 GHz. Both the flux density and integrated profile of PSR J1745–2900 show dramatic changes from epoch to epoch, showing that the pulsar was in its “erratic” phase. On MJD 56836, the flux density of this magnetar was about 8.7 mJy, which was 10 times larger than that reported at the time of discovery, enabling a single-pulse analysis. The emission is dominated by narrow “spiky” pulses that follow a log-normal distribution in peak flux density. From 1913 pulses, we detected 53 pulses whose peak flux densities are 10 times greater than that of the integrated profile. They are concentrated in pulse phase at the peaks of the integrated profile. The pulse widths at the 50% level of these bright pulses were between 0.°2 and 0.°9, much narrower than that of the integrated profile (∼12°). The observed pulse widths may be limited by interstellar scattering. No clear correlation was found between the widths and peak flux density of these pulses and no evidence was found for subpulse drifting. Relatively strong spiky pulses are also detected in the other five epochs of observation, showing the same properties as those detected in MJD 56836. These strong spiky pulses cannot be classified as “giant” pulses but are more closely related to normal pulse emission.

  9. Observation of Diamond Nitrogen-Vacancy Center Photoluminescence under High Vacuum in a Magneto-Gravitational Trap

    Ji, Peng; Hsu, Jen-Feng; Lewandowski, Charles W.; Dutt, M. V. Gurudev; D'Urso, Brian

    2016-05-01

    We report the observation of photoluminescence from nitrogen-vacancy (NV) centers in diamond nanocrystals levitated in a magneto-gravitational trap. The trap utilizes a combination of strong magnetic field gradients and gravity to confine diamagnetic particles in three dimensions. The well-characterized NV centers in trapped diamond nanocrystals provide an ideal built-in sensor to measure the trap magnetic field and the temperature of the trapped diamond nanocrystal. In the future, the NV center spin state could be coupled to the mechanical motion through magnetic field gradients, enabling in an ideal quantum interface between NV center spin and the mechanical motion. National Science Foundation, Grant No. 1540879.

  10. A Case Study Documenting the Process by Which Biology Instructors Transition from Teacher-Centered to Learner-Centered Teaching

    Marbach-Ad, Gili; Hunt Rietschel, Carly

    2016-01-01

    In this study, we used a case study approach to obtain an in-depth understanding of the change process of two university instructors who were involved with redesigning a biology course. Given the hesitancy of many biology instructors to adopt evidence-based, learner-centered teaching methods, there is a critical need to understand how biology instructors transition from teacher-centered (i.e., lecture-based) instruction to teaching that focuses on the students. Using the innovation-decision model for change, we explored the motivation, decision-making, and reflective processes of the two instructors through two consecutive, large-enrollment biology course offerings. Our data reveal that the change process is somewhat unpredictable, requiring patience and persistence during inevitable challenges that arise for instructors and students. For example, the change process requires instructors to adopt a teacher-facilitator role as opposed to an expert role, to cover fewer course topics in greater depth, and to give students a degree of control over their own learning. Students must adjust to taking responsibility for their own learning, working collaboratively, and relinquishing the anonymity afforded by lecture-based teaching. We suggest implications for instructors wishing to change their teaching and administrators wishing to encourage adoption of learner-centered teaching at their institutions. PMID:27856550

  11. [Pheochromocytoma in 8-year observation at a single endocrinological center in Wroclaw].

    Bednarek-Tupikowska, Grazyna; Bucyk, Barbara; Daroszewski, Jacek; Bidzińska-Speichert, Bozena; Bohdanowicz-Pawlak, Anna; Szymczak, Jadwiga; Bednorz, Włodzimierz; Podgórski, Franciszek; Zareba-Bogdał, Elzbieta; Kuliczkowska-Płaksej, Justyna; Lenarcik, Agnieszka; Filus, Alicja; Kałuzny, Marcin; Kubicka, Eliza; Syrycka, Joanna; Tupikowska, Małgorzata; Lizurej, Oskar; Bolanowski, Marek; Milewicz, Andrzej

    2009-01-01

    Pheochromocytoma is rare tumor with a highly variable clinical presentation. This report provides clinical picture, efficiency of diagnostics and treatment of pheochromocytoma in 8-years in the endocrinological center in Wroclaw. The records of 37 patients with pheochromocytoma were identified, who were treated in 2000-2007 in the Department of Endocrinology, Diabetology and Isotope Treatment in Wroclaw. There were 23 women (age 23-75 year) and 14 men (age 17-74). We studied frequency of clinical signs, usefulness of diagnostic methods and efficacy of treatment. The duration of the clinical history ranged from 2 months to 16 years. The most frequent symptoms were: hypertension paroxysmal and constant, palpitations, headache, sweating and anxiety. The most sensitive diagnostic method was increased concentration of urinary metanephrine in 24-hour urine. Computed tomography was the most widely used method for tumor localization. Adrenal pheochromocytoma was detecting by CT in all patients, predominated in right adrenal, in 1 case in urinary bladder. Surgery caused remission of hypertension in 59%, improvement in 26.8%, and no changes in 13.9% of patients. Malignancy was reported in 2 cases, 1 woman died after surgery. MEN 2A occur in 21.6%. The diagnosis of pheochromocytma is usually made after long duration of the disease. The study confirms that clinical presentation of pheochromocytoma is variable and nonspecific, this finding makes the diagnosis very difficult. The most typical symptom is paroxysmal hypertension, which is present only in 40%, other symptoms are nonspecific. The measurement of 24-hour urinary metanephrines was the best indicator. CT was almost always successful in localizing the tumor. Patients with pheochromocytoma should be consider for other endocrine diseases especially medullary carcinoma, primary hyperparathyroidism and other component of MEN 2A.

  12. Observing principles of medical ethics during family planning services at Tehran urban healthcare centers in 2007

    Saeed Motevallizadeh

    2011-01-01

    Full Text Available Background: Family planning has been defined in the framework of mothers and children plan as one of Primary Healthcare (PHC details. Besides quantity, the quality of services, particularly in terms of ethics, such as observing individuals’ privacy, is of great importance in offering family planning services.Objective: A preliminary study to gather information about the degree of medical ethics offered during family planning services at Tehran urban healthcare centers.Materials and Methods: A questionnaire was designed for study. In the first question regarding informed consent, 47 clients who were advised about various contraception methods were asked whether advantages and disadvantages of the contraceptive methods have been discussed by the service provider. Then a certain rank was measured for either client or method in 2007. Finally, average value of advantage and disadvantage for each method was measured. In questions about autonomy, justice and beneficence, yes/no answers have been expected and measured accordingly.Results: Health care providers have stressed more on the advantages of pills and disadvantages of tubectomy and have paid less attention to advantages of injection ampoules and disadvantages of pills in first time clients. While they have stressed more on the advantages and disadvantages of tubectomy and less attention to advantages of condom and disadvantages of vasectomy in second time clients. Clients divulged their 100% satisfaction in terms of observing turns and free charges services.Observance degree of autonomy was 64.7% and 77.3% for first time and second- time clients respectively.Conclusion: Applying the consultant’s personal viewpoint for selecting a method will breach an informed consent for first and second time clients. System has good consideration to justice and no malfeasance

  13. Adalimumab for maintenance therapy for one year in Crohn's disease: results of a Latin American single-center observational study.

    Kotze, Paulo Gustavo; Abou-Rejaile, Vinícius Rezende; Uiema, Luciana Aparecida; Olandoski, Marcia; Sartor, Maria Cristina; Miranda, Eron Fábio; Kotze, Lorete Maria da Silva; Saad-Hossne, Rogério

    2014-01-01

    Adalimumab is a fully-human antibody that inhibits TNF alpha, with a significant efficacy for long-term maintenance of remission. Studies with this agent in Latin American Crohn's disease patients are scarce. The objective of this study was to outline clinical remission rates after 12 months of adalimumab therapy for Crohn's disease patients. Retrospective, single-center, observational study of a Brazilian case series of Crohn's disease patients under adalimumab therapy. Variables analyzed: demographic data, Montreal classification, concomitant medication, remission rates after 1, 4, 6 and 12 months. Remission was defined as Harvey-Bradshaw Index ≤ 4, and non-responder-imputation and last-observation-carried-forward analysis were used. The influence of infliximab on remission rates was analyzed by Fischer and Chi-square tests (Panalysis. After 12 months, remission on patients with previous infliximab occurred in 69.23% as compared to 94.59% in infliximab-naïve patients (P = 0.033). Adalimumab was effective in maintaining clinical remission after 12 months of therapy, with an adequate safety profile, and was also more effective in infliximab naïve patients.

  14. Dark matter and pulsar model constraints from Galactic Center Fermi-LAT gamma-ray observations

    Gordon, Chris; Macías, Oscar

    2013-10-01

    Employing Fermi-LAT gamma-ray observations, several independent groups have found excess extended gamma-ray emission at the Galactic Center (GC). Both annihilating dark matter (DM) or a population of ˜103 unresolved millisecond pulsars (MSPs) are regarded as well-motivated possible explanations. However, there are significant uncertainties in the diffuse galactic background at the GC. We have performed a revaluation of these two models for the extended gamma-ray source at the GC by accounting for the systematic uncertainties of the Galactic diffuse emission model. We also marginalize over point-source and diffuse background parameters in the region of interest. We show that the excess emission is significantly more extended than a point source. We find that the DM (or pulsar-population) signal is larger than the systematic errors and therefore proceed to determine the sectors of parameter space that provide an acceptable fit to the data. We find that a population of 1000-2000 MSPs with parameters consistent with the average spectral shape of Fermi-LAT measured MSPs is able to fit the GC excess emission. For DM, we find that a pure τ+τ- annihilation channel is not a good fit to the data. But a mixture of τ+τ- and bb¯ with a ⟨σv⟩ of order the thermal relic value and a DM mass of around 20 to 60 GeV provides an adequate fit.

  15. Dark matter and pulsar model constraints from Galactic center Fermi/LAT γ-ray observations

    Gordon, Chris; Macias, Oscar

    2014-05-01

    Employing Fermi/LAT γ-ray observations, several independent groups have found excess extended γ-ray emission at the Galactic center (GC). Both, annihilating dark matter (DM) or a population of ~ 103 unresolved millisecond pulsars (MSPs) are regarded as well motivated possible explanations. However, there is significant uncertainties in the diffuse Galactic background at the GC. We have performed a revaluation of these two models for the extended γ-ray source at the GC by accounting for the systematic uncertainties of the Galactic diffuse emission model. We also marginalize over point source and diffuse background parameters in the region of interest. We show that the excess emission is significantly more extended than a point source. We find that the DM (or pulsar population) signal is larger than the systematic errors and therefore proceed to determine the sectors of parameter space that provide an acceptable fit to the data. We found that a population of several thousand MSPs with parameters consistent with the average spectral shape of Fermi/LAT measured MSPs was able to fit the GC excess emission. For DM, we found that a pure τ+τ- annihilation channel is not a good fit to the data. But a mixture of τ+τ- and bb with a of order the thermal relic value and a DM mass of around 20 to 60 GeV provides an adequate fit.

  16. Observations on the radiochemical control of radiopharmaceuticals at tajoura nuclear research center (TNRC)

    Abuzwida, M.A.; Saad, M.A.; Elmagrahi, H.; Elghanodi, Y.

    1998-01-01

    Production of radioisotopes for the radiopharmaceutical purposes is the main task of Tajoura nuclear center. During the analysis of the 131 I- radioactive solution which was produced using the so-called dry method, the following has been observed : in order to reduce the cost and the time of analytical cycle or time used for the radiochemical purity (RCP), a spot test has been used to indicate the position of the radioactivity in the chromatogram rather than using autoradiographing or the x-ray films. This method was based on the reaction between I 2 and starch to give a blue color at different R f values I 2 is liberated by I - oxidation (H 2 O 2 ) or by IO - 3 reaction with SCN - in the presence of HCl. A simple and fast test for the estimation of the content in the radioactive sample has been elaborated.This method was based on the reduction of Te (IV) or (VI) to Te metal using SnCI 2 in a alkaline media. The detection limit of the elaborated method was found to be 131 I- buffer solution, and 16.0 m S for Na CI saline solution were obtained

  17. DENSITY OF WARM IONIZED GAS NEAR THE GALACTIC CENTER: LOW RADIO FREQUENCY OBSERVATIONS

    Roy, Subhashis

    2013-01-01

    We have observed the Galactic center (GC) region at 0.154 and 0.255 GHz with the Giant Metrewave Radio Telescope. A total of 62 compact likely extragalactic (EG) sources are detected. Their scattering sizes decrease linearly with increasing angular distance from the GC up to about 1°. The apparent scattering sizes of the sources are more than an order of magnitude less than predicted earlier by the NE2001 model of Galactic electron distribution within 359.°5 e is ∼10 cm –3 , which matches the NE2001 model. This model predicts the EG sources to be resolved out from 1.4 GHz interferometric surveys. However, out of 10 EG sources expected in the region, 8 likely EG are present in the 1.4 GHz catalog. Ionized interfaces of dense molecular clouds to the ambient medium are most likely responsible for strong scattering and low radio frequency absorption. However, dense GC clouds traced by CS J = 1-0 emission are found to have a narrow distribution of ∼0.°2 across the Galactic plane. Angular distribution of most EG sources seen through the so-called Hyperstrong Scattering Region are random in b, and typically ∼7 out of 10 sources will not be seen through the dense molecular clouds, which explains why most of them are not scatter broadened at 1.4 GHz

  18. A Case Study Documenting the Process by Which Biology Instructors Transition from Teacher-Centered to Learner-Centered Teaching.

    Marbach-Ad, Gili; Hunt Rietschel, Carly

    2016-01-01

    In this study, we used a case study approach to obtain an in-depth understanding of the change process of two university instructors who were involved with redesigning a biology course. Given the hesitancy of many biology instructors to adopt evidence-based, learner-centered teaching methods, there is a critical need to understand how biology instructors transition from teacher-centered (i.e., lecture-based) instruction to teaching that focuses on the students. Using the innovation-decision model for change, we explored the motivation, decision-making, and reflective processes of the two instructors through two consecutive, large-enrollment biology course offerings. Our data reveal that the change process is somewhat unpredictable, requiring patience and persistence during inevitable challenges that arise for instructors and students. For example, the change process requires instructors to adopt a teacher-facilitator role as opposed to an expert role, to cover fewer course topics in greater depth, and to give students a degree of control over their own learning. Students must adjust to taking responsibility for their own learning, working collaboratively, and relinquishing the anonymity afforded by lecture-based teaching. We suggest implications for instructors wishing to change their teaching and administrators wishing to encourage adoption of learner-centered teaching at their institutions. © 2016 G. Marbach-Ad and C. H. Rietschel. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  19. Angiographic characteristics of hysteromyoma and multi-center observation of short-term curative effects of uterine artery embolization

    Li Guangqi; Wang Zhimin; Zhang Hongxin; Yang Qingfeng; Li Chao; Zhao Siyuan; Yang Kangjian; Zhao Binyu; He Chao; Li Bo; Zhang Xufeng; Peng Jianming; Zhang Longquan; Feng Rongcai

    2010-01-01

    contralateral oblique projection (n=824, 71.6%). The results indicated that contralateral oblique projection was the best exposure position for displaying the opening orifice and traveling route of uterine artery. The hysteromyoma got its blood supply from unilateral uterine artery (n=107) or from bilateral uterine artery (n=1 044). Hysteromyoma was supplied by bilateral dominance in 751 cases (65.3%), presented with bilateral dominance of blood supply, bilateral blood supply but lateral dominance in 284 cases (24.7%) and unilateral blood supply in 116 cases (10.1%). The tumor contrast staining was characterized by markedly thickened and tortuous unilateral or bilateral uterine arteries. In the arterial phase,the tumor vessels were increased, thickened and circuitous,and were formed into a globular vascular net in some cases. In addition, intranidal vessels were increased and disordered, and were aggregated into wool coil-shaped structure, producing so called wool-coil sign. In the parenchymal phase, solitary hysteromyoma body was densely and evenly stained with a sharp contour; multiple hysteromyoma body was stained with clear shape and border. However, hysteromyoma body was not stained clearly in 35 cases (3%). In the venous phase, venous angiography did not show the presence of arterio-venous fistula. B-ultrasonography results demonstrated that at 3, 6 and 12 months after treatment the tumor was shrunk to half size in 351 cases (31%), 691 cases (61%) and 897 cases (78%), respectively. Disappearance of hysteromyoma blood supply with no change in tumor size was seen in 79 cases (6.9%). No improvement was seen in 16 cases (1.4%). Conclusion: Large-size multi-center observation indicates that hysteromyoma is a hypervascular benign tumor. Uterine artery embolization shows good short-term curative effects. The understanding of the vascular anatomical characteristics of uterine artery and the use of proper projection body position can greatly improve the successful rate of super

  20. A comparison of patient-centered and case-mix reimbursement for nursing home care.

    Willemain, T R

    1980-01-01

    The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.

  1. The Earth Resources Observation Systems data center's training technical assistance, and applications research activities

    Sturdevant, J.A.

    1981-01-01

    The Earth Resources Observation Systems (EROS) Data Center (EDO, administered by the U.S. Geological Survey, U.S. Department of the Interior, provides remotely sensed data to the user community and offers a variety of professional services to further the understanding and use of remote sensing technology. EDC reproduces and sells photographic and electronic copies of satellite images of areas throughout the world. Other products include aerial photographs collected by 16 organizations, including the U.S. Geological Survey and the National Aeronautics and Space Administration. Primary users of the remotely sensed data are Federal, State, and municipal government agencies, universities, foreign nations, and private industries. The professional services available at EDC are primarily directed at integrating satellite and aircraft remote sensing technology into the programs of the Department of the Interior and its cooperators. This is accomplished through formal training workshops, user assistance, cooperative demonstration projects, and access to equipment and capabilities in an advanced data analysis laboratory. In addition, other Federal agencies, State and local governments, universities, and the general public can get assistance from the EDC Staff. Since 1973, EDC has contributed to the accelerating growth in development and operational use of remotely sensed data for land resource problems through its role as educator and by conducting basic and applied remote sensing applications research. As remote sensing technology continues to evolve, EDC will continue to respond to the increasing demand for timely information on remote sensing applications. Questions most often asked about EDC's research and training programs include: Who may attend an EDC remote sensing training course? Specifically, what is taught? Who may cooperate with EDC on remote sensing projects? Are interpretation services provided on a service basis? This report attempts to define the goals and

  2. Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods Appraisal of Video Directly Observed Therapy.

    Holzman, Samuel B; Zenilman, Avi; Shah, Maunank

    2018-04-01

    Directly observed therapy (DOT) remains an integral component of treatment support and adherence monitoring in tuberculosis care. In-person DOT is resource intensive and often burdensome for patients. Video DOT (vDOT) has been proposed as an alternative to increase treatment flexibility and better meet patient-specific needs. We conducted a pragmatic, prospective pilot implementation of vDOT at 3 TB clinics in Maryland. A mixed-methods approach was implemented to assess (1) effectiveness, (2) acceptability, and (3) cost. Medication adherence on vDOT was compared with that of in-person DOT. Interviews and surveys were conducted with patients and providers before and after implementation, with framework analysis utilized to extract salient themes. Last, a cost analysis assessed the economic impacts of vDOT implementation across heterogeneous clinic structures. Medication adherence on vDOT was comparable to that of in-person DOT (94% vs 98%, P = .17), with a higher percentage of total treatment doses (inclusive of weekend/holiday self-administration) ultimately observed during the vDOT period (72% vs 66%, P = .03). Video DOT was well received by staff and patients alike, who cited increased treatment flexibility, convenience, and patient privacy. Our cost analysis estimated a savings with vDOT of $1391 per patient for a standard 6-month treatment course. Video DOT is an acceptable and important option for measurement of TB treatment adherence and may allow a higher proportion of prescribed treatment doses to be observed, compared with in-person DOT. Video DOT may be cost-saving and should be considered as a component of individualized, patient-centered case management plans.

  3. Technostress in Libraries and Media Centers: Case Studies and Coping Strategies.

    Hickey, Kate D., Ed.

    1992-01-01

    Discusses technostress--i.e., stress brought on by changes in technology--in libraries and media centers. Case studies are presented that show stress in community college libraries caused by the rapid implementation of new technologies; coping strategies for librarians and media specialists are discussed; and strategies for managers are suggested.…

  4. Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

    Story, Julie A.

    2014-01-01

    The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

  5. A Case Study Using Child-Centered Play Therapy Approach to Treat Enuresis and Encopresis.

    Cuddy-Casey, Maria

    1997-01-01

    Demonstrates an alternative method (nondirective child-centered therapy) in treating enuresis and encopresis resulting from emotional disturbances. Examines various etiologies and approaches to treating these conditions. Provides a case study example. Claims that professionals must differentiate between primary and secondary occurrences of these…

  6. Embodying Authentic Leadership through Popular Education at Highlander Research and Education Center: A Qualitative Case Study

    Glowacki-Dudka, Michelle; Griswold, Wendy

    2016-01-01

    In 2013 and 2014, workshops were held at Highlander Research and Education Center that explored the topics of authentic leadership and popular education. The participants shared their experiences through reflective writing upon completion of the workshops and approximately a year following. These reflections were developed into a case study. This…

  7. Case of pancreatolithiasis. CT observation of calculus formation

    Sasaki, Fumio; Koga, Sukehiko; Takeuchi, Akira (Fujita-Gakuen Univ., School of Medicine, Aichi (Japan))

    1982-11-01

    During 3-year follow-up of a case of pancreatolithiasis localized in the pancreatic head, CT showed sudden new appearance of calculi over an extensive area of the body and tail of the pancreas after acute exacerbation of chronic pancreatitis. This case and the etiology and mechanism of pancreatolithiasis were discussed on the basis of literature.

  8. Rituximab for the therapy of systemic sclerosis: a series of 10 cases in a single center.

    Vilela, Verônica Silva; Maretti, Giselle Baptista; Gama, Lívia Marques da Silva; Costa, Claudia Henrique da; Rufino, Rogério Lopes; Levy, Roger A

    Systemic sclerosis (SSc) is a chronic autoimmune disease with a high morbidity and mortality. Although cyclophosphamide is effective for severe and refractory cases, there is demand for new treatments. The biological treatment with B-cell depletion with rituximab (RTX) has demonstrated efficacy for this demand in open-label studies. This study was conducted with the aim to retrospectively evaluate all patients who used RTX for the treatment of SSc in our center. We retrospectively evaluated medical records of all patients with SSc who used RTX to treat this disease from January 2009 to January 2015. Systemic, cutaneous, and pulmonary involvement data and laboratory results before and six months after the first infusion of RTX were collected. Ten patients received treatment during the study period and were included in this series. All patients had a diffuse form of the disease. Five patients suffered from an early (duration of disease shorter or equal to four years), rapidly progressive disease, and another five received RTX at late stages of the disease. In both groups of patients, stabilization of the pulmonary picture was observed, with a fall in the skin score in those patients with early forms of the disease. Similar to findings in previous studies, RTX was effective in treating early and rapidly progressive forms of SSc. We also found that patients with long-term illness may benefit from the treatment. Copyright © 2016. Published by Elsevier Editora Ltda.

  9. A controlled evaluation of case clinical effect coding by poison center specialists for detection of WMD scenarios.

    Beuhler, Michael C; Wittler, Mary A; Ford, Marsha; Dulaney, Anna R

    2011-08-01

    Many public health entities employ computer-based syndromic surveillance to monitor for aberrations including possible exposures to weapons of mass destruction (WMD). Often, this is done by screening signs and symptoms reported for cases against syndromic definitions. Poison centers (PCs) may offer significant contributions to public health surveillance because of their detailed clinical effect data field coding and real-time data entry. Because improper clinical effect coding may impede syndromic surveillance, it is important to assess this accuracy for PCs. An AAPCC-certified regional PC assessed the accuracy of clinical effect coding by specialists in poison information (SPIs) listening to audio recordings of standard cases. Eighteen different standardized cases were used, consisting of six cyanide, six botulism, and six control cases. Cases were scripted to simulate clinically relevant telephone conversations and converted to audio recordings. Ten SPIs were randomly selected from the center's staff to listen to and code case information from the recorded cases. Kappa scores and the percentage of correctly coding a present clinical effect were calculated for individual clinical effects summed over all test cases along with corresponding 95% confidence intervals. The rate of the case coding by the SPIs triggering the PC's automated botulism and cyanide alerts was also determined. The kappa scores and the percentage of correctly coding a present clinical effect varied depending on the specific clinical effect, with greater accuracy observed for the clinical effects of vomiting and agitation/irritability, and poor accuracy observed for the clinical effects of visual defect and anion gap increase. Lack of correct coding resulted in only 60 and 86% of the cases that met the botulism and cyanide surveillance definitions, respectively, triggering the corresponding alert. There was no difference observed in the percentage of coding a present clinical effect between

  10. Inguinal and anorectal Lymphogranuloma Venereum: a case series from a sexually transmitted disease center in Rome, Italy.

    Latini, Alessandra; Zaccarelli, Mauro; Paglia, Maria Grazia; Donà, Maria Gabriella; Giglio, Amalia; Moretto, Domenico; Vulcano, Antonella; Giuliani, Massimo; Colafigli, Manuela; Ambrifi, Marina; Pimpinelli, Fulvia; Cristaudo, Antonio

    2017-06-02

    Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by L1, L2, L3 serovars of C. trachomatis (CT). Since 2003, LGV cases have been increasing in Europe. Aim of this report is to describe the LGV cases diagnosed in the largest STI center in Rome, Italy, from 2000 to 2016. This report shows that two clinically and epidemiologically different series of cases exist, and that, at present, the ano-rectal LGV represents the clinical variant occurring more frequently among men having sex with men (MSM), particularly those HIV-infected. Ten cases of LGV were observed. Three were diagnosed in 2009 in HIV-negative heterosexuals patients that presented the classical genito-ulcerative form with lymphadenopathy. Seven cases were observed in 2015-2016 in HIV-infected MSM, that presented the rectal variant and L2b serovar infection; 4 of these had been misclassified as a chronic bowel disease. Chlamydia infection was confirmed by CT-specific PCR (ompA gene nested PCR), followed by sequence analysis to identify the serovar. All the patients were treated with doxycycline for 3 weeks, obtaining a complete response with healing of both clinical symptoms and dermatological lesions. Our findings suggest that, in case of persistent rectal symptoms in HIV-infected MSM, LGV should be taken into account and investigated through molecular analyses, in order to achieve a correct diagnosis and management of the patients.

  11. Observations of Circumstellar Thermochemical Equilibrium: The Case of Phosphorus

    Milam, Stefanie N.; Charnley, Steven B.

    2011-01-01

    We will present observations of phosphorus-bearing species in circumstellar envelopes, including carbon- and oxygen-rich shells 1. New models of thermochemical equilibrium chemistry have been developed to interpret, and constrained by these data. These calculations will also be presented and compared to the numerous P-bearing species already observed in evolved stars. Predictions for other viable species will be made for observations with Herschel and ALMA.

  12. Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians.

    Mount-Campbell, Austin F; Rayo, Michael F; OʼBrien, James J; Allen, Theodore T; Patterson, Emily S

    Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.

  13. Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

    Sasnett, Bonita; Harris, Susie T; White, Shelly

    Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

  14. Observations of galactic center for annihilation line at 0.511 MeV

    Jayanthi, U.B.; Martin, I.M.; Braga, J.; Neri, J.A.C.F.; Jardim, M.V.A.; Rao, K.R.

    1983-10-01

    The presence of the 0.511 MeV gamma line emission from galactic center is well-established from various balloon experiments. Recent results in 1980-82 from balloon and satellite experiments show significant decrease in this line intensity. To confirm these results a fly on balloon is performed with a large area sodium iodide detector to measure 0.511 MeV line from galactic center. The preliminary results indicate flux -3 photons cm -2 s -1 . (Author) [pt

  15. Case-Control Studies - An Efficient Observational Study Design

    van Stralen, Karlijn J.; Dekker, Friedo W.; Zoccali, Carmine; Jager, Kitty J.

    2010-01-01

    Case-control studies are an efficient research method for investigating risk factors of a disease. The method involves the comparison of the odds of exposure in a patient group with that of the odds of exposure in a control group. As only a minority of the population is included in the study, less

  16. Observability of Automata Networks: Fixed and Switching Cases.

    Li, Rui; Hong, Yiguang; Wang, Xingyuan

    2018-04-01

    Automata networks are a class of fully discrete dynamical systems, which have received considerable interest in various different areas. This brief addresses the observability of automata networks and switched automata networks in a unified framework, and proposes simple necessary and sufficient conditions for observability. The results are achieved by employing methods from symbolic computation, and are suited for implementation using computer algebra systems. Several examples are presented to demonstrate the application of the results.

  17. INTEGRAL/IBIS observations of the Galactic center region at the epoch of the short Fermi/LAT flare

    Fiocchi, M.; Sanchez-Fernandez, C.; Natalucci, L.

    2011-01-01

    , the second one was selected because the source position was most optimal, i.e., about 6-8 degrees off-axis, the closest to the Galactic center region. The second slot is only a few hours apart from the Swift/XRT observation of SAX J1747.0-2853 (ATEL #3163), during which very bright emission from this source...

  18. Climate Prediction Center (CPC) U.S. Daily Minimum Air Temperature Observations

    National Oceanic and Atmospheric Administration, Department of Commerce — Observational reports of daily air temperature (1200 UTC to 1200 UTC) are made by members of the NWS Automated Surface Observing Systems (ASOS) network; NWS...

  19. Climate Prediction Center (CPC) U.S. Daily Snow Fall Observations

    National Oceanic and Atmospheric Administration, Department of Commerce — Observational reports of daily snow fall (1200 UTC to 1200 UTC) are made by members of the NWS Automated Surface Observing Systems (ASOS) network and NWS Cooperative...

  20. Climate Prediction Center (CPC) U.S. Daily Maximum Air Temperature Observations

    National Oceanic and Atmospheric Administration, Department of Commerce — Observational reports of daily air temperature (1200 UTC to 1200 UTC) are made by members of the NWS Automated Surface Observing Systems (ASOS) network; NWS...

  1. Climate Prediction Center (CPC) U.S. Daily Snow Depth Observations

    National Oceanic and Atmospheric Administration, Department of Commerce — Observational reports of current snow depth (at 1200 UTC) are made by members of the NWS Automated Surface Observing Systems (ASOS) network and NWS Cooperative...

  2. [Several cases of giant epulis observed in West Africa].

    Cantaloube, D; Larroque, G; Ndiaye, R; Rives, J M; Seurat, P

    1987-01-01

    The presenting symptomatology in 9 cases of giant epulis seen in West Africa was constantly difficulties in mastication or even speech, and on some occasions tumefaction of the face. A certain number of factors are involved in the development of these benign tumors, and although inflammation represents the primum movens of this affection, other causes, including some specific to the African continent, must be considered with a view to a pathogenic approach.

  3. Evaluating the Impact of AIRS Observations on Regional Forecasts at the SPoRT Center

    Zavodsky, Bradley

    2011-01-01

    NASA Short-term Prediction Research and Transition (SPoRT) Center collaborates with operational partners of different sizes and operational goals to improve forecasts using targeted projects and data sets. Modeling and DA activities focus on demonstrating utility of NASA data sets and capabilities within operational systems. SPoRT has successfully assimilated the Atmospheric Infrared Sounder (AIRS) radiance and profile data. A collaborative project is underway with the Joint Center for Satellite Data Assimilation (JCSDA) to use AIRS profiles to better understand the impact of AIRS radiances assimilated within Gridpoint Statistical Interpolation (GSI) in hopes of engaging the operational DA community in a reassessment of assimilation methodologies to more effectively assimilate hyperspectral radiances.

  4. Classroom Observation Practice in Career Schools: A Multiple Case Study

    Withers, Marya G.

    2017-01-01

    Post-secondary career school educational leaders are charged with formulating sufficient, ongoing, and effective faculty development programming to ensure the delivery of quality education in their unique trade-expert led institutions. Classroom observations, which include substantive feedback exchanges from trained personnel are well documented…

  5. Reconsidering the popularity of primary health centers in India: a case study from rural Maharashtra.

    Kamat, V R

    1995-07-01

    Most evaluations of India's primary health care (PHC) program have been critical of the ways government primary health centers have been functioning. It has been commonly noted that utilization of health services is poor and community participation in the PHC outreach program low. Additionally, medical officers and health center staff are often accused of being negligent in their duties. In this paper I argue that it is worthwhile examining how a popular primary health center functions in a context marked by a growing demand for Western medicines. Attention is drawn to the ingenious ways in which health personnel respond to client demands and government medicine shortages. The case of a popular primary health center in rural Maharashtra is presented. This health center is both the site of public and private health care. Discussed is the manner in which rural populations in India maximize available health care options given time, cash and transportation constraints. Current thinking about community health financing is considered in light of existing health care utilization patterns, community evaluation of free services, perceptions of entitlement and the likely response of practitioners to such schemes.

  6. Case Study of Ion Beams Observed By Cluster At Perigee

    Sergeev, V.; Sauvaud, J.-A.; Perigee Beam Team

    During substorms the short beams of ions in the keV-to-tens keV energy range are injected into the auroral flux tubes from the magnetotail (sometimes extending up to >100 keV energy) carrying the information on the source distance, scale-size and temporal history of plasma acceleration. We present observations with the CLUSTER crossing inward the auroral zone flux tubes at ~4Re distance near its perigee during the substorm activity on February 14, 2001. The ion beams cover the same region (poleward half) of the auroral oval where the low-energy ions are extracted from the ionosphere, and where the small-scale transient transverse Alfven waves are observed which carry predominantly the downward parallel Poynting flux into the ionosphere. The multiple beams were basically confirmed to be the transient effects, although some effects including the (spatial) velocity filter and the parallel electric fields (im- posed by quasineutrality requirement) may complicate the interpretation. The gener- ation region of ion beams is not limited to most poleward, newly-reconnected flux tubes; the beam generation region could extend across magnetic field inward by as much as >100km (if mapped to the ionosphere). Surprising variety of injection dis- tances observed nearly simultaneously (ranging between >60 Re and ~10 Re) have been inferred when using the full available energy and time resolution, with shorter injection distances be possibly associated with the flow braking process. The beam multiplicity often displays the apparent ~3 min quasiperiodicity inherent to the basic dissipation process, it was not yet explained by any substorm theory.

  7. Optimal health insurance: the case of observable, severe illness.

    Chernew, M E; Encinosa, W E; Hirth, R A

    2000-09-01

    We explore optimal cost-sharing provisions for insurance contracts when individuals have observable, severe diseases with a discrete number of medically appropriate treatment options. Variation in preferences for alternative treatments is unobserved by the insurer and non-contractible. Interest in such situations is increasingly common, exemplified by disease carve-out programs and shared decision-making (SDM) tools. We demonstrate that optimal insurance charges a copay to patients choosing the high-cost treatment and provides consumers of the low-cost treatment a cash payment. A simulation of the effect of such a policy, based on prostate cancer, indicates a substantial reduction in moral hazard.

  8. A cross-case analysis of three Native Science Field Centers

    Augare, Helen J.; Davíd-Chavez, Dominique M.; Groenke, Frederick I.; Little Plume-Weatherwax, Melissa; Lone Fight, Lisa; Meier, Gene; Quiver-Gaddie, Helene; Returns From Scout, Elvin; Sachatello-Sawyer, Bonnie; St. Pierre, Nate; Valdez, Shelly; Wippert, Rachel

    2017-06-01

    Native Science Field Centers (NSFCs) were created to engage youth and adults in environmental science activities through the integration of traditional Native ways of knowing (understanding about the natural world based on centuries of observation including philosophy, worldview, cosmology, and belief systems of Indigenous peoples), Native languages, and Western science concepts. This paper focuses on the Blackfeet Native Science Field Center, the Lakota Native Science Field Center, and the Wind River Native Science Field Center. One of the long-term, overarching goals of these NSFCs was to stimulate the interest of Native American students in ways that encouraged them to pursue academic and career paths in science, technology, engineering, and mathematics (STEM) fields. A great deal can be learned from the experiences of the NSFCs in terms of effective educational strategies, as well as advantages and challenges in blending Native ways of knowing and Western scientific knowledge in an informal science education setting. Hopa Mountain—a Bozeman, Montana-based nonprofit—partnered with the Blackfeet Community College on the Blackfeet Reservation, Fremont County School District #21 on the Wind River Reservation, and Oglala Lakota College on the Pine Ridge Reservation to cooperatively establish the Native Science Field Centers. This paper presents a profile of each NSFC and highlights their program components and accomplishments.

  9. Fast radio bursts: the observational case for a Galactic origin

    Maoz, Dan; Loeb, Abraham; Shvartzvald, Yossi; Sitek, Monika; Engel, Michael; Kiefer, Flavien; Kiraga, Marcin; Levi, Amir; Mazeh, Tsevi; Pawlak, Michał; Rich, R. Michael; Tal-Or, Lev; Wyrzykowski, Lukasz

    2015-12-01

    There are by now ten published detections of fast radio bursts (FRBs) - single bright GHz-band millisecond pulses of unknown origin. Proposed explanations cover a broad range from exotic processes at cosmological distances to atmospheric and terrestrial sources. Loeb, Maoz, and Shvartzvald have previously suggested that FRB sources could be nearby flare stars, and pointed out the presence of a W-UMa-type contact binary within the beam of one out of three FRB fields that they examined. To further test the flare-star hypothesis, we use time-domain optical photometry and spectroscopy, and now find possible flare stars in additional FRB fields, with one to three such cases among all eight FRB fields studied. We evaluate the chance probabilities of these possible associations to be in the range ˜0.1 per cent to 9 per cent, depending on the input assumptions. Further, we re-analyse the probability that two FRBs recently discovered three years apart within the same radio beam are unrelated. Contrary to other claims, we conclude with 99 per cent confidence that the two events are from the same repeating source. The different dispersion measures between the two bursts then rule out a cosmological intergalactic-medium origin for the dispersion measure, but are consistent with the flare-star scenario with a varying plasma blanket between bursts. Finally, we review some theoretical objections that have been raised against a local flare-star FRB origin, and show that they are incorrect.

  10. Relation of people-centered public health and person-centered healthcare management: a case study to reduce burn-out.

    Stoyanov, Drozdstoj S; Cloninger, C Robert

    2012-01-01

    Healthcare management is one practical tool for mediation and implementation of public health into clinical healthcare outcomes and is taken in our case study as an exemplar arena to demonstrate the vital importance of the person-centered approach. Healthcare personnel are frequently at risk for the 'burn-out' syndrome. However, modern measures of burn-out recognize burn-out only at a late stage when it is fully developed. There are no available methods to assess the risk for vulnerability to burnout in healthcare systems. Our aim was therefore to design a complex person-centered model for detection of high risk for burn-out at an early stage, that has been termed 'flame-out'. We accept the observation that decreased personal performance is one crucial expression of burn-out. Low personal performance and negative emotions are strongly related to low self-directedness as measured by the Temperament and Character Inventory (TCI). At the same time, burn-out is characterized by decreased interest and positive emotions from work. Decreased positive emotion is directly related to low self-transcendence as measured by the TCI. Burn-out is also frequently associated with feelings of social alienation or inadequacy of support, which is in turn related to low TCI Cooperativeness. However, high Persistence and Harm Avoidance are predisposing traits for burn-out in healthcare professionals who are often overly perfectionistic and compulsive, predisposing them to anxiety, depression, suicide and burn-out. Hence, people at risk for future burn-out are often highly conscientious over-achievers with intense mixtures of positive and negative emotions. The high demand for perfection comes from both intrinsic characteristics and from features of the social milieu in their psychological climate. Letting go of the unfulfillable desire to be perfect by increasing self-transcendence allows acceptance of the imperfection of the human condition, thereby preventing burn-out and other

  11. The Examination of The Outdoors of Family Health-Care Center: A Case Study In Çanakkale City Center

    SAĞLIK, Alper; KELKİT, Abdullah

    2017-01-01

    The gardens of the health-care centers are areas of fear, anxiety and stress based. In the process of the treatment of patients, these areas have psychological, physical and social significance. For this reason, health-care center gardens should be designed to help treatment of patients. Well designed gardens are important for elimination of adverse effects of clinical environments on patients and helping patients to stay away from the stress by ensuring their socia...

  12. U.S. Geological Survey (USGS) Earth Resources Observation and Science (EROS) Center-fiscal year 2010 annual report

    Nelson, Janice S.

    2011-01-01

    The Earth Resources Observation and Science (EROS) Center is a U.S. Geological Survey (USGS) facility focused on providing science and imagery to better understand our Earth. The work of the Center is shaped by the earth sciences, the missions of our stakeholders, and implemented through strong program and project management, and application of state-of-the-art information technologies. Fundamentally, EROS contributes to the understanding of a changing Earth through 'research to operations' activities that include developing, implementing, and operating remote-sensing-based terrestrial monitoring capabilities needed to address interdisciplinary science and applications objectives at all levels-both nationally and internationally. The Center's programs and projects continually strive to meet, and where possible exceed, the changing needs of the USGS, the Department of the Interior, our Nation, and international constituents. The Center's multidisciplinary staff uses their unique expertise in remote sensing science and technologies to conduct basic and applied research, data acquisition, systems engineering, information access and management, and archive preservation to address the Nation's most critical needs. Of particular note is the role of EROS as the primary provider of Landsat data, the longest comprehensive global land Earth observation record ever collected. This report is intended to provide an overview of the scientific and engineering achievements and illustrate the range and scope of the activities and accomplishments at EROS throughout fiscal year (FY) 2010. Additional information concerning the scientific, engineering, and operational achievements can be obtained from the scientific papers and other documents published by EROS staff or by visiting our web site at http://eros.usgs.gov. We welcome comments and follow-up questions on any aspect of this Annual Report and invite any of our customers or partners to contact us at their convenience. To

  13. Lionfish string experiences of an inland poison center: a retrospective study of 23 cases.

    Trestrail, J H; al-Mahasneh, Q M

    1989-04-01

    From January 1979 through March 1988, our regional poison center, located many hundreds of miles from the nearest coastal salt water, documented 23 cases of envenomation by "Lionfish" (members of genus Pterois). All cases involved specimens which were maintained in the homes of amateur aquarists. A study of patient epidemiology showed the following: patient's sex 91.3% male, 8.7% female; patients ages ranged from 17 to 50 years with an average age for males of 29.8 years and 35 years for females; the site of the envenomation accident was always in the home; the only part of the body envenomated was the hand or finger; and all of the patients were symptomatic. Symptoms noted included sharp pain, swelling, redness, bleeding, nausea, numbness, joint pain, anxiety, headache, disorientation, and dizziness. One patient had a complication of cellulitis. Treatment provided included immersion of the effected area in hot water at 40 C for 60 to 90 min, analgesics, tetanus toxoid, and antibiotics. There were no deaths noted and treatment proved effective in all cases. This paper also discusses the natural history, clinical effects, and current treatment for envenomations from these beautiful but dangerous venomous fish, which can cause poisoning exposures that are likely to be encountered by poison centers anywhere in the world.

  14. Longitudinal Observations of Infants' Daily Arrivals at a Day Care Center.

    Willis, E. Anne; Ricciuti, Henry N.

    This longitudinal study was concerned with infants' reactions to being greeted by a caregiver upon arrival at the nursery, being left by the parent with the caregiver, and to reunion with the parents. Observations were made twice weekly in the natural setting of the nursery foyer where parents normally arrive with their infants. An affectivity…

  15. A NuSTAR observation of the center of the coma cluster

    Gastaldello, Fabio; Wik, Daniel R.; Molendi, S.

    2015-01-01

    . The brightness of the thermal component in this central region does not allow more stringent upper limits on the IC component when compared with non-imaging instruments with much larger fields of view where claims of detections have been made. Future mosaic NuSTAR observations of Coma will further address...

  16. Student-Centered Teaching Meets New Media: Concept and Case Study

    Andreas Holzinger

    2002-10-01

    Full Text Available There exists empirical evidence proving that students who are given the freedom to explore areas based on their personal interests, and who are accompanied in their learning by a supportive, understanding facilitator, not only achieve superior academic results but also develop socially and grow personally. However, pure Student-Centered Teaching is more demanding in terms of communication, organization, as well as the provision of learning material. Thus, the basic idea underlying our paradigm is to combine Student-Centered Teaching with eLearning in order to exploit the advantages of the two approaches. We refer to this combined style as Student-Centered eLearning (SCeL. Strongly simplified, the computer takes over the task of providing information, while presence phases can be used for giving the content more meaning by means of transparent, open, respectful and empathic interactions within the group. Our case study indicates that Student-Centered eLearning has the potential of reducing the increased demands of Student-Centered Teaching in the long run, while fully retaining all its benefits, such as deeper learning processes, personal growth, social skills, and a higher degree of flexibility. Furthermore, the maturity for life-long learning is cultivated. In this paper we introduce our concept and derive first hypotheses on the conditions under which our paradigm appears most effective. While potential continuations of our studies are manifold, we intend to employ SCeL in the course of the new curriculum of the medical faculty of GrazUniversity where a Virtual Medical Campus (http://vmc.uni-graz.at is currently being developed.

  17. Personality traits affect teaching performance of attending physicians: results of a multi-center observational study.

    Scheepers, Renée A; Lombarts, Kiki M J M H; van Aken, Marcel A G; Heineman, Maas Jan; Arah, Onyebuchi A

    2014-01-01

    Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties. We conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ). Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI), yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness. Overall, 622 (77%) attending physicians and 549 (68%) residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02). Openness was negatively associated with scores on feedback for surgical specialties only (B: -0.10, 95% CI: -0.15 to -0.05, Pwork on development paths of attending physicians in medical education.

  18. High-resolution far-infrared observations of the galactic center

    Harvey, P.M.; Campbell, M.F.; Hoffmann, W.F.

    1976-01-01

    A map at 53 μ with 17'' resolution and three-color observations at 53 μ, 100 μ, and 175 μ with approx.30'' beams of Sgr A are presented. Sagittarius A is resolved into two main sources, one associated with the cluster of strong 10 μ sources and another approx.45'' to the southwest coincident with a weak 10 μ source. The dust temperature peaks near the strong 10 μ sources, but the 100 μ and 175 μ fluxes and the far-infrared optical depth are greatest near the southwest source. The amount of dust required to explain the far-infrared emission is comparable to that observed in absorption in the near-infrared

  19. [Medical fault or professional negligence? Case studies in two recovery nutrition centers in Niger].

    Halidou Doudou, M; Manzo, M L; Guero, D

    2014-12-01

    In developing countries such as Niger, the risk of medical malpractice is ubiquitous in health, jeopardizing patient safety. The aim of this work was to contribute to patients' safety and respect of code of ethics and conduct in the exercise of the medical profession. The reported cases involved two children under 5 years who were admitted to nutrition rehabilitation centers, died as a result of medical malpractice. In Niger, there are no statistics on this phenomenon and a few cases found have always been considered "accident" or "fate." The establishment of an observatory collections of such information should improve their frequency, consequences and propose a prevention plan. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  20. Variability in prostate and seminal vesicle delineations defined on magnetic resonance images, a multi-observer, -center and -sequence study

    Nyholm, Tufve; Jonsson, Joakim; Söderström, Karin

    2013-01-01

    and approximately equal for the prostate and seminal vesicles. Large differences in variability were observed for individual patients, and also for individual imaging sequences used at the different centers. There was however no indication of decreased variability with higher field strength. CONCLUSION: The overall......BACKGROUND: The use of magnetic resonance (MR) imaging as a part of preparation for radiotherapy is increasing. For delineation of the prostate several publications have shown decreased delineation variability using MR compared to computed tomography (CT). The purpose of the present work....... Two physicians from each center delineated the prostate and the seminal vesicles on each of the 25 image sets. The variability between the delineations was analyzed with respect to overall, intra- and inter-physician variability, and dependence between variability and origin of the MR images, i...

  1. Personality traits affect teaching performance of attending physicians: results of a multi-center observational study.

    Renée A Scheepers

    Full Text Available BACKGROUND: Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties. METHOD: We conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ. Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI, yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness. RESULTS: Overall, 622 (77% attending physicians and 549 (68% residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02. Openness was negatively associated with scores on feedback for surgical specialties only (B: -0.10, 95% CI: -0.15 to -0.05, P<0.001 and conscientiousness was positively related to evaluation of residents for non-surgical specialties only (B: 0.13, 95% CI: 0.03 to 0.22, p = 0.01. CONCLUSIONS: Extraverted attending physicians were consistently evaluated as better supervisors. Surgical attending physicians who display high levels of

  2. A NuSTAR OBSERVATION OF THE CENTER OF THE COMA CLUSTER

    Gastaldello, Fabio; Molendi, S. [IASF-Milano, INAF, Via Bassini 15, I-20133 Milan (Italy); Wik, Daniel R.; Zhang, W. W. [Astrophysics Science Division, NASA/Goddard Space Flight Center, Greenbelt, MD 20771 (United States); Westergaard, N. J.; Hornstrup, A.; Ferreira, D. D. M.; Christensen, F. E. [DTU Space, National Space Institute, Technical University of Denmark, Elektrovej 327, DK-2800 Lyngby (Denmark); Madejski, G. [Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, Menlo Park, CA 94025 (United States); Boggs, S. E.; Craig, W. W. [Space Sciences Laboratory, University of California, Berkeley, CA 94720 (United States); Grefenstette, B. W.; Harrison, F. A.; Madsen, K. K. [Cahill Center for Astronomy and Astrophysics, California Institute of Technology, Pasadena, CA 91125 (United States); Hailey, C. J. [Columbia Astrophysics Laboratory, Columbia University, New York, NY 10027 (United States); Stern, D., E-mail: gasta@lambrate.inaf.it [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 (United States)

    2015-02-20

    We present the results of a 55 ks NuSTAR observation of the core of the Coma Cluster. The global spectrum can be explained by thermal gas emission, with a conservative 90% upper limit to non-thermal inverse Compton (IC) emission of 5.1 × 10{sup –12} erg cm{sup –2} s{sup –1} in a 12' × 12' field of view. The brightness of the thermal component in this central region does not allow more stringent upper limits on the IC component when compared with non-imaging instruments with much larger fields of view where claims of detections have been made. Future mosaic NuSTAR observations of Coma will further address this issue. The temperature map shows a relatively uniform temperature distribution with a gradient from the hot northwest side to the cooler southeast, in agreement with previous measurements. The temperature determination is robust given the flat effective area and low background in the 3-20 keV band, making NuSTAR an ideal instrument to measure high temperatures in the intracluster medium.

  3. Radiotherapy of primary cutaneous follicle center lymphoma: case report and review of literature

    Ceovic, Romana; Jovanovic, Ivana; Kostovic, Kresimir; Rados, Jaka; Dotlic, Snjezana; Radman, Ivo; Kulisic, Sandra Marinovic; Loncaric, Davorin

    2013-01-01

    Primary cutaneous follicle center lymphoma is an indolent primary cutaneous B-cell lymphoma originating from the follicle center cells, composed of a combination of centrocytes (small and large cleaved cells) and centroblasts (large noncleaved cells) with a follicular, follicular/diffuse, or diffuse growth pattern. Lesions are mostly located on the head, neck and trunk. A case is presented of a 56-year-old male patient with primary cutaneous follicle center lymphoma, with lesions involving the skin of the back, shoulders, presternal area and right forearm. As the patient presented a disseminated cutaneous form of the disease that involved several anatomical regions, complete work-up was followed by superficial fractionated radiotherapy of eight fields in VI expositions, with total irradiation dose of 1400 cGy upon the following fields: right and left pectoral region, left and right shoulders, right suprascapular region, and proximal third of the right forearm. Total irradiation dose applied upon each field for the lesions located on the left and right side of the back was 1500 cGy. This therapy resulted in significant reduction of visible tumor. The patient was regularly followed up on outpatient basis for 12 months of radiotherapy, being free from local recurrence and systemic spread of the disease

  4. Statistical Machines for Trauma Hospital Outcomes Research: Application to the PRospective, Observational, Multi-Center Major Trauma Transfusion (PROMMTT Study.

    Sara E Moore

    Full Text Available Improving the treatment of trauma, a leading cause of death worldwide, is of great clinical and public health interest. This analysis introduces flexible statistical methods for estimating center-level effects on individual outcomes in the context of highly variable patient populations, such as those of the PRospective, Observational, Multi-center Major Trauma Transfusion study. Ten US level I trauma centers enrolled a total of 1,245 trauma patients who survived at least 30 minutes after admission and received at least one unit of red blood cells. Outcomes included death, multiple organ failure, substantial bleeding, and transfusion of blood products. The centers involved were classified as either large or small-volume based on the number of massive transfusion patients enrolled during the study period. We focused on estimation of parameters inspired by causal inference, specifically estimated impacts on patient outcomes related to the volume of the trauma hospital that treated them. We defined this association as the change in mean outcomes of interest that would be observed if, contrary to fact, subjects from large-volume sites were treated at small-volume sites (the effect of treatment among the treated. We estimated this parameter using three different methods, some of which use data-adaptive machine learning tools to derive the outcome models, minimizing residual confounding by reducing model misspecification. Differences between unadjusted and adjusted estimators sometimes differed dramatically, demonstrating the need to account for differences in patient characteristics in clinic comparisons. In addition, the estimators based on robust adjustment methods showed potential impacts of hospital volume. For instance, we estimated a survival benefit for patients who were treated at large-volume sites, which was not apparent in simpler, unadjusted comparisons. By removing arbitrary modeling decisions from the estimation process and concentrating

  5. Using secure web services to visualize poison center data for nationwide biosurveillance: a case study.

    Savel, Thomas G; Bronstein, Alvin; Duck, William; Rhodes, M Barry; Lee, Brian; Stinn, John; Worthen, Katherine

    2010-01-01

    Real-time surveillance systems are valuable for timely response to public health emergencies. It has been challenging to leverage existing surveillance systems in state and local communities, and, using a centralized architecture, add new data sources and analytical capacity. Because this centralized model has proven to be difficult to maintain and enhance, the US Centers for Disease Control and Prevention (CDC) has been examining the ability to use a federated model based on secure web services architecture, with data stewardship remaining with the data provider. As a case study for this approach, the American Association of Poison Control Centers and the CDC extended an existing data warehouse via a secure web service, and shared aggregate clinical effects and case counts data by geographic region and time period. To visualize these data, CDC developed a web browser-based interface, Quicksilver, which leveraged the Google Maps API and Flot, a javascript plotting library. Two iterations of the NPDS web service were completed in 12 weeks. The visualization client, Quicksilver, was developed in four months. This implementation of web services combined with a visualization client represents incremental positive progress in transitioning national data sources like BioSense and NPDS to a federated data exchange model. Quicksilver effectively demonstrates how the use of secure web services in conjunction with a lightweight, rapidly deployed visualization client can easily integrate isolated data sources for biosurveillance.

  6. Prevalence of Nontuberculous Mycobacteria among Extrapulmonary Tuberculosis Cases in Tertiary Care Centers in Northern India

    A. K. Maurya

    2015-01-01

    Full Text Available The reports of nontuberculous mycobacteria (NTM associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catalase assay. BIO-LINE SD Ag MPT64 TB test and final identification and differentiation between MTBC and different species of NTM were further confirmed by GenoType Mycobacterium CM/AS assay. 71 cases (9.3% were positive for AFB by ZN staining and 227 cases (30.1% were positive for mycobacteria by culture. Niacin production and catalase activity were negative in 62/227 (27.4% strains and after using a panel of different biochemicals and final confirmation by GenoType Mycobacterium CM assay. Out of 227 cultures tested, 165 (72.6% strains were confirmed as M. tuberculosis complex, and 62 (27.4% were confirmed as NTM. The most common NTM species identified were M. fortuitum 17 (27.5% and M. intracellulare 13 (20.9%. The rapid identification of NTM species may help in targeted therapy and management of the diseases.

  7. Case-mix adjustment and the comparison of community health center performance on patient experience measures.

    Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

    2010-06-01

    To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

  8. ALMA Observations of Molecular Clouds in Three Group-centered Elliptical Galaxies: NGC 5846, NGC 4636, and NGC 5044

    Temi, Pasquale; Amblard, Alexandre; Gitti, Myriam; Brighenti, Fabrizio; Gaspari, Massimo; Mathews, William G.; David, Laurence

    2018-05-01

    We present new ALMA CO(2–1) observations of two well-studied group-centered elliptical galaxies: NGC 4636 and NGC 5846. In addition, we include a revised analysis of Cycle 0 ALMA observations of the central galaxy in the NGC 5044 group. We find evidence that molecular gas is a common presence in bright group-centered galaxies (BGG). CO line widths are broader than Galactic molecular clouds, and using the reference Milky Way X CO, the total molecular mass ranges from 2.6 × 105 M ⊙ in NGC 4636 to 6.1 × 107 M ⊙ in NGC 5044. Complementary observations using the ALMA Compact Array do not exhibit any detection of a CO diffuse component at the sensitivity level achieved by current exposures. The origin of the detected molecular features is still uncertain, but these ALMA observations suggest that they are the end product of the hot gas cooling process and not the result of merger events. Some of the molecular clouds are associated with dust features as revealed by HST dust extinction maps, suggesting that these clouds formed from dust-enhanced cooling. The global nonlinear condensation may be triggered via the chaotic turbulent field or buoyant uplift. The large virial parameter of the molecular structures and correlation with the warm ({10}3{--}{10}5 {{K}})/hot (≥106) phase velocity dispersion provide evidence that they are unbound giant molecular associations drifting in the turbulent field, consistent with numerical predictions of the chaotic cold accretion process. Alternatively, the observed large CO line widths may be generated by molecular gas flowing out from cloud surfaces due to heating by the local hot gas atmosphere.

  9. U.S. Geological Survey (USGS) Earth Resources Observation and Science (EROS) Center-Fiscal Year 2009 Annual Report

    Nelson, Janice S.

    2010-01-01

    The Earth Resources Observation and Science (EROS) Center is a U.S. Geological Survey (USGS) facility focused on providing science and imagery to better understand our Earth. As part of the USGS Geography Discipline, EROS contributes to the Land Remote Sensing (LRS) Program, the Geographic Analysis and Monitoring (GAM) Program, and the National Geospatial Program (NGP), as well as our Federal partners and cooperators. The work of the Center is shaped by the Earth sciences, the missions of our stakeholders, and implemented through strong program and project management and application of state-of-the-art information technologies. Fundamentally, EROS contributes to the understanding of a changing Earth through 'research to operations' activities that include developing, implementing, and operating remote sensing based terrestrial monitoring capabilities needed to address interdisciplinary science and applications objectives at all levels-both nationally and internationally. The Center's programs and projects continually strive to meet and/or exceed the changing needs of the USGS, the Department of the Interior, our Nation, and international constituents. The Center's multidisciplinary staff uses their unique expertise in remote sensing science and technologies to conduct basic and applied research, data acquisition, systems engineering, information access and management, and archive preservation to address the Nation's most critical needs. Of particular note is the role of EROS as the primary provider of Landsat data, the longest comprehensive global land Earth observation record ever collected. This report is intended to provide an overview of the scientific and engineering achievements and illustrate the range and scope of the activities and accomplishments at EROS throughout fiscal year (FY) 2009. Additional information concerning the scientific, engineering, and operational achievements can be obtained from the scientific papers and other documents published by

  10. Viral Hepatitis A in 108 Adult Patients During an Eight-Year Observation at a Single Center in Poland.

    Bura, Maciej; Michalak, Michał; Chojnicki, Michał K; Kowala-Piaskowska, Arleta; Mozer-Lisewska, Iwona

    2015-01-01

    Hepatitis A is related to significant morbidity and occasional mortality. Based on data from the Polish National Institute of Hygiene, from 2000 to 2013 a mean of 213 hepatitis A cases were reported yearly. The aim of the study was to assess selected data in adults hospitalized for symptomatic hepatitis A during an eight-year period in a single center in the Wielkopolska Region of Poland. All the hepatitis A patients hospitalized in the center from 2005 to 2013 were analyzed retrospectively. Data were extracted from the medical records of these individuals. The disease was confirmed by anti-HAV IgM testing. In total, 108 patients (71 men and 37 women), aged 18-65 years, were identified. All but 1 patient recovered (99.1%) and in 6 cases (5.6%) a relapse occurred. Risk factors for hepatitis A were identified in 56 patients (52%), with travel abroad being the most common one (32 patients); 19 cases were secondary and 5 patients were men who have sex with men. One hepatitis A outbreak was noted in the region during the study period. Acalculous cholecystitis was found in 33.3% of the patients who underwent abdominal ultrasound. This tended to be more common among older individuals (47.8% in patients over 40 vs. 22.6% in patients aged 18-40, p=0.0521). Patients with this finding had significantly higher mean peak ALT in comparison to those with no gallbladder abnormalities. Although hepatitis A in adults is typically a benign, self-limited disease, it can occasionally have a fatal course. In a significant proportion of patients with an evident risk factor for hepatitis A, the possibility of active prophylaxis was not used. Hepatitis A should be regarded as a sexually transmitted infection. Acalculous cholecystitis is a frequent finding among adults with symptomatic hepatitis A.

  11. Gastrointestinal stromal tumor: analysis of 146 cases of the center of reference of the National Cancer Institute--INCA.

    Linhares, Eduardo; Gonçalves, Rinaldo; Valadão, Marcus; Vilhena, Bruno; Herchenhorn, Daniel; Romano, Sergio; Ferreira, Maria Aparecida; Ferreira, Carlos Gil; Ramos, Cintia de Araujo; de Jesus, José Paulo

    2011-01-01

    To evaluate the treatment of GIST in INCA. We conducted a retrospective analysis of all cases of GIST treated at INCA in the period from 1997 to 2009. We analyzed 146 patients with a mean age of 44.5 years and female predominance. The main symptom was abdominal pain. We observed the occurrence of a second primary tumor in 22% of cases and 92% of the immunohistochemistry exams were positive for CD117. The most frequent location was in the stomach and the high-risk group was predominant. Surgery was considered R0 (extensive) in 70% of the cases and the main sites of metastases were liver and peritoneum. Overall survival in two and five years was, respectively, 86% and 59%. There was a significant difference between overall survival (p = 0.29) of the high-risk group versus the other. Our patients presented mainly in the form of high-risk disease, with obvious impact on survival. The use of imatinib improved survival of patients with recurrent and metastatic disease. We should study its use in the setting of adjuvant and neoadjuvant therapy to improve results of the high risk group. The creation of reference centers is a need for the study of rare diseases.

  12. Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study

    Spiliopoulos, Stavros, E-mail: stavspiliop@med.uoa.gr, E-mail: stavspiliop@upatras.gr; Karnabatidis, Dimitrios, E-mail: karnaby@med.upatras.gr [Patras University Hospital, Department of Interventional Radiology (Greece); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios, E-mail: adiamantopoulos@gmail.com [Guy’s and St Thomas’ Hospitals, NHS Foundation Trust, King’s Health Partners, Department of Interventional Radiology (United Kingdom); Ali, Tariq, E-mail: tariq.ali@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom); Kitrou, Panagiotis, E-mail: panoskitrou@gmail.com [Patras University Hospital, Department of Interventional Radiology (Greece); Cannavale, Alessandro, E-mail: alessandro.cannavale@hotmail.com; Krokidis, Miltiadis, E-mail: miltiadis.krokidis@addenbrookes.nhs.uk [Addenbrooke’s University Hospital, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)

    2016-12-15

    PurposeThe purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease.Materials and MethodsThis was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications’ rate.ResultsThe study included 652 patients (male 75 %; mean age 68 ± 10 years; range: 27–93), 24.6 % treated for CLI. In 53.3 % of the cases a 6Fr sheath was used. Technical success was 97.1 %. Haemostasis was obtained by manual compression in 52.4 % of the accesses. The primary efficacy outcome occurred in 95.4 % (622/652 patients) and primary safety outcome in 98.6 % (643/652 patients). Major complications included five (0.7 %) retroperitoneal hematomas requiring transfusion; one (0.1 %) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24 h recovery. No major complication was noted after same-day discharge.ConclusionsDay-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.

  13. Epidemiology of volatile substance abuse (VSA) cases reported to US poison centers.

    Spiller, Henry A

    2004-01-01

    Volatile substance abuse (VSA) is believed to be widespread. The Toxic Exposure Surveillance System (TESS) of the American Association of Poison Control Systems offers an opportunity to evaluate the epidemiology of volatile substance abuse using a data set that captures data from a large geographic area covering a wide-ranging group of socioeconomic strata, ethnic groups, and demographics. To utilize this potential we analyzed a data set of TESS for the 6-year period of 1996 through 2001 involving all cases of intentional inhalational abuse of nonpharmaceutical substances. Over the study period there was a mean annual decline of 9% of reported VSA with an overall decline of 37% from 1996 to 2001. Volatile substance abuse was reported primarily in children, with 6358 cases (54%) in children 13-19 yr and 1803 (15%) cases in children 6-12 yr. Fifty-two cases were reported in children air fresheners (6%), and formalin (5%). Three categories were responsible for the majority of deaths: gasoline (45%), air fresheners (26%), and propane/butane (11%). While there was a decline in reported cases, there was no decline in major outcomes or fatalities. Volatile substance abuse was reported in all 50 states, with case distribution similar to population distribution. However, seven states had > 2 times the expected rate based on their population; three western states, two midwestern states, and two Appalachian states. The role of urban vs. rural population may possibly explain the difference in numbers, with a greater incidence of VSA cases reported in states with large rural populations. The mean monthly occurrence rate was 162 VSA cases/month (S.D. +/- 10.85). There were 4 months that were > 2 standard deviations from the mean, with two peak months (May, 192/month and March, 187/month) and two trough months (December, 126/month and January, 137/month). This report presents a broad picture of VSA in the United States. Volatile substance abuse, as reported to U.S. poison centers

  14. Audit of a Scientific Data Center for Certification as a Trustworthy Digital Repository: A Case Study

    Downs, R. R.; Chen, R. S.

    2011-12-01

    Services that preserve and enable future access to scientific data are necessary to ensure that the data that are being collected today will be available for use by future generations of scientists. Many data centers, archives, and other digital repositories are working to improve their ability to serve as long-term stewards of scientific data. Trust in sustainable data management and preservation capabilities of digital repositories can influence decisions to use these services to deposit or obtain scientific data. Building on the Open Archival Information System (OAIS) Reference Model developed by the Consultative Committee for Space Data Systems (CCSDS) and adopted by the International Organization for Standardization as ISO 14721:2003, new standards are being developed to improve long-term data management processes and documentation. The Draft Information Standard ISO/DIS 16363, "Space data and information transfer systems - Audit and certification of trustworthy digital repositories" offers the potential to evaluate digital repositories objectively in terms of their trustworthiness as long-term stewards of digital resources. In conjunction with this, the CCSDS and ISO are developing another draft standard for the auditing and certification process, ISO/DIS 16919, "Space data and information transfer systems - Requirements for bodies providing audit and certification of candidate trustworthy digital repositories". Six test audits were conducted of scientific data centers and archives in Europe and the United States to test the use of these draft standards and identify potential improvements for the standards and for the participating digital repositories. We present a case study of the test audit conducted on the NASA Socioeconomic Data and Applications Center (SEDAC) and describe the preparation, the audit process, recommendations received, and next steps to obtain certification as a trustworthy digital repository, after approval of the ISO/DIS standards.

  15. Three-body scattering problem in the fixed center approximation: The case of attraction

    Kudryavtsev, Alexander E. [National Research Center Kurchatov Institute, Institute for Theoretical and Experimental Physics, Moscow (Russian Federation); Gani, Vakhid A. [National Research Center Kurchatov Institute, Institute for Theoretical and Experimental Physics, Moscow (Russian Federation); National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow (Russian Federation); Romanov, Alexander I. [National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow (Russian Federation)

    2016-12-15

    We study the scattering of a light particle on a bound pair of heavy particles (e.g., the deuteron) within the fixed center approximation in the case of light-heavy attraction, solving the integral equation for the three-body Green's function both in the coordinate and in the momentum space. The results for the three-body scattering amplitude appear to be ambiguous -they depend on a single real parameter. This parameter may be fixed by a three-body input, e.g., the three-body scattering length. We also solve the integral equation for the three-body Green function in the momentum space, introducing a finite cut-off. We show that all three approaches are equivalent. We also discuss how our approach to the problem matches with the introduction of three-body contact interaction as done by other authors. (orig.)

  16. Lyme Neuroborreliosis: Preliminary Results from an Urban Referral Center Employing Strict CDC Criteria for Case Selection

    David S. Younger

    2010-01-01

    Full Text Available Lyme neuroborreliosis or “neurological Lyme disease” was evidenced in 2 of 23 patients submitted to strict criteria for case selection of the Centers for Disease Control and Prevention employing a two-tier test to detect antibodies to Borrelia burgdorferi at a single institution. One patient had symptomatic polyradiculoneuritis, dysautonomia, and serological evidence of early infection; and another had symptomatic small fiber sensory neuropathy, distal polyneuropathy, dysautonomia, and serological evidence of late infection. In the remaining patients symptoms initially ascribed to Lyme disease were probably unrelated to B. burgdorferi infection. Our findings suggest early susceptibility and protracted involvement of the nervous system most likely due to the immunological effects of B. burgdorferi infection, although the exact mechanisms remain uncertain.

  17. Employee health benefit redesign at the academic health center: a case study.

    Marshall, Julie; Weaver, Deirdre C; Splaine, Kevin; Hefner, David S; Kirch, Darrell G; Paz, Harold L

    2013-03-01

    The rapidly escalating cost of health care, including the cost of providing health care benefits, is a significant concern for many employers. In this article, the authors examine a case study of an academic health center that undertook a complete redesign of its health benefit structure to control rising costs, encourage use of its own provider network, and support employee wellness. With the implementation in 2006 of a high-deductible health plan combined with health reimbursement arrangements and wellness incentives, the Penn State Hershey Medical Center (PSHMC) was able to realize significant cost savings and increase use of its own network while maintaining a high level of employee satisfaction. By contracting with a single third-party administrator for its self-insured plan, PSHMC reduced its administrative costs and simplified benefit choices for employees. In addition, indexing employee costs to salary ensured that this change was equitable for all employees, and the shift to a consumer-driven health plan led to greater employee awareness of health care costs. The new health benefit plan's strong focus on employee wellness and preventive health has led to significant increases in the use of preventive health services, including health risk assessments, cancer screenings, and flu shots. PSHMC's experience demonstrates the importance of clear and ongoing communication with employees throughout--before, during, and even after--the process of health benefit redesign.

  18. Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

    H Zare Ahmadabadi

    2007-07-01

    Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

  19. A review of 151 cases of pediatric noncystic fibrosis bronchiectasis in a tertiary care center

    Banjar Hanaa

    2007-01-01

    Full Text Available Objective: This study was conducted to review the etiological factors and diseases associated with pediatric noncystic fibrosis bronchiectasis in a tertiary care center in Saudi Arabia. Materials and Methods: A retrospective review of all patients with confirmed noncystic fibrosis (Non-CF bronchiectasis by chest X-ray and/or CT chest in a pulmonary clinic during the period 1993-2005 at a tertiary care center in Riyadh. Results: A total of 151 cases were diagnosed as Non-CF bronchiectasis. Seventy-five (49.7% were male, 76 (50.3% were female; 148 (98% are alive and 3 (2% died. The southwestern regions constituted 72 (50% of the cases. There was a period of (5 ± 3.2 years between the start of symptoms and diagnosis of bronchiectasis. More than two-thirds of the patients had cough, tachypnea, wheezing, sputum production and failure to thrive. Ninety-one (60% had associated diseases: Pulmonary diseases in 48 (32%, immunodeficiency in 27 (18%, central nervous system anomalies in 10 (7%, cardiac in 10 (7% and asthma in 103 (68% of the patients. Left lower lobe was commonly involved in 114 (76% patients. Sixty-eight (67% were found to have sinusitis. More than two-thirds of patients had two or more associated diseases. Forty-nine (32% developed gastroesophageal reflux. Hemophilus influenza was cultured in 56 (37%, strept pneumoniae in 25 (17% and pseudomonas aeruginosa in 24 (16% of the patients. Eighty percent of the patients who had pulmonary function test had abnormal changes. Disease progression was related to development of symptoms before 5 years of age, persistent atelectasis and right lower lobe involvement ( P < 0.05. Conclusion: Non-CF bronchiectasis should be included in the differential diagnosis of recurrent chest infection in Saudi Arabia. Early diagnosis and identification of associated diseases is needed to prevent progression of the disease.

  20. Empowering patients of a mental rehabilitation center in a low-resource context: a Moroccan experience as a case study.

    Khabbache, Hicham; Jebbar, Abdelhak; Rania, Nadia; Doucet, Marie-Chantal; Watfa, Ali Assad; Candau, Joël; Martini, Mariano; Siri, Anna; Brigo, Francesco; Bragazzi, Nicola Luigi

    2017-01-01

    Mental, neurological and substance use (MNS) disorders represent a major source of disability and premature mortality worldwide. However, in developing countries patients with MNS disorders are often poorly managed and treated, particularly in marginalized, impoverished areas where the mental health gap and the treatment gap can reach 90%. Efforts should be made in promoting help by making mental health care more accessible. In this article, we address the challenges that psychological and psychiatric services have to face in a low-resource context, taking our experience at a Moroccan rehabilitation center as a case study. A sample of 60 patients were interviewed using a semi-structured questionnaire during the period of 2014-2015. The questionnaire investigated the reactions and feelings of the patients to the rehabilitation program, and their perceived psychological status and mental improvement, if any. Interviews were then transcribed and processed using ATLAS.ti V.7.0 qualitative analysis software. Frequencies and co-occurrence analyses were carried out. Despite approximately 30 million inhabitants within the working age group, Morocco suffers from a shortage of specialized health workers. Our ethnographic observations show that psychiatric treatment can be ensured, notwithstanding these hurdles, if a public health perspective is assumed. In resource-limited settings, working in the field of mental health means putting oneself on the line, exposing oneself to new experiences, and reorganizing one's own skills and expertise. In the present article, we have used our clinical experience at a rehabilitation center in Fes as a case study and we have shown how to use peer therapy to overcome the drawbacks that we are encountered daily in a setting of limited resources.

  1. [Monkeypox: second human case observed in Ivory Coast (rural health sector of Daloa].

    Merouze, F; Lesoin, J J

    1983-01-01

    A second case of human monkeypox (world fifty-forth case) has been observed in Ivory Coast (rural health sector of Daloa). A three years old girl presented a major pox-like eruption which evolved to recovery. The authors describe the eruption, the evolution of the sickness, and the scars observed at the fourth month after recovery. It has not been possible to prove neither animal-human nor interhuman contagion.

  2. The center of the core-cusp globular cluster M15: CFHT and HST Observations, ALLFRAME reductions

    Stetson, Peter B.

    1994-03-01

    The central brightness cusps seen in some globular clusters are thought to be the relics of a gravothermal core collapse that occurred sometime in the clusters' past. Recent observations show that the centers of such clusters are bluer than their outskirts, indicating that the stellar populations there are somehow different than those farther out, presumably as a result of unusual physical processes that took place in these extremely dense regions. Here I analyze a large body of digital imagery from the Canada-France-Hawaii Telescope and the Hubble Space Telescope to obtain color-magnitude and color-color diagrams for stars in the central two arcminutes of the prototypical core-cusp globular cluster M15 = NGC 7078 = C 2127 + 119. These data were reduced with a new computer program, named ALLFRAME, that is described in detail here for the first time. ALLFRAME makes simultaneous use of the geometric and photometric information from all images of a given field to derive a self-consistent set of positions and magnitudes for all detected starlike objects in that area of sky, thereby extending the range of magnitude and crowding conditions for which useful photometry is obtainable. I tentatively conclude that the color gradient in M15 is due to three distinct effects: (1) there is a deficiency of the brightest red giants in the central regions of the cluster; (2) the giant branch of the dominant cluster population shifts systematically toward the blue as the center of the cluster is approached; and (3) the very center of the cluster (radius approximately equal or less than 12 seconds) contains a large population of blue and yellow stragglers that occupy the area of the color-magnitude diagram between the main-sequence turnoff and the horizontal branch and between the extended blue horizontal branch and the subgiant branch; many of these appear to have a significant ultraviolet excess.

  3. Predictors of Default from Treatment for Tuberculosis: a Single Center Case-Control Study in Korea.

    Park, Cheol-Kyu; Shin, Hong-Joon; Kim, Yu-Il; Lim, Sung-Chul; Yoon, Jeong-Sun; Kim, Young-Su; Kim, Jung-Chul; Kwon, Yong-Soo

    2016-02-01

    Default from tuberculosis (TB) treatment could exacerbate the disease and result in the emergence of drug resistance. This study identified the risk factors for default from TB treatment in Korea. This single-center case-control study analyzed 46 default cases and 100 controls. Default was defined as interrupting treatment for 2 or more consecutive months. The reasons for default were mainly incorrect perception or information about TB (41.3%) and experience of adverse events due to TB drugs (41.3%). In univariate analysis, low income (defaulter (15.2% vs. 2.0%, P = 0.005), and combined extrapulmonary TB (54.3% vs. 34.0%, P = 0.020) were significant risk factors for default. In multivariate analysis, the absence of TB stigma (adjusted odd ratio [aOR]: 46.299, 95% confidence interval [CI]: 8.078-265.365, P defaulters (aOR: 33.226, 95% CI: 2.658-415.309, P = 0.007), and low income (aOR: 5.246, 95% CI: 1.249-22.029, P = 0.024) were independent predictors of default from TB treatment. In conclusion, patients with absence of disease stigma, treated by a non-pulmonologist, who were former defaulters, and with low income should be carefully monitored during TB treatment in Korea to avoid treatment default.

  4. User-Centered Design for Interactive Maps: A Case Study in Crime Analysis

    Robert E. Roth

    2015-02-01

    Full Text Available In this paper, we address the topic of user-centered design (UCD for cartography, GIScience, and visual analytics. Interactive maps are ubiquitous in modern society, yet they often fail to “work” as they could or should. UCD describes the process of ensuring interface success—map-based or otherwise—by gathering input and feedback from target users throughout the design and development of the interface. We contribute to the expanding literature on UCD for interactive maps in two ways. First, we synthesize core concepts on UCD from cartography and related fields, as well as offer new ideas, in order to organize existing frameworks and recommendations regarding the UCD of interactive maps. Second, we report on a case study UCD process for GeoVISTA CrimeViz, an interactive and web-based mapping application supporting visual analytics of criminal activity in space and time. The GeoVISTA CrimeViz concept and interface were improved iteratively by working through a series of user→utility→usability loops in which target users provided input and feedback on needs and designs (user, prompting revisions to the conceptualization and functional requirements of the interface (utility, and ultimately leading to new mockups and prototypes of the interface (usability for additional evaluation by target users (user… and so on. Together, the background review and case study offer guidance for applying UCD to interactive mapping projects, and demonstrate the benefit of including target users throughout design and development.

  5. Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center.

    Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu

    2012-01-01

    Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

  6. Comparison Of Seismic Performance Of Erciş Cultural Center Building With Observed And Calculated By Turkish Earthquake Code-2007

    Recep Ali Dedecan

    2013-08-01

    Full Text Available The goal of this paper is to review the validity of seismic assessment procedure given in the Turkish Earthquake Code by comparing the assessment results with real structures from Eastern Turkey, where the 2011 Van earthquake occurred. To test the analysis methods for a typically suitable structure, the cultural center building at Erciş with 3 stories, is selected. In order to compare the results of the three different analysis techniques, for an identical earthquake, the ground motion used in analysis was characterized by equivalent elastic earthquake spectra, which were developed from available time history at the nearest construction site. It was found that the damage predictions by using the by Turkish Earthquake Code procedures point out the different level of damages. But, it is concluded that nonlinear time history analysis calculated the best estimation of the damage observed in the site.

  7. The Polarization Signature of Photospheric Magnetic Fields in 3D MHD Simulations and Observations at Disk Center

    Beck, C. [National Solar Observatory, 3665 Discovery Drive, Boulder, CO 80303 (United States); Fabbian, D. [Max-Planck-Institut für Sonnensytemforschung, Justus-von-Liebig-Weg 3, D-37077 Göttingen (Germany); Rezaei, R. [Instituto de Astrofísica de Canarias, C/Vía Láctea S/N, E-38205 La Laguna, Tenerife (Spain); Puschmann, K. G., E-mail: cbeck@nso.edu [Alzenau (Germany)

    2017-06-10

    Before using three-dimensional (3D) magnetohydrodynamical (MHD) simulations of the solar photosphere in the determination of elemental abundances, one has to ensure that the correct amount of magnetic flux is present in the simulations. The presence of magnetic flux modifies the thermal structure of the solar photosphere, which affects abundance determinations and the solar spectral irradiance. The amount of magnetic flux in the solar photosphere also constrains any possible heating in the outer solar atmosphere through magnetic reconnection. We compare the polarization signals in disk-center observations of the solar photosphere in quiet-Sun regions with those in Stokes spectra computed on the basis of 3D MHD simulations having average magnetic flux densities of about 20, 56, 112, and 224 G. This approach allows us to find the simulation run that best matches the observations. The observations were taken with the Hinode SpectroPolarimeter (SP), the Tenerife Infrared Polarimeter (TIP), the Polarimetric Littrow Spectrograph (POLIS), and the GREGOR Fabry–Pèrot Interferometer (GFPI), respectively. We determine characteristic quantities of full Stokes profiles in a few photospheric spectral lines in the visible (630 nm) and near-infrared (1083 and 1565 nm). We find that the appearance of abnormal granulation in intensity maps of degraded simulations can be traced back to an initially regular granulation pattern with numerous bright points in the intergranular lanes before the spatial degradation. The linear polarization signals in the simulations are almost exclusively related to canopies of strong magnetic flux concentrations and not to transient events of magnetic flux emergence. We find that the average vertical magnetic flux density in the simulation should be less than 50 G to reproduce the observed polarization signals in the quiet-Sun internetwork. A value of about 35 G gives the best match across the SP, TIP, POLIS, and GFPI observations.

  8. Human-centered modeling in human reliability analysis: some trends based on case studies

    Mosneron-Dupin, F.; Reer, B.; Heslinga, G.; Straeter, O.; Gerdes, V.; Saliou, G.; Ullwer, W.

    1997-01-01

    As an informal working group of researchers from France, Germany and The Netherlands created in 1993, the EARTH association is investigating significant subjects in the field of human reliability analysis (HRA). Our initial review of cases from nuclear operating experience showed that decision-based unrequired actions (DUA) contribute to risk significantly on the one hand. On the other hand, our evaluation of current HRA methods showed that these methods do not cover such actions adequately. Especially, practice-oriented guidelines for their predictive identification are lacking. We assumed that a basic cause for such difficulties was that these methods actually use a limited representation of the stimulus-organism-response (SOR) paradigm. We proposed a human-centered model, which better highlights the active role of the operators and the importance of their culture, attitudes and goals. This orientation was encouraged by our review of current HRA research activities. We therefore decided to envisage progress by identifying cognitive tendencies in the context of operating and simulator experience. For this purpose, advanced approaches for retrospective event analysis were discussed. Some orientations for improvements were proposed. By analyzing cases, various cognitive tendencies were identified, together with useful information about their context. Some of them match psychological findings already published in the literature, some of them are not covered adequately by the literature that we reviewed. Finally, this exploratory study shows that contextual and case-illustrated findings about cognitive tendencies provide useful help for the predictive identification of DUA in HRA. More research should be carried out to complement our findings and elaborate more detailed and systematic guidelines for using them in HRA studies

  9. [The management of 126 cases of posterior cracked crown of tooth and its effective observation].

    Chen, L L

    2000-06-01

    To detect the treatment and effect of posterior cracked tooth. 162 posterior cracked teeth of 158 cases, including enamel fissure and dentin fissure, all there cases undergone the synthetical treatment and follow up in different period, the longest observation period was 2.5 years. The healing and improved rate of 162 cracked teeth 90.74%. Among cases of failure, we have founded 6 cases of acute pulpitis (3.7%), 3 cases of alveodental abscess (1.85%), 2 cases of chronic apical periodontitis (1.24%), 4 cases of tooth fracture (2.4%). Cracked tooth was caused by multiple factors. Early diagnosis, synthetical treatment, and follow up in different period are 3 main factors in treatment.

  10. Challenges in the Management and Stewardship of Airborne Observational Data at the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL)

    Aquino, J.; Daniels, M. D.

    2015-12-01

    The National Science Foundation (NSF) provides the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL) funding for the operation, maintenance and upgrade of two research aircraft: the NSF/NCAR High-performance Instrumented Airborne Platform for Environmental Research (HIAPER) Gulfstream V and the NSF/NCAR Hercules C-130. A suite of in-situ and remote sensing airborne instruments housed at the EOL Research Aviation Facility (RAF) provide a basic set of measurements that are typically deployed on most airborne field campaigns. In addition, instruments to address more specific research requirements are provided by collaborating participants from universities, industry, NASA, NOAA or other agencies (referred to as Principal Investigator, or PI, instruments). At the 2014 AGU Fall Meeting, a poster (IN13B-3639) was presented outlining the components of Airborne Data Management included field phase data collection, formats, data archival and documentation, version control, storage practices, stewardship and obsolete data formats, and public data access. This talk will cover lessons learned, challenges associated with the above components, and current developments to address these challenges, including: tracking data workflows for aircraft instrumentation to facilitate identification, and correction, of gaps in these workflows; implementation of dataset versioning guidelines; and assignment of Digital Object Identifiers (DOIs) to data and instrumentation to facilitate tracking data and facility use in publications.

  11. ‘Patient-Centered Care’ for Complex Patients with Type 2 Diabetes Mellitus—Analysis of Two Cases

    Jennifer M. Hackel

    2013-01-01

    Purpose This paper serves to apply and compare aspects of person centered care and recent consensus guidelines to two cases of older adults with poorly controlled diabetes in the context of relatively similar multimorbidity. Methods After review of the literature regarding the shift from guidelines promoting tight control in diabetes management to individualized person centered care, as well as newer treatment approaches emerging in diabetes care, the newer guidelines and potential treatment ...

  12. Depression management within GP-centered health care - A case-control study based on claims data.

    Freytag, Antje; Krause, Markus; Lehmann, Thomas; Schulz, Sven; Wolf, Florian; Biermann, Janine; Wasem, Jürgen; Gensichen, Jochen

    For most patients with depression, GPs are the first and long-term medical providers. GP-centered health care (GPc-HC) programs target patients with chronic diseases. What are the effects of GPc-HC on primary care depression management? An observational retrospective case-control study was conducted using health insurance claims data of patients with depressive disorder from July 2011 to December 2012. From 40,298 patients insured with the largest health plan in Central Germany participating in the GPc-HC program (intervention group, IG), we observed 4645 patients with depression over 18months: 72.2% women; 66.6years (mean); multiple conditions (morbidity-weight 2.50 (mean), 86%>1.0). We compared them with 4013 patients who did not participate (control group). In participants we found lower number of incomplete/non-specified depression diagnoses (4.46vs.4.82;MD-0.36; pcare" (38.2%vs.30.2%;PP+8.0;pDepressive patients participating in a GPc-HC program may be more often diagnosed by a GP, receive symptom-monitoring and appropriate depression treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Urea cycle disorders in Spain: an observational, cross-sectional and multicentric study of 104 cases.

    Martín-Hernández, Elena; Aldámiz-Echevarría, Luis; Castejón-Ponce, Esperanza; Pedrón-Giner, Consuelo; Couce, María Luz; Serrano-Nieto, Juliana; Pintos-Morell, Guillem; Bélanger-Quintana, Amaya; Martínez-Pardo, Mercedes; García-Silva, María Teresa; Quijada-Fraile, Pilar; Vitoria-Miñana, Isidro; Dalmau, Jaime; Lama-More, Rosa A; Bueno-Delgado, María Amor; Del Toro-Riera, Mirella; García-Jiménez, Inmaculada; Sierra-Córcoles, Concepción; Ruiz-Pons, Mónica; Peña-Quintana, Luis J; Vives-Piñera, Inmaculada; Moráis, Ana; Balmaseda-Serrano, Elena; Meavilla, Silvia; Sanjurjo-Crespo, Pablo; Pérez-Cerdá, Celia

    2014-11-30

    Advances in the diagnosis and treatment of urea cycle disorders (UCDs) have led to a higher survival rate. The purpose of this study is to describe the characteristics of patients with urea cycle disorders in Spain. Observational, cross-sectional and multicenter study. Clinical, biochemical and genetic data were collected from patients with UCDs, treated in the metabolic diseases centers in Spain between February 2012 and February 2013, covering the entire Spanish population. Heterozygous mothers of patients with OTC deficiency were only included if they were on treatment due to being symptomatic or having biochemistry abnormalities. 104 patients from 98 families were included. Ornithine transcarbamylase deficiency was the most frequent condition (64.4%) (61.2% female) followed by type 1 citrullinemia (21.1%) and argininosuccinic aciduria (9.6%). Only 13 patients (12.5%) were diagnosed in a pre-symptomatic state. 63% of the cases presented with type intoxication encephalopathy. The median ammonia level at onset was 298 μmol/L (169-615). The genotype of 75 patients is known, with 18 new mutations having been described. During the data collection period four patients died, three of them in the early days of life. The median current age is 9.96 years (5.29-18), with 25 patients over 18 years of age. Anthropometric data, expressed as median and z-score for the Spanish population is shown. 52.5% of the cases present neurological sequelae, which have been linked to the type of disease, neonatal onset, hepatic failure at diagnosis and ammonia values at diagnosis. 93 patients are following a protein restrictive diet, 0.84 g/kg/day (0.67-1.10), 50 are receiving essential amino acid supplements, 0.25 g/kg/day (0.20-0.45), 58 arginine, 156 mg/kg/day (109-305) and 45 citrulline, 150 mg/kg/day (105-199). 65 patients are being treated with drugs: 4 with sodium benzoate, 50 with sodium phenylbutyrate, 10 with both drugs and 1 with carglumic acid. Studies like this make it

  14. ADALIMUMAB FOR MAINTENANCE THERAPY FOR ONE YEAR IN CROHN?S DISEASE: results of a Latin American single-center observational study

    Paulo Gustavo KOTZE

    2014-03-01

    Full Text Available Context Adalimumab is a fully-human antibody that inhibits TNF alpha, with a significant efficacy for long-term maintenance of remission. Studies with this agent in Latin American Crohn’s disease patients are scarce. Objectives The objective of this study was to outline clinical remission rates after 12 months of adalimumab therapy for Crohn’s disease patients. Methods Retrospective, single-center, observational study of a Brazilian case series of Crohn’s disease patients under adalimumab therapy. Variables analyzed: demographic data, Montreal classification, concomitant medication, remission rates after 1, 4, 6 and 12 months. Remission was defined as Harvey-Bradshaw Index ≤4, and non-responder-imputation and last-observation-carried-forward analysis were used. The influence of infliximab on remission rates was analyzed by Fischer and Chi-square tests (P<0.05. Results Fifty patients, with median age of 35 years at therapy initiation, were included. Remission rates after 12 months of therapy were 54% under non-responder-imputation and 88% under last-observation-carried-forward analysis. After 12 months, remission on patients with previous infliximab occurred in 69.23% as compared to 94.59% in infliximab-naïve patients (P = 0.033. Conclusions Adalimumab was effective in maintaining clinical remission after 12 months of therapy, with an adequate safety profile, and was also more effective in infliximab naïve patients.

  15. Building a Student-Centered Culture in Times of Natural Disaster: A Case Study

    Hlinka, Karen Ramey

    2013-01-01

    Increased rates of student success and persistence have been positively linked to community colleges with student-centered cultures. A student-centered culture is one in which policies and practices promote a consistent message of concern and respect while expecting high standards of academic accomplishment. Developing a student-centered culture…

  16. The Begun Center for Violence Prevention Research and Education at Case Western Reserve University

    Flannery, Daniel J.; Singer, Mark I.

    2015-01-01

    Established in the year 2000, the Begun Center for Violence Prevention Research and Education is a multidisciplinary center located at a school of social work that engages in collaborative, community-based research and evaluation that spans multiple systems and disciplines. The Center currently occupies 4,200 sq. ft. with multiple offices and…

  17. R&D Characteristics and Organizational Structure: Case Studies of University-Industry Research Centers

    Hart, Maureen McArthur

    2013-01-01

    Within the past few decades, university-industry research centers have been developed in large numbers and emphasized as a valuable policy tool for innovation. Yet little is known about the heterogeneity of organizational structure within these centers, which has implications regarding policy for and management of these centers. This dissertation…

  18. Cusps in the center of galaxies: a real conflict with observations or a numerical artefact of cosmological simulations?

    Baushev, A.N.; Valle, L. del; Campusano, L.E.; Escala, A.; Muñoz, R.R. [Departamento de Astronomía, Universidad de Chile, Casilla 36-D, Correo Central, Santiago (Chile); Palma, G.A., E-mail: baushev@gmail.com, E-mail: ldelvalleb@gmail.com, E-mail: luis@das.uchile.cl, E-mail: aescala@das.uchile.cl, E-mail: rmunoz@das.uchile.cl, E-mail: gpalmaquilod@ing.uchile.cl [Departamento de Física, FCFM, Universidad de Chile, Blanco Encalada 2008, Santiago (Chile)

    2017-05-01

    Galaxy observations and N-body cosmological simulations produce conflicting dark matter halo density profiles for galaxy central regions. While simulations suggest a cuspy and universal density profile (UDP) of this region, the majority of observations favor variable profiles with a core in the center. In this paper, we investigate the convergency of standard N-body simulations, especially in the cusp region, following the approach proposed by [1]. We simulate the well known Hernquist model using the SPH code Gadget-3 and consider the full array of dynamical parameters of the particles. We find that, although the cuspy profile is stable, all integrals of motion characterizing individual particles suffer strong unphysical variations along the whole halo, revealing an effective interaction between the test bodies. This result casts doubts on the reliability of the velocity distribution function obtained in the simulations. Moreover, we find unphysical Fokker-Planck streams of particles in the cusp region. The same streams should appear in cosmological N-body simulations, being strong enough to change the shape of the cusp or even to create it. Our analysis, based on the Hernquist model and the standard SPH code, strongly suggests that the UDPs generally found by the cosmological N-body simulations may be a consequence of numerical effects. A much better understanding of the N-body simulation convergency is necessary before a 'core-cusp problem' can properly be used to question the validity of the CDM model.

  19. Cusps in the center of galaxies: a real conflict with observations or a numerical artefact of cosmological simulations?

    Baushev, A.N.; Valle, L. del; Campusano, L.E.; Escala, A.; Muñoz, R.R.; Palma, G.A.

    2017-01-01

    Galaxy observations and N-body cosmological simulations produce conflicting dark matter halo density profiles for galaxy central regions. While simulations suggest a cuspy and universal density profile (UDP) of this region, the majority of observations favor variable profiles with a core in the center. In this paper, we investigate the convergency of standard N-body simulations, especially in the cusp region, following the approach proposed by [1]. We simulate the well known Hernquist model using the SPH code Gadget-3 and consider the full array of dynamical parameters of the particles. We find that, although the cuspy profile is stable, all integrals of motion characterizing individual particles suffer strong unphysical variations along the whole halo, revealing an effective interaction between the test bodies. This result casts doubts on the reliability of the velocity distribution function obtained in the simulations. Moreover, we find unphysical Fokker-Planck streams of particles in the cusp region. The same streams should appear in cosmological N-body simulations, being strong enough to change the shape of the cusp or even to create it. Our analysis, based on the Hernquist model and the standard SPH code, strongly suggests that the UDPs generally found by the cosmological N-body simulations may be a consequence of numerical effects. A much better understanding of the N-body simulation convergency is necessary before a 'core-cusp problem' can properly be used to question the validity of the CDM model.

  20. Urea cycle disorders in Spain: an observational, cross-sectional and multicentric study of 104 cases

    Martín-Hernández, Elena; Aldámiz-Echevarría, Luis; Castejón-Ponce, Esperanza; Pedrón-Giner, Consuelo; Couce, María Luz; Serrano-Nieto, Juliana; Pintos-Morell, Guillem; Bélanger-Quintana, Amaya; Martínez-Pardo, Mercedes; García-Silva, María Teresa; Quijada-Fraile, Pilar; Vitoria-Miñana, Isidro; Dalmau, Jaime; Lama-More, Rosa A; Bueno-Delgado, María Amor

    2014-01-01

    Background Advances in the diagnosis and treatment of urea cycle disorders (UCDs) have led to a higher survival rate. The purpose of this study is to describe the characteristics of patients with urea cycle disorders in Spain. Methods Observational, cross-sectional and multicenter study. Clinical, biochemical and genetic data were collected from patients with UCDs, treated in the metabolic diseases centers in Spain between February 2012 and February 2013, covering the entire Spanish populatio...

  1. Is total pancreatectomy as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy? A single center, prospective, observational study.

    Casadei, Riccardo; Ricci, Claudio; Taffurelli, Giovanni; Guariniello, Anna; Di Gioia, Anthony; Di Marco, Mariacristina; Pagano, Nico; Serra, Carla; Calculli, Lucia; Santini, Donatella; Minni, Francesco

    2016-09-01

    Total pancreatectomy is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. Our aim was to evaluate whether total pancreatectomy can be considered as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy. A single center, prospective, observational trial, regarding postoperative outcomes, long-term results, and cost-effectiveness, in a tertiary referral center was conducted, comparing consecutive patients who underwent elective total pancreatectomy and/or pancreaticoduodenectomy. Seventy-three consecutive elective total pancreatectomies and 184 pancreaticoduodenectomies were compared. There were no significant differences regarding postoperative outcomes and overall survival. The quality of life, evaluated in 119 patients according to the EQ-5D-5L questionnaire, showed that there were no significant differences regarding the five items considered. The mean EQ-5D-5L score was similar in the two procedures (total pancreatectomy = 0.872, range 0.345-1.000; pancreaticoduodenectomy = 0.832, range 0.393-1.000; P = 0.320). The impact of diabetes according to the Problem Areas in Diabetes (PAID) questionnaire did not show any significant differences except for question 13 (total pancreatectomy = 0.60; pancreaticoduodenectomy = 0.19; P = 0.022). The cost-effectiveness analysis suggested that the quality-adjusted life year was not significantly different between the two procedures (total pancreatectomy = 0.910, range 0.345-1.000; pancreaticoduodenectomy = 0.910, range -0.393-1.000; P = 0.320). From this study, it seems reasonable to suggest that total pancreatectomy can be considered as safe, feasible, and efficacious as PD and acceptable in terms of cost-effectiveness.

  2. Improving Initiation and Tracking of Research Projects at an Academic Health Center: A Case Study.

    Schmidt, Susanne; Goros, Martin; Parsons, Helen M; Saygin, Can; Wan, Hung-Da; Shireman, Paula K; Gelfond, Jonathan A L

    2017-09-01

    Research service cores at academic health centers are important in driving translational advancements. Specifically, biostatistics and research design units provide services and training in data analytics, biostatistics, and study design. However, the increasing demand and complexity of assigning appropriate personnel to time-sensitive projects strains existing resources, potentially decreasing productivity and increasing costs. Improving processes for project initiation, assigning appropriate personnel, and tracking time-sensitive projects can eliminate bottlenecks and utilize resources more efficiently. In this case study, we describe our application of lean six sigma principles to our biostatistics unit to establish a systematic continual process improvement cycle for intake, allocation, and tracking of research design and data analysis projects. The define, measure, analyze, improve, and control methodology was used to guide the process improvement. Our goal was to assess and improve the efficiency and effectiveness of operations by objectively measuring outcomes, automating processes, and reducing bottlenecks. As a result, we developed a web-based dashboard application to capture, track, categorize, streamline, and automate project flow. Our workflow system resulted in improved transparency, efficiency, and workload allocation. Using the dashboard application, we reduced the average study intake time from 18 to 6 days, a 66.7% reduction over 12 months (January to December 2015).

  3. Building an outpatient imaging center: A case study at genesis healthcare system, part 2.

    Yanci, Jim

    2006-01-01

    In the second of 2 parts, this article will focus on process improvement projects utilizing a case study at Genesis HealthCare System located in Zanesville, OH. Operational efficiency is a key step in developing a freestanding diagnostic imaging center. The process improvement projects began with an Expert Improvement Session (EIS) on the scheduling process. An EIS session is a facilitated meeting that can last anywhere from 3 hours to 2 days. Its intention is to take a group of people involved with the problem or operational process and work to understand current failures or breakdowns in the process. Recommendations are jointly developed to overcome any current deficiencies, and a work plan is structured to create ownership over the changes. A total of 11 EIS sessions occurred over the course of this project, covering 5 sections: Scheduling/telephone call process, Pre-registration, Verification/pre-certification, MRI throughput, CT throughput. Following is a single example of a project focused on the process improvement efforts. All of the process improvement projects utilized a quasi methodology of "DMAIC" (Define, Measure, Analyze, Improve, and Control).

  4. Archiving oceanographic data at NOAA's National Oceanographic Data Center: A use-case approach

    Biddle, M.; Arzayus, K. M.; Collins, D.; Paver, C. R.; Rutz, S. B.

    2012-12-01

    Current data holdings at the National Oceanographic Data Center (NODC) include physical, biological and chemical measurements of in situ oceanographic variables, satellite data products, and ocean model simulations. NODC acquires data from a wide variety of partners that span academia, government (including state and federal sources), private industry, and non-profit organizations. NODC provides access to these diverse data collections for both current and future use, to ensure that data consumers have the ability to monitor present and past environmental conditions. Using a flexible archival infrastructure enables NODC to archive almost any type of file format. NODC is deploying web services built upon OPeNDAP, THREDDS, Geoportal, and other standard technologies to enable data integration and application-ready data for a broad spectrum of data consumers. To maximize use of these web services, NODC is working with the oceanographic community to utilize standard formats, such as netCDF, for representing data. This poster outlines use cases which describe how a data provider can 1) establish a relationship with NODC, 2) communicate and document requirements for archiving data, 3) fulfill funding agency data management requirements, and 4) implement an automated process for archiving standard recurring data sets, where applicable. As a result of this interaction, NODC can provide valuable feedback to data providers to improve the quality of their metadata and/or data, provide access to archived data via multiple services, and facilitate data use in various data products to inform scientists and the public about the state of the ocean.

  5. Spitzer Infrared Spectrograph Observations of the Galactic Center: Quantifying the Extreme Ultraviolet/Soft X-ray Fluxes

    Simpson, Janet P.

    2018-04-01

    It has long been shown that the extreme ultraviolet spectrum of the ionizing stars of H II regions can be estimated by comparing the observed line emission to detailed models. In the Galactic Center (GC), however, previous observations have shown that the ionizing spectral energy distribution (SED) of the local photon field is strange, producing both very low excitation ionized gas (indicative of ionization by late O stars) and also widespread diffuse emission from atoms too highly ionized to be found in normal H II regions. This paper describes the analysis of all GC spectra taken by Spitzer's Infrared Spectrograph and downloaded from the Spitzer Heritage Archive. In it, H II region densities and abundances are described, and serendipitously discovered candidate planetary nebulae, compact shocks, and candidate young stellar objects are tabulated. Models were computed with Cloudy, using SEDs from Starburst99 plus additional X-rays, and compared to the observed mid-infrared forbidden and recombination lines. The ages inferred from the model fits do not agree with recent proposed star formation sequences (star formation in the GC occurring along streams of gas with density enhancements caused by close encounters with the black hole, Sgr A*), with Sgr B1, Sgr C, and the Arches Cluster being all about the same age, around 4.5 Myr old, with similar X-ray requirements. The fits for the Quintuplet Cluster appear to give a younger age, but that could be caused by higher-energy photons from shocks from stellar winds or from a supernova.

  6. Metropolitan transportation management center : a case study : Michigan intelligent transportation system : improving safety and air quality while reducing stress for motorists

    1999-10-01

    The following case study provides a snapshot of Michigan's Intelligent Transportation Systems transportation management center (MITSC). It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts ...

  7. The Model of Community Learning Center Development: A Case Study of PKBM Assolahiyah in West Java

    Ferdinal Asmin

    2017-12-01

    Full Text Available Sustaining community learning center (CLC as a community activity centerby increasing the community capacity and skill to deal with socio-economics challenges is an important focus to ensure the success of CLC. This study was aimed to describe the sustainability elements of CLC development and analyze the policy elements that influence the sustainability of CLC program, particularly in related to CSR program. This study approach was combining a qualitative approach and quantitative approach with analytic decision method which is never conducted in the previous studies on CLC. Data and information were collected through document studies, observations and structured interviews through questionnaires, then they were analyzed using descriptive analysis and interpretive structural modeling (ISM analysis. From ten elements of CLC sustainability were analyzed, the result of study emphasized to the importance of CLC management capacity enhancement in PKBM Assolahiyah. The result was synthesized into a policy model of CLC development through CSR program. The policy model should involve the roles of government, scientist, and non-governmental organization (NGO to strengthen the CLC development

  8. Building America Case Study: New Town Builders' Power of Zero Energy Center, Denver, Colorado (Brochure)

    2014-10-01

    New Town Builders, a builder of energy efficient homes in Denver, Colorado, offers a zero energy option for all the homes it builds. To attract a wide range of potential homebuyers to its energy efficient homes, New Town Builders created a 'Power of Zero Energy Center' linked to its model home in the Stapleton community of Denver. This case study presents New Town Builders' marketing approach, which is targeted to appeal to homebuyers' emotions rather than overwhelming homebuyers with scientific details about the technology. The exhibits in the Power of Zero Energy Center focus on reduced energy expenses for the homeowner, improved occupant comfort, the reputation of the builder, and the lack of sacrificing the homebuyers' desired design features to achieve zero net energy in the home. The case study also contains customer and realtor testimonials related to the effectiveness of the Center in influencing homebuyers to purchase a zero energy home.

  9. New Whole-House Solutions Case Study: New Town Builders' Power of Zero Energy Center - Denver, Colorado

    None

    2014-10-01

    New Town Builders, a builder of energy efficient homes in Denver, Colorado, offers a zero energy option for all the homes it builds. To attract a wide range of potential homebuyers to its energy efficient homes, New Town Builders created a "Power of Zero Energy Center" linked to its model home in the Stapleton community. This case study presents New Town Builders' marketing approach, which is targeted to appeal to homebuyers' emotions rather than overwhelming homebuyers with scientific details about the technology. The exhibits in the Power of Zero Energy Center focus on reduced energy expenses for the homeowner, improved occupant comfort, the reputation of the builder, and the lack of sacrificing the homebuyers' desired design features to achieve zero net energy in the home. This case study also contains customer and realtor testimonials related to the effectiveness of the Center in influencing homebuyers to purchase a zero energy home.

  10. New methods for solving a vertex p-center problem with uncertain demand-weighted distance: A real case study

    Javad Nematian

    2015-04-01

    Full Text Available Vertex and p-center problems are two well-known types of the center problem. In this paper, a p-center problem with uncertain demand-weighted distance will be introduced in which the demands are considered as fuzzy random variables (FRVs and the objective of the problem is to minimize the maximum distance between a node and its nearest facility. Then, by introducing new methods, the proposed problem is converted to deterministic integer programming (IP problems where these methods will be obtained through the implementation of the possibility theory and fuzzy random chance-constrained programming (FRCCP. Finally, the proposed methods are applied for locating bicycle stations in the city of Tabriz in Iran as a real case study. The computational results of our study show that these methods can be implemented for the center problem with uncertain frameworks.

  11. Symptoms of central sensitization and comorbidity for juvenile fibromyalgia in childhood migraine: an observational study in a tertiary headache center.

    de Tommaso, Marina; Sciruicchio, Vittorio; Delussi, Marianna; Vecchio, Eleonora; Goffredo, Marvita; Simeone, Michele; Barbaro, Maria Grazia Foschino

    2017-12-01

    Central sensitization is an important epiphenomenon of the adult migraine, clinically expressed by allodynia, pericranial tenderness and comorbidity for fibromyalgia in a relevant number of patients. This study aimed to evaluate the frequency and the clinical characteristics of allodynia, pericranial tenderness, and comorbidity for Juvenile Fibromialgia (JFM) in a cohort of migraine children selected in a tertiary headache center. This was an observational cross-sectional study on 8-15 years old migraine patients. Allodynia was assessed by a questionnaire. Pericranial tenderness and comorbidity for JFM as well as their possible association with poor quality of life and migraine related disability, and with other clinical symptoms as anxiety, depression, sleep disorders and pain catastrophizing, were also evaluated. One hundred and fifty one patients were selected, including chronic migraine (n°47), migraine without aura (n° 92) and migraine with aura (n° 12) sufferers. Allodynia was reported in the 96,6% and pericranial tenderness was observed in the 68.8% of patients. Pericranial tenderness was more severe in patients with more frequent migraine and shorter sleep duration. Allodynia seemed associated with anxiety, pain catastrophizing and high disability scores. Comorbidity for JFM was present in the 0.03% ofpatients. These children presented with a severe depression and a significant reduction of quality of life as compared to the other patients. This study outlined a relevant presence of symptoms of central sensitization among children with migraine. Severe allodynia and comorbidity for JFM seemed to cause a general decline of quality of life, which would suggest the opportunity of a routine assessment of these clinical features.

  12. AN OBSERVATIONAL STUDY OF MATERNAL NEAR MISS CASES IN A TERTIARY CARE CENTRE

    Elizabeth Joseph

    2016-12-01

    Full Text Available BACKGROUND DM WIMS is the only tertiary care referral hospital in the hilly tribal district of Wayanad. This is an observational study of 20 maternal near miss cases that presented in our hospital over a period of 4 months. MATERIALS AND METHODS This study was conducted by collecting data over a period of 4 months. Total number of live births in this period was 373. There were 20 cases of maternal near miss cases. Maternal near miss cases were chosen based on the inclusion criteria provided by WHO near miss approach for maternal health. RESULTS There were 373 live births in the 4-month observational period. In these 4 months, there were 20 cases of maternal near miss cases in our hospital. That is, maternal near miss ratio was 53.6/1000 live births. The majority were referred cases with MNM ratio of intrahospital cases being 13.4/1000 live births. The potentially life-threatening complications were obstetric haemorrhage and hypertensive disorders, which coexisted in majority of the women. The obstetric haemorrhage was mainly due to abruptio placenta, which can be attributed to the hypertensive complications. Preexisting anaemia was present in 35% of the MNM cases increasing their morbidity. CONCLUSION The maternal near miss ratio was 53.6/1000 live births, which is high. This can be attributed to the fact that our hospital is the only tertiary referral hospital in the hilly tribal district of Wayanad. Despite the MNM ratio being high, there were no cases of maternal death in this period. Low maternal mortality indicates the good first line of management given at the periphery hospital.

  13. Information systems performance evaluation, introducing a two-level technique: Case study call centers

    Hesham A. Baraka

    2015-03-01

    The objective of this paper was to introduce a new technique that can support decision makers in the call centers industry to evaluate, and analyze the performance of call centers. The technique presented is derived from the research done on measuring the success or failure of information systems. Two models are mainly adopted namely: the Delone and Mclean model first introduced in 1992 and the Design Reality Gap model introduced by Heeks in 2002. Two indices are defined to calculate the performance of the call center; the success index and the Gap Index. An evaluation tool has been developed to allow call centers managers to evaluate the performance of their call centers in a systematic analytical approach; the tool was applied on 4 call centers from different areas, simple applications such as food ordering, marketing, and sales, technical support systems, to more real time services such as the example of emergency control systems. Results showed the importance of using information systems models to evaluate complex systems as call centers. The models used allow identifying the dimensions for the call centers that are facing challenges, together with an identification of the individual indicators in these dimensions that are causing the poor performance of the call center.

  14. Changes in patterns of uveitis at a tertiary referral center in Northern Italy: analysis of 990 consecutive cases.

    Luca, Cimino; Raffaella, Aldigeri; Sylvia, Marchi; Valentina, Mastrofilippo; Fabiana, Viscogliosi; Marco, Coassin; Annamaria, Soldani; Luisa, Savoldi; Alessandro, De Fanti; Lucia, Belloni; Alessandro, Zerbini; Maria, Parmeggiani; Matthew, Chersich; Alessandra, Soriano; Carlo, Salvarani; Luigi, Fontana

    2018-02-01

    The role of uveitis, an uncommon ocular disease, is often neglected in research and treatment of autoimmune conditions. The study described the spectrum of uveitis at a referral center in North Italy, and compared that to a previously published series of patients. We reviewed all patients with uveitis diagnosed from 2013 to 2015 at the Immunology Eye Unit, Arcispedale S. M. Nuova-IRCCS, Reggio Emilia, Italy. We examined patient characteristics, disease spectrum, and etiologies. In total, 990 cases of uveitis were identified, who were mostly female (59%) with a median age at presentation of 44 years (interquartile range = 29-57). Anterior uveitis was most frequent (53.5%), followed by panuveitis (22.8%), posterior (16.2%), and intermediate uveitis (5.5%). Anterior herpetic uveitis (15.6%), Fuchs uveitis (9.7%), and HLA-B27 positive anterior uveitis (7.7%) were the most common specific diagnoses. Compared with the previous series, we observed an increased incidence of uveitis, and a different pattern of diagnoses. Rates of herpetic, HLA-B27 positive uveitis, and presumed ocular tuberculosis were higher, but Fuchs uveitis was less frequent. The pattern of uveitis appears to be changing, very likely due to population-level increases in infectious diseases, to the availability of new diagnostic tests and to the interdisciplinary approach used in patient diagnosis.

  15. Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study.

    Li, Cheng; Zhao, Wei-Hong; Meng, Chun-Xia; Ping, Hua; Qin, Guo-Juan; Cao, Shu-Jun; Xi, Xiaowei; Zhu, Qian; Li, Xiao-Cui; Zhang, Jian

    2014-01-01

    To evaluate the association between the risk of ectopic pregnancy (EP) and the use of common contraceptives during the previous and current conception/menstrual cycle. A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411). Women with intrauterine pregnancy (IUP) (n = 2,416) and non-pregnant women (n = 2,419) were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and the corresponding 95% confidential intervals (CIs). Previous use of intrauterine devices (IUDs) was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48-2.37]; AOR2 = 1.84 [1.49-2.27]), and the risk increased with the duration of previous use (P1 for trend contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03-0.05]; withdrawal method: AOR = 0.10 [0.07-0.13]; calendar rhythm method: AOR = 0.54 [0.40-0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02-0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16-0.30]; IUDs: AOR = 0.01 [0.005-0.012]; tubal sterilization: AOR = 0.01 [0.001-0.022]) and unwanted EP (condom: AOR1 = 0.05 [0.04-0.06]; withdrawal method: AOR1 = 0.13 [0.09-0.19]; calendar rhythm method: AOR1 = 0.66 [0.48-0.91]; OCPs: AOR1 = 0.14 [0.07-0.26]; IUDs: AOR1 = 0.17 [0.13-0.22]; tubal sterilization: AOR1 = 0.04 [0.02-0.08]). However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64-10.07]), LNG-EC (AOR2 = 4.87 [3.88-6.10]), IUDs (AOR2 = 21.08 [13.44-33.07]), and tubal sterilization (AOR2 = 7.68 [1.69-34.80]) increased the risk of EP compared with the non-use of contraceptives. Current use of most contraceptives reduce the risk of both IUP and EP. However, if the

  16. Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study.

    Cheng Li

    Full Text Available To evaluate the association between the risk of ectopic pregnancy (EP and the use of common contraceptives during the previous and current conception/menstrual cycle.A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411. Women with intrauterine pregnancy (IUP (n = 2,416 and non-pregnant women (n = 2,419 were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs and the corresponding 95% confidential intervals (CIs.Previous use of intrauterine devices (IUDs was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48-2.37]; AOR2 = 1.84 [1.49-2.27], and the risk increased with the duration of previous use (P1 for trend <10-4, P2 for trend <10-4. The current use of most contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03-0.05]; withdrawal method: AOR = 0.10 [0.07-0.13]; calendar rhythm method: AOR = 0.54 [0.40-0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02-0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16-0.30]; IUDs: AOR = 0.01 [0.005-0.012]; tubal sterilization: AOR = 0.01 [0.001-0.022] and unwanted EP (condom: AOR1 = 0.05 [0.04-0.06]; withdrawal method: AOR1 = 0.13 [0.09-0.19]; calendar rhythm method: AOR1 = 0.66 [0.48-0.91]; OCPs: AOR1 = 0.14 [0.07-0.26]; IUDs: AOR1 = 0.17 [0.13-0.22]; tubal sterilization: AOR1 = 0.04 [0.02-0.08]. However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64-10.07], LNG-EC (AOR2 = 4.87 [3.88-6.10], IUDs (AOR2 = 21.08 [13.44-33.07], and tubal sterilization (AOR2 = 7.68 [1.69-34.80] increased the risk of EP compared with the non-use of contraceptives.Current use of most

  17. Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes.

    Reilly-Shah, Vikas N O'; Lynde, Grant C; Mitchell, Matthew L; Maffeo, Carla L; Jabaley, Craig S; Wolf, Francis A

    2018-05-30

    Sugammadex can rapidly reverse deep neuromuscular blockade, but due to cost questions remain as to its optimal utilization. After introduction for unrestricted use at an academic medical center, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS), and emergence time (surgery end to anesthesia end time in PACU). We conducted a retrospective observational study of patients undergoing general anesthesia over a 12-month period. Using multiple variable penalized logistic regression in a one group before-and-after design, we compared categorized rates of PACU MV to examine the effect of sugammadex introduction following a post-hoc chart review to ascertain the reason for postoperative MV. Additionally, multiple variable linear regression was used to assess for differences in PACU LOS and emergence time within a propensity matched set of patients receiving neostigmine or sugammadex. 7,217 cases met inclusion criteria: 3,798 before and 3,419 after the introduction of sugammadex. The incidence of PACU MV was 2.3% before and 1.8% after (p=0.118). PACU MV due to residual neuromuscular blockade (rNMB) decreased from 0.63% to 0.20% (p=0.005). Ventilation due to other causes was unchanged. PACU LOS and emergence time were unchanged in a propensity matched set of 1,444 cases. We identified rNMB as an important contributor to PACU MV utilization and observed a significant decrease after sugammadex was introduced. The selected efficiency measures may not have been sufficiently granular to identify improvements following introduction.

  18. Integrating Student-Centered Learning in Finance Courses: The Case of a Malaysian Research University

    Janor, Hawati; Rahim, Ruzita Abdul; Rahman, Aisyah Abdul; Auzairy, Noor Azryani; Hashim, Noor Azuan; Yusof, Muhamad Zain

    2013-01-01

    The student-centered learning (SCL) approach is an approach to education that focuses on learners and their needs, rather than relying upon the input of the teacher's. The present paper examines how the SCL approach is integrated as a learner-centered paradigm into finance courses offered at a business school in a research university in Malaysia.…

  19. Case studies of individualized professional development at an outdoor education center

    Pearsall, Marjorie

    various activities and lessons while at the center, and the assessment of the student's learning following the experience. The staff works with each teacher to prepare them to use transdisciplinary science lessons which were planned to satisfy and enrich state, district, and school expectations (Outdoor Education Guidebook, 1997). The staff members believe that if the teachers are prepared to do these things, not only will the current students learn more, but that the teacher will experience growth professionally and this will impact more children over time. The teachers gain science content knowledge and learn constructivist teaching strategies while learning how to use the facilities and equipment safely and confidently. Ideas for preparatory and follow-up activities are made available. This study looked closely at the individualization of the professional development provided by this informal science institution. Data from observations of professional development sessions as well as the on-site experiences with the children were used in the study. Teachers were asked to reflect on the degree to which the Arlington Echo approach to professional development was beneficial in building their confidence about providing science-based, interdisciplinary experiences for their students, with comparisons made between the responses of veteran teachers and those of teachers with fewer years of experience. Through the reflections of the participant teachers, it was possible to gather data about whether their beliefs about science and about how science is best taught were modified by this experience.

  20. Managing the Shopping Center Ambience Attributes by Using Importance-Performance Analysis: The Case from Serbia

    Jelica Marković

    2014-06-01

    Full Text Available This paper examined customers’ perceived importance and performance of shopping center ambience on the examples of the Mercator shopping center and Sad Novi Bazaar shopping center in Novi Sad, Serbia. The shopping center ambience was examined through exterior and interior attributes. It was found that a number of them are very important to customers and their shopping behavior. According to the present research, the most important exterior attributes are: address and location, parking availability, congestion and traffic, exterior display windows and entrances. The most important interior attributes are: cleanliness, temperature, merchandise, lighting, music, scents, absence of tobacco smoke, width of aisles and P.A. usage. The paper also provided information for two studied shopping centers with ambience attributes that performed well or not and everything was presented on the importance-performance grids, which can serve managers as guidelines for further development.

  1. Geodetic observations and modeling of magmatic inflation at the Three Sisters volcanic center, central Oregon Cascade Range, USA

    Dzurisin, Daniel; Lisowski, Michael; Wicks, Charles W.; Poland, Michael P.; Endo, Elliot T.

    2006-02-01

    Tumescence at the Three Sisters volcanic center began sometime between summer 1996 and summer 1998 and was discovered in April 2001 using interferometric synthetic aperture radar (InSAR). Swelling is centered about 5 km west of the summit of South Sister, a composite basaltic-andesite to rhyolite volcano that last erupted between 2200 and 2000 yr ago, and it affects an area ˜20 km in diameter within the Three Sisters Wilderness. Yearly InSAR observations show that the average maximum displacement rate was 3-5 cm/yr through summer 2001, and the velocity of a continuous GPS station within the deforming area was essentially constant from June 2001 to June 2004. The background level of seismic activity has been low, suggesting that temperatures in the source region are high enough or the strain rate has been low enough to favor plastic deformation over brittle failure. A swarm of about 300 small earthquakes ( Mmax = 1.9) in the northeast quadrant of the deforming area on March 23-26, 2004, was the first notable seismicity in the area for at least two decades. The U.S. Geological Survey (USGS) established tilt-leveling and EDM networks at South Sister in 1985-1986, resurveyed them in 2001, the latter with GPS, and extended them to cover more of the deforming area. The 2001 tilt-leveling results are consistent with the inference drawn from InSAR that the current deformation episode did not start before 1996, i.e., the amount of deformation during 1995-2001 from InSAR fully accounts for the net tilt at South Sister during 1985-2001 from tilt-leveling. Subsequent InSAR, GPS, and leveling observations constrain the source location, geometry, and inflation rate as a function of time. A best-fit source model derived from simultaneous inversion of all three datasets is a dipping sill located 6.5 ± 2.5 km below the surface with a volume increase of 5.0 × 10 6 ± 1.5 × 10 6 m 3/yr (95% confidence limits). The most likely cause of tumescence is a pulse of basaltic magma

  2. Psychological Factors Associated with Chronic Migraine and Severe Migraine-Related Disability: an Observational Study in a Tertiary Headache Center

    Seng, Elizabeth K.; Buse, Dawn C.; Klepper, Jaclyn E.; Mayson, Sarah Jo; Grinberg, Amy S.; Grosberg, Brian M.; Pavlovic, Jelena M.; Robbins, Matthew S.; Vollbracht, Sarah E.; Lipton, Richard B.

    2016-01-01

    Objective To evaluate relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. Background Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. Methods Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors [depressive symptoms (Patient Health Questionnaire-9), anxious symptoms (Generalized Anxiety Disorder-7), Pain Catastrophizing Scale and Headache Specific Locus of Control]. Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. Results Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1,11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. Conclusions Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate relationships among naturalistic

  3. Ocular syphilis: Case Series (2000–2015) from Two Tertiary Care Centers in Montreal

    Vadboncoeur, Julie; Rabia, Yasmine; Aubin, Marie-Josée; Labbé, Annie-Claude; Jaworsky, Laurence; Serhir, Bouchra; Fortin, Claude

    2017-01-01

    Abstract Background In the past 15 years, a recrudescence of syphilis was observed in Canada, along with a surge in ocular syphilis cases. Without treatment, ocular syphilis can have serious consequences potentially leading to blindness. Our goal was to describe the demographics, clinical presentations, proportion of co-infection with HIV, treatments and visual outcomes of ocular syphilis cases. Methods Patients with a confirmed positive syphilis serology between 2000 and 2015 were identified through the reference laboratory database. A retrospective chart review was performed for those who visited the ophthalmology clinic of Hôpital Maisonneuve-Rosemont or Hôpital Notre-Dame to identify ocular syphilis cases. Results Among the 119 patients (174 eyes) identified (2.5% of the population screened), 80% were male; of which 63% were MSM. Mean presenting logMAR visual acuity was 0.70 (20/100 Snellen) and unilateral ocular involvement occurred in 54%. Ocular manifestations included interstitial keratitis (24 eyes), anterior uveitis (37 eyes), intermediate uveitis (17 eyes), posterior uveitis (31 eyes), panuveitis (27 eyes), isolated optic nerve involvement (25 eyes), and others (12 eyes) including VI nerve palsy, scleritis, and episcleritis. Cerebrospinal fluid (CSF) examination was done in 65 (55%) patients. Of those, VDRL was positive in 14 (22%) patients; white blood cells and proteins were elevated in, respectively, 28 (43%) and 39 (60%) of patients. HIV status was unknown in 39 (33%) patients; among those whose serology were performed (or previous status was known), 38 (48%) were HIV infected. Intravenous aqueous penicillin G was administered in 69 (58%), intramuscular benzathine penicillin in 25 (21%) and other antibiotics, mainly due to allergy, in three (3%) patients. Treatment allowed a visual improvement of –0.22 logMAR (gain of five lines on Snellen chart) after a mean follow-up period of 19 months. Conclusion Syphilis can manifest with a widely

  4. Evaluating and improving incident management using historical incident data : case studies at Texas transportation management centers.

    2009-08-01

    The companion guidebook (0-5485-P2) developed as part of this study provides the procedures and : methodologies for effective use of historical incident data at Texas Transportation Management Centers : (TMCs). This research report documents the resu...

  5. User-centered design in brain-computer interfaces-a case study.

    Schreuder, Martijn; Riccio, Angela; Risetti, Monica; Dähne, Sven; Ramsay, Andrew; Williamson, John; Mattia, Donatella; Tangermann, Michael

    2013-10-01

    The array of available brain-computer interface (BCI) paradigms has continued to grow, and so has the corresponding set of machine learning methods which are at the core of BCI systems. The latter have evolved to provide more robust data analysis solutions, and as a consequence the proportion of healthy BCI users who can use a BCI successfully is growing. With this development the chances have increased that the needs and abilities of specific patients, the end-users, can be covered by an existing BCI approach. However, most end-users who have experienced the use of a BCI system at all have encountered a single paradigm only. This paradigm is typically the one that is being tested in the study that the end-user happens to be enrolled in, along with other end-users. Though this corresponds to the preferred study arrangement for basic research, it does not ensure that the end-user experiences a working BCI. In this study, a different approach was taken; that of a user-centered design. It is the prevailing process in traditional assistive technology. Given an individual user with a particular clinical profile, several available BCI approaches are tested and - if necessary - adapted to him/her until a suitable BCI system is found. Described is the case of a 48-year-old woman who suffered from an ischemic brain stem stroke, leading to a severe motor- and communication deficit. She was enrolled in studies with two different BCI systems before a suitable system was found. The first was an auditory event-related potential (ERP) paradigm and the second a visual ERP paradigm, both of which are established in literature. The auditory paradigm did not work successfully, despite favorable preconditions. The visual paradigm worked flawlessly, as found over several sessions. This discrepancy in performance can possibly be explained by the user's clinical deficit in several key neuropsychological indicators, such as attention and working memory. While the auditory paradigm relies

  6. GLOBE Observer and the Association of Science & Technology Centers: Leveraging Citizen Science and Partnerships for an International Science Experiment to Build Climate Literacy

    Riebeek Kohl, H.; Chambers, L. H.; Murphy, T.

    2016-12-01

    For more that 20 years, the Global Learning and Observations to Benefit the Environment (GLOBE) Program has sought to increase environment literacy in students by involving them in the process of data collection and scientific research. In 2016, the program expanded to accept observations from citizen scientists of all ages through a relatively simple app. Called GLOBE Observer, the new program aims to help participants feel connected to a global community focused on advancing the scientific understanding of Earth system science while building climate literacy among participants and increasing valuable environmental data points to expand both student and scientific research. In October 2016, GLOBE Observer partnered with the Association of Science & Technology Centers (ASTC) in an international science experiment in which museums and patrons around the world collected cloud observations through GLOBE Observer to create a global cloud map in support of NASA satellite science. The experiment was an element of the International Science Center and Science Museum Day, an event planned in partnership with UNESCO and ASTC. Museums and science centers provided the climate context for the observations, while GLOBE Observer offered a uniform experience and a digital platform to build a connected global community. This talk will introduce GLOBE Observer and will present the results of the experiment, including evaluation feedback on gains in climate literacy through the event.

  7. Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa.

    Chowdhury, Sharfuddin; Nicol, Andrew John; Moydien, Mahammed Riyaad; Navsaria, Pradeep Harkison; Montoya-Pelaez, Luis Felipe

    2018-01-01

    The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death. Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications. One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35-60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications ( p  = 0.074). Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

  8. Statistical observation on autopsy cases of malignancy at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital

    Takahara, O; Toyoda, S; Tsuno, S; Mukai, H; Uemura, S [Nagasaki Atomic Bomb Hospital (Japan)

    1976-09-01

    Statistical observation was made as to autopsy cases of atomic-bomb survivors in Nagasaki. The total of autopsy cases at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital from the opening of the hospital, 1968, to December in 1975 was 1,486 cases (autopsy rate, 65.1%) in which 880 cases of atomic bomb survivors (autopsy rate, 68.0%) were contained. Cases of malignancy totaled 829 and 528 cases of those were atomic bomb survivors. Cases of malignancy were divided into three groups, that is, group exposured to atomic bomb at place within 2 km from the explosion place, group exposured at place from more than 2 km or entering after explosion into the city, and not-exposured group. Relationship between main malignancies and exposure was discussed, and the following results were obtained. 1) Obvious relationship was found to exist between exposure and acute and chronic medullary leukemia. 2) Malignant lymphoma was scarcely correlated with exposure, but its occurrence rate was higher than the mean rate in Japan in reflection the region where this disease occurs much geographically. 3) Relationship between exposure and stomach cancer, lung cancer, cancer of the large intestine, and double cancer was not found obviously, but occurrence rate of hepatic cancer was higher than the mean rate in Japan in three groups. The reason was supposed to be geographical factor. 4) Cases of thyroid gland cancer were a small number in female of the group exposured within 2 km, and cases of prostate cancer were a small number in the group within 2 km, but their occurrence rate was high specifically.

  9. Statistical observation on autopsy cases of malignancy at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital

    Takahara, Osamu; Toyoda, Shigeki; Tsuno, Sumio; Mukai, Hideaki; Uemura, Seiji

    1976-01-01

    Statistical observation was made as to autopsy cases of atomic-bomb survivors in Nagasaki. The total of autopsy cases at the Japanese Red Cross, Nagasaki Atomic Bomb Hospital from the opening of the hospital, 1968, to December in 1975 was 1,486 cases (autopsy rate, 65.1%) in which 880 cases of atomic bomb survivors (autopsy rate, 68.0%) were contained. Cases of malignancy totaled 829 and 528 cases of those were atomic bomb survivors. Cases of malignancy were divided into three groups, that is, group exposured to atomic bomb at place within 2 km from the explosion place, group exposured at place from more than 2 km or entering after explosion into the city, and not-exposured group. Relationship between main malignancies and exposure was discussed, and the following results were obtained. 1) Obvious relationship was found to exist between exposure and acute and chronic medullary leukemia. 2) Malignant lymphoma was scarecely correlated with exposure, but its occurrence rate was higher than the mean rate in Japan in reflection the region where this disease occurs much geographically. 3) Relationship between exposure and stomach cancer, lung cancer, cancer of the large intestine, and double cancer was not found obviously, but occurrence rate of hepatic cancer was higher than the mean rate in Japan in three groups. The reason was supposed to be geographical factor. 4) Cases of thyroid gland cancer were a small number in female of the group exposured within 2 km, and cases of prostate cancer were a small number in the group within 2 km, but their occurrence rate was high specifically. (Tsunoda, M.)

  10. Earth Observation Data Quality Monitoring and Control: A Case Study of STAR Central Data Repository

    Han, W.; Jochum, M.

    2017-12-01

    Earth observation data quality is very important for researchers and decision makers involved in weather forecasting, severe weather warning, disaster and emergency response, environmental monitoring, etc. Monitoring and control earth observation data quality, especially accuracy, completeness, and timeliness, is very useful in data management and governance to optimize data flow, discover potential transmission issues, and better connect data providers and users. Taking a centralized near real-time satellite data repository, STAR (Center for Satellite Applications and Research of NOAA) Central Data Repository (SCDR), as an example, this paper describes how to develop new mechanism to verify data integrity, check data completeness, and monitor data latency in an operational data management system. Such quality monitoring and control of large volume satellite data help data providers and managers improve data transmission of near real-time satellite data, enhance its acquisition and management, and overcome performance and management issues to better serve research and development activities.

  11. Symphony: A case study for exploring and describing design methods and guidelines for learner-centered design

    Quintana, Christopher

    Learner-centered design is an evolving software design perspective addressing the needs of learners---a specific audience trying to work in and understand new work practices in which they have a novice or naive understanding. Learner-centered design involves designing software that incorporates work support features (or scaffolding features) informed by social constructivist learning theories. By adopting a constructivist "learning by doing" perspective, scaffolds should support learners so they can mindfully engage in previously inaccessible work activity, which in turn allows those learners to progressively gain a better understanding of the new work. While there is an intuitive notion of "learner-centered design", there is less specific design information for developing learner-centered software. As a result, learner-centered software results from "educated guesses" and ad-hoc design approaches rather than from systematic design methods. Thus there is a need for specific design guidance to facilitate the development of learner-centered tools that help learners see the tasks, terminology, tools, etc. in the new work context and engage in that work. The research in this dissertation provides a more specific base of learner-centered design descriptions, methods, and guidelines to analyze work practices and design and evaluate scaffolds. The research approach involves using the development of Symphony---a scaffolded integrated tool environment for high-school students learning the work of computational science inquiry---as a case study to develop the learner-centered design approach. Symphony incorporates a variety of science tools with process scaffolding to support students in performing complex air pollution investigations. Six ninth-grade students used Symphony to investigate air quality questions for several weeks in an environmental science class. The student testing helped assess the effectiveness of the software scaffolding and in turn, the learner-centered

  12. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases.

    Yamada, Shozo; Fukuhara, Noriaki; Horiguchi, Kentaro; Yamaguchi-Okada, Mitsuo; Nishioka, Hiroshi; Takeshita, Akira; Takeuchi, Yasuhiro; Ito, Junko; Inoshita, Naoko

    2014-12-01

    The aim of this study was to analyze clinicopathological characteristics and treatment outcomes in a large single-center clinical series of cases of thyrotropin (TSH)-secreting pituitary adenomas. The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 consecutive cases of TSH-secreting pituitary adenomas treated with transsphenoidal surgery between December 1991 and May 2013. The patient group included 47 females and 43 males (median age 42 years, range 11-74 years). Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were significantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confirmed in 21 patients (23%). In 67 cases (74%), the tumors were firm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthyroidism was achieved in 40 (83%) of 48 patients and tumor shrinkage was found in 24 (55%) of 44 patients following preoperative somatostatin analog treatment. Conventional transsphenoidal surgery, extended transsphenoidal surgery, and a simultaneous combined supra- and infrasellar approach were performed in 85, 2, and 3 patients, respectively. Total removal with endocrinological remission was achieved in 76 (84%) of 90 patients, including all 16 (100%) patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. None of these 76 patients experienced tumor recurrence during a median follow-up period of 2.8 years. Stratifying by Knosp grade, total removal with endocrinological remission was achieved in 34 of 36 patients with Knosp Grade 0 tumors, all 24 of those with Grade 1 tumors, 12 of the 14 with Grade 2 tumors, 6 of the 8 with Grade 3 tumors, and none of the 8 with Grade 4 tumors. Cavernous sinus invasion and tumor size were significant independent predictors of surgical

  13. Satellite observed impacts of wildfires on regional atmosphere composition and shortwave radiative forcing: multiple cases study

    Fu, Y.; Li, R.; Huang, J.; Bergeron, Y.; Fu, Y.

    2017-12-01

    Emissions of aerosols and trace gases from wildfires and the direct shortwave radiative forcing were studied using multi-satellite/sensor observations from Aqua Moderate-Resolution Imaging Spectroradiometer (MODIS), Aqua Atmospheric Infrared Sounder (AIRS), Aura Ozone Monitoring Instrument (OMI), and Aqua Cloud's and the Earth's Radiant Energy System (CERES). The selected cases occurred in Northeast of China (NEC), Siberia of Russia, California of America have dominant fuel types of cropland, mixed forest and needleleaf forest, respectively. The Fire radiative power (FRP) based emission coefficients (Ce) of aerosol, NOx (NO2+NO), formaldehyde (HCHO), and carbon monoxide (CO) showed significant differences from case to case. 1) the FRP of the cropland case in NEC is strongest, however, the Ce of aerosol is the lowest (20.51 ± 2.55 g MJ-1). The highest Ce of aerosol is 71.34 ± 13.24 g MJ-1 in the needleleaf fire case in California. 2) For NOx, the highest Ce existed in the cropland case in NEC (2.76 ± 0.25 g MJ-1), which is more than three times of those in the forest fires in Siberia and California. 3) The Ce of CO is 70.21±10.97 and 88.38±46.16 g MJ-1 in the forest fires in Western Siberia and California, which are about four times of that in cropland fire. 4) The variation of Ce of HCHO are relatively small among cases. Strong spatial correlations are found among aerosol optical depth (AOD), NOx, HCHO, and CO. The ratios of NOx to AOD, HCHO, and CO in the cropland case in NEC show much higher values than those in other cases. Although huge differences of emissions and composition ratios exist among cases, the direct shortwave (SW) radiative forcing efficiency (SWARFE) of smoke at the top of the atmosphere (TOA) are in good agreement, with the shortwave radiative forcing efficiencies values of 20.09 to 22.93 per unit AOD. Results in this study reveal noteworthy variations of the FRP-based emissions coefficient and relative chemical composition in the smoke

  14. The Link between Internal Marketing and Customer Relationship Management : A Case Study of one Nordea Call Center in Sweden

    Stenbeck, Joakim; Cabander, Robin

    2008-01-01

    Purpose: The purpose of this thesis is to increase the understanding of the link between internal marketing and customer relationship management by conducting a case study of one Nordea call center. Background: Keeping existing customers is less expensive than acquiring new ones. Nowadays, up to sixty percent of marketing budgets are being dedicated towards retaining customers. So forth customer relationship manage-ment is slowly beginning to penetrate the banking industry as sustaina-ble rel...

  15. Marketing Management and Cultural Learning Center: The Case Study of Arts and Cultural Office, Suansunandha Rajabhat University

    Pirada Techaratpong

    2014-01-01

    This qualitative research has 2 objectives: to study marketing management of the cultural learning center in Suansunandha Rajabhat University and to suggest guidelines to improve its marketing management. This research is based on a case study of the Arts and Culture Office in Suansunandha Rajabhat University, Bangkok. This research found the Art and Culture Office has no formal marketing management. However, the marketing management is partly covered in the overall bu...

  16. The Barrow Innovation Center Case Series: A novel 3D-printed retractor for use with electromagnetic neuronavigation systems.

    Bohl, Michael A; Xu, David S; Cavallo, Claudio; Paisan, Gabriella M; Smith, Kris A; Nakaji, Peter

    2018-06-01

    The Barrow Innovation Center consists of an educational program that promotes interdisciplinary collaboration among neurosurgery, legal, and engineering professionals to foster the development of new medical devices. This report describes a common issue faced during the placement of ventricular shunts for the treatment of hydrocephalus, and the solution to this problem that was developed through the Barrow Innovation Center. Neurosurgery residents involved in the Barrow Innovation Center presented the problem of ferromagnetic retractors interfering with pinless image-guidance systems at a monthly meeting. Potential solutions were openly discussed by an interdisciplinary committee of neurosurgeons, patent lawyers, and biomedical engineers. The committee decided to pursue development of a novel self-retaining retractor made of non-ferromagnetic material as a solution to the problem. Each retractor design was tested in the cadaver laboratory for size and functionality. A final design was chosen and used in a surgical case requiring ventriculoperitoneal shunt placement. The new retractor successfully retracted the scalp without interfering with the electromagnetic image-guidance system. Through the interdisciplinary Barrow Innovation Center program, a newly designed, 3-dimensional-printed skin and soft tissue retractor was created, along with an innovative universal shunt retainer. Through this integrated program dedicated to surgical innovation (i.e., the Barrow Innovation Center), the process of developing and implementing new technology at our institution has been streamlined, creating a culture of innovation within the neurosurgery training program. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Case-based Learning in Microbiology: Observations from a North West Indian Medical College.

    Singhal, Anita

    2017-12-01

    Microbiology is usually taught by conventional lectures, and its retention and application is observed to be poor among medical graduates/practitioners. Introduction of case-based learning (CBL) in microbiology for second-year professional MBBS students. Students were divided into two groups of fifty each. Four clinical cases were used for CBL. One group had two CBL sessions whereas the other had didactic lectures (DLs) and then the groups were crossed over. Case scenario handouts were given to students a week before the session, and smaller groups were formed for discussions and presentations in CBL sessions. Posttest, in multiple choice questions format, was conducted in two phases: First, immediately after the completion of the four CBL and DL sessions, and second, 6 weeks after the first posttest. Student and faculty feedback was taken about CBL sessions. Hundred MBBS students of the fourth semester voluntarily participated in the CBL study. The CBL scores were significantly higher than DL session scores ( P = 0.015). This difference was more marked in scoring done after 6 weeks of session completion ( P < 0.001). Student reported satisfaction in being taught by CBL method in 5-point Likert scale feedback form. Faculty feedback was positive for CBL. CBL helped in retention of knowledge and its application better than DL in our observation. More sessions on commonly encountered case scenarios will be useful for students in recalling basic science knowledge in their later years as practitioners.

  18. Trend of tuberculosis cases under directly observed treatment, short-course strategy in Tabriz, Iran, from 2001 to 2011

    Zhila Khamnian

    2016-02-01

    Full Text Available Introduction: The universal target under the Millennium Development Goals (MDGs is to reduce the worldwide burden of tuberculosis (TB 2015, and we wanted to evaluate development in TB control by assessment of the time trend in incidence and death rate in Tabriz, Iran. Methods: This was a retrospective trend analysis of the data have been recorded in East Azerbaijan State TB center during 10 years. Data were related to patients have been registered for treatment under the directly observed treatment, short-course (DOTS strategy from 2001 to 2011. Results: In total, 3283 TB patients were treated under DOTS strategy during 2001-2011. Males constituted 55.0% of subjects. The risk was the highest among the productive age group (15-44 years. About 61.0% of cases had pulmonary, and 78.0% of pulmonary TB patients were found to be the sputum smear positive than 46.0% of them were new sputum smear positive, and 2.0% of them were relapse. On average, for sputum smear positive, TB cases from 2005 to 2011; the treatment success rate was 87.3%; the cure rate was 80.2%; the treatment failure rate was 0.5% and death rate was 10.3%. In general, the TB incidence rate for all TB cases was decreased from 11.9-8.1 a 100000 population and the smear-positive pulmonary TB incidence rate were decreased from 4.7 to 4.1 a 100000 population in eastern Azerbaijan province during 2001-2011. Conclusion: In general, we had a decrease in the incidence rate for all of TB cases. In addition, we had a fall in cure rate and had an increase in drug side effects rate in this year that can be because of elevated old people ratio and high death rate by other indirect causes and lack of regular visits and medications taking according to the treatment protocol.

  19. Observer Variation in Computed Tomography of the Sacroiliac Joints: A Retrospective Analysis of 1383 Cases

    Geijer, M.; Gadeholt Goethlin, G.; Goethlin, J.H.

    2007-01-01

    Background: Computed tomography (CT) for evaluation of sacroiliitis has a higher diagnostic accuracy than radiography. There is a high degree of interobserver variation in evaluating sacroiliitis on radiographs. Purpose: To evaluate interobserver variation in CT of the sacroiliac joints for evaluation of sacroiliitis in a large number of patients. Material and Methods: 1383 CT examinations of the sacroiliac joints were reviewed by two observers. The outcomes as originally reported and the findings from the reviews were classified as no sacroiliitis, equivocal, unilateral sacroiliitis, or bilateral sacroiliitis. The unweighted kappa statistic was used for assessment of observer agreement. Results: The interobserver agreement between the two reviewers was good (0.6724), with excellent agreement on cases of bilateral sacroiliitis and moderate agreement on cases of unilateral sacroiliitis. Excellent agreement was also reached in normal cases. Compared to the original reports, there were moderate interobserver agreements between both reviewers' findings and the original reports 0.4651 and 0.4481, respectively). Conclusion: The interobserver variation for the diagnosis of sacroiliitis on CT between two reviewers in a study setting showed good agreement, with moderate agreement between each of the observers and the original clinical reports. CT is a reliable method for evaluating the sacroiliac joints for changes of sacroiliitis

  20. Observer Variation in Computed Tomography of the Sacroiliac Joints: A Retrospective Analysis of 1383 Cases

    Geijer, M.; Gadeholt Goethlin, G.; Goethlin, J.H. [Dept. of Diagnostic Radiology, Sahlgrenska Univ. Hospital, Goeteborg (Sweden)

    2007-08-15

    Background: Computed tomography (CT) for evaluation of sacroiliitis has a higher diagnostic accuracy than radiography. There is a high degree of interobserver variation in evaluating sacroiliitis on radiographs. Purpose: To evaluate interobserver variation in CT of the sacroiliac joints for evaluation of sacroiliitis in a large number of patients. Material and Methods: 1383 CT examinations of the sacroiliac joints were reviewed by two observers. The outcomes as originally reported and the findings from the reviews were classified as no sacroiliitis, equivocal, unilateral sacroiliitis, or bilateral sacroiliitis. The unweighted kappa statistic was used for assessment of observer agreement. Results: The interobserver agreement between the two reviewers was good (0.6724), with excellent agreement on cases of bilateral sacroiliitis and moderate agreement on cases of unilateral sacroiliitis. Excellent agreement was also reached in normal cases. Compared to the original reports, there were moderate interobserver agreements between both reviewers' findings and the original reports 0.4651 and 0.4481, respectively). Conclusion: The interobserver variation for the diagnosis of sacroiliitis on CT between two reviewers in a study setting showed good agreement, with moderate agreement between each of the observers and the original clinical reports. CT is a reliable method for evaluating the sacroiliac joints for changes of sacroiliitis.

  1. The increasing incidence of paranasal organizing hematoma: a 20-year experience of 23 cases at a single center.

    Kim, Jong Seung; Oh, Jong Seok; Kwon, Sam Hyun

    2016-06-01

    Sinonasal organized hematoma is a rare, benign disease that can be locally aggressive and may be mistaken for malignancy. Because of its rarity, the clinical characteristics are not well known. The aim of this study is to investigate the distinguishing features of organized hematoma with an emphasis on incidence change. In this retrospective study, we reviewed the records of 23 patients with organized hematoma confirmed histopathologically among 5,378 patients who underwent endoscopic sinus surgery performed by a single surgeon from January 1995 to December 2014 at a tertiary care center. Clinical symptoms, endoscopic photography, computed tomography, and operative findings were reviewed. We also reviewed the relevant literature. Age, sex, site, origin subsite and histopathology were investigated. A statistical review was performed using R 3.1.2 to examine incidence change. The most common complaint was frequent epistaxis and nasal obstruction (52.1%). Of the 23 patients, eight were women and 15 were men with an age range of 18 to 75 years. (mean 38.9 years). Nine of these hematomas occurred on the right side and 14 on the left side. The predominant occurrence site was the antrum (65%), followed by the septum (17.3%), inferior turbinate (8%), and ethmoid sinus (8%). The incidence steadily increased over 20 years. Investigation of the clinical characteristics and incidence change of organized hematoma can provide useful information. Through analysis of the 23 cases in our study, the age distribution was found to be bimodal and the incidence of organizing hematoma was observed to steadily increase. Clinicians should be aware of these characteristics to avoid misdiagnoses of malignant tumors.

  2. Managing service potentiality of small urban centers case study: City of Sardasht, south east of Iran

    Farjam Rasoul

    2017-06-01

    Finding showed that those services which are more important in role fulfillment of Sardasht market-town include: sanitation house, health, remedial centers, drugstore, dentistry, high school, pre-university, library, transportation, trading agricultural instrument, referring to the banks, foodstuff and nonfood stuffs stores, post office and telecommunication, referring to official & disciplinary centers, medical services, veterinary. And to some extent farming instruments markets doesn’t affect role fulfillment so it should be focused by those locals in charge. Also the results showed that three settlements, Khomeinishahr, Jakdan and Goharan are going to continue the role fulfillment of Sardasht market- town.

  3. Shopping centers as attractive spaces for urban mobility. The case of the Community of Madrid

    Cristina López García de Leániz

    2017-08-01

    Full Text Available Malls have become important focal points of trips in the outskirts of major urban conurbations. These trips take place predominantly in private vehicles, this compromising the objectives of sustainable mobility policies set by most of the metropolis. This article aims at characterizing the mobility patterns attracted by shopping malls within the Madrid metropolitan area. It is based on surveys carried out in eleven large commercial centers. Its departing hypothesis underlines that the location of shopping centers largely determines its incoming travel patterns. Therefore, from the standpoint of public policy, solutions should be addressed more from the perspective of urban planning that from the improvement of infrastructure and transport services.

  4. High Spectral Resolution Observation of the Soft Diffuse X-ray Background in the Direction of the Galactic Anti-Center

    Wulf, Dallas; Eckart, Mega E.; Galeazzi, Massimiliano; Jaeckel, Felix; Kelley, Richard L.; Kilbourne, Caroline A.; McCammon, Dan; Morgan, Kelsey M.; Porter, Frederick S.; Szymkowiak, Andrew E.

    2018-01-01

    High spectral resolution observations in the soft x-rays are necessary for understanding and modelling the hot component of the interstellar medium and its contribution to the Soft X-ray Background (SXRB). This extended source emission cannot be resolved with most wavelength dispersive spectrometers, making energy dispersive microcalorimeters the ideal choice for these observations. We present here the analysis of the most recent sounding rocket flight of the University of Wisconsin-Madison/Goddard Space Flight Center X-ray Quantum Calorimeter (XQC), a large area silicon thermistor microcalorimeter. This 111 second observation integrates a nearly 1 steradian field of view in the direction of the galactic anti-center (l, b = 165°, -5°) and features ~5 eV spectral resolution below 1 keV. Direct comparison will also be made to the previous, high-latitude observations.

  5. A Place of Her Own: The Case for University-Based Centers for Women Entrepreneurs

    Riebe, Mary

    2012-01-01

    The author describes the benefits of university-based women entrepreneur centers as an educational and outreach strategy and argues for their establishment and support by universities interested in educating women entrepreneurs and advancing women-owned businesses. Based on extensive research on women business owners and firsthand experience with…

  6. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  7. Providing Co-Curricular Support: A Multi-Case Study of Engineering Student Support Centers

    Lee, Walter C., Jr.

    2015-01-01

    In response to the student retention and diversity issues that have been persistent in undergraduate engineering education, many colleges have developed Engineering Student Support Centers (ESSCs) such as Minority Engineering Programs (MEPs) and Women in Engineering Programs (WEPs). ESSCs provide underrepresented students with co-curricular…

  8. The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

    Abdallat, W [King Hussein Medical Centre, Amman (Jordan). Dept. of Ophthalmology

    2011-07-01

    The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

  9. The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

    Abdallat, W

    2011-01-01

    The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

  10. Patterns of Tight and Loose Coupling in a Competitive Marketplace: The Case of Learning Center Franchises

    Aurini, Janice Danielle

    2012-01-01

    The concept of coupling--the relationship between the environment, administrative goals, and instructional practices of education organizations--is a staple in New Institutional research. Yet processes of coupling have remained elusive. Drawing on ethnographic research of the "Ontario Learning Center" (OLC) franchise, along with…

  11. MARKETING POLICIES THROUGH THE INTERNET: THE CASE OF SKIING CENTERS IN GREECE

    Panagiotis LEFAKIS

    2012-09-01

    Full Text Available Lately, Internet constitutes a major tool for transactions in every aspect and supports innovative marketing policies. Broadband Internet has become “the key to success” for businesses, as it offers various advantages and benefits through Internet marketing (e-marketing policies. In Greece, mountainous areas are usually covered with snow during winter months; so, skiing centers have become an important asset for winter tourism. The Internet evolution and the development of network infrastructure enhance marketing policies for winter tourism activities. This paper studies the use of marketing policies in Greek skiing centers through the Internet, such as promotional activities, website interactivity, accommodation & entertainment information, online weather forecast, guest book, etc Therefore, the paper aims to optimize and evaluate skiing centers in Greece, qualitatively and quantitatively according to e-marketing policies used as criteria, based on the multicriteria method of PROMETHEE II and further to classify them in groups. Finally we identify and describe the optimum group of skiing centers to be used as a model with enhanced customer communication services.

  12. Inference in media space. The case of IBM Software Executive Briefing Center - Rome

    Toni Marino

    2014-11-01

    Full Text Available In our paper we apply Peirce's model of Arguments (Statistical Deduction, Probabilistic Deduction, Induction and Abduction to a communication process where negotiating sense and meanings is emphasized. We selected a communication space where everything is planned as a medium of sense (video terminals, screens, lights, etc. namely the IBM Software Executive Briefing Center in Italy, a workplace used to exchange views, negotiate or transact. It is based in Rome in the same building as the International Development Laboratory of the IBM Software Group. The Software Center is the place where IBM welcomes its potential customers and has the opportunity to show them its technology and offer solutions. This paper focuses on "media space" in the Center which is structured by the seller according to his/her idea of the buyer's interpretive process. This paper analyzes the roles of visual codes in the allocation of functions. It also looks into the relation between the symbolism of the company with its marketing, past history and media space in order to define the buyer's typology of inference (deduction, induction or abduction in relation to the communication strategy of the media space design. The research is conducted directly in the field by interviewing the Manager of the IBM Center as well as asking people who use it to fill in an anonymous questionnaire, which analyses both the media space and the plan of the building.

  13. Performing Research at University Centers for Academic Development--An Explorative Case Study in Sweden

    Stigmar, Martin; Edgren, Gudrun

    2017-01-01

    The aim is to explore the absence or presence of, and motives for, research at centers for academic development and to problematize the research situation among academic developers. Boyer's and Healey's theories are used as lenses for the analysis based on the questionnaires that were used for data collection. The conclusion is that research is a…

  14. A Case Study: An ACT Stress Management Group in a University Counseling Center

    Daltry, Rachel M.

    2015-01-01

    The aim of this study was to examine the effectiveness of an acceptance and commitment therapy (ACT) stress management group in a college counseling center setting. This study explored (a) the effectiveness of ACT in increasing participants' ability to tolerate distress, which directly affects their ability to function in a stressful college…

  15. Usability Testing, User-Centered Design, and LibGuides Subject Guides: A Case Study

    Sonsteby, Alec; DeJonghe, Jennifer

    2013-01-01

    Usability testing has become a routine way for many libraries to ensure that their Web presence is user-friendly and accessible. At the same time, popular subject guide creation systems, such as LibGuides, decentralize Web content creation and put authorship into the hands of librarians who may not be trained in user-centered design principles. At…

  16. Technology Transfer Challenges: A Case Study of User-Centered Design in NASA's Systems Engineering Culture

    Quick, Jason

    2009-01-01

    The Upper Stage (US) section of the National Aeronautics and Space Administration's (NASA) Ares I rocket will require internal access platforms for maintenance tasks performed by humans inside the vehicle. Tasks will occur during expensive critical path operations at Kennedy Space Center (KSC) including vehicle stacking and launch preparation activities. Platforms must be translated through a small human access hatch, installed in an enclosed worksite environment, support the weight of ground operators and be removed before flight - and their design must minimize additional vehicle mass at attachment points. This paper describes the application of a user-centered conceptual design process and the unique challenges encountered within NASA's systems engineering culture focused on requirements and "heritage hardware". The NASA design team at Marshall Space Flight Center (MSFC) initiated the user-centered design process by studying heritage internal access kits and proposing new design concepts during brainstorming sessions. Simultaneously, they partnered with the Technology Transfer/Innovative Partnerships Program to research inflatable structures and dynamic scaffolding solutions that could enable ground operator access. While this creative, technology-oriented exploration was encouraged by upper management, some design stakeholders consistently opposed ideas utilizing novel, untested equipment. Subsequent collaboration with an engineering consulting firm improved the technical credibility of several options, however, there was continued resistance from team members focused on meeting system requirements with pre-certified hardware. After a six-month idea-generating phase, an intensive six-week effort produced viable design concepts that justified additional vehicle mass while optimizing the human factors of platform installation and use. Although these selected final concepts closely resemble heritage internal access platforms, challenges from the application of the

  17. Solar radiation observation stations with complete listing of data archived by the National Climatic Center, Asheville, North Carolina and initial listing of data not currently archived

    Carter, E. A.; Wells, R. E.; Williams, B. B.; Christensen, D. L.

    1976-01-01

    A listing is provided of organizations taking solar radiation data, the 166 stations where observations are made, the type of equipment used, the form of the recorded data, and the period of operation of each station. Included is a listing of the data from 150 solar radiation stations collected over the past 25 years and stored by the National Climatic Center.

  18. Study of X-ray and gamma ray sources observed by the SIGNE (Prognoz 6 Satellite) experiment in the regions of the galactic center and anticenter

    Violes, F.

    1981-12-01

    Characteristics of the SIGNE II MP 6 experiment are reported and procedures to obtain the fluxes detected from all the sources are described. We next present deconvolution method used to isolate the galactic center sources. In the last chapter we present and discuss the photon spectra of the sources observed by the SIGNE II MP 6 experiment [fr

  19. Using Student-Centered Cases in the Classroom: An Action Inquiry Approach to Leadership Development

    Foster, Pacey; Carboni, Inga

    2009-01-01

    This article addresses the concern that business schools are not adequately developing the practical leadership skills that are required in the real world of management. The article begins by discussing the limitations of traditional case methods for teaching behavioral skills. This approach is contrasted with an alternative case method drawn from…

  20. Driving under the influence of khat--alkaloid concentrations and observations in forensic cases.

    Toennes, Stefan W; Kauert, Gerold F

    2004-02-10

    The use of the herbal stimulant khat (Catha edulis FORSK) is maintained by immigrants from countries where it is part of their cultural life (Arabian Peninsula and eastern Africa). In western countries the drug and its effects are largely unknown and no experience in evaluating impairment symptoms due to the khat-alkaloids, e.g. cathinone, cathine and norephedrine exists. Blood and urine samples from khat users involved in 19 cases of suspected driving under the influence of drugs were analysed and correlated with the results of medical examination and police officer reports. In 3 cases impaired driving and in 10 cases marked impairment of psychophysical functions was observed such as effects on the nervous system (slow pupil reaction to light, dry mouth, increased heart-rate), trembling, restlessness/nervousness, daze/apathy/dullness, impairment of attention, walking and standing on one leg. However, the alkaloid concentrations assayed in blood did not correlate with the impairment symptoms. Apart from an acute phase of indirect sympathomimetic action the development of habituation and withdrawal symptoms must also be considered in explaining the diversity of effects observed. From these results it can be concluded that chewing khat may severely impair driving ability, but may also be without noticeable effects.

  1. Empowering patients of a mental rehabilitation center in a low-resource context: a Moroccan experience as a case study

    Khabbache H

    2017-04-01

    2014–2015. The questionnaire investigated the reactions and feelings of the patients to the rehabilitation program, and their perceived psychological status and mental improvement, if any. Interviews were then transcribed and processed using ATLAS.ti V.7.0 qualitative analysis software. Frequencies and co-occurrence analyses were carried out. Despite approximately 30 million inhabitants within the working age group, Morocco suffers from a shortage of specialized health workers. Our ethnographic observations show that psychiatric treatment can be ensured, notwithstanding these hurdles, if a public health perspective is assumed. In resource-limited settings, working in the field of mental health means putting oneself on the line, exposing oneself to new experiences, and reorganizing one’s own skills and expertise. In the present article, we have used our clinical experience at a rehabilitation center in Fes as a case study and we have shown how to use peer therapy to overcome the drawbacks that we are encountered daily in a setting of limited resources. Keywords: peer therapy, low-resource setting, patient empowerment, qualitative analysis

  2. Teaching torque with 5E learning strategy: an off-center disk case

    Balta, Nuri

    2018-01-01

    In this paper, five simple demonstrations with an off-center disk that can be easily constructed and demonstrated in science class are described along with the 5E learning strategy. These demonstrations can be used to help students develop an understanding of the relationship between the centre of mass and torque. These STEM activities are appropriate for high school or first-year college physics, and are expected to engage students during physics courses.

  3. Give Design a Chance: A Case for a Human Centered Approach to Operational Art

    2017-03-30

    shortcoming, organizational theorist Jamshid Gharajedaghi suggested, “design is a vehicle for enhancement of choice and holistic thinking ” that goes beyond...To address this question and confront assumptions and current methods of thinking , there is a need for a holistic and human centered approach in...MDMP). This monograph proposes a way of thinking and planning that goes beyond current Army doctrinal methodologies to address the changing

  4. The evolving organizational structure of academic health centers: the case of the University of Florida.

    Barrett, Douglas J

    2008-09-01

    The organizational structures of academic health centers (AHCs) vary widely, but they all exist along a continuum of integration--that is, the degree to which the academic and clinical missions operate under a single administrative and governance structure. This author provides a brief overview of the topic of AHC integration, including the pros and cons of more integrated or less integrated models. He then traces the evolution of the University of Florida (UF) Health Science Center, which was created in the 1950s as a fully integrated AHC and which now operates under a more distributed management and governance model. Starting as a completely integrated AHC, UF's Health Science Center reached a time of maximal nonintegration (or dys-integration) in the late 1990s and at the beginning of this decade. Circumstances are now pushing the expanding clinical and academic enterprises to be more together as they face the challenges of market competition, federal research budget constraints, and reengineering clinical operations to reduce costs, enhance access, and improve quality and patient safety. Although formal organizational integration may not be possible or appropriate for any number of legal or political reasons, the author suggests that AHCs should strive for "functional integration" to be successful in the current turbulent environment.

  5. Robustness analysis of geodetic networks in the case of correlated observations

    Mevlut Yetkin

    Full Text Available GPS (or GNSS networks are invaluable tools for monitoring natural hazards such as earthquakes. However, blunders in GPS observations may be mistakenly interpreted as deformation. Therefore, robust networks are needed in deformation monitoring using GPS networks. Robustness analysis is a natural merger of reliability and strain and defined as the ability to resist deformations caused by the maximum undetecle errors as determined from internal reliability analysis. However, to obtain rigorously correct results; the correlations among the observations must be considered while computing maximum undetectable errors. Therefore, we propose to use the normalized reliability numbers instead of redundancy numbers (Baarda's approach in robustness analysis of a GPS network. A simple mathematical relation showing the ratio between uncorrelated and correlated cases for maximum undetectable error is derived. The same ratio is also valid for the displacements. Numerical results show that if correlations among observations are ignored, dramatically different displacements can be obtained depending on the size of multiple correlation coefficients. Furthermore, when normalized reliability numbers are small, displacements get large, i.e., observations with low reliability numbers cause bigger displacements compared to observations with high reliability numbers.

  6. The molecular epidemiology of respiratory viruses associated with asthma attacks: A single-center observational study in Japan.

    Saraya, Takeshi; Kimura, Hirokazu; Kurai, Daisuke; Ishii, Haruyuki; Takizawa, Hajime

    2017-10-01

    Few reports have described the significance of viral respiratory infections (VRIs) in exacerbation of asthma in adult patients. The aim of this study was to elucidate the profiles of VRIs in adult patients with asthma along with their molecular epidemiology.A cross-sectional observational study was conducted at Kyorin University Hospital from August 2012 to May 2015. To identify respiratory pathogens in inpatients and outpatients suffering from asthma attacks, RT-PCR/sequencing/phylogenetic analysis methods were applied alongside conventional microbiological methods. Phylogenetic and pairwise distance analyses of 10 viruses were performed.A total of 106 asthma attack patients enrolled in this study in both inpatient (n = 49) and outpatient (n = 57) settings. The total 106 respiratory samples were obtained from nasopharyngeal swab (n = 68) or sputum (n = 38). Among these, patients with virus alone (n = 39), virus and bacterial (n = 5), and bacterial alone (n = 5) were identified. The ratio of virus-positive patients in inpatient or outpatient to the total cases were 31.1% (n = 33) and 10.4% (n = 11), respectively. The frequency of virus-positive patients was significantly higher in inpatients (75.3%, n = 33) than in outpatients (19.3%, n = 11). Major VRIs included human rhinovirus (HRV) (n = 24), human metapneumovirus (hMPV) (n = 9), influenza virus (Inf-V) (n = 8), and respiratory syncytial virus (RSV) (n = 3) infections with seasonal variations. HRV-A and HRV-C were the most commonly detected viruses, with wide genetic divergence on phylogenetic analysis.Asthmatic exacerbations in adults are highly associated with VRIs such as HRV-A or HRV-C, hMPV, RSV, and Inf-V infections with seasonal variations and genetic divergence, but similar frequencies of VRIs occurred in asthma attack patients throughout the seasons.

  7. Explaining the accreditation process from the institutional isomorphism perspective: a case study of Jordanian primary healthcare centers.

    Alyahya, Mohammad; Hijazi, Heba; Harvey, Heather

    2018-01-01

    While the main focus of accreditation initiatives has been on hospitals, the implementation of these programs is a relatively new notion among other types of healthcare facilities. Correspondingly, this study aims to understand how accreditation is perceived among primary public healthcare centers using an isomorphic institutional theory. Semi-structured, in-depth interviews were conducted with 56 healthcare professionals and administrative staff from seven non-profit healthcare centers in Jordan using an explanatory case-study approach. The informants' narratives revealed that all three components of institutional theory: coercive, mimetic, and normative pressure, were drivers for institutional change in seeking accreditation. There was an overlapping and blending between the three various types of pressure. While participants perceived that healthcare centers faced formal and informal pressures to achieve accreditation, health centers were reluctant about the time, amount of effort, and their ability to achieve the accreditation. Ambiguity and fear of failure forced them to model successful ones. Moreover, the findings revealed that normative values of health professionals enhanced institutional isomorphism and influenced the accreditation process. Identifying these isomorphic changes may help key stakeholders to develop plans, policies, and procedures that could improve the quality of healthcare and enhance accreditation as an organizational strategic plan. Moreover, the study provided explanations of why and how organizations move to adopt new interventions and grow over time. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. Cultures of education and rituals of transition from home to the infant toddler center. Observing interactions and professional development

    Chiara Bove

    2014-04-01

    Full Text Available At the infant-toddler center, the rituals of transition that mark children’s arrival and going home times offer interesting kaleidoscopes for the study of interactive dynamics with the associated meanings and implicit educational models. Numerous pedagogical studies have investigated the meanings of these events, for the most part drawing on the monocultural model of classical attachment theory to analyze interactions between adults and children. Far less research has approached these rituals using triadic, systemic and intercultural categories of analysis in order to explore not only educators’ actions but also what is going on in their minds. In this paper, we discuss examples from a recent study on rituals of transition in the multicultural context of an infant toddler center, combining description of the timing, behaviors and interactive styles of children and adults, with analysis of the thoughts and representations of the educators.

  9. CLINICAL OBSERVATION ON TREATMENT OF 61 CASES OF INSOMNIA WITH AURICULAR PLASTER THERAPY

    张家彤; 王月

    2003-01-01

    Objective: To observe the therapeutic effect of auricular plaster (otopoint-pressure) therapy in thetreatment of insomnia. Methods: In this paper, 61 cases of insomnia patients including 16 males and 45 females weretreated with Ershenmen (MA-TF 1), Zhen (MA-AT), Yuanzhong (MA-AT), Nao Dian and E (MA-AT), combined withother otopoints according to symptoms. The otopoint was stuck with a piece of plaster adhered with vaccaria seeds andpressured by the patient him- or her-self. The treatment was given twice a week, with 7 times being a therapeuticcourse. Results: After 1 - 2 courses of treatment, 19 (31.15%) cases were cured, 34 (55.74 % ) had improvementand 8 (13.11%) had no changes, with the total effective rate being 86.9%. Conclusion: Auricular plaster therapyworks well in the treatment of insomnia patient.

  10. FIRST CASE OF AUTOCHTHONOUS HUMAN VISCERAL LEISHMANIASIS IN THE URBAN CENTER OF RIO DE JANEIRO: CASE REPORT

    Guilherme Almeida Rosa da Silva

    2014-01-01

    Full Text Available Visceral leishmaniasis is an anthropozoonosis that is caused by protozoa of the genus Leishmania, especially Leishmania (Leishmania infantum, and is transmitted to humans by the bite of sandflies of the genus Lutzomyia, such as Lutzomyia longipalpis. There are many reservoirs, including Canis familiaris. It is a chronic infectious disease with systemic involvement that is characterized by three phases: the initial period, the state period and the final period. The main symptoms are fever, malnutrition, hepatosplenomegaly, and pancytopenia. This article reports a case of a patient diagnosed with visceral leishmaniasis in the final period following autochthonous transmission in the urban area of Rio de Janeiro. The case reported here is considered by the Municipal Civil Defense and Health Surveillance of Rio de Janeiro to be the first instance of autochthonous visceral leishmaniasis in humans in the urban area of this city. The patient was discharged and is undergoing a follow-up at the outpatient clinic, demonstrating clinical improvement.

  11. First case of autochthonous human visceral leishmaniasis in the urban center of Rio de Janeiro: case report.

    Silva, Guilherme Almeida Rosa da; Boechat, Thiago de Oliveira; Ferry, Fernando Raphael de Almeida; Pinto, Jorge Francisco da Cunha; Azevedo, Marcelo Costa Velho Mendes de; Carvalho, Ricardo de Souza; Motta, Rogerio Neves; Veras, Mariana Ferreira

    2014-01-01

    Visceral leishmaniasis is an anthropozoonosis that is caused by protozoa of the genus Leishmania, especially Leishmania (Leishmania) infantum, and is transmitted to humans by the bite of sandflies of the genus Lutzomyia, such as Lutzomyia longipalpis. There are many reservoirs, including Canis familiaris. It is a chronic infectious disease with systemic involvement that is characterized by three phases: the initial period, the state period and the final period. The main symptoms are fever, malnutrition, hepatosplenomegaly, and pancytopenia. This article reports a case of a patient diagnosed with visceral leishmaniasis in the final period following autochthonous transmission in the urban area of Rio de Janeiro. The case reported here is considered by the Municipal Civil Defense and Health Surveillance of Rio de Janeiro to be the first instance of autochthonous visceral leishmaniasis in humans in the urban area of this city. The patient was discharged and is undergoing a follow-up at the outpatient clinic, demonstrating clinical improvement.

  12. Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon.

    Saleh, Shadi; Khodor, Rawya; Alameddine, Mohamad; Baroud, Maysa

    2016-11-10

    eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools. A self-administered questionnaire was used to assess participants' socio-demographics, computer use, literacy, and access, and participants' readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane's T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth. Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants' level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and

  13. Center for Corporate Climate Leadership Success Stories: Case Studies in Supply Chain Engagement

    The case studies on this page provide successful examples of companies engaging with their supply chains to reduce their greenhouse gas emissions, understand their shifting supply chain risks, and take advantage of market opportunities.

  14. Effects of donepezil on behavioural manifestations of thalamic infarction: a single case observation

    Rodrigo eRiveros

    2011-03-01

    Full Text Available Objective: To examine the effect of donepezil for the treatment of cognitive and behavioural disorders associated with thalamic lesions in a 45 years old male who suffered an infarct in the left thalamus. Background: Recent studies suggest that donepezil may improve executive functions impairments due to subcortical ischemic lesionsMethod: The crossover effects of donepezil were analyzed in a single case of thalamic infarction with cognitive and behavioural alterations. Results: Significant behavioural modifications related to improved performances in executive functions were observed with the treatment. Conclusions: The results suggest that donepezil may have significant effect on executive functions that can alter behavioural outcomes after thalamic infarctions

  15. Case Study in International Cooperation: Cuba's Molecular Immunology Center and Roswell Park Cancer Institute.

    Evans, Rachel; Reid, Mary; Segal, Brahm; Abrams, Scott I; Lee, Kelvin

    2018-04-01

    In 1961, the USA severed diplomatic relations with Cuba, and in 1962 an embargo was imposed on trade and financial relations with that country. It was not until five decades later that the USA and Cuba would reestablish relations. This opened the way for the New York State Trade Mission to Cuba in April 2015, during which Cuba's Molecular Immunology Center and Buffalo, New York's Roswell Park Cancer Institute signed a formal agreement that would set in motion biotechnology research collaboration to address one of the most important causes of death in both countries. Significant research from Cuba led to this groundbreaking collaboration. The purpose of this paper is to discuss the development of this cooperation, from the Molecular Immunology Center's initial investigations, through the opening of a phase I clinical trial at Roswell Park Cancer Institute with therapies developed at the Center. This cooperation was responsible for the first clinical trial for CIMAvax-EGF involving advanced-stage non-small cell lung cancer patients in the USA. A license was also approved by the US Department of the Treasury's Office of Foreign Assets Control authorizing a commercial partnership for development of biotechnology products, combining the cancer research efforts of both institutions. This unusual collaboration between Cuba and the USA-the US economic embargo and travel restrictions not withstanding-opens good prospects for expanded medical research between the two countries. While political and logistical challenges remain, the shared mission and dedication of these Cuban and US scientists points the way towards relationships that can lead to development, testing, approval and use of promising new therapies for cancer patients. KEYWORDS Biotechnology, clinical trials, cancer vaccines, cancer immunotherapy, non-small cell lung cancer, NSCLC, Cuba, USA.

  16. Isomorphism in Provision of Culture: The Case of Municipalities in Istanbul and Their Cultural Centers

    Ayça İnce

    2017-01-01

    Full Text Available Regardless of the diminishing budgets for investment in the cultural sphere, especially at the municipality level. Since 2000, 61 cultural centers have been opened in Istanbul alone. In spite of the growing cultural and artistic diversity and Turkish society's various demands in cultural services, of Turkish cultural policies on a local, city, and national level serves as a starting point for investigating how isomorphism transpires to the provision of cultural services on the level of Istanbul's district municipalities. This study not only explains the role of district municipalities in the cultural field of Istanbul, but also argues that three interconnected concepts—democratization, professionalization, and marketization—promote cultural convergence.

  17. An unusual case of foreign body pulmonary embolus: case report and review of penetrating trauma at a pediatric trauma center.

    Boomer, Laura A; Watkins, Daniel J; O'Donovan, Julie; Kenney, Brian D; Yates, Andrew R; Besner, Gail E

    2015-03-01

    Penetrating thoracic trauma is relatively rare in the pediatric population. Embolization of foreign bodies from penetrating trauma is very uncommon. We present a case of a 6-year-old boy with a penetrating foreign body from a projectile dislodged from a lawn mower. Imaging demonstrated a foreign body that embolized to the left pulmonary artery, which was successfully treated non-operatively. We reviewed the penetrating thoracic trauma patients in the trauma registry at our institution between 1/1/03 and 12/31/12. Data collected included demographic data, procedures performed, complications and outcome. Sixty-five patients were identified with a diagnosis of penetrating thoracic trauma. Fourteen of the patients had low velocity penetrating trauma and 51 had high velocity injuries. Patients with high velocity injuries were more likely to be older and less likely to be Caucasian. There were no statistically significant differences between patients with low vs. high velocity injuries regarding severity scores or length of stay. There were no statistically significant differences in procedures required between patients with low and high velocity injuries. Penetrating thoracic trauma is rare in children. The case presented here represents the only report of cardiac foreign body embolus we could identify in a pediatric patient.

  18. Health information security: a case study of three selected medical centers in iran.

    Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Sheikhtaheri, Abbas

    2013-03-01

    Health Information System (HIS) is considered a unique factor in improving the quality of health care activities and cost reduction, but today with the development of information technology and use of internet and computer networks, patients' electronic records and health information systems have become a source for hackers. This study aims at checking health information security of three selected medical centers in Iran using AHP fuzzy and TOPSIS compound model. To achieve that security measures were identified, based on the research literature and decision making matrix using experts' points of view. Among the 27 indicators, seven indicators were selected as effective indicators and Fuzzy AHP technique was used to determine the importance of security indicators. Based on the comparisons made between the three selected medical centers to assess the security of health information, it is concluded that Chamran hospital has the most acceptable level of security and attention in three indicators of "verification and system design, user access management, access control system", Al Zahra Hospital in two indicators of "access management and network access control" and Amin Hospital in "equipment safety and system design". In terms of information security, Chamran Hospital ranked first, Al-Zahra Hospital ranked second and Al- Zahra hospital has the third place.

  19. A Simulation Model for Machine Efficiency Improvement Using Reliability Centered Maintenance: Case Study of Semiconductor Factory

    Srisawat Supsomboon

    2014-01-01

    Full Text Available The purpose of this study was to increase the quality of product by focusing on the machine efficiency improvement. The principle of the reliability centered maintenance (RCM was applied to increase the machine reliability. The objective was to create preventive maintenance plan under reliability centered maintenance method and to reduce defects. The study target was set to reduce the Lead PPM for a test machine by simulating the proposed preventive maintenance plan. The simulation optimization approach based on evolutionary algorithms was employed for the preventive maintenance technique selection process to select the PM interval that gave the best total cost and Lead PPM values. The research methodology includes procedures such as following the priority of critical components in test machine, analyzing the damage and risk level by using Failure Mode and Effects Analysis (FMEA, calculating the suitable replacement period through reliability estimation, and optimizing the preventive maintenance plan. From the result of the study it is shown that the Lead PPM of test machine can be reduced. The cost of preventive maintenance, cost of good product, and cost of lost product were decreased.

  20. PACS and its hospital-wide implementation: A case study at the Madigan Army Medical Center

    Choi, Hyung Sik; Kim, Yong Min; Smith, Donald V.; Bender, Gregory N.

    1993-01-01

    PACS represents the future of radiology in modern hospitals. Workstations and databases can be developed to substantially increase clinician's productivity, improve diagnostic accuracy, and make a large amount of knowledge and patient information available on-line to the physician. Currently, there are several hospitals in the process of implementing a total PACS system. They include Madigan Army Medical Center (Tacoma, Washington), VA Hospital in Baltimore, and Hammersmith Hospital in London (1). In order to provide the radiologist, the clinicians, and other health personnel in Korea with the general concept of PACS and its up-to-date status report, we describe the MDIS system being implemented in MAMC (Madigan Army Medical Center) which is the first hospital-wide large-scale PACS in the world. The major PACS components in MAMC have been installed since March 1992 and the full system implementation will be completed by summer 1993. The goal of the MDIS system in MAMC is to increase to more than 90% filmless by the end of 1993. In this paper, we discuss the introduction and background of PACS and its potential benefits, the current status of PACS installation in MAMC and the future plan, and the flow of image data and text information in MAMC

  1. Energy conserving site design case study, Burke Center, Virginia. Final report

    1979-12-01

    The pattern of energy consumption within a modern suburban community, Burke Center, is examined. A variety of actions that could be incorporated to reduce its future energy demands is proposed. Recommendations have been limited to those that are technically feasible today, are reasonably cost-effective, and that should generate little or no market resistance. Findings are that: of the total energy consumed by the Burke Center Community, 57% will go to off-site transportation needs; energy conserving site planning generally coincides with cost-effective site planning; water-to-air heat pumps proved to be the most efficient and cost-effective method available today in the study area for reducing heating and cooling costs in buildings; certain public services such as the collection of solid waste, mail pick-up and delivery, and other routine activities can be made more energy efficient; and the use of available water saving devices in residential and commercial buildings can reduce a community's total utility energy consumption by as much as 20%. (MCW)

  2. Endoscopic excavation for gastric heterotopic pancreas: an analysis of 42 cases from a tertiary center.

    Zhang, Yu; Huang, Qin; Zhu, Lin-hong; Zhou, Xian-bin; Ye, Li-ping; Mao, Xin-li

    2014-09-01

    Because of the difficulty associated with making an accurate diagnosis of gastric heterotopic pancreas (HP) before surgery, surgical resection is usually performed in suspected cases. However, this is an invasive procedure and prone to certain surgical complications. This study was designed to evaluate the feasibility of endoscopic excavation for gastric HP, as well as the value of endoscopic ultrasonography (EUS) in diagnosing gastric HP. Between January 2007 and January 2013, 42 consecutive patients with gastric HP were enrolled in this retrospective study. Key steps: (1) Injection of a solution (100 ml saline + 2 ml indigo carmine + 1 ml epinephrine) into the submucosal layer after making several dots around the lesion; (2) Incision of the mucosa outside the marker dots with a needle-knife, and then circumferential excavation until complete resection of the lesion; (3) Closure of the artificial ulcer with several clips after tumor removal. In this study, 18 cases (42.9%) were suspected as gastric HP (assessed by two experienced endoscopists before endoscopic excavation), 8 (19.0%) were suspected as gastrointestinal stromal tumors, 7 (16.7%) as gastric polyp, and the remaining 9 cases (21.4%) were still unknown. The mean procedure duration was 28.6 min. En bloc resection by endoscopic excavation was achieved in 40 cases (95.2%), and no massive bleeding, delayed bleeding, perforation, or other severe complication occurred in these patients. Among the 42 lesions, a tube echo could be detected in 11 cases by EUS. Those 11 cases were diagnosed as gastric HP by histopathology. Endoscopic excavation appears to be a safe and feasible procedure for accurate histopathologic evaluation and curative treatment in gastric HP. Use of EUS has some value in the diagnosis of gastric HP before the procedure

  3. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  4. Impact of Case Mix Severity on Quality Improvement in a Patient-centered Medical Home (PCMH) in the Maryland Multi-Payor Program.

    Khanna, Niharika; Shaya, Fadia T; Chirikov, Viktor V; Sharp, David; Steffen, Ben

    2016-01-01

    We present data on quality of care (QC) improvement in 35 of 45 National Quality Forum metrics reported annually by 52 primary care practices recognized as patient-centered medical homes (PCMHs) that participated in the Maryland Multi-Payor Program from 2011 to 2013. We assigned QC metrics to (1) chronic, (2) preventive, and (3) mental health care domains. The study used a panel data design with no control group. Using longitudinal fixed-effects regressions, we modeled QC and case mix severity in a PCMH. Overall, 35 of 45 quality metrics reported by 52 PCMHs demonstrated improvement over 3 years, and case mix severity did not affect the achievement of quality improvement. From 2011 to 2012, QC increased by 0.14 (P case mix severity did not correlate with QC. In multivariate analyses, higher QC correlated with larger practices, greater proportion of older patients, and readmission visits. Rural practices had higher proportions of Medicaid patients, lower QC, and higher QC improvement in interaction analyses with time. The gains in QC in the chronic disease domain, the preventive care domain, and, most significantly, the mental health care domain were observed over time regardless of patient case mix severity. QC improvement was generally not modified by practice characteristics, except for rurality. © Copyright 2016 by the American Board of Family Medicine.

  5. How Well Do Student Nurses Write Case Studies? A Cohesion-Centered Textual Complexity Analysis

    Dascalu, Mihai; Dessus, Philippe; Thuez, Laurent; Trausan-Matu, Stefan

    2017-01-01

    Starting from the presumption that writing style is proven to be a reliable predictor of comprehension, this paper investigates the extent to which textual complexity features of nurse students’ essays are related to the scores they were given. Thus, forty essays about case studies on infectious

  6. Scanning electron microscopy observations of failures of implant overdenture bars: a case series report.

    Waddell, J Neil; Payne, Alan G T; Swain, Michael V; Kieser, Jules A

    2010-03-01

    Soldered or cast bars are used as a standard of care in attachment systems supporting maxillary and mandibular implant overdentures. When failures of these bars occur, currently there is a lack of evidence in relation to their specific etiology, location, or nature. To investigate the failure process of a case series of six failed soldered bars, four intact soldered bars, and one intact cast milled bar, which had been supporting implant overdentures. A total of 11 different overdenture bars were removed from patients with different configuration of opposing arches. A failed bar (FB) group (n = 6) had failed soldered overdenture bars, which were recovered from patients following up to 2 years of wear before requiring prosthodontic maintenance and repair. An intact bar (IB) group (n = 5) had both soldered bars and a single cast milled bar, which had been worn by patients for 2 to 5 years prior to receiving other aspects of prosthodontic maintenance. All bars were examined using scanning electron microscopy to establish the possible mode of failure (FB) or to identify evidence of potential failure in the future (IB). Evidence of a progressive failure mode of corrosion fatigue and creep were observed on all the FB and IB usually around the solder areas and nonoxidizing gold cylinder. Fatigue and creep were also observed in all the IB. Where the level of corrosion was substantial, there was no evidence of wear from the matrices of the attachment system. Evidence of an instantaneous failure mode, ductile and brittle overload, was observed on the fracture surfaces of all the FB, within the solder and the nonoxidizing gold cylinders, at the solder/cylinder interface. Corrosion, followed by corrosion fatigue, appears to be a key factor in the onset of the failure process for overdenture bars in this case series of both maxillary and mandibular overdentures. Limited sample size and lack of standardization identify trends only but prevent broad interpretation of the findings.

  7. Observed activation status of lane departure warning and forward collision warning of Honda vehicles at dealership service centers.

    Reagan, Ian J; McCartt, Anne T

    2016-11-16

    There are little objective data on whether drivers with lane departure warning and forward collision warning systems actually use them, but self-report data indicate that lane departure warning may be used less and viewed less favorably than forward collision warning. The current study assessed whether the systems were turned on when drivers brought their vehicles to dealership service stations and whether the observational protocol is a feasible method for collecting similar data on various manufacturers' systems. Observations of 2013-2015 Honda Accords, 2014-2015 Odysseys, and 2015 CR-Vs occurred at 2 U.S. Honda dealerships for approximately 4 weeks during Summer 2015. Of the 265 vehicles observed to have the 2 systems, 87 (32.8%) had lane departure warning turned on. Accords were associated with a 66% increase in the likelihood that lane departure warning was turned on compared with Odysseys, but the rate was still only about 40% in Accords. In contrast, forward collision warning was turned on in all but one of the observed vehicles. Observations found that the activation rate was much higher for forward collision warning than lane departure warning. The observation method worked well and appears feasible for extending to other manufacturers.

  8. Minimally invasive esophagectomy for cancer: Single center experience after 44 consecutive cases

    Bjelović Miloš

    2015-01-01

    Full Text Available Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36% middle thoracic esophagus tumors and 28 (64% tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes. The average blood loss was 173.6 ml. A total of 12 (27% of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE, better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

  9. Management of groundwater in urban centers: A case study; Greater Dammam Metropolitan Area

    Abderrahman, Walid A.; Elamin, Abdalla S.; Al-Harazin, Ibrahim M.; Eqnaibi, Badie S.

    2007-01-01

    Effective management of groundwater resources in urban centers of arid regions is vital for sustainable development and groundwater protection especially with rapid growth of water demands under water stress conditions. Greater Dammam Metropolitan Area is a good example of rapid growing urban center due to comprehensive development and population growth. The water demand has increased by many times during the last three decades. Groundwater from local aquifers namely Dammam and Umm Er Radhuma, supplies more than 85% of the total water demands. The aquifers have been subjected to extensive and increasing groundwater pumping especially during last three decades. Negative impacts such as significant decline in water levels have been experienced in the area. A new groundwater management scheme in terms of improving the long-term water pumping policies is required for protection of the aquifers groundwater productivity. A special numerical simulation model of the multi-aquifer system including Dammam and Umm Er Radhuma aquifers has been developed to assess the behavior of the aquifer system under long term water stresses in Dammam Metropolitan Area. The developed numerical simulation model has been utilized to predict the responses of the aquifer system in terms of decline in terms of water level under different pumping schemes from the two aquifers during the next 30 years. The model results have postulated the importance of Umm Er Radhuma (UER) aquifer as a major water supply source to Dammam Metropolitan Area, as well as potential recharge source of more than 30% of the total water pumped from Dammam aquifer. These findings have been utilized in improving present and future groundwater management and conservation for the study area. Similar techniques can be used to improve the groundwater management in other parts of the country as well as other arid regions. (author)

  10. Observation of e(+)e(-) -> eta ' J/psi center-of-mass energies between 4.189 and 4.600 GeV

    Ablikim, M.; Achasov, M. N.; Ahmed, S.; Ai, X. C.; Albayrak, O.; Albrecht, M.; Ambrose, D. J.; Amoroso, A.; An, F. F.; An, Q.; Bai, J. Z.; Ferroli, R. Baldini; Ban, Y.; Bennett, D. W.; Bennett, J. V.; Berger, N.; Bertani, M.; Bettoni, D.; Bian, J. M.; Bianchi, F.; Boger, E.; Boyko, I.; Briere, R. A.; Cai, H.; Cai, X.; Cakir, O.; Calcaterra, A.; Cao, G. F.; Cetin, S. A.; Chang, J. F.; Chelkov, G.; Chen, G.; Chen, H. S.; Chen, H. Y.; Chen, J. C.; Chen, M. L.; Chen, S.; Chen, S. J.; Chen, X.; Chen, X. R.; Chen, Y. B.; Cheng, H. P.; Chu, X. K.; Cibinetto, G.; Dai, H. L.; Dai, J. P.; Dbeyssi, A.; Dedovich, D.; Deng, Z. Y.; Denig, A.; Denysenko, I.; Destefanis, M.; De Mori, F.; Ding, Y.; Dong, C.; Dong, J.; Dong, L. Y.; Dong, M. Y.; Dou, Z. L.; Du, S. X.; Duan, P. F.; Fan, J. Z.; Fang, J.; Fang, S. S.; Fang, X.; Fang, Y.; Farinelli, R.; Fava, L.; Fedorov, O.; Feldbauer, F.; Felici, G.; Feng, C. Q.; Fioravanti, E.; Fritsch, M.; Fu, C. D.; Gao, Q.; Gao, X. L.; Gao, X. Y.; Gao, Y.; Gao, Z.; Garzia, I.; Goetzen, K.; Gong, L.; Gong, W. X.; Gradl, W.; Greco, M.; Gu, M. H.; Gu, Y. T.; Guan, Y. H.; Guo, A. Q.; Guo, L. B.; Guo, R. P.; Guo, Y.; Guo, Y. P.; Haddadi, Z.; Hafner, A.; Han, S.; Hao, X. Q.; Harris, F. A.; He, K. L.; Heinsius, F. H.; Held, T.; Heng, Y. K.; Holtmann, T.; Hou, Z. L.; Hu, C.; Hu, H. M.; Hu, J. F.; Hu, T.; Hu, Y.; Huang, G. S.; Huang, J. S.; Huang, X. T.; Huang, X. Z.; Huang, Y.; Huang, Z. L.; Hussain, T.; Ji, Q.; Ji, Q. P.; Ji, X. B.; Ji, X. L.; Jiang, L. W.; Jiang, X. S.; Jiang, X. Y.; Jiao, J. B.; Jiao, Z.; Jin, D. P.; Jin, S.; Johansson, T.; Julin, A.; Kalantar-Nayestanaki, N.; Kang, X. L.; Kang, X. S.; Kavatsyuk, M.; Ke, B. C.; Kiese, P.; Kliemt, R.; Kloss, B.; Kolcu, O. B.; Kopf, B.; Kornicer, M.; Kupsc, A.; Kuehn, W.; Lange, J. S.; Lara, M.; Larin, P.; Leithoff, H.; Leng, C.; Li, C.; Li, Cheng; Li, D. M.; Li, F.; Li, F. Y.; Li, G.; Li, H. B.; Li, H. J.; Li, J. C.; Li, Jin; Li, K.; Li, K.; Li, Lei; Li, P. R.; Li, Q. Y.; Li, T.; Li, W. D.; Li, W. G.; Li, X. L.; Li, X. N.; Li, X. Q.; Li, Y. B.; Li, Z. B.; Liang, H.; Liang, Y. F.; Liang, Y. T.; Liao, G. R.; Lin, D. X.; Liu, B.; Liu, B. J.; Liu, C. X.; Liu, D.; Liu, F. H.; Liu, Fang; Liu, Feng; Liu, H. B.; Liu, H. H.; Liu, H. H.; Liu, H. M.; Liu, J.; Liu, J. B.; Liu, J. P.; Liu, J. Y.; Liu, K.; Liu, K. Y.; Liu, L. D.; Liu, P. L.; Liu, Q.; Liu, S. B.; Liu, X.; Liu, Y. B.; Liu, Y. Y.; Liu, Z. A.; Liu, Zhiqing; Loehner, H.; Lou, X. C.; Lu, H. J.; Lu, J. G.; Lu, Y.; Lu, Y. P.; Luo, C. L.; Luo, M. X.; Luo, T.; Luo, X. L.; Lyu, X. R.; Ma, F. C.; Ma, H. L.; Ma, L. L.; Ma, M. M.; Ma, Q. M.; Ma, T.; Ma, X. N.; Ma, X. Y.; Ma, Y. M.; Maas, F. E.; Maggiora, M.; Mao, Y. J.; Mao, Z. P.; Marcello, S.; Messchendorp, J. G.; Mezzadri, G.; Min, J.; Mitchell, R. E.; Mo, X. H.; Mo, Y. J.; Morales, C. Morales; Muchnoi, N. Yu.; Muramatsu, H.; Musiol, P.; Nefedov, Y.; Nerling, F.; Nikolaev, I. B.; Ning, Z.; Nisar, S.; Niu, S. L.; Niu, X. Y.; Olsen, S. L.; Ouyang, Q.; Pacetti, S.; Pan, Y.; Patteri, P.; Pelizaeus, M.; Peng, H. P.; Peters, K.; Pettersson, J.; Ping, J. L.; Ping, R. G.; Poling, R.; Prasad, V.; Qi, H. R.; Qi, M.; Qian, S.; Qiao, C. F.; Qin, L. Q.; Qin, N.; Qin, X. S.; Qin, Z. H.; Qiu, J. F.; Rashid, K. H.; Redmer, C. F.; Ripka, M.; Rong, G.; Rosner, Ch.; Ruan, X. D.; Sarantsev, A.; Savrie, M.; Schnier, C.; Schoenning, K.; Schumann, S.; Shan, W.; Shao, M.; Shen, C. P.; Shen, P. X.; Shen, X. Y.; Sheng, H. Y.; Shi, M.; Song, W. M.; Song, X. Y.; Sosio, S.; Spataro, S.; Sun, G. X.; Sun, J. F.; Sun, S. S.; Sun, X. H.; Sun, Y. J.; Sun, Y. Z.; Sun, Z. J.; Sun, Z. T.; Tang, C. J.; Tang, X.; Tapan, I.; Thorndike, E. H.; Tiemens, M.; Uman, I.; Varner, G. S.; Wang, B.; Wang, B. L.; Wang, D.; Wang, D. Y.; Wang, K.; Wang, L. L.; Wang, L. S.; Wang, M.; Wang, P.; Wang, P. L.; Wang, S. G.; Wang, W.; Wang, W. P.; Wang, X. F.; Wang, Y.; Wang, Y. D.; Wang, Y. F.; Wang, Y. Q.; Wang, Z.; Wang, Z. G.; Wang, Z. H.; Wang, Z. Y.; Wang, Z. Y.; Weber, T.; Wei, D. H.; Wei, J. B.; Weidenkaff, P.; Wen, S. P.; Wiedner, U.; Wolke, M.; Wu, L. H.; Wu, L. J.; Wu, Z.; Xia, L.; Xia, L. G.; Xia, Y.; Xiao, D.; Xiao, H.; Xiao, Z. J.; Xie, Y. G.; Xiu, Q. L.; Xu, G. F.; Xu, J. J.; Xu, L.; Xu, Q. J.; Xu, Q. N.; Xu, X. P.; Yan, L.; Yan, W. B.; Yan, W. C.; Yan, Y. H.; Yang, H. J.; Yang, H. X.; Yang, L.; Yang, Y. X.; Ye, M.; Ye, M. H.; Yin, J. H.; Yu, B. X.; Yu, C. X.; Yu, J. S.; Yuan, C. Z.; Yuan, W. L.; Yuan, Y.; Yuncu, A.; Zafar, A. A.; Zallo, A.; Zeng, Y.; Zeng, Z.; Zhang, B. X.; Zhang, B. Y.; Zhang, C.; Zhang, C. C.; Zhang, D. H.; Zhang, H. H.; Zhang, H. Y.; Zhang, J.; Zhang, J. J.; Zhang, J. L.; Zhang, J. Q.; Zhang, J. W.; Zhang, J. Y.; Zhang, J. Z.; Zhang, K.; Zhang, L.; Zhang, S. Q.; Zhang, X. Y.; Zhang, Y.; Zhang, Y. H.; Zhang, Y. N.; Zhang, Y. T.; Zhang, Yu; Zhang, Z. H.; Zhang, Z. P.; Zhang, Z. Y.; Zhao, G.; Zhao, J. W.; Zhao, J. Y.; Zhao, J. Z.; Zhao, Lei; Zhao, Ling; Zhao, M. G.; Zhao, Q.; Zhao, Q. W.; Zhao, S. J.; Zhao, T. C.; Zhao, Y. B.; Zhao, Z. G.; Zhemchugov, A.; Zheng, B.; Zheng, J. P.; Zheng, W. J.; Zheng, Y. H.; Zhong, B.; Zhou, L.; Zhou, X.; Zhou, X. K.; Zhou, X. R.; Zhou, X. Y.; Zhu, K.; Zhu, K. J.; Zhu, S.; Zhu, S. H.; Zhu, X. L.; Zhu, Y. C.; Zhu, Y. S.; Zhu, Z. A.; Zhuang, J.; Zotti, L.; Zou, B. S.; Zou, J. H.

    2016-01-01

    The process e(+)e(-) -> eta' J/psi is observed for the first time with a statistical significance of 8.6 sigma at center-of-mass energy root s = 4.226 GeV and 7.3 sigma at root s = 4.258 GeV using data samples collected with the BESIII detector. The Born cross sections are measured to be (3.7 +/-

  11. Nasopharyngeal cancer mimicking otitic barotrauma in a resource-challenged center: a case report

    Daniel Adekunle

    2011-10-01

    Full Text Available Abstract Introduction Nasopharyngeal cancer commonly manifests with cervical lymphadenopathy, recurrent epistaxis and progressive nasal obstruction. Neuro-ophthalmic and otologic manifestations can also occur. Isolated otologic presentations of nasopharyngeal cancer are rare and the diagnosis of nasopharyngeal cancer may not be foremost in the list of differentials. Case presentation We present the case of a 29-year-old Nigerian woman with bilateral conductive hearing loss and tinnitus after air travel. There were no other symptoms. The persistence of the symptoms after adequate treatment for otitic barotrauma necessitated re-evaluation, which led to a diagnosis of nasopharyngeal cancer. Conclusion Isolated otologic manifestations of nasopharyngeal cancer are rare in regions with low incidence of the disease. There is a need for it to be considered as a possible differential in patients presenting with bilateral serous otitis media.

  12. Breast tuberculosis in immunocompetent patients at tertiary care center: A case series

    Manoj Kumar

    2012-01-01

    Full Text Available The breast tuberculosis (TB is an extremely rare manifestation for the reason that mammary cells offer great resistance to the survival and multiplication of Mycobacterium infection. The diagnosis is difficult because of nonspecific clinical and radiological findings. It is usually suspected in a multiparous, reproductive woman. We report three cases of tubercular infection of breast confirmed by either mycobacteriology, pathology or both. We described their diagnostic confirmation and six month follow-up after antitubercular treatment (ATT.

  13. Case Study: South Texas Veterans Health Care System’s Communication Center

    2008-07-14

    appropriate access to health care; technical quality is providing world-class care to our veterans; customer satisfaction is ensuring the STVHCS patients and...were not called. These results not only improved access to health care, but also positively affected customer service. 111 Case Study: South Texas...increased waiting times for the patient . With current regulatory requirements calling for improved access to health care services, many hospital and

  14. Cutaneous sporotrichosis: a six-year review of 19 cases in a tertiary referral center in Malaysia.

    Tang, Min Moon; Tang, Jyh Jong; Gill, Priya; Chang, Choong Chor; Baba, Roshidah

    2012-06-01

    Sporotrichosis is a subcutaneous fungal infection caused by a thermally dimorphic aerobic fungus, Sporothrix schenckii. It results from traumatic inoculation or contact with animals. Most cases were reported mainly in the tropics and subtropics.   The objective of our study is to assess the clinical characteristic of cutaneous sporotrichosis among our patients. We performed a retrospective review of all cases diagnosed with cutaneous sporotrichosis from July 2004 to June 2010. Patients' medical records were retrieved and analyzed according to demography, preceding trauma, sites of lesions, clinical subtypes, treatment, and clinical response. Nineteen cases were diagnosed with cutaneous sporotrichosis with a male/female ratio of 9:10. Thirteen cases (68.4%) were able to recall preceding trauma, and seven of them reported cat scratches or cat bites. Lymphocutaneous sporotrichosis was observed in 13 cases (68.4%) followed by four cases of fixed cutaneous sporotrichosis and two cases of disseminated sporotrichosis. Histologically, 11 cases (57.8%) demonstrated a granulomatous reaction. Sporothrix schenckii was cultured in 12 cases (63.2%). Thirteen cases (68.4%) were successfully treated with oral itraconazole alone for a mean duration of 15.6 weeks. Two cases with disseminated cutaneous sporotrichosis were treated with intravenous amphotericin B.   Lymphocutaneous sporotrichosis was the most common subtype of cutaneous sporotrichosis in our series, with cat scratches or bites being the most common preceding trauma. Oral itraconazole was highly effective for the localized subtypes, whereas intravenous amphotericin B was required in disseminated cutaneous sporotrichosis. © 2012 The International Society of Dermatology.

  15. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis.

    Ma, Fuchang; Lv, Fan; Xu, Peng; Zhang, Dapeng; Meng, Sining; Ju, Lahong; Jiang, Huihui; Ma, Liping; Sun, Jiangping; Wu, Zunyou

    2015-07-02

    The growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China. A qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors' views on shifting the HIV/AIDS case management services to CHSCs. It is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs' wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA's fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services. Shifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be

  16. A direct observation method for auditing large urban centers using stratified sampling, mobile GIS technology and virtual environments.

    Lafontaine, Sean J V; Sawada, M; Kristjansson, Elizabeth

    2017-02-16

    With the expansion and growth of research on neighbourhood characteristics, there is an increased need for direct observational field audits. Herein, we introduce a novel direct observational audit method and systematic social observation instrument (SSOI) for efficiently assessing neighbourhood aesthetics over large urban areas. Our audit method uses spatial random sampling stratified by residential zoning and incorporates both mobile geographic information systems technology and virtual environments. The reliability of our method was tested in two ways: first, in 15 Ottawa neighbourhoods, we compared results at audited locations over two subsequent years, and second; we audited every residential block (167 blocks) in one neighbourhood and compared the distribution of SSOI aesthetics index scores with results from the randomly audited locations. Finally, we present interrater reliability and consistency results on all observed items. The observed neighbourhood average aesthetics index score estimated from four or five stratified random audit locations is sufficient to characterize the average neighbourhood aesthetics. The SSOI was internally consistent and demonstrated good to excellent interrater reliability. At the neighbourhood level, aesthetics is positively related to SES and physical activity and negatively correlated with BMI. The proposed approach to direct neighbourhood auditing performs sufficiently and has the advantage of financial and temporal efficiency when auditing a large city.

  17. Hurricane Public Health Research Center at Louisiana State University a Case of Academia Being Prepared

    van Heerden, I. L.

    2006-12-01

    Recent floods along the Atlantic and Gulf seaboards and elsewhere in the world before Katrina had demonstrated the complexity of public health impacts including trauma; fires; chemical, sewerage, and corpse contamination of air and water; and diseases. We realized that Louisiana's vulnerability was exacerbated because forty percent of the state is coastal zone in which 70% of the population resides. Ninety percent of this zone is near or below sea level and protected by man-made hurricane-protection levees. New Orleans ranked among the highest in the nation with respect to potential societal, mortality, and economic impacts. Recognizing that emergency responders had in the past been unprepared for the extent of the public health impacts of these complex flooding disasters, we created a multi-disciplinary, multi-campus research center to address these issues for New Orleans. The Louisiana Board of Regents, through its millennium Health Excellence Fund, awarded a 5-year contract to the Center in 2001. The research team combined the resources of natural scientists, social scientists, engineers, and the mental health and medical communities. We met annually with a Board of Advisors, made up of federal, state, local government, and non-governmental agency officials, first responders and emergency managers. Their advice was invaluable in acquiring various datasets and directing aspects of the various research efforts. Our center developed detailed models for assessment and amelioration of public health impacts due to hurricanes and major floods. Initial research had showed that a Category 3 storm would cause levee overtopping, and that most levee systems were unprotected from the impacts of storm-induced wave erosion. Sections of levees with distinct sags suggested the beginnings of foundation and subsidence problems. We recognized that a slow moving Cat 3 could flood up to the eaves of houses and would have residence times of weeks. The resultant mix of sewage, corpses

  18. Adult bacterial myositis: report of a single-center series of 26 cases

    Fernando Gallucci

    2016-09-01

    Full Text Available Bacterial infections involving muscle are quite uncommon and generally require specific predisposing factors. Bacterial myositis is more rarely described in the typical kind of patients observed in Internal Medicine (presence of multiple co-morbidities, partial/limited immune-deficiency, advanced age. Twenty-six patients suffering from bacterial myositis (8 women and 18 men; mean age 58.5 years, range 27-82 observed in a single Internal Medicine Unit were reported. Muscles involved were ileopsoas, thigh, paravertebral, gluteus, calf, forearm and rectus abdomen. Simultaneous presence of arthritis was registered in 17 patients and all patients presented relevant comorbidity. Main cultured bacteria were Staphylococcus aureus, Escherichia coli, other Gram-negative bacteria, Streptococcus spp. Multi-drug-resistance was observed in 14 out 26 (53.8%. Computed tomography, ultrasound and magnetic resonance imaging were utilized for diagnostic purposes. Antibiotic treatment was administered to all patients. Surgical debridement and drainage were performed in 12 patients; 7 patients were treated with percutaneous aspiration and drainage. At discharge, relevant functional impairment was present in 17 patients (65.3%. Four patients died (in-hospital mortality 7.6%, global mortality at three months 15.3%. Management of bacterial myositis is difficult and its prognosis is poor. In the near future, this demanding infection will be more frequently observed in Internal Medicine setting as comorbidity, which is very often the main characteristic of these patients.

  19. Recombination luminescence from H centers and conversion of H centers into I centers in alkali iodides

    Berzina, B.J.

    1981-01-01

    The study is aimed at the search for H-plus-electron centers of luminescence and the investigation of the conversion of H- into I centers by the luminescence of H-plus-electron centers in alkali iodide crystals. KI, RbI and NaI crystals were studied at 12 K. H and F centers were created by irradiation with ultraviolet light corresponding to the absorption band of anion excitons. Then the excitation of electron centers by red light irradiation was followed. The spectra of stimulated recombination luminescence were studied. The luminescence of H-plus- electron centers had been observed and the conclusion was made that this center was formed on immobile H centers. In case of stable H centers the optically stimulated conversion of H centers into I centers occurs. The assumption is advanced on the spontaneous annihilation of near placed unstable F, H centers which leads to the creation of H-plus-electron luminescence centers and to the spontaneous H-I-centers conversion [ru

  20. Fish bone foreign body presenting with an acute fulminating retropharyngeal abscess in a resource-challenged center: a case report

    Oyewole Ezekiel O

    2011-04-01

    Full Text Available Abstract Introduction A retropharyngeal abscess is a potentially life-threatening infection in the deep space of the neck, which can compromise the airway. Its management requires highly specialized care, including surgery and intensive care, to reduce mortality. This is the first case of a gas-forming abscess reported from this region, but not the first such report in the literature. Case presentation We present a case of a 16-month-old Yoruba baby girl with a gas-forming retropharyngeal abscess secondary to fish bone foreign body with laryngeal spasm that was managed in the recovery room. We highlight specific problems encountered in the management of this case in a resource-challenged center such as ours. Conclusion We describe an unusual presentation of a gas-forming organism causing a retropharyngeal abscess in a child. The patient's condition was treated despite the challenges of inadequate resources for its management. We recommend early recognition through adequate evaluation of any oropharyngeal injuries or infection and early referral to the specialist with prompt surgical intervention.

  1. EFFECT OF NEBULIZED COLISTIN ON THE VENTILATOR CIRCUIT: A PROSPECTIVE PILOT CASE-CONTROL STUDY FROM A SINGLE CANCER CENTER

    Iyad M Ghonimat

    2015-04-01

    Full Text Available Nebulized colistin (NC is used for the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria. In this one-year case-control study, our objective was to evaluate the effect of NC on the ventilator circuit (VC components. The case group consisted of 25 mechanically-ventilated patients who received NC, while the control group was 25 mechanically-ventilated patients who did not receive NC. Respiratory therapists inspected the VC every 4 hrs and whenever a ventilator alarm was reported. The VC component was changed if the alarm did not subside after necessary measures were performed. Patients from both groups were treated at the adult ICU in King Hussein Cancer Center (KHCC. In the case group, 22(88% patients required changing at least one of the circuit components (flow sensor, exhalation membrane, or nebulizer kit. The median number of changes (range per patient of the flow sensor, exhalation membrane, and nebulizer kit were: 2(1-3, 2(1-6, and 1(1-2, respectively. Large amounts of white crystals, which resembled the colistin powder, were reported on the replaced VC components. The flow sensor was changed in 2 control patients, but white crystals were absent. Crystals obtained from one case subject were confirmed to be colistin by chromatographic mass spectroscopy. Further studies are needed to evaluate the effect of crystal formation on the efficacy of NC and clinical outcomes.

  2. Competitive service centers location in the cities with aim to reduce traffic (Case study: Health centers location in the city if Isfahan

    Hamid Moradi

    2011-03-01

    Full Text Available Abstract   Distribution of goods and services in cities is of utmost importance. Selecting appropriate venues for different service centers in a city not only enables the citizens to access these services much more easily, but also reduces the traffic load caused by trips made to reach them. Unfortunately, the lack of a correct urban planning has led to inappropriate formation of many cities around the world in terms of the locations assumed for different service centers. Since the private sector has been given the responsibility to construct most of these centers, changing their current locations may be restricted due to legal obligations. Therefore, it seems necessary for the government to construct new service centers with high competitive facilities to attract customers and to compete with those built by the private sector. In this paper, the selection of appropriate locations to construct new service centers has been studied. Such locations have been selected in a way to fulfill goals such as rapid and easy accessibility for the customers and reduction of traffic drawbacks caused by the related trips. In this regard, a model for service centers with restricted capacity has been designed and a parallel simulated annealing algorithm has been proposed to solve it. Finally, the proposed algorithm has been utilized to locate the health centers around the city of Isfahan and its efficiency has been investigated. The findings highlight the accuracy and speed of the proposed algorithm in location of the health centers of Isfahan.

  3. Observation of deep oscillation usage and its effectiveness on burn scars – case report

    Justyna A. Pogorzelska

    2017-03-01

    Full Text Available An organism that has undergone tissue damage pursues its immediate recovery. In order to do so, it uses a dynamic and congeneric process of regeneration consisting of several phases. Currently, innovative methods are being sought influencing tissue healing. One such system is deep oscillation, which is based on an intermittent electrostatic field created between the device and the patient’s skin. It causes a unique, deep, and resonant vibration. It is a noninvasive and painless method. The aim of deep oscillation is purposeful interfering in the physiological processes of tissue trophism. In the thesis, the case of 16-month-old girl is presented, who experienced a thermal scald to her left arm and her chest. The aim of the following thesis is observation of deep oscillation use and its effectiveness in the event of newly formed burn scars that undergo remodelling and can lead to curtailment of the healing process.

  4. A rare case of haboob in Tehran: Observational and numerical study

    Karami, S.; Ranjbar, A.; Mohebalhojeh, A. R.; Moradi, M.

    2017-03-01

    A great dust storm occurred in Tehran on 2 June 2014 and caused severe damage to properties and involved loss of human life. From the visual evidence available, it can be regarded as a case of haboob. As a lower latitude phenomenon, its occurrence in Tehran was unprecedented in the last 50 years. This paper aims to present a detailed analysis of the weather conditions, the pathways by which dust particles were ingested by the haboob, as well as the impact of the urban boundary layer on the intensity and propagation of the dust storm. Using numerical simulation carried out by the WRF-Chem model and various observational techniques, the coupling of a low-level small-scale deformation field with a lower-tropospheric cold pool produced by precipitating mid-tropospheric clouds is identified as the main process involved in shaping this rare dust storm.

  5. Corporate Culture Assessments in Integrative Oncology: A Qualitative Case Study of Two Integrative Oncology Centers

    Nadine Mittring

    2013-01-01

    Full Text Available The offer of “integrative oncology” is one option for clinics to provide safe and evidence-based complementary medicine treatments to cancer patients. As known from merger theories, corporate culture and integration models have a strong influence on the success of such integration. To identify relevant corporate culture aspects that might influence the success in two highly visible integrative oncology clinics, we interviewed physicians, nurses, practitioners, and managers. All interviews (11 in a German breast cancer clinic and 9 in an integrative medicine cancer service in the USA were audio-recorded, transcribed and analyzed with content analysis. According to the theoretical framework of mergers, each clinic selected a different integration type (“best of both worlds” and “linking”. Nonetheless, each developed a similar corporate culture that has a strong focus on research and safe and evidence-based treatments, and fosters a holistic and patient-centered approach. Structured communication within the team and with other departments had high relevance. Research was highlighted as a way to open doors and to facilitate a more general acceptance within the hospital. Conventional physicians felt unburdened by the provision of integrative medicine service but also saw problems in the time required for scheduled treatments, which often resulted in long waiting lists.

  6. Integration of footprints information systems in palliative care: the case of Medical Center of Central Georgia.

    Tsavatewa, Christopher; Musa, Philip F; Ramsingh, Isaac

    2012-06-01

    Healthcare in America continues to be of paramount importance, and one of the most highly debated public policy issues of our time. With annual expenditures already exceeding $2.4 trillion, and yielding less than optimal results, it stands to reason that we must turn to promising tools and solutions, such as information technology (IT), to improve service efficiency and quality of care. Presidential addresses in 2004 and 2008 laid out an agenda, framework, and timeline for national health information technology investment and development. A national initiative was long overdue. This report we show that advancements in both medical technologies and information systems can be capitalized upon, hence extending information systems usage beyond data collection to include administrative and decision support, care plan development, quality improvement, etc. In this paper we focus on healthcare services for palliative patients. We present the development and preliminary accounts of a successful initiative in the Medical Center of Central Georgia where footprints information technology was modified and integrated into the hospital's palliative care service and existing EMR systems. The project provides evidence that there are a plethora of areas in healthcare in which innovative application of information systems could significantly enhance the care delivered to loved ones, and improve operations at the same time..

  7. Implementing Cognitive Behavioral Therapy in the real world: A case study of two mental health centers

    Burns Barbara J

    2008-02-01

    Full Text Available Abstract Background Behavioral health services for children and adolescents in the U.S. are lacking in accessibility, availability and quality. Evidence-based interventions for emotional and behavioral disorders can improve quality, yet few studies have systematically examined their implementation in routine care settings. Methods Using quantitative and qualitative data, we evaluated a multi-faceted implementation strategy to implement cognitive-behavioral therapy (CBT for depressed adolescents into two publicly-funded mental healthcare centers. Extent of implementation during the study's duration and variables influencing implementation were explored. Results Of the 35 clinicians eligible to participate, 25 (71% were randomized into intervention (n = 11 or usual care (n = 14. Nine intervention clinicians completed the CBT training. Sixteen adolescents were enrolled in CBT with six of the intervention clinicians; half of these received at least six CBT manually-based sessions. Multiple barriers to CBT adoption and sustained use were identified by clinicians in qualitative interviews. Conclusion Strategies to implement evidence-based interventions into routine clinical settings should include multi-method, pre-implementation assessments of the clinical environment and address multiple barriers to initial uptake as well as long-term sustainability.

  8. Corporate culture assessments in integrative oncology: a qualitative case study of two integrative oncology centers.

    Mittring, Nadine; Pérard, Marion; Witt, Claudia M

    2013-01-01

    The offer of "integrative oncology" is one option for clinics to provide safe and evidence-based complementary medicine treatments to cancer patients. As known from merger theories, corporate culture and integration models have a strong influence on the success of such integration. To identify relevant corporate culture aspects that might influence the success in two highly visible integrative oncology clinics, we interviewed physicians, nurses, practitioners, and managers. All interviews (11 in a German breast cancer clinic and 9 in an integrative medicine cancer service in the USA) were audio-recorded, transcribed and analyzed with content analysis. According to the theoretical framework of mergers, each clinic selected a different integration type ("best of both worlds" and "linking"). Nonetheless, each developed a similar corporate culture that has a strong focus on research and safe and evidence-based treatments, and fosters a holistic and patient-centered approach. Structured communication within the team and with other departments had high relevance. Research was highlighted as a way to open doors and to facilitate a more general acceptance within the hospital. Conventional physicians felt unburdened by the provision of integrative medicine service but also saw problems in the time required for scheduled treatments, which often resulted in long waiting lists.

  9. Radiotherapy of Painful Vertebral Hemangiomas: The Single Center Retrospective Analysis of 137 Cases

    Miszczyk, Leszek; Tukiendorf, Andrzej

    2012-01-01

    Purpose: An evaluation of dose–response relationship and an attempt to define predictive factors. Methods and Materials: A total of 137 cases of painful vertebral hemangioma irradiations (101 patients). Fraction dose (fd) varied from 2 to 15 Gy (123 fractionated and 14 radiosurgical treatments), and total dose (TD) from 8 to 30 Gy (111 cases irradiated with fd of 2 GY to TD of 24 Gy). We evaluated pain relief, changes in analgesic requirements, and reossification. Results: Means of pain relief 1, 6, 12, and 18 months after radiotherapy (defined as a decrease of primary pain level expressed in percent) were 60.5%, 65.4%, 68.3%, and 78.4%, respectively. Proportion of patients with no need for analgesics and patients using tramadol were 39%, 40%, 44%, 57%, and 20%, 17%, 22%, and 11% in these times. The proportion of patients experiencing complete/partial pain relief changed from 36/48% 1 month, to 64/22% 1.5 years after radiotherapy. No impact of radiotherapy on reossification was found. The positive impact of fd and TD increase for analgesics uptake reduction and pain relief was found. An increase of the fd by 1 Gy results in 27% chance of analgesics uptake reduction and 3.8% reduction of pain, whereas 14% analgesics uptake reduction and 2.2% of pain reduction in case of the TD. The predictive factors improving results were found: female gender, older age, better performance states (the chance of the lower analgesic treatment decreases over 2.5 times in comparison to the higher Zubrod degree), bigger Hb concentration, shorter symptoms duration and lower analgesics uptake before radiotherapy. Conclusions: The obtained data support the efficacy of radiotherapy in improving pain secondary to vertebral hemangioma, with the degree of pain amelioration being related to increasing fd and TD. The positive predictive factors were defined: female gender, older age, better performance status, increased Hb concentration, shorter symptoms duration, and lower analgesics uptake

  10. Marked seasonality of Cyclospora cayetanensis infections: ten-year observation of hospital cases, Honduras.

    Kaminsky, Rina Girard; Lagos, Javier; Raudales Santos, Gabriela; Urrutia, Samuel

    2016-02-04

    Document seasonality occurrence and epidemiologic characteristics of Cyclospora cayetanensis infections during a 10-year period from patients consulting at the University Hospital, Honduras. Retrospective non interventional hospital-based study analyzed laboratory results from the period 2002 to 2011 of fresh and Ziehl-Nielsen carbolfuchsin stained routine stool samples received for parasitologic examination. Sporadically a sample with numerous oocysts was allowed to sporulate in 2.5 % potassium dichromate confirming the presence of bi-cystic bi-zoic oocysts. A total of 35,157 fecal samples were examined during a ten-year span, of which a third (28.4 %) was stained by the Ziehl-Neelsen carbolfuchsin method diagnosing a total of 125 (1.3 %) C.cayetanensis infections. A statistically significant apparent seasonality was observed most years during May to August (range p < 0.036-0.001), with 83.3 % of 125 cases occurring in those rainy months. All C. cayetanensis cases came from urban poor neighborhoods; male/female relation was 1:1 except in 2006, when all patients were females (p = 0.05; r(2) = 22,448). Forty four point eight percent of the stool samples were diarrheic or liquid and 65.6 % infections were identified in children 10 years old or less. Enteric helminths and protozoa co-infected Cyclospora positive patients in 52 instances.: 8 % Ascaris lumbricoides, 8 % Giardia duodenalis, 23.2 % Blastocystis spp. and less frequently Entamoeba histolytica/E. dispar, Strongyloides stercoralis, and Trichuris trichiura. Results suggest a seasonal pattern for Cyclospora infections diagnosed in a clinical setting during the rainy months in Tegucigalpa and surrounding areas. Community studies should be conducted to support or dispute these observations.

  11. Continuing inflation at Three Sisters volcanic center, central Oregon Cascade Range, USA, from GPS, leveling, and InSAR observations

    Dzurisin, Daniel; Lisowski, Michael; Wicks, Charles W.

    2009-12-01

    Uplift of a broad area centered ~6 km west of the summit of South Sister volcano started in September 1997 (onset estimated from model discussed in this paper) and was continuing when surveyed in August 2006. Surface displacements were measured whenever possible since August 1992 with satellite radar interferometry (InSAR), annually since August 2001 with GPS and leveling surveys, and with continuous GPS since May 2001. The average maximum displacement rate from InSAR decreased from 3-5 cm/yr during 1998-2001 to ~1.4 cm/yr during 2004-2006. The other datasets show a similar pattern, i.e., surface uplift and extension rates decreased over time but deformation continued through August 2006. Our best-fit model to the deformation data is a vertical, prolate, spheroidal point-pressure source located 4.9-5.4 km below the surface. The source inflation rate decreased exponentially during 2001-2006 with a 1/ e decay time of 5.3 ± 1.1 years. The net increase in source volume from September 1997 to August 2006 was 36.5-41.9 x 106 m3. A swarm of ~300 small ( M max = 1.9) earthquakes occurred beneath the deforming area in March 2004; no other unusual seismicity has been noted. Similar deformation episodes in the past probably would have gone unnoticed if, as we suspect, most are small intrusions that do not culminate in eruptions.

  12. Clinical characteristics of acute hepatitis A outbreak in Taiwan, 2015-2016: observations from a tertiary medical center.

    Chen, Nan-Yu; Liu, Zhuo-Hao; Shie, Shian-Sen; Chen, Tsung-Hsing; Wu, Ting-Shu

    2017-06-20

    Acute hepatitis A is a fecal-oral transmitted disease related to inadequate sanitary conditions. In addition to its traditional classification, several outbreaks in the men who have sex with men (MSM) population have resulted in acute hepatitis A being recognized as a sexually transmitted disease. However, few studies have clarified the clinical manifestations in these outbreaks involving the MSM population. Beginning in June 2015, there was an outbreak of acute hepatitis A involving the MSM population in Northern Taiwan. We conducted a 15-year retrospective study by recruiting 207 patients with the diagnosis of acute hepatitis A that included the pre-outbreak (January 2001 to May 2015) and outbreak (June 2015 to August 2016) periods in a tertiary medical center in Northern Taiwan. Using risk factors, comorbidities, presenting symptoms, laboratory test results and imaging data, we aimed to evaluate the clinical significance of acute hepatitis A in the MSM population, where human immunodeficiency virus (HIV) coinfection is common. There was a higher prevalence of reported MSM (p hepatitis A during the outbreak period. The outbreak population had more prominent systemic symptoms, was more icteric with a higher total bilirubin level (p hepatitis A relapse. The clinical course of acute hepatitis A during an outbreak involving the MSM and HIV-positive population is more symptomatic and protracted than in the general population.

  13. Robotic surgery for rectal cancer: a single center experience of 100 consecutive cases.

    Stănciulea, O; Eftimie, M; David, L; Tomulescu, V; Vasilescu, C; Popescu, I

    2013-01-01

    Minimally invasive techniques have revolutionized the field of general surgery over the few last decades. Despite its advantages, in complex procedures such as rectal surgery, laparoscopy has not achieved a high penetration rate because of its steep learning curve, its relatively high conversion rate and technical challenges. The aim of this study was to present a single center experience with robotic surgery for rectal cancer focusing mainly on early and mid-term postoperative outcome. A series of 100 consecutive patients who underwent robotic rectal surgery between January 2008 and June 2012 was analyzed retrospectively in terms of demographics, pathological data, surgical and oncological outcomes. Seventy-seven patients underwent robotic sphincter-saving resection, and 23 patients underwent robotic abdominoperineal resection. There were 4 conversions. The median operative time for sphincter-saving procedures was 180 min. The median time for robotic abdominoperineal resection was 160 min. The median distal resection margin of the operative specimen was 3 cm. The median number of retrieved lymph nodes was 14. The median hospital stay was 10 days. In-hospital mortality was nil. The overall morbidity was 30%. Four patients presented transitory postoperative urinary dysfunction. Severe erectile dysfunction was reported by 3 patients. The median length of follow-up was 24 months. The 3-year overall survival rate was 90%. Robotic surgery is advantageous for both surgeons (in that it facilitates dissection in a narrow pelvis) and patients (in that it affords a very good quality of life via the preservation of sexual and urinary function in the vast majority of patients and it has low morbidity and good midterm oncological outcomes). In rectal cancer surgery, the robotic approach is a promising alternative and is expected to overcome the low penetration rate of laparoscopy in this field. Celsius.

  14. Transformational leadership, transnational culture and political competence in globalizing health care services: a case study of Jordan's King Hussein Cancer Center

    Pappas Gregory

    2007-11-01

    Full Text Available Abstract Background Following the demise of Jordan's King Hussein bin Talal to cancer in 1999, the country's Al-Amal Center was transformed from a poorly perceived and ineffectual cancer care institution into a Western-style comprehensive cancer center. Renamed King Hussein Cancer Center (KHCC, it achieved improved levels of quality, expanded cancer care services and achieved Joint Commission International accreditation under new leadership over a three-year period (2002–2005. Methods An exploratory case research method was used to explain the rapid change to international standards. Sources including personal interviews, document review and on-site observations were combined to conduct a robust examination of KHCC's rapid changes. Results The changes which occurred at the KHCC during its formation and leading up to its Joint Commission International (JCI accreditation can be understood within the conceptual frame of the transformational leadership model. Interviewees and other sources for the case study suggest the use of inspirational motivation, idealized influence, individualized consideration and intellectual stimulation, four factors in the transformational leadership model, had significant impact upon the attitudes and motivation of staff within KHCC. Changes in the institution were achieved through increased motivation and positive attitudes toward the use of JCI continuous improvement processes as well as increased professional training. The case study suggests the role of culture and political sensitivity needs re-definition and expansion within the transformational leadership model to adequately explain leadership in the context of globalizing health care services, specifically when governments are involved in the change initiative. Conclusion The KHCC case underscores the utility of the transformational leadership model in an international health care context. To understand leadership in globalizing health care services, KHCC

  15. RDBMS Applications as Online Based Data Archive: A Case of Harbour Medical Center in Pekanbaru

    Febriadi, Bayu; Zamsuri, Ahmad

    2017-12-01

    Kantor Kesehatan Pelabuhan Kelas II Pekanbaru is a government office that concerns about healthy, especially about environment health. There is a problem in case of saving electronic data, also in analyzing daily data both for internal and external data. The office has some computers and other tools that are useful in saving electronic data. In fact, the data are still saved in available cupboards and it is not efficient for an important data that is analyzed for more than one time. In other words, it is not good for a data is needed to be analyzed continuously. Rational Data Base Management System (RDBMS) application is an online based saving data and it uses System Development Life Cycle (SDLC) method. Hopefully, the application will be very useful for employees Kantor Kesehatan Pelabuhan Pekanbaru in managing their work.

  16. Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala.

    Hitziger, Martin; Berger Gonzalez, Mónica; Gharzouzi, Eduardo; Ochaíta Santizo, Daniela; Solis Miranda, Regina; Aguilar Ferro, Andrea Isabel; Vides-Porras, Ana; Heinrich, Michael; Edwards, Peter; Krütli, Pius

    2017-08-08

    Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved

  17. Continuing Inflation at Three Sisters Volcanic Center, Central Oregon Cascade Range, USA, From GPS, InSAR, and Leveling Observations

    Lisowski, M.; Dzurisin, D.; Wicks, C. W.

    2007-12-01

    Uplift of a broad area centered ~5 km west of South Sister volcano in central Oregon started sometime after fall 1996, accelerated after fall 1998, and was continuing when last surveyed with GPS and leveling in fall 2006. Surface displacements were measured whenever possible since 1992 with satellite radar interferometry (InSAR), annually since 2001 with GPS and leveling campaigns, and with a continuous GPS station since 2001. The average maximum displacement rate from InSAR was 3 to 5 cm/yr during 1998--2001 and ~1.4 cm/yr during 2004--2006. The other three datasets show a similar pattern, i.e., surface dilation and uplift rates decreased over time but deformation continued through 2006. Our best-fit model is a spherical point pressure (Mogi) source located 6.0--6.5 km below the surface and 4.5--5 km west-southwest of the summit of South Sister volcano. Any marginal improvement gained by using a more complicated source shape is not constrained by the data. This same model fits the deformation data for 2001--2003 and 2003--2006 equally well, so there is no indication that the location or shape of the source has changed. However, the source inflation rate has decreased exponentially since 2001 with a 1/e decay time of about 4 years. The net increase in source volume from the beginning of the episode (~1997) through 2006 was 60 × 106 m3 ± 10 × 106 m3. The only unusual seismicity near the deforming area was a swarm of about 300 small earthquakes on March 23- -26, 2004 ---the first notable seismicity for at least two decades. Timing of the swarm generally coincides with slowing of surface deformation, but any link between the two, if one exists, is not understood. Similar episodes in the past probably would have gone unnoticed if, as we suspect, most were small intrusions that do not culminate in eruptions.

  18. The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration: a descriptive overview.

    Reilly, Karen E; Mueller, Christine; Zimmerman, David R

    2007-01-01

    This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration-the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQDemonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool-the MDS-was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.

  19. A Service-Oriented Healthcare Message Alerting Architecture in an Asia Medical Center: A Case Study

    Jin-Shin Lai

    2009-06-01

    Full Text Available This paper illustrates how our development team has used some information technologies to let physicians obtain an instant abnormal laboratory result report for critical patient care services. We have implementeda healthcare message alerting system (HMAS on a healthcare short message service (HSMS engine and the distributed healthcare-oriented service environment (DiHOSE in the National Taiwan University Hospital (NTUH. The HSMS engine has a general interface for all applications which could easily send any kind of alerting messages. Fundamentally, the DiHOSE uses HL7 standard formats to process the information exchange behaviors and can be flexibly extended for reasonable user requirements. The disease surveillance subsystem is an integral part of NTUH new hospital information system which is based on DiHOSE and the disease surveillance subsystem would send alerting messages through the HSMS engine. The latest cell phone message alerting subsystem, a case study, in NTUH proved that the DiHOSE could integrate the user required functions without much work. We concluded that both HSMS and DiHOSE can generalize and extend application demands efficiently.

  20. Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia.

    Porter, Joanne E; Miller, Nareeda; Giannis, Anita; Coombs, Nicole

    2017-07-01

    Family Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR. One rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study. Seventeen adult presentations (Metro n=9, Rural n=8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication. During 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Pancreaticoduodenectomy in a tertiary referral center in Saudi Arabia: A retrospective case series

    Aziz, A.M.; Gad, H.; Leung, K; Abbas, A.; Al-Saif, O.H.; Meshikhes, A.N.

    2012-01-01

    Context: Perioperative outcome of pancreaticoduodenectomy is related to work load volume and to whether the procedure is carried out in a tertiary specialized hepato-pancreatico-biliary (HPB) unit. Objective: To evaluate the perioperative outcome associated with pancreaticoduodenectomy in a newly established HPB unit. Patients: Analysis of 32 patients who underwent pancreaticoduodenectomy (PD) for benign and malignant indications. Design: Retrospective collection of data on preoperative, intraoperative and postoperative care of all patients undergoing PD. Results: Thirty-two patients (16 male and 16 female) with a mean age of 59.5 ± 12.7 years were analyzed. The overall morbidity rate was high at 53%. The most common complication was wound infection (n = 11; 34.4%). Pancreatic and biliary leaks were seen in 5 (15.6%) and 2 (6.2%) cases, respectively, while delayed gastric emptying was recorded in 7 (21.9%). The female sex was not associated with increased morbidity. Presence of co-morbid illness, pylorus-preserving PD, intra-operative blood loss > 1 L, and perioperative blood transfusion were not associated with significantly increased morbidity. The overall hospital mortality was 3.1% and the cumulative overall (OS) and disease free survival (DFS) at 1 year were 80% and 82.3%, respectively. The cumulative overall survival for pancreatic cancer vs ampullary tumor at 1 year were 52% vs 80%, respectively. Conclusion: PD is associated with a low risk of operative death when performed by specialized HPB surgeons even in a tertiary referral hospital. However, the postoperative morbidity rate remains high, mostly due to wound infection. Further improvement by reducing postoperative infection may help curtail the high postoperative morbidity

  2. Omalizumab in the treatment of allergic bronchopulmonary aspergillosis: One center's experience with 14 cases.

    Aydın, Ömür; Sözener, Zeynep Çelebi; Soyyiğit, Şadan; Kendirlinan, Reşat; Gençtürk, Zeynep; Mısırlıgil, Zeynep; Mungan, Dilşad; Sin, Betül Ayşe; Demirel, Yavuz Selim; Çelik, Gülfem Elif; Bavbek, Sevim

    2015-01-01

    Omalizumab has been a valuable option for patients with severe allergic asthma, but there are only case reports regarding effectiveness of omalizumab in patients with allergic bronchopulmonary aspergillosis (ABPA). To evaluate the clinical and functional effectiveness of omalizumab in patients with asthma and ABPA in long-term follow-up. The study was conducted as a retrospective chart review of patients with ABPA who were treated with omalizumab injections between December 2008 and June 2014. Once treatment with omalizumab was started, data were collected at three time points: at baseline, after 1 year, and, in June 2014, at the last follow-up. Fourteen patients with ABPA (seven women and seven men; mean [± standard deviation (SD)] age, 44.21 ± 13.01 years) were included. The treatment period was 31.5 ± 3.99 months (mean ± SD). The difference between the baseline and the last evaluation of the mean percentage of forced expiratory volume in 1 second (FEV1) was significant (p = 0.02). The mean asthma control test score was increased at all-time points compared with the basal score (p = 0.001). After omalizumab treatment was initiated, the patients' mean oral corticosteroid dosage significantly decreased (p = 0.001). The baseline exacerbation rate was 2.7 ± 1.5/y (mean ± SD), and the hospitalization rate was 1.4/y, and both were zero at the last assessment (p = 0.001). Eleven of the patients (78.6%) responded perfectly, and three (21.4%) partially responded to treatment. The patients who had a total immunoglobulin E level of 1000 IU/mL (p = 0.05). Omalizumab provided a clinically important reduction in exacerbations and steroid requirement, and improved asthma symptoms and pulmonary function parameters in patients with asthma and ABPA who had previously shown an unsatisfactory response to Global Initiative for Asthma step 4 treatment.

  3. Center for Disease Control's Diethylstilbestrol Update: a case for effective operationalization of messaging in social marketing practice.

    Mattson, Marifran; Basu, Ambar

    2010-07-01

    The Center for Disease Control's (CDC) Diethylstilbestrol (DES) Update, a campaign to educate people who may have been exposed to the drug DES, is framed on the premises of the social marketing model, namely formative research, audience segmentation, product, price, placement, promotion, and campaign evaluation. More than that, the campaign takes a critical step in extending the social marketing paradigm by highlighting the need to situate the messaging process at the heart of any health communication campaign. This article uses CDC's DES Update as a case study to illustrate an application of a message development tool within social marketing. This tool promotes the operationalization of messaging within health campaigns. Ultimately, the goal of this project is to extend the social marketing model and provide useful theoretical guidance to health campaign practitioners on how to accomplish stellar communication within a social marketing campaign.

  4. Interprofessional academic health center leadership development: the case of the University of Alabama at Birmingham's Healthcare Leadership Academy.

    Savage, Grant T; Duncan, W Jack; Knowles, Kathy L; Nelson, Kathleen; Rogers, David A; Kennedy, Karen N

    2014-05-01

    The study describes the genesis of the University of Alabama at Birmingham's Healthcare Leadership Academy (HLA), highlights the HLA's outcomes, discloses how the HLA has changed, and delineates future directions for academic health center (AHC) interprofessional leadership training. While interprofessional training is recognized as an important component of the professional education for health professionals, AHCs have not focused on interprofessional leadership training to prepare future AHC leaders. As professional bureaucracies, AHCs require leadership distributed across different professions; these leaders not only should be technical experts, but also skilled at interprofessional teamwork and collaborative governance. The HLA is examined using the case method, which is supplemented with a descriptive analysis of program evaluation data and outcomes. The HLA has created a networked community of AHC leaders; the HLA's interprofessional team projects foster innovative problem solving. Interprofessional leadership training expands individuals' networks and has multiple organizational benefits. © 2014.

  5. Using a Birth Center Model of Care to Improve Reproductive Outcomes in Informal Settlements-a Case Study.

    Wallace, Jacqueline

    2018-06-04

    The world is becoming increasingly urban. For the first time in history, more than 50% of human beings live in cities (United Nations, Department of Economic and Social Affairs, Population Division, ed. (2015)). Rapid urbanization is often chaotic and unstructured, leading to the formation of informal settlements or slums. Informal settlements are frequently located in environmentally hazardous areas and typically lack adequate sanitation and clean water, leading to poor health outcomes for residents. In these difficult circumstances women and children fair the worst, and reproductive outcomes for women living in informal settlements are grim. Insufficient uptake of antenatal care, lack of skilled birth attendants and poor-quality care contribute to maternal mortality rates in informal settlements that far outpace wealthier urban neighborhoods (Chant and McIlwaine (2016)). In response, a birth center model of maternity care is proposed for informal settlements. Birth centers have been shown to provide high quality, respectful, culturally appropriate care in high resource settings (Stapleton et al. J Midwifery Women's Health 58(1):3-14, 2013; Hodnett et al. Cochrane Database Syst Rev CD000012, 2012; Brocklehurst et al. BMJ 343:d7400, 2011). In this paper, three case studies are described that support the use of this model in low resource, urban settings.

  6. Relationships among Shopping Quality and Corporate Social Responsibility of Shopping Centers and Consumer Satisfaction: Case from Novi Sad (Serbia

    Ivana Blešić

    2014-02-01

    Full Text Available Taking into consideration satisfied customer as necessary for business maintenance, companies are trying to discover determinants which have the biggest influence on their consumer satisfaction. Here are presented two factors that have influence on consumer satisfaction in shopping centers: quality of shopping and corporate social responsibility. In this research, each of these factors had six elements. The results of the regression analysis are that “Value for money in stores” (beta=0.387, p=0.000 has the greatest impact on satisfaction when shopping quality performance is concerned, and that “Retailer support for (national/local cultural and sport events“ (beta=0.333, p<0.001 has the greatest impact on satisfaction in the case of CSR performance. Further analysis showed the difference in consumer perception of corporate social responsibility, depending on their occupation and level of education. It is also important to mention that consumers with environment and empathic concern have higher scores perception of CSR. However, there is not statistically important difference in consumer perception of shopping quality in shopping centers

  7. Adult-onset intradural spinal teratoma: report of 18 consecutive cases and outcomes in a single center.

    Wan, Wei; Yang, Cheng; Yan, Wangjun; Liu, Tielong; Yang, Xinghai; Song, Dianwen; Xiao, Jianru

    2017-07-01

    Eighteen consecutive patients with adult-onset intradural spinal teratoma underwent surgical treatment in our center from 1998 to 2013. Teratoma is defined as a neoplasm composed of elements derived from three germ cell layers (ectoderm, endoderm and mesoderm). Intraspinal teratoma is extremely rare and accounts for 0.2-0.5% of all spinal cord tumors. Moreover, teratoma occurs primarily in neonates and young children. Adult-onset intradural spinal teratoma is even rare. The aim of this study was to discuss the clinical characteristics, diagnosis and therapeutic strategies of adult-onset intradural spinal teratoma. This retrospective study included 18 consecutive adult patients with intradural teratoma who were surgically treated in our center between 1998 and 2013. The clinical features, pathogenesis, diagnostic strategies and surgical outcomes were discussed. Neurological function outcomes were evaluated by the JOA scoring system. Of the 18 included patients, 4 patients received subtotal resection and the other 14 patients received total resection. All the 18 cases were diagnosed with mature teratoma. The mean follow-up period was 79.7 (median 60.5; range 27-208) months. Local recurrence occurred in two of the four patients who underwent subtotal resection and in no patient who underwent total resection. The neurologic status improved in 16 cases and remained unchanged in the other two patients. Adult-onset intradural spinal teratoma is extremely rare. To the best of our knowledge, this is the largest series of patients with this disease. Despite the slow-growth and indolent nature, radical resection remains the recommended treatment to reduce tumor recurrence.

  8. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center.

    Weiqiang Liang

    Full Text Available To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery.The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression.Among the 28 patients with postoperative pleural effusion, 24 (85.7% suffered from hemothorax, 2 (7.1% from chylothorax, and 2 (7.1% from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%, on the concave side in 4 patients (14.3%, and on both sides in 4 patients (14.3%. One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old, congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery.The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325, and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old, congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion.

  9. Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis.

    Burton, Rachel A; Lallemand, Nicole M; Peters, Rebecca A; Zuckerman, Stephen

    2018-02-05

    Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by

  10. Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

    Tsumura Ayako

    2012-10-01

    Full Text Available Abstract This report describes a case of rectal cancer with endoscopically observable white nodules caused by distal intramural lymphatic spread. A 57-year-old female presented to our hospital with frequent diarrhea and hemorrhoids. Computed tomography showed bilateral ovarian masses and three hepatic tumors diagnosed as rectal cancer metastases, and also showed multiple lymph node involvement. The patient was preoperatively diagnosed with stage IV rectal cancer. Colonoscopy demonstrated that primary rectal cancer existed 15 cm from the anal verge and that there were multiple white small nodules on the anal side of the primary tumor extending to the dentate line. Biopsies of the white spots were performed, and they were identified as adenocarcinoma. The patient underwent Hartmann’s procedure because of the locally advanced primary tumor. The white nodules were ultimately diagnosed as being caused by intramural lymphatic spreading because lymphatic permeation was strongly positive at the surrounding area. Small white nodules near a primary rectal cancer should be suspected of being intramural spreading. Endoscopic detection of white nodules may be useful for the diagnosis of distal intramural spread.

  11. The Clinical Observation on one case of Patient with Progressive Muscular Dystrophies

    Yoo, Chang-Kil

    2000-12-01

    Full Text Available After observing a patient diagnosed with Progressive Muscular Dystropies from the August, 31, 2000 to the January, 2001, the following results are obtained. Method and Result: Under our assumption that the Korean Bee Venom Therapy is a good method to treat Progress Muscular Dystropies. Korean Bee Venom Therapy was applied on the following acupuncture points: BL23(Shinsu:腎兪, BL26(Guanyuanshu:關元兪, ST36(Chok-Samni:足三里, LI4(Hapkok:合谷, LV3(Taechung:太, SP10(Hyolhae:血海, SI9(Sojang-Kyonjong:貞. In addition CFC(Carthami Flos;紅花: and Cervi Pantotrichum Cornu; Herbal-Acupuncture is also treated on the other acupuncture points. For herbal medication was given to the patient based on the Sasang Constitution, Taeyangin Ogapijangchuk-tang. Following these treatments in this case of Progressive Muscular Dystropies, the skeletal muscle functions made remarkable improvement. Conclusion: Based on the clinical results, traditional Korean Medical treatment is believed to be effective for treating Progressive Muscular Dystropies, and further studies should be conducted to provide more valuable information.

  12. Radiofrequency thermocoagulation for the treatment of lumbar intervertebral disc protrusion: a clinical observation of 30 cases

    Gong Weidong; Li Yazhou; Cao Wei; Yang Wei; Zhang Peng; Wang Zhimin; Wu Zhiqun

    2010-01-01

    Objective: To observe the clinical effects and safety of radiofrequency thermocoagulation in treating the lumbar intervertebral disc protrusion. Methods: Thirty patients with lumbar intervertebral disc protrusion, whose diagnoses were confirmed by clinical manifestations and CT findings, were involved in this study. The needle was punctured to the target point of the diseased intervertebral space under C-arm fluoroscopic guidance. After the testing of sensory nerve, motor nerve and temperature was made, the target needles were heated until the nerve radiofrequency temperature meter reached the point of 92 degree C. This point of temperature was held for 100 seconds and the procedure was repeated for four cycles. Results: Six months after the treatment, all patients showed an obvious improvement in VAS, which decreased from 7.83 ± 0.33 before operation to 2.37 ± 0.48 after treatment (P < 0.05). According to the modified Macnab therapeutic evaluation criteria, excellent result was seen in 9, good result in 12, fair result in 5 and poor result in 4 cases, with a total effective rate of 86.7%. No serious complications occurred in all patients. Conclusion: Radiofrequency thermocoagulation is an effective and safe method for the treatment of lumbar intervertebral disc protrusion. (authors)

  13. Radioimmunoassay of alpha-foeto-protein in hepatology. Observation of 151 cases

    Dao, Mouhamadou.

    1976-03-01

    Alpha-foeto-protein, although discovered several years ago, was considered as only able to exist in primary adult liver cancer. With progress in science and in research it was observed that AFP can be found in normal subjects, without any pathological significance. APF has been found moreover in illnesses other than primary liver cancer. This range of diseases, restricted at first, has continued to widen, a development due to the discovery of new AFP detection methods and radioimmunoassay. Our work, covering 151 cases discussed in detail in the 'Material and Methods' chapter, is interesting from two viewpoints: in hepatology it is useful to know whether the very sensitive radio-immunological method reveals abnormal AFP content variations in different liver diseases; given the large number of hepatomas in our series it is also interesting to have the value of this determination confirmed in primary liver cancer diagnosis. Radioimmunoassay now replaces other quantitative methods (MANCINI's radial immunodiffusion and LAURELL's elec. diffusion) and is the most accurate [fr

  14. General Case in Determining Center-To-Center Spacing Between the Screw and the Roller in a Roller Drive, and Initial Contact Point of Their Mating Thread Turns. Development of Calculation Method and Software

    D. S. Blinov

    2017-01-01

    Full Text Available One of the most important trends in development of machine engineering is to improve load capacity of mechanisms, assemblies and parts without increasing their overall dimensions and weight. This is also relevant to the most promising items so far, i.e. orbital roller drives (ORD, which are the rotational-to-progressive motion converters widely used in vehicles. The previously published article suggested increasing a load capacity (by about 15% through reducing a thread turn section angle of the threaded ORD components and change of the radius of roller thread turn section outline. Due to such ORD modification, a number of the most critical ORD parameters are to be changed thereby demanding further research. Further, the article published suggests a method considering the abovementioned changes to calculate the dimensions of ORD main components and their tolerance ranges.Though this method being not complete as the increment of ORD center-to-center spacing in relation to its rated value, required for assembly, is unknown; and to determine the ORD center-to-center spacing increment, outer diameters of the roller and screw threads are to be known. Hence, these two methods are interconnected.This article presents the numerical calculation method, mathematical support and method to determine the increment of ORD center-to-center spacing and initial contact point of the mating roller and screw thread turns. Due to considerable scope of calculations, the method was turned into the software.Similar calculation methods and techniques were developed to a particular case, where the thread turn section angle of the threaded components was of 90°, and the roller thread turn section outline was a circular arc centered to the roller axis. Hence the developed numerical calculation method, mathematical support and technique refer to the general case which is to determine the ORD center-to-center spacing increment and initial contact point of the mating roller

  15. Patient-centered and clinical outcomes of mandibular overdentures retained with the locator system: A prospective observational study.

    Fernandez-Estevan, Lucia; Montero, Javier; Selva Otaolaurruchi, Eduardo J; Sola Ruiz, Fernanda

    2017-03-01

    Whether clinical or demographic variables affect the perception of treatment in terms of quality of life and satisfaction is unknown. The purpose of this prospective study was to make an evidence-based assessment of the treatment outcomes (patient- and clinically based) of locator-retained mandibular overdentures. This prospective observational study assessed patients with edentulism who had worn mandibular overdentures supported by 2 implants and retained by the locator system for at least 1 year of functional life (N=80). Medical histories were reviewed, and patients underwent oral examinations. Prosthetic clinical outcomes and patient well-being were registered using the Oral Health Impact Profile 20 (OHIP-20) and Oral Satisfaction Scale (OSS). Patient well-being scored an overall OHIP-20 score of 19.0 ±14.0 of 80 (the higher the score, the greater the impact and the worse the oral health-related quality of life); overall oral satisfaction was 8.3 ±1.7 of 10. Women suffered greater social impact (0.8 ±1.0) and disability (0.4 ±0.8) than men (0.4 ±0.7 versus 0.2 ±0.4, respectively). Impact on well-being was inversely proportional to both patient age and the age of the prosthesis (r=-0.25; Poverdentures had been functioning for over 60 months. Relining (46.3%), readjustments (82.5%), and changes of nylon retention (1.5 ±1.8 per patient over 60 months of use) devices negatively influenced well-being. Mandibular overdentures produced good results with regard to quality of life and oral satisfaction, but attention should be paid to factors affecting clinical outcomes and patient well-being. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  16. Magnetic clouds' structure in the magnetosheath as observed by Cluster and Geotail: four case studies

    L. Turc

    2014-10-01

    Full Text Available Magnetic clouds (MCs are large-scale magnetic flux ropes ejected from the Sun into the interplanetary space. They play a central role in solar–terrestrial relations as they can efficiently drive magnetic activity in the near-Earth environment. Their impact on the Earth's magnetosphere is often attributed to the presence of southward magnetic fields inside the MC, as observed in the upstream solar wind. However, when they arrive in the vicinity of the Earth, MCs first encounter the bow shock, which is expected to modify their properties, including their magnetic field strength and direction. If these changes are significant, they can in turn affect the interaction of the MC with the magnetosphere. In this paper, we use data from the Cluster and Geotail spacecraft inside the magnetosheath and from the Advanced Composition Explorer (ACE upstream of the Earth's environment to investigate the impact of the bow shock's crossing on the magnetic structure of MCs. Through four example MCs, we show that the evolution of the MC's structure from the solar wind to the magnetosheath differs largely from one event to another. The smooth rotation of the MC can either be preserved inside the magnetosheath, be modified, i.e. the magnetic field still rotates slowly but at different angles, or even disappear. The alteration of the magnetic field orientation across the bow shock can vary with time during the MC's passage and with the location inside the magnetosheath. We examine the conditions encountered at the bow shock from direct observations, when Cluster or Geotail cross it, or indirectly by applying a magnetosheath model. We obtain a good agreement between the observed and modelled magnetic field direction and shock configuration, which varies from quasi-perpendicular to quasi-parallel in our study. We find that the variations in the angle between the magnetic fields in the solar wind and in the magnetosheath are anti-correlated with the variations in the

  17. Youth Empowerment Through the Use of Prison Libraries: Case Studies of the Tangerang Juvenile Detention Center Library and the Salemba Detention Center Library in Indonesia

    Rahmi Rahmi

    2015-01-01

    Full Text Available It is widely acknowledged that libraries play a positive and important role in the lives of prisoners, just as they do with other people.  They do not only provide resources to support various educational, recreational and welfare programs, but they also create opportunities for prisoners to acquire new skills, skills that they may need once they leave prison.  In addition, prison libraries also help address various psychological issues, attitude problems, as well as other difficulties in coping with prison life.  According to the Ministry of Law and Human Rights of Indonesia, as of 2013, there are 4,622 children in 16 different prisons in Indonesia.  Such statistics show that there is a great need for well-resourced and well-staffed libraries inside these prisons in order to support the educational, recreational, and psychological needs of imprisoned children.  It is evident that the existence of prison libraries and its library collections, facilities, as well as other services could serve as effective rehabilitation for the prisoners and the detainees – to help them develop awareness of their own actions, as well as associated risks and consequences. The purpose of this study is to examine the practical, social, recreational, educational, psychological, and spiritual needs of detained juvenile delinquents in regards to using the collections, facilities and services at the Tangerang Juvenile Detention Center Library and the Salemba Detention Center Library. This study is based on informational interviews conducted with the Head Librarians at the Tangerang Juvenile Detention Center Library (JDC and the Salemba Detention Center Library.  During these interviews, various problems and challenges related to ethics, professionalism, and other professional issues associated to working as a prison librarian, were discussed.  Other issues related to staffing, organizational structure, facilities and the resource situation of the Tangerang

  18. Explanation of observable secular variations of gravity and alternative methods of determination of drift of the center of mass of the Earth

    Barkin, Yury

    2010-05-01

    The summary. On the basis of geodynamic model of the forced relative displacement of the centers of mass of the core and the mantle of the Earth the secular variations of a gravity and heights of some gravimetry stations on a surface of the Earth have ben studied. At the account of secular drift of the center of mass of the Earth which on our geodynamic model is caused by the unidirectional drift of the core of the Earth relatively to the mantle, the full explanation is given to observable secular variations of a gravity at stations Ny-Alesund (Norway), Churchill (Canada), Medicine (Italy), Sayowa (Antarctica), Strastburg (France), Membach (Belgium), Wuhan (China) and Metsahovi (Finland). Two new methods of determination of secular drift of the center of mass of the Earth, alternative to classical method of a space geodesy are offered: 1) on the basis of gravimetry data about secular trends of a gravity at the stations located on all basic regions of the Earth; 2) on the basis of the comparative analysis of altimetry and coastal data about secular changes of sea level also in basic regions of ocean. 1. Secular drift of the center of mass of the core and the center of mass of the Earth. A secular drift of the center of mass of the Earth to the North relatively to special center O on an axis of rotation of the Earth for which the coefficient of third zonal harmonic J3' = 0, has been predicted in the author work [1]. A drift in a direction to a geographical point (pole P) 70°0 N and 104°3 E has been established for the first time theoretically - as a result of the analysis of the global directed redistribution of masses of the Earth, explaining the observed secular drift of the pole of an axis of rotation of the Earth and not tidal acceleration of its axial rotation [2]. In [1] velocity of drift it has been estimated in 1-2 cm/yr. For specified center O the figure of a planet is as though deprived of pure-shaped form (J3' = 0). And in this sense the point O can be

  19. Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center.

    Grigorie, Răzvan; Alexandrescu, Sorin; Smira, Gabriela; Ionescu, Mihnea; Hrehoreţ, Doina; Braşoveanu, Vladislav; Dima, Simona; Ciurea, Silviu; Boeţi, Patricia; Dudus, Ionut; Picu, Nausica; Zamfir, Radu; David, Leonard; Botea, Florin; Gheorghe, Liana; Tomescu, Dana; Lupescu, Ioana; Boroş, Mirela; Grasu, Mugur; Dumitru, Radu; Toma, Mihai; Croitoru, Adina; Herlea, Vlad; Pechianu, Cătălin; Năstase, Anca; Popescu, Irinel

    2017-01-01

    Background: The objective of this study is to assess the outcome of the patients treated for hepatocellular carcinoma (HCC) in a General Surgery and Liver Transplantation Center. Methods: This retrospective study includes 844 patients diagnosed with HCC and surgically treated with curative intent methods. Curative intent treatment is mainly based on surgery, consisting of liver resection (LR), liver transplantation (LT). Tumor ablation could become the choice of treatment in HCC cases not manageable for surgery (LT or LR). 518 patients underwent LR, 162 patients benefited from LT and in 164 patients radiofrequency ablation (RFA) was performed. 615 patients (73%) presented liver cirrhosis. Results: Mordidity rates of patient treated for HCC was 30% and mortality was 4,3% for the entire study population. Five year overall survival rate was 39 % with statistically significant differences between transplanted, resected, or ablated patients (p 0.05) with better results in case of LT followed by LR and RFA. Conclusions: In HCC patients without liver cirrhosis, liver resection is the treatment of choice. For early HCC occurred on cirrhosis, LT offers the best outcome in terms of overall and disease free survival. RFA colud be a curative method for HCC patients not amenable for LT of LR. Celsius.

  20. Monitoring soil wetness variations by means of satellite passive microwave observations: the HYDROPTIMET study cases

    T. Lacava

    2005-01-01

    . This analysis allows us to evaluate the reliability and the efficiency of the proposed technique in identifying different amounts of soil wetness variations in different observational conditions. In particular, the proposed indicator was able to document the actual effects of meteorological events, in terms of space-time evolution of soil wetness changes, for all the analysed HYDROPTIMET test cases. Moreover, in some circumstances, the SWVI was able to identify the presence of a sort of 'early' signal in terms of soil wetness variations, which may be regarded as a timely indication of an anomalous value of soil water content. This evidence suggests the opportunity to use such an index in the pre-operational phases of the modern flood warning systems, in order to improve their forecast capabilities and their reliability.

  1. What do health coaches do? Direct observation of health coach activities during medical and patient-health coach visits at 3 federally qualified health centers.

    Johnson, Christopher; Saba, George; Wolf, Jessica; Gardner, Heather; Thom, David H

    2018-05-01

    To examine activities of health coaches during patient medical visits and when meeting one-on-one with patients at 3 urban federally qualified health centers. Encounters were videotaped and transcribed. Data was analyzed using a matrix analysis approach that allowed a priori identification of expected categories of activity, based on the health coach training model and previously developed conceptual framework, which were modified based on activities observed. A total of 10 medical visits (patient, clinician and health coach), and 8 patient-coach visits were recorded. We identified 9 categories common to both medical and patient-coach visits and 2 categories unique to the medical visit. While observed activities were generally consistent with expected categories, some activities were observed infrequently or not at all. We also observed additional activity categories, including information gathering and personal conversation. The average amount of time spent on some categories of coaching activities differed substantially between medical visits and patient-coach visits. Health coaching activities observed differed in several respects to those expected, and differed between medical visits and coaching only visits. These results provide insights into health coaching behaviors that can be used to inform training and improve utilization of health coaches in practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study.

    Miller, James S; English, Lacey; Matte, Michael; Mbusa, Rapheal; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Siedner, Mark J; Reyes, Raquel; Lee, Patrick T; Mulogo, Edgar; Stone, Geren S

    2018-02-27

    Village health workers (VHWs) in five villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhoea in children under 5 years of age. VHWs use a "Sick Child Job Aid" that guides them through the evaluation and treatment of these illnesses. A retrospective observational study was conducted to measure the quality of iCCM care provided by 23 VHWs in 5 villages in Bugoye subcounty over a 2-year period. Patient characteristics and clinical services were summarized using existing aggregate programme data. Lot quality assurance sampling of individual patient records was used to estimate adherence to the iCCM algorithm, VHW-level quality (based on adherence to the iCCM protocol), and change over time in quality of care (using generalized estimating equations regression modelling). For each of 23 VHWs, 25 patient visits were randomly selected from a 2-year period after iCCM care initiation. In these visits, 97% (150) of patients with diarrhoea were treated with oral rehydration and zinc, 95% (216) of patients with pneumonia were treated with amoxicillin, and 94% (240) of patients with malaria were treated with artemisinin-based combination therapy or rectal artesunate. However, only 44% (44) of patients with a negative rapid test for malaria were appropriately referred to a health facility. Overall, 75% (434) of patients received all the correct evaluation and management steps. Only 9 (39%) of the 23 VHWs met the pre-determined LQAS threshold for high-quality care over the 2-year observation period. Quality of care increased significantly in the first 6 months after initiation of iCCM services (p = 0.003), and then plateaued during months 7-24. Quality of care was high for uncomplicated malaria, pneumonia and diarrhoea. Overall quality of care was lower, in part because VHWs often did not follow the guidelines to refer patients with fever who tested

  3. Risk factors, microbiological findings, and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland.

    Saeed, Ayman

    2012-02-01

    AIM: To identify the risk factors for, and to report the microbiological findings and clinical outcomes of, severe microbial keratitis (MK). METHODS: This was a retrospective study of all cases of presumed MK admitted to a tertiary referral center over a 2-year period (September 2001 to August 2003). Data recorded included demographic data, details relating to possible risk factors, results of microbiological studies, clinical findings at presentation, and clinical and visual outcomes. RESULTS: Ninety patients were admitted with a diagnosis of presumed MK during the study period. The mean age of patients was 45 +\\/- 32 years, and the male to female ratio was 47:43 (52.2%:47.7%). Predisposing risk factors for MK included contact lens wear (37; 41.1%), anterior segment disease (19; 21.1%), ocular trauma (13; 14.4%), systemic disease (5; 5.6%), and previous ocular surgery (1; 1.1%). Cultured organisms included gram-negative bacteria (17; 51.5%), gram-positive bacteria (11, 33.3%), acanthamoeba (2; 6.1%), and fungi (1; 3%). Visual acuity improved significantly after treatment [mean best-corrected visual acuity (+\\/-standard deviation) at presentation: 0.76 (+\\/-0.11); mean best-corrected visual acuity at last follow-up: 0.24 (+\\/-0.07); P < 0.001]. Secondary surgical procedures were required in 18 (20%) cases, and these included punctal cautery (1; 1.1%), tissue glue repair of corneal perforation (2; 2.2%), tarsorrhaphy (9; 9.9%), Botulinum toxin-induced ptosis (1; 1.1%), penetrating keratoplasty (3; 3.3%), and evisceration (2; 2.2%). CONCLUSIONS: Contact lens wear remains a significant risk factor for severe MK. MK remains a threat to vision and to the eye, but the majority of cases respond to prompt and appropriate antimicrobial therapy.

  4. [Use of psychostimulants in a sexual context: Analysis of cases reported to the French network of Addictovigilance Centers].

    Batisse, Anne; Peyrière, Hélène; Eiden, Céline; Courné, Marie-Anne; Djezzar, Samira

    2016-10-01

    The "SLAM" phenomenon is an increasingly popular practice, in Paris and London gay scene, defined by 3 characteristics: injection, sexual party and psychostimulant drugs. The French Medical Agency requested a risk assessment of "SLAM" and more broadly of the use of psychostimulants in a sexual context, by the analysis of complications related to this practice notified to the French Network of Addictovigilance Centers. All cases of complications related to "SLAM" practice, including cases of abuse or dependence, and somatic and psychiatric complications, were analysed. Between January 2008 to December 2013, 51 cases were collected. Users were exclusively men, with a mean age of 40 years, having psychostimulants exposure in a sexual context, mainly in men who have sex with men (MSM) context (100%, n=35). The prevalence of human immunodeficiency virus (HIV) infection was 82% (n=32) with a high level of HIV/hepatitis C virus (HCV) co-infection (50%, n=16). The main psychostimulants reported are synthetic cathinones (89.5%). Cathinones users tended to be polydrug users: 62% also reported use other than psychoactive substances (gamma-butyrolactone [GBL], ketamine, methylenedioxyméthamphetamine [MDMA], lysergic acid diethylamide [LSD]…). The main complications were psychiatric disorders in 50% (psychotic symptoms, agitation, anxiety, suicidal ideas or attempt and forensic problems), acute intoxication in 25% (including 3 deaths), dependence and abuse in 17% and infectious complications in 8% (viral seroconversion). Health professionals as well as users should be aware of the physical (cardiovascular) and behavioural (psychic, fast dependence syndrome) toxicity of cathinones. Risk reduction policy must be targeted to the population of MSM with specific interventions both on risky sexual behavior and substance use. Copyright © 2016 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  5. Pharmacotherapy for primary delusional jealousy, a retrospective observational study of 32 cases with Othello syndrome.

    Liu, Chen-Chung; Wang, Yen-Chin; Hwang, Tzung-Jeng

    2018-03-01

    To determine whether primary delusional jealousy can be treated effectively with antipsychotics or antidepressants, and whether any clinical variables are associated with response to pharmacotherapy, we carried out a retrospective case series observational study by reviewing clinical records of patients with an International Classification of Disease, 9th ed., diagnostic code of 297 (delusional disorders) who were treated at the Department of Psychiatry of a university affiliated hospital from January 2010 to December 2015. Only those records showing obvious delusional jealousy not secondary to other medical conditions, dementia, or schizophrenia were scrutinized thoroughly with respect to types of pharmacotherapy, treatment response, and other demographic and clinical variables likely to be associated with clinical outcomes. All except one of 32 patients, 16 men and 16 women, between 37 and 79 (60.9±10.6) years of age, were treated with low-dose antipsychotics. The general response was favorable as 19 (59.4%) were rated as good and 13 as inadequate responders (seven partial and six limited). Compared with antipsychotic monotherapy, concomitant therapy with antidepressants had a higher rate of good response, although statistically insignificant (75 vs. 53%, P=0.21). Younger age (P=0.01) and presentation at the index visit with their suspected unfaithful spouse were associated with a good response (P=0.036); comorbidity with delusions other than the jealous type was associated with a poor response (P=0.006). The overall outcome for delusional jealousy looks promising if the patients can accept pharmacotherapy in an outpatient setting.

  6. Effects of topical bevacizumab application on early bleb failure after trabeculectomy: observational case series

    Klos-Rola J

    2013-09-01

    Full Text Available Justyna Klos-Rola, Maria Tulidowicz-Bielak, Tomasz Zarnowski Department of Ophthalmology, Medical University of Lublin, Lublin, Poland Background: The aim of this study was to evaluate the influence of topical bevacizumab on the formation and function of filtering blebs in eyes with early bleb failure after antiglaucoma surgery. Methods: Of all patients who underwent mitomycin-augmented trabeculectomy for glaucoma in the Department of Ophthalmology at the Medical University in Lublin, Poland, between March 2009 and March 2010, a total of 21 eyes from 20 patients with injected filtration bleb 9.8 ± 4.7 days after surgery were included in this observational case series. All patients were treated with standard steroid therapy and topical bevacizumab 5 mg/mL five times a day for 20.9 ± 9.8 days. Patients were followed up every other day, and a full eye examination was performed 14, 30, 60, and 180 days after initiation of treatment. Blebs were evaluated for vascularity by slit-lamp examination with concomitant photographic documentation and intraocular pressure measurement. Results: Elevated functional bleb with significantly reduced vascularity was present in 16 eyes, and was flat and nonfunctional in five eyes. Intraocular pressure in all eyes decreased from a mean of 26.6 ± 9.6 mmHg before surgery to 14.6 ± 7.7 mmHg and 15.8 ± 8.3 mmHg at 2 and 6 months after surgery, respectively. Filtration bleb leak was noted in three eyes while on treatment with bevacizumab. Conclusion: Topical application of bevacizumab might favor functional bleb formation after trabeculectomy in eyes with a high risk of failure. Keywords: glaucoma, trabeculectomy, bleb failure, bevacizumab

  7. Evaluation of a National Call Center and a Local Alerts System for Detection of New Cases of Ebola Virus Disease - Guinea, 2014-2015

    2016-03-11

    call centers were established in response to the Ebola epidemic in Guinea, Liberia , and Sierra Leone, the sensitivity of those call centers for...Control and Prevention Evaluation of a National Call Center and a Local Alerts System for Detection of New Cases of Ebola Virus Disease — Guinea, 2014...2015 Christopher T. Lee, MD1,2,3; Marc Bulterys, MD, PhD2,4,5; Lise D. Martel, PhD2,6; Benjamin A. Dahl PhD2,5 The epidemic of Ebola virus disease ( Ebola

  8. Etiological and therapeutical observations in a case of belly dancer's dyskinesia.

    Linazasoro, Girutz; Van Blercom, Nadège; Lasa, Asier; Fernández, José Manuel; Aranzábal, Inés

    2005-02-01

    We report on the case of a woman with belly dancer's syndrome. This case presented two peculiarities: (1) the condition was induced by the chronic use of clebopride, and (2) abdominal dyskinesias showed a dramatic response to the application of transcutaneous electrical nerve stimulation. Copyright 2004 Movement Disorder Society.

  9. Properties, propagation, and excitation of EMIC waves observed by MMS: A case study

    Zhang, J.; Boardsen, S. A.; Coffey, V. N.; Chandler, M. O.; Saikin, A.; Mello, E. M.; Russell, C. T.; Torbert, R. B.; Fuselier, S. A.; Giles, B. L.; Gershman, D. J.

    2017-12-01

    Electromagnetic ion cyclotron (EMIC) waves (0.1-5 Hz) play an important role in particle dynamics in the Earth's magnetosphere. EMIC waves are preferentially excited in regions where hot anisotropic ions and cold dense plasma populations spatially overlap. While the generation region of EMIC waves is usually on or near the magnetic equatorial plane in the inner magnetosphere, EMIC waves have both equatorial and off-equator source regions on the dayside in the compressed outer magnetosphere. Using field and plasma measurements from the Magnetospheric Multiscale (MMS) mission, we perform a case study of EMIC waves and associated local plasma conditions observed on 19 October 2015. From 0315 to 0810 UT, before crossing the magnetopause into the magnetosheath, all four MMS spacecraft detected long-lasting He+-band EMIC wave emissions around local noon (MLT = 12.7 - 14.0) at high L-shells (L = 8.8 - 15.2) and low magnetic latitudes (MLAT = -21.8º - -30.3º). Energetic (> 1 keV) and anisotropic ions were present throughout this event that was in the recovery phase of a weak geomagnetic storm (min. Dst = -48 nT at 1000 UT on 18 October 2015). The testing of linear theory suggests that the EMIC waves were excited locally. Although the wave event is dominated by small normal angles, its polarization is mixed with right- and left-handedness and its propagation is bi-directional with regard to the background magnetic field. The short inter-spacecraft distances (as low as 15 km) of the MMS mission make it possible to accurately determine the k vector of the waves using the phase difference technique. Preliminary analysis finds that the k vector magnitude, phase speed, and wavelength of the 0.3-Hz wave packet at 0453:55 UT are 0.005 km-1, 372.9 km/s, and 1242.9 km, respectively. We will discuss the characteristics of the wave and particle measurements and their significance in this locale.

  10. Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from Zambia.

    Mutanga, Jane N; Raymond, Juliette; Towle, Megan S; Mutembo, Simon; Fubisha, Robert Captain; Lule, Frank; Muhe, Lulu

    2012-01-01

    Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia's Southern Province, and serving a catchment area of 1.2 million people. Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983), 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital's inpatient and outpatient departments (n = 1342), 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early infant diagnosis. The hospital's bolstered antiretroviral

  11. Institutionalizing provider-initiated HIV testing and counselling for children: an observational case study from Zambia.

    Jane N Mutanga

    Full Text Available BACKGROUND: Provider-initiated testing and counselling (PITC is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia's Southern Province, and serving a catchment area of 1.2 million people. METHODS AND PRINCIPAL FINDINGS: Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074, 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983, 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital's inpatient and outpatient departments (n = 1342, 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early

  12. Orthodontic Movement after Regenerative Endodontic Procedure: Case Report and Long-term Observations.

    Chaniotis, Antonis

    2018-03-01

    Although regenerative treatment approaches in teeth with incomplete root formation and pulp necrosis have become part of the suggested therapeutic endodontic spectrum, little is known about the effect of orthodontic movement in the tissue that has been regenerated. Furthermore, as the number of adults undergoing orthodontic treatment increases, there is an increasing need to investigate the changes that these tissues may undergo during orthodontic movement. Here we describe the alterations observed after the application of orthodontic forces in a case of an apically root-fractured necrotic immature root that had been managed with regenerative endodontic procedures in the past. A 9-year-old male patient was referred after suffering the third incidence of trauma in the anterior maxilla. Radiographic evaluation revealed a periapical rarefaction associated with an apically root-fractured immature central incisor. Clinical evaluation revealed a buccal abscess and grade 3 tooth mobility. Periodontal probing was within normal limits. The tooth was accessed and disinfected by using apical negative pressure irrigation of 6% NaOCl. Intracanal dentin conditioning was achieved by using 17% EDTA for 5 minutes. A blood clot was induced from the periapical area, and calcium silicate-based cement was placed in direct contact with the blood clot at the same visit. The composite resin restoration was accomplished in the same appointment. Recall radiographic examination after 24 months revealed healing of the periapical lesion and signs of continuous root development despite the apical root fracture. Clinical evaluation revealed normal tooth development, normal mobility, and a resolving buccal infection. The tooth was subjected to orthodontic treatment because of Class II division 1 malocclusion with an overjet of 11 mm. After completion of the orthodontic treatment, 5.5 years after the initial intervention, the radiographic image revealed marked remodeling of the periapical

  13. Role of observation of live cases done by Japanese experts in the acquisition of ESD skills by a western endoscopist.

    Draganov, Peter V; Chang, Myron; Coman, Roxana M; Wagh, Mihir S; An, Qi; Gotoda, Takuji

    2014-04-28

    To evaluate the role of observation of experts performing endoscopic submucosal dissection (ESD) in the acquisition of ESD skills. This prospective study is documenting the learning curve of one Western endoscopist. The study consisted of three periods. In the first period (pre-observation), the trainee performed ESDs in animal models in his home institution in the United States. The second period (observation) consisted of visit to Japan and observation of live ESD cases done by experts. The observation of cases occurred over a 5-wk period. During the third period (post-observation), the trainee performed ESD in animal models in a similar fashion as in the first period. Three animal models were used: live 40-50 kg Yorkshire pig, explanted pig stomach model, and explanted pig rectum model. The outcomes from the ESDs done in the animal models before and after observation of live human cases (main study intervention) were compared. Statistical analysis of the data included: Fisher's exact test to compare distributions of a categorical variable, Wilcoxon rank sum test to compare distributions of a continuous variable between the two groups (pre-observation and post-observation), and Kruskal-Wallis test to evaluate the impact of lesion location and type of model (ex-vivo vs live pig) on lesion removal time. The trainee performed 38 ESDs in animal model (29 pre-observation/9 post-observation). The removal times post-observation were significantly shorter than those pre-observation (32.7 ± 15.0 min vs 63.5 ± 9.8 min, P < 0.001). To minimize the impact of improving physician skill, the 9 lesions post-observation were compared to the last 9 lesions pre-observation and the removal times remained significantly shorter (32.7 ± 15.0 min vs 61.0 ± 7.4 min, P = 0.0011). Regression analysis showed that ESD observation significantly reduced removal time when controlling for the sequence of lesion removal (P = 0.025). Furthermore, it was also noted a trend towards decrease in

  14. NASA Earth Observing System Data and Information System (EOSDIS): A U.S. Network of Data Centers Serving Earth Science Data: A Network Member of ICSU WDS

    Behnke, Jeanne; Ramapriyan, H. K. " Rama"

    2016-01-01

    NASA's Earth Observing System Data and Information System (EOSDIS) has been in operation since August 1994, and serving a diverse user community around the world with Earth science data from satellites, aircraft, field campaigns and research investigations. The ESDIS Project, responsible for EOSDIS is a Network Member of the International Council for Sciences (ICSU) World Data System (WDS). Nine of the 12 Distributed Active Archive Centers (DAACs), which are part of EOSDIS, are Regular Members of the ICSUWDS. This poster presents the EOSDIS mission objectives, key characteristics of the DAACs that make them world class Earth science data centers, successes, challenges and best practices of EOSDIS focusing on the years 2014-2016, and illustrates some highlights of accomplishments of EOSDIS. The highlights include: high customer satisfaction, growing archive and distribution volumes, exponential growth in number of products distributed to users around the world, unified metadata model and common metadata repository, flexibility provided to uses by supporting data transformations to suit their applications, near-real-time capabilities to support various operational and research applications, and full resolution image browse capabilities to help users select data of interest. The poster also illustrates how the ESDIS Project is actively involved in several US and international data system organizations.

  15. Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy.

    Narra, Roberta; Maestri, Marcello; Budke, Christine M; Tamarozzi, Francesca; Mariconti, Mara; Nicoletti, Giovanni J; Rinaldi, Francesca; Brunetti, Enrico

    2016-08-03

    Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach. © The American Society of Tropical Medicine and Hygiene.

  16. Risk factors associated with mortality in systemic lupus erythematosus. A case-control study in a tertiary care center in Mexico City.

    Hernández-Cruz, B; Tapia, N; Villa-Romero, A R; Reyes, E; Cardiel, M H

    2001-01-01

    To identify the mortality risk factors in a group of Mexican patients with SLE. A case-control autopsy study in a tertiary care center in Mexico, City. Patients with SLE who died during 1958 to 1994 with an autopsy study were selected as cases, and alive patients matched by age (+/- 3 years), decade of SLE onset, and disease duration (+/- 5 years) were defined as controls. Clinical charts were reviewed looking at clinical variables. SLE disease activity was evaluated with the MexSledai index, and SLE disease severity with the Severity Index. Variables were classified as present at any moment during the follow-up and 3 months before death in cases or cut-off date in controls. matched univariate and multivariate analysis by multiple logistic regression were performed, and the results were presented as odds ratio and 95% confidence intervals (OR, 95%CI). 76 matched pairs of patients were studied. Age, gender, and years offormal education were similar in the cases and controls. Variables associated with mortality three months before death were: lung involvement OR= 15.6, 95%CI (4.8-50.3), p<0.001; severe thrombocytopenia 9.6 (2.9-31.7), p<0.001; heart involvement 5.8 (2.6-13.0), p<0.001; and the severity index (cases 8.8 mu, 2.4 sigma vs controls 3.5, 2.0, respectively) 2.2 (1.5-3.4), p<0.001. Variables associated with mortality detected at any moment before death were kidney involvement 2.16 (1.09-4.29), p<0.02; the steroid therapeutic index 2.3 (1.2-4.5), p<0.001; number of previous admissions 2.4 (1.4-4.3), p<0.001; the MEX-SLEDAI index (cases 21.6 mu 6.3 sigma vs controls 12.6, 5.8), 1.2 (1.1-1.3), p<0.001; and the number of severe infections 14.4 (4.4-46.2), p<0.001. Protective variables were skin involvement 0.1 (0.3-0.6), p<0.001; daily dose of chloroquine (cases 3.9 mu, 24.1 sigma vs controls 39.4, 60.0 mg), p <0.0001 and the time from thefirst SLE symptom to the patient's demise or the cut-off date 0.7(0.6-0.9), p<0.001. Multiple logistic regression showed

  17. Vaginismus and subfertility: case reports on the association observed in clinical practice.

    Ramli, M; Nora, Mz; Roszaman, R; Hatta, S

    2012-01-01

    To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms. We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety. The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.

  18. Clinical Observation on Intractable Insomnia Treated by Point Pressure in 42 Cases

    张庆萍

    2002-01-01

    @@ The author have in recent years treated 42 cases of intractable insomnia (with a history of over 2 years) by point pressure, yielding quite satisfactory results when compared with those treated with clonazepam. This is reported as follows.

  19. Contributions of the German Research Center for Geosciences (GFZ) to the EPOS (European Plate Observing System) Implementation Phase 2015-18

    Hoffmann, T. L.; Lauterjung, J.

    2017-12-01

    The European Plate Observing System project is currently approaching the end of year two of its four-year Implementation Phase 2015-18 (EPOS-IP). Under the Horizon 2020 Programme INFRADEV-3, the EPOS cyberinfrastructure is being established as an ERIC (European Research Infrastructure Consortium) and encompasses the implementation of both the EPOS Integrated Core Services (ICS) for solid Earth Science and a multitude of EPOS Thematic Core Services (TCS). During year two, a basic set of ICS and TCS services was developed and implemented, so that in October 2017 the validation phase (year 3) of EPOS is ready to be launched. Up to now, various TCS-Elements have integrated different Service Providers (SD) that are delivering Data, Data Products, Services and Software (DDSS) to their specific scientific community. As one of the 29 awardees of the EC grant, the German Research Center for Geosciences (GFZ) plays an important role in the implementation of EPOS and its Thematic and Integrated Core Services. The presented poster will give an overview of GFZ's participation in the work of nine technical EPOS Work Packages (WP7 ICS Development, WP8 Seismology, WP11 Volcano Observations, WP12 Satellite Data, WP13 Geomagnetic Observations, WP14 Anthropogenic Hazards, WP15 Geological Information and Modelling, WP16 Multi-Scale Laboratories and WP17 Geo Energy Test Beds) as well as in four administrative EPOS Work Packages (WP2 Communication, WP3 Harmonization, WP4 Legal & Governance, and WP5 Financial).

  20. FLOATING ELBOW IN CHILDREN: A DESCRIPTIVE STUDY OF 31 CASES ATTENDED IN A REFERENCE CENTER FOR PEDIATRIC TRAUMA.

    Malheiros, Dorotea Starling; Bárbara, Gustavo Henrique Silva; Mafalda, Leandro Gonçalves; Madureira, João Lopo; Braga, Gilberto Ferreira; Terra, Dalton Lopes

    2011-01-01

    To conduct a descriptive analysis on 31 cases of children with floating elbow who were attended at our clinic between 1994 and 2009, and to review the literature relating to this topic. Data were obtained through examining the medical records. The following variables were used: age, gender, side, mechanism, type of fracture, classification, treatment and complications. Twenty-four patients (77.4%) were male and seven (22.6%) were female. The mean age was 8.5 (± 3.2) years, ranging from one to 14 years. The left side was predominantly affected (67.7%). The commonest injury mechanism was a fall from a height (74.2%). All the supracondylar fractures were Gartland type III. Distal radius fractures alone, of Salter-Harris type II, were diagnosed in 22 patients (71%). Open fractures occurred in 22 cases (71%). Closed reduction and application of a plaster cast for a closed fracture of the distal radius was performed in two patients (6.45%). Simultaneous conservative treatment for two fractures was not used. Sixteen supracondylar fractures (54.8%) were fixed using crossed wires, at 90° to each other, and in 14 cases (45.16%), an intramedullary wire was used together with another wire introduced through the lateral epicondyle at 45°. The following complications were observed: deformed consolidation (10%), nerve injuries (6%), compartment syndrome (3%) and pin path infection (16%). This is an uncommon injury that in most cases results from high-energy trauma. Surgical treatment for both fractures is recommended by most authors. Ulnar nerve injuries were correlated with the fixation method, but no neurological injuries were triggered by the initial trauma.

  1. A PROSPECTIVE OBSERVATIONAL STUDY REGARDING PREVALENCE OF DRY EYE DISEASE IN POST-OPERATIVE CATARACT SURGERY PATIENTS OF 140 CASES.

    S. Srinivasan

    2017-02-01

    Full Text Available BACKGROUND Dry eye disease is one of the most common ocular surface disorder with large number of studies carried out in various countries estimate the prevalence of dry eye disease to be between 5-34%. The prevalence of dry eye increases with age. As per Breaver Dam study regarding dry eye the prevalence of DED 13.3%. Dry eye was apparently higher in women than men. Studies have shown that cataract surgery worsen dry eye symptoms in patients with preexisting dry eye symptoms as well as without preexisting DES, mostly dry eye symptoms last for two months of post cataract surgery period. MATERIALS AND METHODS The prospective observational study was conducted in Department of Ophthalmology, Government Vellore Medical College and Hospital, Vellore. The total number of cataract surgery performed cases were 140 in number. The study period was four months, conducted in tertiary eye center. The Cataract patients were preoperatively at normal tear secretions. Post cataract surgery period from first POD, one week POD, four weeks, six weeks, two months and three months POD examined by slit lamp, Schirmer's test I, TBUT and corneal sensitivity test were performed. RESULTS Our study revealed that increased prevalence in female sex with increased age group range from 51-70 years showed post cataract surgery period dryness of eye. The ratio of Post cataract surgery DED in male and female is 13:29. This shows increased female sex prevalence of postoperative DED. In our study, the prevalence of post cataract surgery dry eye disease was 30%. CONCLUSION 73% cataract surgeries is now clear corneal cataract surgery and this procedure cuts a large part of corneal nerves. The nerve essential for tear production gets disturbed leading to dryness and hence decreased visual function. The corneal nerves are important in self-regulation of tears since they provide the sensation in the feedback loop that signals tear production. When the functions of the nerves get blocked

  2. Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009-2011.

    Sharon K Greene

    Full Text Available Guillain-Barré Syndrome (GBS can be triggered by gastrointestinal or respiratory infections, including influenza. During the 2009 influenza A (H1N1 pandemic in the United States, monovalent inactivated influenza vaccine (MIV availability coincided with high rates of wildtype influenza infections. Several prior studies suggested an elevated GBS risk following MIV, but adjustment for antecedent infection was limited.We identified patients enrolled in health plans participating in the Vaccine Safety Datalink and diagnosed with GBS from July 2009 through June 2011. Medical records of GBS cases with 2009-10 MIV, 2010-11 trivalent inactivated influenza vaccine (TIV, and/or a medically-attended respiratory or gastrointestinal infection in the 1 through 141 days prior to GBS diagnosis were reviewed and classified according to Brighton Collaboration criteria for diagnostic certainty. Using a case-centered design, logistic regression models adjusted for patient-level time-varying sources of confounding, including seasonal vaccinations and infections in GBS cases and population-level controls.Eighteen confirmed GBS cases received vaccination in the 6 weeks preceding onset, among 1.27 million 2009-10 MIV recipients and 2.80 million 2010-11 TIV recipients. Forty-four confirmed GBS cases had infection in the 6 weeks preceding onset, among 3.77 million patients diagnosed with medically-attended infection. The observed-versus-expected odds that 2009-10 MIV/2010-11 TIV was received in the 6 weeks preceding GBS onset was odds ratio = 1.54, 95% confidence interval (CI, 0.59-3.99; risk difference = 0.93 per million doses, 95% CI, -0.71-5.16. The association between GBS and medically-attended infection was: odds ratio = 7.73, 95% CI, 3.60-16.61; risk difference = 11.62 per million infected patients, 95% CI, 4.49-26.94. These findings were consistent in sensitivity analyses using alternative infection definitions and risk intervals for prior

  3. [Connectionist models of social learning: a case of learning by observing a simple task].

    Paignon, A; Desrichard, O; Bollon, T

    2004-03-01

    This article proposes a connectionist model of the social learning theory developed by Bandura (1977). The theory posits that an individual in an interactive situation is capable of learning new behaviours merely by observing them in others. Such learning is acquired through an initial phase in which the individual memorizes what he has observed (observation phase), followed by a second phase where he puts the recorded observations to use as a guide for adjusting his own behaviour (reproduction phase). We shall refer to the two above-mentioned phases to demonstrate that it is conceivable to simulate learning by observation otherwise than through the recording of perceived information using symbolic representation. To this end we shall rely on the formalism of ecological neuron networks (Parisi, Cecconi, & Nolfi, 1990) to implement an agent provided with the major processes identified as essential to learning through observation. The connectionist model so designed shall implement an agent capable of recording perceptive information and producing motor behaviours. The learning situation we selected associates an agent demonstrating goal-achievement behaviour and an observer agent learning the same behaviour by observation. Throughout the acquisition phase, the demonstrator supervises the observer's learning process based on association between spatial information (input) and behavioural information (output). Representation thus constructed then serves as an adjustment guide during the production phase, involving production by the observer of a sequence of actions which he compares to the representation stored in distributed form as constructed through observation. An initial simulation validates model architecture by confirming the requirement for both phases identified in the literature (Bandura, 1977) to simulate learning through observation. The representation constructed over the observation phase evidences acquisition of observed behaviours, although this phase

  4. Resilience paradigm's contributions to socio educational work. The case of the center Zabaloetxe for unaccompanied migrant children

    José Miguel Martín de Castro

    2016-06-01

    Full Text Available In this article it has been carried out an approach to resilience and affectivity as key elements to socio-educational intervention. Its theoretical and qualitative research are based on the intervention of the educator and his ability as a resilience tutor within a center for unaccompanied migrant children. From a qualitative perspective, participant observation and 9 interviews held with 3 female and 6 male educators had been used. The analysis and interpretation of the results show some evidences linked to the detection of risk factors and protection, characteristics of the educational intervention in the reception phase, and the environment as key issues in the period of representation and relation, and finally on the socio-educative bases of the resilience teaching action. Some of the conclusions take in account the results of this investigation are the following: resilience shares with education a key factor such as the importance of the quality of the human environment and the interactions manifested within this last one, and as an educational bond is created, there is a space for its own stimulation. It is also set out the necessity of continuing with the research within this field linked to the resilience and the social education.

  5. Functional and ophthalmoscopic observations in human laser accident cases using scanning-laser ophthalmoscopy

    Zwick, Harry; Lund, David J.; Gagliano, Donald A.; Stuck, Bruce E.

    1994-06-01

    A scanning laser ophthalmoscope (SLO) equipped with an acousto- optical modulator (ACM) was used to make focal acuity and contrast sensitivity measurements in individuals with macular damage. The depth of modulation achieved by the ACM was determined by imaging the SLO raster pattern onto a Pulnix TM 745 video camera and evaluating the intensity distribution with a Big Sky BVA10 beam view analyzer. Contrast levels remained approximately constant over the entire range of SLO input raster power settings. A delta Technologies image processing system produced Landolt ring test stimuli at the center of the raster pattern. Contrast thresholds were determined at various retinal locations by having subjects fixate a specific location on a fixed grid imaged on the raster pattern. This procedure insured that the test stimuli were always imaged in the center of the raster pattern thereby avoiding peripheral variations in the raster pattern intensity distribution. Measurements of contrast sensitivity where focal test targets fell within the macular damage area demonstrated elevated contrast thresholds relative to retinal locations where focal test targets evaluated the border regions between normal and pathological retina.

  6. Evaluation of a National Call Center and a Local Alerts System for Detection of New Cases of Ebola Virus Disease - Guinea, 2014-2015.

    Lee, Christopher T; Bulterys, Marc; Martel, Lise D; Dahl, Benjamin A

    2016-03-11

    The epidemic of Ebola virus disease (Ebola) in West Africa began in Guinea in late 2013 (1), and on August 8, 2014, the World Health Organization (WHO) declared the epidemic a Public Health Emergency of International Concern (2). Guinea was declared Ebola-free on December 29, 2015, and is under a 90 day period of enhanced surveillance, following 3,351 confirmed and 453 probable cases of Ebola and 2,536 deaths (3). Passive surveillance for Ebola in Guinea has been conducted principally through the use of a telephone alert system. Community members and health facilities report deaths and suspected Ebola cases to local alert numbers operated by prefecture health departments or to a national toll-free call center. The national call center additionally functions as a source of public health information by responding to questions from the public about Ebola. To evaluate the sensitivity of the two systems and compare the sensitivity of the national call center with the local alerts system, the CDC country team performed probabilistic record linkage of the combined prefecture alerts database, as well as the national call center database, with the national viral hemorrhagic fever (VHF) database; the VHF database contains records of all known confirmed Ebola cases. Among 17,309 alert calls analyzed from the national call center, 71 were linked to 1,838 confirmed Ebola cases in the VHF database, yielding a sensitivity of 3.9%. The sensitivity of the national call center was highest in the capital city of Conakry (11.4%) and lower in other prefectures. In comparison, the local alerts system had a sensitivity of 51.1%. Local public health infrastructure plays an important role in surveillance in an epidemic setting.

  7. Rosai-Dorfman disease: a report of eight cases in a tertiary care center and a review of the literature

    R.C. Maia

    2015-01-01

    Full Text Available Rosai-Dorfman disease (RDD is a nonmalignant histiocytic disorder of unknown origin that is extremely rare. By immunohistochemistry, the RDD cells are characteristically S-100 positive and CD1a negative. Emperipolesis is a common histopathological finding, although not specific for RDD. Lymph node and cutaneous manifestations are most frequent, but diverse organs can be affected. The clinical course is unpredictable regardless of treatment. Here, we present a series of 8 cases presenting lymph node and/or cutaneous lesions. Lymph node involvement was seen in diverse regions, including mediastinal and retroperitoneal. The treatment response to steroids was diversified, and the chemotherapy response was disappointing. Associated autoimmune diseases (Sjögren syndrome and antiphospholipid syndrome were observed in 2 patients. Regardless of therapy modality, these patients exhibited a favorable prognosis in a follow-up duration that ranged from 15 to 80 months.

  8. Observing new product impacts on sectors value chains : The case of a French electronic SME

    Marche, B.; Boly, V.; Ortt, J.R.

    2016-01-01

    As a new technology impacts both the company itself and its ecosystem, the aim of this study is to visualize the influence of SME's new products on its supply chain. We adopted a case study approach to explore how products can affect the structure of a supply chain. Using data about the

  9. Linking theories of change and observed reality: the Shea value chain partnership case in Burkina

    Drost, S.; Wijk, van J.; Vellema, S.

    2012-01-01

    This case study found out how a public-private partnership in Burkina Faso helped female shea nut producers to link up with the cosmetic industry. Empirical data collected from October-December 2011 revealed that the shea value chain partnership between a international shea processing company, a

  10. Clinical observation of 5686 cases of infant hemangioma treated by 32P

    Liu Qinyuan; Lin Shixiu; Liu Jingtao

    2002-01-01

    Objective: To explore the therapeutic method of treating infant hemangioma by radioisotopes 32 P. Methods: Simple hemangiomata were treated by 32 P dermal application method. The authors prepared 32 P at the activity of 165.98 kBq/cm 2 /h, diluted it with 2 ml water, and then dropped it on filter paper. The authors applied the paper to the impaired site according to the shape and the size of hemangioma. The impaired site received 32 P radiation at the dosage of 9.41 Gy/cm 2 each time. The treatment was repeated once every month. Cavernous hemangiomata were treated by local injections of colloid 32 P at the dosage of 370 kBq/cm 3 once every 2-3 months. Mixed hemangiomata received combined treatment mentioned above. Results: 3383 cases (99.0%) of simple hemangioma were cured by 32 P dermal application method. 1241 case (98.7%) of cavernous hemangioma were cured. 397 cases (83.0%) of mixed hemangioma were cured. 534 cases (98.1%) of naevus flammeus were improved by 32 P application method. The total effective rate was 99.8%. The cure rate was 88.3%. Conclusion: Treating hemangioma with 32 P is satisfactory for its high efficiency and low toxicity. It may be advisable for infant skin disease

  11. Observation and studies of jet quenching in PbPb collisions at nucleon-nucleon center-of-mass energy = 2.76 TeV

    Chatrchyan, Serguei [Yerevan Physics Inst. (Armenia); et al.

    2011-08-01

    Jet production in PbPb collisions at a nucleon-nucleon center-of-mass energy of 2.76 TeV was studied with the CMS detector at the LHC, using a data sample corresponding to an integrated luminosity of 6.7 inverse microbarns. Jets are reconstructed using the energy deposited in the CMS calorimeters and studied as a function of collision centrality. With increasing collision centrality, a striking imbalance in dijet transverse momentum is observed, consistent with jet quenching. The observed effect extends from the lower cut-off used in this study (jet transverse momentum = 120 GeV/c) up to the statistical limit of the available data sample (jet transverse momentum approximately 210 GeV/c). Correlations of charged particle tracks with jets indicate that the momentum imbalance is accompanied by a softening of the fragmentation pattern of the second most energetic, away-side jet. The dijet momentum balance is recovered when integrating low transverse momentum particles distributed over a wide angular range relative to the direction of the away-side jet.

  12. How are the temporary workers? Quality of life and burn-out in a call center temporary employment in Italy: a pilot observational study

    Alice Mannocci

    2014-06-01

    Full Text Available OBJECTIVES. The aim of this study was to quantify the level of health related quality of life and burnout in a call centers sample of precarious workers. METHODS. An observational study was carried out in Italy. A self-reported anonymous questionnaire was administered to temporary workers in order to estimate burn-out and quality of life levels. RESULTS. 227 questionnaires were collected. 78% of the sample was female and the mean age was 35.48 years (SD = 9.91. Among the participants, 40% were smokers, 42% regularly drinkers, 65% changed the body weight (more than 5 kg, in 1 year. The mental component score (MCS was significantly better in subject that have a regularly life style, for example in those no change their body weight (p = 0.001, sleep more than 7 hours (p = 0.018 and followed a diet (p = 0.035. The DP (depersonalization is significant higher in former smokers (p = 0.031, in underweight subjects (p = 0.025 and in the group that have a precarious employment of over 2 years (p = 0.013. CONCLUSIONS. This investigation shows that in this particular category of atypical workers depressive symptoms and quality of life were lower than the general population. It is important to underline that the interpretation of the results is limited partly by the observational character of the study.

  13. Prognosis of patients excluded by the definition of septic shock based on their lactate levels after initial fluid resuscitation: a prospective multi-center observational study.

    Ko, Byuk Sung; Kim, Kyuseok; Choi, Sung-Hyuk; Kang, Gu Hyun; Shin, Tae Gun; Jo, You Hwan; Ryoo, Seung Mok; Beom, Jin Ho; Kwon, Woon Yong; Han, Kap Su; Choi, Han Sung; Chung, Sung Phil; Suh, Gil Joon; Lim, Tae Ho; Kim, Won Young

    2018-02-24

    Septic shock can be defined both by the presence of hyperlactatemia and need of vasopressors. Lactate levels should be measured after volume resuscitation (as per the Sepsis-3 definition). However, currently, no studies have evaluated patients who have been excluded by the new criteria for septic shock. The aim of this study was to determine the clinical characteristics and prognosis of these patients, based on their lactate levels after initial fluid resuscitation. This observational study was performed using a prospective, multi-center registry of septic shock, with the participation of 10 hospitals in the Korean Shock Society, between October 2015 and February 2017. We compared the 28-day mortality between patients who were excluded from the new definition (defined as lactate level definition of septic shock. These patients, in whom perfusion was restored, demonstrated significantly lower age, platelet count, and initial and subsequent lactate levels (all p < 0.01). Similarly, significantly lower 28-day mortality was observed in these patients than in those who had not been excluded (8.2% vs 25.5%, p = 0.02). In-hospital mortality and the maximum SOFA score were also significantly lower in the excluded patients group (p = 0.03, both). It seems reasonable for septic shock to be defined by the lactate levels after volume resuscitation. However, owing to the small number of patients in whom lactate levels were improved, further study is warranted.

  14. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    Bryan A Loy

    Full Text Available Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011 and after (2013 the payment method introduction using relative risks (RR. After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05. For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008 from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20. These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  15. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    Loy, Bryan A; Shkedy, Clive I; Powell, Adam C; Happe, Laura E; Royalty, Julie A; Miao, Michael T; Smith, Gary L; Long, James W; Gupta, Amit K

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  16. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan

    Chang, Kuo-Chin; Chuah, Seng-Kee; Changchien, Chi-Sin; Tsai, Tung-Lung; Lu, Sheng-Nan; Chiu, Yi-Chun; Chen, Yaw-Sen; Wang, Chih-Chi; Lin, Jui-Wei; Lee, Chuan-Mo; Hu, Tsung-Hui

    2006-01-01

    AIM: To analyze 67 cases of splenic abscess in a medical center of Taiwan during a period of 19 years. METHODS: From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE II scores, and mortality rates were analyzed. RESULTS: There were 41 males and 26 females with the mean age of 54.1 ± 14.1 years. Multiple splenic abscesses (MSA) account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixty-seven patients (35.8%) had extrasplenic abscesses, with leading site of liver (34.6%). Microbiological cultures were positive in 58 patients (86.6%), with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus (GNB) infection predominated (55.2%), with leading pathogen of Klebsiella pneumoniae (22.4%), followed by gram positive coccus (GPC) infection (31%). Splenectomy was performed in 26 patients (38.8%), percutaneous drainage or aspiration in 21 (31.3%), and antibiotic therapy alone in 20 patients (29.9%). Eventually, 12 of 67 patients expired (17.9 %). By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC (P = 0.036). Patients with GNB infection (P = 0.009) and multiple abscesses (P = 0.011) experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE II score of 12 expired patients (16.3 ± 3.2) was significantly higher than that of the 55 survivals (7.2 ± 3.8) (P factors. Early surgical intervention should be encouraged when these risk factors are present. PMID:16489650

  17. [Parasitological study of 78 cases of human cystic echinococcosis collected between 2005 to 2012 in Mustapha hospital center of Algiers].

    Zait, H; Boulahbel, M; Normand, A C; Zait, F; Achir, I; Guerchani, M K; Chaouche, H; Ladjadj, Y; Hamrioui, B

    2014-12-01

    The aim of this work is to know the fertility rate of the metacestodes resulting from patients suffering from hydatidosis, the one of protoscoleces's viability and by comparing the results obtained with those found elsewhere. It reports, also, the epidemiological, clinical and diagnostically aspects of the studied patients. This study has carried on 78 hydatics samples resulting from 78 patients collected between 2005 and 2012 at the laboratory of parasitology of the Mustapha hospital center of Algiers. A questionnaire on the epidemiological context (contact with an animal-host of the cycle, place of residence, presence of family cases reached of hydatidosis and knowledge on the hydatic disease) concerned 69 patients. For each sample, a direct microscopic examination is made with or without vital staining. The presence of protoscoleces made qualified the fertile cyst. Those visualized moving or resistant to eosin at 0.2% are considered viables. Indirect diagnosis is based on the techniques: passive hemagglutination, electrophoresis, Elisa IgG Echinococcus granulosus and immunoblotting IgG "Echinococcus". Molecular analysis is based on PCR and sequencing the partials fragments of two mitochondrial genes with the primers COX1 and ND1. The results obtained show that the surgical frequency of hydatidosis is significant at the young adult and at the child. The epidemiological context associated at the disease is the conjointly presence of a dog and herbivores. The fertility rate of human hydatid cysts is 88.4% and the ones of viability of the protoscoleces is 74.5%. In this series, the serology shows global positivity at 70%. The molecular characterization of five samples identify the species: E. granulosus ss. Finally, the viability and fertility rates found here are raised. Sometimes viables protoscoleses are found after use of scolicidal solution. In front of these results, the parasitical treatment is more than necessary in order to minimize the risk of occurred of

  18. Human-centered approaches in geovisualization design: investigating multiple methods through a long-term case study.

    Lloyd, David; Dykes, Jason

    2011-12-01

    Working with three domain specialists we investigate human-centered approaches to geovisualization following an ISO13407 taxonomy covering context of use, requirements and early stages of design. Our case study, undertaken over three years, draws attention to repeating trends: that generic approaches fail to elicit adequate requirements for geovis application design; that the use of real data is key to understanding needs and possibilities; that trust and knowledge must be built and developed with collaborators. These processes take time but modified human-centred approaches can be effective. A scenario developed through contextual inquiry but supplemented with domain data and graphics is useful to geovis designers. Wireframe, paper and digital prototypes enable successful communication between specialist and geovis domains when incorporating real and interesting data, prompting exploratory behaviour and eliciting previously unconsidered requirements. Paper prototypes are particularly successful at eliciting suggestions, especially for novel visualization. Enabling specialists to explore their data freely with a digital prototype is as effective as using a structured task protocol and is easier to administer. Autoethnography has potential for framing the design process. We conclude that a common understanding of context of use, domain data and visualization possibilities are essential to successful geovis design and develop as this progresses. HC approaches can make a significant contribution here. However, modified approaches, applied with flexibility, are most promising. We advise early, collaborative engagement with data – through simple, transient visual artefacts supported by data sketches and existing designs – before moving to successively more sophisticated data wireframes and data prototypes. © 2011 IEEE

  19. Role of Tuition Centers in the Performance and Achievement of Students: A Case of Hyderabad District, Sindh, Pakistan

    Sahito, Zafarullah; Khawaja, Mumtaz; Siddiqui, Abida; Shaheen, Anjum; Saeed, Humera

    2017-01-01

    This research is designed to explore the importance of tuition centers in the perception of students. It tries to find out the role, supporting methods, environment and good characteristics of tuition centers, their owners and management to support the student to learn effectively and bring good grades in their board examinations. A qualitative…

  20. Observation of Clouds Using the CSIR Transportable LIDAR: A Case Study over Durban, South Africa

    Lerato Shikwambana

    2016-01-01

    Full Text Available The Council for Scientific and Industrial Research (CSIR transportable Light Detection And Ranging (LIDAR was used to collect data over Durban (29.9°S, 30.9°E during 20–23 November 2012. Aerosol measurements have been carried out in the past over Durban; however, no cloud measurements using LIDAR have ever been performed. Therefore, this study further motivates the continuation of LIDAR for atmospheric research over Durban. Low level clouds were observed on 20–22 November 2012 and high level clouds were observed on 23 November 2012. The low level cloud could be classified as stratocumulus clouds, whereas the high level clouds could be classified as cirrus clouds. Low level cloud layers showed high extinction coefficients values ranging between 0.0009 and 0.0044 m−1, whereas low extinction coefficients for high level clouds were observed at values ranging between 0.000001 and 0.000002 m−1. Optical depth showed a high variability for 20 and 21 November 2012. This indicates a change in the composition and/or thickness of the cloud. For 22 and 23 November 2012, almost similar values of optical depth were observed. Cloud-Aerosol LIDAR and Infrared Pathfinder Satellite Observations (CALIPSO revealed high level clouds while the CSIR LIDAR could not. However, the two instruments complement each other well to describe the cloudy condition.

  1. Observations of plasma vortices in the vicinity of flow-braking: a case study

    K. Keika

    2009-08-01

    Full Text Available We examine fast plasma flows and magnetic field fluctuations observed by THEMIS at 03:00–03:30 UT on 12 December 2007. All THEMIS probes are situated in the near-Earth plasma sheet (XSM>−10 RE with 1–2 RE spacecraft separations in azimuthal and radial directions. We focus on the observations of plasma convective flows made simultaneously by more than one THEMIS probe. At about 03:10 UT and 03:14 UT, the THEMIS P2 probe observed earthward flows of >100 km/s. The THEMIS P1 probe, located duskward and earthward of P2, observed tailward flows under a positive Bz. The inner most probe THEMIS P4, located at almost the same MLT as THEMIS P1 and P2, did not see any clear flow. We examine the convective flow patterns for the THEMIS observations. We conclude that plasma vortices are formed near the region where the earthward flows slow down and turn in azimuthal directions.

  2. VAGINISMUS AND SUBFERTILITY: CASE REPORTS ON THE ASSOCIATION OBSERVED IN CLINICAL PRACTICE

    Ramli, M; Nora, MZ; Roszaman, R; Hatta, S

    2012-01-01

    Objective: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before beingreferred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentationsof Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despitethe woman’s wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction ...

  3. [1st observations of the pathogenicity of Ichthyophonus in birds. 2 cases of natural infection].

    Chauvier, G; Mortier-Gabet, J

    1984-01-01

    Two cases of ichthyophoniasis (ichthyosporidiosis) are reported for the first time in fish-eating birds, heron and herring gull. The lesions were mainly in the heart, liver, spleen and kidney. The fungus was isolated from them, cultivated and found identical to a strain previously obtained from a sea-fish. It was able to grow at 40 degrees C. Attention is drawn on the potential hazard for human health resulting from the ingestion of raw fish.

  4. Diagnosis of balance between Heritage, housing and tourism in historic centers: case studies from Porto (Portugal and Salvador (Brazil

    Alice Tavares

    2018-01-01

    Full Text Available The sustainability of cultural values of historic centers depends, to a great extent, on the balance achieved between maintaining the resident population, preventing housing abandonment, and reconciling the new functions installed in those centers. Nowadays, tourism is seen as a solution to reactivate historic centers, often neglecting the original resident population. This study analyzes two examples of urban rehabilitation in historic centers, one in Portugal and another in Brazil, respectively, Porto and Salvador da Bahia, with 1996 and 1985 UNESCO classifications, respectively. The present study analyses the interaction between the evolution of building stock, renting and tourism, focusing on aspects that result in positive and negative actions for the preservation of the built heritage of these centers, their identity and exclusion of traditional residents.

  5. [Poisoning with "poppers", a rare cause of methemoglobinemia observed in emergency cases].

    Staïkowsky, F; Perret, A; Péviriéri, F; Zanker, C; Zerkak, D; Pelloux, P; Danhiez, F

    1997-10-04

    Methemoglobulinemia should be entertained as a differential diagnosis in patients with cyanosis. Recently in France there has been an increase in the number of cases of acquired methemoglobulinemia due to inhalation of poppers. Four patients were admitted to the emergency room of a Paris hospital in a state of unconsciousness with cyanosis. All four patients had inhaled poppers shortly before admission. The clinical course was rapidly favorable after intravenous infusion of methylene blue in 3 cases. Poppers are inorganic aliphatic nitrites used for their relaxing effect on smooth muscle and for their aphrodisiac effect. One poorly recognized effect is the development of methemoglobulinemia. Tissue hypoxia results because methemoglobulin cannot bind oxygen, leading to a brown or blue coloration of the blood. Methemoglobulin usually results from exposure to a wide variety of oxidizing compounds including certain drugs. Methylene blue is the specific treatment for symptomatic methemoglobulinemia. These four cases emphasize the toxic effect of products sold in sex shops and calls attention to the life-threatening risks involved.

  6. VAGINISMUS AND SUBFERTILITY: CASE REPORTS ON THE ASSOCIATION OBSERVED IN CLINICAL PRACTICE

    M Ramli

    2012-08-01

    Full Text Available Objective: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before beingreferred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentationsof Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despitethe woman’s wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the mostcommon symptoms.Method: We report a series of cases of Malaysian women who had been suffering from vaginismus and ‘infertility’. All the caseshad never been attended to medically and there were long delays in seeking intervention. There was no history of traumaticsexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety.Conclusion: The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. Theformer have unique psychological features which require psychological interventions.

  7. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

    Loy, Bryan A.; Shkedy, Clive I.; Powell, Adam C.; Happe, Laura E.; Royalty, Julie A.; Miao, Michael T.; Smith, Gary L.; Long, James W.; Gupta, Amit K.

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, ppayment model and assess implications in other populations. PMID:26870963

  8. Conducting an Unplanned Participant Observation: The Case of a Non-Birder in Bird Watchers' Land

    Roni Berger

    2016-12-01

    Full Text Available This article describes two participant observations of birdwatchers, which occurred by serendipity. Characteristics of personal and interpersonal behavior patterns are identified and illustrated. Specifically, four themes including total immersion and dedication to details of birders as well the collaborative-competitive nature of their interactions and sub-culture are discussed in the context of available knowledge about subcultures in other types of sports and leisure activities. Methodological and ethical aspects of unplanned participant observation are also addressed. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs170187

  9. Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study.

    Orban, Kristina; Ekelin, Maria; Edgren, Gudrun; Sandgren, Olof; Hovbrandt, Pia; Persson, Eva K

    2017-09-11

    Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method. In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed. The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone. Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

  10. REFLECTIVE PRACTICE THROUGH JOURNAL WRITING AND PEER OBSERVATION: A Case Study

    B. Samrajya LAKSHMI

    2014-10-01

    Full Text Available Journal writing and Peer Observation in an educational context have become popular techniques, with several different types of applications. They have now been used quite widely in both language teaching and in teacher training. However, despite its reported advantages in both teaching and research, there are not many Peer Observation and Diary studies available based on the writing of experienced language teachers. The Teacher participants maintain Journal writing and Peer Observation as a means of reflective practice. They consider these practices as a mirror, which reflects the teacher’s own image as a practioner. The post-reflection discussion reveals that the teacher participants believe in reflective practice as an effective means of self-evaluation and of developing sensitivity to students’ learning. This paper examines Peer Observation and journal writing of two teachers working on the same language programme in terms of a variety of topic headings, and suggests that reflective practice can be a useful tool for both classroom research and teachers’ professional development.

  11. An Observational Case Study of Near-peer Teaching in Medical and Pharmacy Experiential Training.

    Sharif-Chan, Bayan; Tankala, Dipti; Leong, Christine; Austin, Zubin; Battistella, Marisa

    2016-09-25

    Objective. To compare peer teaching in a medical and a pharmacy clinical teaching unit and to provide suggestions for future research in pharmacy near-peer teaching. Methods. This exploratory observational study used principles of ethnographic methodology for data collection and analysis. Observations were collected in a large downtown teaching hospital. An average of 4-6 hours per day were spent observing a team of medical trainees from the Faculty (School) of Medicine in the general internal medicine (unit for two weeks, followed by a team of pharmacy trainees in an ambulatory hemodialysis (HD) unit for two weeks. Data was collected through field notes and informal interviews that were audiotaped and subsequently transcribed. Data was interpreted by the observer and reviewed weekly by two impartial pharmacists. Results. Five major themes emerged: (1) influence of peer teaching hierarchy; (2) educational distance between peer learners and teachers; (3) effect of the clinical teaching unit size on peer learning; (4) trainees' perception of their teaching role in the clinical teaching unit; and (5) influence of daily schedule and workload on peer teaching. As opposed to pharmacy, a hierarchy and pyramidal structure of peer teaching was observed in medical experiential training. There appeared to be no effect of educational distance on near peer teaching; however, perception of teaching role and influence of daily schedule affected near-peer teaching. Conclusion. Through initial comparisons of medical and pharmacy clinical teaching units, this study provides a reflection of elements that may be necessary to successfully implement near-peer teaching in pharmacy experiential training. Future studies in this area should assess learning outcomes and participant satisfaction, preceptor workload, and impact on patient care.

  12. Asymptomatic Primary Infection with Epstein-Barr Virus: Observations on Young Adult Cases.

    Abbott, Rachel J; Pachnio, Annette; Pedroza-Pacheco, Isabela; Leese, Alison M; Begum, Jusnara; Long, Heather M; Croom-Carter, Debbie; Stacey, Andrea; Moss, Paul A H; Hislop, Andrew D; Borrow, Persephone; Rickinson, Alan B; Bell, Andrew I

    2017-11-01

    Epstein-Barr virus (EBV) is typically acquired asymptomatically in childhood. In contrast, infection later in life often leads to infectious mononucleosis (IM), a febrile illness characterized by anti-EBV IgM antibody positivity, high loads of circulating latently infected B cells, and a marked lymphocytosis caused by hyperexpansion of EBV-specific CD8 + T cells plus a milder expansion of CD56 dim NKG2A + KIR - natural killer (NK) cells. How the two situations compare is unclear due to the paucity of studies on clinically silent infection. Here we describe five prospectively studied patients with asymptomatic infections identified in a seroepidemiologic survey of university entrants. In each case, the key blood sample had high cell-associated viral loads without a marked CD8 lymphocytosis or NK cell disturbance like those seen in patients during the acute phase of IM. Two of the cases with the highest viral loads showed a coincident expansion of activated EBV-specific CD8 + T cells, but overall CD8 + T cell numbers were either unaffected or only mildly increased. Two cases with slightly lower loads, in whom serology suggests the infection may have been caught earlier in the course of infection, also showed no T or NK cell expansion at the time. Interestingly, in another case with a higher viral load, in which T and NK cell responses were undetectable in the primary blood sample in which infection was detected, EBV-specific T cell responses did not appear until several months later, by which time the viral loads in the blood had already fallen. Thus, some patients with asymptomatic primary infections have very high circulating viral loads similar to those in patients during the acute phase of IM and a cell-mediated immune response that is qualitatively similar to that in IM patients but of a lower magnitude. However, other patients may have quite different immune responses that ultimately could reveal novel mechanisms of host control. IMPORTANCE Epstein-Barr virus

  13. [Clinical observation of 5 cases of diabetes insipidus complicated with skeletal fluorosis].

    Wang, Shuan-Chi; Tao, Xiao-Bing; Wang, Fang-Fang; Zhang, Nan

    2017-07-25

    To investigate the mechanism of diabetes insipidus complicated with skeletal fluorosis and the surgical treatment of spinal canal stenosis caused by skeletal fluorosis. From January 2000 to November 2011, 5 patients with diabetes insipidus complicated with skeletal fluorosis were treated with drug and cervical or thoracic posterior decompression including 2 males and 3 females with age of 35, 45, 47, 49, 55 years old respectively. The symptoms was mainly limb motor sensory disturbance accompanied by polyuria and polyuria. Imaging showed that cervical and thoracic multi-segmental continuous spinal stenosis. It was diagnosed with diabetes insipidus according to the symptoms and laboratory tests. According to the symptoms, the vertebral with problems were located and treated by posterior laminectomy decompression or the expansive open-door laminectomy. The recovery of neurological symptoms were recorded and the operation result were evaluate by JOA score improvement rate. The wound healed well in 5 cases, and 1 case of cervical axial pain was improved after symptomatic treatment. Five patients were followed up for 2 to 6 years with an average of 4 years. Numbness of limb and weakness symptoms of follow-up patients were significantly improved, muscle strength and acupuncture hypothyroidism were significantly improved compared with preoperative, the JOA score was significantly improved. At the final follow-up, the improvement rate got excellent results in 2 cases, good in 2 and fair in 1. Long-term high intake of fluoride can cause skeletal fluorosis in patients with diabetes insipidus. The posterior decompression is effective for the majority of spinal canal stenosis caused by skeletal fluorosis.

  14. Measuring Efficiency of Knowledge Production in Health Research Centers Using Data Envelopment Analysis (DEA): A Case Study in Iran.

    Amiri, Mohammad Meskarpour; Nasiri, Taha; Saadat, Seyed Hassan; Anabad, Hosein Amini; Ardakan, Payman Mahboobi

    2016-11-01

    Efficiency analysis is necessary in order to avoid waste of materials, energy, effort, money, and time during scientific research. Therefore, analyzing efficiency of knowledge production in health areas is necessary, especially for developing and in-transition countries. As the first step in this field, the aim of this study was the analysis of selected health research center efficiency using data envelopment analysis (DEA). This retrospective and applied study was conducted in 2015 using input and output data of 16 health research centers affiliated with a health sciences university in Iran during 2010-2014. The technical efficiency of health research centers was evaluated based on three basic data envelopment analysis (DEA) models: input-oriented, output-oriented, and hyperbolic-oriented. The input and output data of each health research center for years 2010-2014 were collected from the Iran Ministry of Health and Medical Education (MOHE) profile and analyzed by R software. The mean efficiency score in input-oriented, output-oriented, and hyperbolic-oriented models was 0.781, 0.671, and 0.798, respectively. Based on results of the study, half of the health research centers are operating below full efficiency, and about one-third of them are operating under the average efficiency level. There is also a large gap between health research center efficiency relative to each other. It is necessary for health research centers to improve their efficiency in knowledge production through better management of available resources. The higher level of efficiency in a significant number of health research centers is achievable through more efficient management of human resources and capital. Further research is needed to measure and follow the efficiency of knowledge production by health research centers around the world and over a period of time.

  15. Quality of Life at Work: the case of penitentiary agents in a Temporary Detention Center in Rio Grande do Norte

    Emerson de França Fagundes

    2017-06-01

    Full Text Available Prison officers, due to the nature of their profession, are subject to various factors of risk, tension, physical and mental exhaustion. This study is a research carried out at a Provisional Detention Center (CDP in Rio Grande do Norte (RN, with the objective of analyzing Quality of Life at Work (QWL, as perceived by prison The model of Walton (1973. The method adopted was a field research, of an exploratory and descriptive character where the data were collected through a questionnaire with structured and closed questions. Allied to the "Quality of Life at Work Scale" according to the Walton model, adapted and proposed by Timossi et al (2009. The target population were the penitentiary agents servants of a RN's CDP. For this collection, the ethical care was adopted, through the letter of agreement of the institution and endorsement of the participants. The theoretical assumptions of this work are based on the studies of Walton (1973 that can be considered as the precursor of a scientific approach to QVT. For Walton, QVT depends closely on the balance between work and other spheres of life, the social role of the organization and the importance of reconciling productivity with QWL. In the analysis of the results it was observed a division by parts of the participants of the research, in which among the dimensions considered satisfactory, we have: the use and development of capacities; The social integration in the organization and the constitutionalism. On the other hand there was dissatisfaction with fair and adequate compensation; work conditions; Opportunity for growth and safety and the social relevance of life at work. It is observed that the QVT is affected by the subjectivity of the perception that each person has in relation to each dimension presented on their personal and professional aspirations in front of the organizational objectives. Some actions are suggested to improve the perception of QWL at work, such as the implementation of

  16. Calculation of controllability and observability matrices for special case of continuous-time multi-order fractional systems.

    Hassanzadeh, Iman; Tabatabaei, Mohammad

    2017-03-28

    In this paper, controllability and observability matrices for pseudo upper or lower triangular multi-order fractional systems are derived. It is demonstrated that these systems are controllable and observable if and only if their controllability and observability matrices are full rank. In other words, the rank of these matrices should be equal to the inner dimension of their corresponding state space realizations. To reduce the computational complexities, these matrices are converted to simplified matrices with smaller dimensions. Numerical examples are provided to show the usefulness of the mentioned matrices for controllability and observability analysis of this case of multi-order fractional systems. These examples clarify that the duality concept is not necessarily true for these special systems. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  17. [Neighborhood Systematic Social Observation; The Case of Chile and its Perspectives for Social Work.

    Sanhueza, Guillermo E; Delva, Jorge; Andrade, Fernando H; Grogan-Kaylor, Andrew; Bares, Cristina; Castillo, Marcela

    2011-12-01

    The study of neighborhood characteristics and their effects on individuals has become an area of increasing attention by scholars from various disciplines in developed countries. Although there are various methods to study neighborhoods and their impact on human populations, one of the most used is the Systematic Social Observation -Observación Sistemática de Vecindarios (OSV), in Spanish-because it allows the collection of information about various features of the physical, social, environmental and economic characteristics of neighborhoods. The purpose of this article is to (i) briefly present some research on neighborhood effects influential in the U.S., ii) describe how they Systematic Social Observation was designed and implemented in the city of Santiago, Chile, iii) discuss some facilitators and obstacles of the implementation process and, finally iv) list possible contributions and limitations this approach would offer the profession of social work in Chile.

  18. State funding for local public health: observations from six case studies.

    Potter, Margaret A; Fitzpatrick, Tiffany

    2007-01-01

    The purpose of this study is to describe state funding of local public health within the context of state public health system types. These types are based on administrative relationships, legal structures, and relative proportion of state funding in local public health budgets. We selected six states representing various types and geographic regions. A case study for each state summarized available information and was validated by state public health officials. An analysis of the case studies reveals that the variability of state public health systems--even within a given type--is matched by variability in approaches to funding local public health. Nevertheless, some meaningful associations appear. For example, higher proportions of state funding occur along with higher levels of state oversight and the existence of local service mandates in state law. These associations suggest topics for future research on public health financing in relation to local accountability, local input to state priority-setting, mandated local services, and the absence of state funds for public health services in some local jurisdictions.

  19. Identifying key components for an effective case report poster: an observational study.

    Willett, Lisa L; Paranjape, Anuradha; Estrada, Carlos

    2009-03-01

    Residents demonstrate scholarly activity by presenting posters at academic meetings. Although recommendations from national organizations are available, evidence identifying which components are most important is not. To develop and test an evaluation tool to measure the quality of case report posters and identify the specific components most in need of improvement. Faculty evaluators reviewed case report posters and provided on-site feedback to presenters at poster sessions of four annual academic general internal medicine meetings. A newly developed ten-item evaluation form measured poster quality for specific components of content, discussion, and format (5-point Likert scale, 1 = lowest, 5 = highest). Evaluation tool performance, including Cronbach alpha and inter-rater reliability, overall poster scores, differences across meetings and evaluators and specific components of the posters most in need of improvement. Forty-five evaluators from 20 medical institutions reviewed 347 posters. Cronbach's alpha of the evaluation form was 0.84 and inter-rater reliability, Spearman's rho 0.49 (p words. Our evaluation tool provides empirical data to guide trainees as they prepare posters for presentation which may improve poster quality and enhance their scholarly productivity.

  20. ALMA observations of AGN fuelling. The case of PKS B1718-649

    Maccagni, F. M.; Morganti, R.; Oosterloo, T. A.; Oonk, J. B. R.; Emonts, B. H. C.

    2018-06-01

    We present ALMA observations of the 12CO (2-1) line of the newly born (tradio 102 years) active galactic nucleus (AGN), PKS B1718-649. These observations reveal that the carbon monoxide in the innermost 15 kpc of the galaxy is distributed in a complex warped disk. In the outer parts of this disk, the CO gas follows the rotation of the dust lane and of the stellar body of the galaxy hosting the radio source. In the innermost kiloparsec, the gas abruptly changes orientation and forms a circumnuclear disk (r ≲ 700 pc) with its major axis perpendicular to that of the outer disk. Against the compact radio emission of PKS B1718-649 (r 2 pc), we detect an absorption line at red-shifted velocities with respect to the systemic velocity (Δv = +365 ± 22 km s-1). This absorbing CO gas could trace molecular clouds falling onto the central super-massive black hole. A comparison with the near-infrared H2 1-0 S(1) observations shows that the clouds must be close to the black hole (r ≲ 75 pc). The physical conditions of these clouds are different from the gas at larger radii, and are in good agreement with the predictions for the conditions of the gas when cold chaotic accretion triggers an active galactic nucleus. These observations on the centre of PKS B1718-649 provide one of the best indications that a population of cold clouds is falling towards a radio AGN, likely fuelling its activity. The reduced datacube is only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/614/A42

  1. The Materiality of Method: The Case of the Mass Observation Archive

    Liz Moor; Emma Uprichard

    2014-01-01

    The Mass Observation Archive presents numerous methodological issues for social researchers. The data are idiosyncratic, difficult to analyze, and the sample design is nonsystematic. Such issues seriously challenge conventional social research protocols. This article highlights a further characteristic of the archive: its unwieldy materiality. Focusing on the sensory experiences of the archive and its particular type of data, the article shows how the experience of getting ‘dirty with dataâ...

  2. Conducting an Unplanned Participant Observation: The Case of a Non-Birder in Bird Watchers' Land

    Roni Berger

    2016-01-01

    This article describes two participant observations of birdwatchers, which occurred by serendipity. Characteristics of personal and interpersonal behavior patterns are identified and illustrated. Specifically, four themes including total immersion and dedication to details of birders as well the collaborative-competitive nature of their interactions and sub-culture are discussed in the context of available knowledge about subcultures in other types of sports and leisure activities. Methodolog...

  3. The role of the observational approach in RI planning: WAG 5 case study

    Brill, A.K.; Kuhaida, A.J. Jr.

    1992-10-01

    A Remedial Investigation (RI) Plan was developed for the Oak Ridge National Laboratory (ORNL) Waste Area Grouping (WAG) 5 in March 1988 and submitted to the Environmental Protection Agency (EPA) Region IV and the State of Tennessee for review and approval. The observational approach was evaluated by the ORNL Environmental Restoration (ER) Program and accepted by EPA as an accelerated and cost-effective approach to the RI/Feasibility Study (FS) process for remediation of WAG 5. The traditional approach used in preparing the 1988 RI Plan focused on data completeness, included a typical range of RI data-gathering activities for determining the nature and extent of contamination at WAG 5, and used multiple iterations of sampling activities to deal with uncertainties without consideration of potential deviations. In fall 1991, a revised Field Sampling Plan (FSP) was developed that used the observational approach to integrate site characterization with site remediation needs. This approach recognized the uncertainties of site characterization/remedial planning and developed contingency plans for dealing with them. The observational approach emphasizes data sufficiency to support remedial planning decisions for WAG 5

  4. Linking Earth Observations and Models to Societal Information Needs: The Case of Coastal Flooding

    Buzzanga, B. A.; Plag, H. P.

    2016-12-01

    Coastal flooding is expected to increase in many areas due to sea level rise (SLR). Many societal applications such as emergency planning and designing public services depend on information on how the flooding spectrum may change as a result of SLR. To identify the societal information needs a conceptual model is needed that identifies the key stakeholders, applications, and information and observation needs. In the context of the development of the Global Earth Observation System of Systems (GEOSS), which is implemented by the Group on Earth Observations (GEO), the Socio-Economic and Environmental Information Needs Knowledge Base (SEE-IN KB) is developed as part of the GEOSS Knowledge Base. A core function of the SEE-IN KB is to facilitate the linkage of societal information needs to observations, models, information and knowledge. To achieve this, the SEE-IN KB collects information on objects such as user types, observational requirements, societal goals, models, and datasets. Comprehensive information concerning the interconnections between instances of these objects is used to capture the connectivity and to establish a conceptual model as a network of networks. The captured connectivity can be used in searches to allow users to discover products and services for their information needs, and providers to search for users and applications benefiting from their products. It also allows to answer "What if?" questions and supports knowledge creation. We have used the SEE-IN KB to develop a conceptual model capturing the stakeholders in coastal flooding and their information needs, and to link these elements to objects. We show how the knowledge base enables the transition of scientific data to useable information by connecting individuals such as city managers to flood maps. Within the knowledge base, these same users can request information that improves their ability to make specific planning decisions. These needs are linked to entities within research

  5. ODM2 (Observation Data Model): The EarthChem Use Case

    Lehnert, Kerstin; Song, Lulin; Hsu, Leslie; Horsburgh, Jeffrey S.; Aufdenkampe, Anthony K.; Mayorga, Emilio; Tarboton, David; Zaslavsky, Ilya

    2014-05-01

    PetDB is an online data system that was created in the late 1990's to serve online a synthesis of published geochemical and petrological data of igneous and metamorphic rocks. PetDB has today reached a volume of 2.5 million analytical values for nearly 70,000 rock samples. PetDB's data model (Lehnert et al., G-Cubed 2000) was designed to store sample-based observational data generated by the analysis of rocks, together with a wide range of metadata documenting provenance of the samples, analytical procedures, data quality, and data source. Attempts to store additional types of geochemical data such as time-series data of seafloor hydrothermal springs and volcanic gases, depth-series data for marine sediments and soils, and mineral or mineral inclusion data revealed the limitations of the schema: the inability to properly record sample hierarchies (for example, a garnet that is included in a diamond that is included in a xenolith that is included in a kimberlite rock sample), inability to properly store time-series data, inability to accommodate classification schemes other than rock lithologies, deficiencies of identifying and documenting datasets that are not part of publications. In order to overcome these deficiencies, PetDB has been developing a new data schema using the ODM2 information model (ODM=Observation Data Model). The development of ODM2 is a collaborative project that leverages the experience of several existing information representations, including PetDB and EarthChem, and the CUAHSI HIS Observations Data Model (ODM), as well as the general specification for encoding observational data called Observations and Measurements (O&M) to develop a uniform information model that seamlessly manages spatially discrete, feature-based earth observations from environmental samples and sample fractions as well as in-situ sensors, and to test its initial implementation in a variety of user scenarios. The O&M model, adopted as an international standard by the Open

  6. Time since death and decomposition of the human body: variables and observations in case and experimental field studies.

    Mann, R W; Bass, W M; Meadows, L

    1990-01-01

    Much of the difficulty in determining the time since death stems from the lack of systematic observation and research on the decomposition rate of the human body. Continuing studies conducted at the University of Tennessee, Knoxville, provide useful information on the impact of carrion insect activity, ambient temperature, rainfall, clothing, burial and depth, carnivores, bodily trauma, body weight, and the surface with which the body is in contact. This paper reports findings and observations accumulated during eight years of research and case studies that may clarify some of the questions concerning bodily decay.

  7. CH4 emissions from European Major Population Centers: Results from aircraft-borne CH4 in-situ observations during EMeRGe-Europe campaign 2017

    Roiger, A.; Klausner, T.; Schlager, H.; Ziereis, H.; Huntrieser, H.; Baumann, R.; Eirenschmalz, L.; Joeckel, P.; Mertens, M.; Fisher, R.; Bauguitte, S.; Young, S.; Andrés Hernández, M. D.

    2017-12-01

    Urban environments represent large and diffuse area sources of CH4 including emissions from pipeline leaks, industrial/sewage treatment plants, and landfills. However, there is little knowledge about the exact magnitude of these emissions and their contribution to total anthropogenic CH4. Especially in the context of an urbanizing world, a better understanding of the methane footprint of urban areas is crucial, both with respect to mitigation and projection of climate impacts. Aircraft-borne in-situ measurements are particularly useful to both quantify emissions from such area sources, as well as to study their impact on the regional distribution. However, airborne CH4 observations downstream of European cities are especially sparse.Here we report from aircraft-borne CH4 in-situ measurements as conducted during the HALO aircraft campaign EMeRGe (Effect of Megacities on the Transport and Transformation of Pollutants on the Regional to Global Scales) in July 2017, which was led by the University of Bremen, Germany. During seven research flights, emissions from a variety of European (Mega)-cities were probed at different altitudes from 3km down to 500m, including measurements in the outflows of London, Rome, Po Valley, Ruhr and Benelux. We will present and compare the CH4 distribution measured downstream of the various studied urban hot-spots. With the help of other trace gas measurements (including e.g. CO2, CO, O3, SO2), observed methane enhancements will be attributed to the different potential source types. Finally, by the combination of in-situ measurements and regional model simulations using the EMAC-MECO(n) model, the contribution of emissions from urban centers to the regional methane budget over Europe will be discussed.

  8. Factors that influence the outcome of open urethroplasty for pelvis fracture urethral defect (PFUD): an observational study from a single high-volume tertiary care center.

    Fu, Qiang; Zhang, Yu-meng; Barbagli, Guido; Zhang, Jiong; Xie, Hong; Sa, Ying-long; Jin, San-bao; Xu, Yue-min

    2015-12-01

    To report the clinical features of pelvic fracture urethral injury (PFUI) and assess the real effect of factors that are believed to have adverse effects on delayed urethroplasty. An observational descriptive study in a single urological center examined 376 male patients diagnosed with PFUI who underwent open urethroplasty from 2009 to 2013. Analyzed factors included patient age at the time of injury, etiology of PFUI, type of emergency treatment, concomitant injuries, length and position of stricture, type of urethroplasty and the outcome of surgery. Univariate and multivariate logistic regression analyses were applied, together with analytical statistic methods such as t test and Chi-square test. The overall success rate of delayed urethroplasty was 80.6 %. Early realignment was associated with reduced stricture length and had beneficial effect on delayed surgery. Concomitant rectum rupture, strictures longer than 1.6 cm and strictures closer than 3 cm to the bladder neck were indicators of poor outcome. Age, type of injury, urethral fistula and bladder rupture were not significant predicators of surgery outcome. Failed direct vision internal urethrotomy and urethroplasty had no significant influence on salvage operation. The outcome of posterior urethroplasty is affected by multiple factors. Early realignment has beneficial effect; while the length and position of stricture and its distance to bladder neck plays the key role, rectum rupture at the time of injury is also an indicator of poor outcome. The effect of other factors seems insignificant.

  9. Ectopic Germinal Centers and IgG4-Producing Plasmacytes Observed in Synovia of HLA-B27+ Ankylosing Spondylitis Patients with Advanced Hip Involvement

    Xiugao Feng

    2015-01-01

    Full Text Available Introduction. Ectopic lymphoid neogenesis and the presence of IgG4-positive plasmacytes have been confirmed in chronic inflammatory sclerosing diseases. This study aims to investigate hip synovial tissues of ankylosing spondylitis (AS patients for IgG4-positive plasma cells and ectopic lymphoid tissues with germinal centers (GCs. Methods. Synovial samples were collected from 7 AS patients who received total hip replacement and were evaluated using immunohistochemistry for the presence of CD20+ B-cells, CD3+ T-cells, CD21+ follicular dendritic cells (FDC, and CD38+ plasma cells. Furthermore, immunoglobulin G (IgG and IgG4, IgA, IgM, and complement components C3d and C4d in synovia were evaluated. Both synovial CD21+ FDCs and IgG4-producing plasmacytes were analyzed. Results. All seven patients had severe fibrosis. Massive infiltrations of lymphocytes were found in 5 out of 7 patients’ synovia. Ectopic lymphoid tissues with CD21+ FDC networks and IgG4-positive plasma cells were observed coincidentally in two patients’ synovia. Conclusion. The pathophysiological mechanism of AS patients’ hip damage might be related to the coincidental presence of ectopic lymphoid tissue with FDCs network and IgG4-positive plasma cells identified here for the first time in AS patients’ inflamed synovial tissue.

  10. MMS Observations of Large Guide Field Symmetric Reconnection Between Colliding Reconnection Jets at the Center of a Magnetic Flux Rope at the Magnetopause

    Oieroset, M.; Phan, T. D.; Haggerty, C.; Shay, M. A.; Eastwood, J. P.; Gershman, D. J.; Drake, J. F.; Fujimoto, M.; Ergun, R. E.; Mozer, F. S.; hide

    2016-01-01

    We report evidence for reconnection between colliding reconnection jets in a compressed current sheet at the center of a magnetic flux rope at Earth's magnetopause. The reconnection involved nearly symmetric Inflow boundary conditions with a strong guide field of two. The thin (2.5 ion-skin depth (d(sub i) width) current sheet (at approximately 12 d(sub i) downstream of the X line) was well resolved by MMS, which revealed large asymmetries in plasma and field structures in the exhaust. Ion perpendicular heating, electron parallel heating, and density compression occurred on one side of the exhaust, while ion parallel heating and density depression were shifted to the other side. The normal electric field and double out-of-plane (bifurcated) currents spanned almost the entire exhaust. These observations are in good agreement with a kinetic simulation for similar boundary conditions, demonstrating in new detail that the structure of large guide field symmetric reconnection is distinctly different from antiparallel reconnection.

  11. The effect of organizational factors on the structure of the buying center :the case study of corporate travel management

    Damonte, Lowell Taylor

    1994-01-01

    In this study the researcher attempts to advance the understanding of the structure of firm buying centers for air travel services. First, an attempt is made to find empirical support for the proposition that firm air travel service buying centers can be grouped on the basis of their size, degree of complexity, centralization, and formalization. The study investigates the relationship of size, structure, and technology of the organization as a whole to the structure of the b...

  12. Locating of Rural Health Centers Equipped with Telehealth using GIS: A Case Study on Khorramabad City, Iran

    Safdari Reza

    2016-10-01

    Full Text Available Residents of the rural and remote area always having limitations on accessing properly required service providers. In such condition, the establishment of rural health centers equipped with telehealth, and also the use of GIS for optimal site selection to the centers, would play an important role in facilitating the achievement of quality health services in desired time factor. This study intended to find the optimal sites for building the Rural Health Centers Equipped with remote health facilities in, Khorramabad City, using GIS. During the pilot study, we identified few effective locating criteria and sub-criteria for rural health centers equipped with telehealth, the priorities was also determined in that descriptive study. Further, we prepared a special layer for each criterion on the site selection, and by integrating such layers based on specified rules and patterns, about the spatial analysis , (like distance and density analysis were done. For such methods, we used Arc Map, Arc Catalog and Arc toolbox environments of Arc GIS (version 9.3. Finally, a map was prepared that indicated the possibility of appropriateness for establishing the centers in the study area. Considering a large number of areas, the research team selected the areas which were the appropriate location for build rural health centers which could be equipped with Telehealth.

  13. Test plan for qualification of the S-type fiberglass materials for use as the liquid observation well casing

    Parra, S.A.

    1995-01-01

    This test plan presents the guidelines and requirements for acceptance of the S-type fiberglass material for use as the liquid observation well casing material. The plan for evaluating the physical properties of the candidate fiberglass materials when subjected to radiation, corrosive chemicals, and high temperatures typically found in the waste tanks are outlined. The tests also include tube connection evaluations. Finally, the test plan identifies the participants, their responsibilities, and the schedule for completion of the work

  14. Knowledge engineering tools for reasoning with scientific observations and interpretations: a neural connectivity use case

    Bota Mihail

    2011-08-01

    Full Text Available Abstract Background We address the goal of curating observations from published experiments in a generalizable form; reasoning over these observations to generate interpretations and then querying this interpreted knowledge to supply the supporting evidence. We present web-application software as part of the 'BioScholar' project (R01-GM083871 that fully instantiates this process for a well-defined domain: using tract-tracing experiments to study the neural connectivity of the rat brain. Results The main contribution of this work is to provide the first instantiation of a knowledge representation for experimental observations called 'Knowledge Engineering from Experimental Design' (KEfED based on experimental variables and their interdependencies. The software has three parts: (a the KEfED model editor - a design editor for creating KEfED models by drawing a flow diagram of an experimental protocol; (b the KEfED data interface - a spreadsheet-like tool that permits users to enter experimental data pertaining to a specific model; (c a 'neural connection matrix' interface that presents neural connectivity as a table of ordinal connection strengths representing the interpretations of tract-tracing data. This tool also allows the user to view experimental evidence pertaining to a specific connection. BioScholar is built in Flex 3.5. It uses Persevere (a noSQL database as a flexible data store and PowerLoom® (a mature First Order Logic reasoning system to execute queries using spatial reasoning over the BAMS neuroanatomical ontology. Conclusions We first introduce the KEfED approach as a general approach and describe its possible role as a way of introducing structured reasoning into models of argumentation within new models of scientific publication. We then describe the design and implementation of our example application: the BioScholar software. This is presented as a possible biocuration interface and supplementary reasoning toolkit for a larger

  15. Knowledge engineering tools for reasoning with scientific observations and interpretations: a neural connectivity use case

    2011-01-01

    Background We address the goal of curating observations from published experiments in a generalizable form; reasoning over these observations to generate interpretations and then querying this interpreted knowledge to supply the supporting evidence. We present web-application software as part of the 'BioScholar' project (R01-GM083871) that fully instantiates this process for a well-defined domain: using tract-tracing experiments to study the neural connectivity of the rat brain. Results The main contribution of this work is to provide the first instantiation of a knowledge representation for experimental observations called 'Knowledge Engineering from Experimental Design' (KEfED) based on experimental variables and their interdependencies. The software has three parts: (a) the KEfED model editor - a design editor for creating KEfED models by drawing a flow diagram of an experimental protocol; (b) the KEfED data interface - a spreadsheet-like tool that permits users to enter experimental data pertaining to a specific model; (c) a 'neural connection matrix' interface that presents neural connectivity as a table of ordinal connection strengths representing the interpretations of tract-tracing data. This tool also allows the user to view experimental evidence pertaining to a specific connection. BioScholar is built in Flex 3.5. It uses Persevere (a noSQL database) as a flexible data store and PowerLoom® (a mature First Order Logic reasoning system) to execute queries using spatial reasoning over the BAMS neuroanatomical ontology. Conclusions We first introduce the KEfED approach as a general approach and describe its possible role as a way of introducing structured reasoning into models of argumentation within new models of scientific publication. We then describe the design and implementation of our example application: the BioScholar software. This is presented as a possible biocuration interface and supplementary reasoning toolkit for a larger, more specialized

  16. Critical role of bioanalytical strategies in investigation of clinical PK observations, a Phase I case study

    Peng, Kun; Xu, Keyang; Liu, Luna; Hendricks, Robert; Delarosa, Reginald; Erickson, Rich; Budha, Nageshwar; Leabman, Maya; Song, An; Kaur, Surinder; Fischer, Saloumeh K

    2014-01-01

    RG7652 is a human immunoglobulin 1 (IgG1) monoclonal antibody (mAb) targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) and is designed for the treatment of hypercholesterolemia. A target-binding enzyme-linked immunosorbent assay (ELISA) was developed to measure RG7652 levels in human serum in a Phase I study. Although target-binding assay formats are generally used to quantify free therapeutic, the actual therapeutic species being measured are affected by assay conditions, such as sample dilution and incubation time, and levels of soluble target in the samples. Therefore, in the presence of high concentrations of circulating target, the choice of reagents and assay conditions can have a significant effect on the observed pharmacokinetic (PK) profiles. Phase I RG7652 PK analysis using the ELISA data resulted in a nonlinear dose normalized exposure. An investigation was conducted to characterize the ELISA to determine whether the assay format and reagents may have contributed to the PK observation. In addition, to confirm the ELISA results, a second orthogonal method, liquid chromatography tandem mass spectrometry (LC-MS/MS) using a signature peptide as surrogate, was developed and implemented. A subset of PK samples, randomly selected from half of the subjects in the 6 single ascending dose (SAD) cohorts in the Phase I clinical study, was analyzed with the LC-MS/MS assay, and the data were found to be comparable to the ELISA data. This paper illustrates the importance of reagent characterization, as well as the benefits of using an orthogonal approach to eliminate bioanalytical contributions when encountering unexpected observations. PMID:25484037

  17. Seasonal and spatial changes in trace gases over megacities from Aura TES observations: two case studies

    K. E. Cady-Pereira

    2017-08-01

    Full Text Available The Aura Tropospheric Emission Spectrometer (TES is collecting closely spaced observations over 19 megacities. The objective is to obtain measurements that will lead to better understanding of the processes affecting air quality in and around these cities, and to better estimates of the seasonal and interannual variability. We explore the TES measurements of ozone, ammonia, methanol and formic acid collected around the Mexico City metropolitan area (MCMA and in the vicinity of Lagos (Nigeria. The TES data exhibit seasonal signals that are correlated with Atmospheric Infrared Sounder (AIRS CO and Moderate Resolution Imaging Spectroradiometer (MODIS aerosol optical depth (AOD, with in situ measurements in the MCMA and with Goddard Earth Observing System (GEOS-Chem model output in the Lagos area. TES was able to detect an extreme pollution event in the MCMA on 9 April 2013, which is also evident in the in situ data. TES data also show that biomass burning has a greater impact south of the city than in the caldera where Mexico City is located. TES measured enhanced values of the four species over the Gulf of Guinea south of Lagos. Since it observes many cities from the same platform with the same instrument and applies the same retrieval algorithms, TES data provide a very useful tool for easily comparing air quality measures of two or more cities. We compare the data from the MCMA and Lagos, and show that, while the MCMA has occasional extreme pollution events, Lagos consistently has higher levels of these trace gases.

  18. Knowledge engineering tools for reasoning with scientific observations and interpretations: a neural connectivity use case.

    Russ, Thomas A; Ramakrishnan, Cartic; Hovy, Eduard H; Bota, Mihail; Burns, Gully A P C

    2011-08-22

    We address the goal of curating observations from published experiments in a generalizable form; reasoning over these observations to generate interpretations and then querying this interpreted knowledge to supply the supporting evidence. We present web-application software as part of the 'BioScholar' project (R01-GM083871) that fully instantiates this process for a well-defined domain: using tract-tracing experiments to study the neural connectivity of the rat brain. The main contribution of this work is to provide the first instantiation of a knowledge representation for experimental observations called 'Knowledge Engineering from Experimental Design' (KEfED) based on experimental variables and their interdependencies. The software has three parts: (a) the KEfED model editor - a design editor for creating KEfED models by drawing a flow diagram of an experimental protocol; (b) the KEfED data interface - a spreadsheet-like tool that permits users to enter experimental data pertaining to a specific model; (c) a 'neural connection matrix' interface that presents neural connectivity as a table of ordinal connection strengths representing the interpretations of tract-tracing data. This tool also allows the user to view experimental evidence pertaining to a specific connection. BioScholar is built in Flex 3.5. It uses Persevere (a noSQL database) as a flexible data store and PowerLoom® (a mature First Order Logic reasoning system) to execute queries using spatial reasoning over the BAMS neuroanatomical ontology. We first introduce the KEfED approach as a general approach and describe its possible role as a way of introducing structured reasoning into models of argumentation within new models of scientific publication. We then describe the design and implementation of our example application: the BioScholar software. This is presented as a possible biocuration interface and supplementary reasoning toolkit for a larger, more specialized bioinformatics system: the Brain

  19. Characterizing the Severe Turbulence Environments Associated With Commercial Aviation Accidents. Part 1; 44 Case Study Synoptic Observational Analyses

    Kaplan, Michael L.; Huffman, Allan W.; Lux, Kevin M.; Charney, Joseph J.; Riordan, Allan J.; Lin, Yuh-Lang; Proctor, Fred H. (Technical Monitor)

    2002-01-01

    A 44 case study analysis of the large-scale atmospheric structure associated with development of accident-producing aircraft turbulence is described. Categorization is a function of the accident location, altitude, time of year, time of day, and the turbulence category, which classifies disturbances. National Centers for Environmental Prediction Reanalyses data sets and satellite imagery are employed to diagnose synoptic scale predictor fields associated with the large-scale environment preceding severe turbulence. These analyses indicate a predominance of severe accident-producing turbulence within the entrance region of a jet stream at the synoptic scale. Typically, a flow curvature region is just upstream within the jet entrance region, convection is within 100 km of the accident, vertical motion is upward, absolute vorticity is low, vertical wind shear is increasing, and horizontal cold advection is substantial. The most consistent predictor is upstream flow curvature and nearby convection is the second most frequent predictor.

  20. [Deliberative devices in mental health and democratization peer exchanges: the case of a user's assembly of a psychosocial care center in Brazil].

    Ruelland, Isabelle

    2015-01-01

    Several mental health public networks in Brazil focus on the participation of a plurality of actors in different collective methods of analysis and co-management of services in order to ensure improved efficiency and greater democratization of social relations. It is clear that the analysis of the effectiveness of these collectives is often done at the expense of the social relations of power they help produce. In other words, it is as if the participatory nature of the devices immediately ensure their democratic potential and their positive impact on the recovery of the users involved.Research is presented that seeks to understand the point of view of the actors involved and to determine whether or not collective spaces for the organization of mental health services contribute to the democratization of social relations that is, the construction of individual and collective capacities for debate, decision and public action. What and how people living with serious mental disorders are protagonists in the design of service and in the struggle for quality public services and how this is involved in their recovery? The research is drawn from an organizational ethnography carried out over nearly one year in Campinas, Brazil in 2012. The research focuses on a case study in a psychosocial care center (CAPS) housing for people living with serious mental disorders. To consolidate the internal validity of the case study, three collecting data techniques were applied: the shadowing over 17 institutionalize methods or devices involved in the organization of services of the CAPS, analysis of documents and forty-seven personal interviews with users, managers and workers. This article focuses on the data from the observation of one of these devices deliberation involving users, the user's assembly, as well as interviews with 15 of these participants. The results highlight how peer exchanges, emerging in the assembly of users and the convivencia space lead to collective

  1. Characteristics of Epstein-Barr virus-associated gastric cancer: A study of 235 cases at a comprehensive cancer center in U.S.A

    Yu Yingyan

    2009-02-01

    Full Text Available Abstract Background Epstein-Barr virus (EBV has been shown to be associated with gastric cancer. However, inconsistent findings have been reported regarding the distribution of EBV infected cells (in normal gastric epithelium vs. intestinal metaplastic cells vs. in neoplastic cells and the characteristics of EBV-associated gastric cancer. Lymph node positive EBV-associated gastric cancer has not been systematically studied. The aims of this study were to evaluate EBV-associated gastric cancer, to assess the distribution of EBV infected cells including all positive lymph nodes, and to define the characteristics of EBV-associated gastric cancer. Design The study included primary gastric cancer patients who underwent surgical resection with no preoperative treatment at M.D. Anderson Cancer Center between 1987 and 2006. Formalin-fixed paraffin-embedded tissue from these resection specimens were assessed for EBV by in situ hybridization, the gold standard for EBV detection in tissue. EBV status was analyzed along with clinicopathologic parameters including age, gender, tumor type, lymph node status, and pathologic stage of the tumor. Results Among 235 patients, 12 had intranuclear expression of EBV. EBV staining was seen only in tumor cells and no detectable EBV was observed in normal gastric mucosa, intestinal metaplasia or stromal cells. Eight of 12 patients with EBV-associated gastric cancer had regional lymph node metastasis. Of note, metastatic tumor cells in all of the involved lymph nodes of these 8 cases contained EBV. The epidemiologic data showed 11 of the 12 patients with EBV-associated gastric cancer were men, ranging in age from 54 to 78 years (mean age, 60 years; median age, 62.1 years. The age distribution for non-EBV associated gastric cancer patients ranged from 21 to 93 years (mean age, 67 years; median age, 66.4 years. Conclusion Our study demonstrated that EBV is present exclusively in gastric cancer cells. The detection of EBV in

  2. The dynamic cusp at low altitudes: A case study combining Viking, DMSP, and Sondrestrom incoherent scatter radar observations

    Watermann, J.; Delabeaujardiere, O.; Lummerzheim, D.; Woch, J.; Newell, P.T.; Potemra, T.A.; Rich, F.J.; Shapshak, M.

    1992-01-01

    A case study involving data from three satellites and a ground-based radar are presented. Focus is on a detailed discussion of observations of the dynamic cusp made on 24 Sep. 1986 in the dayside high-latitude ionosphere and interior magnetosphere. The relevant data from space-borne and ground-based sensors is presented. They include in-situ particle and field measurements from the DMSP-F7 and Viking spacecraft and Sondrestrom radar observations of the ionosphere. These data are augmented by observations of the IMF and the solar wind plasma. The observations are compared with predictions about the ionospheric response to the observed particle precipitation, obtained from an auroral model. It is shown that observations and model calculations fit well and provide a picture of the ionospheric footprint of the cusp in an invariant latitude versus local time frame. The combination of Viking, Sondrestrom radar, and IMP-8 data suggests that an ionospheric signature of the dynamic cusp was observed. Its spatial variation over time which appeared closely related to the southward component of the IMF was monitored

  3. The Impact of Observer Ring Technique on the Writing Achievement: A case of Iranian EFL Learners

    Jahanbakhsh Nikoopour

    2010-11-01

    Full Text Available This study was conducted to probe the effect of the observer ring technique on the participants’ writing achievement. In so doing, the researchers utilized a quasi-experimental design with 20 participants in the control group and 18 in the experimental group. Instrumentation included a writing handout, an Oxford Placement Test (standard proficiency test, and a rating scale of writing. As a treatment, the participants in the experimental group were asked to write at home and bring their papers to the class to be corrected by their classmates and the teacher was the supervisor. In the control group, the papers were corrected by the teacher. The results of the pre-test indicated that the participants of the two groups were homogeneous with regard to proficiency level as well as their writing ability. The results of the post-test revealed that the writing ability of the participants in the experimental group had improved during the study. Moreover, the observer ring technique had a positive and significant effect on the participants' writing ability. The findings may promise implications for incorporating this new interactive feedback model into EFL writing classes.

  4. Observational signatures of past mass-exchange episodes in massive binaries: the case of LSS 3074

    Raucq, F.; Gosset, E.; Rauw, G.; Manfroid, J.; Mahy, L.; Mennekens, N.; Vanbeveren, D.

    2017-05-01

    Context. The role of mass and momentum exchanges in close massive binaries is very important in the subsequent evolution of the components. Such exchanges produce several observational signatures such as asynchronous rotation and altered chemical compositions, that remain after the stars detach again. Aims: We investigated these effects for the close O-star binary LSS 3074 (O4 f + O6-7:(f):), which is a good candidate for a past Roche lobe overflow (RLOF) episode because of its very short orbital period, P = 2.185 days, and the luminosity classes of both components. Methods: We determined a new orbital solution for the system. We studied the photometric light curves to determine the inclination of the orbit and Roche lobe filling factors of both stars. Using phase-resolved spectroscopy, we performed the disentangling of the optical spectra of the two stars. We then analysed the reconstructed primary and secondary spectra with the CMFGEN model atmosphere code to determine stellar parameters, such as the effective temperatures and surface gravities, and to constrain the chemical composition of the components. Results: We confirm the apparent low stellar masses and radii reported in previous studies. We also find a strong overabundance in nitrogen and a strong carbon and oxygen depletion in both primary and secondary atmospheres, together with a strong enrichment in helium of the primary star. Conclusions: We propose several possible evolutionary pathways through a RLOF process to explain the current parameters of the system. We confirm that the system is apparently in overcontact configuration and has lost a significant portion of its mass to its surroundings. We suggest that some of the discrepancies between the spectroscopic and photometric properties of LSS 3074 could stem from the impact of a strong radiation pressure of the primary. Based on observations collected at the European Southern Observatory (La Silla, Chile) and the Cerro Tololo Inter

  5. Study of the nature and of the properties of paramagnetic centers observed by electron spin resonance in conjugated polymers; Etude de la nature des propriete des centres paramagnetiques observes par resonance paramagnetique electronique dans les polymeres conjugues

    Nechtschein, M [Commissariat a l' Energie Atomique, Grenoble (France). Centre d' Etudes Nucleaires

    1967-06-15

    Conjugated polymers contain paramagnetic centers. It is established that these centers are free radicals and a model which defines their electronic structure is proposed. The interactions between these centers are studied, notably by dynamic polarisation experiments. Finally it is shown that the centers have catalytic properties. (author) [French] Les polymeres conjugues contiennent des centres paramagnetiques. L'origine radicalaire de ces centres est etablie et un modele precisant leur structure electronique est propose. Les interactions entre ces centres sont etudiees, notamment a l'aide d'experiences de polarisation dynamique. Des proprietes catalytiques sont mises en evidence. (auteur)

  6. Study of the nature and of the properties of paramagnetic centers observed by electron spin resonance in conjugated polymers; Etude de la nature des propriete des centres paramagnetiques observes par resonance paramagnetique electronique dans les polymeres conjugues

    Nechtschein, M. [Commissariat a l' Energie Atomique, Grenoble (France). Centre d' Etudes Nucleaires

    1967-06-15

    Conjugated polymers contain paramagnetic centers. It is established that these centers are free radicals and a model which defines their electronic structure is proposed. The interactions between these centers are studied, notably by dynamic polarisation experiments. Finally it is shown that the centers have catalytic properties. (author) [French] Les polymeres conjugues contiennent des centres paramagnetiques. L'origine radicalaire de ces centres est etablie et un modele precisant leur structure electronique est propose. Les interactions entre ces centres sont etudiees, notamment a l'aide d'experiences de polarisation dynamique. Des proprietes catalytiques sont mises en evidence. (auteur)

  7. Evaluation of the Association between Air Pollutants and Number of Cases with Severe Acute Respiratory Syndrome Recorded at Emergency Medical Centers in Tehran, Iran in 2013

    sadegh khazaei

    2016-09-01

    Full Text Available Introduction and purpose: Air pollution is an important risk factor for the environment and public health, associated with increased severity of respiratory diseases. This study aimed to evaluate the association between various air pollutants and number of cases with severe acute respiratory syndrome referred to emergency medical centers in Tehran, Iran in 2013. Methods: In this ecological study, the relationship between air pollution and acute respiratory symptoms in patients referred to the emergency centers of Tehran in 2013 was assessed. In total, 36787 patients with acute respiratory symptoms has been registered in these centers. Data on the number of cases with acute respiratory symptoms and air pollutants of emergency centers and air quality monitoring stations were collected. Moreover, Poisson regression was used to assess the relationship between air pollutant concentrations (PM2.5, SO2, NO2, O3, CO and the number of cases with severe acute respiratory syndrome. Results: The results of the current study demonstrated that CO (weekly average IRR=1.1 and SO2 (three days average IRR=1.03 and weekly average IRR= 1.04 increased the risk of respiratory diseases 10%, 3%, and 4%, respectively. Consequently, longer duration of pollutants would increase the risk of respiratory syndromes. Conclusion: According to the results of this study, increased air pollutant concentrations could be associated with escalated number of patients with acute respiratory symptoms referred to the emergency medical centers in Tehran.

  8. Employing the Hilbert-Huang Transform to analyze observed natural complex signals: Calm wind meandering cases

    Martins, Luis Gustavo Nogueira; Stefanello, Michel Baptistella; Degrazia, Gervásio Annes; Acevedo, Otávio Costa; Puhales, Franciano Scremin; Demarco, Giuliano; Mortarini, Luca; Anfossi, Domenico; Roberti, Débora Regina; Costa, Felipe Denardin; Maldaner, Silvana

    2016-11-01

    In this study we analyze natural complex signals employing the Hilbert-Huang spectral analysis. Specifically, low wind meandering meteorological data are decomposed into turbulent and non turbulent components. These non turbulent movements, responsible for the absence of a preferential direction of the horizontal wind, provoke negative lobes in the meandering autocorrelation functions. The meandering characteristic time scales (meandering periods) are determined from the spectral peak provided by the Hilbert-Huang marginal spectrum. The magnitudes of the temperature and horizontal wind meandering period obtained agree with the results found from the best fit of the heuristic meandering autocorrelation functions. Therefore, the new method represents a new procedure to evaluate meandering periods that does not employ mathematical expressions to represent observed meandering autocorrelation functions.

  9. Chronic subdural hematoma associated with arachnoid cyst. Two case histories with pathological observations.

    Takayasu, Takeshi; Harada, Kunyu; Nishimura, Shigeru; Onda, Jun; Nishi, Tohru; Takagaki, Hisashi

    2012-01-01

    Arachnoid cysts are well known to induce chronic subdural hematoma (CSDH) after head injury. However, histological observations of the arachnoid cyst and hematoma membrane have only been rarely described. An 8-year-old boy and a 3-year-old boy presented with CSDH associated with arachnoid cyst. Surgical removal of the hematoma and biopsy of the hematoma membrane and cyst wall were performed. Clinical courses were good and without recurrence more than 1.5 years after surgery. Histological examination suggested that the cysts did not contribute to hematoma development. Pediatric hematoma membranes, similar to adult hematoma membranes, are key in the growth of CSDH. Therefore, simple hematoma evacuation is adequate as a first operation for CSDH associated with arachnoid cyst.

  10. Talar body fatigue stress fractures: three cases observed in elite female gymnasts

    Rossi, F.; Dragoni, S.

    2005-01-01

    To introduce and emphasize the clinical and radiological findings of three talar body fatigue stress fractures in competitive athletes. Clinical and radiographic skeletal records of 24,562 athletes taken between 1962 and 2002 were retrospectively reviewed. Among these, 6851 files related to acute foot and ankle injuries or chronic post-traumatic sequelae were found. There were 925 (3.76%) stress fatigue fractures selected from the whole collection. Among these there were three cases (0.32%) of talar body stress fractures diagnosed in elite female gymnasts 15 - 17 years old. The negative first radiograph become positive 4-6 weeks later. Scintigraphy was positive at an early stage and consistent for the diagnosis. CT and MRI gave positive results 1-2 weeks after the beginning of symptoms which were always greatly diagnostic. The sports medicine literature lacks reports of talar body fatigue stress fractures. The poor initial sensitivity of radiography makes it problematic to establish an early diagnosis. A wise combination of scintigraphy, CT and MRI has therefore to be relied upon. Familiarity with this rare location for a stress fracture may prevent delayed diagnosis and long-lasting damage, both of which are important factors in competitive athletes. (orig.)

  11. Training Diaries during Altitude Training Camp in Two Olympic Champions: An Observational Case Study

    Lorenzo Pugliese, Fabio R. Serpiello, Grégoire P. Millet, Antonio La Torre

    2014-09-01

    Full Text Available Traditionally, Live High-Train High (LHTH interventions were adopted when athletes trained and lived at altitude to try maximising the benefits offered by hypoxic exposure and improving sea level performance. Nevertheless, scientific research has proposed that the possible benefits of hypoxia would be offset by the inability to maintain high training intensity at altitude. However, elite athletes have been rarely recruited as an experimental sample, and training intensity has almost never been monitored during altitude research. This case study is an attempt to provide a practical example of successful LHTH interventions in two Olympic gold medal athletes. Training diaries were collected and total training volumes, volumes at different intensities, and sea level performance recorded before, during and after a 3-week LHTH camp. Both athletes successfully completed the LHTH camp (2090 m maintaining similar absolute training intensity and training volume at high-intensity (> 91% of race pace compared to sea level. After the LHTH intervention both athletes obtained enhancements in performance and they won an Olympic gold medal. In our opinion, LHTH interventions can be used as a simple, yet effective, method to maintain absolute, and improve relative training intensity in elite endurance athletes.

  12. Talar body fatigue stress fractures: three cases observed in elite female gymnasts

    Rossi, F. [National Institute of Sports Medicine of the Italian Olympic Committee, Rome (Italy); Dragoni, S. [National Institute of Sports Medicine of the Italian Olympic Committee, Rome (Italy); Istituto Nazionale di Medicina dello Sport, Rome (Italy)

    2005-07-01

    To introduce and emphasize the clinical and radiological findings of three talar body fatigue stress fractures in competitive athletes. Clinical and radiographic skeletal records of 24,562 athletes taken between 1962 and 2002 were retrospectively reviewed. Among these, 6851 files related to acute foot and ankle injuries or chronic post-traumatic sequelae were found. There were 925 (3.76%) stress fatigue fractures selected from the whole collection. Among these there were three cases (0.32%) of talar body stress fractures diagnosed in elite female gymnasts 15 - 17 years old. The negative first radiograph become positive 4-6 weeks later. Scintigraphy was positive at an early stage and consistent for the diagnosis. CT and MRI gave positive results 1-2 weeks after the beginning of symptoms which were always greatly diagnostic. The sports medicine literature lacks reports of talar body fatigue stress fractures. The poor initial sensitivity of radiography makes it problematic to establish an early diagnosis. A wise combination of scintigraphy, CT and MRI has therefore to be relied upon. Familiarity with this rare location for a stress fracture may prevent delayed diagnosis and long-lasting damage, both of which are important factors in competitive athletes. (orig.)

  13. Retrieval of Aerosol Optical Depth Above Clouds from OMI Observations: Sensitivity Analysis, Case Studies

    Torres, O.; Jethva, H.; Bhartia, P. K.

    2012-01-01

    A large fraction of the atmospheric aerosol load reaching the free troposphere is frequently located above low clouds. Most commonly observed aerosols above clouds are carbonaceous particles generally associated with biomass burning and boreal forest fires, and mineral aerosols originated in arid and semi-arid regions and transported across large distances, often above clouds. Because these aerosols absorb solar radiation, their role in the radiative transfer balance of the earth atmosphere system is especially important. The generally negative (cooling) top of the atmosphere direct effect of absorbing aerosols, may turn into warming when the light-absorbing particles are located above clouds. The actual effect depends on the aerosol load and the single scattering albedo, and on the geometric cloud fraction. In spite of its potential significance, the role of aerosols above clouds is not adequately accounted for in the assessment of aerosol radiative forcing effects due to the lack of measurements. In this paper we discuss the basis of a simple technique that uses near-UV observations to simultaneously derive the optical depth of both the aerosol layer and the underlying cloud for overcast conditions. The two-parameter retrieval method described here makes use of the UV aerosol index and reflectance measurements at 388 nm. A detailed sensitivity analysis indicates that the measured radiances depend mainly on the aerosol absorption exponent and aerosol-cloud separation. The technique was applied to above-cloud aerosol events over the Southern Atlantic Ocean yielding realistic results as indicated by indirect evaluation methods. An error analysis indicates that for typical overcast cloudy conditions and aerosol loads, the aerosol optical depth can be retrieved with an accuracy of approximately 54% whereas the cloud optical depth can be derived within 17% of the true value.

  14. Observation of a "holiday effect": a case of Chinese New Year in Taipei

    Tan, P.-H.; Chou, C.; Chen, P.-Y.; Liang, J.-Y.

    2009-04-01

    Our study was an attempt to conduct a comprehensive and systematical examination of the holiday effect, defined as the difference in air pollutant concentrations between holiday and non-holiday periods. This holiday effect can be applied to other countries with similar national or cultural holidays. Hourly and daily surface measurements of six major air pollutants from thirteen air quality monitoring stations of the Taiwan Environmental Protection Administration during the Chinese New Year (CNY) and non-Chinese New Year (NCNY) periods were used. We documented evidence of a "holiday effect", where air pollutant concentrations were significantly different between holidays (CNY) and non-holidays (NCNY), in the Taipei metropolitan area over the past thirteen years (1994-2006). The concentrations of NOx, CO, NMHC, SO2 and PM10 were lower in the CNY than in the NCNY period, while the variation of O3 was reversed, which was mainly due to the NO titration effect. Similar differences in these six air pollutants between the CNY and NCNY periods were also found in the diurnal cycle and in the interannual variation. For the diurnal cycle, a common traffic-related double-peak variation was observed in the NCNY period, but not in the CNY period. Impacts of dust storms were also observed, especially on SO2 and PM10 in the CNY period. In the 13-year period of 1994-2006, decreasing trends of NOx and CO in the NCNY period implied a possible reduction of local emissions. Increasing trends of SO2 and PM10 in the CNY period, on the other hand, indicated a possible enhancement of long-range transport. These two mechanisms weakened the holiday effect.

  15. Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

    Shi, Leiyu; Lee, De-Chih; Liang, Hailun; Zhang, Luwen; Makinen, Marty; Blanchet, Nathan; Kidane, Ruth; Lindelow, Magnus; Wang, Hong; Wu, Shaolong

    2015-11-30

    Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by

  16. Incontinentia pigmenti--ophthalmological observation of a series of cases and review of the literature.

    O'Doherty, M

    2012-02-01

    AIM: The aims of this study were to make an inventory of the disease in Ireland, to acquire better knowledge of the relationship between genetic makeup and phenotypic ocular presentation and, finally, through literature review and personal experience, to establish clear guidelines on best practice in the management of children with this rare condition both in terms of screening and follow-up. METHODS: All patients who attended the dermatology and genetic clinic in Our Lady\\'s Hospital for Sick Children, Crumlin, with incontinentia pigmenti (IP) were contacted and invited to attend the eye clinic for ocular assessment. Children who were already attending the ophthalmic services before commencement of the study had their charts reviewed for assessment. RESULTS: 11 of 19 patients agreed to attend the clinic for ocular assessment. Of these patients, nine had genetic testing. The mean age of the patients at the examination was 8 years (3 months to 29 years). In 10 patients, IP was the result of a spontaneous mutation, whereas the condition was inherited from an affected mother in one patient. Of the 11 patients with IP, 5 have visually significant ocular findings (47%). We describe the case history of four of these children briefly to outline the severity of this condition. CONCLUSION: Our patients had a significant percentage of ocular abnormalities (47%). We have outlined an examination schedule for patients with and without retinal pathology and recommend fluorescein angiography in patients with retinal pathology to fully determine the extent of ischaemia. Like other studies, early treatment with peripheral retinal photocoagulation to reduce the risk of retinal detachment is recommended in this study.

  17. Training Diaries during Altitude Training Camp in Two Olympic Champions: An Observational Case Study.

    Pugliese, Lorenzo; Serpiello, Fabio R; Millet, Grégoire P; La Torre, Antonio

    2014-09-01

    Traditionally, Live High-Train High (LHTH) interventions were adopted when athletes trained and lived at altitude to try maximising the benefits offered by hypoxic exposure and improving sea level performance. Nevertheless, scientific research has proposed that the possible benefits of hypoxia would be offset by the inability to maintain high training intensity at altitude. However, elite athletes have been rarely recruited as an experimental sample, and training intensity has almost never been monitored during altitude research. This case study is an attempt to provide a practical example of successful LHTH interventions in two Olympic gold medal athletes. Training diaries were collected and total training volumes, volumes at different intensities, and sea level performance recorded before, during and after a 3-week LHTH camp. Both athletes successfully completed the LHTH camp (2090 m) maintaining similar absolute training intensity and training volume at high-intensity (> 91% of race pace) compared to sea level. After the LHTH intervention both athletes obtained enhancements in performance and they won an Olympic gold medal. In our opinion, LHTH interventions can be used as a simple, yet effective, method to maintain absolute, and improve relative training intensity in elite endurance athletes. Key PointsElite endurance athletes, with extensive altitude training experience, can maintain similar absolute intensity during LHTH compared to sea level.LHTH may be considered as an effective method to increase relative training intensity while maintaining the same running/walking pace, with possible beneficial effects on sea level performance.Training intensity could be the key factor for successful high-level LHTH camp.

  18. Observed long-term greening of alpine vegetation—a case study in the French Alps

    Carlson, Bradley Z.; Corona, Monica C.; Dentant, Cédric; Bonet, Richard; Thuiller, Wilfried; Choler, Philippe

    2017-11-01

    We combined imagery from multiple sources (MODIS, Landsat-5, 7, 8) with land cover data to test for long-term (1984-2015) greening or browning trends of vegetation in a temperate alpine area, the Ecrins National Park, in the context of recent climate change and domestic grazing practices. We showed that over half (56%) of the Ecrins National Park displayed significant increases in peak normalized difference vegetation index (NDVImax) over the last 16 years (2000-2015). Importantly, the highest proportional increases in NDVImax occurred in rocky habitats at high elevations (> 2500 m a.s.l.). While spatial agreement in the direction of change in NDVImax as detected by MODIS and Landsat was high (76% overlap), correlations between log-response ratio values were of moderate strength (approx. 0.3). In the context of above treeline habitats, we found that proportional increases in NDVImax were higher between 1984 and 2000 than between 2000 and 2015, suggesting a slowing of greening dynamics during the recent decade. The timing of accelerated greening prior to 2000 coincided with a pronounced increase in the amount of snow-free growing degree-days that occurred during the 1980s and 1990s. In the case of grasslands and low-shrub habitats, we did not find evidence for a negative effect of grazing on greening trends, possibly due to the low grazing intensity typically found in the study area. We propose that the emergence of a longer and warmer growing season enabled high-elevation plant communities to produce more biomass, and also allowed for plant colonization of habitats previously characterized by long-lasting snow cover. Increasing plant productivity in an alpine context has potential implications for biodiversity trajectories and for ecosystem services in mountain landscapes. The presented evidence for long-term greening trends in a representative region of the European Alps provides the basis for further research on mechanisms of greening in alpine landscapes.

  19. Topical session proceedings of the 5. IGSC meeting on: observations regarding the safety case in recent safety assessment studies

    Hooper, Alan J.; Voinis, Sylvie; Van Luik, Abraham E.

    2004-01-01

    Within the NEA, the IGSC (Integration Group for the Safety Case) has, as an essential role, to develop common views on such key aspects of the safety case. Therefore, since the inauguration of the IGSC in 2000, four meetings were organised with topical sessions to explore various of these key aspects. This is a report on the fifth such topical session, held as part of the 5. plenary meeting of the IGSC. The session was attended by 36 participants, representing waste management organisations and regulatory authorities from 16 NEA member countries, the IAEA and the European Commission. The purpose of this topical session was to provide support to the finalising of the IGSC safety case brochure by getting a description of the safety case content of the IAEA Draft Safety Requirements document and by getting an overview of progress that could be observed from national organisations on developing their cases for system safety and/or developing the required methodologies. The objective was that the IGSC safety case brochure should be supportive of the IAEA/NEA document, and be reflective of the experience of the IGSC member programmes and organisations. The topical session was mainly aimed at exchanging information on: - The safety case related content of the proposed IAEA/NEA document (currently titled: 'IAEA Safety Standards Series, Geological Disposal of Radioactive Waste, Draft Safety Requirements (DS-154)'). - National programmes where safety assessments have recently been completed, e.g. ONDRAF/NIRAS, Nagra and Andra. - Feedback from international peer reviews, e.g. the Andra Dossier 2001 Argile, the Belgian SAFIR 2 report, the SR 97 report and the US-DOE Yucca Mountain TSPA. - The evolution of some national assessment methods and approaches e.g. SKB and Nagra. - The content of the draft IGSC safety case brochure entitled: 'The Nature and Purpose of the Post-closure Safety Case in Geological Disposal'. This document presents the various

  20. Improving the quality of health services organization structure by reengineering: circular design and clinical case impact in an academic medical center.

    Lartin-Drake, J M; Curran, C; Gillis-Donovan, J; Kruger, N R; Ziegenfuss, J T; Ostrem, J; Zanotti, M

    1996-01-01

    Innovation to improve the quality of structure and process in health care organization is reported in this case example of change in an academic medical center. Interactive planning and the circular organization design concept were the driving principles and methods. This report presents the needs for and initial obstructions to change, planning and project design work, a description of the change process, and illustrative accomplishments to date--two cases, one of conscious sedation policy and one of nuisance pages. Evaluative criteria for judging the progress and lessons of the project regarding key design characteristics also are included.

  1. A Clinical Observation on the Case of Cauda Equina Syndrome Using Scolopendrid Pharmacopuncture

    Lee Hwi-yong

    2008-06-01

    Full Text Available Objective : This study was investigated on the Scolopendrid Pharmacopuncture of Caude equina syndrome which has been described as a complex of low back pain, bilateral sciatica, saddle anesthesia and motor weakness in the lower extremity that progress to paraplegia with baldder and bowel incontinence. Methods & Results : Clinical observation was done on Cauda equina syndrome in the Department of Acupuncture & Moxibustion, Woosuk jeonju Oriental Medical Hospital frome May 30 to July 13. The patient was treated with Scolopendrid Pharmacopuncture at Shinsu(B23, Gihaesu(B24, Taejangsu(B25, Gwanweonsu(b26, Dangryo(b31, Charyo(b32, Jang-gang(gv1 and Hoe-eum(cv1 with Oriental Medicine treatment. We evaluated SF-36, the bladder incontinence, bowel incontinence, sensibility by sting skin, before and after treatmeat. Conclusion : 1. At the early time, gait disturbance was treated well, but discomfort of bladder incontinence, bilateral sciatica, saddle anesthesia and motor weakness was remained. 2. The symptoms of Cauada equina syndrome, especially bladder incontinence and bilateral sciatica, was recurred in short duration by scolopendrid Pharmacopuncture and oriental medicine treatment.

  2. Case study of mesospheric front dissipation observed over the northeast of Brazil

    Fragoso Medeiros, Amauri; Paulino, Igo; Wrasse, Cristiano Max; Fechine, Joaquim; Takahashi, Hisao; Valentin Bageston, José; Paulino, Ana Roberta; Arlen Buriti, Ricardo

    2018-03-01

    On 3 October 2005 a mesospheric front was observed over São João do Cariri (7.4° S, 36.5° W). This front propagated to the northeast and appeared in the airglow images on the west side of the observatory. By about 1.5 h later, it dissipated completely when the front crossed the local zenith. Ahead of the front, several ripple structures appeared during the dissipative process of the front. Using coincident temperature profile from the TIMED/SABER satellite and wind profiles from a meteor radar at São João do Cariri, the background of the atmosphere was investigated in detail. On the one hand, it was noted that a strong vertical wind shear in the propagation direction of the front produced by a semidiunal thermal tide was mainly responsible for the formation of duct (Doppler duct), in which the front propagated up to the zenith of the images. On the other hand, the evolution of the Richardson number as well as the appearance of ripples ahead of the main front suggested that a presence of instability in the airglow layer that did not allow the propagation of the front to the other side of the local zenith.

  3. A case of basilar artery aneurysm rupture from 1836: lessons in clinical observation and the natural history of the disease.

    Demetriades, Andreas K; Horiguchi, Takashi; Goodrich, James T; Kawase, Takeshi

    2014-11-01

    Although credit is given to Sir William Gull for highlighting the clinical picture of subarachnoid hemorrhage in 1859, we discuss a case presented by Mr. Egerton A. Jennings, Fellow of the Linnaean Society, published 23 years earlier in the 1836 edition of the Transactions of the Provincial Medical and Surgical Association. This case, probably the first reported in the English language of a basilar aneurysm rupture, is of medico-historical interest. Jennings provided a remarkably accurate and detailed description of the patient, who experienced coma as a result of the severity of subarachnoid hemorrhage. The detailed clinical observations on initial assessment and the description of the patient's deterioration to the time of death are a succinct representation of the natural history of this disease. The author's discussion provides evidence of a philosophy committed to medical education and progress at the time based on principles of rational observation, meticulous clinical acumen, insight into experimental physiology, and the awareness of ethical boundaries. In provincial 1836 England, similar to most of Europe, cerebral localization was elementary. Nonetheless, this case report highlights the attempt at linking structure to function by means of observation on the effects of lesioning. It provides evidence of an established thought process already in progress in England in the 19th century. It is characteristic that this thought process came from a surgical practitioner. The cultivation of practical observation in British surgical culture would allow the late 19th century surgeon scientists to match the contributions of British neurologists with landmark steps in the development and establishment of neurosurgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. ERGONOMIC ASPECTS IN THE PLANNING AND EXECUTION OF PROJECTS: A TEXTILE PRODUCTS DISTRIBUTION CENTER PROJECT CASE STUDY

    Emerson Lourenço da Silva

    2013-01-01

    Full Text Available The planning and execution phases of a distribution center project of a large textile industry was made, evaluating the ergonomic aspects related to the operations to be performed in the facility and staff anthropometric data. The ergonomic collaborative analysis of the tasks associated with the method of movement plotting, guided the planning of the picking, manual induction and order consolidation areas from the distribution center. Using this methodology, it was possible to obtain a proper ergonomically project planning and execution of the three studied areas.

  5. A Selection Model to Logistic Centers Based on TOPSIS and MCGP Methods: The Case of Airline Industry

    Kou-Huang Chen

    2014-01-01

    Full Text Available The location selection of a logistics center is a crucial decision relating to cost and benefit analysis in airline industry. However, it is difficult to be solved because there are many conflicting and multiple objectives in location problems. To solve the problem, this paper integrates fuzzy technique for order preference by similarity to an ideal solution (TOPSIS and multichoice goal programming (MCGP to obtain an appropriate logistics center from many alternative locations for airline industry. The proposed method in this paper will offer the decision makers (DMs to set multiple aspiration levels for the decision criteria. A numerical example of application is also presented.

  6. Perioperative echocardiography-derived right ventricle function parameters and early outcomes after tetralogy of Fallot repair in mid-childhood: a single-center, prospective observational study.

    Raj, Ravi; Puri, Goverdhan Dutt; Jayant, Aveek; Thingnam, Shyam Kumar Singh; Singh, Rana Sandip; Rohit, Manoj Kumar

    2016-11-01

    Right ventricular (RV) function alterations are invariably present in all patients after tetralogy of Fallot (TOF) repair. Unlike the developed world where most of the patients with TOF are corrected in infancy, average age of presentation and thus surgery for these patients in the developing world may be higher. We aimed to study the correlation between RV function parameters such as tricuspid annular peak systolic excursion (TAPSE), fractional area change (FAC), and tricuspid annular peak systolic velocity (S') with early outcome variables after intracardiac repair for TOF. Fifty patients with a preoperative diagnosis of tetralogy of Fallot scheduled for corrective surgery were included in this single-center, prospective observational study. A preoperative transthoracic echocardiogram was performed to measure RV function parameters (FAC0, TAPSE0, S'0). Transthoracic echocardiography was repeated postoperatively to measure FAC1, TAPSE1, S'1 (day 1) and FAC2, TAPSE2, and S'2 (day 3). The relationship between preoperative and postoperative RV function parameters with in-hospital mortality, duration of mechanical ventilation, and intensive care unit stay was studied. The median age of patients was 6 years (range 1-14 years). Multiple stepwise logistic regression analysis showed RV FAC as best predictor of clinical outcome. Area under the receiver operating characteristic curve for postoperative RV function parameters, that is, FAC, TAPSE, and S' to predict early or delayed recovery was 0.944, 0.875, and 0.655, respectively. Among the RV function parameters studied, RV FAC best predicted the early outcome variables after TOF repair, followed by TAPSE while lateral tricuspid annular velocity S' being the least predictive. © 2016, Wiley Periodicals, Inc.

  7. Clinical Practice in the Use of Adjuvant Chemotherapy for Patients with Colon Cancer in South Korea: a Multi-Center, Prospective, Observational Study.

    Kim, Jung Han; Baek, Moo Jun; Ahn, Byung-Kwon; Kim, Dae Dong; Kim, Ik Yong; Kim, Jin Soo; Bae, Byung-Noe; Seo, Bong-Gun; Jung, Sang Hun; Hong, Kwan Hee; Kim, Hungdai; Park, Dong Guk; Lee, Ji Hye

    2016-01-01

    Adjuvant chemotherapy is a crucial part of treatment for patients with locally advanced colon cancer. This study was conducted to investigate the actual practice in the use of adjuvant chemotherapy for patients with high-risk stage II or stage III colon cancer in South Korea. This was a 24-month open-label, prospective, observational study conducted at 12 centers across South Korea. Patients with high-risk stage II and stage III colon cancer receiving adjuvant chemotherapy after curative surgery were included, and data were collected at baseline, third, and sixth month. A total of 246 patients were included in the analyses. Of five available regimens (FOLFOX, CAPOX, 5-FU/LV, capecitabine, and UFT/LV), FOLFOX was most commonly used (82.5%). Investigators indicated the "efficacy" as the major cause for selecting FOLFOX or CAPOX. For 5-FU/LV, capecitabine, or UFT/LV, the "safety" or "patient's characteristics (age, comorbidity, and stage)" was one of the most important selecting factors. Patients receiving 5-FU/LV, capecitabine, or UFT/LV had older age, worse PS and lower disease stage (stage II) than patients receiving FOLFOX or CAPOX. Hematologic toxicities were the most common cause of dose adjustment and treatment delay. In South Korea, FOLFOX was the most commonly used regimen for adjuvant chemotherapy and its efficacy was the main cause for selecting this regimen. Patients receiving 5-FU/LV, capecitabine, or UFT/LV had older age, worse PS and lower disease stage (stage II) than patients receiving FOLFOX or CAPOX.

  8. The Clinical Research Center for Depression Study: Baseline Characteristics of a Korean Long-Term Hospital-Based Observational Collaborative Prospective Cohort Study

    Kim, Tae-Suk; Jeong, Seung Hee; Kim, Jung-Bum; Lee, Min-Soo; Kim, Jae-Min; Yim, Hyeon-Woo

    2011-01-01

    Objective The Clinical Research Center for Depression (CRESCEND) study is a 9-year observational collaborative prospective cohort study for the clinical outcomes in participants with depressive disorders in Korea. In this study, we examined the baseline characteristics of the depressive participants as the hospital-based cohort. Methods Participants were assessed using various instruments including the Clinical Global Impression scale, 17-item Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Social and Occupational Functioning Assessment Scale, Beck Depression Inventory-Second Edition, Scale for Suicide Ideation, and World Health Organization Quality of Life assessment instruments-abbreviated version. Also, personal histories of medical and psychiatric illnesses and the range of socio-epidemiologic and clinical data were collected from each participant. Results One thousand one hundred eighty three participants were recruited from 18 hospitals. The mean age of the participants was 47.9±15.9 year-old, 74.4% were female, 82.9% had been diagnosed of major depressive disorder, 40.9% were experiencing their first depressive episode, and 21.4% had a past history of suicide attempts. The majority (85.3%) of the participants were moderately to severely ill. The average HDRS-17 was 19.8±6.1. Significant gender differences at baseline were shown in age, education, marriage, employment, religion, and first depressive episode. Conclusion The baseline findings in the CRESCEND study showed some different characteristics of depression in Korea, suggesting a possibility of ethnic and cultural factors in depression. PMID:21519530

  9. Estimating Allee dynamics before they can be observed: polar bears as a case study.

    Péter K Molnár

    Full Text Available Allee effects are an important component in the population dynamics of numerous species. Accounting for these Allee effects in population viability analyses generally requires estimates of low-density population growth rates, but such data are unavailable for most species and particularly difficult to obtain for large mammals. Here, we present a mechanistic modeling framework that allows estimating the expected low-density growth rates under a mate-finding Allee effect before the Allee effect occurs or can be observed. The approach relies on representing the mechanisms causing the Allee effect in a process-based model, which can be parameterized and validated from data on the mechanisms rather than data on population growth. We illustrate the approach using polar bears (Ursus maritimus, and estimate their expected low-density growth by linking a mating dynamics model to a matrix projection model. The Allee threshold, defined as the population density below which growth becomes negative, is shown to depend on age-structure, sex ratio, and the life history parameters determining reproduction and survival. The Allee threshold is thus both density- and frequency-dependent. Sensitivity analyses of the Allee threshold show that different combinations of the parameters determining reproduction and survival can lead to differing Allee thresholds, even if these differing combinations imply the same stable-stage population growth rate. The approach further shows how mate-limitation can induce long transient dynamics, even in populations that eventually grow to carrying capacity. Applying the models to the overharvested low-density polar bear population of Viscount Melville Sound, Canada, shows that a mate-finding Allee effect is a plausible mechanism for slow recovery of this population. Our approach is generalizable to any mating system and life cycle, and could aid proactive management and conservation strategies, for example, by providing a priori

  10. Quantum generalized observables framework for psychological data: a case of preference reversals in US elections

    Khrennikova, Polina; Haven, Emmanuel

    2017-10-01

    Politics is regarded as a vital area of public choice theory, and it is strongly relying on the assumptions of voters' rationality and as such, stability of preferences. However, recent opinion polls and real election outcomes in the USA have shown that voters often engage in `ticket splitting', by exhibiting contrasting party support in Congressional and Presidential elections (cf. Khrennikova 2014 Phys. Scripta T163, 014010 (doi:10.1088/0031-8949/2014/T163/014010); Khrennikova & Haven 2016 Phil. Trans. R. Soc. A 374, 20150106 (doi:10.1098/rsta.2015.0106); Smith et al. 1999 Am. J. Polit. Sci. 43, 737-764 (doi:10.2307/2991833)). Such types of preference reversals cannot be mathematically captured via the formula of total probability, thus showing that voters' decision making is at variance with the classical probabilistic information processing framework. In recent work, we have shown that quantum probability describes well the violation of Bayesian rationality in statistical data of voting in US elections, through the so-called interference effects of probability amplitudes. This paper is proposing a novel generalized observables framework of voting behaviour, by using the statistical data collected and analysed in previous studies by Khrennikova (Khrennikova 2015 Lect. Notes Comput. Sci. 8951, 196-209) and Khrennikova & Haven (Khrennikova & Haven 2016 Phil. Trans. R. Soc. A 374, 20150106 (doi:10.1098/rsta.2015.0106)). This framework aims to overcome the main problems associated with the quantum probabilistic representation of psychological data, namely the non-double stochasticity of transition probability matrices. We develop a simplified construction of generalized positive operator valued measures by formulating special non-orthonormal bases with respect to these operators. This article is part of the themed issue `Second quantum revolution: foundational questions'.

  11. [A case of pycnodysostosis--observation of the skull by CT scan].

    Anegawa, S; Bekki, Y; Furukawa, Y; Yokota, S; Torigoe, R

    1987-07-01

    A 13-year-old boy was presented to the Department of Neurosurgery, Saiseikai Fukuoka General Hospital for further examinations concerning abnormal findings in the skull radiogram taken when he struck his head. His physical features showed some characteristics the same as those of pycnodysostosis as follows--proportionate dwarfism, prominent forehead, short spoon-shaped fingers, bilateral exophthalmos. A skull radiogram revealed widely open cranial sutures with no healing of the fracture and craniotomy which was performed for an acute epidural hematoma 6 years ago. Furthermore, the mandible was hypoplastic with a virtual loss of mandibular angle. CT of the soft tissues showed somewhat dilated cortical sulci and ventricles without any structural abnormalities in the brain. CT of bone algorithm revealed specific characteristics of this disease. The paranasal sinuses were quite hypoplastic. Especially in the maxillary sinuses, frontal sinuses and mastoid air cells, none of developments of sinuses were noted, even though the middle and internal ear seemed to be normal. Moreover, the ethmoid and sphenoid sinuses were noted, although their developments were poor. The appearance of skull base was normal, including the inlets and outlets of cranial nerves or vessels and synchondroses. However, the density of the skull base, especially in the diploe, was higher than normal in Hansfield number. Furthermore, detailed measurements of skull base demonstrated that the skull base itself was also dwarfism. Pycnodysostosis is a generalized skeletal disease whose cardinal features are moderate generalized osteosclerosis and dwarfism. However, the detailed observation on the cranium by CT has not been reported. In our study, the development of sinuses in bones with intramembranous ossification are worse than that with endochondral ossification.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Science Fairs and Observational Science: A Case History from Earth Orbit

    Lowman, Paul D., Jr.; Smith, David E. (Technical Monitor)

    2002-01-01

    Having judged dozens of science fairs over the years, I am repeatedly disturbed by the ground rules under which students must prepare their entries. They are almost invariably required to follow the "scientific method," involving formulating a hypothesis, a test of the hypothesis, and then a project in which this test is carried out. As a research scientist for over 40 years, I consider this approach to science fairs fundamentally unsound. It is not only too restrictive, but actually avoids the most important (and difficult) part of scientific research: recognizing a scientific problem in the first place. A well-known example is one of the problems that, by his own account, stimulated Einstein's theory of special relativity: the obvious fact that when an electric current is induced in a conductor by a magnetic field , it makes no difference whether the field or the conductor is actually (so to speak) moving. There is in other words no such thing as absolute motion. Physics was transformed by Einstein's recognition of a problem. Most competent scientists can solve problems after they have been recognized and a hypothesis properly formulated, but the ability to find problems in the first Place is much rarer. Getting down to specifics, the "scientific method" under which almost all students must operate is actually the experimental method, involving controlled variables, one of which, ideally, is changed at a time. However, there is another type of science that can be called observational science. As it happens, almost all the space research I have carried out since 1959 has been this type, not experimental science.

  13. Estimating Allee dynamics before they can be observed: polar bears as a case study.

    Molnár, Péter K; Lewis, Mark A; Derocher, Andrew E

    2014-01-01

    Allee effects are an important component in the population dynamics of numerous species. Accounting for these Allee effects in population viability analyses generally requires estimates of low-density population growth rates, but such data are unavailable for most species and particularly difficult to obtain for large mammals. Here, we present a mechanistic modeling framework that allows estimating the expected low-density growth rates under a mate-finding Allee effect before the Allee effect occurs or can be observed. The approach relies on representing the mechanisms causing the Allee effect in a process-based model, which can be parameterized and validated from data on the mechanisms rather than data on population growth. We illustrate the approach using polar bears (Ursus maritimus), and estimate their expected low-density growth by linking a mating dynamics model to a matrix projection model. The Allee threshold, defined as the population density below which growth becomes negative, is shown to depend on age-structure, sex ratio, and the life history parameters determining reproduction and survival. The Allee threshold is thus both density- and frequency-dependent. Sensitivity analyses of the Allee threshold show that different combinations of the parameters determining reproduction and survival can lead to differing Allee thresholds, even if these differing combinations imply the same stable-stage population growth rate. The approach further shows how mate-limitation can induce long transient dynamics, even in populations that eventually grow to carrying capacity. Applying the models to the overharvested low-density polar bear population of Viscount Melville Sound, Canada, shows that a mate-finding Allee effect is a plausible mechanism for slow recovery of this population. Our approach is generalizable to any mating system and life cycle, and could aid proactive management and conservation strategies, for example, by providing a priori estimates of minimum

  14. Commercialization as a recommended approach to hospital restructuring. Case study of Łańcut Medical Center

    Wiktor Patena

    2015-10-01

    Full Text Available Our society is on the brink of health care system reorganization and implementation of new medical technology. Hospitals have to be a core component of the medical revolution so they have to be prepared for the upcoming leap in their development. If Poland wants to be a pioneer in providing new medical solutions, the current ineffective system has to be changed. The necessary action should be taken to deal with the financial problems Polish hospitals have faced for over 20 years. The current structure of hospitals - SPZOZ, is old-fashioned and cannot adapt to a turbulent social and economic environment. The hospitals should be commercialized and restructured. Being capitalized companies will give incentives and new tools to deal with financial problems. The article presents an example of the commercialized hospital in Łańcut. We make the observations that commercialization increases: a hospital’s profitability, its employment productivity, its capital investment spending and leverage. The case proves that the transformation of hospitals to capital companies proposed by the Ministry of Health may be an appropriate approach and it does work once a reasonable management board is in charge. However, the legal structure alteration should be treated as the first step in the overall restructuring process. The article highlights the problem of managers of Polish hospitals who do not only struggle with financial shortages, but barely know which business model they should follow after commercialization to successfully run the restructuring process. Having examined the LMC the authors are crafting a prelude to the overall research on already commercialized hospitals to find an appropriate business model.

  15. Applications of NASA and NOAA Satellite Observations by NASA's Short-term Prediction Research and Transition (SPoRT) Center in Response to Natural Disasters

    Molthan, Andrew L.; Burks, Jason E.; McGrath, Kevin M.; Jedlovec, Gary J.

    2012-01-01

    NASA s Short-term Prediction Research and Transition (SPoRT) Center supports the transition of unique NASA and NOAA research activities to the operational weather forecasting community. SPoRT emphasizes real-time analysis and prediction out to 48 hours. SPoRT partners with NOAA s National Weather Service (NWS) Weather Forecast Offices (WFOs) and National Centers to improve current products, demonstrate future satellite capabilities and explore new data assimilation techniques. Recently, the SPoRT Center has been involved in several activities related to disaster response, in collaboration with NOAA s National Weather Service, NASA s Applied Sciences Disasters Program, and other partners.

  16. Management and Stewardship of Airborne Observational Data for the NSF/NCAR HIAPER (GV) and NSF/NCAR C-130 at the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL)

    Aquino, J.

    2014-12-01

    The National Science Foundation (NSF) provides the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL) funding for the operation, maintenance and upgrade of two research aircraft: the NSF/NCAR High-performance Instrumented Airborne Platform for Environmental Research (HIAPER) Gulfstream V and the NSF/NCAR Hercules C-130. A suite of in-situ and remote sensing airborne instruments housed at the EOL Research Aviation Facility (RAF) provide a basic set of measurements that are typically deployed on most airborne field campaigns. In addition, instruments to address more specific research requirements are provided by collaborating participants from universities, industry, NASA, NOAA or other agencies. The data collected are an important legacy of these field campaigns. A comprehensive metadata database and integrated cyber-infrastructure, along with a robust data workflow that begins during the field phase and extends to long-term archival (current aircraft data holdings go back to 1967), assures that: all data and associated software are safeguarded throughout the data handling process; community standards of practice for data stewardship and software version control are followed; simple and timely community access to collected data and associated software tools are provided; and the quality of the collected data is preserved, with the ultimate goal of supporting research and the reproducibility of published results. The components of this data system to be presented include: robust, searchable web access to data holdings; reliable, redundant data storage; web-based tools and scripts for efficient creation, maintenance and update of data holdings; access to supplemental data and documentation; storage of data in standardized data formats; comprehensive metadata collection; mature version control; human-discernable storage practices; and procedures to inform users of changes. In addition, lessons learned, shortcomings, and desired upgrades

  17. The Development of a Learning Dashboard for Lecturers: A Case Study on a Student-Centered E-Learning Environment

    Santoso, Harry B.; Batuparan, Alivia Khaira; Isal, R. Yugo K.; Goodridge, Wade H.

    2018-01-01

    Student Centered e-Learning Environment (SCELE) is a Moodle-based learning management system (LMS) that has been modified to enhance learning within a computer science department curriculum offered by the Faculty of Computer Science of large public university in Indonesia. This Moodle provided a mechanism to record students' activities when…

  18. Employee Perceptions of Progress with Implementing a Student-Centered Model of Institutional Improvement: An Achieving the Dream Case Study

    Cheek, Annesa LeShawn

    2011-01-01

    Achieving the Dream is a national initiative focused on helping more community college students succeed, particularly students of color and low-income students. Achieving the Dream's student-centered model of institutional improvement focuses on eliminating gaps and raising student achievement by helping institutions build a culture of evidence…

  19. IDENTIFICATION OF EXAMPLES OF GOOD PRACTICE IN ABSORPTION OF STRUCTURAL FUNDS, CASE STUDY PROJECT "CHRISTIAN DAY CENTER"

    CEAUSESCU IONUT

    2016-08-01

    Full Text Available The main purpose of this study is to capture the practical point of view, the main issues in examples of best practices in the application for funding for the project "Christian Day Center- Support for young people and adults with disabilities" project benefited the City Council Târgu Jiu, is a project which was realized in the Regional Operational Programme, Priority Axis 3 DMI 3.2 - "Rehabilitation / modernization / development and equipping of social services", the total value of the project was 3,373,722.72 lei, of which non-repayable funding over was worth 2,592,251.08 lei. Through its general objective, the project "Day Center Christian - Support for young people and adults with disabilities" aims to contribute to improving the quality of infrastructure for social services by ensuring equal access of citizens of Tg-Jiu such services. Christian Day Center- support for young people and adults with physical disabilities, musculoskeletal, neuro, somatic and visual has already proposed to the idea of the project, to be a center which will ensure the social inclusion of these vulnerable and contribute to increasing the quality of life, improve communication and information on the rights and benefits of social services to improve the management and organization of the system of providing social services and facilitating the participation of all stakeholders in the development of social services.

  20. Learning Resources Centers and Their Effectiveness on Students’ Learning Outcomes: A Case-Study of an Omani Higher Education Institute

    Peyman Nouraey

    2017-06-01

    Full Text Available The study aimed at investigating the use and effectiveness of a learning resources center, which is generally known as a library. In doing so, eight elements were investigated through an author-designed questionnaire. Each of these elements tended to delve into certain aspects of the afore-mentioned center. These elements included a students’ visits frequency, b availability of books related to modules, c center facilities, d use of discussion rooms, e use of online resources, f staff cooperation, g impact on knowledge enhancement, and, h recommendation to peers. Eighty undergraduate students participated in the study. Participants were then asked to read the statements carefully and choose one of the five responses provided, ranging from strongly agree to strongly disagree. Data were analyzed based on 5-point Likert Scale. Findings of the study revealed that participants were mostly in agreement with all eight statements provided in the questionnaire, which were interpreted as positive feedbacks from the students. Then, the frequencies of responses by the participants were reported. Finally, the results were compared and contrasted and related discussions on the effectiveness of libraries and learning resources centers on students’ learning performances and outcomes were made.

  1. Educational Entrepreneurism in Higher Education: A Comparative Case Study of Two Academic Centers within One Land-Grant University

    Wilcox, Lori

    2009-01-01

    This research explored the relationship of educational entrepreneurism and organizational culture in the creation and evolution of academic centers within one Midwestern land-grant university facing resource constraints. Particular attention was given to: (a) synthesizing current entrepreneurial and organizational culture and evolution theory as…

  2. A Case Study on the Influence of Organizational Structures and Policies on Faculty Implementation of Learner-Centered Teaching

    Piskadlo, Kevin Scott

    2016-01-01

    In their seminal 1995 article, Barr and Tagg encouraged higher education to think differently about undergraduate education and suggested that a new paradigm be adopted that focused less on what is taught and more on what is learned. Dubbed the learner-centered paradigm, this reframing of education challenges long standing practices and removes…

  3. Clinical profile and 30-day outcome of women with acute coronary syndrome as a first manifestation of ischemic heart disease: A single-center observational study.

    Nanjappa, Veena; Aniyathodiyil, Gopi; Keshava, R

    2016-01-01

    Gender disparity, with respect to women receiving less medical therapy, undergoing fewer invasive procedures, and experiencing worse outcome than men, has been noted in various observational and randomized trials, though guidelines on acute coronary syndrome (ACS) are gender-neutral. Indian data with focus on women with ACS are lacking. This study was undertaken to give us an insight on the clinical presentation, risk factors, and in-hospital outcome of ACS in women and at 30 days. 133 successive cases of women presenting with ACS, who met the inclusion criteria between 2012 and 2014, were included. Cases were grouped into ST elevation myocardial infarction (STEMI), non ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). The mean age was 64.4±11 years. The mean BMI was 23.64±3.23kg/m(2). Diabetes was present in 58.3% in NSTEMI, 65.1% in STEMI, and 57.1% in UA group. Hypertension was found in 75% of NSTEMI, 60.2% of STEMI, and 71.4% of UA group. Severe MR was found in 11.1% of NSTEMI and 3.6% of STEMI patients. 8.3% of NSTEMI and 15.7% of STEMI patients presented in Killips class IV. Single vessel disease was most commonly found across the spectrum of ACS. 68.7% patients in STEMI group underwent primary angioplasty. 5.6% of NSTEMI and 7.2% in STEMI group had contrast-induced nephropathy (CIN). All deaths were noted in STEMI group with eight in-hospital deaths and three during 30-day follow-up period. Killips class III and IV and higher grace score (>150) were predictors of in-hospital mortality. Chronic kidney disease, ischemic mitral regurgitation, LV clot, and in-hospital cardiac arrest were associated with higher risk. Copyright © 2016. Published by Elsevier B.V.

  4. ISTSOS, SENSOR OBSERVATION MANAGEMENT SYSTEM: A REAL CASE APPLICATION OF HYDRO-METEOROLOGICAL DATA FOR FLOOD PROTECTION

    M. Cannata

    2014-01-01

    Full Text Available istSOS (Istituto scienze della Terra Sensor Observation Service is an implementation of the Sensor Observation Service standard from Open Geospatial Consortium (OGC. The development of istSOS started in 2009 in order to provide a simple implementation of the Sensor Observation Service (SOS standard for the management, provision and integration of hydro-meteorological data collected in Canton Ticino (Southern Switzerland. istSOS is entirely written in Python and is based on reliable open source software like PostgreSQL/PostGIS and Apache/mod_wsgi. The authors during this presentation want to illustrate the latest software enhancements together with a real case in a production environment. Latest software enhancement includes the development of a RESTful service and of a Web-based graphical user interface that allows hydrologists a better interaction with measurements. This includes the ability of new services creation, addition of new sensors and relative metadata, visualization and manipulation of stored observations, registration of new measures and setting of system properties like observable properties and data quality codes. The study will show a real case application of the system for the provision of data to interregional partners and to a hydrological model for lake level forecasting and flooding hazard assessment. The hydrological model uses a combination of WPS (Web Processing Service and SOS for the generation of model input data. This system is linked with a dedicated geo-portal used by the civil protection for the management, alert and protection of population and assets of the Locarno area (Verbano Lake flooding. Practical considerations and technical issues will be presented and discussed.

  5. Improving observational study estimates of treatment effects using joint modeling of selection effects and outcomes: the case of AAA repair.

    O'Malley, A James; Cotterill, Philip; Schermerhorn, Marc L; Landon, Bruce E

    2011-12-01

    When 2 treatment approaches are available, there are likely to be unmeasured confounders that influence choice of procedure, which complicates estimation of the causal effect of treatment on outcomes using observational data. To estimate the effect of endovascular (endo) versus open surgical (open) repair, including possible modification by institutional volume, on survival after treatment for abdominal aortic aneurysm, accounting for observed and unobserved confounding variables. Observational study of data from the Medicare program using a joint model of treatment selection and survival given treatment to estimate the effects of type of surgery and institutional volume on survival. We studied 61,414 eligible repairs of intact abdominal aortic aneurysms during 2001 to 2004. The outcome, perioperative death, is defined as in-hospital death or death within 30 days of operation. The key predictors are use of endo, transformed endo and open volume, and endo-volume interactions. There is strong evidence of nonrandom selection of treatment with potential confounding variables including institutional volume and procedure date, variables not typically adjusted for in clinical trials. The best fitting model included heterogeneous transformations of endo volume for endo cases and open volume for open cases as predictors. Consistent with our hypothesis, accounting for unmeasured selection reduced the mortality benefit of endo. The effect of endo versus open surgery varies nonlinearly with endo and open volume. Accounting for institutional experience and unmeasured selection enables better decision-making by physicians making treatment referrals, investigators evaluating treatments, and policy makers.

  6. Representing Geospatial Environment Observation Capability Information: A Case Study of Managing Flood Monitoring Sensors in the Jinsha River Basin

    Hu, Chuli; Guan, Qingfeng; Li, Jie; Wang, Ke; Chen, Nengcheng

    2016-01-01

    Sensor inquirers cannot understand comprehensive or accurate observation capability information because current observation capability modeling does not consider the union of multiple sensors nor the effect of geospatial environmental features on the observation capability of sensors. These limitations result in a failure to discover credible sensors or plan for their collaboration for environmental monitoring. The Geospatial Environmental Observation Capability (GEOC) is proposed in this study and can be used as an information basis for the reliable discovery and collaborative planning of multiple environmental sensors. A field-based GEOC (GEOCF) information representation model is built. Quintuple GEOCF feature components and two GEOCF operations are formulated based on the geospatial field conceptual framework. The proposed GEOCF markup language is used to formalize the proposed GEOCF. A prototype system called GEOCapabilityManager is developed, and a case study is conducted for flood observation in the lower reaches of the Jinsha River Basin. The applicability of the GEOCF is verified through the reliable discovery of flood monitoring sensors and planning for the collaboration of these sensors. PMID:27999247

  7. Long-term observation of the mineral trioxide aggregate extrusion into the periapical lesion: a case series

    Seok-Woo Chang; Tae-Seok Oh; WooCheol Lee; Gary Shun-Pan Cheung; Hyeon-Cheol Kim

    2013-01-01

    One-step apexification using mineral trioxide aggregate (MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex. However, orthograde placement of MTA is a challenging procedure in terms of length control. This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex. Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA. These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues. However, intentional MTA overfilling into the periapical lesion is not to be recommended.

  8. The Plan for Donations or "Don'tations": The Case of the Alumni-Funded Entrepreneurship Center

    Olsen, Mona Anita Kristiansen

    2012-01-01

    This case was developed for use in a course on entrepreneurial education that focuses on leadership. Background from Blue Stone University, including information on its mission, organizational structure, metrics, entrepreneurial programs, and stakeholders, is presented. This case explores how a school within a university approached the creation of…

  9. Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136 cases.

    Shi, Lei; Yu, Jing; Zhao, Ying; Xu, Kan; Yu, Jinlu

    2018-02-01

    It is widely acknowledged that arteriosclerosis and calcification of the parent artery and aneurysm neck make it difficult to clip posterior communicating artery (PCoA) aneurysms. A total of 136 cases of PCoA aneurysms accompanied by arteriosclerosis and calcification were collected and treated with clipping in the present study. Of the 136 patients, 112 were females (82.4%) and 24 were males (17.6%), with ages ranging from 37 to 76 years (mean age, 60.2 years). Rupture of a PCoA aneurysm was identified in 132 cases (97.1%), and there were 4 cases of unruptured PCoA aneurysms (2.9%). According to the severity of arteriosclerosis and calcification, the aneurysms were divided into type I, II or III. The treatment of type I aneurysms achieved the best curative effect. It is difficult to temporarily occlude type II and III aneurysms during surgery, and temporary occlusion failed in almost 50% of cases. Types II and III were prone to intraoperative aneurysm ruptures. A significantly higher rate of intraoperative aneurysm rupture was seen in type III compared with type II cases. Type II and III cases were more likely to be treated using a fenestrated clip for aneurysm clipping compared with type I cases, and fenestrated clips were used significantly more frequently in type III cases compared with type II cases. Arteriosclerosis and calcification were likely to affect the prognosis of patients, particularly in cases with type III arteriosclerosis and calcification of the parent artery and aneurysm neck. Therefore, the stratification of the arteriosclerosis and calcification of the parent artery and aneurysm neck into types I-III can guide the intraoperative aneurysm clipping strategy, aid in choosing the correct clips, and inform predictions of the occurrence of rupture and hemorrhage, as well as the prognosis for aneurysms.

  10. Clinical observation on 96 cases of primary osteoporosis treated with kidney-tonifying and bone-strengthening mixture.

    Mingyue, Wang; Ling, Gong; Bei, Xia; Junqing, Cao; Peiqing, Zhou; Jie, Hu

    2005-06-01

    To objectively evaluate the therapeutic effect and safety of Mixture for Nourishing Kidney and Strengthening Bone. Among 160 cases of osteoporosis under clinical observation, 96 patients in the treatment group were treated with Mixture for Nourishing Kidney and Strengthening Bone, 32 patients in the control group were given Shen Gu Capsule and 32 patients in the blank group were given no drug in half a year. Observation and determination were conducted on bone mineral density (BMD), clinical symptoms, bone gla protein (BGP), pyridinoline (PYD), estradiol (E2), testosterone (T), blood urea nitrogen (BUN), transaminase and routine test on blood and urine. The comprehensive effect in the treatment group was remarkably superior to that in the control group. The safe and reliable Chinese drug can enhance BMD, promote osteogenesis and inhibit bone absorption, hence treating osteoporosis with marked effect.

  11. An Observation Capability Semantic-Associated Approach to the Selection of Remote Sensing Satellite Sensors: A Case Study of Flood Observations in the Jinsha River Basin.

    Hu, Chuli; Li, Jie; Lin, Xin; Chen, Nengcheng; Yang, Chao

    2018-05-21

    Observation schedules depend upon the accurate understanding of a single sensor’s observation capability and the interrelated observation capability information on multiple sensors. The general ontologies for sensors and observations are abundant. However, few observation capability ontologies for satellite sensors are available, and no study has described the dynamic associations among the observation capabilities of multiple sensors used for integrated observational planning. This limitation results in a failure to realize effective sensor selection. This paper develops a sensor observation capability association (SOCA) ontology model that is resolved around the task-sensor-observation capability (TSOC) ontology pattern. The pattern is developed considering the stimulus-sensor-observation (SSO) ontology design pattern, which focuses on facilitating sensor selection for one observation task. The core aim of the SOCA ontology model is to achieve an observation capability semantic association. A prototype system called SemOCAssociation was developed, and an experiment was conducted for flood observations in the Jinsha River basin in China. The results of this experiment verified that the SOCA ontology based association method can help sensor planners intuitively and accurately make evidence-based sensor selection decisions for a given flood observation task, which facilitates efficient and effective observational planning for flood satellite sensors.

  12. An Observation Capability Semantic-Associated Approach to the Selection of Remote Sensing Satellite Sensors: A Case Study of Flood Observations in the Jinsha River Basin

    Chuli Hu

    2018-05-01

    Full Text Available Observation schedules depend upon the accurate understanding of a single sensor’s observation capability and the interrelated observation capability information on multiple sensors. The general ontologies for sensors and observations are abundant. However, few observation capability ontologies for satellite sensors are available, and no study has described the dynamic associations among the observation capabilities of multiple sensors used for integrated observational planning. This limitation results in a failure to realize effective sensor selection. This paper develops a sensor observation capability association (SOCA ontology model that is resolved around the task-sensor-observation capability (TSOC ontology pattern. The pattern is developed considering the stimulus-sensor-observation (SSO ontology design pattern, which focuses on facilitating sensor selection for one observation task. The core aim of the SOCA ontology model is to achieve an observation capability semantic association. A prototype system called SemOCAssociation was developed, and an experiment was conducted for flood observations in the Jinsha River basin in China. The results of this experiment verified that the SOCA ontology based association method can help sensor planners intuitively and accurately make evidence-based sensor selection decisions for a given flood observation task, which facilitates efficient and effective observational planning for flood satellite sensors.

  13. Methods of applying the 1994 case definition of chronic fatigue syndrome - impact on classification and observed illness characteristics.

    Unger, E R; Lin, J-M S; Tian, H; Gurbaxani, B M; Boneva, R S; Jones, J F

    2016-01-01

    Multiple case definitions are in use to identify chronic fatigue syndrome (CFS). Even when using the same definition, methods used to apply definitional criteria may affect results. The Centers for Disease Control and Prevention (CDC) conducted two population-based studies estimating CFS prevalence using the 1994 case definition; one relied on direct questions for criteria of fatigue, functional impairment and symptoms (1997 Wichita; Method 1), and the other used subscale score thresholds of standardized questionnaires for criteria (2004 Georgia; Method 2). Compared to previous reports the 2004 CFS prevalence estimate was higher, raising questions about whether changes in the method of operationalizing affected this and illness characteristics. The follow-up of the Georgia cohort allowed direct comparison of both methods of applying the 1994 case definition. Of 1961 participants (53 % of eligible) who completed the detailed telephone interview, 919 (47 %) were eligible for and 751 (81 %) underwent clinical evaluation including medical/psychiatric evaluations. Data from the 499 individuals with complete data and without exclusionary conditions was available for this analysis. A total of 86 participants were classified as CFS by one or both methods; 44 cases identified by both methods, 15 only identified by Method 1, and 27 only identified by Method 2 (Kappa 0.63; 95 % confidence interval [CI]: 0.53, 0.73 and concordance 91.59 %). The CFS group identified by both methods were more fatigued, had worse functioning, and more symptoms than those identified by only one method. Moderate to severe depression was noted in only one individual who was classified as CFS by both methods. When comparing the CFS groups identified by only one method, those only identified by Method 2 were either similar to or more severely affected in fatigue, function, and symptoms than those only identified by Method 1. The two methods demonstrated substantial concordance. While Method 2

  14. Quality of Life at Work: the case of penitentiary agents in a Temporary Detention Center in Rio Grande do Norte

    Emerson de França Fagundes; Juliherme Carlos da Costa; Tabita Aija Silva Moreira

    2017-01-01

    Prison officers, due to the nature of their profession, are subject to various factors of risk, tension, physical and mental exhaustion. This study is a research carried out at a Provisional Detention Center (CDP) in Rio Grande do Norte (RN), with the objective of analyzing Quality of Life at Work (QWL), as perceived by prison The model of Walton (1973). The method adopted was a field research, of an exploratory and descriptive character where the data were collected through a questionnaire w...

  15. Space and Materials Reservation Software in Mobile Applications Development: The Case of Istanbul Aydin University Information Center

    Agah Alıcı

    2017-06-01

    Full Text Available The aim of this paper is to explain the adoption of mobile application ICReserve (Information Center Reserve to improve the library services in terms of user satisfaction and management processes with an innovative approach. ICReserve is a kind of reservation software developed specifically for the needs of University Library by the Istanbul Aydin University IT Department and is integrated to the institution’s other information systems. This article contains technical information about mobile application development.

  16. Recommendations to increase customer conversion rates through website optimization and online marketing Case company: RCS Training Center

    Bogdanova, Daria

    2016-01-01

    The goal of this thesis is to establish effective online marketing strategy for a small B2C wellness studio. The commissioning company RCS Training Center wishes to attract more customers through their website and social media sites, such as Facebook and Instagram. This objective is justified by the popularity of the wellness and fitness niche online, which creates big market potential in the homeland and internationally. However, popularity also means high competition. A lack of experience i...

  17. [Outcome mesurement: the case of the "Center of Results" of the public healthcare providers network in Catalonia, Spain].

    Argenter-Giralt, Miquel; Barba-Albós, Genoveva; Román-Martínez, Anna

    2010-02-01

    The health information system in Catalonia has experienced an important evolution but obtaining integrated data to evaluate the health services is still difficult. At the end of 2008 the basis of the information system of the "Center of Results" and a first set of indicators has been approved by the health system stakeholders. The "Center of Results" is assigned to the Catalan Health Service. It has a Direction Board and a Technical Committee to regulate its operation. The "Center of Results" has the mission to measure, evaluate and disseminate the results obtained in health care by the members of the public health services, to facilitate decision making with shared responsibility at the service of the quality of the health care given to the citizens of Catalonia. The "Center of Results" is based on performance principles that determine their operation: to share and to coordinate the existing information, to stimulate the participation and the co-responsibility of the implied agents, continuous improvement of the health information, promotion of good practices in the use of information and its responsible use, efficient instrumentation of technologies and analytical capacity to transform data into information. A participative process has been made to select and prioritize indicators. This process has reached consensus on a set of indicators. These indicators must contribute to assess the impact of the interventions of the health system on the level of the population's health and how results, with an efficient use of the resources, are obtained. 2010 Elsevier España S.L. All rights reserved.

  18. Characterization and evaluation of agro-ecosystems on a farm scale a study case: The Paysandu farming center (Medellin. Colombia)

    Juan Camilo de los Rios Cardona; Andres Felipe Gallego Zapata; Leon Dario Velez Vargas; Agudelo Otalvaro, Jose Ignacio; Toro Restrepo, Luis Jairo; Lema Tapias, Alvaro de Jesus; Acevedo Agudelo, Luis Ignacio

    2004-01-01

    The state, condition, and tendencies of the agro-ecosystems (AE) of the Paysandu farming center of the Universidad Nacional de Colombia, sede Medellin were characterized and evaluated by means of parameterization and analysis of the various technological receptivity (RT, after the Spanish initials) and technological intensity (IT), based upon a methodological proposal of Velez and Gasto (1999), in terms of AE diversity and of the uses, management, and technological acceptance, techno-structural and hydro-structural endowment, potential productivity and services to the local, regional, and national society. The results showed that the greater part of the center (72%) has very low RT; which does not permit the establishment of mechanized advanced agro-technological management systems (SMA) however, 69.8% of the area is managed with SMA adequate for the restrictions imposed by the RT sixty-two percent of the area of the center, principally under pasture cover for dairy cattle production, is managed with advanced SMA. As a result of the interaction between RT and the SMA employed, six AE were identified, of which three, that represent 69.8% of the area (100.2 ha.), are managed with technologies adequate for their biophysical conditions or with technological receptivity (adequate IT), and the other three, that represent 28,57% of the are (43.1 ha.) ore managed with technologies that do not correspond to their RT conditions (tradition IT) which leads to a deterioration of their biophysical and ecological conditions

  19. Designing human centered GeoVisualization application--the SanaViz--for telehealth users: a case study.

    Joshi, Ashish; de Araujo Novaes, Magdala; Machiavelli, Josiane; Iyengar, Sriram; Vogler, Robert; Johnson, Craig; Zhang, Jiajie; Hsu, Chiehwen E

    2012-01-01

    Public health data is typically organized by geospatial unit. GeoVisualization (GeoVis) allows users to see information visually on a map. Examine telehealth users' perceptions towards existing public health GeoVis applications and obtains users' feedback about features important for the design and development of Human Centered GeoVis application "the SanaViz". We employed a cross sectional study design using mixed methods approach for this pilot study. Twenty users involved with the NUTES telehealth center at Federal University of Pernambuco (UFPE), Recife, Brazil were enrolled. Open and closed ended questionnaires were used to gather data. We performed audio recording for the interviews. Information gathered included socio-demographics, prior spatial skills and perception towards use of GeoVis to evaluate telehealth services. Card sorting and sketching methods were employed. Univariate analysis was performed for the continuous and categorical variables. Qualitative analysis was performed for open ended questions. Existing Public Health GeoVis applications were difficult to use. Results found interaction features zooming, linking and brushing and representation features Google maps, tables and bar chart as most preferred GeoVis features. Early involvement of users is essential to identify features necessary to be part of the human centered GeoVis application "the SanaViz".

  20. Observational Case Series Evaluation of the Granisetron Transdermal Patch System (Sancuso) for the Management of Nausea/Vomiting of Pregnancy.

    Le, Tran N; Adler, Michael T; Ouillette, Holly; Berens, Pamela; Smith, Judith A

    2017-07-01

    Objective  The objective of this study was to observe the efficacy of antiemetic therapy (no emesis/retching episodes and no rescue medication use) when granisetron is administered via a transdermal patch system (TDS) in women who are 6 to 14 weeks pregnant when compared with oral ondansetron by evaluating the frequency of the use of rescue medications for control of nausea/vomiting of pregnancy (NVP). Methods  This was an observational case series study to observe the potential benefits of granisetron TDS compared with oral ondansetron for management of NVP in pregnant patients during the first trimester. Dates of data collection were September 1, 2014, through December 31, 2015. There was no direct contact with patient. The oral ondansetron and granisetron TDS patients were matched by age, 4:1. The proportion of patients who received rescue antiemetics was calculated from those patients who continued to experience NVP. Risk factors for NVP were identified and compared between groups. Descriptive statistics were used to describe study results. Results  Patients were prescribed rescue antiemetics in 0/3 patients in the granisetron TDS group compared with 2/12 patients in the oral ondansetron group. Conclusion  Prospective efficacy studies on the use of granisetron TDS for management of NVP are needed to confirm this clinical observation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  1. ARCADO - Adding random case analysis to direct observation in workplace-based formative assessment of general practice registrars.

    Ingham, Gerard; Fry, Jennifer; Morgan, Simon; Ward, Bernadette

    2015-12-10

    Workplace-based formative assessments using consultation observation are currently conducted during the Australian general practice training program. Assessment reliability is improved by using multiple assessment methods. The aim of this study was to explore experiences of general practice medical educator assessors and registrars (trainees) when adding random case analysis to direct observation (ARCADO) during formative workplace-based assessments. A sample of general practice medical educators and matched registrars were recruited. Following the ARCADO workplace assessment, semi-structured qualitative interviews were conducted. The data was analysed thematically. Ten registrars and eight medical educators participated. Four major themes emerged - formative versus summative assessment; strengths (acceptability, flexibility, time efficiency, complementarity and authenticity); weaknesses (reduced observation and integrity risks); and contextual factors (variation in assessment content, assessment timing, registrar-medical educator relationship, medical educator's approach and registrar ability). ARCADO is a well-accepted workplace-based formative assessment perceived by registrars and assessors to be valid and flexible. The use of ARCADO enabled complementary insights that would not have been achieved with direct observation alone. Whilst there are some contextual factors to be considered in its implementation, ARCADO appears to have utility as formative assessment and, subject to further evaluation, high-stakes assessment.

  2. Home Air Quality And Case Of Pneumonia In Children Under Five Years Old ((In Community Health Center of South Cimahi and Leuwi Gajah, City of Cimahi

    Rilla Fahimah

    2014-04-01

    Full Text Available Pneumonia is the number one deadliest disease in the world with the prevalence of 44%. In Indonesia, pneumonia in to odler is the leading cause of death, after diarrhea, with proportion 15,5%. Pneumonia is a disease caused by a virus and bacteria influenced by physical and chemical contaminants. The purpose of this study is to analyze indoor air quality with the incidence of pneumonia in children under five years old with cross sectional method. The population in this study is the population living in the region of South Cimahi Public Health Center and Leuwi Gajah Public Health Center. The criteria of selection for the region are: region with the highest population, high pneumonia cases (in the red and yellow area, a coal-fired industrial area, and located near the toll Purbaleunyi. The sample of this research are respondents who live in the region of South Cimahi Public Health Center and Leuwi Gajah Public Health Center with inclusion criteria length of stay ≥1 year with a child under five years old. Significant correlation occur between PM10 and PM2,5 (p 0.05 with pneumonia. Dominant factors that cause pneumonia in infants is PM10 (p 0.036 with a value of OR 4.09 after controlled PM2,5 (p 0.142; OR 2.78, the number of bacteria (p 0.004; OR 0.17 and ventilation the house (p 0.395; OR 0.58.

  3. Dependence of J c on pinning center morphology: An explanation of record J c observed for discontinuous columnar pinning of vortices

    Weinstein, R.; Gandini, A.; Parks, D.; Sawh, R.; Mayes, B.

    2006-01-01

    An experimental study of defects caused by ion irradiation has proven that very discontinuous multiple-in-line-damage results in much higher J c than continuous columnar pinning centers. This is contrary to conventional wisdom. We develop a first approximation to a theory relating J c to the morphology of pinning centers. Qualitative agreement with experiment is achieved. Conclusions indicate the relative importance of pinning potential, percolation, and critical temperature for various morphologies. Results suggest the leading importance of pinning, compared to texture, weak links and oxygenation in achievement of the goal of high J c especially in large grain HTS

  4. Wilms’ Tumor: Histopathological Variants and the Outcomes of 31 Cases at a Tertiary Care Center in Northern India

    Kamal Nain Rattan

    2017-07-01

    Full Text Available Background: Wilms’ tumor is the most common malignant renal tumor in the pediatric age group. This tumor is classically managed by multimodal treatment which involves surgery, radiotherapy and chemotherapy. While there is plenty of data in world literature on the outcome of Wilms’ tumor, there is a paucity of data from India. Methods: All patients with proven diagnosis of Wilms’ tumor between 2008 to 2012 were noted from the hospital’s cancer registry. We performed detailed analyses of all patients’ clinical case records for demographic profiles, clinical features, imaging studies, treatment, and outcome. Histopathological classification of the tumor determined the patient’s post-operative management. All patients were followed for a period of 3 years and we analyzed the eventual outcome in the form of disease-free survival, complications, tumor recurrence, and mortality. Results: There were 31 cases of Wilms’ tumor included in this study. The median age of presentation was 3-4 years (range: 5 months-6 years with a female: male ratio of 1.2:1. Abdominal mass was the chief presenting feature in 20 (64.5% patients followed by abdominal pain in 6 (19.3%. All children had unilateral disease, 25 (80.6% had right-sided and 6 (19.3% had left-sided disease. Bilateral disease was seen in only one case. Of the 31 cases of Wilms’ tumor, 36% cases presented with stages I and II disease, 55% had stage III, and 9% of the cases were stage IV. Most cases of Wilms’ tumor were stage III. The majority had classical Wilms’ tumor with a favourable histology. The estimated 5-year event free survival was 87.3% Conclusion: A multidisciplinary approach can approach similar survival rates compared to the National Wilms’ Tumor Study Group, even in the Indian scenario. Further improvement in survival of these children can only be achieved by increasing awareness, early recognition, appropriate referral, and a multidisciplinary approach.

  5. Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China.

    Zhang, Jinglan; Lu, Jiakai; Zhou, Xiaorui; Xu, Xuefeng; Ye, Qing; Ou, Qitan; Li, Yanna; Huang, Jiapeng

    2018-03-07

    The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China. Observational case series study. Tertiary referral acute care hospital in Beijing, China. The cases of 17 consecutive pregnant idiopathic PAH patients undergoing abortion or parturition at Anzhen Hospital were reviewed retrospectively. Preoperative characteristics, anesthesia method, intensive care management, PAH-specific therapy, and maternal and neonatal outcomes were analyzed in this case series study. Maternal and neonatal outcomes were the main measures. The mean ages of the 17 parturient women with idiopathic PAH were 28.3 ± 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 ± 18.6 mmHg. Fifteen patients (88.2%) received PAH-specific therapy before delivery, including sildenafil, iloprost, and treprostinil. All except 1 parturient received epidural anesthesia for surgery due to an emergency Caesarean section. Three patients experienced pulmonary hypertension crisis that necessitated conversion to general anesthesia. Ten parturients underwent Caesarean delivery at a median gestational age of 31 weeks. Three patients developed acute pulmonary hypertensive crisis intraoperatively. Two patients underwent cardiopulmonary resuscitation and extracorporeal membrane oxygenation support. The maternal mortality was 17.6% (3/17). Of the 10 delivered neonates, 9 (90.0%) survived. The maternal mortality of the idiopathic PAH parturient was high in this case series from China. The authors applied epidural anesthesia, early management with multidisciplinary approaches, PAH

  6. Prevalence and Severity of Off-Centering During Diagnostic CT: Observations From 57,621 CT scans of the Chest, Abdomen, and/or Pelvis.

    Akin-Akintayo, Oladunni O; Alexander, Lauren F; Neill, Rebecca; Krupinksi, Elizabeth A; Tang, Xiangyang; Mittal, Pardeep K; Small, William C; Moreno, Courtney C

    2018-02-23

    To determine distances between patient centroid and gantry isocenter during CT imaging of the chest, abdomen, and/or pelvis, and to evaluate differences based on patient gender, scan region, patient position, and gantry aperture. A water phantom and an anthropomorphic phantom were imaged in the centered position in the CT gantry and at several off-centered positions. Additionally, data from 57,621 adult chest, abdomen, and/or pelvic CT acquisitions were evaluated. Data were analyzed with an analysis of variance using the centroid-to-isocenter data as the dependent variable and the other parameters as independent variables. The majority of patient acquisitions (83.7% (48271/57621)) were performed with the patient's centroid positioned below isocenter (mean 1.7 cm below isocenter (SD 1.8 cm); range 12.1 cm below to 7.8 cm above isocenter). Off-centering in the x-axis was less severe (mean 0.01 cm left of isocenter (SD 1.6 cm)). Distance between centroid and isocenter in the y-axis did not differ as a function of sex but did differ based on scan region, patient position, and gantry aperture. Off-centering is common during CT imaging and has been previously demonstrated to impact dose and image quality. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series

    Prakash Muthusami

    2013-01-01

    Full Text Available Objectives: To describe Magnetic Resonance Urography (MRU appearances of the circumcaval ureter, a rare congenital cause of hydronephrosis. Materials and Methods: Seven cases of circumcaval ureter, suspected on intravenous urography (IVU, underwent subsequent static MRU using heavily T2-weighted sequences. Results: The various appearances of circumcaval ureter on IVU and MRU were studied and compared. The circumcaval portion of the ureter was especially well seen on axial MRU sections, though this portion was routinely not visualized on IVU. In one case with a ureteric calculus, MRU also depicted a circumcaval course of the ureter, thus providing a complete diagnosis. In yet another case, where a circumcaval ureter was suspected on IVU, MRU proved the actual cause of ureteric obstruction to be a crossing vessel. Conclusion: Static MRU using heavily T2-weighted coronal and axial sequences can make or exclude the diagnosis of circumcaval ureter unequivocally.

  8. Largest case series of Latin American eyelid tumors over 13-Years from a single center in Sao Paulo, Brazil

    Jéssica Carolinne Damasceno

    Full Text Available ABSTRACT Purpose: Malignant lesions of the eyelid are the most common eye cancers. Although rarely lethal, late diagnosis can lead to serious visual morbidity. Definitive diagnosis of neoplastic lesions is pathological. Indications and types of eyelid lesions in a single high-volume ophthalmic reference center in Sao Paulo, Brazil, were analyzed. Methods: The surgical pathological reports of patients who underwent eye removal procedures between January 2000 and December 2012 were retrieved from the electronic database of the Ophthalmology Department and retrospectively reviewed. Data regarding the final anatomopathological diagnosis, sex, and age were analyzed via the χ2 test with Yates' correction. Results: Of the 1,113 eyelid tumors resected over the 13-year study period, 324 (29% lesions were malignant. The most prevalent lesions were basal cell, squamous cell, and sebaceous gland carcinomas. The median ages of patients (females, n=165, 51%; males, n=159, 49% with a diagnosis of basal cell, squamous cell, and sebaceous gland carcinomas were 65, 75, and 70 years, respectively. Conclusion: This is the largest retrospective cohort analysis of eyelid tumors in a Latin American population. These findings are in agreement with those from large centers in other countries and regions.

  9. Laparoscopic versus open surgery in management of congenital duodenal obstruction in neonates: a single-center experience with 112 cases.

    Son, Tran Ngoc; Kien, Hoang Huu

    2017-12-01

    A single center study was conducted to compare the short-term clinical outcome between laparoscopic surgery (LS) and open surgery (OS) repair for neonates with congenital duodenal obstruction (CDO). Medical records of all neonates with bodyweight at surgery over 1500g and without other gastrointestinal anomalies that underwent surgery (duodeno-duodenostomy or duodeno-jejunostomy) for CDO at our center between January 2009 and July 2015 were reviewed. The choice of OS or LS was surgeon-dependent. One hundred twelve patients were identified, with a median age and weight at surgery 8.5days and 2500g respectively. Forty-four patients underwent OS and 68 patients LS. There were no significant differences between the two groups regarding patient age, gender, weight at surgery, associated anomalies, and mean operative time. Compared to OS, the LS group had lower postoperative complications (5.9% vs 36.4%, p<0.0001), shorter mean time to initial oral feeding and mean postoperative hospital stay (3.9 vs. 7.1days and 8.6 vs. 12.9days respectively, p<0.0001) and better postoperative cosmesis. LS treatment for neonatal CDO is associated with lower postoperative morbidity, shorter recovery time and postoperative hospital stay and better postoperative cosmesis than OS. Retrospective Comparative Study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Sentinel node mapping in endometrial cancer following Hysteroscopic injection of tracers: A single center evaluation over 200 cases.

    Martinelli, Fabio; Ditto, Antonino; Signorelli, Mauro; Bogani, Giorgio; Chiappa, Valentina; Lorusso, Domenica; Scaffa, Cono; Recalcati, Dario; Perotto, Stefania; Haeusler, Edward; Raspagliesi, Francesco

    2017-09-01

    To analyze detection-rate(DR) and diagnostic-accuracy (A) of sentinel-nodes(SLNs) mapping following hysteroscopic-injection of tracer. To compare DR and A between tracers: ICG and Tc99m. Evaluation of endometrial-cancer patients who underwent SLNs mapping after hysteroscopic-peritumoral-injection of tracer±lymphadenectomy. Analysis of DR (overall-bilateral-aortic) and A in the entire cohort and comparison between tracers. 202 procedures were performed from January/2005 to February/2017. Mean age:60years (28-82); mean BMI: 26.8 kg/m 2 (15-47). In 133 cases (65.8%) hysterectomy and mapping procedure were performed laparoscopically. The overall-DR of the technique was 93.2% (179/192) (10 cases were excluded: 9 for technical-equipment failure; 1 for vagal reaction). Bilateral pelvic mapping was found in 59.7% of cases (107/179) and was more frequent in the ICG group (72.8% vs 53.3%; p: 0.012). In 50.8% of cases (91/179) SLNs were mapped both in pelvic and aortic nodes, and in 5 cases (2.8%) only in the aortic area. The mean number of detected SLNs was 3.7 (1-8). 22 patients (12.3%) had nodal involvement: 10-(45.5%)-macrometastases; 5-(22.7%)-micrometastases; 7-(31.8%)-ITCs. In 6 cases (27.3%) only aortic nodes were positive; in 5 cases (22.7%) both pelvic and aortic nodes and in 11 cases (50%) only pelvic nodes were involved. Three false-negative results were found, all in the Tc99m group. All had isolated aortic metastases with negative pelvic nodes. Overall-sensitivity was 86.4% (95%CI: 68.4-100) and overall-negative-predictive-value (NPV) was 96.4% (95%CI 86.7-100). No differences in terms of overall-DR, overall-sensitivity and overall-NPV were found between the two tracers. Hysteroscopic-injection of tracer for SLNs mapping in endometrial cancer is as accurate as cervical injection with a higher DR in the aortic area. ICG improves bilateral-DR. Further investigation is warranted on this topic. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry.

    Judge, Bryan S; Ouellette, Lindsey M; VandenBerg, Melissa; Riley, Brad D; Wax, Paul M

    2016-03-01

    Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedative-hypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a board-certified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify

  12. Development of the Huddle Observation Tool for structured case management discussions to improve situation awareness on inpatient clinical wards.

    Edbrooke-Childs, Julian; Hayes, Jacqueline; Sharples, Evelyn; Gondek, Dawid; Stapley, Emily; Sevdalis, Nick; Lachman, Peter; Deighton, Jessica

    2018-05-01

    'Situation Awareness For Everyone' (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the 'huddle', a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. A cross-sectional observational design was used to psychometrically develop the 'Huddle Observation Tool' (HOT) over three phases using standardised psychometric methodology. Huddles were observed across four NHS paediatric wards participating in SAFE by five researchers; two wards within specialist children hospitals and two within district general hospitals, with location, number of beds and length of stay considered to make the sample as heterogeneous as possible. Inter-rater reliability was calculated using the weighted kappa and intraclass correlation coefficient. Inter - rater reliability was acceptable for the collaborative culture (weighted kappa=0.32, 95% CI 0.17 to 0.42), environment items (weighted kappa=0.78, 95% CI 0.52 to 1) and total score (intraclass correlation coefficient=0.87, 95% CI 0.68 to 0.95). It was lower for the structure and risk management items, suggesting that these were more variable in how observers rated them. However, agreement on the global score for huddles was acceptable. We developed an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. Future research should examine whether observational evaluations of huddles are associated with other indicators of safety on clinical wards (eg, safety climate and incidents of patient harm), and whether scores on the HOT are associated with improved situation awareness and reductions in deterioration and adverse

  13. Receptor for advanced glycation end-products and World Trade Center particulate induced lung function loss: A case-cohort study and murine model of acute particulate exposure.

    Caraher, Erin J; Kwon, Sophia; Haider, Syed H; Crowley, George; Lee, Audrey; Ebrahim, Minah; Zhang, Liqun; Chen, Lung-Chi; Gordon, Terry; Liu, Mengling; Prezant, David J; Schmidt, Ann Marie; Nolan, Anna

    2017-01-01

    World Trade Center-particulate matter(WTC-PM) exposure and metabolic-risk are associated with WTC-Lung Injury(WTC-LI). The receptor for advanced glycation end-products (RAGE) is most highly expressed in the lung, mediates metabolic risk, and single-nucleotide polymorphisms at the AGER-locus predict forced expiratory volume(FEV). Our objectives were to test the hypotheses that RAGE is a biomarker of WTC-LI in the FDNY-cohort and that loss of RAGE in a murine model would protect against acute PM-induced lung disease. We know from previous work that early intense exposure at the time of the WTC collapse was most predictive of WTC-LI therefore we utilized a murine model of intense acute PM-exposure to determine if loss of RAGE is protective and to identify signaling/cytokine intermediates. This study builds on a continuing effort to identify serum biomarkers that predict the development of WTC-LI. A case-cohort design was used to analyze a focused cohort of male never-smokers with normal pre-9/11 lung function. Odds of developing WTC-LI increased by 1.2, 1.8 and 1.0 in firefighters with soluble RAGE (sRAGE)≥97pg/mL, CRP≥2.4mg/L, and MMP-9≤397ng/mL, respectively, assessed in a multivariate logistic regression model (ROCAUC of 0.72). Wild type(WT) and RAGE-deficient(Ager-/-) mice were exposed to PM or PBS-control by oropharyngeal aspiration. Lung function, airway hyperreactivity, bronchoalveolar lavage, histology, transcription factors and plasma/BAL cytokines were quantified. WT-PM mice had decreased FEV and compliance, and increased airway resistance and methacholine reactivity after 24-hours. Decreased IFN-γ and increased LPA were observed in WT-PM mice; similar findings have been reported for firefighters who eventually develop WTC-LI. In the murine model, lack of RAGE was protective from loss of lung function and airway hyperreactivity and was associated with modulation of MAP kinases. We conclude that in a multivariate adjusted model increased sRAGE is

  14. Receptor for advanced glycation end-products and World Trade Center particulate induced lung function loss: A case-cohort study and murine model of acute particulate exposure.

    Erin J Caraher

    Full Text Available World Trade Center-particulate matter(WTC-PM exposure and metabolic-risk are associated with WTC-Lung Injury(WTC-LI. The receptor for advanced glycation end-products (RAGE is most highly expressed in the lung, mediates metabolic risk, and single-nucleotide polymorphisms at the AGER-locus predict forced expiratory volume(FEV. Our objectives were to test the hypotheses that RAGE is a biomarker of WTC-LI in the FDNY-cohort and that loss of RAGE in a murine model would protect against acute PM-induced lung disease. We know from previous work that early intense exposure at the time of the WTC collapse was most predictive of WTC-LI therefore we utilized a murine model of intense acute PM-exposure to determine if loss of RAGE is protective and to identify signaling/cytokine intermediates. This study builds on a continuing effort to identify serum biomarkers that predict the development of WTC-LI. A case-cohort design was used to analyze a focused cohort of male never-smokers with normal pre-9/11 lung function. Odds of developing WTC-LI increased by 1.2, 1.8 and 1.0 in firefighters with soluble RAGE (sRAGE≥97pg/mL, CRP≥2.4mg/L, and MMP-9≤397ng/mL, respectively, assessed in a multivariate logistic regression model (ROCAUC of 0.72. Wild type(WT and RAGE-deficient(Ager-/- mice were exposed to PM or PBS-control by oropharyngeal aspiration. Lung function, airway hyperreactivity, bronchoalveolar lavage, histology, transcription factors and plasma/BAL cytokines were quantified. WT-PM mice had decreased FEV and compliance, and increased airway resistance and methacholine reactivity after 24-hours. Decreased IFN-γ and increased LPA were observed in WT-PM mice; similar findings have been reported for firefighters who eventually develop WTC-LI. In the murine model, lack of RAGE was protective from loss of lung function and airway hyperreactivity and was associated with modulation of MAP kinases. We conclude that in a multivariate adjusted model increased s

  15. Evaluation of left ventricular mass and function, lipid profile, and insulin resistance in Egyptian children with growth hormone deficiency: A single-center prospective case-control study

    Kotb Abbass Metwalley

    2013-01-01

    Full Text Available Background: Growth hormone deficiency (GHD in adults is associated with a cluster of cardiovascular risk factors that may contribute to an increased mortality for cardiovascular disease. In children, relatively few studies have investigated the effect of GHD and replacement therapy on cardiac performance and metabolic abnormalities that may place them at a higher risk of cardiovascular disease (CVD at an early age. Aim: This study was aimed to assess the left ventricular function, lipid profile, and degree of insulin resistance in Egyptian children with GHD before and after 1 year of GH replacement therapy. Settings and Design: Prospective case-control study, single-center study. Materials and Methods: Thirty children with short stature due to GHD were studied in comparison to 20 healthy age- and sex-matched children. All subjects were subjected to history, clinical examination, auxological assessment, and echocardiography to assess the left ventricular function. Blood samples were collected for measuring IGF-1, lipid profile (Total, LDL, HDL cholesterol, triglyceride, and atherogenic index (AI, fasting blood sugar, and fasting insulin levels. In addition, basal and stimulated GH levels were measured in children with suspected GHD. Statistical Analysis Used: Student′s t-test was used for parametric data, and the Mann-Whitney U-test was used for non-parametric data. Results: Total, LDL cholesterol, triglyceride, AI, and insulin were significantly higher in children with GHD than in healthy controls at baseline. After 12 months of GH replacement therapy, total, LDL cholesterol, triglyceride, AI and insulin were significantly decreased, while homeostatic model assessment for insulin resistance index (HOMA-IR was significantly increased compared to both pre-treatment and control values. At baseline, the left ventricular mass (LVM and left ventricular mass index (LVMi were significantly lower in GHD children than in controls. After 12 months of GH

  16. 77 FR 11136 - Proposed Collection; Comment Request; a Multi-Center International Hospital-Based Case-Control...

    2012-02-24

    ... proposed projects to be submitted to the Office of Management and Budget (OMB) for review and approval... conclusively established and the identification of the key, functional alleles in gene regions associated with... underlying genetic structure. A multidisciplinary case- control study of lymphoma in Asia, where lymphoma...

  17. What Does It Mean to Be Student Centered? An Institutional Case Study of edTPA Implementation

    Fayne, Harriet; Qian, Gaoyin

    2016-01-01

    This longitudinal case study investigated how one School of Education (SOE), situated in an urban, commuter, public university, responded to the New York State mandate to require the edTPA for initial teacher certification. In order to engage faculty in the work of program redesign, SOE administrators employed a covert leadership approach. Based…

  18. Medical Waste Management in Community Health Centers.

    Tabrizi, Jafar Sadegh; Rezapour, Ramin; Saadati, Mohammad; Seifi, Samira; Amini, Behnam; Varmazyar, Farahnaz

    2018-02-01

    Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center's staff. The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data. Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.

  19. RAVEN AND THE CENTER OF MAFFEI 1: MULTI-OBJECT ADAPTIVE OPTICS OBSERVATIONS OF THE CENTER OF A NEARBY ELLIPTICAL GALAXY AND THE DETECTION OF AN INTERMEDIATE AGE POPULATION

    Davidge, T. J.; Andersen, D. R. [Dominion Astrophysical Observatory, National Research Council of Canada, 5071 West Saanich Road, Victoria, BC V9E 2E7 (Canada); Lardière, O.; Bradley, C.; Blain, C. [Department of Mechanical Engineering, University of Victoria, Victoria, BC V8W 3P2 (Canada); Oya, S. [Subaru Telescope, National Optical Observatory of Japan Hilo, HI 96720 (United States); Akiyama, M.; Ono, Y. H., E-mail: tim.davidge@nrc.ca, E-mail: david.andersen@nrc.ca, E-mail: lardiere@uvic.ca, E-mail: cbr@uvic.ca, E-mail: celia.blain@gmail.com, E-mail: oya@subaru.naoj.org, E-mail: akiyama@astr.tohoku.ac.jp, E-mail: yo-2007@astr.tohoku.ac.jp [Astronomical Institute, Tohoku University 6–3 Aramaki, Aoba-ku, Sedai, 980-8578 Japan (Japan)

    2015-10-01

    Near-infrared (NIR) spectra that have an angular resolution of ∼0.15 arcsec are used to examine the stellar content of the central regions of the nearby elliptical galaxy Maffei 1. The spectra were recorded at the Subaru Telescope, with wavefront distortions corrected by the RAVEN Multi-object Adaptive Optics science demonstrator. The Ballick–Ramsey C{sub 2} absorption bandhead near 1.76 μm is detected, and models in which ∼10%–20% of the light near 1.8 μm originates from stars of spectral type C5 reproduce the depth of this feature. Archival NIR and mid-infrared images are also used to probe the structural and photometric properties of the galaxy. Comparisons with models suggest that an intermediate age population dominates the spectral energy distribution between 1 and 5 μm near the galaxy center. This is consistent not only with the presence of C stars, but also with the large Hβ index that has been measured previously for Maffei 1. The J − K color is more or less constant within 15 arcsec of the galaxy center, suggesting that the brightest red stars are well-mixed in this area.

  20. What is driving CO2 emissions in a typical manufacturing center of South China? The case of Jiangsu Province

    Liang Sai; Zhang Tianzhu

    2011-01-01

    Investigating CO 2 emissions of China's manufacturing centers contributes to local and global CO 2 mitigation targets. This study considers Jiangsu Province as a representation of manufacturing centers in South China. Effects of material efficiency improvements, technology development, consumption structure changes and consumption volume growth in Jiangsu Province on its CO 2 emissions during 1997-2007 are investigated using structural decomposition analysis based on environmental input-output table. In order to reduce CO 2 emissions, Jiangsu Province should not only rely on material efficiency improvements and technology development, but also rely on consumption structure changes. For consumption structure changes in detail, Jiangsu Province should not only focus on fixed capital formation and urban residential consumption, but also focus on international and intranational imports and exports. For the implementation of material efficiency improvements and technology development, Jiangsu Province should focus on technology innovation and international technology transfer. For the implementation of consumption structure changes, Jiangsu Province should mainly focus on identified sectors for each separate final demand category: five sectors for urban residential consumption, three sectors for fixed capital formation, four sectors for international exports, five sectors for intranational exports, three sectors for international imports and four sectors for intranational imports. - Highlights: → Effects of four factors on Jiangsu Province's CO 2 emission changes are analyzed. → Key factors are identified for Jiangsu Province to achieve CO 2 mitigation targets. → Key areas for consumption structure changes are analyzed. → Technology innovation and technology transfer should be concerned. → Identified sectors for each final demand category should be concerned.

  1. [Psychophysiological regin for rehabilition of chronic polydrug users in the Center of the Le Patriarche. 446 cases (author's transl)].

    Laffont, F; Engelmajer, L; Vourc'h, G; Nahas, G

    1980-01-01

    From 1974 to 1979, the rehabilitation centers of the association "Le Patriarche" located in the country side of southern France, have received 446 chronic polydrugs users who has consumed at one time or an other cannabis (marihuana, hashish) (87 p. cent), LSD (66 p. cent) and other hallucinogens (35 p. cent), psychodepressants (55 p. cent), psychostimulants (amphetamines, 85 p. cent; cocaïne, 50 p. cent) and opium and its derivatives (brown sugar, 47 p. cent; opiates, 67 p. cent; heroin, 50 p. cent). The dominant addictive drug was heroin and opiates, 52 p. cent, psychodepressants (barbitutiques and benzodiazepines, 33 p. cent, psychostimulants, 15 p. cent. Males were twice as numerous as female. Average age was 21 (range 14-38). Mean duration of drug abuse was 7 years. All these drug abusers display at entrance withdrawal symptoms. These were treated successfully by a drug free, psycho-physiological regimen comprising: 1. An elimination of all psychoactive drugs, including coffee, and alcohol. Tobacco was permitted. 2. Physical therapy (bath, exercise, massage) and forced fluid diuresis. 3. A supportive psychotherapy dispensed by rehabilitated addicts who had undergone successfully a similar regimen. This non-pharmacological method of treating withdrawal symptoms associated with opium, barbiturate and amphetamine addiction, was successful, and was not associated with any major clinical symptoms threatening the vital signs. Mean duration of detoxification was 5 days for opiates, 6 days for amphetamines and 10 days for barbiturates. 78 p. cent of these subjects remained in the centers from 3 months to 2 years, partaking in physical occupational and physiological rehabilitation paograms which allowed then to adopt a drug free life style and prepared them for social reinsertion.

  2. Physicians’ Critical Thinking and Patients’ Satisfaction Level: a Case Study of Tabriz Sina Treatment and Educational Center

    Bahram Jalilzadeh Amin

    2014-12-01

    Full Text Available Introduction: Critical thinking is rational and sound thinking that involves investigation and review of opinions followed by actions and decision-making based on reasons with accurate and rational results. In our modern, complex world, we encounter multiple changes and competition in society, especially when it comes to using the latest technology; society must progress in this trend. Medical science is not exempt in this regard, considering that critical thinking is necessary in fulfilling its goals. This research aims to investigate the physicians’ critical thinking and patient satisfaction level in the Tabriz Sina Treatment and Educational Center.Methods: This study is both descriptive and analytical, and the statistical population involves all physicians and the patients of the Tabriz Sina Treatment and Educational Center in 2013. About 30 physicians and 170 patients were selected randomly, and data were collected using the Watson and Glaser critical thinking questionnaire, as well as the Mogimi and Ramazan patient satisfaction questionnaire. The data were then analyzed by Pearson correlation and regression analysis. Results: The results showed that there was a significant and positive relationship between critical thinking and patient satisfaction in all dimensions except identification. Changes in critical thinking dimensions also changed patient satisfaction. The regression test showed that the critical thinking independent variable effect on the dependent variable was 0.558, which indicated a relatively strong correlation between these variables.Conclusion: Although the critical thinking of the physicians and medical staff is important in patient satisfaction, there is no progress towards these goals in the health system. Healthcare authorities should try to empower critical thinking in order to achieve organizational goals.

  3. The Impact of 2013 Updated ASCO/CAP HER2 Guidelines on the Diagnosis and Management of Invasive Breast Cancer: A Single-Center Study of 1739 Cases.

    Zhang, Xiaofei; Bleiweiss, Ira; Jaffer, Shabnam; Nayak, Anupma

    2017-10-01

    The purpose of this study was to determine the impact of revised ASCO/CAP 2013 HER2 guidelines on the clinical practice of pathologists and oncologists. Retrospective analysis of 1739 patients with invasive breast carcinoma who underwent reflex HER2 (fluorescence in situ hybridization [FISH]) testing, using both 2007 and 2013 guidelines (2007-2014). Using 2013 guidelines, 255 (15%; 95% confidence interval [CI], 13%-16%) cases were classified as HER2 + as opposed to 186 (11%; 95% CI, 9%-12%) by 2007 guidelines (odds ratio [OR] 1.4; 95% CI, 1.2-1.8; P = .0005). Sixty-nine cases equivocal by 2007 guidelines (12% of all equivocal cases) were converted to HER2 + by 2013 guidelines. Sixty-two of these 69 cases shifted from HER2 equivocal to positive due to change in FISH ratio cutoff from 2.2 to 2.0. Six cases had FISH ratio guidelines. No increase in HER2 FISH equivocal cases was observed. Reflex FISH testing of all IHC 1+ cases at our institution additionally detected 58 patients (5%; 95% CI, 4%-6%) with HER2 amplification. The 2013 guidelines increase the detection of HER2 + cases, without introducing significant difference in discordance rate of the IHC and FISH assays. Inclusion of HER2 copy number criterion does not increase the number of FISH equivocal cases in our cohort. We recommend IHC 1+ cases should be offered reflex FISH testing because failure to test them will miss a small number (5%) of potentially treatable cases. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. A STUDY OF CASE SERIES OF INTRAOCULAR FOREIGN BODIES IN A TERTIARY CARE CENTER IN SOUTH INDIA

    Shilpa Y. D

    2017-09-01

    Full Text Available BACKGROUND Intraocular foreign bodies can cause vision threatening complication in cases of penetrating ocular injuries. Ocular injuries can occur anywhere at work place, at home, due to road traffic accidents, etc. Accidental eye injuries are common in males in work place. Awareness about using protective eye wear is required at work places where injuries are common. The aim of the study is to study the demographic profile, visual and anatomical outcome in patients presenting with posterior segment Intraocular Foreign Bodies (IOFB undergoing vitrectomy. MATERIALS AND METHODS Retrospective analysis was done on patients who underwent pars plana vitrectomy for posterior segment IOFB from March 2014 to April 2017. Complete ocular examination, B scan ultrasonography and x-ray orbit were done in all cases and retained posterior segment intraocular foreign body confirmed. Intraoperative difficulties, anatomical and visual outcome and postoperative complications were studied. RESULTS Cases with posterior segment intraocular foreign body and endophthalmitis had poor visual and anatomical outcome. Patients who underwent complete vitrectomy with 240 encirclage band with or without tamponade had better visual outcome. CONCLUSION Imaging in the injured eye is important to identify the presence of intraocular foreign body. Planning of the surgical procedure depending on the ocular condition plays a vital role in visual outcome.

  5. Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center.

    Gondim, Jackson A; Almeida, João Paulo; de Albuquerque, Lucas Alverne F; Gomes, Erika; Schops, Michele; Ferraz, Tania

    2010-10-01

    Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Endoscopic transsphenoidal surgery represents an effective option for treatment of patients

  6. istSOS, a new sensor observation management system: software architecture and a real-case application for flood protection

    M. Cannata

    2015-11-01

    Full Text Available istSOS (Istituto scienze della Terra Sensor Observation Service is an implementation of the Sensor Observation Service (SOS standard from the Open Geospatial Consortium. The development of istSOS started in 2009 in order to provide a simple implementation of the SOS for the management, provision and integration of hydro-meteorological data collected in Canton Ticino (Southern Switzerland. istSOS is an Open Source, entirely written in Python and based on reliable software like PostgreSQL/PostGIS and Apache/mod_wsgi. This paper illustrates the latest software enhancements, including a RESTful Web service and a Web-based graphical user interface, which enable a better and simplified interaction with measurements and SOS service settings. The robustness of the implemented solution has been validated in a real-case application: the Verbano Lake Early Warning System. In this application, near real-time data have to be exchanged by inter-regional partners and used in a hydrological model for lake level forecasting and flooding hazard assessment. This system is linked with a dedicated geoportal used by the civil protection for the management, alert and protection of the population and the assets of the Locarno area. Practical considerations, technical issues and foreseen improvements are presented and discussed.

  7. From observation to understanding: Approach to analysis of wear mechanisms, Case of RCCAs and CRDM latch arms

    Hertz, D.

    2004-01-01

    Component wear can affect the ability of a component to fulfill its required function. For a designer or user, it is reasonable to expect possible wear occurrence as soon as parts are in relative motion. It is less obvious to extend this possibility to motions with small or very small amplitudes and loads. However, it has to be admitted that such cases exist. It then becomes imperative to determine the wear mechanisms so that the lifetime of the components and the optimum date of their replacement can be predicted or the degradation can be remedied. For this purpose, standard and widely accepted practice is to carry out simulator tests. Through examples of wear from nuclear reactor components such as the RCCAs (Rod Cluster Control Assembly) and the CRDM (Control Rod Drive Mechanism) latch arms, an approach for understanding the wear mechanisms and controlling their effects can be undertaken. Cases of wear have been observed on real-life parts, but the first simulator tests have shown deviations from in-reactor behaviour. Comparative examination of the wear facies of actual parts which have operated in reactor or simulators, both control rods and CRDM latch arms, was the key starting point for a new analytical approach, incorporating the formulation of wear mechanism hypotheses which can account for the observed facies. Expert assessment thus highlighted the importance of the environment by revealing that the wear featured a large component linked to friction-assisted corrosion. By including this tribo-corrosion aspect, it became possible to reach understanding of the mechanisms and account for the wear observed in reactor and on simulators. Further well-controlled simulator tests then made it possible to verify the importance of the tribo-corrosion processes in a pressurized water medium. Analysis of the physical chemical behaviour of the original materials (austenitic stainless steel) also explains why these surface modifications limit or remedy wear

  8. Tailoring Systems Engineering Processes in a Conceptual Design Environment: A Case Study at NASA Marshall Spaceflight Center's ACO

    Mulqueen, John; Maples, C. Dauphne; Fabisinski, Leo, III

    2012-01-01

    This paper provides an overview of Systems Engineering as it is applied in a conceptual design space systems department at the National Aeronautics and Space Administration (NASA) Marshall Spaceflight Center (MSFC) Advanced Concepts Office (ACO). Engineering work performed in the NASA MFSC's ACO is targeted toward the Exploratory Research and Concepts Development life cycle stages, as defined in the International Council on Systems Engineering (INCOSE) System Engineering Handbook. This paper addresses three ACO Systems Engineering tools that correspond to three INCOSE Technical Processes: Stakeholder Requirements Definition, Requirements Analysis, and Integration, as well as one Project Process Risk Management. These processes are used to facilitate, streamline, and manage systems engineering processes tailored for the earliest two life cycle stages, which is the environment in which ACO engineers work. The role of systems engineers and systems engineering as performed in ACO is explored in this paper. The need for tailoring Systems Engineering processes, tools, and products in the ever-changing engineering services ACO provides to its customers is addressed.

  9. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center.

    Garvey, Erin M; Haakinson, Danielle J; McOmber, Mark; Notrica, David M

    2015-02-01

    There is no consensus regarding the appropriate use of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric trauma. We report our experience with ERCP for management of pediatric pancreatic and biliary injury following blunt abdominal trauma. A retrospective chart review was performed for pediatric patients with blunt abdominal trauma from July 2008 through December 2012 at our pediatric trauma center. For patients who underwent ERCP, demographics, injury characteristics, diagnostic details, procedures performed, length of stay, total parenteral nutrition use, and complications were reviewed. There were 532 patients identified: 115 hepatic injuries, 25 pancreatic injuries and one gall bladder injury. Nine patients (mean age 7.8 years) underwent ERCP. Seven (78%) had pancreatic injuries, while two (22%) had bilateral hepatic duct injuries. The median time to diagnosis was one day (range, 0-12). Diagnostic ERCP only was performed in three patients, two of which proceeded to distal pancreatectomy. Five patients had stents placed (two biliary and three pancreatic) and four sphincterotomies were performed. Despite pancreatic stenting, one patient required distal pancreatectomy for persistent leak. Median length of stay was 11 days. Pediatric pancreatic and biliary ductal injuries following blunt abdominal trauma are uncommon. ERCP can safely provide definitive treatment for some patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Postoperative Neurosurgical Infection Rates After Shared-Resource Intraoperative Magnetic Resonance Imaging: A Single-Center Experience with 195 Cases.

    Dinevski, Nikolaj; Sarnthein, Johannes; Vasella, Flavio; Fierstra, Jorn; Pangalu, Athina; Holzmann, David; Regli, Luca; Bozinov, Oliver

    2017-07-01

    To determine the rate of surgical-site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database. All consecutive neurosurgical procedures that were performed with a high-field, 2-room ioMRI between April 2013 and June 2016 were included (N = 195; 109 craniotomies and 86 endoscopic transsphenoidal procedures). The incidence of SSIs within 3 months after surgery was assessed for both operative groups (craniotomies vs. transsphenoidal approach). Of the 109 craniotomies, 6 patients developed an SSI (5.5%, 95% confidence interval [CI] 1.2-9.8%), including 1 superficial SSI, 2 cases of bone flap osteitis, 1 intracranial abscess, and 2 cases of meningitis/ventriculitis. Wound revision surgery due to infection was necessary in 4 patients (4%). Of the 86 transsphenoidal skull base surgeries, 6 patients (7.0%, 95% CI 1.5-12.4%) developed an infection, including 2 non-central nervous system intranasal SSIs (3%) and 4 cases of meningitis (5%). Logistic regression analysis revealed that the likelihood of infection significantly decreased with the number of operations in the new operational setting (odds ratio 0.982, 95% CI 0.969-0.995, P = 0.008). The use of a shared-resource ioMRI in neurosurgery did not demonstrate increased rates of infection compared with the current available literature. The likelihood of infection decreased with the accumulating number of operations, underlining the importance of surgical staff training after the introduction of a shared-resource ioMRI. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Evaluation of service quality by using fuzzy MCDM: A case study in Iranian health-care centers

    Leili Afkham

    2012-01-01

    Full Text Available Service quality plays an important role in health care systems since hospitals are responsible for people's lives. This study presents an effective approach for evaluating and comparing service qualities of four hospitals. Service quality consists of different attributes and many of them are intangible and difficult to measure. Therefore, we propose a fuzzy method to resolve the ambiguity of the concepts, which are associated with human judgments. SERVQUAL model is used to evaluate the respondents' judgments of service quality and multi attribute decision making approach is implemented for the comparison among hospitals. The paper use analytical hierarchy process (AHP for obtaining criteria weight and TOPSIS for ranking the cases.

  12. Genotypic analysis of multidrug-resistant tuberculosis isolates from extra pulmonary tuberculosis cases in tertiary care centers in Northern India

    Anand K Maurya

    2016-01-01

    Conclusion: The prevalence (13.4% of MDR-TB among EPTB was high, and the most prominent mutations in rpoB, katG, and inhA genes were S531L (67.3%, S315T1 (94.5%, and C15T (20%, respectively. Beijing stains are significantly associated with MDR-TB among EPTB in this region. We found that the transmission of prominent mutations contributes to an unexpected increase in primary resistance, including MDR-TB cases in Northern India.

  13. Diffusion-weighted magnetic resonance imaging combined with T2-weighted images in the detection of small breast cancer: a single-center multi-observer study.

    Wu, Lian-Ming; Chen, Jie; Hu, Jiani; Gu, Hai-Yan; Xu, Jian-Rong; Hua, Jia

    2014-02-01

    Breast cancer is the most common cancer in women worldwide. However, it remains a difficult diagnosis problem to differentiate between benign and malignant breast lesions, especially in small early breast lesions. To assess the diagnostic value of diffusion-weighted imaging (DWI) combined with T2-weighted imaging (T2WI) for small breast cancer characterization. Fifty-eight patients (65 lesions) with a lesion breast magnetic resonance imaging (MRI) including DWI and histological analysis. Three observers with varying experience levels reviewed MRI. The probability of breast cancer in each lesion on MR images was recorded with a 5-point scale. Areas under the receiver-operating characteristic curve (AUCs) were compared by using the Z test; sensitivity and specificity were determined with the Z test after adjusting for data clustering. AUC of T2WI and DWI (Observer 1, 0.95; Observer 2, 0.91; Observer 3, 0.83) was greater than that of T2WI (Observer 1, 0.80; Observer 2, 0.74; Observer 3, 0.70) for all observers (P breast cancer characterization. It should be considered selectively in the preoperative evaluation of patients with small lesions of the breast.

  14. New and safe treatment of food impacted in the esophagus: a single center experience of 100 consecutive cases.

    Shafique, Muhammad; Yaqub, Sheraz; Lie, Erik S; Dahl, Vegard; Olsbø, Frode; Røkke, Ola

    2013-01-01

    Aim. Large food bits can get stuck in the esophagus and must be removed by endoscopy. In some cases, this can be difficult or unsafe. We describe a new and safe treatment for such patients. Materials and Methods. 100 consecutive patients were referred to Akershus University Hospital with impacted food in the esophagus. In 36 patients (36%), the food passed spontaneously. In 59 (92%) of the remaining 64 patients, the food was removed by endoscopic intervention. In the last five patients, endoscopic removal was judged difficult or unsafe. These patients received the new treatment: one capsule Creon 10000 IU dissolved in 30 mL of Coca-Cola administered by a nasooesophageal tube four times daily for 2-3 days. Results. Of the 59 patients treated with endoscopic procedure, complications occurred in four (7%): three bleedings and one perforation of the esophagus. In five patients treated with Coca-Cola and Creon, the food had either passed or was soft after 2-3 days and could easily be removed. Conclusion. The treatment of choice of impacted food in the esophagus is endoscopic removal. In cases where this is difficult, we recommend treatment with Coca-Cola and Creon for 2-3 days before complications occur.

  15. A human centered GeoVisualization framework to facilitate visual exploration of telehealth data: a case study.

    Joshi, Ashish; de Araujo Novaes, Magdala; Machiavelli, Josiane; Iyengar, Sriram; Vogler, Robert; Johnson, Craig; Zhang, Jiajie; Hsu, Chiehwen E

    2012-01-01

    Public health data is typically organized by geospatial units. Routine geographic monitoring of health data enables an understanding of the spatial patterns of events in terms of causes and controls. GeoVisualization (GeoVis) allows users to see information hidden both visually and explicitly on a map. Despite the applicability of GeoVis in public health, it is still underused for visualizing public health data. The objective of this study is to examine the perception of telehealth users' to utilize GeoVis as a proof of concept to facilitate visual exploration of telehealth data in Brazil using principles of human centered approach and cognitive fit theory. A mixed methods approach combining qualitative and quantitative assessments was utilized in this cross sectional study conducted at the Telehealth Center of the Federal University of Pernambuco (NUTE-UFPE), Recife, Brazil. A convenient sample of 20 participants currently involved in NUTES was drawn during a period of Sep-Oct 2011. Data was gathered using previously tested questionnaire surveys and in-person interviews. Socio-demographic Information such as age, gender, prior education, familiarity with the use of computer and GeoVis was gathered. Other information gathered included participants' prior spatial analysis skills, level of motivation and use of GeoVis in telehealth. Audio recording was done for all interviews conducted in both English and Portuguese, and transcription of the audio content to English was done by a certified translator. Univariate analysis was performed and means and standard deviations were reported for the continuous variables and frequency distributions for the categorical variables. For the open-ended questions, we utilized a grounded theory to identify themes and their relationship as they emerge from the data. Analysis of the quantitative data was performed using SAS V9.1 and qualitative data was performed using NVivo9. The average age of participants was 28 years (SD=7), a

  16. Thiazides and Osteoporotic Spinal Fractures: A Suspected Linkage Investigated by Means of a Two-Center, Case-Control Study.

    De Vecchis, Renato; Ariano, Carmelina; Di Biase, Giuseppina; Noutsias, Michel

    2017-11-01

    An alleged association of chronic use of thiazide diuretics with an increased risk of bone fragility fractures has been highlighted by a relatively recent prospective cohort study. However, the concept that thiazides exert a beneficial effect on osteoporosis is still a predominant view. This effect would be mediated by the decrease in renal clearance of calcium ions, a pharmacological feature recognized for a long time now to this class of drugs, as opposed to the increase in calcium urinary excretion attributed instead to loop diuretics, i.e. furosemide and similar drugs. The purpose of this retrospective study was to attempt to clarify whether regular use of thiazide diuretics as antihypertensive therapeutics is associated with a significantly increased risk of osteoporotic fractures in female patients aged 65 or over. In this two-center retrospective study, we followed up a cohort of female patients with (n = 80) and without (n = 158) thiazide-induced hyponatremia. A total of 48 osteoporotic fractures were recorded during a median follow-up period of 57.5 months. By means of univariate regression analysis, an association was found between thiazide-induced hyponatremia and increased risk of vertebral fractures (odds ratio (OR): 7.6; 95% confidence interval (CI): 3.755 - 15.39; P fractures. No association of a history of thiazide-induced hyponatremia and risk of fracture was noticeable in the final model. Because thiazide-induced hyponatremia was associated with spinal fractures in univariate but not multivariate analysis, a possible explanation is that hyponatremia may be a confounder of the relation between body mass and spinal fractures. Indeed, reduced body mass especially among elderly women with small body build may confer heightened risk of thiazide-induced hyponatremia because of decreased bone sodium available for exchange with the serum sodium. Thus, occurrence of hyponatremia could only serve as an indirect surrogate marker for osteoporosis risk.

  17. Multiple perpetrator rape among girls evaluated at a hospital-based child advocacy center: seven years of reviewed cases.

    Edinburgh, Laurel; Pape-Blabolil, Julie; Harpin, Scott B; Saewyc, Elizabeth

    2014-09-01

    The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n=32) and to compare these findings to a group of single perpetrator sexual assaults (n=534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M=14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Tool for evaluating the evolution Space Weather Regional Warning Centers under the innovation point of view: the Case Study of the Embrace Space Weather Program Early Stages

    Denardini, Clezio Marcos

    2016-07-01

    We have developed a tool for measuring the evolutional stage of the space weather regional warning centers using the approach of the innovative evolution starting from the perspective presented by Figueiredo (2009, Innovation Management: Concepts, metrics and experiences of companies in Brazil. Publisher LTC, Rio de Janeiro - RJ). It is based on measuring the stock of technological skills needed to perform a certain task that is (or should) be part of the scope of a space weather center. It also addresses the technological capacity for innovation considering the accumulation of technological and learning capabilities, instead of the usual international indices like number of registered patents. Based on this definition, we have developed a model for measuring the capabilities of the Brazilian Study and Monitoring Program Space Weather (Embrace), a program of the National Institute for Space Research (INPE), which has gone through three national stages of development and an international validation step. This program was created in 2007 encompassing competence from five divisions of INPE in order to carry out the data collection and maintenance of the observing system in space weather; to model processes of the Sun-Earth system; to provide real-time information and to forecast space weather; and provide diagnostic their effects on different technological systems. In the present work, we considered the issues related to the innovation of micro-processes inherent to the nature of the Embrace program, not the macro-economic processes, despite recognizing the importance of these. During the development phase, the model was submitted to five scientists/managers from five different countries member of the International Space Environment Service (ISES) who presented their evaluations, concerns and suggestions. It was applied to the Embrace program through an interview form developed to be answered by professional members of regional warning centers. Based on the returning

  19. Prophylactic use of Saccharomyces boulardii probiotics in preventing antibiotic-associated diarrhea: a single center hospital-based case-control study in Serbia

    Nikola Panic

    2015-12-01

    Full Text Available Background. Antibiotic-associated diarrhea (AAD develops through the loss of normal bacterial intestinal flora. We have conducted a case-control study in order to assess whether prophylactic administration of Saccharomyces boulardii (S. boulardii prevents occurrence of AAD among adult hospitalized patients. Methods. Single-center hospital based case-control study was conducted in University Clinic “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia. Hospital records were screened in order to identify all the patients developing AAD in period January 1. 2010 – August 31. 2015. For every case, one age and gender matched control was randomly selected among patients hospitalized at the same time at the same department who were administered with antibiotics and did not develop AAD. For both cases and controls data were extracted on demographics, medical history, indication for use of antibiotics, antibiotics used, and prophylactic use of S.boulardii probiotics. The relationship between occurrence of AAD and putative risk factors were measured using the odds ratios (ORs and their 95% confidence interval (CI derived from logistic regression analysis. Results. Number of 59 cases and 59 controls were included in the study. Most of AAD cases were associated with old age (mean age of 78.05, and almost half (49.15% were hospitalized on geriatrics department. Most prescribed class of antibiotics among cases was III generation cephalosporins (50.85%, followed by fluoroquinolones (28.81% and trimethoprim-sulfamethoxazole (20.34%. Significantly more cases than controls were treated with carbapenems (16.95% vs. 5.08% respectively, p=0.04. Significantly less cases were administered with prophylactic S. boulardii probiotics (18.64% vs. 42.37% p=0.005. We identified prophylactic use of S. boulardii to act protectively against development of AAD from both univariate (OR: 0.31, 95% CI: 0.14-0.72 and multivariate analysis (OR:0.36, 95% CI: 0.14-0.80. Use of

  20. Brain urea increase is an early Huntington's disease pathogenic event observed in a prodromal transgenic sheep model and HD cases.

    Handley, Renee R; Reid, Suzanne J; Brauning, Rudiger; Maclean, Paul; Mears, Emily R; Fourie, Imche; Patassini, Stefano; Cooper, Garth J S; Rudiger, Skye R; McLaughlan, Clive J; Verma, Paul J; Gusella, James F; MacDonald, Marcy E; Waldvogel, Henry J; Bawden, C Simon; Faull, Richard L M; Snell, Russell G

    2017-12-26

    The neurodegenerative disorder Huntington's disease (HD) is typically characterized by extensive loss of striatal neurons and the midlife onset of debilitating and progressive chorea, dementia, and psychological disturbance. HD is caused by a CAG repeat expansion in the Huntingtin ( HTT ) gene, translating to an elongated glutamine tract in the huntingtin protein. The pathogenic mechanism resulting in cell dysfunction and death beyond the causative mutation is not well defined. To further delineate the early molecular events in HD, we performed RNA-sequencing (RNA-seq) on striatal tissue from a cohort of 5-y-old OVT73 -line sheep expressing a human CAG-expansion HTT cDNA transgene. Our HD OVT73 sheep are a prodromal model and exhibit minimal pathology and no detectable neuronal loss. We identified significantly increased levels of the urea transporter SLC14A1 in the OVT73 striatum, along with other important osmotic regulators. Further investigation revealed elevated levels of the metabolite urea in the OVT73 striatum and cerebellum, consistent with our recently published observation of increased urea in postmortem human brain from HD cases. Extending that finding, we demonstrate that postmortem human brain urea levels are elevated in a larger cohort of HD cases, including those with low-level neuropathology (Vonsattel grade 0/1). This elevation indicates increased protein catabolism, possibly as an alternate energy source given the generalized metabolic defect in HD. Increased urea and ammonia levels due to dysregulation of the urea cycle are known to cause neurologic impairment. Taken together, our findings indicate that aberrant urea metabolism could be the primary biochemical disruption initiating neuropathogenesis in HD.

  1. [Acute Chagas' disease: transmission routes, clinical aspects and response to specific therapy in diagnosed cases in an urban center].

    Shikanai-Yasuda, M A; Lopes, M H; Tolezano, J E; Umezawa, E; Amato Neto, V; Barreto, A C; Higaki, Y; Moreira, A A; Funayama, G; Barone, A A

    1990-01-01

    The authors report clinical features and therapeutic response of 24 outpatients with acute Chagas' disease, and 3 in the initial chronic phase, referred to the Clinic for Infectious and Parasitic Diseases of the FMUSP "Clínicas" Hospital between 1974 and 1987. The following transmission routes were involved: triatominae in 7 cases, blood transfusion in 9, kidney transplantation and/or blood transfusion in 4, accidental in 1, oral route in 3, probably breast feeding in 1, congenital or breast feeding in 1, and congenital or blood transfusion in 1. Six patients infected by triatominac acquired the disease between 1974 and 1980 and one in 1987. The blood transfusion infected patients acquired the disease in Greater São Paulo, seven of whom after 1983. The acute phase Chagas' disease was oligosymptomatic in 4 patients: three of such patients being immunocompromised by drugs or other diseases. Another two adult immunocompromised patients developed myocarditis and congestive heart failure. Clinical features were severe in 5 from 6 children under two years, irrespective of the transmission route. Evaluation of the acute phase patients treated with benznidazol (4-10 mg/kg/day) showed: therapeutic failure in 4/16 (25.0%); possible cure in 9/16 (53.2%) and inconclusive results in 3/16 (18.8%). The antibody and complement-mediated lysis reaction was in keeping with the xenodiagnosis in 18/22 cases, having shown negative results after treatment earlier than classical serological reactions. One aplastic anaemia patient receiving corticosteroid presented lymphoproliferative disease 6 years after being treated with benznidazol for acute Chagas' disease.

  2. General practitioners: Between integration and co-location. The case of primary care centers in Tuscany, Italy.

    Barsanti, Sara; Bonciani, Manila

    2018-01-01

    Healthcare systems have followed several strategies aimed at integrating primary care services and professionals. Medical homes in the USA and Canada, and primary care centres across Europe have collocated general practitioners and other health and social professionals in the same building in order to boost coordination among services and the continuity of care for patients. However, in the literature, the impact of co-location on primary care has led to controversial results. This article analyses the possible benefits of the co-location of services in primary care focusing on the Italian model of primary care centres (Case della Salute) in terms of general practitioners' perception. We used the results of a web survey of general practitioners in Tuscany to compare the experiences and satisfaction of those general practitioners involved and not involved in a primary care centre, performed a MONAVA and ANOVA analysis. Our case study highlights the positive impact of co-location on the integration of professionals, especially with nurses and social workers, and on organizational integration, in terms of frequency of meeting to discuss about quality of care. Conversely, no significant differences were found in terms of either clinical or system integration. Furthermore, the collaboration with specialists is still weak. Considering the general practitioners' perspective in terms of experience and satisfaction towards primary care, co-location strategies is a necessary step in order to facilitate the collaboration among professionals and to prevent unintended consequences in terms of an even possible isolation of primary care as an involuntary 'disintegration of the integration'.

  3. Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery.

    Barry, Peter

    2012-02-01

    PURPOSE: To describe cases of postoperative endophthalmitis in the European Society of Cataract & Refractive Surgeons (ESCRS) study of the prophylaxis of endophthalmitis, compare characteristics of unproven cases and cases proven by culture or polymerase chain reaction, and compare the characteristics with those in other reported series. SETTING: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. METHODS: Univariable and multivariable logistic regression models were used to analyze data for statistical association of signs and symptoms in cases with proven or unproven endophthalmitis. Specific data describing characteristics of the cases were compared between the 2 types of cases. RESULTS: Data from 29 endophthalmitis cases were analyzed. Swollen lids and pain were statistically associated with proven cases of endophthalmitis on univariable regression analysis. Multivariable analysis indicated that swollen lids and an opaque vitreous were associated with proven cases. Five cases of endophthalmitis occurred in the cefuroxime-treated groups. No case of streptococcal infection occurred in the cefuroxime-treated groups. However, cases of infection due to streptococci showed striking differences in visual acuity and were associated with earlier onset. Characteristics in the 29 cases parallel results in previous studies, such as the Endophthalmitis Vitrectomy Study, although the addition of a control group in the ESCRS study elicited additional findings. CONCLUSION: Swollen lids, pain, and an opaque vitreous were statistically associated with proven endophthalmitis cases in the ESCRS study.

  4. Targeting the environmental assessment of veterinary drugs with the multi-species-soil system (MS{center_dot}3) agricultural soil microcosms: the ivermectin case study

    Carbonell-Martin, G.; Pro-Gonzalez, J.; Aragones-Grunert, P.; Babib-Vich, M. M.; Fernandez-Rorija, C.; Tarazona-Lafarga, J. V.

    2011-07-01

    The environmental risk assessment of the veterinary pharmaceutical ivermectin is receiving significant attention. This paper assesses the capacity of the MS{center_dot}3 soil microcosm as a tool for targeting the environmental impact assessment of veterinary drugs, using ivermectin as model. Two screening MS{center_dot}3 were performed using different European soils; one with a soil collected in an agricultural station near to Madrid, Spain and a second with a soil collected in a farm area close to York, UK. Soils were fortified with ivermectin at the following ranges: 0.01-10 mg kg{sup -}1 and 0.1-100 mg kg{sup -}1 in the Madrid and York studies, respectively. The effects on earthworms, plants and soil microorganisms were assessed in the Madrid soil. Toxicity tests on aquatic organisms (algae, cladocerans and in vitro fish cell line RTLW1) were also conducted with the leachates. No effects were observed in earthworms and plants at any tested concentration; reduction in the respiration rate (< 5%) of soil microorganisms was detected. Earthworm/soil bioconcentration factors decreased with the increase in soil concentrations and were higher for the York soil. Effects on daphnids were observed in tested leachates; based on measured levels of ivermectin in the leachates an EC50 of about 0.5{mu}gL{sup -}1 can be estimated. Comparisons based on toxicity data and equilibrium partitioning confirmed that the main risk is expected to be related to the high sensitivity of cladocerans. The results confirm that MS{center_dot}3 systems are cost-effective tools for assessing the impact of veterinary pharmaceuticals when applied to agricultural land, as previously demonstrated for antimicrobials. (Author) 39 refs.

  5. Efficiency of radial transport of ices in protoplanetary disks probed with infrared observations: the case of CO2

    Bosman, Arthur D.; Tielens, Alexander G. G. M.; van Dishoeck, Ewine F.

    2018-04-01

    Context. Radial transport of icy solid material from the cold outer disk to the warm inner disk is thought to be important for planet formation. However, the efficiency at which this happens is currently unconstrained. Efficient radial transport of icy dust grains could significantly alter the composition of the gas in the inner disk, enhancing the gas-phase abundances of the major ice constituents such as H2O and CO2. Aim. Our aim is to model the gaseous CO2 abundance in the inner disk and use this to probe the efficiency of icy dust transport in a viscous disk. From the model predictions, infrared CO2 spectra are simulated and features that could be tracers of icy CO2, and thus dust, radial transport efficiency are investigated. Methods: We have developed a 1D viscous disk model that includes gas accretion and gas diffusion as well as a description for grain growth and grain transport. Sublimation and freeze-out of CO2 and H2O has been included as well as a parametrisation of the CO2 chemistry. The thermo-chemical code DALI was used to model the mid-infrared spectrum of CO2, as can be observed with JWST-MIRI. Results: CO2 ice sublimating at the iceline increases the gaseous CO2 abundance to levels equal to the CO2 ice abundance of 10-5, which is three orders of magnitude more than the gaseous CO2 abundances of 10-8 observed by Spitzer. Grain growth and radial drift increase the rate at which CO2 is transported over the iceline and thus the gaseous CO2 abundance, further exacerbating the problem. In the case without radial drift, a CO2 destruction rate of at least 10-11 s-1 or a destruction timescale of at most 1000 yr is needed to reconcile model prediction with observations. This rate is at least two orders of magnitude higher than the fastest destruction rate included in chemical databases. A range of potential physical mechanisms to explain the low observed CO2 abundances are discussed. Conclusions: We conclude that transport processes in disks can have

  6. Case Study for the ARRA-funded Ground Source Heat Pump (GSHP) Demonstration at Wilders Grove Solid Waste Service Center in Raleigh, NC

    Liu, Xiaobing [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Malhotra, Mini [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Xiong, Zeyu [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2017-11-01

    High initial costs and lack of public awareness of ground-source heat pump (GSHP) technology are the two major barriers preventing rapid deployment of this energy-saving technology in the United States. Under the American Recovery and Reinvestment Act (ARRA), 26 GSHP projects have been competitively selected and carried out to demonstrate the benefits of GSHP systems and innovative technologies for cost reduction and/or performance improvement. This paper highlights the findings of a case study of one of the ARRA-funded GSHP demonstration projects, a distributed GSHP system for providing all the space conditioning, outdoor air ventilation, and 100% domestic hot water to the Wilders Grove Solid Waste Service Center of City of Raleigh, North Carolina. This case study is based on the analysis of measured performance data, construction costs, and simulations of the energy consumption of conventional central heating, ventilation, and air-conditioning (HVAC) systems providing the same level of space conditioning and outdoor air ventilation as the demonstrated GSHP system. The evaluated performance metrics include the energy efficiency of the heat pump equipment and the overall GSHP system, pumping performance, energy savings, carbon emission reductions, and cost-effectiveness of the GSHP system compared with conventional HVAC systems. This case study also identified opportunities for reducing uncertainties in the performance evaluation and improving the operational efficiency of the demonstrated GSHP system.

  7. Compaction of Aquifer at Different Depths: Observations from a Vertical GPS Array in the Coastal Center of the University of Houston, Texas

    Lee, D.; Kearns, T.; Yang, L.; Wang, G.

    2014-12-01

    Houston and the surrounding Harris County have experienced the detrimental effects of subsidence even prior to World War II, to the extent that the land along Galveston Bay had sunk as much as 20 feet since 1906. One dramatic example is the Brownwood subdivision, a coastal community in Baytown where continuous flooding due to subsidence forced the area to be deemed unlivable and consequently abandoned. Thus, Houston's changes in groundwater and compaction of its aquifers are of relatively high concern to those in the public (infrastructure), private (oil & gas), and international (Port of Houston Authority) sectors. One of the key questions related to the subsidence issue in Houston area is what are the contributions of sediments at different depths, and what particularly is the contribution from shallow sediments? To address these questions, University of Houston has installed a vertical GPS array in the UH Coastal Center in March 2014. The GPS array includes four permanent GPS stations with the antenna pole foundations anchored at different depths below ground surface (-10 m, -7m, -4m, 0 m). A special, double-pipe GPS antenna monument was designed for GPS stations with the array. This project was funded by an NSF grant and a UH internal grant. Five groundwater wells with the depths ranging from 2 m to 100 m below the ground surface were also installed at the UH Coastal Center site. This study will investigate continuous GPS and groundwater level measurements (March-November, 2014) at the UHCC site. It is expected that the GPS array will provide total information on subsidence as well as compaction of aquifers within different depth ranges (0 to -4m, -4 to -7 m, -7 to -10m, and below -10 m). Correlation of land subsidence and groundwater fluctuation will also be investigated.

  8. Chronological observation in early radiation myelopathy of the cervical spinal cord; Gadolinium-enhanced MRI findings in two cases

    Hirota, Saeko; Yoshida, Shoji; Soejima, Toshinori (Hyogo Medical Center for Adults, Akashi (Japan)) (and others)

    Gd-enhanced MR images of two patients with clinically and histopathologically diagnosed chronic progressive radiation myelitis (CPRM) were observed chronologically. One of them had had nasopharyngeal cancer and received radiotherapy at a dose of 100 Gy to the C1-2 level of the spinal cord. She developed CPRM 25 months after the termination of radiotherapy. The other had had malignant lymphoma originating from the tonsil and received chemoradiotherapy. The dose delivered to her cervical spinal cord was 40 Gy, and she developed CPRM 30 months later. Gd-enhanced MRI in the early phase revealed a small crescent-shaped nidus with or without a very small central nonenhanced area in both cases. Enhancement was not great. At that time, patients noticed only the inability to perceive pain and temperature or paresthesia in the opposite side. In a few months, MRI revealed a much more strongly enhanced and larger nidus with enlargement of a central nonenhanced area accompanied by long segmental cord enlargement. The patients' neurological symptoms had also progressed, with hemiparesis developing, for example. (author).

  9. Epstein-Barr Virus-Negative Post-Transplant Lymphoproliferative Diseases: Three Distinct Cases from a Single Center

    Şule Mine Bakanay

    2014-03-01

    Full Text Available Three cases of Epstein-Barr virus (EBV-negative post-transplant lymphoproliferative disease that occurred 6 to 8 years after renal transplantation are reported. The patients respectively had gastric mucosa-associated lymphoid tissue lymphoma, gastric diffuse large B-cell lymphoma, and atypical Burkitt lymphoma. Absence of EBV in the tissue samples was demonstrated by both in situ hybridization for EBV early RNA and polymerase chain reaction for EBV DNA. Patients were treated with reduction in immunosuppression and combined chemotherapy plus an anti-CD20 monoclonal antibody, rituximab. Despite the reduction in immunosuppression, patients had stable renal functions without loss of graft functions. The patient with atypical Burkitt lymphoma had an abnormal karyotype, did not respond to treatment completely, and died due to disease progression. The other patients are still alive and in remission 5 and 3 years after diagnosis, respectively. EBV-negative post-transplant lymphoproliferative diseases are usually late-onset and are reported to have poor prognosis. Thus, reduction in immunosuppression is usually not sufficient for treatment and more aggressive approaches like rituximab with combined chemotherapy are required.

  10. Dupuytren’s Disease: Predicting Factors and Associated Conditions. A Single Center Questionnaire-Based CaseControl Study

    Ilaria Morelli

    2017-11-01

    Full Text Available Background: Conflicting studies link several conditions and risk factors to Dupuytren’s disease (DD. A questionnaire-based case-control study was set to investigate associated conditions and clinical features of DD in a sample of Italian patients. The main purpose was the identification of predicting factors for: DD development; involvement of multiple rays; involvement of both hands; development of radial DD; development of recurrences and extensions. Methods: A self-administered questionnaire was used to investigate medical and drug histories, working and life habits, DD clinical features, familial history, recurrences and extensions. Binary logistic regression, Mann Whitney U-test and Fisher’s exact test were used for the statistical analysis. Results: A role in DD development was found for male sex, cigarette smoking, diabetes and heavy manual work. The development of aggressive DD has been linked to age, male sex, high alcohol intake, dyslipidemias and positive familial history. Conclusion: Further studies might explain the dual relationship between ischemic heart disease and DD. According to our results, the questionnaire used for this study revealed to be an easy-handling instrument to analyze the conditions associated to DD. Nevertheless, its use in further and larger studies is needed to confirm our results as well as the role of the questionnaire itself as investigation tool for clinical studies.

  11. Using spontaneous commentary of nursing home residents to develop resident-centered measurement tools: A case study.

    Bangerter, Lauren R; Abbott, Katherine; Heid, Allison; Eshraghi, Karen; Van Haitsma, Kimberly

    Nursing home (NH) residents routinely complete surveys that assess their health, well-being, preferences, and care needs. Such surveys reveal important information, however, are largely based on the concerns of providers as opposed to the concerns of residents. Thus, researchers must enhance efforts to ensure that these surveys are guided by the priorities, needs, and concerns of residents. We present a case study to demonstrate how spontaneous commentary of NH residents holds particular efficacy for ensuring that measurement tools are guided by the needs, concerns, and priorities of residents. Spontaneous comments from NH residents (N = 370) collected as part of a study developing the Preferences for Everyday Living Inventory for NH residents (PELI-NH) were used to refine the PELI-NH across key phases of measurement development. This work demonstrates how the spontaneous commentary of NH residents may contribute to the refinement of NH measurement tools, and allow researchers to base these tools on the needs and priorities of NH residents. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Effect of evidence-based approach on the customer orientation (Case study: Physicians Health Centers in Isfahan province in 2014)

    Esfahani, NG; Maharati, Y

    2015-01-01

    Introduction: The purpose of this research was to examine the approach, based on evidence to customer-orientation attending physicians in the region, them being the subject collection. Research method: This is a definitive-analytic and cross-sectional configuration, which was completed in 2014. The statistical community in this research consists of 212 doctors in the healthcare hubs. The working physicians chose 200 patients by means of a simple accidental sampling. The analysis means was the researcher built survey whose efficacy and reliability were verified. In this research, the fundamental equation design and partial least square technique were applied to examine the presumptions and fitness pattern and the structural design was agreed as adequate. Findings: The outcomes showed four cases linked to the character, a behavior which was meant to treat; traditional origins of evidence were employed to retrieve data based on the reliable evidence and the shortage of limitations to the performance of client orientation strategy of evidence-based influences were meaningful. Two ranges of the doctor's information, the absence of restrictions, and the finding of the sign of dimensions about the client orientation approach were according to the evidence that had no meaningful influence. Conclusion: The utilization of evidence-based training not only increased awareness, character, and abilities of the doctors but also allowed them to answer to the requirements of clients in choosing excellent decisions and presenting a better quality of healthcare, by decreasing treatment prices for patients, bringing satisfaction of patients, and finally having a better effectiveness for patients and institutions. PMID:28316691

  13. Spectrum of central nervous system tumours-a single center histopathological review of 761 cases over 5 years

    Ahsan, J.; Hashmi, S.N.; Din, H.U.; Masood, A.

    2015-01-01

    The incidence of central nervous system (CNS) tumours has rapidly increased over the past few years. There is no accurate nationwide CNS tumour epidemiology in Pakistan that makes policy making for tumour screening and early treatment difficult. The purpose of this study was to provide the spectrum of CNS tumours in a premier diagnostic and referral centre of Pakistan. Methods: This cross-sectional study was carried out at Histopathology Department, Armed Forces Institute of Pathology over a period of 5 years. A total of 761 cases patients who were diagnosed with CNS tumours on histopathology, both benign and malignant, belonging to both genders, between the ages of 1-85 years, from 11.2009 to 31.12.2013 were included in the study. Results: Seven CNS tumour categories were as follows; tumours of neuroepithelial tissue (56.0%), tumours of the meninges (28.3%), tumour of the sellar region (2.6%), germ cell tumour (0.1), tumour of cranial and paraspinal nerves (5.4%), lymphomas and haematopoietic neoplasm (2.4%), metastatic tumours (4.9%), where histological types by age and gender showed great variability. Astrocytic tumours were the commonest neuroepithelial tumours (69.4%). Glioblastoma multiform forming the largest subtype of neuroepithelial tumours (40.4%) with a mean age at diagnosis being 47.1 years. Overall, males exceeded females in number of most of the CNS tumour types, however meningeal tumours were more frequently noted in females. Conclusions: Neuroepithelial tumours are commonest tumour and comprise more than half of all operated CNS tumours in our setup, followed by meningeal tumours. Glioblastoma multiforme is largest subtype of neuroepithelial tumour, and comprising 40.4% of all. (author)

  14. Retrospective benzene exposure assessment for a multi-center case-cohort study of benzene-exposed workers in China.

    Portengen, Lützen; Linet, Martha S; Li, Gui-Lan; Lan, Qing; Dores, Graça M; Ji, Bu-Tian; Hayes, Richard B; Yin, Song-Nian; Rothman, Nathaniel; Vermeulen, Roel

    2016-01-01

    Quality of exposure assessment has been shown to be related to the ability to detect risk of lymphohematopoietic disorders in epidemiological investigations of benzene, especially at low levels of exposure. We set out to build a statistical model for reconstructing exposure levels for 2898 subjects from 501 factories that were part of a nested case-cohort study within the NCI-CAPM cohort of more than 110,000 workers. We used a hierarchical model to allow for clustering of measurements by factory, workshop, job, and date. To calibrate the model we used historical routine monitoring data. Measurements below the limit of detection were accommodated by constructing a censored data likelihood. Potential non-linear and industry-specific time-trends and predictor effects were incorporated using regression splines and random effects. A partial validation of predicted exposures in 2004/2005 was performed through comparison with full-shift measurements from an exposure survey in facilities that were still open. Median cumulative exposure to benzene at age 50 for subjects that ever held an exposed job (n=1175) was 509 mg/m(3) years. Direct comparison of model estimates with measured full-shift personal exposure in the 2004/2005 survey showed moderate correlation and a potential downward bias at low (<1 mg/m(3)) exposure estimates. The modeling framework enabled us to deal with the data complexities generally found in studies using historical exposure data in a comprehensive way and we therefore expect to be able to investigate effects at relatively low exposure levels.

  15. Organizing centers in parameter space of discontinuous 1D maps. The case of increasing/decreasing branches

    Sushko Iryna

    2012-08-01

    Full Text Available This work contributes to classify the dynamic behaviors of piecewise smooth systems in which border collision bifurcations characterize the qualitative changes in the dynamics. A central point of our investigation is the intersection of two border collision bifurcation curves in a parameter plane. This problem is also associated with the continuity breaking in a fixed point of a piecewise smooth map. We will relax the hypothesis needed in [4] where it was proved that in the case of an increasing/decreasing contracting functions on the left/right side of a border point, at such a crossing point, we have a big-bang bifurcation, from which infinitely many border collision bifurcation curves are issuing. Cet travail est une contribution à la classification des comportements dynamiques de systèmes réguliers par morceaux dans lesquels les bifurcations de collision au bord caractérisent les changements qualitatifs de la dynamique. Un point central de notre étude est l’intersection de deux courbes de bifurcation de colision au bord dans un plan de paramètre. Ce problème est aussi associé avec la rupture de continuité en un point fixe d’une application régulière par morceaux. Nous allons relacher l’hypothèse requise dans [4], où il a été montré que dans le cas de fonctions contractantes croissantes/décroissantes strictement à gauche/droite d’un point du bord, en un tel point de franchissement, nous avons une bifurcation big-bang, de laquelle est issue une infinité de courbes de bifurcation de collision au bord.

  16. Realizing improved patient care through human-centered operating room design: a human factors methodology for observing flow disruptions in the cardiothoracic operating room.

    Palmer, Gary; Abernathy, James H; Swinton, Greg; Allison, David; Greenstein, Joel; Shappell, Scott; Juang, Kevin; Reeves, Scott T

    2013-11-01

    Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR). Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized. The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%). By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.

  17. Extreme covariant quantum observables in the case of an Abelian symmetry group and a transitive value space

    Haapasalo, Erkka Theodor; Pellonpaeae, Juha-Pekka

    2011-01-01

    We represent quantum observables as normalized positive operator valued measures and consider convex sets of observables which are covariant with respect to a unitary representation of a locally compact Abelian symmetry group G. The value space of such observables is a transitive G-space. We characterize the extreme points of covariant observables and also determine the covariant extreme points of the larger set of all quantum observables. The results are applied to position, position difference, and time observables.

  18. Invasive amebiasis and ameboma formation presenting as a rectal mass: An uncommon case of malignant masquerade at a western medical center

    2007-01-01

    A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated, necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy. These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica, which regressed completely with medical therapy. In Western countries, the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm. Not sur