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Sample records for challenge primary omental

  1. Primary omental Gastrointestinal stromal tumor (GIST

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    Hirahara Nobutsune

    2007-06-01

    Full Text Available Abstract Background We report herein a rare case of primary omental gastrointestinal stromal tumor (GIST. Case presentation A 65 year-old man was referred to our hospital with a huge abdominal mass occupying the entire left upper abdomen as shown by sonography. On computed tomography (CT, this appeared as a heterogeneous low-density mass with faint enhancement. Abdominal angiography revealed that the right gastroepiploic artery supplied the tumor. With such an indication of gastric GIST, liposarcoma, leiomyosarcoma or mesothelioma laparotomy was performed and revealed that this large mass measured 20 × 17 × 6 cm, arising from the greater omentum. It was completely resected. Histopathologically, it was composed of proliferating spindle and epithelioid cells with an interlacing bundle pattern. Immunohistochemically, the tumor was positive for myeloid stem cell antigen (CD34, weakly positive for c-KIT (CD117 and slightly positive for neuron-specific enolase (NSE, but negative for cytokeratin (CK, alpha-smooth muscle actin (SMA and S-100 protein. A mutation was identified in the platelet-derived growth factor alpha (PDGFRA juxtamembrane domain (exon 12, codon561 and the tumor was diagnosed as an omental GIST. The postoperative course was uneventful. The patient is treated by Glevec® and is alive well with no sign of relapse. Conclusion Our case demonstrated a weak immunohistochemical expression of c-kit (CD117 and a point mutation in PDGFRA exon 12 resulting in an Asp for Val561 substitution. Imatinib therapy as an adjuvant to complete resection has been carried out safely. Because of the rarity of primary omental GISTs, it is inevitable to analyze accumulating data from case reports for a better and more detailed understanding of primary omental GISTs.

  2. Primary omental yolk sac tumor.

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    Lim, Seon Hwa; Kim, Yon Hee; Yim, Ga Won; Nam, Eun Ji; Kim, Young Tae; Kim, Sunghoon

    2013-11-01

    Extra-ovarian yolk sac tumor arising in the omentum is extremely rare. As yolk sac tumor originated from the omentum has been rarely reported, its clinical information is very limited. The authors encountered a case of yolk sac tumor originated from the omentum, and reported the case herein. A 32-year-old woman was presented with developed low abdominal distension for a month. Magnetic resonance imaging findings were suggestive of ovarian malignancy with ascites and peritoneal seeding nodules. Explorative laparotomy was performed and then the findings from frozen biopsy of omentum were suggestive of poorly differentiated tumor though whether it was primary or metastatic was uncertain. Thus, staging laparotomy were performed. Histopathology confirmed that the tumor was a yolk sac tumor of omentum origin. Then, 6 cycles of postoperative adjuvant chemotherapy at intervals of 3 weeks were performed using bleomycin, etoposide, and cisplatin regimen. Four-year outpatient follow-up thereafter showed no relapse. PMID:24396822

  3. PRIMARY OMENTAL HYDATID CYST – A RARE ENTITY

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    Prashant M

    2015-08-01

    Full Text Available Hydatid cyst is caused by the parasite Echinococcus granulosus ( L arval form in humans with lesions most frequently encountered in the liver and lungs. It can rarely involve extra - hepatic organs. Primary omental hydatid cyst is rare entity. This report presents the interesting case of a very large primary omental hydatid cyst.

  4. Mesenteric and Omental Primary Cysts: Image Findings; Quistes primarios mesentericos y omentales: hallazgos e imagen

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    Castillo Caro, S.; Vargas Serrano, B. [Hospital Universitario Virgen del Rocio. Sevilla (Spain); Rodriguez, M. L. [Hospital Morales Meseguer. Murcia (Spain)

    2004-07-01

    To describe the radiological appearance of different histological subtypes of mesenteric and omental cysts: lymph angioma, enteric duplication cysts, enteric and mesothelial, and non-pancreatic pseudocysts. The basis of this study is the clinical, radiological and pathological review os 13 cases from our departmental archives involving cystic lesions of the omentum or mesentery: 3 lympangiomas, one enteric duplication cyst, 7 mesothelial cysts and 2 non-pancreatic pseudocysts. The sex distribution was 9 women and 4 men. Most common clinical findings were pain and abdominal distension. Echography (ultra-sound scanning) was performed in 8 cases, abdominal x-ray in 10 and computerized tomography (CT in 13 cases. In the ultra-sound and CT studies, lymphangiomas appeared as large thin-walled multilocular cystic lesions. Mesonthelial cysts were observed as unilocular thin-walled (calcified in 2 cases) cystic lesions of varying size. Duplication cysts were unilocular, seemingly liquid-filled under ultrasound scan and with a thick calcified wall. the non-pancreatic pseudocysts were of varying size, heterogeneous and thick-walled. Aside from being able to determine whether abdominal masses are cystic in nature, ultrasound scan and CT can determine whether such are mesenteric or omental in origin. They can also determine the cystic nature of an abdominal mass which would be helpful in narrowing down diagnostic possibilities. It is important to remember that some malignant neoplasia can occasionally resemble cystic lesions with imaging techniques. (Author) 7 refs.

  5. Primary omental malignant mixed Müllerian tumor in a 67-year-old woman

    Institute of Scientific and Technical Information of China (English)

    魏丽惠; 王建六; 张岫屏; 崔恒; 沈丹华; 钱和年

    2002-01-01

    @@Malignant mixed Müllerian tumors (MMMTs) are highly aggressive neoplasms composed of sarcomatous and carcinomatous elements commonly encountered in the female genital tract and rarely occur in extragenital sites. Most of extragenital MMMTs develop from the peritoneum. To our knowledge, only 25 cases have been described in the literature. Among them, only 2 cases have arised in the major omentum.1 Here we report a case of a 67-year-old female with primary MMMT of the major omentum.

  6. A huge 6.2 kilogram uterine myoma coinciding with omental leiomyosarcoma: case report.

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    Ruan, C W; Lee, C L; Yen, C F; Wang, C J; Soong, Y K

    1999-12-01

    Surgery for massive abdominal tumors is both interesting and challenging. We present a case involving a multiple uterine myoma weighing 6.2 Kg which coincided with omental leiomyosarcoma. To our knowledge, this is the first report of this type of condition in the English literature. A 44-year-old nulliparous woman had suffered from abdominal pain for a long time. A huge abdominal mass was palpated on physical examination. Computed tomography scanning revealed a huge pelvic-abdominal mass with the possibility of small bowel loops invaded by the mass. A 6-cm omental mass was incidentally found during the subsequent hysterectomy procedure. Perforation of the urinary bladder occurred during the dissection of adhesion. Resection of the omental mass, wide wedge resection of the invaded small bowel, primary repair of the bladder, and hysterectomy were performed. The final pathologic diagnosis was uterine leiomyomata with omental leiomyosarcoma. The patient returned home on postoperative day 14 and was well at the 18-month follow-up examination. The challenge of these tumors lies in their proper diagnosis and surgical management. More case reports and follow-up studies are needed to confirm the efficacy of their management.

  7. UNILOCULAR OMENTAL CYST IN ADULT FEMALE PRESENTING AS HUGE ABDOMINAL LUMP: A RARE CASE REPORT

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    Himansu

    2015-05-01

    Full Text Available Omental cysts are rare entity with a prevalence of 1: 1,000,000 in adults and in 1: 20, 000 in children. We are reporting a case of a 30 year female patient with abdominal lump over epigastrium and left hypochondrium for 6 months; diagnosed on laparotomy as uniloculated omental cyst originating from lesser omentum. Omental cyst is a challenging diagnostic entity with varied presentations and a wide range of differential diagnosis has to be kept in mind.

  8. Primary omental yolk sac tumor

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    Lim, Seon Hwa; Kim, Yon Hee; Yim, Ga Won; Nam, Eun Ji; Kim, Young Tae; KIM, SUNGHOON

    2013-01-01

    Extra-ovarian yolk sac tumor arising in the omentum is extremely rare. As yolk sac tumor originated from the omentum has been rarely reported, its clinical information is very limited. The authors encountered a case of yolk sac tumor originated from the omentum, and reported the case herein. A 32-year-old woman was presented with developed low abdominal distension for a month. Magnetic resonance imaging findings were suggestive of ovarian malignancy with ascites and peritoneal seeding nodules...

  9. Postoperative omental infarction following colonic resection

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    Kerr, S.F., E-mail: skerr44@doctors.org.uk [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Hyland, R.; Rowbotham, E.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2012-02-15

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution's electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  10. Postoperative omental infarction following colonic resection

    International Nuclear Information System (INIS)

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution’s electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  11. Malignant mesothelioma of the greater omentum mimicking omental infarction: A case report

    Institute of Scientific and Technical Information of China (English)

    Min-Kee Shin; Ok-Jae Lee; Chang-Yoon Ha; Hyun-Joo Min; Tae-Hyo Kim

    2009-01-01

    Mesothelioma develops most commonly in the pleura, and less frequently in the peritoneum. Usually, it manifests as diffuse peritoneal thickening and multiple nodules, and rarely as a solitary mass. We report a rare case of primary malignant mesothelioma of the greater omentum, which mimicked omental infarct. A 54-year-old Korean man was admitted because of severe abdominal pain of sudden onset. A tender mass with indistinct margins was palpated in the upper abdomen. Abdominal ultrasound and computed tomography showed an illdefined mass in the greater omentum and little ascites in the peri-hepatic space, and neutrophil-dominant exudates were documented on paracentesis. Intravenous antibiotics and analgesics were given for omental infarction with superimposed infection, which resulted in symptomatic improvement. The imaging studies after a week revealed a growing mass and ascites. Laparoscopic surgery was performed and an 8 cm × 3.3 cm greater omental mass was found, with multiple small nodules on the peritoneum, diaphragm, and pelvic cavity wall. Histological examination showed proliferating malignant epithelioid cells that stained strongly for calretinin, which was compatible with malignant mesothelioma. We recommend that primary omental mesothelioma should be included in the differential diagnosis of patients with omental infarction, despite its rarity.

  12. Comparison of Closure of Gastric Perforation Ulcers With Biodegradable Lactide-Glycolide-Caprolactone or Omental Patches

    NARCIS (Netherlands)

    Bertleff, Marietta J. O. E.; Stegmann, Toon; Liem, Robert S. B.; Kors, Geert; Robinson, Peter H.; Nicolai, Jean Philippe; Lange, Johan F.

    2009-01-01

    Background: The current treatment of perforated peptic ulcers is primary closure, supported by the application of an omental patch. It is difficult and time consuming to perform this procedure by laparoscopic surgery, largely because of the required suturing. It was our aim to develop and test a new

  13. Giant omental lipoblastoma and CD56 expression

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    Go Miyano

    2013-01-01

    Full Text Available We report a case of giant omental lipoblastoma in a 13-month-old boy, which was treated successfully by total excision. Tumor cells were positive for S100, CD34 and CD56. This is the first report of lipoblastoma expressing CD56, a fact that could be used to differentiate lipoblastoma from liposarcoma.

  14. Primary progressive aphasia: conceptual evolution and challenges

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    Leyton CE

    2016-04-01

    Full Text Available Cristian E Leyton, Kirrie J Ballard Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia Abstract: Since the modern description of primary progressive aphasia (PPA more than 30 years ago, the interest in neurodegenerative conditions that selectively target the language network has grown exponentially. Fueled by advances in neuroimaging and biomarkers, progress in the field has brought new insights into clinical categorization, neural correlates of language, and pathological mechanisms of progression in PPA. Of relevance, the inception of logopenic progressive aphasia as an atypical presentation of Alzheimer's disease and the formalization of the international diagnostic criteria and classification of PPA represent milestones in the field. Paradoxically, those advances have also brought controversy and challenges. The application of the current classification in cases with mixed or very mild language deficits is still challenging, while the accurate pathological prediction at the individual level remains elusive. In addition, it is more evident now that nonlanguage deficits, including other cognitive and motor deficits, can appear early on and potentially assist in the differential diagnosis. From a historical perspective, this review addresses the conceptual evolution of PPA and the contribution that clinical refinements, cognitive neuropsychology, and pathology have made to the field. Keywords: primary progressive aphasia, nonfluent variant, logopenic variant, frontotemporal lobar degeneration, frontotemporal dementia, semantic dementia, Alzheimer's disease

  15. Omental transposition flap in colorectal carcinoma: adjunctive use in prevention and treatment of radiation complications

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    Russ, J.E. (St. Joseph Hospital, Elgin, IL); Smoron, G.L.; Gagnon, J.D.

    1984-01-01

    The versatility of the omentum has led to its use as a surgical adjunct in the total oncological management of primary and recurrent colorectal carcinoma. The omentum is used as a transposition pedicle flap, broadly based on the left gastroepiploic vascular supply. Following abdominoperineal resection or low anterior resection of the rectum, the small bowel is elevated out of the pelvis by the omental bulk. The pelvic defect is reperitonealized and the risk of pelvic small bowel adhesions is diminished. With the increasing use of postoperative radiation to the pelvis for rectal carcinoma, the tolerance to therapy may be improved and the incidence of radiation enteritis and enteropathy should be reduced. Surgical complications such as leakage from low anterior anastomoses and pelvic abscesses, which may delay or contraindicate necessary postoperative radiation, are dramatically decreased. Reconstruction of the perineum with omental flap provides adequate soft tissue bulk and contour when a radical resection has been performed. The omental flap has been used in 24 patients with colorectal carcinoma; one flap was lost as a result of distal omental infarction in a patient with recurrent rectal carcinoma and radionecrosis of the perineum. The safety and ease of this procedure has allowed increased surgical innovation, especcially in the prevention and treatment of radiation complications.

  16. Omental transposition flap in colorectal carcinoma: adjunctive use in prevention and treatment of radiation complications

    International Nuclear Information System (INIS)

    The versatility of the omentum has led to its use as a surgical adjunct in the total oncological management of primary and recurrent colorectal carcinoma. The omentum is used as a transposition pedicle flap, broadly based on the left gastroepiploic vascular supply. Following abdominoperineal resection or low anterior resection of the rectum, the small bowel is elevated out of the pelvis by the omental bulk. The pelvic defect is reperitonealized and the risk of pelvic small bowel adhesions is diminished. With the increasing use of postoperative radiation to the pelvis for rectal carcinoma, the tolerance to therapy may be improved and the incidence of radiation enteritis and enteropathy should be reduced. Surgical complications such as leakage from low anterior anastomoses and pelvic abscesses, which may delay or contraindicate necessary postoperative radiation, are dramatically decreased. Reconstruction of the perineum with omental flap provides adequate soft tissue bulk and contour when a radical resection has been performed. The omental flap has been used in 24 patients with colorectal carcinoma; one flap was lost as a result of distal omental infarction in a patient with recurrent rectal carcinoma and radionecrosis of the perineum. The safety and ease of this procedure has allowed increased surgical innovation, especcially in the prevention and treatment of radiation complications

  17. Calcifying fibrous tumour: an unusual omental lesion

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    Sudhakar, Sniya; Gibikote, Sridhar [Christian Medical College Hospital, Department of Radiology, Vellore, Tamil Nadu (India); Mistry, Yogesh [Christian Medical College Hospital, Department of Pathology, Vellore, Tamil Nadu (India); Dastidar, Arindam; Sen, Sudipta [Christian Medical College Hospital, Department of Pediatric Surgery, Vellore, Tamil Nadu (India)

    2008-11-15

    Calcifying fibrous tumour (CFT) is a recently described distinct clinicopathological entity characterized by calcifying lesions usually occurring in soft tissue of the extremities, trunk, axilla, pleura, mediastinum and peritoneum of children and adults. Most reported cases involving the peritoneum have been in adults. We present the imaging, surgical and pathology findings of CFT in a 7-year-old child who presented with an incidental finding of a large omental mass. (orig.)

  18. Calcifying fibrous tumour: an unusual omental lesion

    International Nuclear Information System (INIS)

    Calcifying fibrous tumour (CFT) is a recently described distinct clinicopathological entity characterized by calcifying lesions usually occurring in soft tissue of the extremities, trunk, axilla, pleura, mediastinum and peritoneum of children and adults. Most reported cases involving the peritoneum have been in adults. We present the imaging, surgical and pathology findings of CFT in a 7-year-old child who presented with an incidental finding of a large omental mass. (orig.)

  19. Ultrasound-guided omental biopsy: Review of 173 patients

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    Govindarajan Padmapriya; Keshava Shyamkumar

    2010-01-01

    Background: Omental biopsy has conventionally been performed using a surgical approach. USG-guided omental biopsy is a safe and effective alternative. The purpose of this study was to assess the utility of USG guidance for biopsy of the greater omentum. Study design: Retrospective study. Materials and Methods: We retrospectively reviewed all omental biopsies performed under USG guidance from April 2006 to March 2010 in a tertiary care hospital. Results: One hundred and seventy-three patients ...

  20. Two Cases of Omental Torsion Mimicking Acute Appendicitis

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    Feeroz Alam Khan; Naeem Liaqat; Sajid Hameed Dar; Asif Iqbal Sandhu; Sajid Nayyer

    2014-01-01

    Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel’s diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion.

  1. Two Cases of Omental Torsion Mimicking Acute Appendicitis

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    Feeroz Alam Khan

    2014-02-01

    Full Text Available Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel’s diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion.

  2. Two Cases of Omental Torsion Mimicking Acute Appendicitis

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    Liaqat, Naeem; Dar, Sajid Hameed; Sandhu, Asif Iqbal; Nayyer, Sajid

    2014-01-01

    Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel’s diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion. PMID:24834389

  3. Primary breast osteosarcoma: A diagnostic challenge

    International Nuclear Information System (INIS)

    Extraskeletal osteosarcomas account for < 1% of the soft tissue sarcomas and are known to more often localize in soft tissues of the lower extremities. Primary osteosarcomas of the breast are extremely rare. A majority of the reported cases were in fact initially erroneously diagnosed and treated as primary breast carcinomas. We recently got to treat an interesting case of a primary breast osteosarcoma and discuss its evaluation and management with added emphasis on the incremental role of technetium 99-methylene diphosphonate (Tc-99m) bone scintigraphy in its clinical diagnosis. Tc-99m uptake can occasionally be seen in the delayed bone scintigraphy images of extra skeletal malignancies, but the uptakes are considered to be typically less intense than the uptakes noted in primary skeletal malignancies. Extraskeletal osteosarcomas are however the exceptions to this rule, the intense uptake in bone scintigraphy further aided in an accurate preoperative diagnosis and management of our patient

  4. Greater Omental Pancake Tumour due to Metastasis of Ovarian Cancer – A Cadaveric Study

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    Bhusari, Prashant A.; Khairnar, Karan B.

    2014-01-01

    Cancer of ovary is the one of the common of all gynecological tumors and is the leading cause of death among women. A unique attempt is made to trace masses & its causes found in an abdomen of female cadaver during routine anatomy dissection. The mass was thick, hard and somewhat nodular in the region of greater omentum, After dissecting the pelvic cavity, it was found that both the ovaries were bulky, nodular & hard. Whole abdominal cavity was dissected & found that liver also involved by metastasis. Case suggests that there is the development of metastatic omental mass from grade IV ovarian cancer. Primary human omental adipocytes promote homing, migration and invasion of ovarian cancer cells. Adipokines like interleukin-8 (IL-8) mediate these activities. PMID:24596747

  5. Greater Omental Pancake Tumour due to Metastasis of Ovarian Cancer - A Cadaveric Study.

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    Bhusari, Prashant A; Khairnar, Karan B

    2014-01-01

    Cancer of ovary is the one of the common of all gynecological tumors and is the leading cause of death among women. A unique attempt is made to trace masses & its causes found in an abdomen of female cadaver during routine anatomy dissection. The mass was thick, hard and somewhat nodular in the region of greater omentum, After dissecting the pelvic cavity, it was found that both the ovaries were bulky, nodular & hard. Whole abdominal cavity was dissected & found that liver also involved by metastasis. Case suggests that there is the development of metastatic omental mass from grade IV ovarian cancer. Primary human omental adipocytes promote homing, migration and invasion of ovarian cancer cells. Adipokines like interleukin-8 (IL-8) mediate these activities. PMID:24596747

  6. Omental infarction associated with right-sided heart failure

    International Nuclear Information System (INIS)

    A 31-year-old man with a known congenital heart disease presented with cardial decompensation and an acute abdomen with tenderness in the right inferior abdominal quadrant. Because infectious parameters were slightly elevated, acute appendicitis was suspected. A CT scan showed an isolated focal infiltration of the omentum, superficial to the ascending colon, small amounts of ascites, and dilated hepatic and mesenteric veins. Laparoscopic resection and histopathologic examination confirmed hemorrhagic omental infarction due to thromboses of several small omental veins. This is a report on the pathogenesis, differential diagnoses, and CT findings of omental infarction. (orig.)

  7. Omental infarction associated with right-sided heart failure

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    Wiesner, W.; Bongartz, G. [Institute of Diagnostic Radiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel (Switzerland); Kaplan, V. [Department of Internal Medicine, University Hospital Zuerich, Raemistrasse 100, CH-8091 Zuerich (Switzerland)

    2000-07-01

    A 31-year-old man with a known congenital heart disease presented with cardial decompensation and an acute abdomen with tenderness in the right inferior abdominal quadrant. Because infectious parameters were slightly elevated, acute appendicitis was suspected. A CT scan showed an isolated focal infiltration of the omentum, superficial to the ascending colon, small amounts of ascites, and dilated hepatic and mesenteric veins. Laparoscopic resection and histopathologic examination confirmed hemorrhagic omental infarction due to thromboses of several small omental veins. This is a report on the pathogenesis, differential diagnoses, and CT findings of omental infarction. (orig.)

  8. Idiopathic omental infarction, diagnosed and managed laparoscopically: a case report.

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    Abdulaziz, Ahmed; El Zalabany, Tamer; Al Sayed, Abdul Rahim; Al Ansari, Ahmed

    2013-01-01

    Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

  9. Idiopathic Omental Infarction, Diagnosed and Managed Laparoscopically: A Case Report

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    Ahmed AbdulAziz

    2013-01-01

    Full Text Available Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF at day 2 before admission. A physical examination revealed a fever (38.2∘C, severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5×4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6×4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

  10. Omental and Retroperitoneal Hydatid Cyst: A Case Report

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    "M. Sirus

    2006-07-01

    Full Text Available Hydatid disease is one of the commonest parasitic infections of the liver, rupture of which into the peritoneal cavity leads to secondary echinococcosis. Seventy percent of hydatid disease cases occur in the liver, although any organ may be involved. A case of omental and retroperitoneal hydatid disease along with the hydatid cyst of the liver is present.

  11. Omental torsion in a captive polar bear (Ursus maritimus).

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    Mendez-Angulo, Jose L; Funes, Francisco J; Trent, Ava M; Willette, Michelle; Woodhouse, Kerry; Renier, Anna C

    2014-03-01

    This is the first case report of an omental torsion in a polar bear (Ursus maritimus). A captive, 23-yr-old, 250-kg, intact female polar bear presented to the University of Minnesota Veterinary Medical Center with a 2-day history of lethargy, depression, and vomiting. Abdominal ultrasound identified large amounts of hyperechoic free peritoneal fluid. Ultrasound-guided abdominocentesis was performed and yielded thick serosanguinous fluid compatible with a hemoabdomen. An exploratory laparotomy revealed a large amount of malodorous, serosanguineous fluid and multiple necrotic blood clots associated with a torsion of the greater omentum and rupture of a branch of the omental artery. A partial omentectomy was performed to remove the necrotic tissue and the abdomen was copiously lavaged. The polar bear recovered successfully and is reported to be clinically well 6 mo later. This condition should be considered as a differential in bears with clinical signs of intestinal obstruction and hemoabdomen. PMID:24712179

  12. Use of omental pedicles in mycotic abdominal aortic aneurysm repair

    OpenAIRE

    Alibhai, M.K.; Samee, A; Ahmed, M.; Duffield, R.

    2011-01-01

    We report a case of a sixty year old man with a mycotic infra-renal abdominal aortic aneurysm complicated by a left psoas abscess. After treatment with parenteral antibiotics he underwent early aortic reconstruction with an in-situ prosthetic graft wrapped in an omental pedicle. Mycotic abdominal aortic aneurysms can be treated in this way despite the potential for graft infection from persisting retroperitoneal sepsis.

  13. Omental infarction in the postpartum period: a case report and a review of the literature

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    Izbicki Jakob R

    2010-11-01

    Full Text Available Abstract Introduction Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. It affects predominantly young and middle aged women. Case presentation This is a case report of a 26-year-old Caucasian woman with spontaneous omental infarction two weeks after normal vaginal delivery. Conclusion Omental infarction is a differential diagnosis in the postpartum acute abdomen. As some cases of omental infarction, which are caused by torsion, can be adequately diagnosed via computed tomography, a conservative treatment strategy for patients without complications should be considered in order to avoid any unnecessary surgical intervention.

  14. Epiploic appendicitis and omental infarction. Findings in the ultrasonography and computerized tomography; Apendicitis epiploica e infarto omental. Hallazgos en ecografia y tomografia computarizada

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    Migule, A.; Ripolles, T.; Martinez, M. J.; Morote, V.; Ruiz, A. [Hospital Universitario Dr. Peset. Valencia (Spain)

    2001-07-01

    Describe the findings in the ultrasonography and computerized tomography (CT) of the omental infarction and epiploic appendicitis. The clinical and radiological findings of the patients diagnosed in our hospital with epiploic appendicitis or omental infarctions between August 1994 and March 2001 were assessed retrospectively. We found a high incidence (42 cases) of these two diseases: 30 patients with diagnosis of epiploic appendicitis and 12 with the diagnosis of omental infarction. Four patients were treated surgically, while the remaining 38 were conservatively, without posterior complications. The ultrasonography and CT images is characteristics. making it possible to make a diagnosis of epiploic appendicitis or omental infarction with certainty. It is not necessary to make a differential diagnosis between the two entities because their prognosis and treatment are similar. Their incidence is much more frequent than that previously published. (Author) 19 refs.

  15. Laparoscopic splenectomy for primary immune thrombocytopenia: Current status and challenges.

    Science.gov (United States)

    Zheng, Dong; Huang, Chen-Song; Huang, Shao-Bin; Zheng, Chao-Xu

    2016-09-16

    Primary immune thrombocytopenia (ITP) is an immune-mediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for ITP, but only 20%-40% of cases achieve a stable response. Splenectomy is the main therapy for patients failing to respond to corticosteroids for decades, and about two-thirds of patients achieve a long-lasting response. Although some new drugs are developed to treat ITP as second-line therapies in recent years, splenectomy is still the better choice with less cost and more efficiency. Laparoscopic splenectomy (LS) for ITP proves to be a safe technique associated with lower morbidity and faster recovery and similar hematological response when compared to traditional open splenectomy. Based on the unified hematological outcome criteria by current international consensus, the response rate of splenectomy should be reassessed. So far, there are not widely accepted preoperative clinical indicators predicting favorable response to LS. Since the patients undergoing surgery take the risk of complications and poor hematological outcome, the great challenge facing the doctors is to identify a reliable biomarker for predicting long-term outcome of splenectomy which can help make the decision of operation. PMID:27668071

  16. Literacy in Early Childhood and Primary Education: Issues, Challenges, Solutions

    Science.gov (United States)

    McLachlan, Claire; Nicholson, Tom; Fielding-Barnsley, Ruth; Mercer, Louise; Ohi, Sarah

    2012-01-01

    Literacy in Early Childhood and Primary Education provides a comprehensive introduction to literacy teaching and learning. The book explores the continuum of literacy learning and children's transitions from early childhood settings to junior primary classrooms and then to senior primary and beyond. Reader-friendly and accessible, this book equips…

  17. Omental torsion in acute abdomen: a case report

    Directory of Open Access Journals (Sweden)

    Alibakhshi A

    2010-01-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Management of acute abdomen usually does not necessitate accurate pre-operative diagnosis but the surgeon should make a decision about the need for emergent laparotomy. This fact is somehow different for localized peritonitis (e.g. acute appendicitis in which the clinical presentation directs straightly to the diagnosis. However, acute appendicitis has lots of differential diagnoses, finding the normal appendix during laparotomy is just a start point to look for other diagnoses. Omental torsion is a rare cause for acute abdomen that is usually missed. Knowing about this rare condition and its frequently encountered presentation at the operating room (sero-sanguinous fluid coming out of peritoneal cavity may prevent missing the diagnosis and doing a malpractice."n"nCase report: Report a 9 year- old boy presented with acute abdomen which turned out to be an omental torsion after the operation."n"nConclusion: Knowledge about this rare condition "omental torsion" and its clinical and intra operative presentations may prevent missing the diagnosis and a malpractice.

  18. Free greater omental flap for treatment of mandibular osteoradionecrosis

    Energy Technology Data Exchange (ETDEWEB)

    Moran, W.J.; Panje, W.R.

    1987-04-01

    Osteoradionecrosis can involve the mandible following radical irradiation for treatment of oral cavity cancer. The radionecrosis of the mandible is often associated with severe intractable pain, local or extensive deformity, including pathologic fracture, orocutaneous fistula formation, and frequent loss of function. Treatment has ranged from analgesia and antibiotics to hyperbaric oxygen treatments to local or extensive sequestrectomies with partial or total mandibulectomy and restoration of tissue losses with unirradiated tissue. To our knowledge, this is the first report of the successful use of a free greater omental flap for immediate treatment of mandibular osteoradionecrosis and concomitant reconstruction. We found the omentum to be an excellent vascular bed that rapidly resolved the osteoradionecrosis and pain, promoted healing, and restored mandibular function with minimal discomfort to the patient.

  19. Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

    LENUS (Irish Health Repository)

    Parissis, Haralabos

    2011-09-19

    Abstract Background To report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flaps Methods From February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve. Results Superficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol\\/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days. Conclusion Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.

  20. Ethical challenges and how to develop ethics support in primary health care.

    Science.gov (United States)

    Lillemoen, Lillian; Pedersen, Reidar

    2013-02-01

    Ethics support in primary health care has been sparser than in hospitals, the need for ethics support is probably no less. We have, however, limited knowledge about how to develop ethics support that responds to primary health-care workers' needs. In this article, we present a survey with a mixture of closed- and open-ended questions concerning: How frequent and how distressed various types of ethical challenges make the primary health-care workers feel, how important they think it is to deal with these challenges better and what kind of ethics support they want. Five primary health-care institutions participated. Ethical challenges seem to be prominent and common. Most frequently, the participants experienced ethical challenges related to scarce resources and lack of knowledge and skills. Furthermore, ethical challenges related to communication and decision making were common. The participants welcomed ethics support responding to their challenges and being integrated in their daily practices.

  1. Secondary omental infarction related to open and laparoscopic-assisted distal gastrectomy: report of two cases.

    Science.gov (United States)

    Park, Kyung Eun; Chung, Dong Jin; Kim, Wook; Hahn, Seong-Tae; Lee, Jae Moon

    2011-01-01

    Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.

  2. Omental Lymphangioma in Adults—Rare Presentation Report of a Case

    Directory of Open Access Journals (Sweden)

    T. Narayana Rao

    2012-01-01

    Full Text Available Lymphangioma is an uncommon benign lesion that usually occurs during childhood. Its occurrence in adults is rare. Its presentation in the abdomen is even rare. This case report describes a case of omental lymphangioma presented as retroperitoneal lump. Subsequent imaging, operative, and histological findings revealed omental lymphangioma. Laparotomy done under general anesthesia, a 10 × 12 cm cystic swelling arising from omentum, identified complete excision of the cyst done and send the specimen for histopathological examination. Biopsy report came as omental lymphangioma. Complete surgical excision is the treatment of choice. Prognosis is excellent and recurrence rate is very low if resection is complete. During two years of followup no recurrence was detected. Omental lymphangioma is very rare presentation among abdominal lymphangiomas specifically in adults. Complete excision is the treatment of choice. Long-term followup is required to detect recurrence.

  3. The oncoplastic breast surgery with pedicled omental flap harvested by laparoscopy: initial experiences from China

    OpenAIRE

    Guan, Dandan; Lin, Hui; LV, ZHENYE; Xin, Ying; MENG, KEXIN; Song, Xiangyang

    2015-01-01

    Background A new technique of oncoplastic breast surgery (OBS) using laparoscopically harvested pedicled omental flap has been developed in the past 10 years. This study aimed to evaluate the feasibility of this technique. Methods Twenty-five patients underwent OBS using laparoscopically harvested omental flap. Operative time, blood loss, complications, recurrence, and cosmetic outcomes were prospectively analyzed. Results Between June 2010 and March 2014, 25 patients were recruited in our st...

  4. 99mTc-Macroaggregated Albumin SPECT/CT Perfusion Imaging of Omental Extrahepatic Vascularization.

    Science.gov (United States)

    Nguyen, Ba D; Yang, Ming; Roarke, Michael C

    2016-01-01

    The authors present a case of omental perfusion by an extrahepatic branch of the right hepatic artery depicted during pre-embolization planning with 99mTc-macroaggregated albumin SPECT/CT imaging. This omental scintigraphic finding corresponds to an extrahepatic branch of the right hepatic artery demonstrated by selective angiography and related CT angiography. The authors would like to add the omentum to the previously reported sites of extrahepatic vascularization encountered during the hepatic pre-embolization imaging. PMID:26650883

  5. Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer

    Directory of Open Access Journals (Sweden)

    Hemmat Maghsoudi

    2011-01-01

    Full Text Available Background/Aim: Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. Patients and Methods: Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. Results: Seventeen (4% patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. Conclusions: Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention.

  6. Computed Tomography and Ultrasound of Omental Infarction in Children: Differential Diagnoses of Right Lower Quadrant Pain

    Energy Technology Data Exchange (ETDEWEB)

    Lim, So Yeoun; Hong, Hyun Sook; Lee, Hae Kyung; Lee, Min Hee [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of); Kim, Young Tong [Dept. of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of)

    2013-03-15

    Omental infarction in children occurs rarely and is often confused with other diseases that cause right lower quadrant (RLQ) pain. This study evaluates ultrasonography (US) and computed tomography (CT) findings of omental infarction in children with abdominal pain. The CT and US findings and clinical presentations of nine children diagnosed with omental infarction between 2005 and 2012 were retrospectively reviewed. Distributions of abdominal pain in the patients included RLQ (n = 6), right upper quadrant (RUQ, n = 1), periumbilical (n = 1), and the epigastric (n = 1) region. All patients underwent abdominal CT, and three underwent abdominal US. On CT scan, a typical triangular, heterogeneous fatty mass was seen between the abdominal wall and ascending colon (n = 6) or hepatic flexure (n = 1). A fatty mass with an enhanced rim that mimicked acute appendagitis was present in two patients. The other two patients had diffuse fat infiltration without mass. On US, a heterogeneously hyperechoic omental mass was seen in the RLQ (n = 2) or RUQ (n = 1). Three patients underwent appendectomy and partial omentectomy, and pathology confirmed omental infarction. Knowledge of the typical imaging features of omental infarction and application for diagnosis are important for its differentiation from other conditions that also present with RLQ pain and can avoid unnecessary surgery.

  7. Primary School English Reform in Japan: Policies, Progress and Challenges

    Science.gov (United States)

    Ng, Chin Leong Patrick

    2016-01-01

    In April 2011, the Ministry of Education in Japan formally introduced Primary School English (PSE) language teaching in Japanese elementary schools. The PSE policy made it mandatory for fourth- and fifth-graders to attend English lessons once a week. Using the theoretical framework on why educational language plans fail [Kaplan, R. B., Baldauf, R.…

  8. Spatial accessibility of primary care: concepts, methods and challenges

    Directory of Open Access Journals (Sweden)

    Guagliardo Mark F

    2004-02-01

    Full Text Available Abstract Primary care is recognized as the most important form of healthcare for maintaining population health because it is relatively inexpensive, can be more easily delivered than specialty and inpatient care, and if properly distributed it is most effective in preventing disease progression on a large scale. Recent advances in the field of health geography have greatly improved our understanding of the role played by geographic distribution of health services in population health maintenance. However, most of this knowledge has accrued for hospital and specialty services and services in rural areas. Much less is known about the effect of distance to and supply of primary care on primary care utilization, particularly in the U.S. For several reasons the shortage of information is particularly acute for urban areas, where the majority of people live. First, explicit definitions and conceptualizations of healthcare access have not been widely used to guide research. An additional barrier to progress has been an overwhelming concern about affordability of care, which has garnered the majority of attention and research resources. Also, the most popular measures of spatial accessibility to care – travel impedance to nearest provider and supply level within bordered areas – lose validity in congested urban areas. Better measures are needed. Fortunately, some advances are occurring on the methodological front. These can improve our knowledge of all types of healthcare geography in all settings, including primary care in urban areas. This paper explains basic concepts and measurements of access, provides some historical background, outlines the major questions concerning geographic accessibility of primary care, describes recent developments in GIS and spatial analysis, and presents examples of promising work.

  9. Salt Sensitivity: Challenging and Controversial Phenotype of Primary Hypertension.

    Science.gov (United States)

    Iatrino, Rossella; Manunta, Paolo; Zagato, Laura

    2016-09-01

    Increases in life expectancy and cardiovascular adverse events in patients with hypertension highlight the need for new risk-reduction strategies to reduce the burden of degenerative diseases. Among the environmental factors, high salt consumption is currently considered the most important risk factor of hypertension. However, while high salt intake significantly raises blood pressure in some individuals, others do not show variation or even decrease their blood pressure. This heterogeneity is respectively classified as salt sensitivity and salt resistance. In this review, we propose salt sensitivity as a useful phenotype to unravel the mechanistic complexity of primary hypertension. The individual variability in blood pressure modification in response to salt intake changes derives from the combination of genetic and environmental determinants. This combination of random and non random determinants leads to the development of a personal index of sensitivity to salt. However, those genes involved in susceptibility to salt are still not completely identified, and the triggering mechanisms underlying the following development of hypertension still remain uncovered. One reason might be represented by the absence of a specific protocol, universally followed, for a standard definition of salt sensitivity. Another reason may be linked to the absence of common criteria for patient recruitment during clinical studies. Thus, the generation of a reliable approach for a proper recognition of this personal index of sensitivity to salt, and through it the identification of novel therapeutic targets for primary hypertension, should be one of the aspirations for the scientific community. PMID:27614755

  10. Children stories about primary schools: sceneries and (autobiographic research challenges

    Directory of Open Access Journals (Sweden)

    Maria da Conceição Passeggi

    2014-01-01

    Full Text Available This study deals with 4-10 year-old children stories and analyses how they portrait their experiences at school. It is the outcome of an inter-institutional research project performed at schools in Natal, São Paulo, Recife, Niterói and Boa Vista. To collect data, we opted for conversations of children in groups of five, who would share a conversation with a little alien whose planet lacked schools. The analyses revealed consensus and tensions between scholar cultu - re and childhood cultures, which affect the way children play and learn, make friends or not, remain children or not. When narrating, the child redefines his/her experience and contributes to seize the primary school as a place where he/she becomes (or not a citizen.

  11. Primary cardiac lymphoma: diagnostic tools and treatment challenges.

    LENUS (Irish Health Repository)

    Bambury, R

    2011-03-01

    Primary cardiac lymphoma (PCL) is a rare malignancy and the optimal treatment strategy remains uncertain. It appears to respond much better to systemic chemotherapy than to surgery and it should be considered in the differential diagnosis of all cardiac tumours before definitive management is undertaken. We report a case of this rare disorder treated successfully with a combination of rituximab and cyclophosphamide, adriamycin, vincristine and prednisolone. The patient developed recurrent unstable ventricular tachycardia (VT) post-chemotherapy secondary to extensive scarring at the tumour site. The tumour as well as the post-treatment scarring is well illustrated by cardiac magnetic resonance imaging highlighting its usefulness in this setting. An implantable cardioverter defibrillator (ICD) was placed. This is only the second case in the literature of PCL to have an ICD placed for recurrent VT. A brief literature review is included.

  12. Challenges in diagnostic accuracy studies in primary care: The fecal calprotectin example

    NARCIS (Netherlands)

    G.A. Holtman (Gea A); Y. van Leeuwen (Yvonne); B.J. Kollen (Boudewijn ); J.C. Escher (Johanna); A. Kindermann; P.F.V. Rheenen (Patrick F Van); M.Y. Berger (Marjolein)

    2013-01-01

    textabstractAbstract. Background: Low disease prevalence and lack of uniform reference standards in primary care induce methodological challenges for investigating the diagnostic accuracy of a test. We present a study design that copes with these methodological challenges and discuss the methodologi

  13. Challenges in diagnostic accuracy studies in primary care : the fecal calprotectin example

    NARCIS (Netherlands)

    Holtman, Gea A.; Lisman-van Leeuwen, Yvonne; Kollen, Boudewijn J.; Escher, Johanna C.; Kindermann, Angelika; van Rheenen, Patrick F.; Berger, Marjolein Y.

    2013-01-01

    Background: Low disease prevalence and lack of uniform reference standards in primary care induce methodological challenges for investigating the diagnostic accuracy of a test. We present a study design that copes with these methodological challenges and discuss the methodological implications of ou

  14. Primary hyperparathyroidism masquerading as rickets: diagnostic challenge and treatment outcomes.

    Science.gov (United States)

    Dutta, Deep; Kumar, Manoj; Das, Ram Narayan; Datta, Saumik; Biswas, Dibakar; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

    2013-01-01

    Primary hyperparathyroidism (PHPT) is extremely uncommon among children and is more likely to be associated with genetic syndromes, multiglandular involvement, and more severe symptoms. Rickets can very rarely be the presenting feature of PHPT in children. Rickets was diagnosed in a 12-year-old girl presenting with short stature, genu valgum, eversion deformity at the ankle joints, and flat feet. Radiograms showed generalized osteopenia, widening of the distal ends of the long bones along with splaying, cupping and fraying. Biochemical evaluation revealed low serum calcium (7.8 mg/dL), low phosphorus (1.4 mg/dL), vitamin-D deficiency [25-hydroxy-vitamin-D (25(OH)D): 8.7 ng/mL], and elevated intact parathyroid hormone (PTH, 811 pg/mL). Re-evaluation due to lack of clinical improvement following vitamin-D and calcium supplementation revealed hypercalcemia 11.9 mg/dL, normal 25(OH)D 41 ng/mL, persistence of elevated PTH 632 pg/mL. A 99mTc-sestamibi scan showed increased uptake at the lower pole of the right lobe of the thyroid. A right inferior parathyroidectomy was performed. Histopathology revealed chief cell type parathyroid adenoma. Last evaluated 4 months after surgery, the bone pains and proximal weakness had resolved, with significant improvement in the patient's quality of life. Rickets in the setting of PHPT often masks the classical phenotype of PHPT. In a child with rickets, lack of improvement following vitamin-D supplementation, hypercalcemia at presentation or following vitamin-D supplementation are warning signs which necessitate further evaluation to rule out PHPT.

  15. Primary Schools Facing Challenging Circumstances: Effective leadership and the potential contribution of complexity theory.

    OpenAIRE

    Harcourt-Heath, Michèle Jean

    2013-01-01

    Abstract Schools operate in a multitude of different contexts, with some facing more difficult situations than others. The central question this research seeks to investigate is, ‘What happens in primary schools facing challenging circumstances that results in their improvement or decline?’ It reports on a study of three English primary schools either subject to an Ofsted (Office for Standards in Education) improvement category following inspection and/or coping without a permanent head...

  16. The Right to Primary Education in Ethiopia: Progress, Prospects and Challenges

    OpenAIRE

    2009-01-01

    The present study focuses on Ethiopia, a country despite facing daunting development challenges, is said to have sustained a notable push towards realizing universal primary education. The study was, therefore, made with an objective of critically assessing and evaluating the right to primary education in the present Ethiopia. Using both qualitative and quantitative method, this study not only attempted to describe the political, economic and legal/policy reforms the Ethiopian Government...

  17. Challenges in diagnostic accuracy studies in primary care: The fecal calprotectin example

    OpenAIRE

    Holtman, Gea A; Leeuwen, Yvonne van; Kollen, Boudewijn; Escher, Johanna; Kindermann, A.; van Rheenen, Patrick F.; Berger, Marjolein

    2013-01-01

    textabstractAbstract. Background: Low disease prevalence and lack of uniform reference standards in primary care induce methodological challenges for investigating the diagnostic accuracy of a test. We present a study design that copes with these methodological challenges and discuss the methodological implications of our choices, using a quality assessment tool for diagnostic accuracy studies (QUADAS-2). Design. The study investigates the diagnostic value of fecal calprotectin for detecting ...

  18. The challenge of objective confirmation of asthma diagnosis in primary care

    OpenAIRE

    Kaicker, Jatin; Dang, Wilfred; D’Urzo, Anthony

    2014-01-01

    Asthma represents one of the most common chronic conditions encountered in primary care and diagnosis should be confirmed objectively with the demonstration of variable airflow obstruction. As many asthmatics have normal lung function at the time of clinical presentation, objective confirmation of airflow limitation may be challenging. Fluctuations in airflow obstruction can be documented with simple office spirometry after bronchodilator challenge, home monitoring of peak expiratory flow and...

  19. Increased levels of endothelin ETB receptor mRNA in human omental arteries after organ culture

    DEFF Research Database (Denmark)

    Möller, S; Adner, M; Edvinsson, L

    1998-01-01

    1. Using competitive reverse transcription-polymerase chain reaction (RT-PCR) and in vitro pharmacology, smooth muscle endothelin ETB receptor expression was studied in segments of human omental artery, fresh and after organ culture for 1 and 5 days. 2. The competitive RT-PCR assay used in the pr...

  20. Application and evaluation of postural stimulation test and captopril challenge test in diagnosis of primary aldosteronism

    Institute of Scientific and Technical Information of China (English)

    郝岩

    2014-01-01

    Methods One hundred and twenty-eight patients with essential hypertension and 71 patients with primary aldosteronism were included in this study.The efficacy of different diagnostic indices of postural stimulation test(PST)with captopril challenge test(CCT)were compared by constructing receiver operating characteristic curve.The

  1. The Teaching of African Traditional Religion in Primary Schools in Zimbabwe: Challenges and Opportunities

    Science.gov (United States)

    Marashe, Joel; Ndamba, Gamuchirai Tsitsiozashe; Chireshe, Excellent

    2009-01-01

    Zimbabwe's Education Ministry recommended the teaching of African Traditional Religion in recognition of its multi-religious society. This study sought to establish the extent to which African Traditional Religion is taught in primary schools, the challenges faced by teachers, and opportunities for promoting its teaching. A descriptive survey…

  2. It Was a Challenge but We Did It! Digital Worlds in a Primary Classroom

    Science.gov (United States)

    Graham, Lynda

    2009-01-01

    In this article I explore one day in the life of a primary classroom in which teacher and children are "playful social" insiders in digital worlds. I argue that this snapshot offers glimmers of unimagined ways forward in teaching in digital worlds. The classroom culture is one of challenge, collective intelligence and reflection. The teacher's own…

  3. Integration in stroke services: the challenges for primary and community care services

    OpenAIRE

    Baeza, Juan I; Fraser, Alec; Boaz, Dr Annette

    2012-01-01

    Objectives A number of evidence-based interventions are now available for stroke patients. Good quality stroke care involves a range of health professionals located across ambulance, hospital, community and primary care services. This study examined the perspectives of healthcare workers involved in stroke care in two different English case study sites on the integration challenges stroke care presents.

  4. The relationship of omental and subcutaneous adipocyte size to metabolic disease in severe obesity.

    LENUS (Irish Health Repository)

    O'Connell, Jean

    2012-02-01

    OBJECTIVE: Several studies have reported the existence of a subgroup of obese individuals with normal metabolic profiles. It remains unclear what factors are responsible for this phenomenon. We proposed that adipocyte size might be a key factor in the protection of metabolically healthy obese (MHO) individuals from the adverse effects of obesity. SUBJECTS: Thirty-five patients undergoing bariatric surgery were classified as MHO (n = 15) or metabolically unhealthy obese (MUO, n = 20) according to cut-off points adapted from the International Diabetes Federation definition of the metabolic syndrome. Median body mass index (BMI) was 48 (range 40-71). RESULTS: There was a moderate correlation between omental adipocyte size and subcutaneous adipocyte size (r = 0.59, p<0.05). The MHO group had significantly lower mean omental adipocyte size (80.9+\\/-10.9 microm) when compared with metabolically unhealthy patients (100.0+\\/-7.6 microm, p<0.0001). Mean subcutaneous adipocyte size was similar between the two groups (104.1+\\/-8.5 microm versus 107.9+\\/-7.1 microm). Omental, but not subcutaneous adipocyte size, correlated with the degree of insulin resistance as measured by HOMA-IR (r = 0.73, p<0.0005), as well as other metabolic parameters including triglyceride\\/HDL-cholesterol ratio and HbA1c. Twenty-eight patients consented to liver biopsy. Of these, 46% had steatohepatitis and fibrosis. Fifty percent (including all the MHO patients) had steatosis only. Both omental and subcutaneous adipocyte size were significantly associated with the degree of steatosis (r = 0.66, p<0.0001 and r = 0.63, p<0.005 respectively). However, only omental adipocyte size was an independent predictor of the presence or absence of fibrosis. CONCLUSION: Metabolically healthy individuals are a distinct subgroup of the severely obese. Both subcutaneous and omental adipocyte size correlated positively with the degree of fatty liver, but only omental adipocyte size was related to metabolic health

  5. Isolated omental metastasis of renal cell carcinoma after extraperitoneal open partial nephrectomy: A case report

    Science.gov (United States)

    Acar, Ömer; Mut, Tuna; Sağlıcan, Yeşim; Sag, Alan Alper; Falay, Okan; Selcukbiricik, Fatih; Tabak, Levent; Esen, Tarık

    2016-01-01

    Introduction Metachronous metastatic spread of clinically localized renal cell carcinoma (RCC) affects almost 1/3 of the patients. They occur most frequently in lung, liver, bone and brain. Isolated omental metastasis of RCC has not been reported so far. Case presentation A 62-year-old patient previously diagnosed and treated due to pulmonary sarcoidosis has developed an omental metastatic lesion 13 years after having undergone open extraperitoneal partial nephrectomy for T1 clear-cell RCC. Constitutional symptoms and imaging findings that were attributed to the presence of a sarcomatoid paraneoplastic syndrome triggered by the development this metastatic focus complicated the diagnostic work-up. Biopsy of the [18F]-fluorodeoxyglucose (+) lesions confirmed the diagnosis of metastatic RCC and the patient was managed by the resection of the omental mass via near-total omentectomy followed by targeted therapy with a tyrosine kinase inhibitor. Discussion Late recurrence of RCC has been reported to occur in 10–20% of the patients within 20 years. Therefore lifelong follow up of RCC has been advocated by some authors. Diffuse peritoneal metastases have been reported in certain RCC subtypes with adverse histopathological features. However, isolated omental metastasis without any sign of peritoneal involvement is an extremely rare condition. Conclusion To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnostic. PMID:26874583

  6. CT findings of lymphoma with peritoneal, omental and mesenteric involvement: Peritoneal lymphomatosis

    Energy Technology Data Exchange (ETDEWEB)

    Karaosmanoglu, Devrim [Department of Radiology, Hacettepe University School of Medicine, Ankara (Turkey); Karcaaltincaba, Musturay [Department of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)], E-mail: musturayk@yahoo.com; Oguz, Berna; Akata, Deniz; Ozmen, Mustafa; Akhan, Okan [Department of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)

    2009-08-15

    Purpose: We aimed to describe computed tomography (CT) findings in patients with peritoneal, omental and mesenteric lymphoma involvement. Materials and methods: We searched our archive retrospectively to find out patients with peritoneal, omental and mesenteric lymphoma involvement. We found 16 patients with non-hodgkin lymphoma meeting these criteria. CT studies of these patients were reevaluated for the presence of peritoneal involvement, ascites, omental mass, organomegaly, retroperitoneal lymphadenopathy, bowel wall thickening and other associated findings. Results: There were 14 males and 2 females with peritoneal and/or mesenteric and omental lymphoma involvement. Mean age was 39 (range 4-76). Subgroups of non-hodgkin lymphoma were diffuse large B-cell lymphoma (n = 11), small cell lymphocytic lymphoma (n = 2), small cleaved cell lymphoma (n = 1), T-cell lymphoma (n = 1) and Burkitt's lymphoma (n = 1). Peritoneal involvement was seen in 15 patients (93.8%) in the form of linear (n = 12) and nodular (n = 3) thickening. Ascites was seen in 12 (75%) patients. Omental and mesenteric masses were present in 10 (66.6%) and 10 (66.6%) patients, respectively. Bowel wall thickening, retroperitoneal lymphadenopathy and hepatosplenomegaly were also common and observed in 10, 10 and 11 patients, respectively. Solid organ involvement in the form of liver and splenic lesions was seen in 9 (56%) patients. Conclusion: Peritoneal involvement can be seen in many subtypes of lymphoma and most frequently in diffuse large B-cell lymphoma. Peritoneal lymphomatosis can mimic peritoneal carcinomatosis and should be included in the differential diagnosis list in patients with ascites, hepatosplenic lesions and unidentified cause of peritoneal thickening on CT in a male patient.

  7. DIFFERENTIAL EXPRESSION OF GENES IN OMENTAL FAT OF NORMAL WEIGHT AND OBESE SUBJECTS AND OBESE DIABETIC PATIENTS USING cDNA MICROARRAY

    Institute of Scientific and Technical Information of China (English)

    LUO Tian-hong; ZHENG Pei-zheng; ZHAO Chun-jun; ZHAO Yu; LI Guo; ZHANG Hong-li; LI Wen-yi; LIU You-ping; LUO Min; WANG Kan-kan; ZHANG Ji

    2007-01-01

    Objective To identify genes differentially expressed in omental fat of normal weight subjects,obese subjects and obese diabetic patients. Methods Using a high-density cDNA microarray, gene expression profile of omental fat from normal weigh subjects, obese subjects and obese diabetic patients were compared.Results Totally, 119 and 257 genes were up-regulated in obese subjects and obese diabetic patients respectively,while 46 and 58 genes were down-regulated. A total of 77 genes, including PDK4, which switched from carbohydrate to fatty acids as the primary source of fuel, were up-regulated in both obese and obese diabetic patients, while 8 genes, including key enzymes in lipid synthesis, such as HMG-CoA synthase, fatty acid synthase and stearoyl-CoA desaturase, were down-regulated in both groups. Tyrosine-3-monooxygenase/tryptophan 5-monooxygenase activation protein θ ( YWHAZ) , a negative regulator for insulin signal transduction, was up-regulated only in obese diabetic patient, but not in normal-glycemic obese subjects. Conclusion The study demonstrated that decrease of lipogenesis along with increase of fatty acids oxidation of adipose tissue could be a common cause of insulin resistance in obesity and type 2 diabetes, while block of insulin signal transduction may trigger the transition from obesity to diabetes. Further exploration of these genes will be useful in the understanding of the pathogenesis of obesity and diabetes.

  8. Caries detection in primary teeth is less challenging than in permanent teeth

    Directory of Open Access Journals (Sweden)

    Fausto M Mendes

    2013-01-01

    Full Text Available Introduction: Most studies about caries detection methods have been performed using permanent teeth. Primary teeth, however, present significant differences from permanent teeth; hence findings of these studies with permanent teeth cannot be extrapolated. The Hypothesis: Our hypothesis is that the caries diagnosis process in primary teeth is less challenging than in permanent teeth. This assertion is based on the fact that primary enamel is thinner and the caries process progresses faster in this type of teeth when compared to permanent teeth. For these reasons, the majority of caries lesions in primary teeth would be more evident and therefore, easily detected through visual inspection. Only a few number of caries lesions would be missed by visual inspection. Thus, adjunct diagnostic methods, such as radiographs, would be unnecessary for primary teeth. Evaluation of the Hypothesis: To evaluate this hypothesis, researchers should conduct studies about the performance of the caries detection methods avoiding selection bias and defining appropriate settings. Clinical trials randomizing the diagnostic strategies would be worthwhile. The evidence supporting the benefits of adjunct methods in detecting caries lesions in primary lesions is limited. However, clinical guidelines have recommended the use of the radiographic method to detect caries in primary teeth in all symptomless children. The confirmation of our hypothesis would lead to the need to re-evaluate such guidelines.

  9. CT findings of peritoneal tuberculosis and peritoneal carcinomatosis: relationship between peritoneal change and omental infiltration

    International Nuclear Information System (INIS)

    To compare the CT findings of peritoneal tuberculosis (PT) and peritoneal carcinomatosis (PC) based on the morphologic features of the peritoneum and assess the relationship between the degree of peritoneal thickness and the severity of omental infiltration in PT and PC. We retrospectively reviewed the CT findings of 15 patients with PT and 14 with PC. We checked morphologic changes of the peritoneum as seen on CT, for the following points: 1) the presence of peritoneal change: 2) the pattern of any change-diffuse thickening, plaque or nodularity, combined thickening (diffuse and plaque, or nodularity) 3) the degree of thickness on the whole peritoneum - mild (grossly definite, but not more than 3mm), moderate (more than 3mm); 4) the presence of irregularity on the peritoneal surface. We also evaluated the significance of the relationship between peritoneal thickness and omental infiltration in both disease entities. The degree of omental infiltration was described as follows : grade 1 (no change or focal smudge pattern); grade 2 (diffuse smudge), grade 3 (omental cake regardless extent). Peritoneal change was seen in 12 of 15 PT patients and in 7 of 14 PC patients. In all 12 PT patients, the pattern of change was diffuse thickening, and among the seven PC patients, there was diffuse thickening in one, plaque or nodular thickening in four, and combined thickening in two. In PT patients, the degree of thickness on the whole peritoneum was mild in six and moderate in six, and in PC patients it was mild in two and moderate in one. An irregular peritoneum surface was seen in one patient with PT and in two with PC. The degree of omental infiltration in PT was grade 1 in four patients, grade 2 in six and grade 3 in five. In PC, it was grade 1 in six patients, grade 2 in two and grade 3 in six. Smooth diffuse thickening of the peritoneum was seen in 11 of 15 PT cases and in one of 14 PC (P 0.5). In PT and PC different CT findings based on peritoneal morphologic changes

  10. Role of the Use of Omental Flap in Prognosis of Cases with Induced Acute Pancreatitis in Experimental Dogs

    OpenAIRE

    Mohamed Hassan; Nader Shaaban; Abu-Seida, Ashraf M.; Mostafa Khodeir; Reem Jan; Hisham Elsharkawy; Engie Hefnawy

    2016-01-01

    Aim Acute pancreatitis frequently involves peripancreatic tissues and remote organ systems resulting in severe complications and high risk of mortality. Therefore, the present study was carried out to assess the effect of omental flap as a new treatment of acute pancreatitis. Methods Ten mongrel dogs with experimentally induced acute pancreatitis were randomly divided into two equal groups; treated and control groups. The pancreas was wrapped with omental flap in the treated group and the pan...

  11. The Challenges of Distributing Leadership in Irish Post-Primary Schools

    OpenAIRE

    Margaret O’DONOVAN

    2015-01-01

    This study explores the challenges and opportunities in relation to developing distributed leadership practice in Irish post-primary schools. It considers school leadership within the context of contemporary distributed leadership theory. Associated concepts such as distributed cognition and activity theory are used to frame the study. The study is situated in a space which acknowledges the current complex reality in our schools, where school leadership is characterised by increased workload ...

  12. Approaches and challenges to optimising primary care teams’ electronic health record usage

    Directory of Open Access Journals (Sweden)

    Nancy Pandhi

    2014-07-01

    Full Text Available Background Although the presence of an electronic health record (EHR alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality.Objective To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams’ EHR use at a large U.S. academic health care system.Methods A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.Results Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams’ demand for EHR customisation. They gained an understanding of health information technology (HIT leadership’s and primary care team’s goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult.Conclusions Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care.

  13. Challenges in diagnostic accuracy studies in primary care: the fecal calprotectin example

    Science.gov (United States)

    2013-01-01

    Background Low disease prevalence and lack of uniform reference standards in primary care induce methodological challenges for investigating the diagnostic accuracy of a test. We present a study design that copes with these methodological challenges and discuss the methodological implications of our choices, using a quality assessment tool for diagnostic accuracy studies (QUADAS-2). Design The study investigates the diagnostic value of fecal calprotectin for detecting inflammatory bowel disease in children presenting with chronic gastrointestinal symptoms in primary care. It is a prospective cohort study including two cohorts of children: one cohort will be recruited in primary care and the other in secondary/tertiary care. Test results of fecal calprotectin will be compared to one of the two reference standards for inflammatory bowel disease: endoscopy with histopathological examination of mucosal biopsies or assessment of clinical symptoms at 1-year follow-up. Discussion According to QUADAS-2 the use of two reference standards and the recruitment of patients in two populations may cause differential verification bias and spectrum bias, respectively. The clinical relevance of this potential bias and methods to adjust for this are presented. This study illustrates the importance of awareness of the different kinds of bias that result from choices in the design phase of a diagnostic study in a low prevalence setting. This approach is exemplary for other diagnostic research in primary care. PMID:24274463

  14. The Challenges of Distributing Leadership in Irish Post-Primary Schools

    Directory of Open Access Journals (Sweden)

    Margaret O’DONOVAN

    2015-12-01

    Full Text Available This study explores the challenges and opportunities in relation to developing distributed leadership practice in Irish post-primary schools. It considers school leadership within the context of contemporary distributed leadership theory. Associated concepts such as distributed cognition and activity theory are used to frame the study. The study is situated in a space which acknowledges the current complex reality in our schools, where school leadership is characterised by increased workload and an ever-expanding role-definition. Drawing on the empirical findings from semi-structured interviews conducted with principals, deputy principals, post of responsibility holders and teachers in three case-study schools, the study probes: (1 how school leaders (reconstruct a form of leadership suited to the needs of the current reality, by exploring their leadership and management styles; (2 how the internal conditions are created in which distributed leadership can function; (3 the challenges posed by distributed leadership and how they might be overcome. The findings clarify that school leadership is a construct beyond the scope of the principal alone. While there is widespread support for a distributed model of leadership, the concept does not explicitly form part of the discourse in the case-study schools. This poses challenges for school leaders and policy-makers to put mechanisms in place to re-culture schools, to develop teacher-leadership capacity and to reflect on the future direction of leadership in Irish post-primary schools.

  15. The challenges of liver transplantation in children with primary sclerosing cholangitis.

    Science.gov (United States)

    Venkat, Veena L; Ranganathan, Sarangarajan; Sindhi, Rakesh

    2015-03-01

    Primary sclerosing cholangitis (PSC) in children can progress to end-stage liver disease requiring liver transplantation. PSC poses many challenges beginning with evaluation and classification of ductal involvement and overlap syndromes, few options for medical management and unique risks in the post-transplant period. The construct that PSC may be an autoimmune disease is based on positive autoantibodies, association with inflammatory bowel disease, linkage to HLA type and overlap/autoimmune sclerosing cholangitis; however, PSC is not responsive to standard immunosuppression. Study of PSC and post-transplant outcomes in children may provide a unique background in which to study this challenging disease. This is particularly intriguing in the subset of patients diagnosed in the first decade of life, suggesting a strong link to predisposing genetic susceptibility and immune dysregulation. Long-term, multicenter effort is likely to be the only mechanism to study this rare disease in children and to improve outcomes in the future.

  16. Challenges for Quality Primary Education in Papua New Guinea—A Case Study

    Directory of Open Access Journals (Sweden)

    Ravinder Rena

    2011-01-01

    Full Text Available There is an urgent need to reform the educational system to achieve universal primary education in Papua New Guinea (PNG. Even after 35 years of independence, PNG has been struggling to educate an estimated 2 million elementary- and primary-aged children and faces numerous challenges in providing Education for All (EFA. This study was conducted in four primary schools of Buma Yong area of Lae district of Morobe Province, PNG. The study revealed that the quality of education has been deteriorated over the past few decades. Many schools in PNG do not have classrooms, teachers, and basic facilities. As a result, the children are losing interest in going to school. The children dropped out of school so as to assist their families in the household and agricultural activities. It also reveals that the dropout rate of girls is more than that of the boys due to the gender disparity in the country. The study recommended that budgetary allocations should be increased so as to improve the infrastructural facilities and encourage the children to attend primary school and thus achieve the Millennium Development Goal/Education For All in PNG.

  17. T-Cell lymphoproliferative disorder of hand-mirror cell morphology presenting in an eosinophilic loculated peritoneal effusion, with omental "caking"

    Directory of Open Access Journals (Sweden)

    Tufankjian Dearon

    2006-01-01

    Full Text Available Abstract Background Cells with "hand mirror" morphology have not, to the best of our knowledge, been described in a primary effusion sample. This paper describes a case of T-cell lymphoma with eosinophilia in a patient with suspected peritoneal carcinomatosis. Rarely, a T-cell lymphoproliferative process may mimic primary peritoneal carcinomatosis, clinically suggested by a presentation in CT imaging of omental caking with bilateral massive loculated effusions in a patient without lymphadenopathy or splenomegaly. Methods A 60 year old caucasian male presented with vague abdominal discomfort and increasing abdominal girth. Computed tomography showed a two centimeter thick omental cake and a small loculated effusion. The clinical presentation and imaging findings were most consistent with peritoneal carcinomatosis. Cytologic evaluation of the effusion was undertaken for diagnostic study. Results Rapid intraprocedural interpretation of the effusion sample showed a monomorphic population of cells with "hand-mirror" cell morphology exhibiting cytoplasmic extensions (uropodia with 3–5 course dark cytoplasmic granules and a rim of vacuolated cytoplasm capping the opposing "mirror head" side. These cells were seen within a background of mature eosinophils. Flow cytometric evaluation of the ascites fluid demonstrated an atypical T-cell population with the following immunophenotype: CD2-, CD3+, CD4-, CD5-, CD7-, CD8+, CD56+. T-cell receptor (TCR gene rearrangement was positive for clonal TCR-gamma gene rearrangement, supporting the diagnosis of a T-lymphoprolifereative disorder. Conclusion A T-cell lymphoproliferative process may present with "hand mirror" morphology in an effusion sample. These cells may show polar cytoplasmic vacuolization and 3–5 course granules within the "handle" of these unique cells. Cytoplasm shows peripheral constriction around the nucleus.

  18. Case Report of Multimodality Imaging in Omental Cake: Plain Radiograph, Computed Tomography, and Ultrasonography: A Care-Compliant Article.

    Science.gov (United States)

    Juan, Yu-Hsiang; Cheung, Yun-Chung; Ng, Koon-Kwan; Ng, Shu-Hang; Huang, Jen-Seng; Chang, Liang-Che; Lin, Yu-Ching

    2015-11-01

    The imaging finding of omental cake has been demonstrated in other modalities, such as computed tomography, magnetic resonance imaging, and ultrasonography. However, to the best of our knowledge, the image presentation of omental cake on a routine kidney-ureter-bladder film has not been reported before in the literature. We presented a unique case of a 61-year-old woman, with known advanced cecal colon mucinous adenocarcinoma, presented to our institution with abdominal fullness, poor appetite, and decreased stool passage for 20 days. Physical examination was unremarkable, except distended abdomen. Subsequent study revealed massive post-pigtail catheter drainage ascites with a prominent soft-tissue mass-causing centralization and tethering of focally distended small bowel gas, suggestive of omental cake on plain radiograph. The imaging finding in plain radiograph corresponds to the findings in other imaging modalities, including abdominal sonography and computed tomography. The patient underwent subtotal colectomy and ileostomy during later courses of chemotherapy due to adhesion ileus and possible intraabdominal abscess, and pathologic study confirmed the diagnosis of cecal mucinous adenocarcinoma and peritoneal carcinomatosis. Although the image finding of omental cake on plain radiograph has never been described, this image finding is unique and should be recognized, as it may suggest the presence of omental cake when first identified in the emergency department from patients with abdominal distension and warrant further evaluation to evaluate the underlying cause.

  19. Introducing E-portfolio Use to Primary School Pupils: Response, Benefits and Challenges

    Directory of Open Access Journals (Sweden)

    Dimitra Theodosiadou

    2015-03-01

    Full Text Available Electronic portfolios (e-portfolios have a positive impact on the learning process in a broad range of educational sectors and on learners of all ages. Yet because most e-portfolio-related studies are about their implementation in higher education, this type of research is less usual in the early childhood context, and there is no available research for Greek schools. This study aims to investigate the impact of e-portfolios on learning in a Greek primary school and to provide a resource regarding the educational benefits of e-portfolio in primary education. To do that, it employs the qualitative naturalistic method to collect data, along with mixed methods which were used to achieve triangulation and strengthen confidence in the outcomes. Participants in the research were fourteen 8-year-old pupils, and one of the researchers was their regular teacher. Data evaluation revealed that the e-portfolio added value in pupils’ learning, acted as a medium to involve parents, promoted pupils’ self-esteem, and was acknowledged as a valuable assessment tool and a challenge for the school community. Based on the experience of the e-portfolio implementation, the authors provide some suggestions that would possibly help researchers and primary school teachers adopt and develop e-portfolio systems in their particular settings.

  20. Demands, constructions and challenges experienced by occupational therapists in primary health care

    Directory of Open Access Journals (Sweden)

    Fernanda dos Reis

    2014-05-01

    Full Text Available Objective: To understand the demands, constructions and challenges experienced by occupational therapists in primary health care in Fortaleza city, Ceará, Brazil. Methods: This is a qualitative study conducted with 13 occupational therapists of the Support Centers for Family Health. It used the focus group method in March 2011 at the headquarters of the Regional Council of Physiotherapy and Occupational Therapy – 6th Region. After the thematic analysis of the material, with theoritical contributions of occupational therapy and collective health, the following categories emerged: construction of work processes; demand and assisted population; contributions and challenges of the occupational therapists. Results: It could be observed that occupational therapists encouraged teams to perform joint actions through health promotion activities for priority groups and created room for planning the construction of comprehensive care between healthcare teams and users, highlighting the challenges of the territory as a space for interdisciplinary achievements, where the problem resolution requires sensitivity and recognition by the professional categories in field. Conclusion: It is understood that diversities and specificities inherent to the territory relate to the needs, and the community daily routine, in addition to the field stresses, counters the team work logic, implying fragility in the actions of supporters. doi:10.5020/18061230.2013.p356

  1. Omental Torsion after Laparoscopic Roux-en-Y Gastric Bypass Mimicking Appendicitis: A Case Report and Review of the Literature

    Science.gov (United States)

    Basilicata, Giacinto; Nocito, Antonio

    2016-01-01

    Introduction. Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a common procedure in obesity surgery. The aim of an antecolic approach is to reduce the rate of internal herniation. Our aim is to make bariatric surgeons aware of another possible complication of antecolic LRYGBP. Methods and Results. We present a case report of omental torsion 24 months after antecolic LRYGBP presenting as an acute abdomen, suggesting appendicitis. During diagnostic laparoscopy, omental infarction due to torsion was observed. Resection of the avital omentum was performed. Discussion. Omental torsion after antecolic LRYGBP is a rare complication. When appearing in the early postoperative phase, it may mimic an anastomotic leakage. It may also occur as late complication, presenting with acute abdomen as an appendicitis. PMID:27019758

  2. Human omental-derived adipose stem cells increase ovarian cancer proliferation, migration, and chemoresistance.

    Directory of Open Access Journals (Sweden)

    Aleksandra Nowicka

    Full Text Available Adipose tissue contains a population of multipotent adipose stem cells (ASCs that form tumor stroma and can promote tumor progression. Given the high rate of ovarian cancer metastasis to the omental adipose, we hypothesized that omental-derived ASC may contribute to ovarian cancer growth and dissemination.We isolated ASCs from the omentum of three patients with ovarian cancer, with (O-ASC4, O-ASC5 and without (O-ASC1 omental metastasis. BM-MSCs, SQ-ASCs, O-ASCs were characterized with gene expression arrays and metabolic analysis. Stromal cells effects on ovarian cancer cells proliferation, chemoresistance and radiation resistance was evaluated using co-culture assays with luciferase-labeled human ovarian cancer cell lines. Transwell migration assays were performed with conditioned media from O-ASCs and control cell lines. SKOV3 cells were intraperitionally injected with or without O-ASC1 to track in-vivo engraftment.O-ASCs significantly promoted in vitro proliferation, migration chemotherapy and radiation response of ovarian cancer cell lines. O-ASC4 had more marked effects on migration and chemotherapy response on OVCA 429 and OVCA 433 cells than O-ASC1. Analysis of microarray data revealed that O-ASC4 and O-ASC5 have similar gene expression profiles, in contrast to O-ASC1, which was more similar to BM-MSCs and subcutaneous ASCs in hierarchical clustering. Human O-ASCs were detected in the stroma of human ovarian cancer murine xenografts but not uninvolved ovaries.ASCs derived from the human omentum can promote ovarian cancer proliferation, migration, chemoresistance and radiation resistance in-vitro. Furthermore, clinical O-ASCs isolates demonstrate heterogenous effects on ovarian cancer in-vitro.

  3. Protection from septic peritonitis by rapid neutrophil recruitment through omental high endothelial venules.

    Science.gov (United States)

    Buscher, Konrad; Wang, Huiyu; Zhang, Xueli; Striewski, Paul; Wirth, Benedikt; Saggu, Gurpanna; Lütke-Enking, Stefan; Mayadas, Tanya N; Ley, Klaus; Sorokin, Lydia; Song, Jian

    2016-01-01

    Acute peritonitis is a frequent medical condition that can trigger severe sepsis as a life-threatening complication. Neutrophils are first-responders in infection but recruitment mechanisms to the abdominal cavity remain poorly defined. Here, we demonstrate that high endothelial venules (HEVs) of the greater omentum constitute a main entry pathway in TNFα-, Escherichia coli (E. coli)- and caecal ligation and puncture-induced models of inflammation. Neutrophil transmigration across HEVs is faster than across conventional postcapillary venules and requires a unique set of adhesion receptors including peripheral node addressin, E-, L-selectin and Mac-1 but not P-selectin or LFA-1. Omental milky spots readily concentrate intra-abdominal E. coli where macrophages and recruited neutrophils collaborate in phagocytosis and killing. Inhibition of the omental neutrophil response exacerbates septic progression of peritonitis. This data identifies HEVs as a clinically relevant vascular recruitment site for neutrophils in acute peritonitis that is indispensable for host defence against early systemic bacterial spread and sepsis.

  4. Experimental study on spinal cord injury treated by embryonic spinal cord transplantation and greater omental transposition

    Institute of Scientific and Technical Information of China (English)

    Hao Dingjun(郝定均); Zheng Yonghong(郑永宏); Yuan Fuyong(袁福镛); He Liming; Wang Rong; Yuan Yong

    2004-01-01

    Objective: To observe the clinical efficacy of the embryonic spinal cellular transplantation and greater omental transposition for treatment of the spinal cord injury in 24 mongrel dogs. Methods: 24 adult mongrel dogs, weighing 10 ~ 13kg,bryonic spinal cellular transplantation and greater omental transposition group (group D). Each group consisted of 6 dogs. SEP(somatosensory evoked potential) and MEP (motor evoked potential) of the spinal cord were examed prior to the spinal cord injury and 2 months after the treatment to observe the changes of the animals' behavior. All dogs were killed 2 months after surgery and the spinal cord sections were obtained from T12 to L1 level for pathological analysis and observation under the electron microscope.Results: There was an obvious difference in the spinal somatosensory evoked potential and the motor evoked potential between the group D and the other three groups (group A, B, and C). Recovery of the behavior was noted. The spinal cells had survived for two months following the transplantation. Conclusion: Transplantation of the embryonic spinal cell and greater omentum for treatment of the spinal cord injury in dogs can gain a better outcome than the other groups in behavior and spinal somatosensory and motor evoked potential, but the further study is still essential to confirm its clinical efficacy.

  5. Primary health care accessibility challenges in remote indigenous communities in Canada's North

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    Tim Michiel Oosterveer

    2015-10-01

    Full Text Available Background: Despite many improvements, health disparities between indigenous and non-indigenous populations in Canada's North persist. While a strong primary health care (PHC system improves the health of a population, the majority of indigenous communities are very remote, and their access to PHC services is likely reduced. Understanding the challenges in accessing PHC services in these communities is necessary to improve the health of the population. Objective: The objective of the study was to document and analyze the challenges in accessing PHC services by indigenous people in remote communities in Canada's Northwest Territories (NWT from the perspectives of users and providers of PHC services. Methods: Using explorative, qualitative methods, our study involved 14 semi-structured interviews with PHC service providers (SPs and service users (SUs in 5 communities across the NWT which varied according to population, remoteness, ethnic composition and health care resources. The interview guide was developed after key informant consultations. Results: Both SPs and SUs understood the constraints in providing equitable access to PHC services in remote communities. The provision of emergency care was found to be particularly challenging, because of the lack of qualified staff in the community and the dependence on aeromedical evacuations. Wider dissemination of first aid skills among community members was seen to cover some gaps and also increase self-confidence. For non-emergency care, the need to travel outside the community was generally disliked. All recognized the need for more preventive services which were often postponed or delayed because of the overwhelming demand for acute care. As long as services were provided in a community, the satisfaction was high among SUs. SPs appreciated the orientation they received and the ability to build rapport with the community. Conclusions: Northern SUs and SPs generally acknowledge the health

  6. Opportunities and challenges of clinical trials in cardiology using composite primary endpoints

    Institute of Scientific and Technical Information of China (English)

    Geraldine; Rauch; Bernhard; Rauch; Svenja; Schüler; Meinhard; Kieser

    2015-01-01

    In clinical trials, the primary efficacy endpoint often corresponds to a so-called "composite endpoint". Composite endpoints combine several events of interest within a single outcome variable. Thereby it is intended to enlarge the expected effect size and thereby increase the power of the study. However, composite endpoints also come along with serious challenges and problems. On the one hand, composite endpoints may lead to difficulties during the planning phase of a trial with respect to the sample size calculation, asthe expected clinical effect of an intervention on the composite endpoint depends on the effects on its single components and their correlations. This may lead to wrong assumptions on the sample size needed. Too optimistic assumptions on the expected effect may lead to an underpowered of the trial, whereas a too conservatively estimated effect results in an unnecessarily high sample size. On the other hand, the interpretation of composite endpoints may be difficult, as the observed effect of the composite does not necessarily reflect the effects of the single components. Therefore the demonstration of the clinical efficacy of a new intervention by exclusively evaluating the composite endpoint may be misleading. The present paper summarizes results and recommendations of the latest research addressing the above mentioned problems in the planning, analysis and interpretation of clinical trials with composite endpoints, thereby providing a practical guidance for users.

  7. Effect of foods and drinks on primary tooth enamel after erosive challenge with hydrochloric acid

    Directory of Open Access Journals (Sweden)

    Késsia Suênia Fidelis de MESQUITA-GUIMARÃES

    2015-01-01

    Full Text Available The aim of this study was to evaluate the effect of industrialised foods and drinks on primary tooth enamel previously eroded with hydrochloric acid (HCl. The crowns of one hundred two specimens were subjected to an erosive challenge with HCl and randomly divided into six groups (n = 17: Chocolate Milk (Toddynho® - Pepsico - negative control; Petit Suisse Yogurt (Danoninho® - Danone; Strawberry Yogurt (Vigor; Apple puree (Nestlé; Fermented Milk (Yakult® - Yakult; and Home Squeezed Style Orange Juice (del Valle - positive control. The 28-day immersion cycles for the test products were performed twice daily and were interspersed with exposure of the test substrate to artificial saliva. Measurements of enamel surface microhardness (SMH were performed initially, after immersion in HCl and at 7, 14, 21 and 28 days of experimentation. A two-way ANOVA, according to a split-plot design, followed by the sum of squares decomposition and Tukey’s test, revealed a significant effect for the interaction between Foods and Drinks and Length of Exposure (p < 0.00001. Orange juice resulted in greater mineral loss of enamel after 28 days. None of the test products was associated with recovery of tooth enamel microhardness.

  8. Challenge of Primary Voltage Control in Large Scale Wind Integrated Power System: A Danish Power System Case Study

    DEFF Research Database (Denmark)

    Rather, Zakir Hussain; Chen, Zhe; Thøgersen, Paul

    2013-01-01

    Grid integration of Renewable Energy (RE) at large scale poses vast majority of challenges to secure and stable operation of Power System. This paper presents the challenge of short circuit power and primary voltage control of wind integrated power system where majority of conventional generators...... are replaced by wind generators. The impact of large scale wind integration on fast reactive power support is studied in this paper. Considering both technical and economic aspects, alternatives to address the challenge of dynamic voltage support have also been demonstrated in this paper. A case study...

  9. The Challenges of Implementing Group Work in Primary School Classrooms and Including Pupils with Special Educational Needs

    Science.gov (United States)

    Baines, Ed; Blatchford, Peter; Webster, Rob

    2015-01-01

    Findings from two studies are discussed in relation to the experiences and challenges faced by teachers trying to implement effective group work in schools and classrooms and to reflect on the lessons learnt about how to involve pupils with special educational needs (SEN). The first study reports on UK primary school teachers' experiences of…

  10. Industrial hazardous waste management in Turkey: Current state of the field and primary challenges

    International Nuclear Information System (INIS)

    A holistic evaluation of a country's hazardous waste management (HWM) practices is useful in identifying the necessary actions to focus on. Based on an analysis of industrial hazardous waste (HW) generation in Turkey, this paper attempts to critically evaluate and report current Turkish HWM practices and discuss the primary challenges to be addressed. The generation of industrial HW for Turkey reported in 2004 was 1.195 million tons, which accounted for 7% of the total industrial solid waste (ISW) generated by the manufacturing industry, and for nearly 4.9% of the total solid waste generated in the country. The HW generated by the top five manufacturing product categories - basic metals, chemicals and chemical products, food and beverages, coke and refined petroleum, motor vehicles and trailers - accounted for 89.0% of total industrial HW. 21% of the HW generated in 2004 was recycled or reused, and 6% was sold or donated, whereas 73% was sent to ultimate disposal. 67% of the HW sent to ultimate disposal was disposed of at municipal landfills. The total capacity of the existing regional HW facilities is 212,500 tons/year, which accounts for about 24% of the HW to be disposed. Turkey has identified the HW problem in the country and enacted legislation, designated a lead agency, and promulgated rules and regulations. Several new initiatives are planned for improving HW management nationally; however, some HWM problems will be persistent due to previous and existing industrial development plans. These development policies led to the concentration of industry in regions marked by precious agricultural fields and high population density. This occurred because the government previously exhibited a default prioritization towards industrial development, leading to insufficient implementation of regulations on HW generators. Some of the problems may also be rooted in other countries that allow illegal transboundary HW movements despite international regulations.

  11. The use of routinely collected computer data for research in primary care: opportunities and challenges.

    NARCIS (Netherlands)

    Lusignan, S. de; Weel, C. van

    2006-01-01

    INTRODUCTION: Routinely collected primary care data has underpinned research that has helped define primary care as a specialty. In the early years of the discipline, data were collected manually, but digital data collection now makes large volumes of data readily available. Primary care informatics

  12. Primary osteoclast-like giant cell tumor of parotid gland: A rare extraskeletal presentation with diagnostic challenges

    Science.gov (United States)

    Singh, Ritika; Zaheer, Sufian; Mandal, Ashish K

    2016-01-01

    Primary osteoclast-like giant cell tumor (OC-GCT) has been rarely described in extraskeletal sites. The diagnosis primarily hinges on the detection of giant cells. However, these giant cells are also seen in many giant cell lesions, thus creating diagnostic confusion and dilemma. Here, we describe a rare case of a 24-year-old male with primary extraskeletal, OC-GCT presenting as a swelling in the right parotid region and highlight its cytological, histological and immunohistochemical characteristics with diagnostic challenges. PMID:27601838

  13. Pedicle omental graft created by laparoscopic surgery for filling a radiation-induced ulcer in a woman with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ida, Katsuya [Kosai General Hospital, Shizuoka (Japan)

    2002-06-01

    In patients with advanced or recurrent breast cancer, it is difficult to reconstruct chest wall ulcers due to postoperative irradiation, which is often infected. We present a laparoscopic technique for creating and mobilizing an omental flap. A 63-year-old woman diagnosed with parasternal lymph node metastases from left breast cancer 11 months after standard radical mastectomy underwent lymph node resection with radiation therapy. She developed ulceration of the irradiated chest wall 3 years and 10 months later. An omental flap obtained by laparoscopy was used to fill the space after the radiation-induced ulcer was resected and covered with a free skin graft. The skin graft adapted to the omentum. This laparoscopic procedure is more cosmetrically acceptable and less invasive than laparotomy in obtaining the omentum while yielding equivalent results in chest wall reconstruction. (author)

  14. Laparoscopic versus Open Omental Patch Repair for Early Presentation of Perforated Peptic Ulcer: Matched Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Daniel Jin Keat Lee

    2016-01-01

    Full Text Available Introduction. The aim of this study was to compare the outcomes between laparoscopic and open omental patch repair (LOPR versus OR in patients with similar presentation of perforated peptic ulcer (PPU. The secondary aim was to evaluate the outcomes according to the severity of peritonitis. Methods. All patients who underwent omental patch repair at two university-affiliated institutes between January 2010 and December 2014 were reviewed. Matched cohort between LOPR and OR groups was achieved by only including patients that had ulcer perforation 21, LOPR is also shown to benefit, particularly resulting in significant shorter LOS (4 days versus 11 days, p<0.01. Conclusion. LOPR offers improved short-term outcomes in patients who present within 48 hours and with perforation size <2 cm. LOPR also proved to be more beneficial in high MPI cases.

  15. Refugee Children in South Africa: Access and Challenges to Achieving Universal Primary Education

    Science.gov (United States)

    Meda, L.; Sookrajh, R.; Maharaj, B.

    2012-01-01

    This paper questions whether the second Millennium Development Goal of achieving universal primary education targets by 2015 for all children to complete a full course of primary schooling, can be realised. A key contention of this paper is that this forecast is far-fetched when we take into cognizance refugee children's accessibility to…

  16. A rare cause of bleeding after laparoscopic sleeve gastrectomy : pseudo-aneurysm of the gastro-omental artery.

    Science.gov (United States)

    Mege, D; Louis, G; Berthet, B

    2013-01-01

    A serious complication of laparoscopic sleeve gastrectomy (LSG) is bleeding that is primarily located along the staples lines. Bleeding may be due to several causes, including hematomas, trocar sites, or visceral pseudo-aneurysms. We reported here a case of bleeding related to a pseudo-aneurysm of the gastro-omental artery. An LSG was performed on a 43-year-old woman (BMI = 46 kg/m2) without apparent surgical complications. Fifteen days later, she was admitted to the emergency department for hematemesis and symptoms of hemorrhagic shock. Abdominal computed tomography angiography revealed blood in the stomach, without a digestive leak, and active bleeding from a pseudo-aneurysm of the gastro-omental artery. An arterial embolisation was performed with the sandwich technique and angiographic guide wires and the placement of several detachable coils. The patient was discharged two days later. We demonstrated for the first time that post-LSG bleeding may involve a pseudo-aneurysm of the gastro-omental artery.

  17. Role of the Use of Omental Flap in Prognosis of Cases with Induced Acute Pancreatitis in Experimental Dogs

    Directory of Open Access Journals (Sweden)

    Mohamed Hassan

    2016-03-01

    Full Text Available Aim Acute pancreatitis frequently involves peripancreatic tissues and remote organ systems resulting in severe complications and high risk of mortality. Therefore, the present study was carried out to assess the effect of omental flap as a new treatment of acute pancreatitis. Methods Ten mongrel dogs with experimentally induced acute pancreatitis were randomly divided into two equal groups; treated and control groups. The pancreas was wrapped with omental flap in the treated group and the pancreas was left without treatment in control group. Urea, Creatinine, lactate dehydrogenase, serum Amylase, Ca, and C-reactive protein were measured in all dogs before surgery and 2 hours, 3 days, 7 days, and 4 weeks post-surgery. Weekly ultrasound examination was performed post-surgery. Exploratory laparotomy was carried out 45 days post-surgery, all findings were reported and pancreatic biopsies were collected and prepared for histopathological examination using Schmidt Scoring system. Data were displayed as the mean ± SD and SPSS was used. Statistical significance (at P < 0.05 was calculated by χ2 test. Results There was a significant difference between the two groups in favor of the treated group as regards levels of lactate dehydrogenase, ultrasonographic findings, pathological findings and Schmidt scoring. Conclusion Omental flap can be used as a new minimally invasive effective technique for treatment of acute pancreatitis.

  18. Challenges in participatory primary stress management interventions in knowledge intensive SMEs

    DEFF Research Database (Denmark)

    Gish, Liv; Ipsen, Christine

    2013-01-01

    While knowledge intensive SMEs have recognized the need for change with respect to productivity and wellbeing, and to some extend have access to tools and methods for enabling this, they still lack process competences and are uncertain about how to approach primary stress interventions and initiate...... relevant change processes. This paper presents the outline of our research and development project on participatory primary stress management interventions in knowledge intensive SMEs, as well as the preliminary results and related implications. The research and development project is conducted in order...... to develop an operational model which SMEs can use when they want to initiate participatory primary stress management interventions in their company. The development project builds on a process model for participatory primary interventions in larger knowledge intensive companies and the premises behind...

  19. The challenges of boundary spanners in supporting inter-organizational collaboration in primary care

    DEFF Research Database (Denmark)

    Kousgaard, Marius Brostrøm; Joensen, Anne Sofie Kjær; Thorsen, Thorkil

    2015-01-01

    Background: The visions of more integrated care have created new roles and accountabilities for organizationsand professionals. Thus, professionals are increasingly expected to engage in boundary spanning activities in order to facilitate inter-organizational and inter-sectoral collaboration....... However, this task can be difficult for individual actors and it is important to investigate the work and challenges of boundary spanners in various settings. This study explores the challenges related to a new boundary spanning role for general practitioners employed to facilitate collaboration between...... and distinct categories covering the different types of challenges experienced by the informants. Results: The main challenges of the general practitioners acting as boundary spanners were: 1) defining and negotiating the role in terms of tasks and competencies; 2) representing and mobilizing colleagues...

  20. The interface between primary health care and population health: challenges and opportunities for prevention.

    Science.gov (United States)

    Harris, Mark

    2016-01-01

    Primary health care has the potential to contribute to population health at the individual and population levels. The '5As' (ask, assess, advise/agree, assist and arrange) provide a framework to realise this potential, especially for disadvantaged and vulnerable populations, not only by better organising multidisciplinary preventive interventions within primary health care, but also by linking these interventions with more intensive community and population programs and services, especially for patients with low health literacy. This requires changes to information systems to prompt and record preventive care, work with practices to engage a range of disciplines, including practice nurses, and development of effective linkages with other services in the local community. This has important implications for the newly established Primary Health Networks in supporting improvement within primary care, and creating linkages and partnerships with a range of organisations involved in delivering preventive interventions in the community. However, prevention in primary health care needs to be underpinned by funding systems that support multidisciplinary and preventive care for a population, rather than simply reactive, episode-based care. PMID:26863164

  1. Proactive and integrated primary care for frail older people: design and methodological challenges of the Utrecht primary care PROactive frailty intervention trial (U-PROFIT

    Directory of Open Access Journals (Sweden)

    Bleijenberg Nienke

    2012-04-01

    Full Text Available Abstract Background Currently, primary care for frail older people is reactive, time consuming and does not meet patients' needs. A transition is needed towards proactive and integrated care, so that daily functioning and a good quality of life can be preserved. To work towards these goals, two interventions were developed to enhance the care of frail older patients in general practice: a screening and monitoring intervention using routine healthcare data (U-PRIM and a nurse-led multidisciplinary intervention program (U-CARE. The U-PROFIT trial was designed to evaluate the effectiveness of these interventions. The aim of this paper is to describe the U-PROFIT trial design and to discuss methodological issues and challenges. Methods/Design The effectiveness of U-PRIM and U-CARE is being tested in a three-armed, cluster randomized trial in 58 general practices in the Netherlands, with approximately 5000 elderly individuals expected to participate. The primary outcome is the effect on activities of daily living as measured with the Katz ADL index. Secondary outcomes are quality of life, mortality, nursing home admission, emergency department and out-of-hours General Practice (GP, surgery visits, and caregiver burden. Discussion In a large, pragmatic trial conducted in daily clinical practice with frail older patients, several challenges and methodological issues will occur. Recruitment and retention of patients and feasibility of the interventions are important issues. To enable broad generalizability of results, careful choices of the design and outcome measures are required. Taking this into account, the U-PROFIT trial aims to provide robust evidence for a structured and integrated approach to provide care for frail older people in primary care. Trial registration NTR2288

  2. Women as primary caregivers in Mexico: challenges to well-being.

    Science.gov (United States)

    DiGirolamo, Ann M; Salgado de Snyder, Nelly

    2008-01-01

    The purpose of this contribution is to review the peer reviewed literature from the last 20 years regarding the role of Mexican women in the family, and to describe the psychosocial and health challenges they face. We analyze the current problems and recent improvements in three areas: reproductive health, nutrition, and mental health, and we discuss how the role of caregiver may influence or be influenced by these health issues. We emphasize the cultural context, women's role as caregivers, the challenges they face, and the strength and resilience these women exhibit. We conclude that it is imperative that we modify the way in which Mexican women's needs are assessed, interpreted, and confronted, along with a definite need for concrete proposals that take into account both women's challenges and strengths, and the cultural context and national reality.

  3. Primary serous papillary carcinoma of the peritoneum : a case report

    International Nuclear Information System (INIS)

    Primary serous papillary carcinoma of the peritoneum is a rare neoplasm arising from the mesothelium. Histologically it is indistinguishable from ovarian serous papillary carcinoma, but it should be free of tumor or involved only superficially with the ovary. Radiologically its common findings are peritoneal and omental masses with ascites, and it is indistinguishable from peritoneal carcinomatosis or malignant mesothelioma. We report a case of surgically proven primary serous papillary carcinoma of the peritoneum in a 63-year-old woman

  4. Simple esophageal hiatus omental herina%单纯食管裂孔网膜疝

    Institute of Scientific and Technical Information of China (English)

    葛青松; 黄虹; 曹和涛; 吴献华; 王鸿帼

    2014-01-01

    Objective To discusses the characteristic MSCT findings of simple esophageal hiatus omental hernia (SE-HOH) .Methods Prospective study was made on 7 cases of SEHOH confirmed by surgery ,all patients were examined by plain and enhanced MSCT scan to make MPR and MIP with sub-millimeter data .Results All 7 cases showed sizes of a pure fat vascular sac above the diaphragmatic esophageal hiatus (EH) on a cross-sectional image ,among which 3 cases presented oval and 3 presented similar round in shape ,1 case showed lobulated ;Most of them located at the right front side of esophagus .On sagittal images ,the sac all displayed casting fat density shadow at postcordial ,and the morphology of the sac raged from half or triangle in the middle of the sagittal image to that of triangle or semicircle in the parasagittal planar ;In the coronal planar images ,the sac displayed oval in 3 cases ,pear-shaped upside-down in 1 case and lobulated in 1 case ,The bottom of the pure fat vascular sac that presented narrow neck shape connected with abdominal omental fat , and the diaphragmatic esophageal membrane that was shoved off in the upper polar of the pure fat vascular sac linked with the esophageal then formed an angle .The whole 7 cases of MIP images showed that the trunk of GLA was stiff on MIP , and it passed through EH with a symmetric "∩"near the esophagus branch .Gastro-esophageal connections were all loca-ted under the diaphragm .Conclusion The following findings are characteristically presents of SEHOH ,which are of great importance to imaging diagnosis of SEHOH :the expansablity ,morphological plasticity ,closed to the esophagus and con-nected to the abdominal omental of the pure fat vascular sac ,and stiff of the trunk of GLA ,and it passes through EH near the esophagus branch with a symmetric "∩".%目的:探讨单纯食管裂孔网膜疝(simple esophageal hiatus omental hernia ,SEHOH)的MSCT影像特点。方法回顾性分析7例手术证实的SEHOH ,均

  5. Characterization and comparison of adipose tissue-derived cells from human subcutaneous and omental adipose tissues.

    Science.gov (United States)

    Toyoda, Mito; Matsubara, Yoshinori; Lin, Konghua; Sugimachi, Keizou; Furue, Masutaka

    2009-10-01

    Different fat depots contribute differently to disease and function. These differences may be due to the regional variation in cell types and inherent properties of fat cell progenitors. To address the differences of cell types in the adipose tissue from different depots, the phenotypes of freshly isolated adipose tissue-derived cells (ATDCs) from subcutaneous (SC) and omental (OM) adipose tissues were compared using flow cytometry. Our results showed that CD31(-)CD34(+)CD45(-)CD90(-)CD105(-)CD146(+) population, containing vascular smooth muscle cells and pericytes, was specifically defined in the SC adipose tissue while no such population was observed in OM adipose tissue. On the other hand, CD31(-)CD34(+)CD45(-)CD90(-)CD105(-)CD146(-) population, which is an undefined cell population, were found solely in OM adipose tissue. Overall, the SC adipose tissue contained more ATDCs than OM adipose tissue, while OM adipose tissue contained more blood-derived cells. Regarding to the inherent properties of fat cell progenitors from the two depots, adipose-derived stem cells (ADSCs) from SC had higher capacity to differentiate into both adipogenic and osteogenic lineages than those from OM, regardless of that the proliferation rates of ADSCs from both depots were similar. The higher differentiation capacity of ADSCs from SC adipose tissue suggests that SC tissue is more suitable cell source for regenerative medicine than OM adipose tissue.

  6. Unique transcriptomic signature of omental adipose tissue in Ossabaw swine: a model of childhood obesity.

    Science.gov (United States)

    Toedebusch, Ryan G; Roberts, Michael D; Wells, Kevin D; Company, Joseph M; Kanosky, Kayla M; Padilla, Jaume; Jenkins, Nathan T; Perfield, James W; Ibdah, Jamal A; Booth, Frank W; Rector, R Scott

    2014-05-15

    To better understand the impact of childhood obesity on intra-abdominal adipose tissue phenotype, a complete transcriptomic analysis using deep RNA-sequencing (RNA-seq) was performed on omental adipose tissue (OMAT) obtained from lean and Western diet-induced obese juvenile Ossabaw swine. Obese animals had 88% greater body mass, 49% greater body fat content, and a 60% increase in OMAT adipocyte area (all P development, 2) cellular function and maintenance, and 3) connective tissue development and function, while transcripts associated with RNA posttranslational modification, lipid metabolism, and small molecule biochemistry were reduced. DAVID and Gene Ontology analyses showed that many of the classically recognized gene pathways associated with adipose tissue dysfunction in obese adults including hypoxia, inflammation, angiogenesis were not altered in OMAT in our model. The current study indicates that obesity in juvenile Ossabaw swine is characterized by increases in overall OMAT transcript number and provides novel data describing early transcriptomic alterations that occur in response to excess caloric intake in visceral adipose tissue in a pig model of childhood obesity.

  7. Challenges in preventing cardiovascular complications in type 2 diabetes in primary care

    NARCIS (Netherlands)

    Ubink-Veltmaat, L.J.; Bilo, H.J.; Groenier, K.H.; Rischen, R.O.; Meyboom-de Jong, B.

    2005-01-01

    BACKGROUND: Prevalence of type 2 diabetes mellitus (DM2) continues to increase worldwide. The associated cardiovascular morbidity and mortality are high. OBJECTIVES: To study daily practice in preventing cardiovascular disease (CVD) in an unselected primary care patient population with DM2, and to s

  8. Environmental Education in Serbian Primary Schools: Challenges and Changes in Curriculum, Pedagogy, and Teacher Training

    Science.gov (United States)

    Stanišic, Jelena; Maksic, Slavica

    2014-01-01

    The protection of human health and the preservation of the environment are topics that form an integral part of the primary school curriculum in Serbia. However, research studies have shown that students do not have enough knowledge to contribute to the development of a healthy lifestyle and environmental awareness. The latest changes in school…

  9. Integration of mental health into primary health care in Uganda: opportunities and challenges

    OpenAIRE

    Kigozi, Fred N.; Ssebunnya, Joshua

    2009-01-01

    Background Worldwide, a number of reforms have been undertaken with the intention of improving access to mental health services. Notable among these is the integration of mental health services into primary health care, which has been one of the most fundamental healthcare reform recommendations globally.

  10. The "Curriculum Challenge": Moving towards the "Storyline" Approach in a Case Study Urban Primary School

    Science.gov (United States)

    Nuttall, Amanda

    2016-01-01

    This article draws on an inquiry into the design and implementation of the curriculum in a case study urban primary school in the north of England. In response to the introduction of the revised National Curriculum in September 2014, teachers and the school head engaged in a critical discourse around their perceptions of students' attainment and…

  11. Educational Support for Orphans and Vulnerable Children in Primary Schools: Challenges and Interventions

    Science.gov (United States)

    Mwoma, Teresa; Pillay, Jace

    2016-01-01

    Educational status is an important indicator of children's wellbeing and future life opportunities. It can predict growth potential and economic viability of a state. While this is an ideal situation for all children, the case may be different for orphans and vulnerable children (OVC) due to the challenges they go through on a daily basis. This…

  12. Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges.

    Science.gov (United States)

    Siddiqui, Ruqaiyyah; Khan, Naveed Ahmed

    2014-08-01

    First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France). A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries.

  13. Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges.

    Directory of Open Access Journals (Sweden)

    Ruqaiyyah Siddiqui

    2014-08-01

    Full Text Available First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France. A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries.

  14. Primary Amoebic Meningoencephalitis Caused by Naegleria fowleri: An Old Enemy Presenting New Challenges

    Science.gov (United States)

    Siddiqui, Ruqaiyyah; Khan, Naveed Ahmed

    2014-01-01

    First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France). A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries. PMID:25121759

  15. Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges.

    OpenAIRE

    Ruqaiyyah Siddiqui; Naveed Ahmed Khan

    2014-01-01

    First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France). A large number of cases in developing countries go unnoticed. In particular...

  16. Patient-centred interprofessional collaboration in primary care: challenges for clinical, educational and health services research. An EGPRN keynote paper.

    Science.gov (United States)

    Van Royen, Paul; Rees, Charlotte E; Groenewegen, Peter

    2014-12-01

    The theme 'patient-centred interprofessional collaboration' of the EGPRN conference in October 2012, captures in just three words important challenges for European primary care and its research agenda. Challenges for future research are formulated, in three domains: clinical, educational and health services research. Transferability of research, based upon advanced computational infrastructure, will facilitate a rapid learning health care system. In educational research, this includes the use of observational and reflexivity methods. Outcomes should be defined in terms of improvement of functional status and social participation rather than in terms of disease-specific outcomes. Partnership with all stakeholders, patients, GPs and their health care colleagues and students, can help in reducing avoidable waste in the production and reporting of research evidence.

  17. Studies on herd-immunity and primary versus secondary infection of VHSV in challenge and vaccination trials with rainbow trout

    DEFF Research Database (Denmark)

    Lorenzen, Ellen; Kjær, Torben Egil; Lorenzen, Niels

    Abstract for Scofda meeting 4-5.11.09 Studies on herd-immunity effect and primary versus secondary infection of VHSV by Ellen Lorenzen, Torben Eigil Kjær & Niels Lorenzen, National Veterinary Laboratory, Århus The phenomenon of “herd-immunity” is one of the basal principles behind vaccination...... interpreted this as an effect of herd-immunity, where the vaccinated fish protected the naïve fish, probably by secreting less virus compared to the naïve fish. We tried to demonstrate this phenomenon in 3 later experiments, but without success, probably due to a too high challenge load in relation...

  18. Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study.

    Science.gov (United States)

    Asselin, J; Osunlana, A M; Ogunleye, A A; Sharma, A M; Campbell-Scherer, D

    2016-04-01

    Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams. PMID:26815638

  19. Primary Musculoskeletal Hydatid Cyst of the Thigh: Diagnostic and Curative Challenge for an Unusual Localization

    Directory of Open Access Journals (Sweden)

    Nicolas Argy

    2013-01-01

    Full Text Available Primary muscular echinococcosis is an uncommon localization of hydatid cysts. The nonspecific clinical presentation and possible post-therapeutic complications lead to problems for the diagnosis of this infection and the support of the patient. The authors describe an unusual case of double hydatid cyst of the vastus intermedius muscle. After a precise preoperative evaluation based on clinical, radiological and biological examinations, a surgical excision by pericystectomy combined with perioperative chemotherapy enabled the authors to treat the patient and to prevent postoperative complications. The diagnostic tools and the treatment of this particular type of echinococcosis are discussed.

  20. Evaluability of the Program to Value Primary Healthcare Professionals (PROVAB): management challenges.

    Science.gov (United States)

    Oliveira, Catia Martins; Cruz, Marly Marques da; Kanso, Solange; Reis, Ana Cristina; Lima, Antônio; Torres, Raquel Maria Cardoso; Gonçalves, Aline Leal; Carvalho, Silvia Cristina de; Grabois, Victor

    2015-10-01

    The objective of this article is to present the results of a study on the evaluability of the Program to Value Primary Healthcare Professionals (PROVAB in the Portuguese) that was created by the Brazilian Ministry of Health in 2011. The Program is part of the Manage Healthcare Work and Educationstrategy which seeks to invest in a number of measures aimed at improving and valuing the work carried out by primary healthcare teams. The research, which used qualitative methods, was carried out between February and November 2013 and involved five stages: (a) analysis of documents; (b) identification of potential users; (c) strategic analysis; (d) modelling of the intervention; (e) sharing of lessons learned. Data collection took place in three iterative phases: document analysis, key informant interviews and a workshop. The activities of the program were grouped into three areas: functional and working conditions, teaching/learning and management. The results showed that the program can be evaluated, since it was possible to specify its feasibility by means of a logical model. The potential and priority areas were mapped for future evaluations, whose central focus is to address the problem of unequal distribution of Brazilian health professionals.

  1. Hepatocellular Carcinoma with Blood Supply from Parasitized Omental Artery: Angiographic Appearance And Chemoembolization

    Institute of Scientific and Technical Information of China (English)

    Song Gao; Ren-jie Yang; Jia-hong Dong

    2012-01-01

    Objective:To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA),and evaluate the technical feasibility,safety and therapeutic efficacy of chemoembolization via the POAs.Methods:A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively.The evaluated indexes included the incidence rate of POAs,success rate of superselective catheterization,post-reaction after chemoembolization,and the cumulative survival rates.Results:Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures,and 32 patients with POAs were enrolled,with 97 POAs found in 76 angiography procedures,giving an incidence rate of 2.09%.POA was observed mostly at the right lobe and left medial lobe except the segment Ⅱ,and 62 POAs underwent superselective catheterization with microcatheter,giving a success rate of 63.9%.The angiographic appearance was:(1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11),displaced due to tumor's oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7).In 19 patients,chemoembolization via POAs was performed successfully (A group),while the remaining 13 patients failed (B group).Except 1 acute edema pancreatitis case,no serious complication was recorded.The cumulative survival rates of 6-,12-,18-and 24-month were 78.9%,47.4%,31.6% and 21.1% respectively for A group; correspondingly,61.5%,30.g%,15.4% and 7.7%% for B group,in which 2 patients died of ruptured HCC.Conclusion:Chemoembolization with microcatheter via POAs is a relatively safe,feasible and valuable method.

  2. Colgajo de omento para tratamiento de dehiscencia de herida esternal Omental flap for management of sternal wound dehiscence

    Directory of Open Access Journals (Sweden)

    A. Pérez García

    2013-03-01

    Full Text Available La mediastinitis es una de las complicaciones más graves de la cirugía cardíaca. Aparece en el 0,5-5 % de las esternotomías y esta incidencia es mucho mayor en pacientes diabéticos, obesos, inmunodeprimidos, con enfermedad pulmonar obstructiva crónica (EPOC, etc. Presentamos el caso de una paciente diabética, obesa mórbida, que sufre mediastinitis tras doble by-pass coronario. Para la cobertura del defecto se empleó un colgajo de epiplon tunelizado transdiafragmático. El colgajo omental permite cubrir grandes defectos además de que posee capacidad antimicrobiana y favorece la revascularización tisular. Las características de este colgajo hacen que actualmente deba considerarse como primera elección en pacientes con grandes defectos esternales y trastornos de la inmunidad y la cicatrización.Mediastinitis is one of the most serious complications from cardiac surgery. It is reported to occur in 0'5-5 % of sternotomy incisions, and this incidence is much higher in diabetic patients, obese, immunocompromised, COPD, etc. We report a case of a diabetic and morbid obese woman suffering mediastinitis after double coronary bypass surgery. For the reconstruction a transdiaphragmatic tunnelled omental flap was used. The omentum is useful to cover large defects. It has antiinfective properties and promotes revascularization of neighbouring tissues. Omental flap can be a highly effective treatment for patients with large sternal wounds and immune disorders and wound healing disorders.

  3. Orphan drugs in development for primary biliary cirrhosis: challenges and progress

    Directory of Open Access Journals (Sweden)

    Ali AH

    2015-09-01

    Full Text Available Ahmad H Ali,1 Thomas J Byrne,1 Keith D Lindor1,21Division of Gastroenterology and Hepatology, Mayo Clinic, 2College of Health Solutions, Arizona State University, Phoenix, AZ, USAAbstract: Primary biliary cirrhosis (PBC is a chronic progressive liver disease that often leads to fibrosis, cirrhosis, and end-stage liver disease. The diagnosis is made when there is evidence of cholestasis and reactivity to the antimitochondrial antibody. The etiology of PBC is poorly understood; however, several lines of evidence suggest an environmental factor that triggers a series of immune-mediated inflammatory reactions in the bile ducts in a genetically susceptible individual. Fatigue and pruritus are the most common symptoms of PBC; however, many patients are diagnosed with PBC only based on laboratory abnormalities. The only pharmacological treatment approved for PBC is ursodeoxycholic acid (UDCA. Several controlled studies have shown that UDCA improves liver biochemistries and prolongs transplant-free survival in PBC patients. Nearly 40% of PBC patients do not respond to UDCA, and those patients are at high risk of serious adverse events, such as the development of liver failure. Therefore, newer alternative therapeutic options for PBC are needed. Obeticholic acid is a first-in-class farnesoid X receptor agonist that has been recently evaluated in PBC patients with inadequate response to UDCA, and demonstrated beneficial results in improving liver biochemistries. Several other agents (fibrates and glucocorticoids have been previously examined in PBC patients with inadequate response to UDCA, and preliminary results showed biochemical improvement. However, large-scale controlled clinical trials are needed to determine the long-term effects of fibrates and glucocorticoids on the clinical outcomes of PBC. Clinical trials of NGM282 (a fibroblast growth factor-19 analog and Abatacept (a fusion protein composed of the Fc portion of immunoglobulin G1 fused to

  4. Segmental omental infarction in childhood: an unusual case of left-sided location with extension into the pelvis

    International Nuclear Information System (INIS)

    Segmental omental infarction (OI) is a rare cause of abdominal pain in children. It generally occurs in the right lower and upper quadrants of the abdomen and only a few cases of other locations have been described in adults. We report a unique paediatric case of OI with an unusual left-sided location extending into the pelvis in a 6-year-old non-obese girl. The diagnosis was suspected on US and CT based on imaging patterns previously described in adults and children. Laparoscopic resection should be balanced with nonsurgical management. (orig.)

  5. In vitro modeling of host-parasite interactions: the 'subgingival' biofilm challenge of primary human epithelial cells

    Directory of Open Access Journals (Sweden)

    Thurnheer Thomas

    2009-12-01

    Full Text Available Abstract Background Microbial biofilms are known to cause an increasing number of chronic inflammatory and infectious conditions. A classical example is chronic periodontal disease, a condition initiated by the subgingival dental plaque biofilm on gingival epithelial tissues. We describe here a new model that permits the examination of interactions between the bacterial biofilm and host cells in general. We use primary human gingival epithelial cells (HGEC and an in vitro grown biofilm, comprising nine frequently studied and representative subgingival plaque bacteria. Results We describe the growth of a mature 'subgingival' in vitro biofilm, its composition during development, its ability to adapt to aerobic conditions and how we expose in vitro a HGEC monolayer to this biofilm. Challenging the host derived HGEC with the biofilm invoked apoptosis in the epithelial cells, triggered release of pro-inflammatory cytokines and in parallel induced rapid degradation of the cytokines by biofilm-generated enzymes. Conclusion We developed an experimental in vitro model to study processes taking place in the gingival crevice during the initiation of inflammation. The new model takes into account that the microbial challenge derives from a biofilm community and not from planktonically cultured bacterial strains. It will facilitate easily the introduction of additional host cells such as neutrophils for future biofilm:host cell challenge studies. Our methodology may generate particular interest, as it should be widely applicable to other biofilm-related chronic inflammatory diseases.

  6. Effect of the CGRP receptor antagonist BIBN4096BS in human cerebral, coronary and omental arteries and in SK-N-MC cells

    DEFF Research Database (Denmark)

    Edvinsson, Lars; Alm, Rikard; Shaw, Duncan;

    2002-01-01

    , coronary, and omental arteries were studied with a sensitive myograph technique. CGRP induced a concentration-dependent relaxation that was antagonized by both CGRP-(8-37) and BIBN4096BS in a competitive manner. CGRP was a weaker agonist on coronary arteries as compared to intracranial arteries; however......, BIBN4096BS was an equally effective antagonist. In human omental arteries, CGRP did not induce relaxation. BIBN4096 had a pA(2) value of 10.1 in cerebral and 10.4 in coronary arteries. The results of clinical trials with BIBN4096BS for acute migraine attacks are awaited with great interest....

  7. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider

    Directory of Open Access Journals (Sweden)

    Nidhi Mehrotra

    2011-02-01

    Full Text Available Ware G Kuschner, Sunayana Reddy, Nidhi Mehrotra, Harman S PaintalDivision of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USAAbstract: Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1 the emergence of a novel nicotine delivery system known as the electronic (e- cigarette; and 2 new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS. The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room

  8. LITERATURE IN PRIMARY AS CURRICULAR AXIS: AN INNOVATION FULL OF CHALLENGES

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    Alexandre Camacho Prats

    2016-07-01

    Full Text Available This paper presents an educational practice based on the implementation of a resource designed and produced ad hoc, by fostering passion for literature in the last year of primary education. Thus, we are able to reach many contents settled in the curricula of Spanish Language, Social Sciences, Natural Sciences and Social and Civic Values, established in the Spanish Education Act 8/2013, of December 9, for improvement of educational quality (commonly known as LOMCE. The evidence we have tested suggests that students feel a special motivation not only to the rich literary elements at our disposal, but also enrich their knowledge and social values in other academic and personal settings. At this point, we believe that this way of working the curriculum in a more interactive way is a great motivator for the assimilation of content from different areas and skills development element, as it is also capable of being applied to a greater or lesser extent curricular areas and other educational realities.

  9. Primary primitive neuroectodermal tumor of kidney: A rare case report with diagnostic challenge

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    Sunita Kakkar

    2014-01-01

    Full Text Available Primary primitive neuroectodermal tumors (PNETs of the kidney are quite rare and can be mistaken for a wide variety of other small round blue cell tumors which includes rhabdomyosarcoma, Wilm′s tumor, carcinoid, neuroblastoma, clear cell sarcoma of the kidney, lymphoma etc. Renal Ewings/PNET can occur in the age group from 4 to 61 years. Approximately, 90% of Ewing sarcoma (ES/PNET have a specific t(11;22 which results in a chimeric EWS-FLI-1 fusion protein. Immunohistochemical for the carboxy-terminus of FLI-1 is sensitive and highly specific for the diagnosis of ES/PNET. Herein, we have an interesting presentation in a 23-year-old male who came with neck pain and progressive quadriparesis and was diagnosed as a case of poorly differentiated malignant tumor with a differential of lymphoma versus metastatic renal cell carcinoma. The patient′s condition deteriorated fast and he had a rapid downhill course. The final diagnosis of Ewings/PNET was confirmed at autopsy.

  10. Endovascular Aortic Repair of Primary Adult Coarctation: Implications and Challenges for Postoperative Nursing.

    Science.gov (United States)

    Sheppard, Christina E; Then, Karen L; Rankin, James A; Appoo, Jehangir J

    2015-01-01

    Endovascular aortic repair is a relatively new surgical technique used to treat a variety of aortic pathologies. Aortic coarctation traditionally has been managed with open surgical repair, involving a large posterolateral thoracotomy, cardiopulmonary bypass, and replacement of the narrowed section of the aorta with a dacron graft. Recent advances in minimally invasive aortic surgery have allowed for repair of the diseased section with an endovascular stent placed percutaneously through the groin under intraoperative fluoroscopic guidance. In this paper, the authors willfocus on the implicationsfor postoperative nursing care after endovascular repair of aortic coarctation using a case study of a 17-year-old male. This novel technique required education of the health care team with respect to implications for practice, understanding potential complications, discharge planning and follow-up. With any new surgical technique there are many questions and challenges that health care professionals raise. The main concerns expressed from the health care team stemmed from a lack of understanding of the disease pathology, and the different risk profile associated with an endovascular repair in contrast to an open repair. The authors will address these concerns in detail.

  11. Cyberbullying and Primary-School Aged Children: The Psychological Literature and the Challenge for Sociology

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    Lesley-Anne Ey

    2015-05-01

    Full Text Available Cyberbullying is an international issue for schools, young people and their families. Whilst many research domains have explored this phenomenon, and bullying more generally, the majority of reported studies appear in the psychological and educational literatures, where bullying, and more recently, cyberbullying has been examined primarily at the individual level: amongst adolescents and young people, with a focus on the definition, its prevalence, behaviours, and impact. There also is growing evidence that younger children are increasingly accessing technology and engaging with social media, yet there is limited research dedicated to this younger age group. The purpose of this paper is to report on a systematic literature review from the psychological and educational research domains related to this younger age group, to inform future research across the disciplines. Younger children require different methods of engagement. This review highlights the methodological challenges associated with this age group present in the psychological literature, and argues for a greater use of sociological, child-centred approaches to data collection. This review examined studies published in English, between 2009 and 2014, and conducted with children aged 5–12 years, about their experiences with cyberbullying. Searches were conducted on seven key databases using keywords associated with cyberbullying and age of children. A Google Scholar search also examined published and unpublished reports. A total of 966 articles and reports were retrieved. A random peer review process was employed to establish inter-rater reliability and veracity of the review. Findings revealed 38 studies reported specifically on children aged 5–12 years. The dominant focus of these articles was on prevalence of cyberbullying, established through survey methodology. Few studies noted impacts, understanding and behaviours or engaged children’s independent voice. This review

  12. Research and Development Projects with ICT and students as learning designers in Primary Schools: A methodological challenge

    DEFF Research Database (Denmark)

    Levinsen, Karin Ellen Tweddell; Sørensen, Birgitte Holm; Tosca, Susana;

    In this paper we present some methodological challenges that emerged during the process of shaping the research design for the comprehensive and complex research project Children as learning designers in a digital school. The project is the realization of our proposal to a research call from...... the use of ICT in the Danish primary school from 2012-2015 combined with an increased focus on fulfilling learning objectives and to build competencies. This effort is on the one side due to a decade of disappointing Danish PISA results regarding reading, writing and math; on the other side due...... the Danish Ministry of Education named Development projects and pilot school experiments (Udviklingsprojekter med demonstrationsskoleforsøg vedr. it i folkeskolen – see Undervisningsministeriet 2013) in the spring 2013. The call was based on a governmental decision to allocate 500 million DKR to increase...

  13. [Primary healthcare: a multidimensional study on challenges and potential in the São Paulo Metropolitan Region (SP, Brazil)].

    Science.gov (United States)

    Heimann, Luiza Sterman; Ibanhes, Lauro Cesar; Boaretto, Roberta Cristina; Castro, Iracema Ester do Nascimento; Telesi Júnior, Emilio; Cortizo, Carlos Tato; Fausto, Márcia Cristina Rodrigues; do Nascimento, Vânia Barbosa; Kayano, Jorge

    2011-06-01

    This paper presents some results of a case study in the Metropolitan Region of São Paulo (SP, Brazil) as part of a multicentric study conducted in Argentina, Brazil, Paraguay and Uruguay. The aim is to evaluate Primary Health Care (PHC) as a strategy to achieve integrated and universal healthcare systems. The methodological approach was based on five analytical dimensions: stewardship capability; financing; provision; comprehensiveness and intersectoral approach. The techniques included literature review, document analysis and interviews with key informants: policy makers; managers, experts, users and professionals. The results were organized in response to the challenges and possibilities of PHC as a structural system according to the five dimensions. The following emerged from the interviews: different interpretations on the concept and role of PHC and a consensus as the gateway to the system; weaknesses in funding; challenges in health workforce administration and the need for new legal-institutional design for regional management. The potential aspects were: broader coverage/universality, PHC as the basis for the organization of the system; connection with the territory and understanding specific population needs.

  14. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

    Directory of Open Access Journals (Sweden)

    Bajorek B

    2016-06-01

    Full Text Available Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care, Group B (Intervention, or Group C (Short Intervention. Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively, improvement in medication adherence scores (P=0.01, and a slight improvement in quality of life (EQ-5D-3L Index scores (P=0.91. There were no significant changes in Group B (the full intervention, and no differences in comparison to Group A (usual care. Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

  15. Use of primary corticosteroid injection in the management of plantar fasciopathy: is it time to challenge existing practice?

    Science.gov (United States)

    Kirkland, Paul; Beeson, Paul

    2013-01-01

    Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option.

  16. 多排螺旋CT 诊断小网膜囊病变的价值%Diagnostic value of multi-detector CT for abnormalities in lesser omental bursa

    Institute of Scientific and Technical Information of China (English)

    成峰; 吴凯宏; 李孝虎

    2011-01-01

    目的 探讨小网膜囊正常解剖及病变的多排螺旋CT(MDCT)表现,评价小网膜囊病变的CT 诊断价值.方法 对24 例小网膜囊病变进行上腹部CT 平扫及三期增强扫描检查,均经手术病理证实.结果 小网膜囊病变中:原发肿瘤6 例(神经鞘瘤2 例,平滑肌瘤1 例,血管瘤1 例,脂肪肉瘤1 例,淋巴瘤1 例),CT 表现为小网膜囊内边界清晰肿块.邻近脏器的良、恶性肿瘤8 例(胰头癌4 例,肝左叶肝细胞癌2 例,胃间质瘤2 例),CT 表现为小网膜囊肿块与邻近相应肿瘤边界不清.转移性肿瘤2 例.结核1 例,CT 表现多个病灶融合,内见钙化.积液(腹水漏出液、炎性渗出液、脓液、血液、胆汁、淋巴液)6 例;假性囊肿1 例;CT 均表现为小网膜囊内液性密度灶.结论 多排螺旋CT对小网膜囊病变具有重要的诊断价值.%Objective To investigate the normal CT anatomy and diagnostic value of CT for abnormalities of lesser omental bursa. Methods Twenty-four patients with 6 primary neoplasms (2 neurinomas, 1 leiomyoma, 1 cavernous hemangioma, 1 liposarcoma, 1 lymphoma), 8 local spread from adjacent benign or malignant neoplasms (4 carcinomas of head of pancreas, 2 left hepatic tumors, 2 gastrointestinal stromal tumors of the stomach), 2 metastatic tumors, 1 tuberculosis, 6 fluid collections (transudate ascites, inflammatory infiltrate, pus, blood, bile, lymph), lpseudocyst were enrolled in the study. All of the lesions were confirmed by operation and pathology. The pre- and post-contrast abdominal CT scans were reviewed. Results The borders of the 6 primary neoplasms were well-defined on CT whereas the 8 benign or malignant neoplasms originating from adjacent structures were contiguous with the primary tumors. CT showed multiple aggregated lesions on 2 patients with metastases and 1 patient with tuberculosis. The 6 fluid collections and lpseudocyst displayed fluid density within lesser omental bursa on CT. Conclusion CT is valuable in

  17. Medication discrepancies despite pharmacist led medication reconciliation: the challenges of maintaining an accurate medication list in primary care

    Directory of Open Access Journals (Sweden)

    Stewart AL

    2014-03-01

    Full Text Available Objective: Describe the types of medication discrepancies that persist despite pharmacist-led medication reconciliation using the primary care electronic medical record (EMR. Methods: Observational case series study of established patients from an urban, indigent care clinic. Medication reconciliation was conducted immediately prior to the physician visit at baseline and return visit. Main outcome measures included: frequency, types, and reasons for discrepancies, patient knowledge, and adherence. Results: There was a 14.5% reduction in the number of patients with a discrepancy and the frequency of discrepancies was reduced by 7.3%. The rate of medication discrepancies in the chart was reduced by 31.3%. The most common type of discrepancy that persisted at follow up were medications listed on the chart that the patient stopped taking. Discrepancies were more likely to persist in Caucasian subjects when compared to African Americans. Conclusion: While pharmacist led medication reconciliation appears effective at reducing the likelihood of a medication discrepancy in the EMR, challenges persist in maintaining this accuracy specifically as it relates to patient driven changes to the medication regimen.

  18. Determining the effects and challenges of incorporating genetic testing into primary care management of hypertensive patients with African ancestry.

    Science.gov (United States)

    Horowitz, C R; Abul-Husn, N S; Ellis, S; Ramos, M A; Negron, R; Suprun, M; Zinberg, R E; Sabin, T; Hauser, D; Calman, N; Bagiella, E; Bottinger, E P

    2016-03-01

    People of African ancestry (Blacks) have increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical factors. Two variants in the APOL1 gene are now thought to account for much of the racial disparity associated with hypertensive kidney failure in Blacks. However, this knowledge has not been translated into clinical care to help improve patient outcomes and address disparities. GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African ancestry, without kidney dysfunction, are recruited from diverse clinical settings and randomized to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control). Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff return APOL1 results to patients and provide low-literacy educational materials. Real-time clinical decision support tools alert clinicians of their patients' APOL1 results and associated risk status at the point of care. Our academic-community-clinical partnership designed a study to generate information about the impact of genetic risk information on patient care (blood pressure and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors. GUARDD will help establish the effective implementation of APOL1 risk-informed management of hypertensive patients at high risk of CKD, and will provide a robust framework for future endeavors to implement genomic medicine in diverse clinical practices. It will also add to the important dialog about factors that contribute to and may help eliminate racial disparities in kidney disease. PMID:26747051

  19. Segmental infarction of the omentum and primary epiploic appendagitis: Clinical, US, and CT findings

    International Nuclear Information System (INIS)

    Purpose: To describe US and CT findings of primary epiploic appendagitis and segmental infarction of the omentum. Material and methods: From 1986 through 1996 thirteen patients presented with these pathological findings at our institution (6 patients with greater omental infarction and 7 patients with epiploic appendagitis). US (n=13) and CT findings (n=7) were retrospectively reviewed. Results: US revealed moderately hyperechoic, ovoid lesions adherent to the peritoneoum. On CT scans the masses appeared as areas of fat with slightly increased attenuation and sometimes with hyperattenuating peripheral rims. Secondary omental or appendiceal involvement caused by inflammation of adjacent organs has to be excluded. Conclusion: Segmental infarction of the omentum and primary epiploic appendagitis have charcteristic US and CT features that enable the correct diagnosis. (orig.)

  20. Association of adipocyte genes with ASP expression: a microarray analysis of subcutaneous and omental adipose tissue in morbidly obese subjects

    Directory of Open Access Journals (Sweden)

    Lu HuiLing

    2010-01-01

    Full Text Available Abstract Background Prevalence of obesity is increasing to pandemic proportions. However, obese subjects differ in insulin resistance, adipokine production and co-morbidities. Based on fasting plasma analysis, obese subjects were grouped as Low Acylation Stimulating protein (ASP and Triglyceride (TG (LAT vs High ASP and TG (HAT. Subcutaneous (SC and omental (OM adipose tissues (n = 21 were analysed by microarray, and biologic pathways in lipid metabolism and inflammation were specifically examined. Methods LAT and HAT groups were matched in age, obesity, insulin, and glucose, and had similar expression of insulin-related genes (InsR, IRS-1. ASP related genes tended to be increased in the HAT group and were correlated (factor B, adipsin, complement C3, p Results HAT adipose tissue demonstrated increased lipid related genes for storage (CD36, DGAT1, DGAT2, SCD1, FASN, and LPL, lipolysis (HSL, CES1, perilipin, fatty acid binding proteins (FABP1, FABP3 and adipocyte differentiation markers (CEBPα, CEBPβ, PPARγ. By contrast, oxidation related genes were decreased (AMPK, UCP1, CPT1, FABP7. HAT subjects had increased anti-inflammatory genes TGFB1, TIMP1, TIMP3, and TIMP4 while proinflammatory PIG7 and MMP2 were also significantly increased; all genes, p Conclusion Taken together, the profile of C5L2 receptor, ASP gene expression and metabolic factors in adipose tissue from morbidly obese HAT subjects suggests a compensatory response associated with the increased plasma ASP and TG.

  1. Primary Care Physicians’ Perceptions of the Challenges and Barriers in the Timely Diagnosis, Treatment and Management of Fibromyalgia

    Directory of Open Access Journals (Sweden)

    Nandini Hadker

    2011-01-01

    Full Text Available OBJECTIVES: To describe beliefs and practice patterns of primary care physicians (PCPs providing fibromyalgia (FM care, and to characterize differences between PCPs who report being able to provide timely and beneficial care versus the remaining PCPs.

  2. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

    Science.gov (United States)

    Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

    2013-12-01

    The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

  3. Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis

    Directory of Open Access Journals (Sweden)

    Peters Sarah

    2011-12-01

    Full Text Available Abstract Background The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME] within a primary care setting. Methods A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset. Results Analyses identified four sets of challenges that were common to both interventions: (i being a novice therapist, (ii engaging patients in the therapeutic model, (iii dealing with emotions, and (iv the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions. Conclusions Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found

  4. Public Funding and Budgetary Challenges To Providing Universal Access To Primary Education in Sub-Saharan Africa

    Science.gov (United States)

    Omwami, Edith Mukudi; Keller, Edmond J.

    2010-02-01

    Budgetary capacity that would allow for the public funding of the provision of universal access to primary education is lacking in many sub-Saharan economies. National revenues significantly lag behind the overall economic productivity measure of GDP. Analysis of data derived from UNESCO and UNDP for 2004 shows that governments in the region spend far less in US dollars per unit cost on primary education than do developed countries. Increasing the unit cost of education in order to enable a government to guarantee universal primary education would take away resources from other tiers of the education system in many countries in the region. The alternative is to universalise access, despite existing budget allocation constraints, and thereby further compound the problems of poor infrastructure and limited human resource capacity that continue to compromise education quality in sub-Saharan Africa.

  5. Primary Headship, State Policy and the Challenge of the 1990s: An Exceptional Story That Disproves Total Hegemonic Rule.

    Science.gov (United States)

    Riseborough, George

    1993-01-01

    Celebrates life and work of British primary headteacher over past decade, using ethnographic conversational data. Stan Fast's intellectual and moral vision, his theories and practices, are set in context of recent (conservative) policy. Although his transformative "hidden curriculum" stressing three C's (caring, cooperation, compassion) is…

  6. Language, Culture and Identity in the Transition to Primary School: Challenges to Indigenous Children's Rights to Education in Peru

    Science.gov (United States)

    Ames, Patricia

    2012-01-01

    This paper analyses a "critical moment" in the educational trajectories of young indigenous children in Peru: the transition to primary school. It addresses the inequalities in educational services that affect indigenous children, before looking at the micro-level processes that take place in school settings, through a focus on two selected case…

  7. Public Funding and Budgetary Challenges to Providing Universal Access to Primary Education in Sub-Saharan Africa

    Science.gov (United States)

    Omwami, Edith Mukudi; Keller, Edmond J.

    2010-01-01

    Budgetary capacity that would allow for the public funding of the provision of universal access to primary education is lacking in many sub-Saharan economies. National revenues significantly lag behind the overall economic productivity measure of GDP. Analysis of data derived from UNESCO and UNDP for 2004 shows that governments in the region spend…

  8. English Language Teaching in Public Primary Schools in Mexico: The Practices and Challenges of Implementing a National Language Education Program

    Science.gov (United States)

    Ramírez Romero, José Luis; Sayer, Peter; Pamplón Irigoyen, Elva Nora

    2014-01-01

    Over the past 15?years, many state governments in Mexico have initiated local programs to introduce English at the primary school level. In 2009, the Mexican Ministry of Education formalized the "Programa Nacional de Inglés en Educación Básica" (PNIEB) as part of the national curriculum, based on the argument that increasing the number…

  9. Influence of obesity and insulin sensitivity on insulin signaling genes in human omental and subcutaneous adipose tissue.

    Science.gov (United States)

    MacLaren, R; Cui, W; Simard, S; Cianflone, K

    2008-02-01

    Obesity and insulin resistance are independent risk factors for metabolic syndrome, diabetes, and cardiovascular disease. Adipose tissue samples from nonobese (NO), insulin-sensitive obese (ISO), and insulin-resistant obese (IRO) subjects from subcutaneous (SC) and omental (OM) adipose tissue (n = 28) were analyzed by microarray and confirmed by real-time PCR. Insulin signaling gene expression changes were greater in OM than in SC tissue and were related to insulin resistance rather than to obesity; few genes correlated with body mass index. Insulin receptor and insulin receptor substrate 1 (IRS-1) increased in the IRO versus pooled insulin-sensitive (NO+ISO) subjects. In glucose transport, PI3Kalpha and PDK2 decreased in IRO subjects, whereas PI3Kgamma, Akt2, GLUT4, and GLUT1 increased. IRS-1 regulators Jnk and IKK increased in IRO (P < 0.01 and P < 0.001 respectively). In protein synthesis, most genes examined were downregulated in IRO subjects, including mTor, Rheb, and 4EBP and eIF members (all P < 0.05). In proliferation, SHC, SOS, and Raf1 (P < 0.05) were increased, whereas Ras and MEK1/2 kinase 1 (P < 0.05) were decreased, in IRO subjects. Finally, in differentiation, PPARgamma, CEBPalpha, and CEBPbeta decreased, whereas PPARdelta, CEBPgamma, and CEBPepsilon increased, in IRO subjects (P < 0.05). Together, microarray and real-time PCR data demonstrate that insulin resistance rather than obesity is associated with altered gene expression of insulin signaling genes, especially in OM adipose tissue. PMID:17986714

  10. A malignant omental extra-gastrointestinal stromal tumor on a young man: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Almaroof Babatunde

    2008-05-01

    Full Text Available Abstract Background Gastrointestinal stromal tumors (GIST are uncommon intra-abdominal tumors. These tumors tend to present with higher frequency in the stomach and small bowel. In fewer than 5% of cases, they originate primarily from the mesentery, omentum, or peritoneum. Furthermore, these extra-gastrointestinal tumors (EGIST tend to be more common in patients greater than 50 years of age. Rarely do EGIST tumors present in those younger than 40 years of age. Case presentation We report a case of a large EGIST in a 27-year-old male. An abdominal pelvic computerized tomography imaging demonstrated an intra-abdominal mass of 22 cm, without invasion of adjacent viscera or liver lesions. This mass was resected en bloc with its fused omentum and an adherent portion of sigmoid colon. Pathology results demonstrated a malignant gastrointestinal stromal tumor with positive CD117 (c-kit staining, and negative margins of resection, and no continuity of tumor with the sigmoid colon. Due to the malignant and aggressive nature of this patient's tumor, he was started on STI-571 as adjuvant chemotherapy. Conclusion Stromal tumors of an extra-gastrointestinal origin are rare. Of the reported omental and mesenteric EGISTs in four published series, a total of 99 tumors were studied. Of the 99 patients in these series only 8 were under 40 years of age, none were younger than 30 years old; and only 5 were younger than 35 years old. Our patient's age is at the lower end of the age spectrum for the reported EGISTs. Young patients who present with an extra-gastrointestinal stromal tumor (EGIST, who have complete resection with negative margins, have a good prognosis. There is little data to support the role of STI-571 in adjuvant or neoadjuvant therapy after curative resection. Given the lack of data, the use of STI-571 must be individualized.

  11. Opposing Effects of Omega-3 and Omega-6 Long Chain Polyunsaturated Fatty Acids on the Expression of Lipogenic Genes in Omental and Retroperitoneal Adipose Depots in the Rat

    Directory of Open Access Journals (Sweden)

    B. S. Muhlhausler

    2010-01-01

    Full Text Available This study aimed to determine the effect of varying dietary intake of the major n-3 PUFA in human diets, α-linolenic acid (ALA; 18 : 3n-3, on expression of lipogenic genes in adipose tissue. Rats were fed diets containing from 0.095%en to 6.3%en ALA and a constant n-6 PUFA level for 3 weeks. Samples from distinct adipose depots (omental and retroperitoneal were collected and mRNA expression of the pro-lipogenic transcription factors Sterol-Retinoid-Element-Binding-Protein1c (SREBP1c and Peroxisome Proliferator Activated Receptor-γ (PPARγ, lipogenic enzymes Sterol-coenzyme Desaturase1 (SCD-1, Fatty Acid Synthase (FAS, lipoprotein lipase (LPL and glycerol-3-phosphate dehydrogenase (G3PDH and adipokines leptin and adiponectin determined by qRT-PCR. Increasing dietary ALA content resulted in altered expression of SREBP1c, FAS and G3PDH mRNA in both adipose depots. SREBP1c mRNA expression was related directly to n-6 PUFA concentrations (omental, r2=.71; P<.001; Retroperitoneal, r2=.20; P<.002, and inversely to n-3 PUFA concentrations (omental, r2=.59; P<.001; Retroperitoneal, r2=.19; P<.005 independent of diet. The relationship between total n-6 PUFA and SREBP1c mRNA expression persisted when the effects of n-3 PUFA were controlled for. Altering red blood cell concentrations of n-3 PUFA is thus associated with altered expression of lipogenic genes in a depot-specific manner and this effect is modulated by prevailing n-6 PUFA concentrations.

  12. Economic and Psychological Challenges Facing HIV and Aids Orphaned Boys’ Education in Public Primary Schools in Nairobi East District, Kenya

    OpenAIRE

    Redempta A.J. Munyendo; Peter Odera; Moses W. Poipoi; Szumbah Mwanaongoro

    2013-01-01

    This study sought to establish the economic and psychological effects of HIV and AIDS on orphaned boys’ education in primary schools in Nairobi East District, Kenya. Adler’s theory of Individual Psychology as cited in Sherman and Dinkmeyer formed the theoretical framework for the study. Descriptive survey research design was adopted for the study. A total of 200 pupils and 40 teachers formed the study sample. Data was collected using the questionnaire and interview schedules. Data was analyze...

  13. Positron emission tomography/computer tomography: Challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies

    OpenAIRE

    Sun, Long; Wu, Hua; Guan, Yong-Song

    2007-01-01

    Computer tomography (CT) and magnetic resonance imaging (MRI), as conventional imaging modalities, are the preferred methodology for tumor, nodal and systemic metastasis (TNM) staging. However, all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition, relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intri...

  14. Integrating HIV treatment with primary care outpatient services: opportunities and challenges from a scaled-up model in Zambia

    OpenAIRE

    Topp, Stephanie M.; Chipukuma, Julien M.; Chiko, Matimba M; Matongo, Evelyn; Bolton-Moore, Carolyn; Reid, Stewart E.

    2012-01-01

    Background Integration of HIV treatment with other primary care services has been argued to potentially improve effectiveness, efficiency and equity. However, outside the field of reproductive health, there is limited empirical evidence regarding the scope or depth of integrated HIV programmes or their relative benefits. Moreover, the body of work describing operational models of integrated service-delivery in context remains thin. Between 2008 and 2011, the Lusaka District Health Management ...

  15. Characterization of Mucosal Immune Responses to Enterotoxigenic Escherichia coli Vaccine Antigens in a Human Challenge Model: Response Profiles after Primary Infection and Homologous Rechallenge with Strain H10407.

    Science.gov (United States)

    Chakraborty, Subhra; Harro, Clayton; DeNearing, Barbara; Ram, Malathi; Feller, Andrea; Cage, Alicia; Bauers, Nicole; Bourgeois, A Louis; Walker, Richard; Sack, David A

    2015-11-18

    Enterotoxigenic Escherichia coli (ETEC) bacteria are the most common bacterial cause of diarrhea in children in resource-poor settings as well as in travelers. Although there are several approaches to develop an effective vaccine for ETEC, no licensed vaccines are currently available. A significant challenge to successful vaccine development is our poor understanding of the immune responses that correlate best with protection against ETEC illness. In this study, ETEC-specific mucosal immune responses were characterized and compared in subjects challenged with ETEC strain H10407 and in subjects rechallenged with the homologous organism. IgA responses to lipopolysaccharide (LPS), heat-labile toxin B subunit (LTB), and colonization factor antigen I (CFA/I) in antibody in lymphocyte supernatant (ALS), feces, lavage fluid, and saliva samples were evaluated. In all assay comparisons, ALS was the most sensitive indicator of a local immune response, but serum IgA was also a useful indirect marker of immune response to oral antigens. Volunteers challenged and then rechallenged with strain H10407 were protected from illness following rechallenge. Comparing mucosal antibody responses after primary and homologous rechallenge, protection against disease was reflected in reduced antibody responses to key ETEC antigens and in reduced fecal shedding of the H10407 challenge strain. Subjects challenged with strain H10407 mounted stronger antibody responses to LPS and LTB than subjects in the rechallenge group, while responses to CFA/I in the rechallenge group were higher than in the challenge group. We anticipate that this study will help provide an immunological benchmark for the evaluation of ETEC vaccines and immunization regimens in the future.

  16. A Diagnostic Challenge for Primary Care Physicians: PFAPA Syndrome (Periodic Fevers With Aphthous Stomatitis, Pharyngitis, And Adenitis

    Directory of Open Access Journals (Sweden)

    Çelikcan G et al.

    2012-10-01

    Full Text Available PFAPA, characterized by periodic episodes of high fever, aphthous stomatitis, pharyngitis and cervical adenitis, is a non-hereditary syndrome. Admission with stomatitis, fever, pharyngitis and adenitis is known to hold an important place in the pediatric patient population of family medicine practice. Our objective with this review is to provide information about PFAPA syndrome, which is not yet well-recognized by primary care physicians. PFAPA is a non-common disorder, but should be kept in mind for the patients that admitted with periodic fever, pharyngitis, and adenitis.

  17. [Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings].

    Science.gov (United States)

    Diez-Canseco, Francisco; Ipince, Alessandra; Toyama, Mauricio; Benate-Galvez, Ysabel; Galán-Rodas, Edén; Medina-Verástegui, Julio César; Sánchez-Moreno, David; Araya, Ricardo; Miranda, J Jaime

    2014-01-01

    In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Additionally, the gap between access to mental health care in Peru is analyzed. Lastly, the alternatives to reduce the gap are explored. Of these alternatives, the integration of mental health into primary care services is emphasized; as a feasible way to meet the care needs of the general population, and people with chronic diseases in particular, in the Peruvian context. PMID:24718538

  18. Teachers' perceptions of the benefits and the challenges of integrating educational robots into primary/elementary curricula

    Science.gov (United States)

    Khanlari, Ahmad

    2016-05-01

    Twenty-first century education systems should create an environment wherein students encounter critical learning components (such as problem-solving, teamwork, and communication skills) and embrace lifelong learning. A review of literature demonstrates that new technologies, in general, and robotics, in particular, are well suited for this aim. This study aims to contribute to the literature by studying teachers' perceptions of the effects of using robotics on students' lifelong learning skills. This study also seeks to better understand teachers' perceptions of the barriers of using robotics and the support they need. Eleven primary/elementary teachers from Newfoundland and Labrador English Schools District participated in this study. The results of this study revealed that robotics is perceived by teachers to have positive effects on students' lifelong learning skills. Furthermore, the participants indicated a number of barriers to integrate robotics into their teaching activities and expressed the support they need.

  19. The place of receptionists in access to primary care: Challenges in the space between community and consultation.

    Science.gov (United States)

    Neuwelt, Pat M; Kearns, Robin A; Browne, Annette J

    2015-05-01

    At the point of entry to the health care system sit general practice receptionists (GPRs), a seldom studied employment group. The place of the receptionist involves both a location within the internal geography of the clinic and a position within the primary care team. Receptionists literally 'receive' those who phone or enter the clinic, and are a critical influence in their transformation from a 'person' to a 'patient'. This process occurs in a particular space: the 'waiting room'. We explore the waiting room and its dynamics in terms of 'acceptability', an under-examined aspect of access to primary care. We ask 'How do GPRs see their role with regard to patients with complex health and social needs, in light of the spatio-temporal constraints of their working environments?' We engaged receptionists as participants to explore perceptions of their roles and their workspaces, deriving narrative data from three focus groups involving 14 GPRs from 11 practices in the Northland region of New Zealand. The study employed an adapted form of grounded theory. Our findings indicate that GPRs are on the edge of the practice team, yet carry a complex role at the frontline, in the waiting space. They are de facto managers of this space; however, they have limited agency within general practice settings, due to the constraints imposed upon them by physical and organisational structures. The agency of GPRs is most evident in their ability to shape the social dynamics of the waiting space, and to frame the health care experience as positive for people whose usual experience is marginalisation. We conclude that, if well supported, receptionists have the potential to positively influence health care acceptability, and patients' access to care. PMID:25455478

  20. Association of SelS mRNA expression in omental adipose tissue with Homa-IR and serum amyloid A in patients with type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    DU Jian-ling; SUN Chang-kai; L(U) Bo; MEN Li-li; YAO Jun-jie; AN Li-jia; SONG Gui-rong

    2008-01-01

    Background Tanis was repoded as a putative receptor for serum amyloid A(SAA)involving glucose regulated protein in insulin regulated resistance.It was found to be dysregulated in diabetic rats(Psammomys obesus,Israeli sand rat)and its homologue for humans is SelS/AD-015.The present study analyzed mRNA expression of SelS in omental adipose tissue biopsies from patients with type 2 diabetes mellitus (T2DM),and age-and weight-matched nondiabetic patients,the relationship of SelS mRNA with Homa-IR and serum SAA level.Methods Human omental adipose tissues from ten cases of type 2 diabetic patients and twelve cases of nondiabetic individuals were analyzed for the expression level of SelS mRNA by semiquantitative polymerase chain reaction(PCR),Homa-IR estimated by standard formula and SM level by enzyme-linked immunosorbent assay(ELISA).Results SelS mRNA expression.Homa-IR and serum SAA were higher in T2DM sufferers than in nondiabeUc control group.SelS mRNA level was positively correlated with Homa-IR and SAA level in each group.Conclusions SelS protein may be involved in insulin resistarice;in Chinese with T2DM by acting as the SAA receptor,thus playing an important role in the development of T2DM and atherosclerosis.

  1. Expression of Genes Related to Prostaglandin Synthesis or Signaling in Human Subcutaneous and Omental Adipose Tissue: Depot Differences and Modulation by Adipogenesis

    Directory of Open Access Journals (Sweden)

    Andréanne Michaud

    2014-01-01

    Full Text Available Objectives. (1 To examine depot-specific PGE2 and PGF2α release and mRNA expression of enzymes or receptors involved in PG synthesis or signaling in human adipose tissues; (2 to identify changes in expression of these transcripts through preadipocyte differentiation; and (3 to examine associations between adipose tissue mRNA expression of these transcripts and adiposity measurements. Methods. Fat samples were obtained surgically in women. PGE2 and PGF2α release by preadipocytes and adipose tissue explants was measured. Expression levels of mRNA coding for enzymes or receptors involved in PG synthesis or signaling were measured by RT-PCR. Results. Cultured preadipocytes and explants from omental fat released more PGE2 and PGF2α than those from the subcutaneous depot and the corresponding transcripts showed consistent depot differences. Following preadipocyte differentiation, expression of PLA2G16 and PTGER3 mRNA was significantly increased whereas COX-1, COX-2, PTGIS, and PTGES mRNA abundance were decreased in both compartments (P≤0.01 for all. Transcripts that were stimulated during adipogenesis were those that correlated best with adiposity measurements. Conclusion. Cells from the omental fat compartment release more PGE2 and PGF2α than those from the subcutaneous depot. Obesity modulates expression of PG-synthesizing enzymes and PG receptors which likely occurs through adipogenesis-induced changes in expression of these transcripts.

  2. Positron emission tomography/computer tomography:Challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies

    Institute of Scientific and Technical Information of China (English)

    Long Sun; Hua Wu; Yong-Song Guan

    2007-01-01

    Computer tomography (CT) and magnetic resonance imaging (MRI), as conventional imaging modalities,are the preferred methodology for tumor, nodal and systemic metastasis (TNM) staging. However, all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition, relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer, one cannot give an appropriate assessment of the biological characteristics of tumors. Currently, positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors, and monitoring the therapeutic efficacy in hepatic malignancies. Recently, investigators have measured glucose utilization in liver tumors using 18F-FDG, PET and PET/CT in order to establish diagnosis of tumors, assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis, staging, restaging and evaluating its biological characteristics, which can benefit the patients suffering from hepatic metastases, hepatocellular carcinoma and cholangiocarcinoma.

  3. Economic and Psychological Challenges Facing HIV and Aids Orphaned Boys’ Education in Public Primary Schools in Nairobi East District, Kenya

    Directory of Open Access Journals (Sweden)

    Redempta A.J. Munyendo

    2013-07-01

    Full Text Available This study sought to establish the economic and psychological effects of HIV and AIDS on orphaned boys’ education in primary schools in Nairobi East District, Kenya. Adler’s theory of Individual Psychology as cited in Sherman and Dinkmeyer formed the theoretical framework for the study. Descriptive survey research design was adopted for the study. A total of 200 pupils and 40 teachers formed the study sample. Data was collected using the questionnaire and interview schedules. Data was analyzed using descriptive statistics. The study established that the guardians are not economically able to cater for all the orphans’ needs and this makes the orphans look for alternative ways of catering for their needs by being partially employed or fully employed leading to child labour. Missing their basic needs leads these orphans to be affected psychologically leading to poor performance, absenteeism, and truancy and later drop out of school and may join the street children. It was recommended that the community should be trained and educated on capacity building and reproductive health and helped to design and implement economic projects and programmes to uplift their standard.

  4. Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation.

    Science.gov (United States)

    Freeman, Toby; Baum, Frances E; Jolley, Gwyneth M; Lawless, Angela; Edwards, Tahnia; Javanparast, Sara; Ziersch, Anna

    2016-01-01

    Community participation is a key principle of comprehensive primary health care (PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives, and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data were collected through analysis of policy documents, service reports on activity, and a web-based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all services were positive about the benefits of participation but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising individual treatment services, particularly at state-managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state-managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services. Copyright © 2014 John Wiley & Sons, Ltd. PMID:24789355

  5. Smoking cessation counseling for Asian immigrants with serious mental illness: using RE-AIM to understand challenges and lessons learned in primary care-behavioral health integration.

    Science.gov (United States)

    Saw, Anne; Kim, Jin; Lim, Joyce; Powell, Catherine; Tong, Elisa K

    2013-09-01

    Engagement in modifiable risk behaviors, such as tobacco use, substantially contributes to early mortality rates in individuals with serious mental illness (SMI). There is an alarmingly high prevalence of tobacco use among subgroups of Asian Americans, such as immigrants and individuals with SMI, yet there are no empirically supported effective smoking cessation interventions that have been tailored to meet the unique cultural, cognitive, and psychological needs of Asian immigrants with SMI. In this article, we share the experiences of clinicians in the delivery of smoking cessation counseling to Asian American immigrants with SMI, in the context of an Asian-focused integrated primary care and behavioral health setting. Through a qualitative analysis of clinician perspectives organized with the RE-AIM framework, we outline challenges, lessons learned, and promising directions for delivering smoking cessation counseling to Asian American immigrant clients with SMI. PMID:23667056

  6. Primary papillary serous carcinoma of the peritoneum: a case report=20

    International Nuclear Information System (INIS)

    Primary papillary serous carcinoma of the peritoneum is a rare primary tumor involving the peritoneum.Histologically, it is indistinguishable from serous ovarian papillary carcinoma, although it either spares the ovaries or only microscopically involves their surface. The characteristic features of this tumor are extensive peritoneal and omental masses or implants with psammmomatous calcification, and ascites. In addition, it can occur focally in the pelvic peritoneum. We report the CT findings, with histopathologic correlation of promary papillary serous carcinoma of the peritomeum occurring in the upper mesorectum. (author)

  7. Indoleamine 2,3-dioxygenase (IDO) activity during the primary immune response to influenza infection modifies the memory T cell response to influenza challenge.

    Science.gov (United States)

    Sage, Leo K; Fox, Julie M; Mellor, Andrew L; Tompkins, Stephen M; Tripp, Ralph A

    2014-04-01

    The generation of a heterosubtypic memory T cell response is important for cross-protective immunity against unrelated strains of influenza virus. One way to facilitate the generation of the memory T cell population is to control the activity of immune modulatory agents. The enzyme, indoleamine 2,3-dioxygenase (IDO), is upregulated during influenza infection by the interferon response where IDO activity depletes tryptophan required in T cell response. In this study, IDO activity was pharmacologically inhibited with 1-methyl-tryptophan (1MT) during the primary response to influenza virus infection and the effect on the memory T cell response was evaluated. 1MT treatment improved the memory T cell response to influenza virus challenge by increasing interferon gamma expression by CD4 and CD8 T cells, and numbers of lung virus-specific CD8+ T cells, and increased the Th1 response as well as modifying the immunodominance hierarchy to increase the number of subdominant epitope specific CD8+ T cells, a feature which may be linked to decreased regulatory T cell function. These changes also accompanied evidence of accelerated lung tissue repair upon virus challenge. These findings suggest that modulation of IDO activity could be exploited in influenza vaccine development to enhance memory T cell responses and reduce disease burden. PMID:24702331

  8. CT features of primary epiploic appendagitis

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Keng Sin [Department of Oncologic Imaging, National Cancer Centre, 11 Hospital Drive, Singapore 169610 (Singapore)]. E-mail: ngkeng@gmail.com; Tan, Andrew Gee Seng [Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore. (Singapore); Chen, Kevin K' o Wen [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Wong, Siew Kune [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Tan, How Ming [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore)

    2006-08-15

    Objective: The aim of this study is to describe the computed tomography (CT) findings of primary epiploic appendagitis (PEA). Methods: We reviewed the clinical records and CT images of 14 consecutive patients in Singapore who presented with acute abdominal pain from July 2000 to April 2004 and had radiological signs of PEA. Results: Hyperattenuated ring with adjacent fat stranding was present in all the patients. The central high attenuation dot was seen in 42.9% (6/14) of the patients. We observed a lobulated fatty mass in 21.4% (3/14) of our patients. All patients recovered during clinical follow-up. Conclusions: We believe the lobulated appearance of PEA is due to two or more, contiguous infarcted epiploic appendages lying in close proximity. This appearance further aids in the diagnosis of PEA and helps differentiates the condition from omental infarction. Recognizing the CT signs of PEA should allow a confident diagnosis and avoid unnecessary surgery.

  9. Protection against Chlamydia promoted by a subunit vaccine (CTH1 compared with a primary intranasal infection in a mouse genital challenge model.

    Directory of Open Access Journals (Sweden)

    Anja Weinreich Olsen

    Full Text Available BACKGROUND: The chlamydial proteins CT443 (OmcB and CT521 (rl16 have previously been identified as human B and/or T cell targets during a chlamydial infection in humans. Here we compare the protective effector mechanism promoted by a fusion protein composed of CT521 and CT443 (CTH1 with a primary intranasal Chlamydia muridarum infection known to provide high levels of protection against a genital chlamydial challenge. METHODOLOGY/PRINCIPAL FINDINGS: The fusion protein CTH1, adjuvanted with a strong Th1 inducing cationic adjuvant (CAF01, significantly reduced the bacterial shedding compared to a control group in both a C. trachomatis Serovar D and C. muridarum challenge model. The CTH1/CAF01 vaccine was found to induce polyfunctional T cells consisting of TNFalpha/IL-2 and TNFalpha/IL-2/IFN-gamma positive cells and high titers of CTH1 specific IgG2a and IgG1. By depletion experiments the protection in the C. muridarum challenge model was demonstrated to be mediated solely by CD4(+ T cells. In comparison, an intranasal infection with C. muridarum induced a T cell response that consisted predominantly of TNFalpha/IFN-gamma co-expressing effector CD4(+ T cells and an antibody response consisting of C. muridarum specific IgG1, IgG2a but also IgA. This response was associated with a high level of protection against challenge-a protection that was only partially dependent on CD4(+ T cells. Furthermore, whereas the antibody response induced by intranasal infection was strongly reactive against the native antigens displayed in the chlamydial elementary body, only low levels of antibodies against this preparation were found after CTH1/CAF01 immunization. CONCLUSIONS/SIGNIFICANCE: Our data demonstrate that CTH1 vaccination promotes a CD4(+ T cell dependent protective response but compared with intranasal C. muridarum infection lacks a CD4 independent protective mechanism for complete protection.

  10. 带蒂大网膜包肾防治肾小球硬化的实验研究%The Effects of Pedicled Omental Transposition on Rats with Glomerulosclerosis

    Institute of Scientific and Technical Information of China (English)

    董兴刚; 安增梅; 杨海春; 周江华; 殷祥雷; 顾建新

    2001-01-01

    To investigate the protective effects of pedicled omental transposition on the kidney with glomerulosclerosis.Uninephrectomized rats were divided into two groups.Normal rats were put in the blank control group,glomerulosclerosis rats by adriamycin were divided into glomerulosclerosis group and pedicled omental transposition group.Serum lipids,urea and urinary protein were assayed. Renal histological examination was also performed. Results showed that pedicled omental transposition could not only reduced the serum levels of total cholesterol and triglyceride, but also decrease the accumulation of extracellular matrix (P<0.05).Conclusions pedicled omental transposition has the effect of attenuating renal damage in rats with glomerulosclerosis.%为探讨带蒂大网膜包肾术防治肾小球硬化的作用。采用单侧肾切除加二次注射阿霉素制备的肾小球硬化动物模型,观察带蒂大网膜包肾对肾脏的作用。结果表明,带蒂大网膜包肾可降低血胆固醇、甘油三脂,尿蛋白排泄,肾小球球囊粘连减轻。血尿素氮有下降趋势。说明带蒂大网膜包肾术对肾小球硬化大鼠的肾脏损伤有保护作用。

  11. Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

    Directory of Open Access Journals (Sweden)

    Veen Robert ER

    2011-07-01

    Full Text Available Abstract Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs. Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs within 13 European Countries. General Practitioners (GPs recruited consecutive patients with an acute cough. GPs completed a case report form (CRF and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i selecting, setting up and maintaining PCNs; ii designing local context-appropriate data collection tools and efficient data management systems; and iii gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i appointing key individuals (National Network Facilitator and Coordinator with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos

  12. Primary CNS Teratocarcinoma

    Directory of Open Access Journals (Sweden)

    Danilo eVitorovic

    2012-02-01

    Full Text Available Primary central nervous system (CNS teratomas are rare tumors that consist of all three germ cell layers. We describe a young man with a primary malignant CNS teratocarcinoma presenting as leptomeningeal carcinomatosis. Diagnosis of primary CNS teratocarcinomas is challenging; relentless pursuit of the diagnosis must follow even if early ancillary studies are inconclusive.

  13. Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

    Science.gov (United States)

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2015-01-01

    Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. PMID:26515687

  14. Measuring Challenge, Fun and Sterility on a "Phunometre" Scale: Evaluating Creative Teaching and Learning with Children and Their Student Teachers in the Primary School

    Science.gov (United States)

    Elton-Chalcraft, Sally; Mills, Kären

    2015-01-01

    "It was the funnest week in the whole history of funnest weeks": our case study, the second phase in a three-phase research project, evaluates the successes and limitations of creative teaching and learning during the "The Creative and Effective Curriculum" module for PGCE primary student teachers which includes a one-week…

  15. Teachers' Understandings of Curriculum Adaptations for Learners with Learning Difficulties in Primary Schools in Botswana: Issues and Challenges of Inclusive Education

    Science.gov (United States)

    Otukile-Mongwaketse, Mpho; Mangope, Boitumelo; Kuyini, Ahmed Bawa

    2016-01-01

    This paper derives from research carried out in a number of Botswana primary schools on teachers' understanding of curriculum adaptations for learners who experience learning difficulties (LD) as part of implementing inclusive education. Teachers' understanding play a crucial role in how they make curriculum accessible for learners with LD during…

  16. The Contribution of Teachers' Continuous Professional Development (CPD) Program to Quality of Education and Its Teacher-Related Challenging Factors at Chagni Primary Schools, Awi Zone, Ethiopia

    Science.gov (United States)

    Belay, Sintayehu

    2016-01-01

    This study examined the contribution of teachers' Continuous Professional Development (CPD) to quality of education and its challenging factors related with teachers. For this purpose, the study employed descriptive survey method. 76 or 40.86% participant teachers were selected using simple random sampling technique. Close-ended questionnaire was…

  17. Equity and Quality? Challenges for Early Childhood and Primary Education in Ethiopia, India and Peru. Working Papers in Early Childhood Development, No. 55. Studies in Early Childhood Transitions

    Science.gov (United States)

    Woodhead, Martin; Ames, Patricia; Vennam, Uma; Abebe, Workneh; Streuli, Natalia

    2009-01-01

    Part of the "Studies in Early Transitions" series, this Working Paper draws on interviews and observations carried out as part of "Young Lives", a 15-year longitudinal study of childhood poverty in Ethiopia, India, Peru and Vietnam based at the University of Oxford's Department of International Development. This paper focuses on the challenges of…

  18. Amenorrhea - primary

    Science.gov (United States)

    Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary ... with an average of around 12 years old. Primary amenorrhea typically occurs when a girl is older ...

  19. Translating 10 lessons from lean six sigma project in paper-based training site to electronic health record-based primary care practice: challenges and opportunities.

    Science.gov (United States)

    Aleem, Sohaib

    2013-01-01

    Lean Six Sigma is a well-proven methodology to enhance the performance of any business, including health care. The strategy focuses on cutting out waste and variation from the processes to improve the value and efficiency of work. This article walks through the journey of "green belt" training using a Lean Six Sigma approach and the implementation of a process improvement project that focused on wait time for patients to be examined in an urban academic primary care clinic without requiring added resources. Experiences of the training and the project at an urban paper-based satellite clinic have informed the planning efforts of a data and performance team, including implementing a 15-minute nurse "pre-visit" at primary care sites of an accountable care organization.

  20. Translating 10 lessons from lean six sigma project in paper-based training site to electronic health record-based primary care practice: challenges and opportunities.

    Science.gov (United States)

    Aleem, Sohaib

    2013-01-01

    Lean Six Sigma is a well-proven methodology to enhance the performance of any business, including health care. The strategy focuses on cutting out waste and variation from the processes to improve the value and efficiency of work. This article walks through the journey of "green belt" training using a Lean Six Sigma approach and the implementation of a process improvement project that focused on wait time for patients to be examined in an urban academic primary care clinic without requiring added resources. Experiences of the training and the project at an urban paper-based satellite clinic have informed the planning efforts of a data and performance team, including implementing a 15-minute nurse "pre-visit" at primary care sites of an accountable care organization. PMID:23807134

  1. Primary Education for All in the City of Mumbai, India: The Challenge Set by Local Actors. School Mapping and Local-Level Planning.

    Science.gov (United States)

    Juneja, Nalini

    This book discusses primary education of the poor in the city of Mumbai, India. It focuses on the city of Mumbai itself and the poor who live in it, answering questions such as What makes the city the way it is? What does it mean to be poor in Mumbai? and How does the poverty of the poor in Mumbai affect their chances of receiving a basic…

  2. Women as primary caregivers in Mexico: challenges to well-being Las mujeres como cuidadoras principales en México: retos para su bienestar

    Directory of Open Access Journals (Sweden)

    Ann M DiGirolamo

    2008-12-01

    Full Text Available The purpose of this contribution is to review the peer reviewed literature from the last 20 years regarding the role of Mexican women in the family, and to describe the psychosocial and health challenges they face. We analyze the current problems and recent improvements in three areas: reproductive health, nutrition, and mental health, and we discuss how the role of caregiver may influence or be influenced by these health issues. We emphasize the cultural context, women's role as caregivers, the challenges they face, and the strength and resilience these women exhibit. We conclude that it is imperative that we modify the way in which Mexican women's needs are assessed, interpreted, and confronted, along with a definite need for concrete proposals that take into account both women's challenges and strengths, and the cultural context and national reality.El propósito de esta contribución fue revisar la literatura publicada en los últimos 20 años con respecto al papel que tienen las mujeres mexicanas en el ámbito familiar y describir los retos psicosociales y de salud que cotidianamente enfrentan. Se analizan los problemas actuales y las mejoras que han ocurrido en tres áreas: salud reproductiva, nutrición y salud mental; se discute cómo el papel de cuidadora de otros influye o es influido por estos temas de salud. Se enfatiza el entorno cultural, su rol como cuidadoras, los retos que enfrentan y la fortaleza y resistencia que demuestran. Se concluye que es imperativo modificar la manera en que las necesidades de la mujer mexicana están siendo evaluadas, interpretadas y confrontadas, junto con una necesidad impostergable de concretar propuestas que tomen en cuenta retos y fortalezas, así como el contexto cultural y la realidad nacional.

  3. Challenges in using cultured primary rodent hepatocytes or cell lines to study hepatic HDL receptor SR-BI regulation by its cytoplasmic adaptor PDZK1.

    Directory of Open Access Journals (Sweden)

    Kosuke Tsukamoto

    Full Text Available BACKGROUND: PDZK1 is a four PDZ-domain containing cytoplasmic protein that binds to a variety of membrane proteins via their C-termini and can influence the abundance, localization and/or function of its target proteins. One of these targets in hepatocytes in vivo is the HDL receptor SR-BI. Normal hepatic expression of SR-BI protein requires PDZK1 - <5% of normal hepatic SR-BI is seen in the livers of PDZK1 knockout mice. Progress has been made in identifying features of PDZK1 required to control hepatic SR-BI in vivo using hepatic expression of wild-type and mutant forms of PDZK1 in wild-type and PDZK1 KO transgenic mice. Such in vivo studies are time consuming and expensive, and cannot readily be used to explore many features of the underlying molecular and cellular mechanisms. METHODOLOGY/PRINCIPAL FINDINGS: Here we have explored the potential to use either primary rodent hepatocytes in culture using 2D collagen gels with newly developed optimized conditions or PDZK1/SR-BI co-transfected cultured cell lines (COS, HEK293 for such studies. SR-BI and PDZK1 protein and mRNA expression levels fell rapidly in primary hepatocyte cultures, indicating this system does not adequately mimic hepatocytes in vivo for analysis of the PDZK1 dependence of SR-BI. Although PDZK1 did alter SR-BI protein expression in the cell lines, its influence was independent of SR-BI's C-terminus, and thus is not likely to occur via the same mechanism as that which occurs in hepatocytes in vivo. CONCLUSIONS/SIGNIFICANCE: Caution must be exercised in using primary hepatocytes or cultured cell lines when studying the mechanism underlying the regulation of hepatic SR-BI by PDZK1. It may be possible to use SR-BI and PDZK1 expression as sensitive markers for the in vivo-like state of hepatocytes to further improve primary hepatocyte cell culture conditions.

  4. [Family Health Support Centers: challenges and opportunities from the perspective of primary care professionals in the city of São Paulo, Brazil].

    Science.gov (United States)

    Silva, Andréa Tenório Correia da; Aguiar, Márcia Ernani de; Winck, Kelly; Rodrigues, Karen Gonzaga Walter; Sato, Mariana Eri; Grisi, Sandra Josefina Ferraz Ellero; Brentani, Alexandra; Rios, Izabel Cristina

    2012-11-01

    Family Health Support Centers (NASF) were created in Brazil to increase the case-resolution capacity of primary healthcare. Prior to their implementation in the West Side of the city of São Paulo, Brazil, a series of workshops were held for primary healthcare professionals to prepare a proposal for such centers. Hermeneutic analysis was used to study the transcribed material. The thematic categories were: role, constitution, and functioning of the NASF, relationship with family health teams, and interdisciplinarity. The participants' expected the NASF to be an empowering device for comprehensiveness of care, intervening in an existing culture of unnecessary referrals while fostering linkage with other levels of care. The participants also expected the NASF to contribute to the discussion on health professionals' training and stimulating reflection with policymakers on health indicators based exclusively on the number of consultations. These indicators fail to reflect the impact on the services' activities and the quality of care offered to the population in the coverage area. PMID:23147949

  5. Identification of ovarian cancer metastatic miRNAs.

    Directory of Open Access Journals (Sweden)

    Souriya Vang

    Full Text Available Serous epithelial ovarian cancer (EOC patients often succumb to aggressive metastatic disease, yet little is known about the behavior and genetics of ovarian cancer metastasis. Here, we aim to understand how omental metastases differ from primary tumors and how these differences may influence chemotherapy. We analyzed the miRNA expression profiles of primary EOC tumors and their respective omental metastases from 9 patients using miRNA Taqman qPCR arrays. We find 17 miRNAs with differential expression in omental lesions compared to primary tumors. miR-21, miR-150, and miR-146a have low expression in most primary tumors with significantly increased expression in omental lesions, with concomitant decreased expression of predicted mRNA targets based on mRNA expression. We find that miR-150 and miR-146a mediate spheroid size. Both miR-146a and miR-150 increase the number of residual surviving cells by 2-4 fold when challenged with lethal cisplatin concentrations. These observations suggest that at least two of the miRNAs, miR-146a and miR-150, up-regulated in omental lesions, stimulate survival and increase drug tolerance. Our observations suggest that cancer cells in omental tumors express key miRNAs differently than primary tumors, and that at least some of these microRNAs may be critical regulators of the emergence of drug resistant disease.

  6. Primary Health Care Challenges in Rural/Remote Areas of Yakutia and Use of Automated Systems for the Medical Screening Examination of the Pediatric Population

    Directory of Open Access Journals (Sweden)

    Sardana A. Evseeva

    2015-12-01

    Full Text Available The negative consequences of social and economic changes in recent decades have primarily affected the rural population and violated the main principles of medical care organization for this group. The reduction by one third in the number of district hospitals, uncompensated by adequate development of outpatient care, and a shortage of doctors in rural clinics led to reduced availability of primary care. Specialized medical assistance in regional and national hospitals has also become less accessible to the rural population due to the high cost of travel. The number of doctors and nurses in rural areas is lower by 3.4 and 1.6 times, respectively, than in cities. In this regard, the burden and responsibility for rural health workers is much higher. Study of the opinions of the medical staff of the Northern and Arctic regions is an important part of the decision-making system in health care, allowing us to carry out modernization programs in the industry and increase their efficiency through feedback mechanisms. This article presents the available data on the problems of organizing medical assistance for residents of the Northern and Arctic regions of Yakutia, because dealing with these problems is still the most socially significant task for the authorities and carries a great load of negative experience, stereotypes, and scientific-methodological errors. To assess the quality of medical care, we conducted an anonymous survey of parents and medical staff of the Northern and Arctic regions of Yakutia. A total of 1,415 parents and 322 health specialists were interviewed between 2011 and 2012. The results of the anonymous survey revealed that in the Northern and Arctic regions of Yakutia there is a deficit of qualified specialists of different profiles, an unsatisfactory infrastructure of medical offices and hospitals, and a low level of income for medical personnel and the whole population. All above listed are some of the reasons for developing

  7. Primary Syphilis

    Science.gov (United States)

    ... and rashes clinical tools newsletter | contact Share | Primary Syphilis Information for adults A A A This image ... ulcer with a red base, typical of primary syphilis. Overview Primary syphilis is a disease caused by ...

  8. Health promotion: a challenge for primary care

    Directory of Open Access Journals (Sweden)

    Armando Henrique Norman

    2013-07-01

    Full Text Available Aliviar o sofrimento é um imperativo moral infindável, mas a obsessão contemporânea pela manutenção da saúde faz parte da persistente e recorrente ilusão do sonho humano de controlar o futuro. A atual manifestação desse sonho é mediada pela ciência, cujo novo Santo Graal é uma vida longa e sem sofrimento, que termina na velhice extrema, com rápido declínio e morte, também milagrosamente sem sofrimento. Iona Heath1 Nesta edição, a RBMFC traz artigos que abordam a promoção da saúde e prevenção de doenças, em seus vários matizes. O tema da promoção da saúde é bastante complexo e controverso sob o ponto de vista de sua operacionalização nos serviços da APS/ESF. De acordo com a OMS2: [...] a promoção da saúde é o processo que empodera as pessoas, tanto no sentido de melhoria como de controle de sua saúde [...]. A saúde é, portanto, vista como recurso para o dia a dia, não como objetivo do viver. É um conceito positivo, que enfatiza recursos sociais e pessoais, bem como as capacidades físicas. Sendo assim, promoção da saúde não é apenas responsabilidade do setor da saúde, indo além de um estilo de vida saudável, rumo ao bem-estar. A promoção da saúde tem na sua raiz conceitual o alívio do sofrimento das pessoas, e essa relação, apesar de não estar claramente explícita em sua definição, é muito importante para os profissionais da saúde. Na busca do alívio do sofrimento, existem ações que pertencem ao campo dos serviços de saúde e ações externas aos serviços de saúde. Estas últimas incluem moradia, educação, renda, alimentação, ecossistema estável, recursos sustentáveis, lazer, paz, trabalho com condições dignas, mobilidade, enfim, uma gama de ações que visam o bem comum, a redistribuição das riquezas e a redução das desigualdades sociais2,3. Neste sentido, um exemplo concreto de promoção da saúde, internacionalmente reconhecido, é a política adotada pelo governo brasileiro com o programa Bolsa Família, que tem auxiliado na redução do sofrimento de milhões de pessoas que viviam abaixo da linha da pobreza, ou seja, uma medida sanitária cujo núcleo de ação está fora dos serviços de saúde, mas que envolve a intersetorialidade4.Já na esfera dos serviços de saúde, a promoção da saúde, ou seja, o alívio dos sofrimentos ocorre tradicionalmente de duas formas: ações preventivas e ações assistenciais envolvidas no ato de cuidar. Ao se ancorar a promoção da saúde no alívio do sofrimento, ter-se-ia um referencial a partir do qual seria possível construir estratégias mais efetivas para os serviços de saúde. Por exemplo, quando Starfield et al.5 questionam se é correto que quase metade das consulta médicas nos Estados Unidos se dediquem a check-ups, enquanto muitas pessoas carecem de acesso aos serviços quando têm algum problema de saúde, os autores estão indagando se é eticamente aceitável priorizar ações preventivas, que, por definição, ocorrem sobre pessoas assintomáticas, em detrimento do atendimento de pessoas com sofrimento “real”, ferindo os preceitos da equidade e da justiça social. Não seria este um desvio assistencial promotor da lei de cuidados inversos6, “[...] em que a disponibilidade de uma boa assistência médica tende a variar inversamente com a necessidade da população atendida”?No SUS, por vezes, não tem sido diferente, pois tradicionalmente se tem um discurso em que o “PSF deveria fazer promoção e prevenção da saúde” e que a demanda espontânea atrapalha essa “nobre missão” da APS/ESF. Isso resulta em agendas hipertrofiadas com atividades programáticas em detrimento de um acesso facilitado ao cuidado à saúde pelas equipes da ESF7.Parece haver uma confusão relacionada à distinção entre a função principal e a função complementar das equipes da APS/ ESF, tanto no imaginário dos profissionais como dos gestores do SUS. A função principal das equipes da ESF é o alívio do sofrimento por meio do cuidado individual e familiar, ou seja, responder às necessidades da população contribuindo para a promoção da saúde8,9. Complementarmente, as equipes da ESF deveriam fazer atividades de promoção e prevenção, em âmbito micro social, cujos efeitos são difusos e leves, mas que contribuem para a melhoria da “consciência sanitária” e da organização popular para reivindicações e para a participação na gestão local do SUS7.Portanto, na operacionalização dos serviços da APS/ESF, a promoção da saúde não deveria estar conceitualmente dissociada das ações assistenciais e/ou dos cuidados realizados pelos profissionais das equipes da ESF, pois a legitimidade destes e da própria APS/ESF consolida-se socialmente ao oferecer cuidado efetivo diante do sofrimento dos indivíduos. Como afirmado por Heath1, “[...] priorizar a prevenção em relação à cura é o tipo de slogan fácil de fazer, amado por políticos e gestores, mas que ignora sistematicamente as implicações desta retórica.”

  9. Primary hyperparathyroidism : challenges and pitfalls in management

    NARCIS (Netherlands)

    Witteveen, Janneke Egbertine

    2012-01-01

    In patients with sporadic PHPT, the rate of persistence after initial PTx is 7% and that of recurrence none. In the case of persistent PHPT, the sensitivity of the widely used, non-invasive Tc99m-MIBI-SPECT imaging technique is decreased and is significantly lower than that of the invasive techniqu

  10. Expression profiling of primary and metastatic ovarian tumors reveals differences indicative of aggressive disease.

    Directory of Open Access Journals (Sweden)

    Alexander S Brodsky

    Full Text Available The behavior and genetics of serous epithelial ovarian cancer (EOC metastasis, the form of the disease lethal to patients, is poorly understood. The unique properties of metastases are critical to understand to improve treatments of the disease that remains in patients after debulking surgery. We sought to identify the genetic and phenotypic landscape of metastatic progression of EOC to understand how metastases compare to primary tumors. DNA copy number and mRNA expression differences between matched primary human tumors and omental metastases, collected at the same time during debulking surgery before chemotherapy, were measured using microarrays. qPCR and immunohistochemistry validated findings. Pathway analysis of mRNA expression revealed metastatic cancer cells are more proliferative and less apoptotic than primary tumors, perhaps explaining the aggressive nature of these lesions. Most cases had copy number aberrations (CNAs that differed between primary and metastatic tumors, but we did not detect CNAs that are recurrent across cases. A six gene expression signature distinguishes primary from metastatic tumors and predicts overall survival in independent datasets. The genetic differences between primary and metastatic tumors, yet common expression changes, suggest that the major clone in metastases is not the same as in primary tumors, but the cancer cells adapt to the omentum similarly. Together, these data highlight how ovarian tumors develop into a distinct, more aggressive metastatic state that should be considered for therapy development.

  11. Atenção primária à saúde: diretrizes, desafios e recomendações. Revisão de bibliografia internacional Primary health care: guidelines, challenges and recommendations. A review of international literature

    Directory of Open Access Journals (Sweden)

    Luiz Gustavo Silva Souza

    2011-01-01

    Full Text Available Apresentamos uma revisão de bibliografia internacional que teve por objetivo identificar e analisar a diversidade de temas associados à Atenção Primária à Saúde, especialmente o cotidiano de trabalho de seus profissionais, suas diretrizes e seus desafios políticos e clínicos. Analisamos os resumos de 105 artigos publicados entre 1999 e 2009. Selecionamos, para análise, 34 artigos identificados de acordo com critérios específicos. Criamos categorias temáticas e comparamos os dados com certa literatura brasileira sobre o tema. Os artigos centram-se no profissional de medicina e enfatizam a noção de medicina baseada em evidências. Abordam principalmente a implementação de diretrizes na Atenção Primária e as relações entre profissionais e usuários. Admitem a complexidade da Atenção Primária e a importância de aproximação à realidade dos pacientes. Entretanto, não abordam a intersetorialidade, não questionam radicalmente o especialismo curativista e não mencionam a promoção de cidadania, autonomia e cogestão junto aos usuários. Falam da necessidade de abordar problemas "humanos" nos níveis de implementação de diretrizes, encontro clínico etc., mas se mostram distanciados das ciências humanas.We present a review of international literature, aiming at identifying and analyzing the diversity of themes associated to Primary Health Care. We focused on the characteristics of the work of health care personnel, its guidelines and its political and clinical challenges. We analyzed the abstracts of 105 articles published between 1999 and 2009. Then, we integrally read and analyzed 34 articles, creating thematic categories. We compared data to Brazilian literature on the subject. The articles focus on physician's work and emphasize the notion of evidence-based medicine. They mainly approach the implementation of guidelines to primary health care and the professional-patient relations. They acknowledge the complexity of

  12. Metastatic signet ring cell carcinoma of unknown primary source

    OpenAIRE

    O'Kane, Dermot; Dean, Kylie; Nightingale, Rachael; Carlotto, Simone

    2014-01-01

    An elderly man presented to the emergency department following a motorbike accident. He had sustained chest injuries and a grade 1 splenic laceration. He had a moderate amount of free fluid and some omental standing on trauma CT, which was concerning for occult malignancy. A follow-up CT 4 weeks later showed a marked progression of the ascites and omental stranding. Ascitic tap was negative for malignancy. Tumour markers were normal. The patient developed a proximal small bowel obstruction wh...

  13. Primary papillary serous carcinoma of the peritoneum: Four cases and review of computed tomography findings

    International Nuclear Information System (INIS)

    Primary papillary serous carcinoma of the peritoneum is an uncommon primary malignancy of the peritoneum and is histologically indistinguishable from papillary serous carcinoma of the ovary. The diagnosis of primary peritoneal papillary serous carcinoma should be considered in the presence of peritoneal and omental masses in the absence of an ovarian mass. Although it has been extensively documented in the pathological and gynaecological oncology literature, the CT appearance of primary papillary serous carcinoma of the peritoneum has been reported in only 51 cases in five reports. We present four patients with CT findings of pathologically proven primary papillary serous carcinoma of the peritoneum. There were a total of 23 patients with a histopathologically proven diagnosis of primary papillary serous carcinoma of the peritoneum between 1980 and 2002 with CT imaging. However, only four of the 23 patients' CT films were retrieved for retrospective evaluation. The rest of the films were not available as either patients had misplaced the films or patients were deceased. Copyright (2004) Blackwell Science Pty Ltd

  14. Primary explosives

    Energy Technology Data Exchange (ETDEWEB)

    Matyas, Robert; Pachman, Jiri [Pardubice Univ. (Czech Republic). Faculty of Chemical Technology

    2013-06-01

    The first chapter provides background such as the basics of initiation and differences between requirements on primary explosives used in detonators and igniters. The authors then clarify the influence of physical characteristics on explosive properties, focusing on those properties required for primary explosives. Furthermore, the issue of sensitivity is discussed. All the chapters on particular groups of primary explosives are structured in the same way, including introduction, physical and chemical properties, explosive properties, preparation and documented use.

  15. Primary fibromyalgia

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Jensen, L T; Foldager, Marie Viftrup;

    1990-01-01

    Serum concentrations of procollagen type III aminoterminal peptide have previously been reported to be low in some patients with primary fibromyalgia and the aim of this study was to determine if such patients differ clinically from primary fibromyalgia patients with normal levels of procollagen...... type III aminoterminal peptide. Subjective symptoms, tender points and dynamic muscle strength in 45 women with primary fibromyalgia were related to serum concentrations of procollagen type III aminoterminal peptide. Patients with low serum concentrations of procollagen type III aminoterminal peptide...... concentrations of procollagen type III aminoterminal peptide of primary fibromyalgia patients are connected to the disease impact....

  16. Syphilis - primary

    Science.gov (United States)

    Primary syphilis; Secondary syphilis; Late syphilis; Tertiary syphilis ... Syphilis is a sexually transmitted, infectious disease caused by the spirochete bacterium Treponema pallidum . This bacterium causes ...

  17. Hyperthyroidism (primary)

    DEFF Research Database (Denmark)

    Nygaard, Birte

    2010-01-01

    . METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for primary hyperthyroidism? What are the effects of surgical treatments for primary hyperthyroidism? What are the effects of treatments for subclinical...

  18. Featherweight Challenge

    Science.gov (United States)

    Love, Tyler S.; Ryan, Larry

    2012-01-01

    As science, technology education, and engineering programs suffer budget cuts, educators continue to seek cost-effective activities that engage students and reinforce standards. The featherweight challenge is a hands-on activity that challenges students to continually refine their design while not breaking the budget. This activity uses one of the…

  19. Primary Inflation

    OpenAIRE

    Izawa, K. -I.

    1997-01-01

    We consider an inflationary universe scenario with multiple stages of inflation. The primary inflation, which may start at the Planck epoch, is followed by secondary inflations, which include the cosmological inflation that causes the primordial density fluctuations of our universe. We point out that an initial condition for a secondary inflation is naturally realized if the e-fold number of the primary inflation is sufficiently large.

  20. Primary Yolk Sac Tumor of the Omentum: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Kenichi Harano

    2012-12-01

    Full Text Available Yolk sac tumor (YST is a rare malignant tumor originating from germ cells. YST normally originates from the gonads, rarely occurring in extragonadal sites. We report a 35-year-old man with YST arising in the omentum, which is the first reported case of a primary YST of the omentum in an adult male. The patient presented to the community hospital with abdominal distension. A CT scan showed thickening of the omentum with ascites. The patient underwent open biopsy of the omental mass. The Pathology Department of the hospital could not make a definitive diagnosis at that time, and the tumor was considered a cancer of unknown primary (CUP origin with features of primary colorectal cancer based on the immunohistochemistry (IHC findings of the biopsy specimen (CK7–/CK20+ and CDX-2+. He was then referred to our hospital. We found that serum α-fetoprotein was abnormally elevated to 7,144 ng/ml (normal <10.0, and reevaluation of the biopsy specimen revealed microcystic or reticular patterns of tumor cells with Schiller-Duval bodies typical of YST. The present case suggests that IHC is a very useful diagnostic tool for subtyping CUP but should be interpreted in the context of clinical and morphological findings.

  1. Challenging Identities

    DEFF Research Database (Denmark)

    Keydar, Ceglar; Marin, Manuela; Janik, Allan;

    , cultural, and political practices. Notions of national identity and national politics are challenged by European integration, as well as by increasing demographic heterogeneity due to migration, and migrants experience conflicts of identification stemming from clashes between cultural heritage...

  2. Metastatic signet ring cell carcinoma of unknown primary source.

    Science.gov (United States)

    O'Kane, Dermot; Dean, Kylie; Nightingale, Rachael; Carlotto, Simone

    2014-01-01

    An elderly man presented to the emergency department following a motorbike accident. He had sustained chest injuries and a grade 1 splenic laceration. He had a moderate amount of free fluid and some omental standing on trauma CT, which was concerning for occult malignancy. A follow-up CT 4 weeks later showed a marked progression of the ascites and omental stranding. Ascitic tap was negative for malignancy. Tumour markers were normal. The patient developed a proximal small bowel obstruction which appeared to be related to this omental caking in the left upper quadrant on CT. Gastroduodenoscopy did not display any mass lesion. There was an external compression of the duodenum which could not be traversed with the scope. Laparoscopy showed a widespread peritoneal carcinomatosis. Biopsies of the omentum and peritoneum confirmed metastatic signet ring cell carcinoma (cytokeratin 7 and cytokeratin 20 positive). The patient was palliated but died 2 weeks after his diagnosis. PMID:24536055

  3. Effect of different antimicrobial treatments on serum acute phase responses and leukocyte counts in pigs after a primary and a secondary challenge infection with Actinobacillus pleuropneumoniae

    DEFF Research Database (Denmark)

    Sjölund, M; Fossum, C; Martin de la Fuente, AJM;

    2011-01-01

    The susceptibility to an initial challenge and a re-challenge inoculation with Actinobacillus pleuropneumoniae was analysed in pigs that were treated with antimicrobials of different efficacies following the first exposure to A pleuropneumoniae. In brief, 30 nine-week-old specific pathogen......-free pigs were allocated to five groups of six. After acclimatisation, four groups were inoculated with A pleuropneumoniae serotype 2. At the onset of clinical signs, three of the groups of pigs were treated with enrofloxacin, tetracycline or penicillin. A fourth group served as the inoculated control and...

  4. Primary Processing

    NARCIS (Netherlands)

    Mulder, W.J.; Harmsen, P.F.H.; Sanders, J.P.M.; Carre, P.; Kamm, B.; Schoenicke, P.

    2012-01-01

    Primary processing of oil-containing material involves pre-treatment processes, oil recovery processes and the extraction and valorisation of valuable compounds from waste streams. Pre-treatment processes, e.g. thermal, enzymatic, electrical and radio frequency, have an important effect on the oil r

  5. Primary care for refugees.

    Science.gov (United States)

    Eckstein, Barbara

    2011-02-15

    Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients.

  6. Logistical challenges

    Directory of Open Access Journals (Sweden)

    Steve Matthews

    2005-07-01

    Full Text Available The impact of the Asian tsunami was unprecedented and the logistical challenges of meeting the needs of those affected were enormous. Had the tsunami happened even five years ago, World Vision would not have been able to respond nearly as effectively as it did.

  7. Ethical Challenges

    Science.gov (United States)

    Morris, Michael

    2004-01-01

    All evaluators face the challenge of striving to adhere to the highest possible standards of ethical conduct. Translating the AEA's Guiding Principles and the Joint Committee's Program Evaluation Standards into everyday practice, however, can be a complex, uncertain, and frustrating endeavor. Moreover, acting in an ethical fashion can require…

  8. Archiving challenges

    OpenAIRE

    Ringersma, J.

    2010-01-01

    Teaching slides on: What is a digital archive? Parties involved in digital archiving Archiving challenges organization of data coherence and persistency access and safety Language archiving software Different users, different needs For: Saami Language Documentation and Revitalization. Winter school, Bodø, Norway

  9. Modelling DW-MRI data from primary and metastatic ovarian tumours

    Energy Technology Data Exchange (ETDEWEB)

    Winfield, Jessica M. [Institute of Cancer Research, CRUK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, Surrey (United Kingdom); Royal Marsden NHS Foundation Trust, Surrey (United Kingdom); Institute of Cancer Research and Royal Marsden Hospital, MRI Unit, Surrey (United Kingdom); DeSouza, Nandita M.; Collins, David J. [Institute of Cancer Research, CRUK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, Surrey (United Kingdom); Royal Marsden NHS Foundation Trust, Surrey (United Kingdom); Priest, Andrew N.; Hodgkin, Charlotte; Freeman, Susan [University of Cambridge, Department of Radiology, Addenbrooke' s Hospital, Cambridge (United Kingdom); Wakefield, Jennifer C.; Orton, Matthew R. [Institute of Cancer Research, CRUK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, Surrey (United Kingdom)

    2015-07-15

    To assess goodness-of-fit and repeatability of mono-exponential, stretched exponential and bi-exponential models of diffusion-weighted MRI (DW-MRI) data in primary and metastatic ovarian cancer. Thirty-nine primary and metastatic lesions from thirty-one patients with stage III or IV ovarian cancer were examined before and after chemotherapy using DW-MRI with ten diffusion-weightings. The data were fitted with (a) a mono-exponential model to give the apparent diffusion coefficient (ADC), (b) a stretched exponential model to give the distributed diffusion coefficient (DDC) and stretching parameter (α), and (c) a bi-exponential model to give the diffusion coefficient (D), perfusion fraction (f) and pseudodiffusion coefficient (D*). Coefficients of variation, established from repeated baseline measurements, were: ADC 3.1 %, DDC 4.3 %, α 7.0 %, D 13.2 %, f 44.0 %, D* 165.1 %. The bi-exponential model was unsuitable in these data owing to poor repeatability. After excluding the bi-exponential model, analysis using Akaike Information Criteria showed that the stretched exponential model provided the better fit to the majority of pixels in 64 % of lesions. The stretched exponential model provides the optimal fit to DW-MRI data from ovarian, omental and peritoneal lesions and lymph nodes in pre-treatment and post-treatment measurements with good repeatability. (orig.)

  10. Identification and comparison between omental type Ⅰ and type Ⅱ milky spots of the greater omentum in rat%大鼠大网膜Ⅰ型和Ⅱ型乳斑的确定及对比

    Institute of Scientific and Technical Information of China (English)

    李尚胜; 黄允宁

    2011-01-01

    Objective: To identify the type of milky spots, and investigate the similarities and differences between type Ⅰ and type Ⅱ milky spots in number, area and cell composition. Methods: Double-labeling of rat omental milky spots with activated carbon and H-E staining were used to measure the number and the area of type Ⅰ and type Ⅱ milky spots by Image-Pro plus software, and the differences in ultrastructure between type Ⅰ and type Ⅱ milky sports were observed under an electron microscope. Results: In physiological conditions, the number of the type Ⅱ milky spots was more significant than that of the type Ⅰ milky spots [(9. 153±0. 818)per cm2 vs (1. 913±0. 851)per cm2 , P<0. 01], and the area of the type Ⅱ milky spots was significantly larger than that of the type Ⅰ milky spots [(0. 421±0.136)mm2 vs (0. 102±0.041)mm2 , P <0. 01]. Two types of milk spots were mainly composed of macrophages, lymphocytes, mast cells, monocytes, plasma cells, eosinophils, reticular cells and stromal cells; vessel, lymph vessel and adipocyte were observed in type Ⅱ milky spots.Activated carbon particles were observed in macrophages of two types milky spots. Conclusion: Both activated carbon and H-E staining can mark milky spots; Omental milky spots can be classified into two types: type Ⅰ and type Ⅱ (type Ⅰ milky spots are located in the thin serous membrane of the omentum and no blood vessels or adipose tissues are found in the surrounding area; type Ⅱ milky spots are distributed close to vascular networks and adipose tissues, curved vessel can be observed in this milky spots). Two types of the milky spots in the tissue cell composition are different due to the distribution; Macrophages in both types of milky spots have the immune function of phagocytizing foreign particles.%目的:对乳斑的分型进行确定,并探讨Ⅰ型乳斑和Ⅱ型乳斑数量、面积及细胞构成的异同.方法:微粒子活性炭及H-E染色双重标

  11. CHALLENGES IN BRONCHIAL CHALLENGE TESTING

    NARCIS (Netherlands)

    Lexmond, A. J.; Hagedoorn, P.; Frijlink, H. W.; de Boer, A. H.

    2013-01-01

    Background: In the adenosine 5'-monophosphate (AMP) bronchial challenge test, AMP is usually administered according to dosing protocols developed for histamine/methacholine. It has never been thoroughly investigated whether these protocols are suitable for AMP as well. Methods: The setup of the two-

  12. Mobility Challenges

    DEFF Research Database (Denmark)

    Jensen, Ole B.; Lassen, Claus

    2011-01-01

    This article takes point of departure in the challenges to understand the importance of contemporary mobility. The approach advocated is a cross-disciplinary one drawing on sociology, geography, urban planning and design, and cultural studies. As such the perspective is to be seen as a part...... of the so-called ‘mobility turn’ within social science. The perspective is illustrative for the research efforts at the Centre for Mobility and Urban Studies (C-MUS), Aalborg University. The article presents the contours of a theoretical perspective meeting the challenges to research into contemporary urban...... mobilities. In particular the article discusses 1) the physical city, its infrastructures and technological hardware/software, 2) policies and planning strategies for urban mobility and 3) the lived everyday life in the city and the region....

  13. ESTHETICS IN PRIMARY TEETH

    Directory of Open Access Journals (Sweden)

    Mathew Renu Ann

    2013-08-01

    Full Text Available Dental esthetics is an integral part of facial esthetics. Esthetic problems in childhood and adolescence can have a significant effect on psychosocial development and interaction with peers. Esthetic restoration of primary anterior teeth can be especially challenging due to the small size of the teeth, close proximity of pulp to tooth surface, relatively thin enamel and surface area for bonding, issues related to child behavior and finally cost of the treatment. The advent of different techniques, devices, and materials helps in creating beautiful restorations which help children and adolescents improve their self-image.

  14. Clinical application of free omental flap transfer

    Energy Technology Data Exchange (ETDEWEB)

    Harii, K.

    1978-04-01

    In the field of reconstruction surgery, the greater omentum has been used as a transposed flap for the treatment of chronic lymphedema, radionecrosis, and so forth. Its transferable range was limited by the length of its pedicle. Microvascular anastomosis allows for free transplantation of this organ and has vastly expanded its usefulness.

  15. Data Challenges

    CERN Multimedia

    McCubbin, N A

    Some two years ago we planned a series of Data Challenges starting at the end of 2001. At the time, that seemed to be comfortingly far in the future... Well, as the saying goes, doesn't time fly when you are having fun! ATLAS Computing is now deep in the throes of getting the first Data Challenge (DC0) up and running. One of the main aims of DC0 is to have a software 'release' in which we can generate full physics events, track all particles through the detector, simulate the detector response, reconstruct the event, and study it, with appropriate data storage en route. As all software is "always 95% ready" (!), we have been able to do most of this, more or less, for some time. But DC0 forces us to have everything working, together, at the same time: a reality check. DC0 should finish early next year, and it will be followed almost immediately afterwards by DC1 (DC0 was foreseen as the 'check' for DC1). DC1 will last into the middle of 2002, and has two major goals. The first is generation, simulation, and r...

  16. SPS Challenges

    CERN Document Server

    Chapochnikova, Elena

    2008-01-01

    In future the SPS should be able to transfer to the LHC the beam produced by a completely new pre-injector chain and required by the LHC for different upgrade scenarios. The issues related to this extremely challenging task are presented together with some possible ways of overcoming the problems that arise. Besides an increase in injection energy provided by PS2, these measures can include both an SPS vacuum chamber upgrade against the e-cloud and operation with larger longitudinal emittance for beam stability. As a result the power plant of the SPS RF system must be doubled. The SPS upgrade will also need the improvement or replacement of many other machine elements.

  17. Study on expression of visfatin mRNA in abdominal omental adipose tissue and its relationship with blood lipid in type 2 diabetics%内脂素在2型糖尿病伴高甘油三酯血症患者网膜脂肪组织中的表达及与血脂的关系

    Institute of Scientific and Technical Information of China (English)

    王淑艳; 孟晓梅; 陈述林

    2012-01-01

    目的 探讨内脂素( visfatin)基因在2型糖尿病(T2DM)患者网膜脂肪组织中的表达情况及与血脂的关系.方法 选取2型糖尿病患者161例,分为高甘油三酯及正常甘油三酯两组.采用Northern blot印迹技术研究两组的网膜脂肪组织中visfatin mRNA的表达水平,并测定血清visfatin浓度、空腹血糖、血脂谱及其他生化指标.结果 (1)2型糖尿病伴高甘油三酯血症组血清visfatin增高[( 129.07±21.35) ng/mL vs(101.65±15.23) ng/mL,t =2.295,P<0.05],网膜组织的visfatin mRNA表达量高于正常甘油三酯组(P<0.05).(2)血清visfatin与甘油三酯(β=0.592,P<0.05)及空腹血糖(β=0.763,P<0.01)呈正相关,网膜脂肪组织visfatin与空腹血糖、甘油三酯等均无相关.结论 T2DM患者血清visfatin可能与甘油三酯代谢相关.%Objective To investigate the expression of visfatin mRNA in abdominal omental adipose tissue and its relationship with blood lipid in type 2 diabetes mellitus.Methods 161 type 2 diabetic patients were divided into two groups according to triglyceride ( TG ),high triglyceride group ( TG ≥ 1.7mmol/L) and normal triglyceride group(TG < 1.7 mmol/L).The expression of visfatin mRNA in abdominal omental adipose tissue was measured with Northern Blot.Visfatin plasma concentration,fasting plasma glucose (FPG),blood lipid profiles and other biochemical indicators were also measured.Results Comparing with normal triglyceride group,the diabetic patients in high triglyceride group had significantly increased levels of visfatin plasma concentration [ ( 129.07 ± 21.35)ng/mL vs ( 101.65 ± 15.23 ) ng/mL,t =2.295,P <0.05]and mRNA expression in omental adipose tissue( P <0.05).Visfatin plasma concentration was positively correlated with TG( β =0.592,P <0.05 ) and FPG( β =0.763,P <0.01 ).Visfatin mRNA expression in omental adipose tissue had no correlation with FPG,TG and other biochemical indicators.Conclusions The plasma visfatin level in T2DM

  18. 2型糖尿病患者皮下、大网膜脂肪组织脂联素mRNA表达变化及意义%Expression and significance of adiponectin mRNA in subcutaneous and omental adipose tissue of type 2 diabetic patients

    Institute of Scientific and Technical Information of China (English)

    李倩倩; 蒋秀琴; 李慧敏; 缪珩

    2011-01-01

    映胰岛素抵抗程度.%Objective: To observe the adiponectin mRNA expression in subcutaneous and omental adipose tissue of type 2 diabetic patients and their relation with serum adiponectin, body mass index(BMI), waist circumference (WC),waist hip ratio (WHR), blood pressure, fasting plasma glucose (FPG), HbA 1 c, blood lipids and uric acid (UA). Methods:Twenty-three T2DM patients with obesity,23 T2DM patients, 33 obesity patients and 23 controls were selected. The adiponectin mRNA expression level in adipose tissue was assayed by RT-PCR. The level of serum adiponectin was measured with ELISA kit. FBG, triglyceride (TG), total cholesterol(TC),high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), HbAlc, UA of all subjects were determined and their blood pressure, height, weight, waist circumference, hip circumference were measured to calculate BMI,WHR.Results: ①The SBP, DBP, FPG, HbA1c, TG, LDL-C, UA were significantly higher, and serum adiponectin, HDL-C and adiponectin mRNA expression level in both subcutaneous and omental adipose tissue were significantly lower in diabetic obesity group than in obesity group (P < 0.05), the adiponectin mRNA expression level in omental were significantly lower than in subcutaneous adipose tissue in both groups (P < 0.01). ②The FPG, HbAlc, TG, UA were higher, serum adiponectin, HDL-C and adiponectin mRNA levels expressed in both subcutaneous and omental adipose tissue were lower in diabetic group without obesity than in control group without obesity (P < 0.05), the adiponectin mRNA expression level in omental was lower than in subcutaneous adipose tissue in both groups (P < 0.01). ③The BMI,WHR,SBP,DBP,FPG,HbA1C,TG,UA were higher, serum adiponectin and adiponectin mRNA level expressed in both subcutaneous and omental adipose tissue were lower in diabetic obese group than in diabetic group without obesity(P < 0.05). ④The adiponectin mRNA expression level in omental adipose tissue of diabetic

  19. Scrapheap Challenge

    CERN Multimedia

    2004-01-01

    Three British guys at CERN recently took a break from work to try their hand at Scrapheap Challenge. Shown on Channel 4 in the UK, it is a show where two teams must construct a machine for a specific task using only the junk they can scavenge from the scrap yard around them. And they have just 10 hours to build their contraption before it is put to the test. The first round, aired 19 September, pitted a team of three women, from the British Army's Royal Electrical and Mechanical Engineers, against the CERN guys - the Up 'n Atoms: Ali Day, David McFarlane and James Ridewood. Each team, with the help of an appointed expert, had the task of making a giant, 3-metre self-propelled "bowling ball", to roll down a 50 metre bowling alley at skittles 4 metres high. The Up 'n Atoms' contraption featured a small car with a huge wheel on its back. Once up to speed, slamming on the brakes caused the wheel to roll over and take the car with it. On their very last run they managed to take out seven pins. Luckily, though, ...

  20. How the Project Approach Challenges Young Children

    Science.gov (United States)

    Burns, Marcia V.; Lewis, Alisha L.

    2016-01-01

    In this article, educators at University Primary School in Champaign, Illinois, share examples and understandings of the ways The Project Approach challenges young children to think critically about topics of importance in their world. Project investigations that provoke academic and social challenges for individuals and classroom communities of…

  1. Energetic challenges

    International Nuclear Information System (INIS)

    Full text: Connecting the 2 billion people who have no access to commercial energy is the most important energy challenge facing the world community. Women and children, primarily in developing countries, spend their days collecting wood or cow dung for fuel for cooking and heating their homes in very inefficient stoves: this both harms the environment and directly threatens the health of their families. Outmoded boilers linked to central heating systems in most of the cities of Eastern Europe and the former Soviet Union pose another challenge. They are inefficient; they lack modern pollution control; and the end use of the heat is not metered, leading to more inefficiency and waste. Both of these problems cry out to the world for investment. Investing in energy solutions in these countries can bring about significant and immediate local environmental improvements, achieve greatly improved energy efficiency, and substantially reduce greenhouse gas emissions. But, energy and environmental policy tends to direct investment towards industrial countries, even though it would have a greater impact on the environment - not to mention the human condition in general - in the developing countries and transition economies. We need a new direction in energy policy. The World Energy Council has studied the needs and we believe a number of our proposed policy recommendations would lead towards greater investment in the countries where it is most needed. The political risk of key energy project investments must be addressed both by the countries seeking outside investment and by the global community at large. The countries must create an investor-friendly climate, which includes the rule of law and recognizes private property rights. The global community can contribute by developing new political risk insurance schemes rewarding the countries that create this climate. Energy must be priced to cover costs and ensure payment. In too many countries, blanket subsidies for energy

  2. Regulatory challenges

    International Nuclear Information System (INIS)

    The problem for policy makers wanting to liberalize natural gas markets is that its concentrated structure may also be the socially most efficient one. Because of scale economies, more firms operating in the market may incur higher transportation costs unless the market grows sufficiently in each geographic segment. This argument goes for product extension through vertical (or horizontal) integration and the exploitation of economies of scope as well. Thus, the challenge for governments is to intervene in a way that preserves a market structure that has the potential to minimize cost, and at the same lime change its behavior in order to avoid possible lax cost control and exploitation of market power. The existence of scope advantages indicates that liberalization of the market should open for the possibility to bundle services in competition with provision of unbundled services. If operations are unbundled and there exist economies of scope, the gain from increased competition should be weighed against the losses of less efficient operations of each firm. Thus, with the growth in the European market, gradually more arguments support the idea of unbundling. The significant scale economy in trunk pipelines, sunk investments and capital immobility, possible economies of scope in vertical integration and companies' bundling of services influences vertical and horizontal ownership relations and contractual terms in the European gas market. In specific segments of the markets, these relationships may promote efficient investments and pricing without public interference, but the strong concentration of market power indicates that this is rather the exception than the rule. In order to design an efficient and welfare maximizing way of regulating the market one needs a closer identification of the actual goal of the regulation. Microeconomic theory is often used for this purpose. The author discusses the alternatives of laissez-faire, nationalization or regulation for the

  3. Regulatory challenges

    Energy Technology Data Exchange (ETDEWEB)

    Austvik, Ole Gunnar

    2003-07-01

    The problem for policy makers wanting to liberalize natural gas markets is that its concentrated structure may also be the socially most efficient one. Because of scale economies, more firms operating in the market may incur higher transportation costs unless the market grows sufficiently in each geographic segment. This argument goes for product extension through vertical (or horizontal) integration and the exploitation of economies of scope as well. Thus, the challenge for governments is to intervene in a way that preserves a market structure that has the potential to minimize cost, and at the same lime change its behavior in order to avoid possible lax cost control and exploitation of market power. The existence of scope advantages indicates that liberalization of the market should open for the possibility to bundle services in competition with provision of unbundled services. If operations are unbundled and there exist economies of scope, the gain from increased competition should be weighed against the losses of less efficient operations of each firm. Thus, with the growth in the European market, gradually more arguments support the idea of unbundling. The significant scale economy in trunk pipelines, sunk investments and capital immobility, possible economies of scope in vertical integration and companies' bundling of services influences vertical and horizontal ownership relations and contractual terms in the European gas market. In specific segments of the markets, these relationships may promote efficient investments and pricing without public interference, but the strong concentration of market power indicates that this is rather the exception than the rule. In order to design an efficient and welfare maximizing way of regulating the market one needs a closer identification of the actual goal of the regulation. Microeconomic theory is often used for this purpose. The author discusses the alternatives of laissez-faire, nationalization or regulation for

  4. Primary tumors of the patella.

    Science.gov (United States)

    Song, Mingzhi; Zhang, Zhen; Wu, Yuxuan; Ma, Kai; Lu, Ming

    2015-01-01

    The patella is an uncommon location for cancerous occurrence and development. The majority of tumors of the patella are benign, with a significant incidence of giant cell tumors and chondroblastoma. With the development of modern diagnostic technologies, there appear however many other histological types which raise challenges of diagnosis and treatment. In this article, we review the reported histological types of primary patellar tumors. Specifically, epidemiology, symptomatology, imageology, histopathology, and treatment options for these histological lesions will be discussed, respectively. As there is an increasing focus on the diagnosis and the treatment of these lesions, the availability of the integrated information about primary patellar tumors becomes more significant. PMID:25906772

  5. El Sistema Nacional Integrado de Salud en Uruguay y los desafíos para la Atención Primaria The Integrated National Healthcare System in Uruguay and the challenges for Primary Healthcare

    Directory of Open Access Journals (Sweden)

    Ana Sollazzo

    2011-06-01

    Full Text Available El artículo aborda resultados del análisis panorámico de la Atención Primaria en Salud (APS en Uruguay en Uruguay en 2009, en el marco de un estudio multicéntrico con objetivo de identificar posibilidades para reorientar la Atención Primaria en Salud (APS como estrategia para alcanzar sistemas de salud universales, considerando la segmentación del sistema y la fragmentación en la provisión. La metodología incluyó análisis documental, entrevistas con informantes clave y triangulación de fuentes de información. Los resultados se presentan en base al modelo analítico construido en cinco dimensiones: conducción, financiamiento, recursos, integralidad e intersectorialidad de la APS. A nivel macro se observa la reciente reforma sectorial con creación de un Sistema Nacional Integrado de Salud (SNIS que favorece el desarrollo de la APS desde una concepción integradora. Se han definido acciones que apuntan a superar la segmentación del sistema y la fragmentación de los cuidados. Sin embargo a nivel operativo la segmentación presente antes del SNIS, así como el bajo nivel de coordinación de los cuidados no se han modificado aún. Esto se relaciona con la capacidad de gestión y factores organizacionales. La falta de recursos humanos adecuados para la implementación de la estrategia de APS, se identifica como factor relevante.The article examines the results of the overview of PHC (Primary Healthcare in Uruguay in 2009, within the context of the multicentric study of PHC with a view to identifying possibilities of redefining PHC as a strategy to achieve universal healthcare systems, taking into account the healthcare system's segmentation and fragmentation. The methodology included document analysis, key informant interviews and triangulation of information sources. The results presented are based on the analytical model structured in five dimensions: delivery, financing, resources, and integrated and intersectoral PHC. At the macro

  6. Effect of Metformin on v-SNAREs expression in Human omental Adipocytes%二甲双胍对人网膜脂肪细胞中v-SNAREs家族表达的影响

    Institute of Scientific and Technical Information of China (English)

    丁跃; 刘云峰; 章毅; 杨静

    2015-01-01

    Objective:To observe the effects of metformin on the expression of vesicle-associated membrane proteins (VAMP2,3,4,7,8) which the subfailmilies of vescical-souble N-ethymaleimide sensitive factor attachment proteins receptor (v-SNAREs) in human omental adipocytes. Method:Induce human preadipocytes into mature adipocytes and proofed by oil red O staining. Twenty-four hours after giving different concentration metfomin ( 0mM, 1mM, 10mM) intervention, we using real-time PCR technology to detect the mRNA expression of VAMP2,3,4,5,7,8.Results The levels of VAMP4,5,8 in 1mM metformin group was increased compared with control group (respectively, P<0.05, P<0.05, P<0.05,) , while the levels of VAMP3,7 was decreased ( respectively,P<0.05,P<0.01) ,the expression of VAMP2 do not have statistically significant difference. 10mM met-formin could also increase the VAMP4,5,8 expression,compared with those in control group ( respectively, P<0.01, P<0.01,P<0.01,) , and the levels of VAMP7 was decreased (P<0.05) ,while the effection on VAMP2、3 do not have statistically significant difference. Comparison:of 1mM group and 10mM group, 10mM group metformin increase the levels of VAMP3,4,5,8 ( re-spectively, P<0.05, P<0.05, P<0,05,P<0.01),but the expression of VAMP2,7 do not have statistically significant difference be-tween the two groups. Conclusion:Metformin can increases the levels of VAMP4,5,8 and decreases the levels of VAMP3,7 in adipocytes with a certain degree of dose-dependently, do not regulate the expression of VAMP2, which show that metformin regulated GLUT4 trafficking may through its regulation of v-SNAREs expression.%目的:观察二甲双胍对人成熟脂肪细胞中囊泡相关可溶性N-乙酰基亚胺敏感因子附着蛋白受体(vescical-souble N-ethymaleimide sensitive factor attachment proteins receptor, v-SNAREs)家族成员VAMP2、3、4、5、7、8表达的影响。方法:诱导分化人前脂肪细胞为成熟脂肪细胞,并用油红O染色证

  7. Effect of Metformin on v-SNAREs expression in Human omental Adipocytes%二甲双胍对人网膜脂肪细胞中v-SNAREs家族表达的影响

    Institute of Scientific and Technical Information of China (English)

    丁跃; 刘云峰; 章毅; 杨静

    2015-01-01

    目的:观察二甲双胍对人成熟脂肪细胞中囊泡相关可溶性N-乙酰基亚胺敏感因子附着蛋白受体(vescical-souble N-ethymaleimide sensitive factor attachment proteins receptor, v-SNAREs)家族成员VAMP2、3、4、5、7、8表达的影响。方法:诱导分化人前脂肪细胞为成熟脂肪细胞,并用油红O染色证明。给予不同浓度二甲双胍(0mM,1mM,10mM)干预24小时后,运用实时荧光相对定量PCR技术检测脂肪细胞VAMP2、3、4、5、7、8的mRNA基因水平。结果:与对照组(0mM二甲双胍)相比,1mM二甲双胍上调脂肪细胞VAMP4,5,8水平(分别P<0.05,P<0.05,P<0.05,),下调VAMP3、7水平(分别P<0.05,P<0.01),对VAMP2表达的差异无统计学意义;与对照组相比10mM二甲双胍上调脂肪细胞VAMP4、5、8水平(分别P<0.01,P<0.01,P<0.01),下调VAMP7水平(P<0.01),VAMP2、3表达差异无统计学意义。10mM二甲双胍干预组与1mM组比较, VAMP3、4、5、8表达水平升高(P<0.05,P<0.05,P<0.05,P<0.01),VAMP2、7表达差异无统计学意义。结论:二甲双胍可上调VAMP4,5,8的表达,可下调VAMP3、7的表达,且具有一定的剂量依赖效应,对VAMP2的表达无影响,显示二甲双胍可能通过对v-SNAREs家族表达的调节而参与对脂肪细胞GLUT4转运的调节。%Objective:To observe the effects of metformin on the expression of vesicle-associated membrane proteins (VAMP2,3,4,7,8) which the subfailmilies of vescical-souble N-ethymaleimide sensitive factor attachment proteins receptor (v-SNAREs) in human omental adipocytes. Method:Induce human preadipocytes into mature adipocytes and proofed by oil red O staining. Twenty-four hours after giving different concentration metfomin ( 0mM, 1mM, 10mM) intervention, we using real-time PCR technology to detect the mRNA expression of VAMP2,3,4,5,7,8.Results The levels of VAMP4,5,8 in 1mM metformin group was increased compared with

  8. Primary Mediastinal Classical Hodgkin Lymphoma.

    Science.gov (United States)

    Piña-Oviedo, Sergio; Moran, Cesar A

    2016-09-01

    Primary mediastinal Classical Hodgkin lymphoma (CHL) is rare. Nodular sclerosis CHL (NS-CHL) is the most common subtype involving the anterior mediastinum and/or mediastinal lymph nodes. Primary thymic CHL is exceedingly rare. The disease typically affects young women and is asymptomatic in 30% to 50% of patients. Common symptoms include fatigue, chest pain, dyspnea and cough, but vary depending on the location and size of the tumor. B-symptoms develop in 30% of cases. By imaging, primary mediastinal CHL presents as mediastinal widening/mediastinal mass that does not invade adjacent organs but may compress vital structures as bulky disease. Histopathology is the gold standard for diagnosis. Primary mediastinal NS-CHL consists of nodules of polymorphous inflammatory cells surrounded by broad fibrous bands extending from a thickened lymph node capsule. The cellular nodules contain variable numbers of large Hodgkin/Reed-Sternberg cells, required for diagnosis. Primary thymic CHL may exhibit prominent cystic changes. The histopathologic recognition of NS-CHL can be challenging in cases with prominent fibrosis, scant cellularity, artifactual cell distortion, or an exuberant granulomatous reaction. The differential diagnosis includes primary mediastinal non-HLs, mediastinal germ cell tumors, thymoma, and metastatic carcinoma or melanoma to the mediastinum. Distinction from primary mediastinal non-HLs is crucial for adequate therapeutic decisions. Approximately 95% of patients with primary mediastinal CHL will be alive and free of disease at 10 years after treatment with short courses of combined chemoradiotherapy. In this review, we discuss the history, classification, epidemiology, clinicoradiologic features, histopathology, immunohistochemistry, differential diagnosis, and treatment of primary mediastinal CHL. PMID:27441757

  9. Environmental upbringing of primary education

    OpenAIRE

    Pěničková, Ludmila

    2013-01-01

    The society is constantly confronted with increasing challenges devastated environment. Implementation of environmental education in to the education of children in primary education not only provides a real chance to improve current reducing development of society and nature. It also allows to begin an active communication with the society as a key cause of environmental reduction. This paper tries to define the social importance of environmental education, education and enlightenment and...

  10. Paraganglioma: a potentially challenging tumor.

    Science.gov (United States)

    Trombetta, Mark; Silverman, Jan; Colonias, Athanasios; Lee, Vincent; Mohanty, Alok; Parda, David

    2008-03-01

    Paragangliomas are usually low-grade neoplasms with a benign natural history. While the treatment of paraganglioma has historically been controversial, surgery and radiotherapy have become standardized as therapies of choice for primary therapy. More recently, stereotactic radiosurgery has been used effectively against this rare tumor. The development of metastatic disease in patients with paraganglioma is an unusual and challenging event. This case report and review describes the specific features of this disease and the multiple therapeutic options.

  11. Expression and significance of hemeoxygenase-1 (HO-1) in subcutaneous and omental adipose tissue of type 2 diabetic patients%2型糖尿病患者脂肪组织中的HO-1表达及临床意义

    Institute of Scientific and Technical Information of China (English)

    李倩倩; 李慧敏; 钟继娟; 缪珩

    2012-01-01

    Objective To observe the heme oxygenase-1 (HO-1) mRNA and protein expression in subcutaneous and omental adipose tissue of type 2 diabetic patients and their relation with serum adiponectin level, and other clinical indexes. Methods 23 type 2 diabetic patients with obesity, 23 type 2 diabetic patients, 33 controls with obesity and 23 controls were selected . The HO-1 mRNA expression level in adipose tissue was assayed by RT-PCR, and HO-1 protein expression level was assayed by Western blot. Being usedlinear correlation analysis, their correlations were observed. Results ① The expressions of HO-1 mRNA in subcutaneous adipose tissue of type 2 diabetic patients with obesity were significantly lower ( all P < 0.05), and the level in omental adipose tissue was negatively correlated to BMI (P < 0.01).② Type 2 diabetic patients and those with obesity showed significantly lower expressions of HO-1 protein in subcutaneous and omental adipose tissue comparing with control groups (all P < 0.05) , and the level in omental adipose tissue of type 2 diabetic patients with obesity were negatively correlated to BMI, FPG, TG (all P <0.05). ③The expression level of HO-1 protein in omental adipose tissue of type 2 diabetic patients was positively correlated to the level of serum adiponectin (P < 0.05). Conclusions The levels of HO-1 mRNA and protein in type 2 diabetic patients are significantly lower than those of controls. The higher level of BMI is, the lower of HO-1 expression is. The low expression of HO-1 may be correlated with the occurrence and development of insulin resistance and DM.%目的 探讨2型糖尿病(T2DM)患者脂肪组织中血红素加氧酶-1(HO-1)基因及蛋白表达的临床意义.方法 选择T2DM患者46例(T2DM组),其中伴肥胖者23例(T2DM+ FAT组)、单纯T2DM 23例(单纯T2DM组);非T2DM患者56例(非T2DM组),其中单纯非T2DM患者33例(单纯非T2DM组)、伴肥胖者23例(非T2DM+ FAT组).采用RT-PCR技术检测各组腹部皮下

  12. Research of resistin protein expression in abdominal omental and subcutaneous adipose tissue in type 2 diabetic patients%2型糖尿病患者大网膜与皮下脂肪组织抵抗素蛋白表达的研究

    Institute of Scientific and Technical Information of China (English)

    许莉军; 张木勋; 杨再刚; 马洪波; 张晶; 周咏明; 张建华

    2004-01-01

    目的了解2型糖尿病(type 2 diabetes mellitus,T2DM)患者大网膜与皮下脂肪组织抵抗素蛋白表达的情况,探讨肥胖和糖尿病间的关系.方法Western bolt法检测大网膜及皮下脂肪组织抵抗素表达情况;磁性分离酶联免疫法测定空腹血胰岛素水平,葡萄糖氧化酶法测定血糖浓度,并计算胰岛素敏感指数;测量身高、体重、臀围、收缩压(SBP)、舒张压(DBP),计算腰臀比(WHR)、体重指数(BMI)、体内脂肪百分比(BF%).结果以OD值表示,正常对照组(57411±1225.59)大网膜与皮下脂肪组织抵抗素蛋白表达明显较单纯肥胖组(41671±884.38)(P<0.01)、非肥胖T2DM组(42132±1286.15)(P<0.01)\\肥胖T2DM组(42677±1751.10)(P<0.05)表达增高,后三组抵抗素蛋白表达差异无显著性.四组自身的大网膜与皮下脂肪组织抵抗素蛋白表达无显著差异.逐步回归分析示WHR、BMI、FBG对抵抗素表达的作用显著,方程为v=116338-38562×WHR-1154.99×BMI-1243.63×FBG.结论正常对照组大网膜与皮下脂肪组织抵抗素蛋白表达明显较单纯肥胖组、非肥胖T2DM组、肥胖T2DM组表达增高,抵抗素与腰臀比、体重指数、空腹血糖呈显著负相关提示人体抵抗素不是肥胖和糖尿病的联系所在.%Objective:To investigate the expression of resistin protein in abdominal omental and subcutaneous adipose tissues in type 2 diabetic patients and the relationship between obesity and diabetes mellitus.Methods: The expression of resistin protein in omental and subcutaneous adipose tissues was measured using Western blot method.Fasting insulin and glucose levels were measured by enzyme immunoassay and glucose oxidase assay respectively to calculate insulin sensitivity index. Height, weight, waist circumference, hip circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured to calculate waist-hip ratio, body mass index (BMI) and body fat percentage (BF%). Results

  13. Enhancing Teacher Education in Primary Mathematics with Mobile Technologies

    Science.gov (United States)

    Schuck, Sandy

    2016-01-01

    A challenge of teacher education is to produce graduate primary school teachers who are confident and competent teachers of mathematics. Various approaches to primary school teacher education in mathematics have been investigated, but primary teacher education graduates still tend to be diffident in their teaching of mathematics. In an age where…

  14. [Challenges and potentials of primary care in a multicultural society].

    Science.gov (United States)

    Bungartz, J; Joos, S; Steinhäuser, J; Szecsenyi, J; Freund, T

    2011-11-01

    The greatest proportion of basic health care for patients with a migrational background living in Germany is provided by general practitioners. There is evidence that patients with a migrational background see a general practitioner as a gate keeper in case of physical or mental complaints even more frequently than the native German population. In contrast, the impact of migration-specific tasks in general practice appears to be relatively low in the medical and public discourse. This article analyzes the current situation of medical care for migrant patients in general practice and shows its potential to offer low-threshold high quality health care services to migrant patients and the whole population. In addition, an overview on migration-specific issues in research, teaching, and continuous medical education of general practitioners is provided. Finally, the implications of these findings for future research questions on migration-sensitive interventions are discussed. PMID:22015790

  15. Current and Future Challenges in Primary Sjogren's Syndrome

    NARCIS (Netherlands)

    Vissink, Arjan; Bootsma, Hendrika; Spijkervet, Fred K. L.; Hu, Shen; Wong, David T.; Kallenberg, Cees G. M.

    2012-01-01

    Sjogren's syndrome (SS) is an autoimmune inflammatory disorder of exocrine glands. SS particularly affects the lacrimal and salivary glands. Dry mouth and dry eyes are frequently proffered as presenting symptoms, but nonspecific symptoms such as malaise and fatigue, and extraglandular manifestations

  16. Bilateral primary fallopian tube papillary serous carcinoma in postmenopausal woman: Report of two cases

    Directory of Open Access Journals (Sweden)

    Dipanwita Nag

    2016-01-01

    Full Text Available Primary carcinoma of the fallopian tube is rare and accounts for about 0.14-1.8% of all gynecological malignancies. Correct diagnosis is rarely made preoperatively as clinically tubal carcinoma closely resembles ovarian carcinoma. Here, we report two cases of bilateral primary fallopian tube carcinomas. Case 1: A 54-year-old female presented with postmenopausal bleeding, abdominal pain, and pervaginal watery discharge for 10 days. Ultrasonography (USG of pelvis showed endometrial thickening and multiple tiny echogenic foci in omentum suggestive of omental cake. With a provisional diagnosis of endometrial carcinoma, total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was done. On gross examination, small and rudimentary right ovary was adherent to the fimbrial end of the tube. Left-sided tubo-ovarian mass was present, cut section of which showed yellowish solid area in tubal wall and encroaching on ovarian surface. On histological examination, sections from the fimbrial end of both fallopian tubes showed features of papillary serous adenocarcinoma. Case 2: 70-year-old lady, 15 years postmenopausal presented with gradual onset pain and swelling of abdomen, urinary incontinence since 4 days. USG showed bulky uterus, 5 cm × 2 cm fibroid, bilateral tubes, and ovaries were not visualized. Serum cancer antigen-125 was raised (159.7 U/ml. Total hysterectomy and bilateral salpingo-oophorectomy with infracolic omentectomy was done. On gross examination, ovaries were firmly attached to tubes and no apparent solid area was noted. On microscopy, papillary serous adenocarcinoma arising from tubal wall was seen infiltrating focally into ovarian stroma; tubal epithelium showed dysplastic change. Sections from omentum showed numerous psammoma bodies.

  17. Challenges and Opportunities for Primary School Teachers Preservice Training Brought about by the Reform of Teacher Qualification Examination System Development%教师资格考试制度改革给小学教师职前培养带来的挑战与机遇

    Institute of Scientific and Technical Information of China (English)

    陈秋红

    2014-01-01

    In recent years , teacher qualification examination system gradually changes from the�provincial test" to �national test" , which brings both challenges and opportunities for preservice training of primary school teachers . T he challenge lies in the poor comprehensive ability existing in the present elementary education majors , so it is hard for them to pass the exam and get teacher certificate . The opportunity lies in that the teacher training institutions can take advantage of this chance , to explore the best way to cultivate students'comprehensive quality , such as strengthening the research on teachers'professional standard , optimizing the curriculum , enhancing educational practice ,and improving the quality of education teaching , so as to pioneer a new path of sustainable development .%近年来,教师资格考试制度逐步从“省考”走向“国考”,这对小学教师的职前培养来说,既是挑战,也是机遇。挑战主要在于目前初等教育专业学生普遍存在的综合素质能力短板,相关专业的学生难以通过考试,顺利拿到教师资格证。机遇则在于师范培养机构可以充分利用这个机会,探索学生综合素质培养的最佳途径,诸如加强教师职业标准能力研究,优化课程设置,强化教育实习环节,提高教育教学质量,从而走出一条可持续发展之路。

  18. DIGITAL PAKISTAN: OPPORTUNITIES & CHALLENGES

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2008-10-01

    Full Text Available IT has revolutionized the social and organizational life around the globe. Given the newness of IT as a technology, there is a lot of potential that needs to be explored. It is however, argued that as IT can revolutionize the economic development, by the same coin, although its mismanagement in adoption process can end up in problems or even straight failure of the technology at the business-end. This study was conducted with reference to opportunities and challenges in the IT adoption process in Pakistan. The aim of the study was to point out the barriers that are impeding the country’s computerization process in order to provide facts to the policy makers for smooth computerization. The primary data collected through structured questionnaires was analyzed and tested through correlation, regressions analysis and t-test. Out of 10 hypotheses, 3 were accepted while in the rest null hypotheses were not substantiated. Based on primary and secondary data analysis this study has found that all independent bureaucratic, political, education and social and cultural variables are mutually correlated and have significant impact on shaping and reshaping of IT in Pakistan, while the Pakistan IT policy is inconsistent, administrative machinery attitude is negative and non cooperative, procedures are cumbersome and implementation is weak and ineffective, not to mention the lack of IT knowledge on the bureaucratic side. The political environment is instable and law and order is worse which is discouraging the investment. Moreover, physical and legal infrastructure is insufficient and the country is lacking good quality IT professionals. IT organization alignment is another serious issue in Pakistan. However, government incentives and growing interest from the private sector indicate positive attitude towards computerization of the country.

  19. DIGITAL PAKISTAN: OPPORTUNITIES & CHALLENGES

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2008-12-01

    Full Text Available ABSTRACT IT has revolutionized the social and organizational life around the globe. Given the newness of IT as a technology, there is a lot of potential that needs to be explored. It is however, argued that as IT can revolutionize the economic development, by the same coin, although its mismanagement in adoption process can end up in problems or even straight failure of the technology at the business-end. This study was conducted with reference to opportunities and challenges in the IT adoption process in Pakistan. The aim of the study was to point out the barriers that are impeding the country’s computerization process in order to provide facts to the policy makers for smooth computerization. The primary data collected through structured questionnaires was analyzed and tested through correlation, regressions analysis and t-test. Out of 10 hypotheses, 3 were accepted while in the rest null hypotheses were not substantiated. Based on primary and secondary data analysis this study has found that all independent bureaucratic, political, education and social and cultural variables are mutually correlated and have significant impact on shaping and reshaping of IT in Pakistan, while the Pakistan IT policy is inconsistent, administrative machinery attitude is negative and non cooperative, procedures are cumbersome and implementation is weak and ineffective, not to mention the lack of IT knowledge on the bureaucratic side. The political environment is instable and law and order is worse which is discouraging the investment. Moreover, physical and legal infrastructure is insufficient and the country is lacking good quality IT professionals. IT organization alignment is another serious issue in Pakistan. However, government incentives and growing interest from the private sector indicate positive attitude towards computerization of the country.

  20. Primary vertex reconstruction with the ATLAS detector

    CERN Document Server

    Meloni, Federico; The ATLAS collaboration

    2016-01-01

    Efficient and precise reconstruction of the primary vertex in a LHC collision is essential for determining the full kinematic properties of a hard-scatter event and of soft interactions as a measure of the amount of pile-up. The reconstruction of primary vertices in the busy, high pile-up environment of Run-2 of the LHC is a challenging task. The algorithms developed by the ATLAS experiments to reconstruct multiple vertices with small spatial separation are presented.

  1. Primary ciliary dyskinesia.

    Science.gov (United States)

    Lobo, Jason; Zariwala, Maimoona A; Noone, Peadar G

    2015-04-01

    Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder of cilia structure, function, and biogenesis leading to chronic infections of the respiratory tract, fertility problems, and disorders of organ laterality. The diagnosis can be challenging, using traditional tools such as characteristic clinical features, ciliary function, and ultrastructural defects and newer screening tools such as nasal nitric oxide levels and genetic testing add to the diagnostic algorithm. There are 32 known PCD-causing genes, and in the future, comprehensive genetic testing may screen young infants before developing symptoms, thus improving survival. Therapies include surveillance of pulmonary function and microbiology, in addition to airway clearance, antibiotics, and early referral to bronchiectasis centers. As with cystic fibrosis (CF), standardized care at specialized centers using a multidisciplinary approach likely improves outcomes. In conjunction with the CF foundation, the PCD foundation, with experienced investigators and clinicians, is developing a network of PCD clinical centers to coordinate the effort in North America and Europe. As the network grows, clinical care and knowledge will improve. PMID:25826585

  2. [Geriatrics - an interdisciplinary challenge].

    Science.gov (United States)

    Nau, Roland; Djukic, Marija; Wappler, Manfred

    2016-06-01

    The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson's syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units. PMID:27167886

  3. Developing a Watershed Challenge

    Science.gov (United States)

    Roman, Harry T.

    2010-01-01

    This article presents a watershed challenge that gives students an opportunity to investigate the challenge of using a watershed area as a site for development, examining the many aspects of this multifaceted problem. This design challenge could work well in a team-based format, with students taking on specific aspects of the challenges and…

  4. Beyond survival: Challenges facing South African automotive component exporters

    OpenAIRE

    M. J. Naude; C. O'Neill

    2006-01-01

    Purpose and Objective: The South African automotive component industry faces huge challenges in a very competitive global market. The primary focus of this research article is to determine the challenges facing exporters within this industry with special reference to selected sub-sectors. The challenges are approached from a supply chain perspective only. Problem Investigated: The research problem of this study was to identify these unique challenges and ascertain whether the implement...

  5. Primary lumbar hernia: A rarely encountered hernia

    Directory of Open Access Journals (Sweden)

    Sharada Sundaramurthy

    2016-01-01

    Conclusion: A surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach.

  6. Primary Considerations for Primary TEFL in China

    Institute of Scientific and Technical Information of China (English)

    Yvonne Griffiths

    2007-01-01

    This article will focus on five key areas relating to Primary TEFL in China. Firstly, the real TEFL context in Chinese primary schools will be discussed in terms of its special characteristics. Secondly, the current methodological approach will be examined from both a theoretical perspective, focusing on government (MOE) policy for primary TEFL, and a practical perspective, based on personal observations of classroom practice. The third section of the article will highlight some perceived shortcomings of current practice, while the fourth will outline the actual needs of primary learners in the Chinese educational system. Finally, the question of how teachers can meet these needs will be examined in relation to: methodological integration;integration of skills and sub-skills teaching/learning; and the exploitation of materials and activities to provide learners with three different types of language input and output opportunities (extensive, intensive and analysed: Swan, 2006).

  7. Brain tumor - primary - adults

    Science.gov (United States)

    ... Vestibular schwannoma (acoustic neuroma) - adults; Meningioma - adults; Cancer - brain tumor (adults) ... Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, ...

  8. 78 FR 49296 - Centennial Challenges 2014 Sample Return Robot Challenge

    Science.gov (United States)

    2013-08-13

    ... SPACE ADMINISTRATION Centennial Challenges 2014 Sample Return Robot Challenge AGENCY: National Aeronautics and Space Administration (NASA). ACTION: Notice of Centennial Challenges 2014 Sample Return Robot... Robot Challenge is scheduled and teams that wish to compete may register. Centennial Challenges is...

  9. Primary Care's Dim Prognosis

    Science.gov (United States)

    Alper, Philip R.

    2010-01-01

    Given the chorus of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this is far from certain. And when one looks to history and recognizes that primary care medicine has failed virtually every conceivable market test in recent years, its…

  10. Challenges of Parenting Multiples

    Science.gov (United States)

    ... the American Society for Reproductive Medicine Challenges of Parenting Multiples There are many psychological, social, and economic ... the unique challenges and rewards that come from parenting multiples. For more information on the medical aspects ...

  11. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available ... on Women's Health Skip Navigation Skip top navigation Home A-Z Health Topics ePublications News About Us ... Only Natural email updates. Enter email address Submit Home > It's Only Natural > Overcoming challenges Overcoming breastfeeding challenges ...

  12. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available A project of the U.S. Department of Health and Human Services Office on Women's Health Skip Navigation ... challenges Overcoming breastfeeding challenges Dealing with lack of family support Is my baby getting enough ...

  13. Incorporating Qualitative Evidence in Systematic Reviews: Strategies and Challenges

    Science.gov (United States)

    Caracelli, Valerie J.; Cooksy, Leslie J.

    2013-01-01

    The quality of mixed methods systematic reviews relies on the quality of primary-level studies. The synthesis of qualitative evidence and the recent development of synthesizing mixed methods studies hold promise, but also pose challenges to evidence synthesis.

  14. The Backpack Design Challenge

    Science.gov (United States)

    Roman, Harry T.

    2010-01-01

    Something as simple as carrying books to school can be an interesting design challenge for students. It's an old problem that gets reinvented from time to time. In this article, the author discusses a backpack design challenge in which teachers work with students to design another way to carry books to school. The challenge started by trying to…

  15. Energy transition - economic challenge, climate challenge, industrial challenge

    International Nuclear Information System (INIS)

    This document highlights and discusses the different economic, climate and industrial challenges, identifies and discusses the different objectives and main results for a successful energy transition respectively in its relationships with the energy mix (the result is to divide emissions by a factor 4), with governance (the result should be a balanced distribution of energy governance), with energy consumption

  16. 腹腔镜与开腹消化性溃疡穿孔带蒂网膜修补术临床疗效比较%Comparing the clinical efficacy between laparoscopic and open omental patch repair for perforated peptic ulcer

    Institute of Scientific and Technical Information of China (English)

    颜松龄; 张道建; 纪程宏; 王东明; 郭久冰

    2010-01-01

    目的 比较腹腔镜与开腹消化性溃疡穿孔带蒂网膜修补术的临床疗效.方法 回顾性分析消化性溃疡穿孔带蒂网膜修补术127例,分为腹腔镜组74例,开腹组53例.比较两组的手术时间,术中出血量,术后1、3 d疼痛程度,肛门排气时间,恢复饮食时间,腹腔引流管留置时间,手术部位感染,全身并发症及术后住院时间等指标.结果 腹腔镜组术中出血量、术后3d视觉模拟评分法(VAS)评分、肛门排气时间、恢复饮食时间、腹腔引流管留置时间、切口感染率、术后住院时间分别为(32.7±25.6)ml、(2.8±1.5)分、(25.8±20.1)h、(2.7±2.1)d、(2.0±1.5)d、O、(4.8±2.3)d,与开腹组的(53.2±30.0)ml、(3.7±2.0)分、(36.9±27.9)h、(3.6±2.3)d、(2.9±2.2)d、9.4%(5/53)、(6.6±4.0)d比较差异有统计学意义(P<0.01或<0.05);两组手术时间、术后1 d VAS评分、腹腔内脓肿及全身并发症发生率比较差异无统计学意义.两组术后均无消化道漏、二次手术及死亡病例.结论 腹腔镜消化性溃疡穿孔带蒂网膜修补术是安全、有效的,与开腹手术相比具有疼痛轻、肠道功能恢复快、切口感染率低、住院时间短等优势.%Objective To investigate the clinical efficacy of laparoscopic versus open omental patch repair for perforated peptic ulcer. Methods One hundred and twenty-seven patients who underwent omental patch repair for perforated peptic ulcer were analyzed retrospectively. There were 74 cases in the laparoscopic repair group (LR group) and 53 cases in the open repair group (OR group) respectively. Operative time, intraoperative blood loss,postoperative pain at 1 d and 3 d.time to first flatus and resumption of diet, time to drainage removal,surgical site infections (wound infection and intra-abdominal abscess),systemic complications and length of postoperative hospital stay were compared. Results LR group experienced less intraoperative blood loss[(32.7 ±25.6) ml], lower

  17. Rotary endodontics in primary teeth - A review.

    Science.gov (United States)

    George, Sageena; Anandaraj, S; Issac, Jyoti S; John, Sheen A; Harris, Anoop

    2016-01-01

    Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the "gold-standard" over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel-titanium (Ni-Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel-titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

  18. Pulpectomy procedures in primary molar teeth

    Directory of Open Access Journals (Sweden)

    Hany Mohamed Aly Ahmed

    2014-01-01

    Full Text Available Premature loss of primary molars can cause a number of undesirable consequences including loss of arch length, insufficient space for erupting premolars and mesial tipping of the permanent molars. Pulpectomy of primary molar teeth is considered as a reasonable treatment approach to ensure either normal shedding or a long-term survival in instances of retention. Despite being a more conservative treatment option than extraction, efficient pulpectomy of bizarre and tortuous root canals encased in roots programmed for physiologic resorption that show close proximity to developing permanent tooth buds presents a critical endodontic challenge. This article aims to provide an overview of this treatment approach, including partial and total pulpectomy, in primary molar teeth. In addition, the recommended guidelines that should be followed, and the current updates that have been developed, while commencing total pulpectomy in primary molars are discussed.

  19. Priorities for health services research in primary care.

    NARCIS (Netherlands)

    Schäfer, W.; Groenewegen, P.P.; Hansen, J.; Black, N.

    2011-01-01

    Background: All European health systems face several common challenges related to increases in lifestyle and chronic diseases, a decreasing future workforce, inequalities in health and the consequences of societal changes. Primary care, which has the potential to help meet these challenges, would be

  20. Challenges to Business Excellence: Some Empirical Evidence

    Directory of Open Access Journals (Sweden)

    Brown Alan

    2014-11-01

    Full Text Available The business excellence models are used by many organisations around the world as a strategic driver for business improvement and in some cases as the basis for applications for awards based on the models. These include the Baldrige, EFQM, Australian Business Excellence Framework and many other national and regional models. Whilst many award recipients showcase their achievements, comparatively little is known about the challenges and impediments they face in reaching and sustaining high levels of success as evidenced by winning awards. This paper seeks to identify challenges faced by examining the experience of a sample of Australian Business Excellence Award winners. Findings suggest that the primary challenges include; leadership support, drive and consistency throughout the organisation and communicating strategy and making it meaningful for people at all levels. The study also found variability in challenges across organisations.

  1. Primary Dealer Systems

    OpenAIRE

    World Bank

    2010-01-01

    Primary dealer system can make substantial contributions to the development of the market when its establishment is appropriate for prevailing market conditions. While by no means a precondition for a well functioning government securities market, primary dealers know the market best and are the counterpart of the investors who are the debt management office’s ultimate target. The purpose of this background note is to provide some guidance on how to design a primary dealer syst...

  2. Primary cutaneous amyloidosis

    OpenAIRE

    Shah Mona; Padhiar Bela; Karia Umesh; Shah Bela; Rawal R; Bilimoria F

    1997-01-01

    Three cases of primary cutaneous amyloidosis are reported. Family history was negative. Systemic involvement was ruled out. Histopathology was confirmed by congored stain. Patients responded to oral colchicine.

  3. Integrated primary health care in Australia

    Directory of Open Access Journals (Sweden)

    Gawaine Powell Davies

    2009-10-01

    Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

  4. Challenges of Relativistic Astrophysics

    CERN Document Server

    Opher, Reuven

    2013-01-01

    I discuss some of the most outstanding challenges in relativistic astrophysics in the subjects of: compact objects (Black Holes and Neutron Stars); dark sector (Dark Matter and Dark Energy); plasma astrophysics (Origin of Jets, Cosmic Rays and Magnetic Fields) and the primordial universe (Physics at the beginning of the Universe). In these four subjects, I discuss twelve of the most important challenges. These challenges give us insight into new physics that can only be studied in the large scale Universe. The near future possibilities, in observations and theory, for addressing these challenges, are also discussed.

  5. Transforming Primary Mathematics

    Science.gov (United States)

    Askew, Mike

    2011-01-01

    What is good mathematics teaching? What is mathematics teaching good for? Who is mathematics teaching for? These are just some of the questions addressed in "Transforming Primary Mathematics", a highly timely new resource for teachers which accessibly sets out the key theories and latest research in primary maths today. Under-pinned by findings…

  6. Primary ovarian insufficiency

    NARCIS (Netherlands)

    De Vos, Michel; Devroey, Paul; Fauser, Bart C. J. M.

    2010-01-01

    Primary ovarian insufficiency is a subclass of ovarian dysfunction in which the cause is within the ovary. In most cases, an unknown mechanism leads to premature exhaustion of the resting pool of primordial follicles. Primary ovarian insufficiency might also result from genetic defects, chemotherapy

  7. Multiple primary bronchogenic carcinomas.

    Science.gov (United States)

    Yang, X; Ji, H; Paljarvi, L; Soimakallio, S

    1996-07-01

    Multiple primary bronchogenic carcinomas (MPBCa) are extremely rare. The differentiation of a MPBCa from a pulmonary metastasis due to an extrathoracic neoplasm is sometimes difficult. We reviewed 324 pathologically proved primary pulmonary carcinomas and found six cases of MPBCa (1.9%). We herewith present the series and discuss the diagnosis of MPBCa. PMID:21594435

  8. Primary Spinal Meningeal Melanocytoma

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Dong Ho [Dong-A University, Busan (Korea, Republic of)

    2009-12-15

    Primary meningeal melanocytic neoplasms are rare lesions that originate from leptomeningeal melanocytes. An intradural meningeal melanocytoma in the thoracic spine is less common than a malignant melanoma, which is its malignant counterpart. We report a case of a histopathologically confirmed primary intradural meningeal melanocytoma in the thoracic spine along with a literature.

  9. Pathophysiology of primary headaches

    DEFF Research Database (Denmark)

    Edvinsson, L

    2001-01-01

    The cerebral circulation is innervated by sympathetic, parasympathetic, and sensory nerves, which store a considerable number of neurotransmitters. The role of these has been evaluated in primary headaches. A clear association between head pain and the release of calcitonin gene-related peptide...... normalized. These data show the involvement of sensory and parasympathetic mechanisms in the pathophysiology of primary headaches....

  10. [The primary healthcare centres].

    Science.gov (United States)

    Brambilla, Antonio; Maciocco, Gavino

    2014-04-01

    The central attributes of primary care are: first contact (accessibility), longitudinality (person- focused preventive and curative care overtime), patient-oriented comprehensiveness and coordination (including navigation towards secondary and tertiary care). Besides taking care of the needs of the individuals, primary health care teams are also looking at the community, especially when addressing social determinants of health. The rationale for the benefits for primary care for health has been found in: 1) greater access to needed services; 2) better quality of care; 3) a greater focus on prevention; 4) early management of health problems; 5) organizing and delivering high quality care for chronic non-communicable diseases. This paper describes the role of primary healthcare centres in strengthening community primary services and in reducing health inequalities. Furthemore, the experiences of Regional Health Services from Tuscany and Emilia-Romagna are discussed, with a brief overview of the literature. PMID:24770539

  11. CHALLENGES OF PERMANENT TEACHER TRAINING

    Directory of Open Access Journals (Sweden)

    María Manuela Valles-Ornelas

    2015-07-01

    Full Text Available The new challenges for teachers and managers require to assume permanent formation as a tool for responding effectively and efficiently to them, different perspective to strengthen from the initial teacher education programs. The research was done in a primary school in the state of Chihuahua. The method used was research action, the question was: How can we encourage the lifelong learning and training of the staff of this school, with the purpose to assist them in these processes to improve the service that the school provides to students. The school group is the center of the process, the cooperative and collaborative work accompanied by educational leadership and persuasive provide better results, and all accompanied by the professional selfinvitation.

  12. First Aid Challenge

    Science.gov (United States)

    Roman, Harry T.

    2011-01-01

    This article describes a challenge wherein students will be asked to design a portable first aid kit that is normally carried in a recreational vehicle (RV), but can also be hand-carried or backpacked off road for distances of approximately 1-2 miles. This can be a very practical challenge for the students because it touches everyone. Everybody…

  13. Challenge and Change

    Science.gov (United States)

    Mehaffy, George L.

    2012-01-01

    In the past twenty years, various industries have been forever altered by technology: newspapers, book publishing, the photography business, and many more. Higher education too faces unprecedented challenges primarily driven by rapid changes in technology. To meet these challenges and adapt to these changes, new models are needed. Six challenges…

  14. Science Challenge Day

    Science.gov (United States)

    Siegel, Deborah

    2013-01-01

    Science fairs can be good motivators, but as extracurricular activities, they leave some students behind. However, by staging a Science Challenge Day at school, educators can involve all students in doing everything from choosing activities to judging projects. This article presents a model for running a successful Science Challenge Day. The…

  15. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available ... size | Print | Skip left navigation It's Only Natural Planning ahead Overcoming challenges Overcoming breastfeeding challenges Dealing with ... it into your life My breastfeeding story Partner resources Subscribe ... at the U.S. Department of Health and Human Services 200 Independence Avenue, S.W. • Washington, DC 20201 ...

  16. Pharmacotherapy for Insomnia in Primary Care.

    Science.gov (United States)

    Smith, Emily; Narang, Puneet; Enja, Manasa; Lippmann, Steven

    2016-01-01

    Pharmacotherapy for insomnia in primary care settings can be challenging. Frequently, there are multiple coexisting medical and psychiatric conditions, drug interactions, concern regarding use of habit-forming sleep aids, and paucity of time in office visits to discuss management of sleep difficulties. This article reports the results of a literature search related to pharmacotherapy for insomnia and presents 4 clinical vignettes with corresponding treatment options. PMID:27486547

  17. Cotton Germplasm Collections:Opportunities and Challenges

    Institute of Scientific and Technical Information of China (English)

    PERCY Richard G

    2008-01-01

    @@ According to an FAO report in 1996,49000 cotton genotypes are being maintained in germplasm collections worldwide.Of these accessions,approximately 67% reside in the six largest collections.Identification of mutual opportunities and challenges faced by these germplasm banks could result in major benefits to the international research community.A primary goal of all germplasm collections always has been the expansion and improvement of the genetic diversity residing within them.

  18. APPLYING SIMPLE TECHNOLOGY ACCOMPLISHES VISUAL INSPECTION CHALLENGES

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, C

    2007-07-21

    This paper discusses the successful implementation of simple video technologies at the Savannah River Site (SRS) to perform complex visual inspection, monitoring, and surveillance tasks. Because SRS facilities are similar to those of an industrial plant, the environmental and accessibility considerations for remote viewing are the primary determining factors in the selection of technology. The constraints and challenges associated with remote viewing are discussed, and examples of applications are given.

  19. The challenges of dismantling

    International Nuclear Information System (INIS)

    This document gathers Power Point presentations which address the contexts and challenges of dismantling (legal framework, safety and radiation protection challenges, waste processing industry), and propose illustrations of dismantling challenges (example of operations to prepare EURODIF dismantling and CLIGEET work-group on EURODIF dismantling, examples of dismantling of EDF installations and CLIs' opinion on the dismantling of EDF installations, Brennilis dismantling follow-up performed by the CLI, examples of dismantling of CEA installations and opinion of a CLI on the dismantling of CEA installations)

  20. Challenges of serious games

    Directory of Open Access Journals (Sweden)

    B. Fernández-Manjón

    2015-11-01

    Full Text Available Although educational games have revealed to be a very effective focus in diverse situations, their use in education is still very limited. In this paper we analyse the main challenges concerning educational games that, from our perspective, have to be approached so that the use of this kind of games can be widespread. These challenges are classified in three main dimensions: socio-cultural, educational and technological. Once the challenges are identified, some possible measures are suggested to address or reduce these problems so that the use of educational games may be widespread.

  1. Big Data Challenges

    Directory of Open Access Journals (Sweden)

    Alexandru Adrian TOLE

    2013-10-01

    Full Text Available The amount of data that is traveling across the internet today, not only that is large, but is complex as well. Companies, institutions, healthcare system etc., all of them use piles of data which are further used for creating reports in order to ensure continuity regarding the services that they have to offer. The process behind the results that these entities requests represents a challenge for software developers and companies that provide IT infrastructure. The challenge is how to manipulate an impressive volume of data that has to be securely delivered through the internet and reach its destination intact. This paper treats the challenges that Big Data creates.

  2. Primary Meningeal Rhabdomyosarcoma

    Directory of Open Access Journals (Sweden)

    Manisha Palta

    2011-01-01

    Full Text Available Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13. Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC systemic therapy.

  3. Primary infertility (image)

    Science.gov (United States)

    Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy ... to do so through unprotected intercourse. Causes of infertility include a wide range of physical as well ...

  4. [Results of primary healthcare].

    Science.gov (United States)

    Duponchel, J L

    2004-01-01

    The concept of primary healthcare was formulated at the international conference held in Alma-Ata (USSR) on September 6 to 12, 1978. Over the past quarter-century, the term "primary healthcare" has been widely used as a basis for implementing healthcare policies in various nations, especially those considered as developing countries. However many programs initiated in the name of the primary healthcare concept have only partially complied with the spirit of the final declaration of Alma-Ata. Analysis of the healthcare in Mali shows that the system followed that evolution. Although considerable time and energy were regrettably wasted in implementing the village health agent strategy, this phase may have been a necessary step in the political development of the state at that time. Recent changes in the country's healthcare system in compliance with the original principles of primary healthcare show that the 1978 declaration is sound and remains pertinent as democracy makes further gains in the world. PMID:15816127

  5. Health Care Challenges in Iran

    Directory of Open Access Journals (Sweden)

    M Davari

    2005-10-01

    Full Text Available All health systems across the world have faced new challenges, which is primarily referable to increasing the cost of health care services as well as growing demands for new and expensive health technologies. The aim of this study is to analyse the main challenges facing the Iranian health system. A review of available governmental and relevant publications about Iranian health care system was undertaken to assess the direction of future healthcare policy. Electronic news agencies, newspapers, and parliament’s electronic news also reviewed to realise policy-makers points of view about the health system. Healthcare services in Iran have had a great success in primary healthcare services in last 25 years, which is mainly attributable to National Health Networks policy. Between 1979 and 2003, average life expectancy at birth increased from 57 to 70 and infant mortality rate fell from 104 to 26 per thousand live births. Active vaccination system, very good distribution and coverage, free end point services, family planning, maternal teaching, and primary referral system are of strong advantages of health networks in Iran. However, the healthcare system is now subject to a range of new pressures that must be addressed. Many of these pressures are common to all health services (rising consumer demands and expectations for expensive new technologies, changing disease patterns, and resources shortage, but some are largely specific to Iran. Financial fairness contribution of the population to health system, responsiveness of health system, overusing new technologies, inadequate integration of health services, and inequitable distribution of the resources are of the main challenges of health system in Iran. In addition, considering demographic changes of the Iranian population in recent decades, which made Iranian population young, potential pressures due to an aging population will reveal in coming years. Many of these pressures relate to policies and

  6. Primary Hypothyroidism with Markedly High Prolactin.

    Science.gov (United States)

    Ansari, Mohd Saleem; Almalki, Mussa H

    2016-01-01

    Secondary pituitary enlargement due to primary hypothyroidism is not a common manifestation. The loss of thyroxin feedback inhibition in primary hypothyroidism causes overproduction of thyrotropin-releasing-hormone (TRH), which results in secondary pituitary enlargement. TRH has a weak stimulatory effect on the lactotroph cells of the pituitary, so a mild to moderate increase in prolactin (PRL) levels is expected. We report the case of a 67-year-old female who presented with a large pituitary mass and a very high level of TSH in association with a significant rise in PRL level. In this case, diagnosing a sellar mass was challenging; it was difficult to distinguish between pituitary prolactinoma and primary hypothyroidism with secondary pituitary hyperplasia. Thyroid hormone replacement proved that this patient's hyperprolactinemia was due to hyperplasia of the pituitary gland. As such, making the correct diagnosis and initiating thyroid hormone therapy can prevent unnecessary treatment with dopamine agonists. PMID:27199892

  7. Primary Hypothyroidism With Markedly High Prolactin

    Directory of Open Access Journals (Sweden)

    MOHD SALEEM ANSARI

    2016-04-01

    Full Text Available Secondary Pituitary enlargement due to primary hypothyroidism is not a common manifestation. The loss of thyroxin feedback inhibition in primary hypothyroidism causes overproduction of thyroid-releasing hormone (TRH, which results in secondary pituitary enlargement.TRH has a weak stimulatory effect on lactotroph cells of pituitary, so mild to moderate rise in prolactin (PRL level is expected. We report a 67 years old female who presented with a large pituitary mass and very high level of TSH with a significant rise in PRL level. In this case the diagnosis of seller mass was challenging, it was difficult to distinguish between pituitary prolactinoma and primary hypothyroidism with secondary pituitary hyperplasia. The thyroid hormone replacement proved that hyperprolactinemia was due to hyperplasia of the pituitary gland.Hence, the correct diagnosis and thyroid hormone therapy can prevent unnecessary treatment with dopamine agonist.

  8. Challenging behaviour: a challenge to change.

    Science.gov (United States)

    van Berckelaer-Onnes, I A; van Loon, J; Peelen, A

    2002-09-01

    People with intellectual disability often exhibit severe behavioural problems. Treatment of these problems is frequently very difficult. In The Netherlands, parents, institutes, schools and others can request the services of an independent advisory team with a pool of professionals who have experience with individuals who exhibit challenging behaviour. In this article the methods of the team will be described using a 24-year-old man as an example. The process took almost 7 years. Finally, this man, who had been living full time in one room in total isolation from the rest of the world, fulfilled his heart's desire--visiting the UK by Hovercraft. PMID:12212917

  9. Primary leiomyosarcoma of epididymis

    Directory of Open Access Journals (Sweden)

    Dillip Kumar Muduly

    2012-01-01

    Full Text Available Primary leiomyosarcomas rarely arise from epididymis. But they are the most common histopathological types of sarcoma arising from the epididymis. Primary epididymal leiomyosarcoma occurs usually in older patients. We report a young patient of 35 years presenting with leiomyosarcoma of left epididymis. He did not have any metastasis and underwent left high inguinal orchiectomy. He is on regular follow-up and disease free for last two years.

  10. Treatment of primary syphilis.

    Science.gov (United States)

    Elliott, W C

    1976-12-01

    Reports in the English language of the treatment of primary syphilis are reviewed. Except for benzathine penicillin, the efficacy of the currently recommended dosage schedules are documented only by Schroeter et al. Although these investigators reported generally acceptable failure rates, further study is necessary to determine: (1) if differences in efficacy exist among regimes; (2) if the current schedules are equally effective in both primary and secondary syphilis; and (3) if increased dosages reduce failure rates. PMID:1010777

  11. Primary gastrointestinal lymphoma

    OpenAIRE

    Amir Aledavood; Mohammad Reza Ghavam Nasiri; Bahram Memar; Soodabeh Shahidsales; Hamid Reza Raziee; Kamran Ghafarzadegan; Samira Mohtashami

    2012-01-01

    Background: Extranodal lymphoma may arise anywhere outside lymph nodes mostly in the gastrointestinal (GI) tract as non-Hodgkin′s disease. We reviewed the clinicopathological features and treatment results of patients with primary GI lymphoma. Materials and Methods : A total number of 30 cases with primary GI lymphoma were included in this study. Patients referred to the Radiation Oncology Department of Omid Hospital (Mashhad, Iran) during a 5-year period (2006-11). Clinical, paraclinical, an...

  12. Spirometry in primary care

    OpenAIRE

    Allan L Coates; Brian L Graham; McFadden, Robin G; Colm McParland; Dilshad Moosa; Steeve Provencher; Jeremy Road

    2013-01-01

    Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inf...

  13. Primary headache disorders.

    Science.gov (United States)

    Benoliel, Rafael; Eliav, Eli

    2013-07-01

    Primary headache disorders include migraine, tension-type headaches, and the trigeminal autonomic cephalgias (TACs). "Primary" refers to a lack of clear underlying causative pathology, trauma, or systemic disease. The TACs include cluster headache, paroxysmal hemicrania, and short-lasting neuralgiform headache attacks with conjunctival injection and tearing; hemicrania continua, although classified separately by the International Headache Society, shares many features of both migraine and the TACs. This article describes the features and treatment of these disorders.

  14. A challenging read

    Directory of Open Access Journals (Sweden)

    Cathy Foley

    2004-11-01

    Full Text Available Andrei Mourachkine uses his new book to argue that superconductivity could be achieved at room temperature and, while his thesis may rest on some unconfirmed evidence, it does challenge preconceptions, says Cathy Foley.

  15. Community Challenge Grantees

    Data.gov (United States)

    Department of Housing and Urban Development — HUD's Community Challenge Grants aim to reform and reduce barriers to achieving affordable, economically vital and sustainable communities. The funds are awarded to...

  16. The Electric Car Challenge.

    Science.gov (United States)

    Diehl, Brian E.

    1997-01-01

    Describes the Electric Car Challenge during which students applied methods of construction to build lightweight, strong vehicles that were powered by electricity. The activity required problem solving, sheet metal work, electricity, design, and construction skills. (JOW)

  17. Brazil World Cup Challenges

    Directory of Open Access Journals (Sweden)

    MANSUR, R.

    2012-12-01

    Full Text Available Overcoming the productivity challenge is the main benefit of the 2014 World Cup for Brazilian people. The sustainable development of our cultural tourism industry will catapult the new middle class growing up rate.

  18. Better Buildings Challenge Overview

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-06-01

    The Better Buildings Challenge is a national leadership initiative calling on corporate chief executive officers, university presidents, and state and local leaders to make a significant commitment to building energy efficiency.

  19. Rotorcraft Health Management Issues and Challenges

    Science.gov (United States)

    Zakrajsek, James J.; Dempsey, Paula J.; Huff, Edward M.; Augustin, Michael; Safa-Bakhsh, Robab; Ephraim, Piet; Grabil, Paul; Decker, Harry J.

    2006-01-01

    This paper presents an overview of health management issues and challenges that are specific to rotorcraft. Rotorcraft form a unique subset of air vehicles in that their propulsion system is used not only for propulsion, but also serves as the primary source of lift and maneuvering of the vehicle. No other air vehicle relies on the propulsion system to provide these functions through a transmission system with single critical load paths without duplication or redundancy. As such, health management of the power train is a critical and unique part of any rotorcraft health management system. This paper focuses specifically on the issues and challenges related to the dynamic mechanical components in the main power train. This includes the transmission and main rotor mechanisms. This paper will review standard practices used for rotorcraft health management, lessons learned from fielded trials, and future challenges.

  20. Overcoming Safeguards Challenges

    International Nuclear Information System (INIS)

    The focus of the 2010 IAEA International Safeguards Symposium was how best, from a technical perspective, to prepare for future verification challenges during this time of change. By bringing together the leading experts in the field from across the world, this symposium provided an opportunity for stakeholders to explore possible solutions in support of the IAEA's nuclear verification mission, and to identify areas where the different stakeholders in the safeguards business can help address these challenges

  1. Optimal challenges in tennis

    OpenAIRE

    Clarke, S. R.; Norman, J.M.

    2012-01-01

    The use of technology in sport to assist umpires has been gradually introduced into several sports. This has now been extended to allow players to call upon technology to arbitrate when they disagree with the umpire's decision. Both tennis and cricket now allow the players to challenge a doubtful decision, which is reversed if the evidence shows it to be incorrect. However, the number of challenges is limited, and players must balance any possible immediate gain with the loss of a future righ...

  2. Considerations on testing of CFGT primary segments

    Science.gov (United States)

    Jiang, Liyuan; Li, Xinnan

    2010-10-01

    Larger primary collect more light. Limited by the casting techniques, the largest single primary mirror can be cast is about 8.4-m. So segmented primary is widely adopted by large telescope with the aperture over 10-m since the twin 10-m KECK built or designed during the past two decades. Segmented primary creates new challenges for fabrication and measurements. Chinese Future Giant Telescope (CFGT), a 30m telescope project, has been proposed by Chinese astronomers. The primary of CFGT is a 30-meter diameter hyperboloid with a focal ratio F/1.2 and divided to 17 rings evenly from the center to the edge. Each ring is divided into several sector-shaped segments with the size about 1.1-meter in diagonal. The total amount of the off-axis sector-shaped aspheric sub-mirror is 1122 including 17 different types. In this case, how to test the large quantities of off-axis sector-shaped aspheric segments precisely and efficiently with less cost is highly required to be considered. In this paper, the parameters of the CFGT primary and the 17 different types of the segments are presented. Three potential methods of measurements for testing the large amount of CFGT primary off-axis aspherical segments are compared and analyzed. The advantages and disadvantages of these three measurements are discussed. By comparing, a method that test the segments with a standard flat mirror and another method which tests the segments with a CGH and a test plate may be served as two candidates of the measurement for CFGT primary segments. It may provide useful reference for the future research.

  3. Other primary headaches

    Directory of Open Access Journals (Sweden)

    Anish Bahra

    2012-01-01

    Full Text Available The ′Other Primary Headaches′ include eight recognised benign headache disorders. Primary stabbing headache is a generally benign disorder which often co-exists with other primary headache disorders such as migraine and cluster headache. Primary cough headache is headache precipitated by valsalva; secondary cough has been reported particularly in association with posterior fossa pathology. Primary exertional headache can occur with sudden or gradual onset during, or immediately after, exercise. Similarly headache associated with sexual activity can occur with gradual evolution or sudden onset. Secondary headache is more likely with both exertional and sexual headache of sudden onset. Sudden onset headache, with maximum intensity reached within a minute, is termed thunderclap headache. A benign form of thunderclap headache exists. However, isolated primary and secondary thunderclap headache cannot be clinically differentiated. Therefore all headache of thunderclap onset should be investigated. The primary forms of the aforementioned paroxysmal headaches appear to be Indomethacin sensitive disorders. Hypnic headache is a rare disorder which is termed ′alarm clock headache′, exclusively waking patients from sleep. The disorder can be Indomethacin responsive, but can also respond to Lithium and caffeine. New daily persistent headache is a rare and often intractable headache which starts one day and persists daily thereafter for at least 3 months. The clinical syndrome more often has migrainous features or is otherwise has a chronic tension-type headache phenotype. Management is that of the clinical syndrome. Hemicrania continua straddles the disorders of migraine and the trigeminal autonomic cephalalgias and is not dealt with in this review.

  4. Estimating primaries by sparse inversion and application to near-offset data reconstruction

    NARCIS (Netherlands)

    Van Groenestijn, G.J.A.; Verschuur, D.J.

    2009-01-01

    Accurate removal of surface-related multiples remains a challenge in many cases. To overcome typical inaccuracies in current multiple-removal techniques, we have developed a new primary-estimation method: estimation of primaries by sparse inversion (EPSI). EPSI is based on the same primary-multiple

  5. Primary renal synovial sarcoma

    Directory of Open Access Journals (Sweden)

    Girish D. Bakhshi

    2012-03-01

    Full Text Available Primary Renal Sarcoma is rare tumor comprising only 1% of all renal tumours. Synovial sarcomas are generally deep-seated tumors arising in the proximity of large joints of adolescents and young adults and account for 5-10% of all soft tissue tumours. Primary synovial sarcoma of kidney is rare and has poor prognosis. It can only be diagnosed by immunohistochemistry. It should be considered as a differential in sarcomatoid and spindle cell tumours. We present a case of 33-year-old female, who underwent left sided radical nephrectomy for renal tumour. Histopathology and genetic analysis diagnosed it to be primary renal synovial sarcoma. Patient underwent radiation therapy and 2 years follow up is uneventful. A brief case report with review of literature is presented.

  6. Primary lymphoma of the brain

    Science.gov (United States)

    Brain lymphoma; Cerebral lymphoma; Primary lymphoma of the central nervous system; Lymphoma - brain ... The cause of primary brain lymphoma is not known. People with a weakened immune system are at high risk for primary lymphoma of the brain. ...

  7. Challenges in obesity research

    Directory of Open Access Journals (Sweden)

    Andreu Palou

    2013-09-01

    Full Text Available Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors -often interrelated and many of them still unknown or poorly understood- can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regarding basic aspects of obesity and emerging science for its control, including brown adipose tissue thermogenesis and browning of white fat as possible therapeutic targets for obesity, the influence of the microbioma, and genetics, epigenetics, nutrigenomics and nutrigenetics of obesity. We also highlight hot topics in relation to food and lifestyle as determinants of obesity, including the brain mechanisms underlying environmental motivation to eat, the biological control of spontaneous physical activity, the possible role of concrete foods and food components, and the importance of early life nutrition and environment. Challenges regarding the connections of obesity with other alterations and pathologies are also briefly addressed, as well as social and economical challenges in relation to healthy food production and lifestyle for the prevention of obesity, and technological challenges in obesity research and management. The objective is to give a panoramic of advances accomplished and still ahead relevant to the different stakeholders engaged in understanding and combating obesity.

  8. Challenges in obesity research.

    Science.gov (United States)

    Palou, Andreu; Bonet, M Luisa

    2013-09-01

    Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors--often interrelated and many of them still unknown or poorly understood--can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regarding basic aspects of obesity and emerging science for its control, including brown adipose tissue thermogenesis and browning of white fat as possible therapeutic targets for obesity, the influence of the microbioma, and genetics, epigenetics, nutrigenomics and nutrigenetics of obesity. We also highlight hot topics in relation to food and lifestyle as determinants of obesity, including the brain mechanisms underlying environmental motivation to eat, the biological control of spontaneous physical activity, the possible role of concrete foods and food components, and the importance of early life nutrition and environment. Challenges regarding the connections of obesity with other alterations and pathologies are also briefly addressed, as well as social and economical challenges in relation to healthy food production and lifestyle for the prevention of obesity, and technological challenges in obesity research and management. The objective is to give a panoramic of advances accomplished and still ahead relevant to the different stakeholders engaged in understanding and combating obesity.

  9. Challenges in obesity research.

    Science.gov (United States)

    Palou, Andreu; Bonet, M Luisa

    2013-09-01

    Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors--often interrelated and many of them still unknown or poorly understood--can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regarding basic aspects of obesity and emerging science for its control, including brown adipose tissue thermogenesis and browning of white fat as possible therapeutic targets for obesity, the influence of the microbioma, and genetics, epigenetics, nutrigenomics and nutrigenetics of obesity. We also highlight hot topics in relation to food and lifestyle as determinants of obesity, including the brain mechanisms underlying environmental motivation to eat, the biological control of spontaneous physical activity, the possible role of concrete foods and food components, and the importance of early life nutrition and environment. Challenges regarding the connections of obesity with other alterations and pathologies are also briefly addressed, as well as social and economical challenges in relation to healthy food production and lifestyle for the prevention of obesity, and technological challenges in obesity research and management. The objective is to give a panoramic of advances accomplished and still ahead relevant to the different stakeholders engaged in understanding and combating obesity. PMID:24010755

  10. Bilateral Primary Intraocular Lymphoma

    Directory of Open Access Journals (Sweden)

    Mehrdad Karimi

    2011-01-01

    Full Text Available Purpose: To report a case of bilateral primary intraocular lymphoma. Case report: A 33-year-old man presented with bilateral blurred vision since two years ago. Examination revealed large keratic precipitates, anterior chamber reaction, posterior subcapsular cataracts, and vitreous infiltration. After a short trial of topical and periocular steroids, diagnostic 25-gauge pars plana vitrectomy was performed and cytologic evaluation of the aspirate confirmed a diagnosis of intraocular lymphoma. The patient was subsequently managed with intravitreal methotrexate in both eyes and responded favorably. Central nervous system workup for lymphoma was negative. Conclusion: Primary intraocular lymphoma should be considered in young adults suffering from chronic recalcitrant panuveitis.

  11. Psychiatry and primary care.

    Science.gov (United States)

    Goldberg, David

    2003-10-01

    There is now almost universal recognition that primary care is the place where most mentally distressed people first present for help. However, the pace at which the health system has adapted to this reality varies greatly from country to country, depending on the amount of resource devoted to mental illness services, the way in which primary care physicians have organized their practice, and the inertia of the system. Here we present several models from developed and developing countries and address briefly the issue of training of health workers. PMID:16946921

  12. Primary Prevention With Statins

    DEFF Research Database (Denmark)

    Mortensen, Martin B; Afzal, Shoaib; Nordestgaard, Børge G;

    2015-01-01

    BACKGROUND: Guidelines recommend initiating primary prevention for atherosclerotic cardiovascular disease (ASCVD) with statins based on absolute ASCVD risk assessment. Recently, alternative trial-based and hybrid approaches were suggested for statin treatment eligibility. OBJECTIVES: This study....../AHA risk-based approach, the net reclassification index for eligibility for statin therapy among 40- to 75-year-old subjects from the CGPS was -0.21 for the trial-based approach and -0.13 for the hybrid approach. CONCLUSIONS: The clinical performance of the ACC/AHA risk-based approach for primary...

  13. Diverticular Disease in the Primary Care Setting.

    Science.gov (United States)

    Wensaas, Knut-Arne; Hungin, Amrit Pali

    2016-10-01

    Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown. Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care. The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases. PMID:27622376

  14. Quantum Randi Challenge

    CERN Document Server

    Vongehr, Sascha

    2012-01-01

    Violations of Bell type inequalities in quantum experiments disprove all relativistic micro causal, classically real models. Desperate attempts at saving classicality retreated to claiming what Shimony calls a conspiracy. It is time to embrace the quantum paradigm instead of being stuck in defending it against positions on par with the belief in divinely planted fossils. However, different from 'quantum-magic' pseudoscience, there is resistance against quantum mechanics among scientific literate audiences, and it is growing. The Quantum Randi Challenge is designed to help scientists and educators discredit local realistic models and related attacks against quantum physics. Its 'Randi-type' properties are ensured via a simple computer game that can be made attractive and understandable to lay people. We introduce the general concept of a 'James Randi type' challenge as a tool for science outreach aimed against the spread of pseudoscience. This is a challenge which, according to the laws of nature as known to s...

  15. Meeting the Challenge

    Directory of Open Access Journals (Sweden)

    T. Reg Bott

    2009-01-01

    Full Text Available The first Chempor Conference held in Lisbon in 1975 under the auspices of the Calouste Gulbenkian Foundation, heralded a regular wide-ranging review of research and development in Portugal and the UK Progressively in later years the Conferences have attracted contributions from other European countries and indeed further afield. There is an increasing awareness of the problems for the environment, notably global warming, brought about by human activities. Recent predictions about the future are dire, particularly regarding food and water for a rapidly growing world population. They represent a substantial challenge to the scientific and technical fraternity. In response to that challenge it is important to keep up to date with technical developments, to meet and keep in touch with coworkers in associated fields, and to cooperate wherever possible. The papers presented at the Chempor and other conferences have made and continue to make a significant contribution to that objective of meeting the challenge.

  16. Consumer Adoption Challenges To The Smart Grid

    Directory of Open Access Journals (Sweden)

    Anu Gupta

    2012-12-01

    Full Text Available The smart grid represents the next significant evolution of the power infrastructure with many enhancements and challenges. This paper provides a qualitative review of the key consumer adoption challenges of the smart grid. This literature review takes disparate pieces of work and identifies strategic research focal areas. Through existing research and media documents, it identifies the primary consumer adoption challenges as privacy, Radio Frequency (RF safety, and power rate increases. It also provides a review of each adoption challenge. The review is applied to the Canadian perspective drawing from smart grid experiences across North America. The review demonstrates that each of the challenge areas has a negative impact on the adoption and support of the smart grid. This paper recommends further in-depth research be conducted in the following areas: testing each of the consumer adoption challenges—privacy, RF Safety, and rate increases—separately with quantitative measures; testing the willingness to accept a power infrastructure with the security and stability level of a bank; and testing the impact that proactively educating the public would have on the smart grid adoption.

  17. British Muslims: A Challenge

    OpenAIRE

    Abdel-Hady, Zakaryya Mohamed [زكريا محمد عبد الهادي

    2007-01-01

    The Muslim community in Britain today face multiple challenges covering a wide range of spectrum from the basic right to exists, fighting the increasing trends of Islamophobia, having equal opportunities, to participate in public life, fully integrate within the society and be a positive member of the community. The recent events of September 11th in the US, July 7th in UK and the more recent row over the ban of the headscarf in UK and other European countries have placed tremendous challenge...

  18. Banff Challenge 2

    CERN Document Server

    Junk, Thomas R

    2011-01-01

    Experimental particle physics collaborations constantly seek newer and better ideas for improving the sensitivity of their searches for new particles and phenomena. Statistical techniques are the last step in interpreting the results of an experiment; they are used to make discoveries (hypothesis testing), and to measure parameters (point estimation). They are also used in the first step - experiment and analysis design. Banff Challenge 2 asks participants to test their methods of disco vering hidden signals in simulated datasets and of measuring the properties of these signals. The Challenge problems are described, and the performances of the submitted entries is summarized, for datasets with and without simulated signals present.

  19. Challenges of ecological restoration

    DEFF Research Database (Denmark)

    Halme, Panu; Allen, Katherine A.; Aunins, Ainars;

    2013-01-01

    on Biological Diversity. Several northern countries are now taking up this challenge by restoring forest biodiversity with increasing intensity. The ecology and biodiversity of boreal forests are relatively well understood making them a good model for restoration activities in many other forest ecosystems. Here...... of the target ecosystem should be established with the need for restoration carefully assessed and the outcome properly monitored. Finally, we identify the most important challenges that need to be solved in order to carry out efficient restoration with powerful and long-term positive impacts on biodiversity...

  20. Challenges facing production grids

    Energy Technology Data Exchange (ETDEWEB)

    Pordes, Ruth; /Fermilab

    2007-06-01

    Today's global communities of users expect quality of service from distributed Grid systems equivalent to that their local data centers. This must be coupled to ubiquitous access to the ensemble of processing and storage resources across multiple Grid infrastructures. We are still facing significant challenges in meeting these expectations, especially in the underlying security, a sustainable and successful economic model, and smoothing the boundaries between administrative and technical domains. Using the Open Science Grid as an example, I examine the status and challenges of Grids operating in production today.

  1. Philosophy in Primary Schools?

    Science.gov (United States)

    White, John

    2012-01-01

    The article is a critical discussion of the aims behind the teaching of philosophy in British primary schools. It begins by reviewing the recent Special Issue of the "Journal of Philosophy of Education" Vol 45 Issue 2 2011 on "Philosophy for Children in Transition", so as to see what light this might throw on the topic just mentioned. The result…

  2. Neurobiology in primary headaches

    DEFF Research Database (Denmark)

    Edvinsson, Lars; Uddman, Rolf

    2005-01-01

    , usually accompanied by nausea, vomiting, photophobia and/or phonophobia. A number of hypothesis have emerged to explain the specific causes of migraine. Current theories suggest that the initiation of a migraine attack involves a primary central nervous system (CNS) event. It has been suggested...

  3. Primary intracerebral Hodgkin's lymphoma.

    OpenAIRE

    Doorly, T P; Farrell, M A; Phillips, J.

    1987-01-01

    The case is reported of a 51 year old man with primary intracerebral Hodgkin's lymphoma treated by surgical excision, intrathecal chemotherapy and whole-brain irradiation. One year later the patient had no evidence of Hodgkin's lymphoma intracranially or elsewhere. The possible histogenesis of this rare condition is discussed and a brief review of the literature is presented.

  4. Surgery of Primary Melanomas

    International Nuclear Information System (INIS)

    Surgery remains the mainstay of melanoma therapy, regardless of the tumor site. Only the early diagnosis combined with proper surgical therapy currently gives patients affected by this malignancy the chance for a full cure. The main goal of surgical therapy is to provide the local control of the disease and to secure long-term survival of the patient without reasonable functional and esthetic impairment. The recommended method of biopsy—excisional biopsy, as an initial diagnostic and, to some extent, therapeutic procedure—is performed under local anesthesia as an elliptical incision with visual clear margins of 1–3 mm and with some mm of subcutaneous tissue. The extent of radical excision of the primary tumor (or scar after excisional biopsy) is based on the histopathologic characteristics of the primary tumor and usually consists of 1–2 cm margins with primary closure. The philosophy behind conducted randomized clinical trials has been to find the most conservative surgical approach that is able to guarantee the same results as more demolitive treatment. This has been the background of the trials designed to define the correct margins of excision around a primary cutaneous melanoma. Much less definition can be dedicated to the surgical management of patients with non-cutaneous melanomas

  5. Assembly of primary cilia

    DEFF Research Database (Denmark)

    Pedersen, Lotte B; Veland, Iben R; Schrøder, Jacob M;

    2008-01-01

    in primary cilia assembly or function have been associated with a panoply of disorders and diseases, including polycystic kidney disease, left-right asymmetry defects, hydrocephalus, and Bardet Biedl Syndrome. Here we provide an up-to-date review focused on the molecular mechanisms involved in the assembly...

  6. Multiple Primary Cancer Monograph

    Science.gov (United States)

    To identify groups of cancer survivors that are at increased risk for multiple primary cancers, investigators led an effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S., resulting in a monograph.

  7. Primary and Presidential Candidates

    DEFF Research Database (Denmark)

    Goddard, Joseph

    2012-01-01

    This article looks at primary and presidential candidates in 2008 and 2012. Evidence suggests that voters are less influenced by candidates’ color, gender, or religious observation than previously. Conversely, markers of difference remain salient in the imaginations of pollsters and journalists...

  8. Primary cutaneous myoepithelial carcinoma

    DEFF Research Database (Denmark)

    Frost, Markus Winther; Steiniche, Torben; Damsgaard, Tine Engberg;

    2013-01-01

    This study describes a case of primary myoepithelial carcinoma of the skin and reviews the available literature on this topic. Myoepitheliomas and carcinomas arise most frequently from myoepithelial cells within the salivary glands but are found in many anatomical locations. We documented a case...

  9. Healthcare is primary.

    Science.gov (United States)

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  10. Primary care guidelines

    DEFF Research Database (Denmark)

    Ijäs, Jarja; Alanen, Seija; Kaila, Minna;

    2009-01-01

    OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross...

  11. Restoring primary anterior teeth.

    Science.gov (United States)

    Waggoner, William F

    2002-01-01

    A variety of esthetic restorative materials are available for restoring primary incisors. Knowledge of the specific strengths, weakness, and properties of each material will enhance the clinician's ability to make the best choice of selection for each individual situation. Intracoronal restorations of primary teeth may utilize resin composites, glass ionomer cements, resin-modified ionomers, or polyacid-modified resins. Each has distinct advantages and disadvantages and the clinical conditions of placement may be a strong determining factor as to which material is utilized. Full coronal restoration of primary incisors may be indicated for a number of reasons. Crowns available for restoration of primary incisors include those that are directly bonded onto the tooth, which generally are a resin material, and those crowns that are luted onto the tooth and are some type of stainless steel crown. However, due to lack of supporting clinical data, none of the crowns can be said to be superior to the others under all circumstances. Though caries in the mandibular region is rare, restorative solutions for mandibular incisors are needed. Neither stainless steel crowns nor celluloid crown forms are made specifically for mandibular incisors. Many options exist to repair carious primary incisors, but there is insufficient controlled, clinical data to suggest that one type of restoration is superior to another. This does not discount the fact that dentists have been using many of these crowns for years with much success. Operator preferences, esthetic demands by parents, the child's behavior, and moisture and hemorrhage control are all variables which affect the decision and ultimate outcome of whatever restorative treatment is chosen.

  12. Primary gastrointestinal lymphoma

    Directory of Open Access Journals (Sweden)

    Amir Aledavood

    2012-01-01

    Full Text Available Background: Extranodal lymphoma may arise anywhere outside lymph nodes mostly in the gastrointestinal (GI tract as non-Hodgkin′s disease. We reviewed the clinicopathological features and treatment results of patients with primary GI lymphoma. Materials and Methods : A total number of 30 cases with primary GI lymphoma were included in this study. Patients referred to the Radiation Oncology Department of Omid Hospital (Mashhad, Iran during a 5-year period (2006-11. Clinical, paraclinical, and radiological data was collected from medical records of the patients. Results: Out of the 30 patients with primary GI lymphoma in the study, 12 were female (40% and 18 were male (60% (male to female ratio: 3/2. B symptoms were present in 27 patients (90%. Antidiuretic hormone (LDH levels were elevated in 9 patients (32.1%. The most common primary site was stomach in 14 cases (46.7%. Other common sites included small intestine and colon each in 8 patients (26.7%. All patients had histopathologically proven non-Hodgkin′s lymphoma. The most common histologic subtype was diffuse large B-cell lymphoma (DLBL in 16 patients (53.3%. In addition, 28 patients (93.3% received chemotherapy with cyclophosphamide, vincristine, doxorubicin, prednisolone (CHOP regimen. The median course of chemotherapy was 6 cources. Moreover, 8 patients (26.7% received radiotherapy with cobalt 60. The median follow-up time was 26 months. The overall 5-year survival rate was 53% and the median survival time was 60 months. Conclusion : Primary GI lymphoma is commonly seen in stomach and small intestine and mostly is DLBCL or mucosa-associated lymphoid tissue (MALT lymphoma.

  13. Restoring primary anterior teeth.

    Science.gov (United States)

    Waggoner, William F

    2002-01-01

    A variety of esthetic restorative materials are available for restoring primary incisors. Knowledge of the specific strengths, weakness, and properties of each material will enhance the clinician's ability to make the best choice of selection for each individual situation. Intracoronal restorations of primary teeth may utilize resin composites, glass ionomer cements, resin-modified ionomers, or polyacid-modified resins. Each has distinct advantages and disadvantages and the clinical conditions of placement may be a strong determining factor as to which material is utilized. Full coronal restoration of primary incisors may be indicated for a number of reasons. Crowns available for restoration of primary incisors include those that are directly bonded onto the tooth, which generally are a resin material, and those crowns that are luted onto the tooth and are some type of stainless steel crown. However, due to lack of supporting clinical data, none of the crowns can be said to be superior to the others under all circumstances. Though caries in the mandibular region is rare, restorative solutions for mandibular incisors are needed. Neither stainless steel crowns nor celluloid crown forms are made specifically for mandibular incisors. Many options exist to repair carious primary incisors, but there is insufficient controlled, clinical data to suggest that one type of restoration is superior to another. This does not discount the fact that dentists have been using many of these crowns for years with much success. Operator preferences, esthetic demands by parents, the child's behavior, and moisture and hemorrhage control are all variables which affect the decision and ultimate outcome of whatever restorative treatment is chosen. PMID:12412967

  14. A daunting challenge

    DEFF Research Database (Denmark)

    Rebolj, Matejka; Bonde, Jesper; Ejegod, Ditte;

    2015-01-01

    We compared cytology with Hybrid Capture 2 (HC2), cobas, CLART and APTIMA Human Papillomavirus (HPV) assays in primary cervical screening at age 23-29 years based on data from the Danish Horizon study. SurePath samples were collected from 1278 women undergoing routine cytology-based screening...

  15. Making Physics Matter in Primary Schools

    Science.gov (United States)

    Flaherty, Jackie; Cox, Wendy; Poole, Amanda; Watson, Jenny; Greygoose, Kirstin

    2016-04-01

    "Efforts to broaden students' aspirations, particularly in relation to STEM, need to begin in primary school." Kings College London "Aspires" Research Project 2013 From my outreach activity I have learnt that primary teachers could feel under pressure when faced with delivering the science curriculum. The teachers could be lacking confidence in their subject knowledge, lacking the equipment needed to deliver practical science or lacking enthusiasm for the subject. In addition, English and Mathematics were the subjects that were externally tested and reported to the authorities and so some teachers felt that time for science was being marginalised to ensure the best results in the externally assessed subjects. In my work with The Ogden Trust Primary Science team I have been involved in developing a range of strategies to address some of the issues outlined above. • CPD (Teacher Training) Programme We have provided free training to improve teachers knowledge and understanding of key physics concepts to GCSE standard and a practical workshop consisting of ten investigations, extension and challenge tasks. The teachers each receive a book of lesson plans and a resource box containing a class set of the equipment required. The four year programme covers Forces Light and Sound Electricity Earth & Space • "Phiz Labs" Funding from The Ogden Trust has allowed us to set up science laboratories within primary schools. The pupils have lab coats, goggles and access to a range of equipment that allows them to participate in more practical science activity and open-ended investigative work. My Phiz Lab is in the secondary school where I teach physics and practical workshops for primary pupils and teachers are held there on a regular basis. • Enrichment In order to enthuse and challenge the primary pupils a variety of enrichment activities take place. These include "Physics of Go-Karts" and "Particle Physics for Primary" workshops, competitions and regional Science Fairs

  16. MALL: The Pedagogical Challenges

    Science.gov (United States)

    Burston, Jack

    2014-01-01

    In this paper the development of mobile-assisted language learning (MALL) over the past 20 years is reviewed with a particular focus on the pedagogical challenges facing its exploitation. Following a consideration of the definition of mobile learning, the paper describes the dominant mobile technologies upon which MALL applications have been…

  17. Tackling the Unemployment Challenge

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    As the world's largest economy in transition, Chinafaces a severe unemployment challenge. With aworking population of 751 million, China'sunemployment rate stands at more than l O% in urbanareas," including rural surplus laborers, it is astaggering 20%. Since assuming office in March

  18. Asia's new challenges

    DEFF Research Database (Denmark)

    Brach, Juliana; Vang, Jan

    2012-01-01

    Asian countries are currently undergoing significant changes with respect to their role in and interaction with the international economy. Despite their heterogeneity, Asian countries share the common aim to upgrade capacities, skills and capabilities. This paper aims at unpacking the challenges...

  19. The Clay Challenge Continues...

    Science.gov (United States)

    Coy, Mary

    2007-01-01

    It was time for yet another challenge. Bright colored glazes were on hiatus; earth tones and mixed media took center stage. Inspiration was provided this time by the myriad Native American potters from the desert Southwest. The project: create a coil pot that demonstrates interesting form and good artistry and reflects, through symbolism or mixed…

  20. Challenges of Retrenchment.

    Science.gov (United States)

    Mingle, James R.; And Others

    The retrenchment experiences of a variety of institutions--large and small, public and private--are described and evaluated using an extensive spectrum of case studies sponsored by the Southern Regional Education Board. Part One discusses challenges of retrenchment (James R. Mingle) and strategies for the 1980s (David W. Breneman). Part Two,…

  1. Fortification Challenges and Needs

    Institute of Scientific and Technical Information of China (English)

    RODOLFOF.FLORENTINO

    2001-01-01

    Experience in many parts of the developing world has shown that food fortification offers a costeffective and sustainable solution to the problem of micronutrient malnutrition.Building on the advances in science and technology and backed by studies on the economic benefits of fortification programs,govenments and industry are beginning to respond positively to the call of nutrition advocates to adopt fortification as a long-term strategy.On the other hand,formidable challenges still remain in many countries in Asia,constraining the widespread adoption of this strategy,The science and technology community needs to provide adequate scientific and technological information as basis for planning and decision making,The governent faces the challenge of providing the enabling environment for all stakeholders to cooperate in the fortification effort.Industry faces the challenge of adapting its production system to the requirements of fortification in oreder that they can contribute to social bojectives while pursuing their economic objectives,The international and bilateral aid agencies need to seek tried and innovative ways to support the multiple players of food fortification,as these players in turn face the challenges that confront them.

  2. Fortification Challenges and Needs

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Experience in many parts of the developing world has shown thatfood fortification offers a cost-effective and sustainable solution to the problem of micronutrient malnutrition. Building on the advances in science and technology and backed by studies on the economic benefits of fortification programs, governments and industry are beginning to respond positively to the call of nutrition advocates to adopt fortification as a long-term strategy. On the other hand, formidable challenges still remain in many countries in Asia, constraining the widespread adoption of this strategy. The science and technology community needs to provide adequate scientific and technological information as basis for planning and decision making. The government faces the challenge of providing the enabling environment for all stakeholders to cooperate in the fortification effort. Industry faces the challenge of adapting its production system to the requirements of fortification in order that they can contribute to social objectives while pursuing their economic objectives. The international and bilateral aid agencies need to seek tried and innovative ways to support the multiple players of food fortification, as these players in turn face the challenges that confront them.

  3. Hopes and Challenges

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    China tops the medal tally again at the Asian Games but still faces challenges in some events The curtain of the 16th Asian Games has fallen, but the 15 days of exciting competitions will be recorded in the history of the Games.

  4. The Moon Challenge

    Science.gov (United States)

    Fitzsimmons, Pat; Leddy, Diana; Johnson, Lindy; Biggam, Sue; Locke, Suzan

    2013-01-01

    This article describes a first-grade research project that incorporates trade books and challenges misconceptions. Educators see the power of their students' wonder at work in their classrooms on a daily basis. This wonder must be nourished by students' own experiences--observing the moon on a crystal clear night--as well as by having…

  5. Ecommerce: Ongoing Challenges

    Directory of Open Access Journals (Sweden)

    Derek Mohammed

    2010-08-01

    Full Text Available This paper examines some of the challenges of online marketing, including the importance of adding online marketing to corporation budgets. A review of the pros and cons of social networking on the Internet, when used as a marketing tool by companies is presented. In addition, new forms of Internet shoppers and new niches for companies are identified

  6. Electric Vehicle Battery Challenge

    Science.gov (United States)

    Roman, Harry T.

    2014-01-01

    A serious drawback to electric vehicles [batteries only] is the idle time needed to recharge their batteries. In this challenge, students can develop ideas and concepts for battery change-out at automotive service stations. Such a capability would extend the range of electric vehicles.

  7. Ecommerce: Ongoing Challenges

    OpenAIRE

    Derek Mohammed

    2010-01-01

    This paper examines some of the challenges of online marketing, including the importance of adding online marketing to corporation budgets. A review of the pros and cons of social networking on the Internet, when used as a marketing tool by companies is presented. In addition, new forms of Internet shoppers and new niches for companies are identified

  8. Challenging the Boundaries

    DEFF Research Database (Denmark)

    Nørgaard, Nina

    2004-01-01

    To many people, challenging the boundaries between the traditional disciplines in foreign language studies means doing cultural studies. The aim of this article is to pull in a different direction by suggesting how the interface between linguistics and literature may be another fertile field to e...

  9. Anthropocene Age Wicked Challenges

    DEFF Research Database (Denmark)

    Edgeman, Rick; Wu, Zhaohui

    2015-01-01

    Grand global challenges, including wicked human caused or influenced ones key to sustainability, characterize the Anthropocene Age. Among these are climate change driven by increased methane and CO2 in the atmosphere; consequent global warming and increasing intensity and incidence of extreme...

  10. Challenging and valuable

    OpenAIRE

    Van Hal, J.D.M.

    2008-01-01

    Challenging and valuable Inaugural speech given on May 7th 2008 at the occasion of the acceptance of the position of Professor Sustainable Housing Transformation at the faculty of Architeeture of the Delft University of Technology by Prof. J.D.M. van Hal MSc PhD.

  11. Experiences of social workers in primary care in Ireland

    OpenAIRE

    Ní Raghallaigh, Muireann; Allen, Mary; Cunniffe, Rosemary; Quin, Suzanne

    2013-01-01

    This article presents the findings of research conducted with social workers in primary health care teams in Ireland. Data from questionnaires and from a focus group were analysed. The findings draw attention to the nature of the role of the primary care social worker, including both the satisfying and challenging aspects of this role. It was evident that the participants liked the generic nature of their role and the fact that they worked with non-mandated clients. However, th...

  12. 77 FR 70835 - Centennial Challenges 2013 Sample Return Robot Challenge

    Science.gov (United States)

    2012-11-27

    ... SPACE ADMINISTRATION Centennial Challenges 2013 Sample Return Robot Challenge AGENCY: National... in accordance with 51 U.S.C. 20144(c). The 2013 Sample Return Robot Challenge is scheduled and teams... Robot Challenge is a prize competition designed to encourage development of new technologies...

  13. 76 FR 56819 - Centennial Challenges 2012 Sample Return Robot Challenge

    Science.gov (United States)

    2011-09-14

    ... SPACE ADMINISTRATION Centennial Challenges 2012 Sample Return Robot Challenge AGENCY: National... 42 U.S.C. 2451(314)(d). The 2012 Sample Return Robot Challenge is scheduled and teams that wish to... technologies of interest and value to NASA and the nation. The 2012 Sample Return Robot Challenge is a...

  14. Control challenges for extremely large telescopes

    Science.gov (United States)

    MacMartin, Douglas G.

    2003-08-01

    The next generation of large ground-based optical telescopes are likely to involve a highly segmented primary mirror that must be controlled in the presence of wind and other disturbances, resulting in a new set of challenges for control. The current design concept for the California Extremely Large Telescope (CELT) includes 1080 segments in the primary mirror, with the out-of-plane degrees of freedom actively controlled. In addition to the 3240 primary mirror actuators, the secondary mirror of the telescope will also require at least 5 degree of freedom control. The bandwidth of both control systems will be limited by coupling to structural modes. I discuss three control issues for extremely large telescopes in the context of the CELT design, describing both the status and remaining challenges. First, with many actuators and sensors, the cost and reliability of the control hardware is critical; the hardware requirements and current actuator design are discussed. Second, wind buffeting due to turbulence inside the telescope enclosure is likely to drive the control bandwidth higher, and hence limitations resulting from control-structure-interaction must be understood. Finally, the impact on the control architecture is briefly discussed.

  15. Seven challenges for neuroscience.

    Science.gov (United States)

    Markram, Henry

    2013-01-01

    Although twenty-first century neuroscience is a major scientific enterprise, advances in basic research have not yet translated into benefits for society. In this paper, I outline seven fundamental challenges that need to be overcome. First, neuroscience has to become "big science" - we need big teams with the resources and competences to tackle the big problems. Second, we need to create interlinked sets of data providing a complete picture of single areas of the brain at their different levels of organization with "rungs" linking the descriptions for humans and other species. Such "data ladders" will help us to meet the third challenge - the development of efficient predictive tools, enabling us to drastically increase the information we can extract from expensive experiments. The fourth challenge goes one step further: we have to develop novel hardware and software sufficiently powerful to simulate the brain. In the future, supercomputer-based brain simulation will enable us to make in silico manipulations and recordings, which are currently completely impossible in the lab. The fifth and sixth challenges are translational. On the one hand we need to develop new ways of classifying and simulating brain disease, leading to better diagnosis and more effective drug discovery. On the other, we have to exploit our knowledge to build new brain-inspired technologies, with potentially huge benefits for industry and for society. This leads to the seventh challenge. Neuroscience can indeed deliver huge benefits but we have to be aware of widespread social concern about our work. We need to recognize the fears that exist, lay them to rest, and actively build public support for neuroscience research. We have to set goals for ourselves that the public can recognize and share. And then we have to deliver on our promises. Only in this way, will we receive the support and funding we need. PMID:24139651

  16. Seven challenges for neuroscience

    Science.gov (United States)

    Markram, Henry

    Summary Although twenty-first century neuroscience is a major scientific enterprise, advances in basic research have not yet translated into benefits for society. In this paper, I outline seven fundamental challenges that need to be overcome. First, neuro-science has to become “big science” – we need big teams with the resources and competences to tackle the big problems. Second, we need to create interlinked sets of data providing a complete picture of single areas of the brain at their different levels of organization with “rungs” linking the descriptions for humans and other species. Such “data ladders” will help us to meet the third challenge – the development of efficient predictive tools, enabling us to drastically increase the information we can extract from expensive experiments. The fourth challenge goes one step further: we have to develop novel hardware and software sufficiently powerful to simulate the brain. In the future, supercomputer-based brain simulation will enable us to make in silico manipulations and recordings, which are currently completely impossible in the lab. The fifth and sixth challenges are translational. On the one hand we need to develop new ways of classifying and simulating brain disease, leading to better diagnosis and more effective drug discovery. On the other, we have to exploit our knowledge to build new brain-inspired technologies, with potentially huge benefits for industry and for society. This leads to the seventh challenge. Neuroscience can indeed deliver huge benefits but we have to be aware of widespread social concern about our work. We need to recognize the fears that exist, lay them to rest, and actively build public support for neuroscience research. We have to set goals for ourselves that the public can recognize and share. And then we have to deliver on our promises. Only in this way, will we receive the support and funding we need. PMID:24139651

  17. Benefits and Challenges of Over-Actuated Excitation Systems

    OpenAIRE

    Norman Fitz-Coy; Vivek Nagabhushan; Michael T. Hale

    2010-01-01

    This paper provides a comprehensive discussion on the benefits and technical challenges of controlling over-determined and over-actuated excitation systems ranging from 1-DOF to 6-DOF. The primary challenges of over-actuated systems result from the physical constraints imposed when the number of exciters exceeds the number of mechanical degree-of-freedom. This issue is less critical for electro-dynamic exciters which tend to be more compliant than servo-hydraulic exciters. To facilitate the t...

  18. CULTURAL GLOBALISATION AND CHALLENGES TO TRADITIONAL COMMUNICATION THEORIES

    OpenAIRE

    Lauren Movius

    2010-01-01

    This article reviews existing traditional media theories, and analyses the challenges that the current developments of globalisation present to them. The article provides a short history of the concept of globalisation, and reviews the primary theoretical approaches to globalisation that are critical to communication scholars. The article also examines how globalisation challenges the ways in which media and communication have traditionally been theorised. Specifically, the cultural imperiali...

  19. Canine hypothyroidism. A diagnostic challenge?

    International Nuclear Information System (INIS)

    Hypothyroidism is one of the most common endocrinopathies in dogs. Clinical symptoms and hematological and biochemical parameters lead to a first suspicion. To confirm diagnosis can be challenging, however. Determination of total serum T4 concentration is accepted as the primary screening test for the disease, and low serum T4 concentrations are intuitively suggestive of hypothyroidism. However it is well known that low T4 concentrations are frequently encountered in euthyroid dogs with various nonthyroidal diseases and in dogs receiving certain pharmacologic agents. Since assessment of endogenous TSH (canine TSH) using current canine TSH assays shows normal values in a high percentage of hypothyroid dogs (up to 40%), its diagnostic value is only limited. The TSH-stimulation test can still be recognized as the gold standard for the diagnosis of hypothyroidism in dogs. Determination of circulating T4 concentration before and 6 hours after the administration of exogenous TSH (recombinant human TSH, Thyrogen registered) provides an assessment of the functional reserve capacity of the thyroid gland with minimal change in post-TSH T4 concentration, compared with the basal concentration, expected in dogs with hypothyroidism. Also this test can be influenced by nonthyroidal illness and by medications known to affect thyroid function. This suppressing influence seems to be less pronounced using a higher dose of TSH. Therefore, to improve the discriminatory power of the TSH stimulation test to differentiate between euthyroid-sick and primary hypothyroidism, the higher dose should be used in cases in which testing cannot be delayed. More recently, ultrasonography and scintigraphy have been used for the diagnosis of primary hypothyroidism. Using ultrasonography, a sensitivity of 98% was reported if size and echogenicity of the gland were combined. However, specificity was as low as 77%. and care must be taken when measuring the gland because of a relatively high interobserver

  20. Omental infarction: a reappraisal of conservative management in children.

    Science.gov (United States)

    Estevão-Costa, José; Alvarenga, Ana Sofia; Fragoso, Ana Catarina; Garcia, Maria; Campos, Miguel

    2014-01-01

    Introdução: A melhoria da acuidade diagnóstica do enfarte do omento resultou num incremento da atitude conservadora no seu tratamento. Com o objectivo de avaliar a eficácia e segurança da abordagem não-operatória, analisámos os casos de enfarte do omento tratados num hospital terciário. Material e Métodos: Incluímos os casos de enfarte do omento primários tratados entre 2004 e 2011. Os enfartes do omento diagnosticados por imagiologia foram submetidos a tratamento conservador que constou de analgésicos e antibioterapia intravenosa. Avaliámos os dados demográficos, apresentação clínica, dados laboratoriais, imagiologia e resultado. Resultados: Ocorreram nove casos de enfarte do omento. Oito pacientes (4 rapazes), com uma idade mediana de 8,5 anos, apresentaram- se na fase inicial da doença por dor abdominal à direita; a contagem leucocitária era normal ou ligeiramente elevada. Seis casos, diagnosticados por TC após ecografia suspeita de enfarte do omento em quatro, foram trados conservadoramente sem complicações, tendo alta ao terceiro dia (mediana). Dois doentes foram apenas diagnosticados durante a intervenção cirúrgica por suposta apendicite. O nono caso apresentou-se com uma obstrução intestinal devida a hérnia interna que foi resolvida por laparoscopia. Discussão: A imagiologia foi diagnóstica na maioria dos casos de enfarte do omento, permitindo a adoção de uma abordagem conservadora. O tratamento não-operatório foi eficaz e sem complicações em todos os doentes que se apresentaram na fase inicial da doença. Um doente apresentou-se com uma complicação grave que requereu intervenção cirúrgica. Conclusão: Na ausência de um tratamento consensual para o enfarte do omento, a abordagem não-operatória é uma alternativa não invasiva e eficaz, mas requer uma vigilância clínica ativa.

  1. Regulation of lipoprotein lipase in primary cultures of isolated human adipocytes.

    OpenAIRE

    Kern, P A; Marshall, S; Eckel, R H

    1985-01-01

    To study the regulation of adipose tissue lipoprotein lipase (LPL) in human adipocytes, omental adipose tissue was obtained from healthy subjects and digested in collagenase. The isolated adipocytes thus obtained were suspended in Medium 199 and cultured at 37 degrees C. Cell viability was demonstrated in adipocytes cultured for up to 72 h by constancy of cell number, cell size, trypan-blue exclusion, and specific 125I-insulin binding. In addition, chloroquine induced an increase in cell-asso...

  2. Primary pulmonary Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Two cases of primary pulmonary Hodgkin's lymphoma (PPHL) are presented, a male aged 21, and a female aged 32 years. Symptoms included non-productive cough, shortness of breath, low grade fever, wheezing and weight loss. Duration of illness varied between 6 weeks in the male patient to female patient. Both patients were given an empirical trial of antibiotics and anti-cough measures with no response. Radiological studies carried out after failure to respond to medical treatment, revealed the presence of pulmonary parenchymal masses in both patients. Cytology, bronchoscopic and transbronchial biopsies were not diagnostic, which led to opened wedge resections. Finally, the diagnosis of primary pulmonary Hodgkin's disease was reached after supportive immunohistochemical staining (CD 30 and CD 15 both positive in Rs cells). Both patients were regarded as stage I extranodal (IE) after exhaustive measures failed to demonstrate involvement of other body cites. (author)

  3. Primary renal hydatidosis

    Directory of Open Access Journals (Sweden)

    Johnsy Merla Joel

    2016-01-01

    Full Text Available Echinococcosis or hydatidosis caused by the tapeworm, Echinococcus granulosus, has the highest prevalence in endemic regions and sheep farming areas. The most common organ involved is the liver (50–75% followed by the lungs (15–20% and other organs (10–20%. Primary involvement of the kidney without the involvement of the liver and lungs, i.e., isolated renal hydatid disease is extremely rare even in endemic areas. The incidence of renal echinococcosis is 2–4%. Renal hydatid cysts usually remain asymptomatic for many years and are multiloculated. A 63-year-old male presented with left loin pain. Computed tomography scan abdomen revealed a presumptive diagnosis of renal hydatid disease. The nephrectomy specimen received in histopathology confirmed the diagnosis. We describe a rare case of primary renal hydatidosis.

  4. Primary spinal epidural lymphomas

    Directory of Open Access Journals (Sweden)

    Goutham Cugati

    2011-01-01

    Full Text Available An epidural location for lymphoma is observed in 0.1-6.5% of all the lymphomas. Primary spinal epidural lymphoma (PSEL is a subset of lymphomas, where there are no other recognizable sites of lymphomas at the time of diagnosis. The incidence of this subset of lymphomas is much less. It, however, is increasingly diagnosed, due to the increased use of more sensitive imaging modalities. For the electronic search, Pubmed was used to identify journals that enlisted and enumerated PSEL from 1961 to January 2011. The following combination of terms: "primary," "spinal," "epidural," and "lymphoma" were used. The most significant articles and their bibliographies were analyzed by the authors. The symptoms, pathogenesis, diagnostic workup, histopathology, treatment, and outcome have been analyzed in a systematic manner

  5. Primary Retroperitoneal Mucinous Cystadenoma.

    Science.gov (United States)

    Lee, Seok Youn; Han, Weon Cheol

    2016-02-01

    Mucinous cystadenomas and cystadenocarcinomas of the ovary are clinically and histopathologically well-established common tumors. However, primary retroperitoneal mucinous cystic tumors are extremely rare, and although their histopathogenesis is still uncertain, several theories have been proposed. Most authors suggest that they develop through mucinous metaplasia in a preexisting mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. Delay in diagnosis and treatment of this tumor may be fatal for the patient because of complications such as rupture, infection, and malignant transformation. We describe the case of a 31-year-old woman with abdominal pain and a palpable mass. Computed tomography of the abdomen revealed a retroperitoneal cystic mass, which was resected successfully through laparoscopy. Histopathological examination of the resected mass confirmed the diagnosis of a primary retroperitoneal mucinous cystadenoma. The patient was discharged on postoperative day 5 without any complications.

  6. Astronomy Education Challenges in Egypt

    Science.gov (United States)

    El Fady Beshara Morcos, Abd

    2015-08-01

    One of the major challenges in Egypt is the quality of education. Egypt has made significant progress towards achieving the Education for All and the Millennium Development Goals (MDGs). Many associations and committees as education reform program and education support programs did high efforts in supporting scientific thinking through the scientific clubs. The current state of astronomical education in Egypt has been developed. Astronomy became a part in both science and geography courses of primary, preparatory and secondary stages. Nowadays the Egyptian National Committee for Astronomy, put on its shoulders the responsibility of revising of astronomy parts in the education courses, beside preparation of some training programs for teachers of different stages of educations, in collaboration with ministry of education. General lectures program has been prepared and started in public places , schools and universities. Many TV and Radio programs aiming to spread astronomical culture were presented. In the university stage new astronomy departments are established and astrophysics courses are imbedded in physics courses even in some private universities.

  7. Exploring the contemporary ethical challenges in coaching psychology in South Africa

    OpenAIRE

    Claire E. Simon; Aletta Odendaal; Xenia Goosen

    2014-01-01

    Orientation: This article focuses on the contemporary ethical challenges in coaching psychology in the South African context.Research purpose: The primary objective was to qualitatively explore the contemporary ethical challenges faced by coaching psychologists when coaching clients and organisations and develop an exploratory framework of ethical challenges.Motivation for the study: There may not be sufficient practical guidance to resolving the ethical challenges coaching psychologists enco...

  8. Primary cicatricial alopecia

    OpenAIRE

    Ali Karakuzu

    2014-01-01

    Cicatricial alopecia implies that follicular epithelium has been replaced by connective tissue. In other words cicatricial alopecia might include all forms of alopecia in which all hair follicles are permanently lost. In most of the cases, it is accepted that there is a permanent damage to follicular stem cell. While main target is hair follicle in primary cicatricial alopecia, in secondary cicatricial alopecia hair follicle damage is caused indirectly by a disease that is not in association ...

  9. [Primary care in France].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. PMID:26304179

  10. Bilateral Primary Intraocular Lymphoma

    OpenAIRE

    Mehrdad Karimi; Masoud Soheilian; Mozhgan Rezaei Kanavi

    2011-01-01

    Purpose: To report a case of bilateral primary intraocular lymphoma. Case report: A 33-year-old man presented with bilateral blurred vision since two years ago. Examination revealed large keratic precipitates, anterior chamber reaction, posterior subcapsular cataracts, and vitreous infiltration. After a short trial of topical and periocular steroids, diagnostic 25-gauge pars plana vitrectomy was performed and cytologic evaluation of the aspirate confirmed a diagnosis of intraocular lympho...

  11. PRIMARY CARIES: AN OVERVIEW

    OpenAIRE

    Gaurav Solanki

    2012-01-01

    Primary caries is an initial lesions produced by direct extension from an external surface. Dental caries is called as tooth decay or a cavity is a disease in which bacterial processes changes carbohydrate to acid which than dematerializes the hard tooth structure like enamel, dentin and cementum. Streptococcus mutans and Lactobacillus are the bacteria responsible for the dental caries by acid production. This article throws light on the dental caries disease, its sign and symptoms, treatment...

  12. Primary sleep apnoea syndrome.

    OpenAIRE

    Chokroverty, S.; Sharp, J T

    1981-01-01

    Polygraphic study in 18 men with the sleep apnoea syndrome showed central, upper airway obstructive, and mixed apnoeas. Fifty per cent of the total apnoea time was central, 33% was obstructive, and 17% was mixed. Apnoeic episodes were accompanied by oxygen desaturation, relative bradycardia and hypotonia of orofacial muscles innervated by ponto-medullary neurons. During regular breathing these muscles revealed tonic and phasic inspiratory EMG activities. The data suggest that the primary slee...

  13. [Primary liposarcoma of bone].

    Science.gov (United States)

    Tatić, V; Cerović, S; Skaro-Milić, A; Jovanović, Z

    2001-01-01

    A case of 75-year-old man with extremely rare primary liposarcoma of the bone was presented. Stains for lipid, Sudan III, Sudan IV, and Oil Red "O", demonstrated the presence of intracellular lipid in the lipoblasts. Similarly, the S-100 immunoreactivity and electron microscopic findings of tumor cells confirmed the diagnosis of liposarcoma. Histochemical stains for PAS, Alcian-blue, mucikarmin, Toluidin-blue and Coloidal Iron were negative. PMID:11419292

  14. Primary pulmonary alveolar proteinosis

    OpenAIRE

    Šarac Sanja; Milić Rade; Zolotarevski Lidija; Aćimović Slobodan; Tomić Ilija; Plavec Goran

    2012-01-01

    Introduction. Pulmonary alveolar proteinosis is an uncommon disease characterized by the accumulation of surfactant proteins and phospholipids within the alveolar spaces. Acquired disease can be idiopathic (primary) and secondary. The prevalence of acquired pulmonary alveolar proteinosis is about 0.37 per 100,000 persons. Common symptoms are dyspnea and cough. Chest X-ray shows bilateral perihilar infiltrates. Open-lung biopsy is the gold standard for the diagnosis. Treatment includes w...

  15. Primary pulmonary cryptococcosis

    OpenAIRE

    Asadi Gharabaghi, Mehrnaz; Allameh, Seyyed Farshad

    2014-01-01

    Here, we report a case of primary cryptococcal pneumonia in a 25-year-old woman who presented with several weeks’ history of cough, dyspnoea and night sweating. These symptoms started in the third trimester of her pregnancy. She was being treated for infertility and got pregnant with in vitro fertilisation. On chest imaging, there were bilateral air space consolidation and cavitary lesions. Fungal pulmonary infection was diagnosed after surgical lung biopsy. She received fluconazole 400 mg pe...

  16. What Is Primary Care Informatics?

    OpenAIRE

    de Lusignan, Simon

    2003-01-01

    Primary care informatics is an emerging academic discipline that remains undefined. The unique nature of primary care necessitates the development of its own informatics discipline. A definition of primary care informatics is proposed, which encompasses the distinctive nature of primary care. The core concepts and theory that should underpin it are described. Primary care informatics is defined as a science and as a subset of health informatics. The proposed definition is intended to focus th...

  17. Primary Intracranial Synovial Sarcoma

    Directory of Open Access Journals (Sweden)

    Mohit Patel

    2016-01-01

    Full Text Available Background. Synovial sarcoma is an aggressive soft tissue sarcoma with uncertain histological origin. The pathology frequently presents as a localized disease, especially near large joints around the knee and thigh. Intracranial disease, which is rare, has been reported as metastasis from synovial sarcoma. We report a case with no obvious primary extracranial pathology, suggesting primary intracranial disease; this has not been reported in the literature. Case Description. A 21-year-old male, with a prior right skull lesion resection for atypical spindle cell neoplasm, presented with headaches, gait instability, left arm weakness, and left homonymous hemianopsia. CT of head demonstrated a right parietal hemorrhagic lesion with mass effect, requiring surgical decompression. Histopathology revealed synovial sarcoma. FISH analysis noted the existence of the t(X;18(p11.2;q11.2 chromosomal translocation. PET scan did not show other metastatic disease. He underwent stereotactic radiotherapy and adjuvant chemotherapy. At 2-year follow-up, he remained nonfocal without recurrence. Conclusion. We report the first known case of primary intracranial synovial sarcoma. Moreover, we stress that intracranial lesions may have a tendency for hemorrhage, requiring urgent lifesaving decompression.

  18. Primary hepatic carcinosarcoma

    Institute of Scientific and Technical Information of China (English)

    Mehmet Çelikbilek; Kemal Deniz; Edip Torun; Tarık Artış; Ersin Özaslan; Ökkeş İbrahim Karahan; Tahir Ercan Patıroğlu; Ömer Özbakır

    2011-01-01

    BACKGROUND: Primary hepatic carcinosarcoma is a rare malignant tumor containing an intimate mixture of carci-nomatous and sarcomatous elements. Reports on risk factors, epidemiology, and pathogenesis of the tumor as well as the experience in its treatment are limited. METHOD: We present a case of primary carcinosarcoma of the liver in a 69-year-old man who complained of right hypochondrial pain and weight loss for two months. RESULTS:  Magnetic resonance imaging revealed a 14×12 cm mass in segments 7-8 and 4 of the liver with vena hepatica invasion. An ultrasonography-guided biopsy showed osteoid tissue without osteoblastic rimming. Vascular structures accompanied the osteoid tissue. The patient underwent surgery after a diagnosis of hemangioma. Intraoperative frozen sections revealed a carcinosarcoma associated with an osteosarcoma and cholangiocellular carcinoma components. CONCLUSIONS: Preoperative diagnosis of this rare primary hepatic malignant tumor may be difficult by biopsy owing to intratumoral heterogeneity. Highly mature areas of the osteosarcomatous component may lead to misdiagnosis of metaplastic bone tissue. Clinicopathologic features of this rare entity are discussed.

  19. Diagnostic Challenges at SNS

    CERN Document Server

    Plum, M A

    2003-01-01

    The Spallation Neutron Source now being built in Oak Ridge, Tennessee, USA, accelerates an H- ion beam to 1000 MeV with an average power of 1.4 MW. The H- beam is then stripped to H+, compressed in a storage ring to a pulse length of 695 ns, and then directed onto a mercury neutron spallation target. Most of the acceleration is accomplished with superconducting rf cavities. The presence of these cavities, the high average beam power, and the large range of beam intensity in the storage ring, provide unique challenges to the beam diagnostics systems. In this talk we will discuss these challenges and some of our solutions, including the laser profile monitor system, the residual gas ionization profile monitors, and network attached devices. Measurements performed using prototype instrumentation will also be presented.

  20. Mathematical olympiad challenges

    CERN Document Server

    Andreescu, Titu

    2000-01-01

    Mathematical Olympiad Challenges is a rich collection of problems put together by two experienced and well-known professors and coaches of the U.S. International Mathematical Olympiad Team. Hundreds of beautiful, challenging, and instructive problems from algebra, geometry, trigonometry, combinatorics, and number theory were selected from numerous mathematical competitions and journals. An important feature of the work is the comprehensive background material provided with each grouping of problems. The problems are clustered by topic into self-contained sections with solutions provided separately. All sections start with an essay discussing basic facts and one or two representative examples. A list of carefully chosen problems follows and the reader is invited to take them on. Additionally, historical insights and asides are presented to stimulate further inquiry. The emphasis throughout is on encouraging readers to move away from routine exercises and memorized algorithms toward creative solutions to open-e...

  1. Challenges in sexual medicine

    DEFF Research Database (Denmark)

    Cellek, Selim; Giraldi, Annamaria

    2012-01-01

    The sexual medicine field has been in mode of revolution until recently. Like all other fields of biomedical research, the economic situation around the world has had a negative impact on the field's momentum-research funding bodies, regulatory bodies and pharmaceutical companies seem to have...... placed sexual medicine in their low-priority list. But this is not the only challenge the field is facing. The successful development of phosphodiesterase type 5 (PDE5) inhibitors for treatment of erectile dysfunction (ED) means that research in this area seems to have slowed. However, there remain...... several unmet medical needs within sexual medicine such as premature ejaculation, severe ED and hypoactive sexual desire disorder, which await novel therapeutic approaches. Despite these challenges, research into finding and developing such therapies is likely to continue in the sexual medicine field...

  2. The challenge of conceiving

    DEFF Research Database (Denmark)

    Hansen, Claus Thorp; Jørgensen, Ulrik

    2011-01-01

    different or even not very well established ideas of what might be a good design result. We present two mutually supportive approaches to problem identification that we have developed, applied and refined. The first is providing an approach to map the arenas of development that influence the context......One of the big challenges in the CDIO approach to engineering education is the first part focusing on conceiving problems to be handled and eventually solved. Traditional engineering education has been dominated by its focus on technical disciplines emphasising their individual tool box of problem...... the perspective of engineering design challenges where the need for problem identification is obvious to avoid the pitfall to reproduce and piecemeal engineer already existing product or service concepts. Problem identification is not a simple desk research task as it often involves a multitude of actors having...

  3. Challenges in Request Management

    DEFF Research Database (Denmark)

    Sommer, Anita Friis

    2014-01-01

    Request management (RQM) is a new term used for managing customer requests for new products. It is the counterpart to typical product development processes, which has no direct customer involvement. It is essential to manage customer requests in a structured and efficient way to obtain...... profitability. This research study seeks to investigate the challenges of RQM in practice. Existing demand chain management literature is used as a basis for developing a RQM framework. RQM is investigated through an explorative research design in a dyadic B2B case study including a global industrial company...... and its customers. The study provides an insight into a new area of supply chain management, including the process activity flow and challenges involved across the process. Furthermore, the method is dyadic including the customer in the case study, which is rare in related research....

  4. Challenges to Resistance Welding

    DEFF Research Database (Denmark)

    Song, Quanfeng

    simulation of resistance welding has been under development for many years. Yet it is no easy to make simulation results reliable and accurate because of the complexity of resistance welding process. In the 2nd part of the report numerical modeling of resistance welding is reviewed, some critical factors......This report originates from the compulsory defense during my Ph.D. study at the Technical University of Denmark. Resistance welding is an old and well-proven technology. Yet the emergence of more and more new materials, new designs, invention off new joining techniques, and more stringent...... requirement in quality have imposed challenges to the resistance welding. More some research and development have to be done to adapt the old technology to the manufacturing industry of the 21st century. In the 1st part of the report, the challenging factors to the resistance welding are reviewed. Numerical...

  5. Computerizing primary schools in rural kenya

    DEFF Research Database (Denmark)

    Ogembo, J.G.; Ngugi, B.; Pelowski, Matthew John

    2012-01-01

    questions surrounding this endeavour. Specifically: 1.) what problems do rural schools actually want to solve with computerization; 2.) is computerization the most important priority for rural schools; 3.) are schools ready, in terms of infrastructure, for a computer in the classroom; or 4.) might......This paper investigates the outstanding challenges facing primary schools' computerization in rural Kenya. Computerization of schools is often envisaged as a 'magic', or at least a particularly efficient, solution to many of the problems that developing countries face in improving primary school...... targets for computerization, only eleven percent had at least one ICT compliant teacher, of which all were considered to require further training. In addition we found inadequate infrastructural preparedness - lack of access to electricity, internet; no classroom computer space, few desks, secure walls...

  6. Two Cases of Primary Ectopic Ovarian Pregnancy

    Directory of Open Access Journals (Sweden)

    Sonia Gon

    2011-04-01

    Full Text Available Primary ovarian pregnancy is one of the rarest varieties of ectopic pregnancies. Patients frequently present with abdominal pain and menstrual irregularities. Intrauterine devices have evolved as probable risk factors. Preoperative diagnosis is challenging but transvaginal sonography has often been helpful. A diagnostic delay may lead to rupture, secondary implantation or operative difficulties. Therefore, awareness of this rare condition is important in reducing the associated risks. Here, we report two cases of primary ovarian pregnancies presenting with acute abdominal pain. Transabdominal ultrasonography failed to hint at ovarian pregnancy in one, while transvaginal sonography aided in the correct diagnosis of the other. Both cases were confirmed by histopathological examinations and were successfully managed by surgery.

  7. Treatment recommendations for primary extradural meningiomas.

    Science.gov (United States)

    Mattox, Austin; Hughes, Betsy; Oleson, James; Reardon, David; McLendon, Roger; Adamson, Cory

    2011-01-01

    Primary extradural meningiomas (PEMs) represent about 2% of all meningiomas and are often encountered by non-neurosurgeons. These lesions typically present as enlarging, painless, benign masses that can be surgically cured. Imaging is critical for defining involvement of adjacent structures; however, diagnosis depends on classic histologic patterns. Treatment for benign PEMs (WHO I) consists of resection with wide margins, whereas adjuvant therapy after resection of atypical (WHO II) or malignant (WHO III) PEMs should be considered. By using the collective experience from our comprehensive cancer center, including neuro-oncologists, neuroradiologists, and neurosurgeons, in addition to a complete literature review, the authors have established treatment guidelines not previously reported. This manuscript describes key features of these challenging tumors to aid in diagnosis, presents the largest published review of all reported PEMs (n = 163), and provides salient treatment guidelines to surgeons unfamiliar with these challenging tumors.

  8. PHARMACOVIGILANCE: BARRIERS AND CHALLENGES

    OpenAIRE

    Varma, S. K.; RAPELLIWAR A; S. Sutradhar; THAWARE P; Misra, A. K.

    2013-01-01

    Pharmacovigilance is a new discipline which deals with adverse drug or any drug related problems. Pharmacovigilance programme was not bed of roses but its path is laid with challenges and barriers. It is facing obstacles from deficiency from professional health personal to web-based sale of drugs, counterfeit drug to self-medication, etc. It is an integral part of the health sector and identification and reporting of adverse drug effects will have a positive impact on the public health. Impro...

  9. Terabit Wireless Communication Challenges

    Science.gov (United States)

    Hwu, Shian U.

    2012-01-01

    This presentation briefly discusses a research effort on Terabit Wireless communication systems for possible space applications. Recently, terahertz (THz) technology (300-3000 GHz frequency) has attracted a great deal of interest from academia and industry. This is due to a number of interesting features of THz waves, including the nearly unlimited bandwidths available, and the non-ionizing radiation nature which does not damage human tissues and DNA with minimum health threat. Also, as millimeter-wave communication systems mature, the focus of research is, naturally, moving to the THz range. Many scientists regard THz as the last great frontier of the electromagnetic spectrum, but finding new applications outside the traditional niches of radio astronomy, Earth and planetary remote sensing, and molecular spectroscopy particularly in biomedical imaging and wireless communications has been relatively slow. Radiologists find this area of study so attractive because t-rays are non-ionizing, which suggests no harm is done to tissue or DNA. They also offer the possibility of performing spectroscopic measurements over a very wide frequency range, and can even capture signatures from liquids and solids. According to Shannon theory, the broad bandwidth of the THz frequency bands can be used for terabit-per-second (Tb/s) wireless communication systems. This enables several new applications, such as cell phones with 360 degrees autostereoscopic displays, optic-fiber replacement, and wireless Tb/s file transferring. Although THz technology could satisfy the demand for an extremely high data rate, a number of technical challenges need to be overcome before its development. This presentation provides an overview the state-of-the- art in THz wireless communication and the technical challenges for an emerging application in Terabit wireless systems. The main issue for THz wave propagation is the high atmospheric attenuation, which is dominated by water vapor absorption in the THz

  10. Energy challenges in Asia

    International Nuclear Information System (INIS)

    Energy challenges represent one of the most important security paradigms in the Asia Pacific region where you have a mixture of growing energy dependency, fuelled by high economic growth, the emergence of new major players like China and India, and a quasi-complete absence of regional regulatory mechanisms to tackle the challenges in a multilateral way. These challenges mostly concern Japan and China, where crucial energy issues are aggravated by power rivalry, historical and ideological issues, and a lack of both economic and political harmony between them. Neither countries are self sufficient in terms of energy needs. This can lead to a shared analysis and common approaches regarding Japan and China concerning this issue. Their cases are. however very different and the solutions applied are related to different world views that are not easily reconcilable. Both countries share common objectives: both want security and stable supply. But there are also big divergences and these divergences could be new sources of conflict and misunderstanding between Tokyo and Beijing. One of the main differences is history related. Both China and Japan are uneasy regarding outside energy dependency. In Japan, memories of the pre-war oil embargo have not disappeared. The oil shocks of the 70's renewed this uneasiness. However, Japan's outside dependency is not new. Tokyo has learned to live with it, finding a system to alleviate this vulnerability in cooperation with its partners, multilateral institutions like the International Energy Agency (IEA). China's outside dependency is new. The country's dependency on oil, which began in 1993, is particularly challenging since the principles of independence, non interference and military autonomy, principles at the core of Maoist foreign strategy, did not completely disappear in spite of China's new policy of reform and opening up. China's leadership, even the fourth generation, did not forget its isolation during the 60's and 70's

  11. CHALLENGES FOR FOREIGN TEACHERS

    Institute of Scientific and Technical Information of China (English)

    DengJing

    2004-01-01

    The learner differences and contrasts between the two cultures involved are important aspects that influence foreign language teaching and learning. The foreign teacher as an outsider of the learner's native culture, inevitably faces quite a few challenges. With the focus on the self-esteem, character types, and motivation of the learner, the paper analyses how these factors influence the foreign teacher's teaching. Relevant solutions are also proposed.

  12. Challenges in Danish VET

    DEFF Research Database (Denmark)

    Aarkrog, Vibe

    2011-01-01

    In Denmark the 95 percent target, meaning that in 2015 95 percent of a youth cohort should complete a youth education programme, is particularly challenging for the vocational educational and training (VET) system. In the article is given a short outline of the significant characteristics of the...... Danish dual VET system as well as of the current central initiatives aimed at reaching the 95 percent target....

  13. Librarianship: A Challenging Profession

    OpenAIRE

    Lalithabai, K K.

    1996-01-01

    Defines librarianship as the art and science of managing recorded knowledge. Observes that in earlier days when the recorded sources of information were limited in number, scholars could be the users as well as managers of libraries. But today’s libraries with torrents of information sources and users on either side makes management a truly challenging task requiring highly specialized knowledge and training in the sophisticated techniques of information handling. Views that in information co...

  14. Cleanroom laboratory challenge overcome.

    Science.gov (United States)

    Quinn, Ronan

    2010-10-01

    Ronan Quinn, managing director of interior construction specialist Ardmac, describes the challenges of building and fitting out a new cleanroom laboratory for blood and bone marrow therapeutic treatment at Our Lady's Children's Hospital Crumlin in Dublin. The "state-of-the-art" facility, which fully complies with the recent EU Directive concerning human tissues and cells, has been well received by the client and end-users alike, but, as he explains, there were many obstacles to overcome during its completion.

  15. South China Sea Challenge

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    China's attempts to solve disputes with ASEAN over the South China Sea help regional peace China's marine economy and security are currently faced with new challenges, requiring careful handling, especially in disputes with ASEAN countries and in promoting common development of the South China Sea. The outcome of how this is dealt with could undoubtedly pave the way for solutions to other oceanic disputes. The South China Sea is located south of

  16. Challenges in Crowd Simulation

    OpenAIRE

    Thalmann, Daniel; Grillon, Helena; Maim, Jonathan; Yersin, Barbara

    2009-01-01

    The purpose of this paper is to identify the problems to solve in order to simulate real-time crowds in a Virtual Environment. We try to classify these problems and study how they have been addressed until now by the research community and our Lab in particular. We then discuss for each problem what are the,future challenges and how to address them.

  17. Gaddafi's Death Poses Challenges

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The death of Muammar Gaddafi marks a new era for Libya.It also poses a huge challenge for Libyan authorities dealing with tribal conflicts.He Wenping,a researcher with the Institute of West-Asian and African Studies at the Chinese Academy of Social Sciences,believes that Libya is in danger of falling into a period of internal strife and tribal conflict.

  18. Sustainability challenges and trends

    OpenAIRE

    De Ridder, M.

    2011-01-01

    In the coming decades, increases in population, income and health will put additional pressures on our planet’s biosphere. To meet the needs of future generations, we need to adapt our ways of living and definitions of economic development. A transition to a more sustainable world is imperative if we want to stop depleting the Earth’s resources more quickly than it can regenerate them. This paper synthesizes current trends and challenges that are relevant for the policy debate on sustainabili...

  19. Surface primary bone tumors: Systematic approach and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Mendez Diaz, Cristina; Soler Fernandez, Rafaela; Rodriguez Garcia, Esther; Fernandez Armendariz, Pablo; Diaz Angulo, Carolina [Complejo Hospitalario Universitario A Coruna, Department of Radiology, A Coruna (Spain)

    2015-09-15

    Surface primary bone tumors may appear similar to their intramedullary counterpart, but because they are rare, they may pose diagnostic challenges when showing different characteristics compared to their intramedullary counterpart. It is important for radiologists to recognize the imaging findings for various uncommon surface primary bone tumors, which may help to reduce the differential diagnosis or to lead to a specific diagnosis. Radiography is typically used for first-line imaging. If necessary, it is followed by CT or MRI for evaluation and characterization of surface bone tumors. The aim of this article is to review the imaging findings and differential diagnosis for surface primary bone tumors. (orig.)

  20. ATLAS Data Challenge 1

    CERN Document Server

    DC1 TaskForce

    2003-01-01

    The ATLAS Collaboration at CERN is preparing for the data taking and analysis at LHC that will start in 2007. Therefore, in 2002 a series of Data Challenges (DC's) was started whose goals are the validation of the Computing Model, of the complete software suite, of the data model, and to ensure the correctness of the technical choices to be made. A major feature of the first Data Challenge (DC1) was the preparation and the deployment of the software required for the production of large event samples for the High Level Trigger and Physics communities, and the production of those large data samples as a worldwide distributed activity. It should be noted that it was not an option to "run everything at CERN" even if we had wanted to; the resources were not available at CERN to carry out the production on a reasonable time-scale. We were therefore faced with the great challenge of organising and then carrying out this large-scale production at a significant number of sites around the world. However, the benefits o...

  1. IDEOLOGICALLY CHALLENGING ENTERTAINMENT (ICE

    Directory of Open Access Journals (Sweden)

    Dana Lori Chalmers

    2015-09-01

    Full Text Available Ideologically Challenging Entertainment (ICE is entertainment that challenges ‘us vs. them’ ideologies associated with radicalization, violent conflict and terrorism. ICE presents multiple perspectives on a conflict through mainstream entertainment. This article introduces the theoretical underpinnings of ICE, the first ICE production and the audience responses to it. The first ICE production was Two Merchants: The Merchant of Venice adapted to challenge ideologies of the Arab-Israeli Conflict. A mixed-methods study of audience responses explored whether this production inspired audiences to shift their ideological views. Each performance included two versions of the adaptation: a Jewish dominated society with an Arab Muslim minority, contrasted with an Arab Muslim dominated society and a Jewish minority. A mixed-methods study of audience responses explored whether this production inspired audiences to shift their ideological views to become more tolerant of differences away from ideological radicalization. Of audience members who did not initially agree with the premise of the production, 40% reconsidered their ideological views, indicating increased tolerance, greater awareness of and desire to change their own prejudices. In addition, 86% of the audience expressed their intention to discuss the production with others, thereby encouraging critical engagement with, and broader dissemination of the message. These outcomes suggest that high quality entertainment – as defined by audience responses to it - can become a powerful tool in the struggle against radicalised ideologies.

  2. Homelessness: a problem for primary care?

    Science.gov (United States)

    Riley, Anthony J; Harding, Geoffrey; Underwood, Martin R; Carter, Yvonne H

    2003-06-01

    Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness. PMID:12939894

  3. Primary liver cancer; Tumeurs primitives hepatiques

    Energy Technology Data Exchange (ETDEWEB)

    Quivrina, M.; Martin, E.; Ligey-Bartolomeu, A.; Nouhaud, E.; Chamois, J.; Maingon, P.; Crehange, G. [Departement de radiotherapie, Centre Georges-Francois-Leclerc, 21 - Dijon (France); Mornex, F.; Enachescu, C. [Departement de radiotherapie, Centre hospitalier Lyon-Sud, 69 - Lyon-Pierre-Benite (France)

    2010-07-01

    Due to its increasing incidence and a grim prognosis, primary liver cancer remains a diagnostic and therapeutic challenge. For small localized tumors, surgical resection and liver transplantation are standard treatments with a curative-intent. Therapeutic options for locally advanced or metastatic diseases are limited. Globally, surgery fits less than 20% of patients. Early detection in high-risk patients and prevention of risk factors remain the key points in the standard care. External radiotherapy is a non invasive treatment with encouraging results for non operable patients. Emerging stereotactic radiotherapy yields high rates of local control without compromising toxicity. Tumors with bad prognostic factors could be cured with this approach. (authors)

  4. Challenger and Chernobyl: lessons and reflections

    International Nuclear Information System (INIS)

    The primary cause of the Challenger accident was the failure of O-ring seals in the solid rocket booster, a subcomponent which had been known to be faulty for some time. When Hans Mark was the most senior engineering member of the NASA management executive team, he had asked for a complete review of these subcomponents; this was not done. The accident to the Chernobyl atomic reactor has not been publicly analyzed to the same extent as the Challenger explosion, and hence there must remain some speculation as to the detailed sequence of events. The lessons from both accidents are clear: faulty human understanding the the equipment and the lack of education, training and discipline were critical. The authors conclude that the Shuttle will fly again soon, and that political problems in the Soviet Union may be great and may force some changes. (author)

  5. Scientific Challenges for Understanding the Quantum Universe

    Energy Technology Data Exchange (ETDEWEB)

    Khaleel, Mohammad A.

    2009-10-16

    A workshop titled "Scientific Challenges for Understanding the Quantum Universe" was held December 9-11, 2008, at the Kavli Institute for Particle Astrophysics and Cosmology at the Stanford Linear Accelerator Center-National Accelerator Laboratory. The primary purpose of the meeting was to examine how computing at the extreme scale can contribute to meeting forefront scientific challenges in particle physics, particle astrophysics and cosmology. The workshop was organized around five research areas with associated panels. Three of these, "High Energy Theoretical Physics," "Accelerator Simulation," and "Experimental Particle Physics," addressed research of the Office of High Energy Physics’ Energy and Intensity Frontiers, while the"Cosmology and Astrophysics Simulation" and "Astrophysics Data Handling, Archiving, and Mining" panels were associated with the Cosmic Frontier.

  6. CULTURAL GLOBALISATION AND CHALLENGES TO TRADITIONAL COMMUNICATION THEORIES

    Directory of Open Access Journals (Sweden)

    Lauren Movius

    2010-01-01

    Full Text Available This article reviews existing traditional media theories, and analyses the challenges that the current developments of globalisation present to them. The article provides a short history of the concept of globalisation, and reviews the primary theoretical approaches to globalisation that are critical to communication scholars. The article also examines how globalisation challenges the ways in which media and communication have traditionally been theorised. Specifically, the cultural imperialism theory is discussed, as well as the main challenges to the theory. Audience reception studies, which focus on how audiences negotiate meaning differently in specific cultural contexts, are highlighted as the key critique of cultural imperialism

  7. Status and challenges of dissimilar metal welding

    OpenAIRE

    Simar, Aude; Jimenez Mena, Norberto; Avettand Fénoël, Marie-Noëlle; 10th International Friction Stir Welding Symposium

    2016-01-01

    A review of the status and current challenges of dissimilar metal welding is proposed. By dissimilar metal welding we mean the welding between metals of different primary chemical nature. The FSW scientific research community has been highly focussed on dissimilar metal welding in the past years as lightweighting is a major concern for the transportation (e.g. welding Al to steel, Al to Ti, Al to Mg, etc…) and electrical energy (e.g. welding Cu to Al) industry. Placing the right material at t...

  8. Challenges in neurological practice in developing countries

    Directory of Open Access Journals (Sweden)

    Sanjay Pandey

    2012-01-01

    Full Text Available The burden of neurological illness is much higher in developing countries. Neurological disorders in these countries are mainly due to poverty and malnutrition. Spectrums of diseases are also different in comparison with developed countries. Lack of resources, ignorance, and overpopulation make it very difficult and challenging to tackle this problem. Majority of the patients are seen by general practitioners who have little knowledge about neurological illnesses. Most of the countries have very few or no neurologist. There is a greater need of taking neurological care at primary care level where majority of the patients struggle with epilepsy, stroke and neuroinfections.

  9. Turner's syndrome: challenges of late diagnosis.

    Science.gov (United States)

    Lee, Marilyn Cheng; Conway, Gerard S

    2014-04-01

    Girls and women with Turner's syndrome who come to medical attention older than 12 years present a challenge of medical management. Puberty is already delayed and some compromises have to be made in adjusting the timing of artificially induced puberty to optimise overall outcome with respect to stature, secondary sex characteristics, and psychosocial endpoints. Additionally, individuals who present with primary amenorrhoea to adult services might miss the opportunity for effective growth hormone treatment. Further, induction of puberty regimens lack an evidence base or even clear guidelines for the timing and dose of oestrogen replacement. We have searched the scientific literature to inform management of Turner's syndrome. PMID:24703051

  10. The Road to Excellence for Primary Care Resident Teaching Clinics.

    Science.gov (United States)

    Gupta, Reena; Dubé, Kate; Bodenheimer, Thomas

    2016-04-01

    Primary care residency programs and their associated primary care clinics face challenges in their goal to simultaneously provide a good education for tomorrow's doctors and excellent care for today's patients. A team from the Center for Excellence in Primary Care at the University of California, San Francisco, conducted site visits to 23 family medicine, internal medicine, and pediatric residency teaching clinics. The authors found that a number of programs have transformed themselves with respect to engaged leadership, resident scheduling, continuity of care for patients and residents, team-based care, and resident engagement in practice improvement. In this Commentary, the authors highlight the features of transforming programs that are melding inspiring resident education with excellent patient care. The authors propose a model, the 10 + 3 Building Blocks of Primary Care Teaching Clinics, to illustrate the themes that characterize transforming primary care residency programs. PMID:26826073

  11. Primary Gastric Chorioadenocarcinoma.

    Science.gov (United States)

    Baraka, Bahaaeldin A; Al Kharusi, Suad S; Al Bahrani, Bassim J; Bhathagar, Gunmala

    2016-09-01

    Primary gastric chorioadenocarcinoma (PGC) is a rare and rapidly invasive tumor. Choriocarcinoma is usually known to be of endometrial origin and gestational; however, it has been reported in other extragenital organs, such as the gall bladder, prostate, lung, liver, and the gastrointestinal tract. Human chorionic gonadotropin related neoplasms of the stomach are seldom discussed in the literature. We report a case of PGC in a 56-year-old man treated with a standard non-gestational choriocarcinoma chemotherapy regimen, EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), with a complete response and good tolerability. PMID:27602194

  12. Selectively tritiated primary alcohols

    International Nuclear Information System (INIS)

    A procedure is suggested for the preparation of aliphatic primary alcohols selectively tritiated in the alpha position. The tritium donor is HTO; out of the catalysts tested, dichlorotris(triphenylphosphine)ruthenium(VI) gave the best results. The isotopic exchange can be performed over the temperature region of 130-200 degC. The amount of side products formed is negligible. The specific activity of the product is determined by the specific activity of HTO used and by the reactant ratio. The method is analogous to the reaction with D2O described by S.L. Regen in 1974. (author). 2 figs., 2 tabs., 17 refs

  13. Teacher of primary English

    CERN Document Server

    2003-01-01

    Part-time teacher of primary English needed for September 2003 to teach English National Curriculum (KS2) and NLS to mother tongue or good second language English-speakers aged 7-10. 4 hours contact time per week, team planning, marking and meetings. Candidates should be English mother tongue qualified teachers, confident, flexible classroom practitioners and team players. For further details and how to apply see http://enpferney.org/staff_vacancies.htm English National Programme, Lycée International, Ferney-Voltaire (http://enpferney.org/)

  14. PRIMARY SCHOOL TEACHER

    CERN Multimedia

    Madeleine Dittus

    2002-01-01

    For January 2003, the A.P.E.G. has an opening for a primary school teacher in the German national language program. The position requires one afternoon of teaching (13:30 till 16:30) every Tuesday at the Collège in Prévessin. The candidate should be a native speaker of German and have some knowledge of French. If you are interested, please send your CV, a copy of your diploma, and a short letter of motivation, until December 9th, to the following address. Madeleine Dittus Présidente A.P.E.G. 5, La vie Destraz 01630 St. Genis-Pouilly (France)

  15. [Primary glomerulonephritis in focus].

    Science.gov (United States)

    Bourquin, Vincent; Ponte, Belén; Zellweger, Micheal; Levy, Marc; Moll, Solange

    2013-04-10

    The glomerulonephritis (GN) are responsible for a significant amount of end stage renal disease. They may be secondary to another disease or idiopathic. When a secondary etiology has been excluded, it is called primary glomerulonephritis (PGN). Glomerular damage may have different presentations and there are many way to classify them. It is thus difficult for the non-specialist to understand the terminology used. This article is a summary of the most frequently encountered PGN such as: IgA nephropathy, membranous GN, idiopathic nephrotic syndrome, extracapillary and membranoproliferative GN. A brief description is given for each one of the PGN including epidemiology, semiology, histology and a pathophysiology explanation. PMID:23659154

  16. PRIMARY CARIES: AN OVERVIEW

    Directory of Open Access Journals (Sweden)

    Gaurav Solanki

    2012-01-01

    Full Text Available Primary caries is an initial lesions produced by direct extension from an external surface. Dental caries is called as tooth decay or a cavity is a disease in which bacterial processes changes carbohydrate to acid which than dematerializes the hard tooth structure like enamel, dentin and cementum. Streptococcus mutans and Lactobacillus are the bacteria responsible for the dental caries by acid production. This article throws light on the dental caries disease, its sign and symptoms, treatment and prevention of it. A review of some patents on dental caries is also provided that summarizes the recent technical advancements taken place in this area.

  17. Primary Ciliary Dyskinesia.

    Science.gov (United States)

    Knowles, Michael R; Zariwala, Maimoona; Leigh, Margaret

    2016-09-01

    Primary ciliary dyskinesia (PCD) is a recessive genetically heterogeneous disorder of motile cilia with chronic otosinopulmonary disease and organ laterality defects in ∼50% of cases. The prevalence of PCD is difficult to determine. Recent diagnostic advances through measurement of nasal nitric oxide and genetic testing has allowed rigorous diagnoses and determination of a robust clinical phenotype, which includes neonatal respiratory distress, daily nasal congestion, and wet cough starting early in life, along with organ laterality defects. There is early onset of lung disease in PCD with abnormal airflow mechanics and radiographic abnormalities detected in infancy and early childhood. PMID:27514592

  18. Primary pulmonary cryptococcosis.

    Science.gov (United States)

    Asadi Gharabaghi, Mehrnaz; Allameh, Seyyed Farshad

    2014-01-01

    Here, we report a case of primary cryptococcal pneumonia in a 25-year-old woman who presented with several weeks' history of cough, dyspnoea and night sweating. These symptoms started in the third trimester of her pregnancy. She was being treated for infertility and got pregnant with in vitro fertilisation. On chest imaging, there were bilateral air space consolidation and cavitary lesions. Fungal pulmonary infection was diagnosed after surgical lung biopsy. She received fluconazole 400 mg per day orally for 6 months and recovered completely. PMID:24692384

  19. Prioritizing Threats to Patient Safety in Rural Primary Care

    Science.gov (United States)

    Singh, Ranjit; Singh, Ashok; Servoss, Timothy J.; Singh, Gurdev

    2007-01-01

    Context: Rural primary care is a complex environment in which multiple patient safety challenges can arise. To make progress in improving safety with limited resources, each practice needs to identify those safety problems that pose the greatest threat to patients and focus efforts on these. Purpose: To describe and field-test a novel approach to…

  20. Universal Primary Education among Tribals in Jharkhand: A Situational Analysis

    Science.gov (United States)

    Kumar, Anant

    2008-01-01

    The paper is an attempt to understand and analyse the status of universal primary education among tribals in Jharkhand and its challenges. Considering the low literacy among tribals and high drop out rates at elementary and higher levels, there is need of special focus on tribal's education, inclusive of context-specific traditional and innovative…

  1. Teaching Medical Students Basic Neurotransmitter Pharmacology Using Primary Research Resources

    Science.gov (United States)

    Halliday, Amy C.; Devonshire, Ian M.; Greenfield, Susan A.; Dommett, Eleanor J.

    2010-01-01

    Teaching pharmacology to medical students has long been seen as a challenge, and one to which a number of innovative approaches have been taken. In this article, we describe and evaluate the use of primary research articles in teaching second-year medical students both in terms of the information learned and the use of the papers themselves. We…

  2. More than Numbers: Teaching ELLs Mathematical Language in Primary Grades

    Science.gov (United States)

    Sistla, Michelle; Feng, Jay

    2014-01-01

    Teaching English Language Learners (ELL) academics while they are acquiring English language skills is a challenge for teachers. This action research examines the use of Response To Intervention (RTI) in teaching ELLs mathematical language and its effect on students' math achievement in primary grades. It shows that when mathematical language…

  3. Literature Review of Learning English in Primary Schools and Universities

    Institute of Scientific and Technical Information of China (English)

    程云

    2015-01-01

    For the students all over the world, once they start to learn an additional language, they are going to have some chal-lenges with themselves. This article describes something that is focused on the situation about how do Chinese students learning English. And how do they get their success in an efficient way while they in both primary schools and universities.

  4. The Experience of Working with Refugees: Counsellors in Primary Care

    Science.gov (United States)

    Century, Gillian; Leavey, Gerard; Payne, Helen

    2007-01-01

    The provision of counselling services for refugee and asylum-seeking patients is relatively new in the UK and their complex needs may present considerable challenges within primary care, where access to specialist support resources is often limited. As far as we know, no previous research has attempted to look at the experiences of the counsellors…

  5. EEG and Eye Tracking Demonstrate Vigilance Enhancement with Challenge Integration

    Science.gov (United States)

    Bodala, Indu P.; Li, Junhua; Thakor, Nitish V.; Al-Nashash, Hasan

    2016-01-01

    Maintaining vigilance is possibly the first requirement for surveillance tasks where personnel are faced with monotonous yet intensive monitoring tasks. Decrement in vigilance in such situations could result in dangerous consequences such as accidents, loss of life and system failure. In this paper, we investigate the possibility to enhance vigilance or sustained attention using “challenge integration,” a strategy that integrates a primary task with challenging stimuli. A primary surveillance task (identifying an intruder in a simulated factory environment) and a challenge stimulus (periods of rain obscuring the surveillance scene) were employed to test the changes in vigilance levels. The effect of integrating challenging events (resulting from artificially simulated rain) into the task were compared to the initial monotonous phase. EEG and eye tracking data is collected and analyzed for n = 12 subjects. Frontal midline theta power and frontal theta to parietal alpha power ratio which are used as measures of engagement and attention allocation show an increase due to challenge integration (p EEG also shows statistically significant suppression on the frontoparietal and occipital cortices due to challenge integration (p EEG, we infer that saccade amplitude and saccade velocity decrease with vigilance decrement along with frontal midline theta and frontal theta to parietal alpha ratio. Conversely, blink rate and relative delta power increase with vigilance decrement. However, these measures exhibit a reverse trend when challenge stimulus appears in the task suggesting vigilance enhancement. Moreover, the mean reaction time is lower for the challenge integrated phase (RTmean = 3.65 ± 1.4s) compared to initial monotonous phase without challenge (RTmean = 4.6 ± 2.7s). Our work shows that vigilance level, as assessed by response of these vital signs, is enhanced by challenge integration. PMID:27375464

  6. EEG and Eye Tracking Demonstrate Vigilance Enhancement with Challenge Integration.

    Science.gov (United States)

    Bodala, Indu P; Li, Junhua; Thakor, Nitish V; Al-Nashash, Hasan

    2016-01-01

    Maintaining vigilance is possibly the first requirement for surveillance tasks where personnel are faced with monotonous yet intensive monitoring tasks. Decrement in vigilance in such situations could result in dangerous consequences such as accidents, loss of life and system failure. In this paper, we investigate the possibility to enhance vigilance or sustained attention using "challenge integration," a strategy that integrates a primary task with challenging stimuli. A primary surveillance task (identifying an intruder in a simulated factory environment) and a challenge stimulus (periods of rain obscuring the surveillance scene) were employed to test the changes in vigilance levels. The effect of integrating challenging events (resulting from artificially simulated rain) into the task were compared to the initial monotonous phase. EEG and eye tracking data is collected and analyzed for n = 12 subjects. Frontal midline theta power and frontal theta to parietal alpha power ratio which are used as measures of engagement and attention allocation show an increase due to challenge integration (p power of EEG also shows statistically significant suppression on the frontoparietal and occipital cortices due to challenge integration (p power increase with vigilance decrement. However, these measures exhibit a reverse trend when challenge stimulus appears in the task suggesting vigilance enhancement. Moreover, the mean reaction time is lower for the challenge integrated phase (RTmean = 3.65 ± 1.4s) compared to initial monotonous phase without challenge (RTmean = 4.6 ± 2.7s). Our work shows that vigilance level, as assessed by response of these vital signs, is enhanced by challenge integration. PMID:27375464

  7. Budgetary Challenges of Higher Education: Evidence from Bangladesh

    Science.gov (United States)

    Sarkar, Shakhawat Hossain; Hossain, Syed Zabid

    2016-01-01

    This study strives to ascertain the financial and nonfinancial challenges of higher education budget for human resources development (HRD) based on both primary and secondary sources of data. Inadequate budgetary support from the government and inappropriate implementation of the same due to nonexistence of good governance and inefficient…

  8. The Challenge of Violence. [Student Text and] Teacher's Guide.

    Science.gov (United States)

    Croddy, Marshall; Degelman, Charles; Hayes, Bill

    This document addresses violence as one of the key challenges facing the democratic and pluralistic republic under the framework of the Constitution and its Bill of Rights. Primary focus is on criminal violence and the factors and behaviors that contribute to violent crime. The text is organized into three chapters: (1) "The Problem of Violence";…

  9. Challenges in pharmacogenetics.

    Science.gov (United States)

    Cascorbi, Ingolf; Bruhn, Oliver; Werk, Anneke N

    2013-05-01

    The attempt to optimize drug treatment of patients by using evidenced-based medicine considering individual physiological and disease-related conditions is standard of modern medicine. Pharmacogenetics (PGx) has contributed to individualization considering hereditary genetic information; however, increasingly, pharmacogenomics is becoming essential, particularly in relation to modern oncology. New technologies such as next-generation sequencing and rapid development of computational and information sciences will help to better elucidate the consequences of genetic variation, considering also epigenetics and gene-environmental interactions and their translation into clinically relevant individual phenotypes. This review highlights the current challenging and most promising examples of PGx. PMID:23640184

  10. The Biofilm Challenge

    DEFF Research Database (Denmark)

    Alhede, Maria; Alhede, Morten

    2014-01-01

    reveals the significance of biofilms, as evidenced by a dramatic increase in scientific publications on the topic, as well as in publications concerning wounds with biofilms, which reached 600 publications in 2013. Judged from the number of publications, it appears that biofilms play a significant role...... in wounds. However, the impact of biofilms is often debated, because infected wounds were also treated before the concept of biofilms was coined. In this short review, we will address the significance of biofilms and their role in wounds, and discuss the future tasks of the biofilm challenge....

  11. Energy challenges in Asia

    Energy Technology Data Exchange (ETDEWEB)

    Niquet, V.

    2007-07-01

    Energy challenges represent one of the most important security paradigms in the Asia Pacific region where you have a mixture of growing energy dependency, fuelled by high economic growth, the emergence of new major players like China and India, and a quasi-complete absence of regional regulatory mechanisms to tackle the challenges in a multilateral way. These challenges mostly concern Japan and China, where crucial energy issues are aggravated by power rivalry, historical and ideological issues, and a lack of both economic and political harmony between them. Neither countries are self sufficient in terms of energy needs. This can lead to a shared analysis and common approaches regarding Japan and China concerning this issue. Their cases are. however very different and the solutions applied are related to different world views that are not easily reconcilable. Both countries share common objectives: both want security and stable supply. But there are also big divergences and these divergences could be new sources of conflict and misunderstanding between Tokyo and Beijing. One of the main differences is history related. Both China and Japan are uneasy regarding outside energy dependency. In Japan, memories of the pre-war oil embargo have not disappeared. The oil shocks of the 70's renewed this uneasiness. However, Japan's outside dependency is not new. Tokyo has learned to live with it, finding a system to alleviate this vulnerability in cooperation with its partners, multilateral institutions like the International Energy Agency (IEA). China's outside dependency is new. The country's dependency on oil, which began in 1993, is particularly challenging since the principles of independence, non interference and military autonomy, principles at the core of Maoist foreign strategy, did not completely disappear in spite of China's new policy of reform and opening up. China's leadership, even the fourth generation, did not forget its isolation

  12. The New Asian Challenge

    OpenAIRE

    C. Fred Bergsten

    2000-01-01

    The initial postwar challenge from East Asia was economic. Japan crashed back into global markets in the 1960s, became the largest surplus and creditor country in the 1980s, and was viewed by many as the world’s dominant economy by 1990. The newly industrialized countries (Korea, Taiwan, Hong Kong, Singapore) followed suit on a smaller but still substantial scale shortly thereafter. China only re-entered world commerce in the 1980s but has now become the second largest economy (in purchasing ...

  13. Challenging the Innovation Paradigm

    CERN Document Server

    Sveiby, Karl Erik; Segercrantz, Beata

    2012-01-01

    Innovation is almost always seen as a "good thing". Challenging the Innovation Paradigm is a critical analysis of the innovation frenzy and contemporary innovation research. The one-sided focus on desirable effects of innovation misses many opportunities to reduce the undesirable consequences. Authors in this book show how systemic effects outside the innovating firms reduce the net benefits of innovation for individual employees, customers, as well as for society as a whole - also the innovators' own organizations. This book analyzes the dominant discourses that construct and recons

  14. Semantic Web Evaluation Challenge

    CERN Document Server

    2014-01-01

    This book constitutes the thoroughly refereed post conference proceedings of the first edition of the Semantic Web Evaluation Challenge, SemWebEval 2014, co-located with the 11th Extended Semantic Web conference, held in Anissaras, Crete, Greece, in May 2014. This book includes the descriptions of all methods and tools that competed at SemWebEval 2014, together with a detailed description of the tasks, evaluation procedures and datasets. The contributions are grouped in three areas: semantic publishing (sempub), concept-level sentiment analysis (ssa), and linked-data enabled recommender systems (recsys).

  15. Perishable Inventory Challenges

    DEFF Research Database (Denmark)

    Damgaard, Cecilie Maria; Nguyen, Vivi Thuy; Hvolby, Hans-Henrik;

    2012-01-01

    The paper investigates how inventory control of perishable items is managed and line up some possible options of improvement. This includes a review of relevant literature dealing with the challenges of determining ordering policies for perishable products and a study of how the current procedures...... in the retail supply chains. The goal is to find and evaluate the parameters which affect the decision making process, when finding the optimal order quantity and order time. The paper takes a starting point in the retail industry but links to other industries....

  16. New challenges? Well, certainly!

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.

    New challenges? Well, certainly! With the internationalization of European higher education, teaching and learning through the medium of a foreign language has become more and more widespread in recent years. This requires, of course, that lecturers as well as students have the necessary language......, different cultural backgrounds, different educational backgrounds and be used to a diverse set of didactic traditions and norms. Given this diversity, higher education institutions (HEIs) need to have measures in place to deal with this. Policies and practices must go hand in hand and, more often than not...

  17. Primary colorectal lymphomas

    Directory of Open Access Journals (Sweden)

    Stanojević Goran

    2009-01-01

    Full Text Available Background/Aim. Colorectal lymphoma is a rare tumor representing 1.4% of human lymphomas, 10-20% of gastrointestinal lymphomas, namely 0.2-0.6% of all malignancies in the colon. The aim of this study was to review clinical characteristics of primary colorectal lymphoma and overall survival. Methods. A detailed analysis of 16 surgically treated patients included patients age, symptoms and signs, tumor site, type of surgery, histopathologic findings, diagnosis of the disease, disease stage, type of surgery related to the degree of emergency (elective or urgent, applied adjuvant therapy, patient follow-up and treatment outcomes. Survival was expressed by the Kaplan-Meier curve, while the difference in survival among the two groups by the Log-rank test. Results. The all patients were on an average followed-up for a median of 29 months (range 2-60 months, while those with chemotherapy 48 months (range 4-60 months. An overall mean survival time was 38.65 months. Conclusion. Primary colorectal lymphoma is a rare malignant tumor of the large bowel. Therapy usually involves resection of the affected colon or rectum and regional lymphovascular structures, followed by adjuvant therapy. Survival period is short and, therefore, timely diagnosis is crucial in early disease stages when the probability of cure is high.

  18. Primary pediatric gastrointestinal lymphoma

    Directory of Open Access Journals (Sweden)

    Ranjana Bandyopadhyay

    2011-01-01

    Full Text Available Background: Primary non-Hodgkin′s lymphoma (NHL of the gastrointestinal (GI tract is the most common extranodal lymphoma in pediatric age group. Yet, the overall incidence is very low. The rarity of the disease as well as variable clinical presentation prevents early detection when the possibility of cure exists. Materials and Methods: We studied six cases of primary GI NHL in pediatric age group with reference to their clinical presentation, anatomic distribution and histopathologic characteristics. Results: All were males except one. Intestinal obstruction was the presenting feature in 50%. Half the cases showed ileocaecal involvement, while large bowel was involved in 16%. Histology showed four cases of diffuse large B-cell lymphoma (DLBCL, one case of Burkitt lymphoma, and one Burkitt-like lymphoma. Immunohistochemistry for Tdt, CD20, CD3, CD30, bcl2, bcl6 confirmed the morphological diagnosis. Conclusion: Pediatric GI lymphoma commonly involves the ileocaecal region and presents with intestinal obstruction. A higher prevalence of DLBCL is found compared to other series. A high proliferative index is useful in differentiating Burkitt-like lymphoma from DLBCL.

  19. Primary Sclerosing Cholangitis

    Directory of Open Access Journals (Sweden)

    A Stiehl

    2000-01-01

    Full Text Available Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease characterized by fibrosing inflammation and obliteration of intra- and/or extrahepatic bile ducts. The disease is one of the most common cholestatic diseases in adults and is diagnosed with increasing frequency. It is very often associated with ulcerative colitis. Patients with PSC have an increased incidence of bile duct carcinomas, and those with ulcerative colitis also have an increased incidence of colonic carcinomas. In end-stage disease, liver transplantation is the treatment of choice. Immunosuppressive treatment has little effect. Ursodeoxycholic acid (UDCA, which has been shown to improve liver histology and survival in patients with primary biliary cirrhosis, has a beneficial effect in PSC, provided that patients who develop major duct stenoses are treated endoscopically. The aim is to treat patients as early as possible to prevent progression to the advanced stages of the disease. During treatment with UDCA, stenoses of major ducts may develop, and early endoscopic dilation is highly effective. Because UDCA treatment improves but does not cure cholestatic liver diseases, permanent treatment seems to be necessary. Such prolonged treatment with UDCA may be recommended because, until now, no side effects have been reported. In patients with end-stage disease, UDCA is not effective and liver transplantation is indicated.

  20. Primary pulmonary alveolar proteinosis

    Directory of Open Access Journals (Sweden)

    Šarac Sanja

    2012-01-01

    Full Text Available Introduction. Pulmonary alveolar proteinosis is an uncommon disease characterized by the accumulation of surfactant proteins and phospholipids within the alveolar spaces. Acquired disease can be idiopathic (primary and secondary. The prevalence of acquired pulmonary alveolar proteinosis is about 0.37 per 100,000 persons. Common symptoms are dyspnea and cough. Chest X-ray shows bilateral perihilar infiltrates. Open-lung biopsy is the gold standard for the diagnosis. Treatment includes whole-lung lavage, application of granulocyte-macrophage colonystimulating factor and lung transplantation. Case report. We reported a 51 year-old man with primary form of the disease. It was the second case of this extremely rare disease in the past 30 years in our clinic. The symptoms were longlasting dry cough, fever and physical deterioration. Chest Xray revealed bilateral pulmonary infiltrates; computed tomography showed patchy ground-glass opacification with interlobular thickening. The diagnosis was established by open lung biopsy. Additional tests were performed to exclude secondary form of the disease. Conclusion. We presented a rare clinical entity with typical clinical features and clinical and radiological course of the disease, in order to improve differential diagnostic approach to patients with bilateral lung infiltrations. In patients with pulmonary alveolar proteinosis timely diagnosis and adequate treatment can improve a prognosis.

  1. [Relaunching primary healthcaree].

    Science.gov (United States)

    Marcolongo, Adriano; Talarico, Francesco

    2014-01-01

    The health environment today is characterized by diffuse inequalities, the emergence of chronic diseases, and the introduction of new technologies, all of which, together with other factors are leading to a healthcare system that is becoming increasingly less sustainable from a financial point of view. Primary healthcare, public health and hospitals should work together to define a comprehensive healthcare delivery model characterized by continuity of care, information and management. The proposed model of disease management, in particular of chronic diseases, must reorganize health services around the needs of citizens and the community and involve patients and their families in the disease management process, by promoting self-help groups and patient organizations that cooperate with health services. In order to put this change into effect, evidence-based medicine and evidence-based practice need to be adopted. From an organizational point of view, it will be important to change wage rules, so as to implement a new payment system based upon performance. In this new contest, physicians specialized in hygiene and public health can play an important role that includes leadership, governance and coordination. By integrating the concepts of accountability, community intervention and training, we can acquire the tools to change the current hospital-based system to a new model of primary healthcare that works together with the community to move the focus from healthcare provider to patient. PMID:25715897

  2. Methotrexate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Giljaca, Vanja; Poropat, Goran; Stimac, Davor;

    2010-01-01

    Methotrexate has been used to treat patients with primary biliary cirrhosis as it possesses immunosuppressive properties. The previously prepared version of this review from 2005 showed that methotrexate seemed to significantly increase mortality in patients with primary biliary cirrhosis. Since...

  3. Bezafibrate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Rudic, Jelena S; Poropat, Goran; Krstic, Miodrag N;

    2012-01-01

    Treatment of primary biliary cirrhosis is complicated. There are studies suggesting that bezafibrate, alone or in combination with ursodeoxycholic acid (UDCA), is effective in the treatment of primary biliary cirrhosis, but no systematic review has summarised the evidence yet....

  4. Safeguards by Design Challenge

    Energy Technology Data Exchange (ETDEWEB)

    Alwin, Jennifer Louise [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-09-13

    The International Atomic Energy Agency (IAEA) defines Safeguards as a system of inspection and verification of the peaceful uses of nuclear materials as part of the Nuclear Nonproliferation Treaty. IAEA oversees safeguards worldwide. Safeguards by Design (SBD) involves incorporation of safeguards technologies, techniques, and instrumentation during the design phase of a facility, rather that after the fact. Design challenge goals are the following: Design a system of safeguards technologies, techniques, and instrumentation for inspection and verification of the peaceful uses of nuclear materials. Cost should be minimized to work with the IAEA’s limited budget. Dose to workers should always be as low are reasonably achievable (ALARA). Time is of the essence in operating facilities and flow of material should not be interrupted significantly. Proprietary process information in facilities may need to be protected, thus the amount of information obtained by inspectors should be the minimum required to achieve the measurement goal. Then three different design challenges are detailed: Plutonium Waste Item Measurement System, Marine-based Modular Reactor, and Floating Nuclear Power Plant (FNPP).

  5. Review - China's Environmental Challenges

    Directory of Open Access Journals (Sweden)

    Bill Bleisch

    2013-12-01

    Full Text Available Review of: Judith Shapiro. 2012. China's Environmental Challenges. Cambridge: UK and Malden, MA: Polity Press. Judith Shapiro's latest ambitious work picks up the story of modern China's checkered relationship with the environment at approximately the point where her previous study, Mao's War Against Nature (2001, left off. This latest book sets out to address questions of grave importance to China and to the world. The litany of challenges – poisonous water and toxic air, scarcity of water and other resources, deforestation, soil erosion, loss of biodiversity – seem nearly insurmountable, despite evidence of considerable attention from the Chinese government and from China's public, and despite the rocket-like rise of China's economic power and political influence in the world. Shapiro adds to this list the growing problems with lapses in environmental justice, both within China and passed on to its neighbours and to the countries with which it trades. Not only do growing environmental problems affect China's ability to achieve the government's stated goals of a 'harmonious society' with 'moderate prosperity for all,' but these problems, and the ways that ...

  6. The ALICE Data Challenges

    CERN Document Server

    Baud, J P; Carminati, F; Collignon, M; Collin, F; Divià, R; Durand, J D; Jarp, S; Jouanigot, J M; Panzer, B; Rademakers, F; Saiz, P; Schossmaier, K; Van de Vyvre, P; Vascotto, Alessandro

    2001-01-01

    Since 1998, the ALICE experiment and the CERN/IT division have jointly executed several large-scale high throughput distributed computing exercises: the ALICE data challenges. The goals of these regular exercises are to test hardware and software components of the data acquisition and computing systems in realistic conditions and to execute an early integration of the overall ALICE computing infrastructure. This paper reports on the third ALICE Data Challenge (ADC III) that has been performed at CERN from January to March 2001. The data used during the ADC III are simulated physics raw data of the ALICE TPC, produced with the ALICE simulation program AliRoot. The data acquisition was based on the ALICE online framework called the ALICE Data Acquisition Test Environment (DATE) system. The data after event building were then formatted with the ROOT I/O package and a data catalogue based on MySQL was established. The Mass Storage System used during ADC III is CASTOR. Different software tools have been used to mo...

  7. Résultats challenge

    CERN Multimedia

    Club de pétanque

    2015-01-01

    C'est avec un temps magnifique que se disputait pour la deuxième année le Challenge de notre cher ami Patrick DURAND le jeudi 30 juillet 2015. Vingt-six personnes formées en doublettes s'affrontaient pour trois parties .Après des parties très serrées le juge arbitre Claude JOUVE épaulé par Alain PHILIPONA déclarait  vainqueur l'imbattable Claude MACARI suivi de très près par Eric DARMEDRU et à la troisième place Christian JOUVE. La première féminine était Mireille ROCHE. La soirée se clôturait par une succulente paëlla préparée par Jennifer et sa maman Sylvie JOUVE. Rendez-vous à tous pour le jeudi 27 août 2015 pour le challenge Jean-Claude FROT Nos concours sont ouverts à tous les amateurs de pétanque.

  8. Proteomics Technologies and Challenges

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Proteomics is the study of proteins and their interactions in a cell. With the completion of the Human Genome Project, the emphasis is shifting to the protein compliment of the human organism. Because proteome reflects more accurately on the dynamic state of a cell, tissue, or organism, much is expected from proteomics to yield better disease markers for diagnosis and therapy monitoring. The advent of proteomics technologies for global detection and quantitation of proteins creates new opportunities and challenges for those seeking to gain greater understanding of diseases. High-throughput proteomics technologies combining with advanced bioinformatics are extensively used to identify molecular signatures of diseases based on protein pathways and signaling cascades. Mass spectrometry plays a vital role in proteomics and has become an indispensable tool for molecular and cellular biology. While the potential is great, many challenges and issues remain to be solved, such as mining low abundant proteins and integration of proteomics with genomics and metabolomics data. Nevertheless, proteomics is the foundation for constructing and extracting useful knowledge to biomedical research. In this review, a snapshot of contemporary issues in proteomics technologies is discussed.

  9. Rising to the Challenge

    Directory of Open Access Journals (Sweden)

    Xiaoping Li

    2015-06-01

    Full Text Available Writing is recognized as a vital skill in education and the workplace; students in the United States finishing K-12 schooling are expected to be competent writers. Yet, the Nation’s Report Card found that U.S. high school graduates coming into the workforce are particularly deficient in writing skills. Teachers serve as a crucial link in the move to improve literacy skills of K-12 students; however, teachers themselves are underprepared to be writers and writing teachers. Therefore, there is an urgent need to improve teachers’ writing skills and skills of teaching writing to improve K-12 students’ writing skills in the United States. This qualitative study examined the process-based writing project experienced by 22 practicing teachers through their reflective practices in a graduate capstone class. In particular, this study explored the challenges the teachers faced and the lessons they learned through the recursive phases of writing: planning, drafting, revising, editing, conferring, and publishing. The triangulation of the researchers’ field notes, teachers’ daily reflections, and informal interviews between the instructor and the teachers indicated that the challenges the teachers faced and the lesson they learned through the process-based writing project were phase specific. On the completion of the writing project, the participating teachers (a developed a deep understanding of process-based writing; (b learned new skills of planning, drafting, revising, editing, and sharing; and (c were more confident as writers themselves and as writing teachers for their students.

  10. Challenge Based Innovation gala

    CERN Document Server

    CERN. Geneva; Utriainen, Tuuli Maria; Toivonen, Harri; Nordberg, Markus

    2014-01-01

    Challenge Based Innovation gala   There’s a new experiment starting in CERN called IdeaLab where we work together with detector R&D researchers to help them to bridge their knowledge into a more human, societally oriented context. Currently we are located in B153, but will move our activities to a new facility next to the Globe in May 2014. One of our first pilot projects is a 5 month course CBI (Challenge Based Innovation) where two multidisciplinary student teams join forces with Edusafe & TALENT projects at CERN. Their goal is to discover what kind of tools for learning could be created in collaboration with the two groups. After months of user interviews and low resolution prototyping they are ready to share the results with us in the form of an afternoon gala. We warmly welcome you to join us to see the students' results and experience the prototypes they have conceived. The event is in three parts, you are welcome to visit all of them,...

  11. The ALICE Data Challenges

    Institute of Scientific and Technical Information of China (English)

    J.P.Baud; W.Carena; 等

    2001-01-01

    Since 1998,the ALICE experiment and the CERN/IT division have jointly executed several large-scale high throughput distributed computing exercises:the ALICE data challenges.The goals of these regular exercises are to test hardware and software components of the data acqusition and computing systems in realistic conditions and to execute an early integration of the overall ALICE computing infrastructure.This paper reports on the third ALICE Data Challenge (ADC III) that has been performed at CERN from January to March 2001.The data used during the ADC Ⅲ are simulated physics raw data of the ALICE TPC,produced with the ALICE simulation program AliRoot.The data acquisition was based on the ALICE online framework called the ALICE Data Acquisition Test Environment (DATE) system.The data after event building,were then formatted with the ROOT I/O package and a data catalogue based on MySQl was established.The Mass Storage System used during ADC III is CASTOR.Different software tools have been used to monitor the performances,DATE has demonstrated performances of more than 500 MByte/s.An aggregate data throughput of 85 MByte/s was sutained in CASTOR over several days.The total collected data amounts to 100 TBytes in 100.00 files.

  12. The competitive challenge in banking

    NARCIS (Netherlands)

    A.W.A. Boot; A. Schmeits

    2005-01-01

    The increasingly competitive environment poses challenges to bankers. This paper emphasizes relationship banking as a prime source of the banks' comparative advantage. The proliferation of transaction-oriented banking (trading and financial market activities) does however seriously challenge relatio

  13. JWST ISIM Distortion Analysis Challenge

    Science.gov (United States)

    Cifie, Emmanuel; Matzinger, Liz; Kuhn, Jonathan; Fan, Terry

    2004-01-01

    Very tight distortion requirements are imposed on the JWST's ISM structure due to the sensitivity of the telescope's mirror segment and science instrument positioning. The ISIM structure is a three dimensional truss with asymmetric gusseting and metal fittings. One of the primary challenges for ISIM's analysis team is predicting the thermal distortion of the structure both from the bulk cooldown from ambient to cryo, and the smaller temperature changes within the cryogenic operating environment. As a first cut to estimate thermal distortions, a finite element model of bar elements was created. Elements representing joint areas and metal fittings use effective properties that match the behavior of the stack-up of the composite tube, gusset and adhesive under mechanical and thermal loads. These properties were derived by matching tip deflections of a solid model simplified T-joint. Because of the structure s asymmetric gusseting, this effective property model is a first attempt at predicting rotations that cannot be captured with a smeared CTE approach. In addition to the finite element analysis, several first order calculations have been performed to gauge the feasibility of the material design. Because of the stringent thermal distortion requirements at cryogenic temperatures, a composite tube material with near zero or negative CTE is required. A preliminary hand analysis of the contribution of the various components along the distortion path between FGS and the other instruments, neglecting second order effects were examined. A plot of bounding tube longitudinal and transverse CTEs for thermal stability requirements was generated to help determine the feasibility of meeting these requirements. This analysis is a work in progress en route to a large degree of freedom hi-fidelity FEA model for distortion analysis. Methods of model reduction, such as superelements, are currently being investigated.

  14. Brucellosis: Epizootiologic and diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Radojičić Sonja

    2005-01-01

    Full Text Available Although it has been known as a separate etiological entity for almost 150 years, brucellosis is, on a global scale, one of the most frequent diseases that is transferred from animals to humans. It is present as an endemic disease in almost all countries of the Mediterranean Sea, which indicates that a large number of aspects in connection with the control and epizootiology of this disease still remain unexplained. Three of the six types of brucella have been officially confirmed in our country as well. They are Brucella melitensis biotip 3, Brucella suis biotip 2 and Brucella canis. Brucellosis is endemically present in Kosovo and Metohija province and in southern Serbia proper; over the past few years, the spread of brucellosis in sheep and goats as primary hosts for B. melitensis to new territories, mostly in Vojvodina province, has shown that risk analysis is one of the main factors in selecting and implementing control programmes. A correctly selected set of diagnostic tests yields reliable data in most cases, but interpretations of results are prone to result in subjective assessments as well. A special problem in the serological diagnosis of brucellosis is the cross reactivity of brucellas and some other bacteria, often a weak immunological response of the animal, or that the type of brucella that causes the infection determines the sensitivity and specificity of the applied tests, most often screenings tests. Due to the big economic losses resulting from disease control and eradication, and the serious risk to human health, brucellosis still poses an epizootiological, and, in particular, a diagnostic challenge.

  15. Offshore northern Europe, the challenges

    International Nuclear Information System (INIS)

    This paper relates to challenges of the offshore activity in the North Sea. It is appropriate to address these challenges in the context of generating values through efficient management of resources, markets, safety and technology, as the challenges lie therein. The petroleum industry is built to turn natural resources into market value, assuring broad benefits to stake holders and shareholders. In the following, the challenges facing the industry the industry offshore Northern Europe is examined on this background

  16. WCET Tool Challenge 2011: Report

    OpenAIRE

    Bonenfant, Armelle; Cassé, Hugues; Bünte, Sven; Fellger, Wolfgang; Gepperth, Sebastian; Gustafsson, Jan; Huber, Benedikt; Islam, Nazrul Mohammad; Kästner, Daniel; Kirner, Raimund; Kovács, Laura; Krause, Felix; De Michiel, Marianne; Olesen, Mads Christian; Prantl, Adrian

    2011-01-01

    Following the successful WCET Tool Challenges in 2006 and 2008, the third event in this series was organized in 2011, again with support from the ARTIST DESIGN Network of Excellence. Following the practice established in the previous Challenges, the WCET Tool Challenge 2011 (WCC’11) defined two kinds of problems to be solved by the Challenge participants with their tools, WCET problems, which ask for bounds on the execution time, and flow-analysis problems, which ask for bounds on the number ...

  17. Offshore northern Europe, the challenges

    Energy Technology Data Exchange (ETDEWEB)

    Bergseth, S. [Statoil, Stavenger (Norway)

    1996-12-31

    This paper relates to challenges of the offshore activity in the North Sea. It is appropriate to address these challenges in the context of generating values through efficient management of resources, markets, safety and technology, as the challenges lie therein. The petroleum industry is built to turn natural resources into market value, assuring broad benefits to stake holders and shareholders. In the following, the challenges facing the industry the industry offshore Northern Europe is examined on this background

  18. Primary breast sarcoma

    DEFF Research Database (Denmark)

    Holm, Maibritt; Aggerholm-Pedersen, Ninna; Mele, Marco;

    2016-01-01

    AIM: The aim of this study was to contribute to the collected knowledge of prognostic factors in primary breast sarcomas (PBS) to the benefit of possible future prospective studies and therapeutic guidelines. METHOD: All patients with pathologically verified PBS in the period of 1979-2014 were...... in those with superficial tumors was observed as well as an increased incidence in radiation-induced angiosarcoma (AS) of the breast, however, prognosis was no different from non-radiation-induced AS. CONCLUSION: Prognostic factors in PBS patients were size and grade with a trend towards better survival...... in those with superficial tumors. There was no difference in survival between radiation-induced and spontaneous breast sarcomas. High rate of local recurrence suggests the need for aggressive surgical approach or the routine addition of postoperative radiotherapy in those selected for breast conserving...

  19. Primary hyperparathyroidism in pregnancy.

    Science.gov (United States)

    Kamenický, Peter; Lecoq, Anne-Lise; Chanson, Philippe

    2016-06-01

    Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders in the general population but is rarely diagnosed during pregnancy. Symptoms of gestational PHPT may be unrecognized, or masked by physiological changes in calcium homeostasis associated with pregnancy. Gestational PHPT may have severe consequences for both mother and fetus. However, nowadays, gestational PHPT is usually diagnosed in earlier stages and milder forms, with low complication rates. Treatment should be individually tailored according to gestational age, the severity of hypercalcemia, and the risk-benefit balance. The conservative approach is preferred in mild forms, whereas surgery, usually performed during the second trimester, is reserved for symptomatic hypercalcemic PHPT. Given the young age of the patients, genetic causes should be considered. PMID:27157105

  20. PRIMARY SCHOOL TEACHER

    CERN Multimedia

    Madeleine Dittus

    2002-01-01

    For the beginning of the school year 2002/2003, the A.P.E.G. has an opening for a primary school teacher in the German national language program. The position requires one afternoon of teaching (13:30 till 16:30) every Tuesday at the Collège in Prévessin. The candidate should be a native speaker of German and have some knowledge of French. If you are interested, please send your CV, a copy of your diploma, and a short letter of motivation, until March 10th, to the following address. Madeleine Dittus - Présidente A.P.E.G. 5, La vie Destraz 01630 St. Genis-Pouilly - France

  1. Accountability and primary healthcare.

    Science.gov (United States)

    Mukhi, Shaheena; Barnsley, Jan; Deber, Raisa B

    2014-09-01

    This paper examines the accountability structures within primary healthcare (PHC) in Ontario; in particular, who is accountable for what and to whom, and the policy tools being used. Ontario has implemented a series of incremental reforms, using expenditure policy instruments, enforced through contractual agreements to provide a defined set of publicly financed services that are privately delivered, most often by family physicians. The findings indicate that reporting, funding, evaluation and governance accountability requirements vary across service provider models. Accountability to the funder and patients is most common. Agreements, incentives and compensation tools have been used but may be insufficient to ensure parties are being held responsible for their activities related to stated goals. Clear definitions of various governance structures, a cohesive approach to monitoring critical performance indicators and associated improvement strategies are important elements in operationalizing accountability and determining whether goals are being met. PMID:25305392

  2. Prostaglandins and primary dysmenorrhea

    International Nuclear Information System (INIS)

    In 100 patients a total of 171 PG determinations in the menstrual blood was performed under standardized conditions. The primary PGE1 and PGFsub(2α) were determined by RIA. The evaluation of the analysis of the sexual hormones resulted in a group with a biphasic cycle without dysmenorrhea and a group with a biphasic cycle with dysmenorrhea. Highly significant differences (p < 0.01) were found in the PGFsub(2α) concentration in menstrual blood between a group of healthy women and one of patients with dysmenorrhea. In dysmenorrhea the ratio of the PGs investigated is shifted in favor of PGFsub(2α). Indomethacin can decrease the PGFsub(2α) levels in dysmenorrhea up to 15% (p < 0.01). All treated patients reported that their conditions had improved. Five out of seven women were completely without any complaints. (author)

  3. Gluteal primary cutaneus actinomycosis

    Directory of Open Access Journals (Sweden)

    Chatterjee Manas

    2005-01-01

    Full Text Available A 58 year old male presented with multiple areas of painless purulent discharge from the buttocks. He had pallor and dermatological examination revealed multiple subcutaneus nodules and discharging sinuses over the buttocks with hyperpigmentation and indurated puckered scarring. Examination of the pus revealed ′sulphur granules′ and Gram stain showed narrow bacillary forms and elongated hyphae with occasional branching. Skin biopsy revealed granular colonies in which ′ray fungus′ were seen. In brain-heart glucose agar in anerobic environment, white spidery colonies of Actinomyces israelii were grown at 37o C in 4 days, confirming primary cutaneus actinomycosis. He was managed with capsule doxycycline with regression of pus discharge in 6 weeks and therapy is planned for 18 months.

  4. Primary Identity in Literature

    DEFF Research Database (Denmark)

    Graham, Brian Russell

    In our times, literary criticism, as well as larger political and cultural developments, is characterized by identity politics, meaning that our discourses are structured around the notion of different socially identifiable populations in society. In relation to literature, this results in our...... viewing the characters in literature in terms of these political identities. Literature is consequently discussed in relation to political causes. Literary criticism is animated by the same causes, and is viewed as having a direct intervention in society in relation to them. In this paper, I will discuss......, in relation to Frye’s works, the idea that the primary identities of characters in literature were and, to a considerable extent, continue to be those of family-member identities. As such, literature should not be appropriated to a political context too readily. Whereas viewing characters in terms of...

  5. Primary conjunctival amyloidosis

    Directory of Open Access Journals (Sweden)

    Chandana Chakraborti

    2014-01-01

    Full Text Available A 19-year-old previously healthy male presented with a 4 year history of painless drooping of right upper eyelid.On eversion of the right upper eyelid, a yellowish pink mass was seen in the tarsal region. Rest of the ocular examination was normal in both the eyes. Initial biopsy showed chronic inflammation. Subsequently, the entire mass was excised and histopathological examination showed the presence of amyloid in the subconjunctival stroma. At 3 months follow-up, similar lesion was detected in the right lower, left upper, and lower lid, which were treated with cryotherapy, with partial resolution. Patient has been followed up for more than 2 years without any complaints. To our knowledge, this is the first case report of an isolated primary conjunctival amyloidosis with involvement of both the upper and lower palpebral conjunctiva of either eye. It was treated successfully by excision and cryotherapy.

  6. Primary fallopian tube carcinoma

    Directory of Open Access Journals (Sweden)

    Mladenović-Segedi Ljiljana

    2009-01-01

    Full Text Available Introduction. Primary fallopian tube carcinoma is extremely rare, making 0.3-1.6% of all female genital tract malignancies. Although the etymology of this tumor is unknown, it is suggested to be associated with chronic tubal inflammation, infertility, tuberculous salpingitis and tubal endometriosis. High parity is considered to be protective. Cytogenetic studies show the disease to be associated with over expression of p53, HER2/neu and c-myb. There is also some evidence that BRCA1 and BRCA2 mutations have a role in umorogeneis. Clinical features. The most prevailing symptoms with fallopian tube carcinoma are abdominal pain, abnormal vaginal discharge/bleeding and the most common finding is an adnexal mass. In many patients, fallopian tube carcinoma is asymptomatic. Diagnosis. Due to its rarity, preoperative diagnosis of primary fallopian tube carcinoma is rarely made. It is usually misdiagnosed as ovarian carcinoma, tuboovarian abscess or ectopic pregnancy. Sonographic features of the tumor are non-specific and include the presence of a fluid-filled adnexal structure with a significant solid component, a sausage-shaped mass, a cystic mass with papillary projections within, a cystic mass with cog wheel appearance and an ovoid-shaped structure containing an incomplete separation and a highly vascular solid nodule. More than 80% of patients have elevated pretreatment serum CA-125 levels, which is useful in follow-up after the definite treatment. Treatment. The treatment approach is similar to that of ovarian carcinoma, and includes total abdominal hysterectomy and bilateral salpingo-oophorectomy. Staging is followed with chemotherapy.

  7. Vaccination with the Defined Chlamydial Secreted Protein CPAF Induces Robust Protection Against Female Infertility Following Repeated Genital Chlamydial Challenge

    OpenAIRE

    Murthy, Ashlesh K.; Li, Weidang; Guentzel, M. Neal; Zhong, Guangming; Arulanandam, Bernard P.

    2011-01-01

    We previously have shown the efficacy of recombinant (r) chlamydial protease-like activity factor (CPAF) vaccination against hydrosalpinx development following primary genital chlamydial challenge. In this study, we evaluated further the protection induced by rCPAF vaccination against infertility. Following primary challenge, fertility levels were not significantly different between the mock- and CPAF-vaccinated and Chlamydia alone challenged mice. However, following secondary genital chlamyd...

  8. Challenging Fieldwork Situations

    DEFF Research Database (Denmark)

    Bille, Thomas; Østergaard Steenfeldt, Vibeke

    2013-01-01

    understanding on the phenomenon of awkwardness as a natural way for researchers to respond to challenging fieldwork situations. Finally, they propose and unfold mutual interviewing and cooperative analysis as methods of investigating researcher’s subjectivity in facing such situations.......Researching two different work settings, police work and hospice care, the authors experienced a strange sense of discomfort in their bodies during their fieldwork when investigating professional training and work situations, especially in encounters with citizens and patients. In some of those...... situations, the authors withdrew physically or mentally from the situation without wanting to do so, feeling emotionally affected by the uncertainty of the situations, not fully grasping the meaning of what was going on. In a strange way they felt awkwardly detached from their research activities...

  9. Multicore Programming Challenges

    Science.gov (United States)

    Perrone, Michael

    The computer industry is facing fundamental challenges that are driving a major change in the design of computer processors. Due to restrictions imposed by quantum physics, one historical path to higher computer processor performance - by increased clock frequency - has come to an end. Increasing clock frequency now leads to power consumption costs that are too high to justify. As a result, we have seen in recent years that the processor frequencies have peaked and are receding from their high point. At the same time, competitive market conditions are giving business advantage to those companies that can field new streaming applications, handle larger data sets, and update their models to market conditions faster. The desire for newer, faster and larger is driving continued demand for higher computer performance.

  10. Challenges in plastics recycling

    DEFF Research Database (Denmark)

    Pivnenko, Kostyantyn; Jakobsen, L. G.; Eriksen, Marie Kampmann;

    2015-01-01

    Recycling of waste plastics still remains a challenging area in the waste management sector. The current and potential goals proposed on EU or regional levels are difficult to achieve, and even to partially fullfil them the improvements in collection and sorting should be considerable. A study...... was undertaken to investigate the factors affecting quality in plastics recycling. The preliminary results showed factors primarily influencing quality of plastics recycling to be polymer cross contamination, presence of additives, non-polymer impurities, and polymer degradation. Deprivation of plastics quality......, with respect to recycling, has been shown to happen throughout the plastics value chain, but steps where improvements may happen have been preliminary identified. Example of Cr in plastic samples analysed showed potential spreading and accumulation of chemicals ending up in the waste plastics. In order...

  11. Sustainable Consumption: Research Challenges

    DEFF Research Database (Denmark)

    Reisch, Lucia A.; Cohen, Maurie J.; Thøgersen, John;

    The Board of the Swedish Foundation for Strategic Environmental Research (Mistra) decided in October 2015 that a proposal for a funding application call in the research area of “sustainable consumption” should be drawn up. According to the statutes of Mistra, research funded by the foundation...... policy) processes that are underway in Sweden and the rest of the European Union (EU) to tackle these challenges; ► to provide an overview of where the international research frontline is located and the status of Swedish research gaps in the area from an international perspective; ► to propose in detail...... “shall promote the development of strong research environments of the highest international class with importance for Sweden’s future competitiveness. The research shall be of importance for finding solutions to important environmental problems and for a sustainable development of society. Opportunities...

  12. The challenge of implementation

    DEFF Research Database (Denmark)

    Andersen, Karen Heide Hauge

    2015-01-01

    Reaching the students in innovation and entrepreneurship courses is hard, when the courses are a requirement but not included in the main project of the curriculum. It is a major paradox for lecturers, who have never participated in and cannot see the relevance of such course, to implement...... these concepts in daily teaching, as it is strongly encouraged by policy makers and educations. This paper aims to discuss how lecturers experience the challenge of teaching their own discipline while being imposed to embrace and promote innovation and entrepreneurship teaching. Through a single study case...... of the paper: which factors influence the degree of implementation of innovation and entrepreneurship in the individual lecturers’ daily teaching? The paper questions the common approach taken by higher educational institutions whereby lecturers are urged to teach innovation and entrepreneurship with minor...

  13. EOSDIS Customer Support Challenges

    Science.gov (United States)

    Moses, J. F.; Boquist, C. L.

    2006-05-01

    The Earth Observation System Data and Information System (EOSDIS) is a large, complex data system currently supporting over 18 operational NASA satellite missions including the flagship EOS missions: Terra, Aqua, and Aura. The observations collected by these missions are kept at geographically distributed data centers. EOSDIS manages over four petabytes of data accessed by over 200,000 distinct users last year. The data centers distributed more than 37 million Earth science data products during 2005 to a diverse customer community. An important goal for these data centers is to provide an adequate service at a uniform level for the user community to ensure we get the most benefit from our investment in space resources. This paper discusses the challenges, the ways the data centers coordinate among themselves to provide service, and recent results of measuring customer satisfaction with this service.

  14. PHARMACOVIGILANCE: BARRIERS AND CHALLENGES

    Directory of Open Access Journals (Sweden)

    VARMA S. K

    2013-01-01

    Full Text Available Pharmacovigilance is a new discipline which deals with adverse drug or any drug related problems. Pharmacovigilance programme was not bed of roses but its path is laid with challenges and barriers. It is facing obstacles from deficiency from professional health personal to web-based sale of drugs, counterfeit drug to self-medication, etc. It is an integral part of the health sector and identification and reporting of adverse drug effects will have a positive impact on the public health. Improvement in knowledge in pharmacovigilance and communication from the top level to the grass-root level in the health sector will help in proper implementation of the programme. Patient should be educated to report any adverse effects after taking drug and stop relaying on acquiring information related to drugs in web. Proper detection, reporting and analysis would help to implement the programme for the betterment of society.

  15. Challenge Measurements For Authentication

    International Nuclear Information System (INIS)

    Authentication of systems with an information barrier that protects sensitive information is difficult; in particular, the information barrier can allow a hidden switch to be implemented by the system fabricator and operator. The hidden switch is the operator's ability to subvert the measurement system and force it to produce a desired and false result. It is usually discussed in the context of an attribute measurement in which a faked item is presented in place of a real item regulated by an agreement, with the driving motivation being the ability to preserve a stock of valuable items. In simple terms, the hidden switch enables a shell game with assets, and the information barrier protects the switch. This presentation outlines challenge measurements that could be used to detect the implementation of a hidden switch and assist the authentication process.

  16. A specific nanomanufacturing challenge

    Science.gov (United States)

    Kelly, M. J.; Dean, M. C.

    2016-03-01

    For a science to become a technology, a certain level of control has to have been established over the way items are fabricated for manufacture and use. Here we first consider the challenge of making and using a LEGO® brick scaled down by a factor of 10 n for n = 0-6 in each spatial dimension, i.e. from millimetres to nanometres. We consider both the manufacture and the subsequent properties of the nanobricks that pertain to their use in constructing and dismantling structures. As n increases, the ability to use fails first, to manufacture fails second and to fabricate fails last. Applied to the vast literature in nanoscience, this process emphasises the unmanufacturability of most nanoscale artefacts.

  17. Polyhydroxyalkanoates, challenges and opportunities.

    Science.gov (United States)

    Wang, Ying; Yin, Jin; Chen, Guo-Qiang

    2014-12-01

    Microbial polyhydroxyalkanoates (PHA) have been developed as biodegradable plastics for the past many years. However, PHA still have only a very limited market. Because of the availability of large amount of shale gas, petroleum will not raise dramatically in price, this situation makes PHA less competitive compared with low cost petroleum based plastics. Therefore, two strategies have been adopted to meet this challenge: first, the development of a super PHA production strain combined with advanced fermentation processes to produce PHA at a low cost; second, the construction of functional PHA production strains with technology to control the precise structures of PHA molecules, this will allow the resulting PHA with high value added applications. The recent systems and synthetic biology approaches allow the above two strategies to be implemented. In the not so distant future, the new technology will allow PHA to be produced with a competitive price compared with petroleum-based plastics.

  18. New challenges in gas

    Energy Technology Data Exchange (ETDEWEB)

    Mandil, C. [Institut Francais du Petrole (IFP), 92 - Rueil-Malmaison (France); Chabrelie, M.F. [Cedigaz, 92 - Rueil Malmaison (France); Streicher, C. [Prosernat, 92 - Paris la Defense (France)] [and others

    2003-07-01

    New developments in the area of gas treatment will be to a large extent driven by the need to find appropriate solutions to the fundamental need of sustainable development. New gas treatment processes are developed with the aim to minimise contaminant emissions and meet most stringent environmental specifications. A new major challenge for the industry will be to implement new cost effective technologies for reducing CO{sub 2} emissions. Industry has also to minimise its costs, and therefore, in order to ensure at the same time a better protection of the environment and a better safety, it is necessary to innovate. The purpose of this seminar is precisely to identify better the innovations which are required in the area of gas treatment. These proceedings comprise 8 papers and a summary of the contributions to a round-table discussion dealing with the options for CO{sub 2} capture and sequestration. The presentations treat of: the future prospects for the gas industry (M.F. Chabrelie, Cedigaz); the solutions for offshore gas treatment (C. Streicher, Prosernat); gas treatment with membranes (H. Meyer, GTI); the Axens Multibed{sub TM} technology for natural gas treatment (G. Jochem, Axens); the potentials and applications for the Propure co-current contactors (F.P. Nilsen, ProPure); the production of very-sour and super-sour large gas reserves: the new challenges (F. Lallemand, TotalFinaElf); Hybrisol, a new gas treatment process for sour natural gases (F. Lecomte, IFP); and the conception and building of large acid-gas removal units (J. Castel, Technip-Coflexip). (J.S.)

  19. Biomarkers and special features of oxidative stress in the anterior segment of the eye linked to lens cataract and the trabecular meshwork injury in primary open-angle glaucoma: challenges of dual combination therapy with N-acetylcarnosine lubricant eye drops and oral formulation of nonhydrolyzed carnosine.

    Science.gov (United States)

    Babizhayev, Mark A

    2012-02-01

    The implication of oxidative stress associated with increased oxidant production in mammalian and human cells characterized by the release of free radicals, resulting in cellular degeneration, is involved in many ocular diseases, such as age-related macular degeneration, retinopathy of prematurity, retinal light damage, primary open-angle glaucoma (POAG), and cataract. Cataract is the leading cause of blindness, accounting for 50% of blindness worldwide. Glaucoma, the leading cause of irreversible blindness, is considered as a progressive optic neuropathy often caused by elevated intraocular pressure (IOP) consequent to abnormally high resistance to aqueous humor (AH) drainage via the trabecular meshwork (TM) and Schlemm's canal. Morphological and biochemical analyses of the TM of patients with POAG revealed the loss of cells, increased accumulation of extracellular matrix proteins (ECM), changes in the cytoskeleton, cellular senescence, and the process of subclinical inflammation. The TM is the target tissue of glaucoma in the anterior chamber, and the development and progression of glaucoma are accompanied by the accumulation of oxidative damage in this tissue. The separate studies were conducted to comparatively evaluate the sensitivity to oxidative stress and lipid peroxidation (LPO) of anterior chamber tissues including TM. Accumulation of the primary, secondary, and end products of LPO (diene and triene conjugates, Schiff's bases) was noted in the studied extracts. Significant differences in the levels of all mentioned LPO products in comparison with the control were observed. The data may be considered as an evidence of LPO participation in the destruction of the trabecule and Schlemm's canal in POAG. Treatment of TM cells with oxidative stress induced POAG-typical changes such as ECM accumulation, cell death, disarrangement of the cytoskeleton, advanced senescence, and the release of inflammatory markers. By pretreatment with antioxidants, prostaglandin

  20. Primary hyperparathyroidism in pregnancy.

    Science.gov (United States)

    Diaz-Soto, Gonzalo; Linglart, Agnès; Sénat, Marie-Victoire; Kamenicky, Peter; Chanson, Philippe

    2013-12-01

    Primary hyperparathyroidism (PHPT) is rarely diagnosed during pregnancy but is associated with significant maternal and fetal morbidity and mortality. Information on appropriate management is limited. We reviewed the medical literature through December 2012 for key articles on PHPT during pregnancy, focusing on large series. Clinical knowledge in this area is restricted to isolated case reports and a few retrospective studies. Diagnosis can be difficult, owing to the non-specific nature of signs and symptoms of hypercalcemia during pregnancy. Pregnant women with a calcium level over 2.85 mmol/L (11.4 mg/dL) and prior pregnancy loss are at a particularly high risk of maternal complications (hypercalcemic crisis, nephrolithiasis, pancreatitis, etc.) and fetal loss. Around one-half of neonates born to mothers with untreated PHPT have hypocalcemia and tetany. Algorithms proposed for the management of the pregnant woman with PHPT are not evidence based, reflecting the paucity of data. Treatment should thus be individually tailored. Gestational age and the severity of hypercalcemia should be taken into account when assessing the risk-benefit balance of a conservative approach (hyperhydration and vitamin D supplementation) versus parathyroid surgery. Current evidence supports parathyroidectomy as the main treatment, performed preferably during the second trimester, when the serum calcium is above 2.75 mmol/L (11 mg/dL). In the patients with mild forms of PHPT, which are nowadays the most frequent, a conservative management is generally preferred. PMID:23670708

  1. [Primary and secondary hypocholesterolemia].

    Science.gov (United States)

    Song, Jun-xian; Ren, Jing-yi; Chen, Hong

    2010-10-18

    Hypocholesterolemia is characterized by serum total cholesterol that is lower than the 5th percentile for age and sex, or the cut-off value which predicts the adverse prognosis by epidemiological study. Unlike hypercholesterolemia, physicians pay less attention to the morbidity, causes and consequences of hypocholesterolemia in clinical practice. In fact, hypocholesterolemia is a common dislipidemia, and mainly results from secondary factors. The causes of primary hypocholesterolemia are some disorders owing to genetic mutation in the pathway of cholesterol absorption, biosynthesis or metabolism, including abetalipoproteinemia, hypobetalipoproteinemia, Tangier disease, chylomicron retention disease and inherited disorders of cholesterol biosynthesis. The causes of secondary hypocholesterolemia comprise anemia, hyperthyroidism, malignancy, live disease, critical illness, serious stress, malabsorption or malnutrition, acute or chronic infection, chronic inflammation, and use of some drugs. In addition, what's more important is that hypocholesterolemia can result in some adverse events, such as increased mortality, intracerebral hemorrhage, cancer, infection, adrenal failure, suicide and mental disorder. Therefore, with the practice of intensive lipid-lowering treatment and the tendency to the increased indications of statins, it's high time that physicians attached more importance to hypocholesterolemia. PMID:20957025

  2. Primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Marina G Silveira

    2008-01-01

    Full Text Available Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts, resulting in end-stage liver disease and reduced life expectancy. PSC primarily affects young and middle-aged men, often in association with underlying inflammatory bowel disease. The etiology of PSC includes immune-mediated components and elements of undefined nature. A cholestatic picture of liver biochemistries with elevations in serum alkaline phosphatase, nonspecific autoantibodies such as perinuclear antineutrophilic antibody, antinuclear antibodies and smooth muscle antibodies, and diffuse multifocal biliary strictures, resulting in a ‘beaded’ appearance on radiographic studies, are the hallmarks of the disease. No effective medical therapy is currently available, although clinical studies are in progress. Ursodeoxycholic acid at high doses (28 mg/kg/day to 30 mg/kg/day is the most promising agent but is unproven so far. Liver transplantation is currently the only life-extending therapy for patients with end-stage disease, although recurrent disease can be observed in the transplanted liver. The multiple complications of PSC include pruritus, fatigue, vitamin deficiencies, metabolic bone disease, peristomal varices, bacterial cholangitis, dominant biliary strictures, gallbladder stones and polyps, and malignancy, particularly cholangiocarcinoma, which is the most lethal complication of PSC.

  3. Primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Chapman Roger

    2006-10-01

    Full Text Available Abstract Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease of unknown aetiology characterised by inflammation and fibrosis of the biliary tree. The mean age at diagnosis is 40 years and men are affected twice as often as women. There is a reported annual incidence of PSC of 0.9–1.31/100,000 and point prevalence of 8.5–13.6/100,000. The onset of PSC is usually insidious and many patients are asymptomatic at diagnosis or have mild symptoms only such as fatigue, abdominal discomfort and pruritus In late stages, splenomegaly and jaundice may be a feature. In most, the disease progresses to cirrhosis and liver failure. Cholangiocarcinoma develops in 8–30% of patients. PSC is thought to be immune mediated and is often associated with inflammatory bowel disease, especially ulcerative colitis. The disease is diagnosed on typical cholangiographic and histological findings and after exclusion of secondary sclerosing cholangitis. Median survival has been estimated to be 12 years from diagnosis in symptomatic patients. Patients who are asymptomatic at diagnosis, the majority of whom will develop progressive disease, have a survival rate greater than 70% at 16 years after diagnosis. Liver transplantation remains the only effective therapeutic option for patients with end-stage liver disease from PSC, although high dose ursodeoxycholic acid may have a beneficial effect.

  4. Primary gastrointestinal lymphoma

    Institute of Scientific and Technical Information of China (English)

    Prasanna Ghimire; Guang-Yao Wu; Ling Zhu

    2011-01-01

    Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific,thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.

  5. Primary hyperoxaluria in infants

    Directory of Open Access Journals (Sweden)

    Manel Jellouli

    2016-01-01

    Full Text Available The infantile form of primary hyperoxaluria type-1 (PH-1 is characterized by a rapid progression to the end-stage renal disease (ESRD due to both increased oxalate load and reduced glomerular filtration rate. In the literature, data on this form are limited. The purpose of this study is to analyze retrospectively the clinical, biological, and radiological features of children who were diagnosed with PH-1 during the 1styear of life. We reviewed the records of all children with PH-1 diagnosed and followed-up at our department between January 1995 and December 2013. Among them, only infants younger than 12 months of age were retrospectively enrolled in the study. Fourteen infants with the median age of two months were enrolled in the study. At diagnosis, 11 patients had ESRD. All patients had nephrocalcinosis and two of them had calculi. The diagnosis was established in nine patients on the basis of the positive family history of PH-1, bilateral nephrocalcinosis, and quantitative crystalluria. In four patients, the diagnosis was made with molecular analysis of DNA. Kidney biopsy contributed to the diagnosis in one patient. During follow-up, two patients were pyridoxine sensitive and preserved renal function. Seven among 11 patients who had ESRD died, four patients are currently undergoing peritoneal dialysis. Children with infantile PH and ESRD are at high risk of early death. Peritoneal dialysis is not a treatment of choice. Combined liver-kidney transplantation is mandatory.

  6. [PRIMARY SCLEROSING CHOLANGITIS

    Science.gov (United States)

    Dantas, Waldomiro

    2000-01-01

    Primary sclerosing cholangitis (PSC) is a chronic cholestatic and progressive disease, of unknown etiology, characterized by inflammation and fibrosis of intra-hepatic and extra-hepatic biliary tree. Two thirds of the patients have, simultaneously, ulcerative colitis (UC); on the other hand, PSC is the most common chronic hepatic disease in patients with inflammatory bowel disease (IBD). Patients who have both diseases simultaneously are prone to develop colorectal carcinoma and cholangiocarcinoma. The disease predominantly affects young men, may be asymptomatic or presented as fluctuating jaundice, pruritus and increased levels of the cholestasis biochemical markers, or as secondary billiary cirrhosis. The diagnostic gold standard are the cholangiographic abnormalities, consisting of multifocal stenosis and dilatations, involving both the intrahepatic and the extrahepatic biliary tree. Liver biopsy is useful only for staging the disease and to confirm the diagnosis, in the atypical forms. Ursodeoxycholic acid is a promising drug, nowadays, mainly in the first stages of the disease, in spite of doubtful efficacy. Combination therapy, using ursodeoxicolic acid, methotrexate and alternating antibiotics monthly may be sucessfull in PSC before bile strictures occur. Liver transplantation is the only life-saving therapeutic alternative, able to improve significantly the survival and the life quality of the patients. PMID:12140588

  7. Primary aldosteronism and pregnancy.

    Science.gov (United States)

    Landau, Ester; Amar, Laurence

    2016-06-01

    Hypertension (HT) is a complication of 8% of all pregnancies and 10% of HT cases are due to primary aldosteronism (PA). There is very little data on PA and pregnancy. Given the changes in the renin angiotensin system during pregnancy, the diagnosis of PA is difficult to establish during gestation. It may be suspected in hypertensive patients with hypokalemia. A comprehensive literature review identified reports covering 40 pregnancies in patients suffering from PA. Analysis of these cases shows them to be high-risk pregnancies leading to maternal and fetal complications. Pregnancy must be programmed, and if the patient has a unilateral form of PA, adrenalectomy should be performed prior to conception. It is customary to stop spironolactone prior to conception and introduce antihypertensive drugs that present no risk of teratogenicity. When conventional antihypertensive drugs used during pregnancy fail to control high blood pressure, diuretics, including potassium-sparing diuretics may be prescribed. Adrenalectomy can be considered during the second trimester of pregnancy exclusively in cases of refractory hypertension. A European retrospective study is currently underway to collect a larger number of cases. PMID:27156905

  8. Primary systemic amyloidosis

    Directory of Open Access Journals (Sweden)

    Tanasilović Srđan

    2007-01-01

    Full Text Available Background. Systemic amyloidosis is a rare disorder which usually occurs in aged persons and has a poor prognosis. Systemic amyloidosis can be primary, occasionally associated with multiple myeloma, or secondary, associated with another disease. Case report. We presented a 72-year-old male patient with periocular purpura ("racoon sign" and waxy papules, petechiae and ecchymoses on the neck and thoracic area. Purpuric macules were present also on the lips and tongue which was edematous (macroglossia. The skin lesions occurred two years earlier, the patient lost more than 15 kilograms of the body mass for less than a year. Immunoelectrophoresis of urine and serum demonstrated the presence of immunoglobulin light chains of the circulating monoclonal protein. Histopathological examination of skin lesions showed Congo red positive deposits in the derm. Cardiac evaluation revealed the signs of heart failure, and renal evaluation revealed nephrotic syndrome, with excessive protein lost. He was treated with oral melphalan and prednisolone, and died 7 days after starting the therapy due to heart failure. Conclusion. This patient considered as a rare case with systemic amyloidosis highlights the importance of histopathological and physical examination in any cases with periocular purpura, petechiae, ecchymoses and macroglossia.

  9. Safeguards information challenges

    International Nuclear Information System (INIS)

    Full text: Overall, the aim of this paper is to provide the background and the broader vision in which the various information related presentations and posters proposed by the Department find their place, exploring solutions to the challenges faced. At a time when the Agency is expected to be a reference for the assessment of nuclear proliferation threats, providing the international community with independent, impartial, timely and credible conclusions that no declared nuclear material is diverted to non-peaceful purposes and that no undeclared nuclear material or activities exist in States, it has to address major challenges with regard to information. Drawing credible conclusions assumes that all relevant information is accessible and put into relevant context. Because of the legal constraints under which it operates, the limitation of resources for collecting existing but difficult to reach details and simply because of the overwhelming quantity of the information needed to properly evaluate proliferation issues, the Agency has to continually improve the way it collects, processes and internally disseminates safeguards relevant information. Developing a coherent picture of a State's nuclear capability is a complex process based on many experts' assessments and fusion of information. The search for better, broader and deeper information through dedicated collection processes is an ongoing effort aimed at filling the gaps of such pictures. Implementing well selected information collection tools is a sine qua non to render effective the Agency's detection capabilities. Beyond collection, another prerequisite to ensuring that the available information is accessible to those who need to know is the establishment of a proper information system architecture and an efficient set of standard business processes. At the same time, that information must be sufficiently protected by appropriate security measures, particularly at a time when private hacking has become a

  10. Safeguards information challenges

    International Nuclear Information System (INIS)

    The purpose of this paper is to provide the background and broader vision in which the various presentations and posters on information related matters, prepared by staff of the Department of Safeguards, find their place, exploring solutions to the challenges faced. At a time when the IAEA is expected to be a reference for the assessment of nuclear proliferation issues, it faces major challenges with regard to the information needed to provide the international community with independent, impartial, timely and soundly based conclusions regarding the non-diversion of declared nuclear material and the absence of undeclared nuclear material or activities in States. The drawing of such conclusions assumes that all relevant information is accessible and has been put in the relevant context. Unfortunately, because of legal constraints under which it operates, or because of limitations on resources available for collecting existing but difficult to reach facts, or simply because of the overwhelming aspect of the information needed to properly evaluate proliferation issues, the IAEA needs to enhance the way it collects, processes, analyses, evaluates and disseminates safeguards relevant information. The search for better, broader and deeper information through dedicated collection means is an ongoing effort aimed at filling the gaps that constrain the development of the coherent picture that analysts need to be comfortable with the results of complex analyses. Implementation of well-selected information collection tools is sine qua non for effective IAEA verification capabilities. Beyond collection, the establishment of a proper information architecture and documented business processes is a prerequisite for ensuring that the available information is accessible to those with a need to know. At the same time, information must be sufficiently protected by appropriate security measures, particularly when hacking has become an intellectual sport and institutional security

  11. Socio–affective development in primary teachers’ initial training

    Directory of Open Access Journals (Sweden)

    María Pilar Teruel Melero

    2009-04-01

    Full Text Available This article begins by analysing the importance of socio-affective education at school, considering that it should be framed within ethics. It then analyses why it is important to train primary teachers in emotional education, advocating that it should be articulated around two basic standpoints: theoretical training and personal, experienced training, highlighting that the second one is crucial in order for primary teachers to emotionally educate their pupils. The article further focuses on the main socio-affective competences the primary teacher should have to face the challenges of education in such an unsettled and complex world as ours, positioning ourselves in favour of a socio-affective, experienced and active methodology. Finally, we provide an overview of emotional education in the Spanish school system and in primary teacher initial training curricula.

  12. Rotary endodontics in primary teeth – A review

    Directory of Open Access Journals (Sweden)

    Sageena George

    2016-01-01

    Full Text Available Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the “gold-standard” over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel–titanium (Ni–Ti rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel–titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

  13. Primary cutaneous T-cell lymphomas: a review.

    Science.gov (United States)

    Sidiropoulos, Konstantinos G; Martinez-Escala, M Estela; Yelamos, Oriol; Guitart, Joan; Sidiropoulos, Michael

    2015-12-01

    Primary cutaneous T-cell lymphomas (CTCLs) represent a number of extranodal lymphomas arising from a malignant population of lymphocytes in the skin, with the most common type being mycosis fungoides (MF) representing half of all primary CTCLs. Despite advances in immunohistochemistry and molecular methodology, significant diagnostic challenges remain due to phenotypic overlap of primary CTCLs with several inflammatory dermatoses, secondary lymphomas, among other conditions. Clinical features such as presentation and morphology, staging, histology, immunophenotype and molecular features must be considered in detail before a diagnosis is made in order to minimise false-positive, false-negative and indeterminate diagnoses. Herein, we review primary CTCLs, including epidemiological data, a brief summary of clinical presentations, immunophenotype, molecular signatures and differential diagnoses. PMID:26602417

  14. Community nurses working in piloted primary care teams: Irish Republic.

    LENUS (Irish Health Repository)

    Burke, Triona

    2010-08-01

    Primary care health services in the Irish Republic have undergone fundamental transformation with the establishment of multidisciplinary primary care teams nationwide. Primary care teams provide a community-based health service delivered through a range of health professionals in an integrated way. As part of this initiative ten pilot teams were established in 2003. This research was undertaken in order to gain an understanding of nurse\\'s experiences of working in a piloted primary care team. The methodology used was a focus group approach. The findings from this study illustrated how community nurse\\'s roles and responsibilities have expanded within the team. The findings also highlighted the benefits and challenges of working as a team with various other community-based health-care disciplines.

  15. Cancer of unknown primary origin: a case report

    Directory of Open Access Journals (Sweden)

    Elisa De Carlo

    2013-03-01

    Full Text Available Carcinoma of unknown primary origin (CUP accounts for 2-10% of all malignancies. The apparent absence of the primary tumour, the development of early, uncommon systemic metastases and the resistance to therapy and poor prognosis are hallmarks of this heterogeneous clinical entity and are a challenge for physicians. The diagnostic workup of patients with CUP includes a large amount of histopathological examination, as well as the use of imaging techniques that often fail to identify the primary tumour. Therefore, the optimal workup and treatment for these patients remains to be determined. Molecular diagnostic tools, such as DNA microarray analysis, could help in the search for "lost" CUP origin and guide the further treatment approach. We report the case of a 66-year-old man, with mediastinal lymph nodes metastasis of carcinoma and neurological syndrome with diplopia and balance disorders, in which many exams have been performed without finding the primary tumour.

  16. Perspectives on English Teacher Development in Rural Primary Schools in China

    Science.gov (United States)

    Ping, Wang

    2013-01-01

    Questionnaires are used to examine Chinese rural primary school English teachers' needs and challenges and perceptions in the implementation of Standards for Teachers of English in Primary Schools as professional development in rural school contexts in China. A total of 300 teachers participated in the research. Their feedback illustrates…

  17. Preformed resin-veneered stainless steel crowns for restoration of primary incisors.

    Science.gov (United States)

    Croll, T P; Helpin, M L

    1996-05-01

    Stainless steel crown forms with bonded resin veneers for primary incisors are commercially available to dentists. This type of preveneered crown was developed to serve as a convenient, durable, reliable, and esthetic solution to the difficult challenge of restoring severely carious primary incisors. This article describes preveneered crowns, reviews their advantages and disadvantages, and details a technique for placement of such restorations.

  18. Learned Helplessness in Inclusive Music Classrooms: Voices of Hong Kong Primary Schools Music Teachers

    Science.gov (United States)

    Wong, Marina Wai-yee; Chik, Maria Pik-yuk

    2015-01-01

    In Hong Kong, inclusive education is concerned with educating all students, including those who are categorised as having special educational needs (SEN). This qualitative study reports three challenges faced by primary schools music teachers required to implement inclusive education. The first two challenges echo those reported…

  19. Religious Diversity in Primary Schools: Reflections from the Republic of Ireland

    Science.gov (United States)

    Faas, Daniel; Darmody, Merike; Sokolowska, Beata

    2016-01-01

    Growing secularisation of the population and the arrival of new culturally and religiously diverse migrants are posing new challenges to schools in the Republic of Ireland (Ireland). These challenges are particularly acute in Irish primary schools, the majority of which are under Catholic patronage. Recent changes have necessitated an extensive…

  20. The new Australian Primary Health Networks: how will they integrate public health and primary care?

    Science.gov (United States)

    Booth, Mark; Hill, Graham; Moore, Michael J; Dalla, Danielle; Moore, Michael G; Messenger, Anne

    2016-01-01

    On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities. PMID:26863166