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Sample records for challenge primary omental

  1. Recurrent Omental Hemangiopericytoma: A Therapeutic Challenge

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    Sara Jaber

    2016-01-01

    Full Text Available Hemangiopericytomas are vascular tumors with a susceptibility to arise anywhere in the human body. We present a case of a 68-year-old female with primary omental hemangiopericytoma and a two-time recurrence managed with surgery and close follow-up. The first recurrence was at 52 months and the second at 37 months following the prior presentation. No adjuvant chemotherapy or radiation therapy was administered. Given the widespread nature of the cell of origin, routine follow-up postoperatively with interval imaging in order to detect recurrences is imperative. Pathologic tumor characteristics may determine potential for recurrence and may also assist in determining whether adjuvant treatment modalities should be included in the management plan. Review of the English literature reveals a total of 24 cases of omental hemangiopericytomas inclusive of the current report.

  2. 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.

  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. Primary Omental Hydatid Cyst”: A Rare Entity

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    Shailesh Sable

    2012-01-01

    Full Text Available Hydatid cyst is caused by the parasite Echinococcus granulosus commonly seen in temperate regions. Primary omental hydatid cyst is rare entity. Diagnosis can be achieved with contrast-enhanced computed tomography of abdomen and pelvis along with serology. Eosinophilia is a strong pointer to hydatid cyst as a differential diagnosis. Open or laparoscopic excision of the cyst along with medical therapy remains the treatment of choice.

  5. Primary omental torsion in a 12-year-old boy

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    曹文刚; 张金哲

    2001-01-01

    @@Primany omental torsion (POT), known since 1899, is a disease that usually occurs in the fourth and fifth decades of life. Men are affected twice as frequently as women, with the majority being overweight.1 It is a rare acute abdomen among children, which should call for the special awareness of pediatric surgeons.

  6. Acute primary haemorrhagic omental torsion mimicking perforated appendicitis: an unorthodox surgical paradox.

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    Rehman, Abdul

    2014-08-01

    Acute primary haemorrhagic omental torsion is an atypical and deceptive cause of acute abdomen that could closely mimic a myriad of intra-abdominal catastrophes, especially perforated appendicitis. The author reports a 30 years man who had presented with gradually worsening right-sided abdominal pain of 2 days duration. Laboratory work-up and abdominal radiographs were inconclusive. Abdominal sonography detected presence of free fluid in the pelvic cul-de-sac. Based on clinical and sonographic findings, presumptive diagnosis of perforated appendicitis was made and the patient was explored through extended Rockey-Davis incision. About 500 - 700 ml of dark-coloured blood (haemoperitoneum) was present in the peritoneal cavity and the pelvis secondary to acute haemorrhagic omental torsion. The appendix was grossly normal. Omentectomy and prophylactic appendicectomy resulted in uneventful recovery of the patient. Acute primary omental torsion is an uncommon pathology that must be kept in mind during differential diagnosis of acute abdomen, especially acute or perforated appendicitis.

  7. Primary omental actinomycosis as a differential diagnosis of acute appendicitis in children. Case report

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    Sergio Castañeda

    2016-09-01

    Full Text Available Actinomycosis is a chronic suppurative granulomatous inflammation caused by Actinomyces species. Abdominal actinomycosis is a rare condition, with very low incidence in childhood, and usually associated to trauma or perforation of hollow viscera. We are presenting a case of a ten-year-old boy with omental actinomycosis mimic and appendiceal infection, without a history of trauma or perforation, suggesting a hemmatogen spread. The complete resection of the affected tissue may warrant a cure in spite of a short antibiotic curse.

  8. 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.

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

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    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.

  10. Effects of Rosmarinus officinalis extract on human primary omental preadipocytes and adipocytes.

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    Stefanon, Bruno; Pomari, Elena; Colitti, Monica

    2015-07-01

    The prevalence of obesity is increasing all over the world. Although it has been shown that natural substances influence fat metabolism, little is known about the effect on cellular and molecular mechanisms in human. In this in vitro study, the activity of Rosmarinus officinalis (RO) standardized extract in modulating human primary visceral preadipocytes differentiation, lipolysis, and apoptosis was investigated. Moreover, gene expression of key adipogenesis modulators and microRNAs-seq were evaluated. Preadipocytes treated with RO extract significantly reduced triglyceride incorporation during maturation in a dose-dependent manner without affecting cell viability. In addition, RO extract stimulated lipolytic activity in differentiating preadipocytes and mature adipocytes in treated cells compared to controls. Differentiating preadipocytes incubated in the presence of RO extract showed a decreased expression of cell cycle genes such as cyclin D1, cyclin-dependent kinase 4, cyclin-dependent kinase inhibitor 1A (p21, Cip1) and an increased expression of GATA binding protein 3, wingless-type MMTV integration site family, member 3A mRNA levels. Recent studies have demonstrated that some phytochemicals alter the expression of specific genes and microRNAs that play a fundamental role in the pathogenesis of obesity and related diseases. Interestingly, genes modulated in RO-treated cells were found to be validated miRNAs targets, such as let-7f-1, miR-17, and miR-143. The results indicated that RO extract modulates human adipocyte differentiation and significantly interferes with adipogenesis and lipid metabolism, supporting its interest as dietary supplement.

  11. Strangulated double omental hernia presenting as an epigastric lump.

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    Mukherjee, Ramanuj; Paira, Susil Kumar; Ghosh, Parthasarathi; Halder, Sandip K; Roy, Bipradas; Ray, Debasis; Mukherjee, Saibal Kumar

    2012-09-01

    Internal herniations constitute one of the relatively uncommon surgical emergencies. Among them double omental hernia with bowel strangulation is very rare and is a major diagnostic challenge. A case of a strangulated double omental hernia in a 42-year-old female patient is reported. The patient presented with a painful tender epigastric lump.There was a diagnostic dilemma. CT scan was followed by laparotomy which revealed a strangulated double omental hernia.

  12. Omental Infarction Mimicking Cholecystitis

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    David Smolilo

    2015-01-01

    Full Text Available Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction.

  13. Omental infarction in an obese 10-year-old boy

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    Katerina Kambouri

    2011-09-01

    Full Text Available Primary omental infarction (POI has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intraoperative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.

  14. CT findings of benign omental lesions following abdominal cancer surgery

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    Lee, Sang Yun; Kim, Dong Won; Cho, Jin Han; Kwon, Hee Jin; Ha, Dong Ho; Oh, Jong Young [Diagnostic Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of)

    2016-07-15

    The greater omentum is the largest peritoneal fold and can be the origin of primary pathologic conditions, as well as a boundary and conduit for disease processes. Most diseases involving the omentum manifest with nonspecific and overlapping features on computed tomography (CT). In particular, varying benign disease processes of traumatic, inflammatory, vascular, or systemic origin can occur in the omentum during the follow-up period after surgery for intra-abdominal malignancy. It can be challenging for radiologists due to various spectrum of CT findings. Thus, we reviewed the CT findings of various benign omental lesions after surgery for intra-abdominal malignancy.

  15. An omental teratoma in a young girl

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    Bhushan N. Wani

    2011-12-01

    Full Text Available Teratoma is the most commonly encountered germ cell tumour among the most common ovarian tumours; however, teratomas of the omentum and mesentery are extremely rare. They are usually asymptomatic or can produce compressive symptoms. The imaging features are suggestive. The present report describes such a case of primary omental teratoma encountered in a young patient, which was managed by surgical resection. The histopathological examination confirmed the diagnosis of mature cystic teratoma. Germ cell tumors are congenital tumors containing derivatives of all the three germinal layers, frequently seen in gonads. But their occurrence in extragonadal sites, such as omental teratoma, is relatively rare.

  16. 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.

  17. 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.

  18. Omental Lipid-Coated Mesh

    Science.gov (United States)

    2011-06-16

    civilian medicine. REFERENCES: 1. Takada T, Kamei Y, Iwata T, et al. Effect of Omental Lipid Fraction on Enhancement of Skin Flap Survival. Annals of...Characterization of Feline Omentum Lipids. Lipids, 1987; 22:229-235. 7. Nottebaert M, Lane J, Juhn A, et al. Omental Angiogenic Lipid Fraction and

  19. Left-sided omental torsion: CT appearance

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    Aoun, N.; Haddad-Zebouni, S.; Slaba, S.; Ghossain, M. [Hotel-Dieu de France Hospital, Beirut (Lebanon). Dept. of Radiology; Noun, R. [Hotel-Dieu de France Hospital, Beirut (Lebanon). Dept. of General Surgery

    2001-01-01

    A 34-year-old male presented with exquisite left flank pain. Computed tomography showed a hyperdense vascular structure surrounded by whirling linear streaks situated in the greater omentum under the splenic flexure of the colon. Omental stranding extended caudally into the pelvis where part of the inflamed omentum entered a left inguinal hernia sac. Surgery revealed left-sided torsion of the greater omentum. Left-sided omental torsion is infrequent and pre-operative diagnosis is rarely established. The CT findings of an omental fatty mass with a whirling pattern is characteristic of omental torsion. Preoperative diagnosis is important because conservative management has been suggested. (orig.)

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

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    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

  1. Challenges in developing drugs for primary headaches

    DEFF Research Database (Denmark)

    Schytz, Henrik Winther; Hargreaves, Richard; Ashina, Messoud

    2017-01-01

    This review considers the history of drug development in primary headaches and discusses challenges to the discovery of innovative headache therapeutics. Advances in headache genetics have yet to translate to new classes of therapeutics and there are currently no clear predictive human biomarkers......, there have been many near misses and failures in the discovery and development of headache therapeutics. Glutamate receptor antagonism whilst efficacious has central side effects and some approaches such as nitric oxide synthase inhibition, substance P antagonism and cortical spreading depression blockade...

  2. 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.

  3. Surgical Management of Enteric Perforation by Using Omental Patch : A Prospective Study of 60 Patients

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    Sunder Goyal

    2013-04-01

    Full Text Available Enteric perforation is a serious complication of typhoid fever. Depending upon the bowel condition, primary closure of perforation is the treatment of choice. Development of fecal fistula is the key apprehension in primary closure. The purpose of this study is to find out the benefit of an omental patch when used over primary closure. It is a small study of 60 patients, which were divided into two groups: Group I - Primary closure with omental patch, and Group II - only primary closure. The outcomes were measured in relation to wound infection, fecal fistula, wound dehiscence, and intra-abdominal abscess. The incidence of complications including fecal fistula and mortality is significantly lower in the group-I patients. Fecal fistula occurs in 13.33% in group II, while in only 3.3% in group I. There was no significant difference in the incidence of wound infection and wound dehiscence. Primary closure with an omental patch is a better option compared with only primary closure in enteric perforation patients. It can be suggested as an alternative method to primary closure only in selective enteric perforation patients. [Arch Clin Exp Surg 2013; 2(2.000: 80-84

  4. An estimation of diazinon in omental tissue.

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    Kirkbride, K P

    1987-01-01

    A fatality in which diazinon was the suspected toxic agent was investigated. Samples of omental tissue, blood, and liver tissue were examined by gas chromatography and thin layer chromatography. Diazinon was found in the omentum (at a level of 5.1 mg/kg) and blood (in a trace amount), but no diazinon was found in the liver tissue. Methods are given for the extraction of diazinon from omental fat, the purification of these extracts by sweep co-distillation and fat precipitation, and for an estimation of the amount of diazinon present. It is not possible to determine whether the low level found arose from chronic occupational exposure, accidental dermal contact, or ingestion of a lethal dose.

  5. Omental fibroma: CT and US findings

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    Paksoy, Y.; Acikgoezoglu, S.; Oedev, K. [Department of Radiology, Selcuk Univ., Konya (Turkey); Sahin, M. [Department of General Surgery, Selcuk Univ., Konya (Turkey); Oemeroglu, E. [Department of Pathology, Selcuk Univ., Konya (Turkey)

    1998-10-01

    The US, CT, and X-ray findings in a patient with omental fibroma of the lesser omentum are described. Ultrasound showed a solid mass with cystic areas in the central region. At CT the lesion showed peripheral enhancement and central hypodensity. On X-ray studies with barium, there was border distortion in the lesser curvature of the stomach. The mass was resected surgically. A pathologic diagnosis of fibroma was confirmed. (orig.) (orig.) With 5 figs., 8 refs.

  6. Teaching Challenging Topics with Primary Sources

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    Singer, Alan J.

    2012-01-01

    The most common activity in a social studies classroom should be the analysis of primary sources. Students are intrigued and engaged by edited and unedited documents, written statements, transcribed speeches, photographs, pictures, charts, graphs, cartoons, and even material objects. Ideally, the goal of social studies teachers is to prepare…

  7. Quality Primary Schooling an Open Global Challenge

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    Sayyed Farooq Shah

    2015-11-01

    Full Text Available This article draws upon research undertaken for exploring those factors and indicators which directly or indirectly influence the primary schooling quality and explores the efforts and steps taken by UNESCO, Education For All(EFA, and WORLD DAKAR FORUM and most recently by Mellinium Development Goal(MGD announced for 2015 as well. Relevant Data were collected from the above mentioned forums and from the teaches, head teachers, parents, policy makers, stake holders and learners to some extent, their views, expert opinions, expressions thoughts were filtered and international seminars announcements were also taken as model. At the end common view point was developed about the quality enhancing factors especially at primary level of schooling

  8. Primary Hepatic Lymphoma: A Challenging Diagnosis

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    D. Myoteri

    2014-01-01

    Full Text Available Introduction. Primary hepatic lymphoma is an unusual malignancy and is very difficult to diagnose promptly. An intrigue case presenting with cholestatic jaundice is reviewed and main disease characteristics are further discussed. Case Report. A 70-year-old male presented with dull right upper quadrant abdominal pain and mild cholestatic jaundice. Initial evaluation revealed mildly elevated liver function tests and normal tumor markers, while imaging with an abdominal CT-scan showed multiple hypodense nodules in both liver lobes. First impression of metastatic deposits from gastrointestinal origin was not confirmed by endoscopic means. After CT-guided biopsy, primary diffuse large B-cells non-Hodgkin lymphoma was revealed. Appropriate chemotherapy improved patient’s condition markedly. Discussion. Primary hepatic lymphoma is a rare form of extranodal lymphomas, accounting for less than 1% of all extranodal lymphomas in general. In order to define the condition as PHL, liver has to be the only site of lymphoma occurrence or to be involved in a major degree with minimal nonliver disease. Most PHLs are of B-cell origin with large cells as the main cell type.

  9. IDIOPATHIC OMENTAL INFARCTION : A RARE CAUSE OF ACUTE PAIN ABDOMEN

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    Narendra Nath

    2015-02-01

    Full Text Available Omental torsion leading on to omental infarction is an unusual cause of acute abdominal pain in adults. Often the condition mimics common causes of acute abdomen like acute cholecystitis, acute appendicitis or acute pancreatitis. A review of literature reveals that this enigmatic condition has been managed both non - operatively and by surgery in the past. We report the case of a 46 - year - old man who presented with a 4 - day history of severe right - sided abdominal pain mimicking acute cholecystitis. Abdominal CT scan revealed a right upper quadrant mass with a whirl - like appearance, suspicious for omental infarction. He was started on conservative management with analgesics and antibiotics. He improved symptomatically and was discharged

  10. School choice : challenge to Sharpeville public primary school principals

    OpenAIRE

    2012-01-01

    M.Ed. This qualitative phenomenological study focuses on school choice as challenge to principals of Sharpeville public primary schools. Different aspects of these choices are explored. School choice is an important component of parental involvement in the education of their children. Parents and learners tend to be open about their right through the support of the Schools Act 84 of 1996. You may not discriminate on the basis of race trough the language policy at your school. This means th...

  11. Lesser omental hernia after total colectomy: report of a case.

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    Konishi, Takanori; Morita, Yasuhiro; Takanishi, Kijuro; Nitta, Jun; Matsumoto, Jun; Miyazaki, Masaru

    2014-07-01

    Lesser omental hernia is a rare type of hernia that can cause intestinal obstruction. To our knowledge, there are only 16 documented cases of lesser omental hernia, including the present case. The subject of this case report was a 42-year-old man with a history of total colectomy for colon perforation caused by Crohn's disease 15 years earlier, who presented with epigastralgia and vomiting. Abdominal computed tomography (CT) revealed a distended bowel loop ventral to the stomach and convergence of mesenteric vessels at the lesser curvature of the stomach. Based on a diagnosis of intestinal obstruction caused by a lesser omental hernia, he underwent emergency surgery, which revealed a 150-cm jejunal segment herniating through a 5-cm defect in the lesser omentum from the retrogastric space. We reduced the herniated loop and closed the hernial orifice successfully. We describe the characteristic CT findings, which allowed us to make the preoperative diagnosis, and speculate how the past total colectomy, in which the gastrocolic ligament was isolated and the transverse colon was resected, probably caused by this hernia. This case serves to demonstrate that lesser omental hernia could be a postoperative complication of total colectomy.

  12. Proteomic analysis of bovine omental, subcutaneous and intramuscular preadipocytes during in vitro adipogenic differentiation.

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    Rajesh, Ramanna Valmiki; Heo, Gang-Nyung; Park, Mi-Rim; Nam, Jin-Seon; Kim, Nam-Kuk; Yoon, Duhak; Kim, Tae-Hun; Lee, Hyun-Jeong

    2010-09-01

    Given the substantial rise in obesity, depot-specific fat accumulation and its associated diseases like diabetes, it is important to understand the molecular basis of depot-specific adipocyte differentiation. Many studies have successfully exploited the adipocyte differentiation, but most of them were not related to depot-specificity, particularly using freshly isolated primary preadipocytes. Using 2-dimensional polyacrylamide gel electrophoresis coupled with sequencing mass spectrometry, we searched and compared the proteins differentially expressed in undifferentiated and differentiated preadipocytes from bovine omental, subcutaneous and intramuscular adipose depots. Our proteome mapping strategy to identify differentially expressed intracellular proteins during adipogenic conversion revealed 65 different proteins that were found to be common for the three depots. Further, we validated the differential expression for a subset of proteins by immunoblotting analyses. The results demonstrated that many structural proteins were down-regulated during differentiation of preadipocytes from all the depots. Most up-regulated proteins like Ubiquinol-cytochrome-c reductase complex core protein I (UQCRC1), ATP synthase D chain, Superoxide dismutase (SOD), Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), Sulfotransferase 1A1 (SULT1A1), Carnitine O-palmitoyltransferase 2 (CPT2) and Heat-shock protein beta 1 (HSPB1) across the three depots were found to be associated with lipid metabolism and metabolic activity. Further, all the up-regulated proteins were found to have higher protein expression in omental than subcutaneous or intramuscular depots.

  13. Primary Adenocarcinoma of Appendix Presenting as Omental Metastasis

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    Arun Gupta, Subhash Bhardwaj, Jyotsna Suri

    2001-07-01

    Full Text Available The adenocarcinoma of appendix is a rare entity The patients present usually with symptoms ofappendicitis, a palpable abdominal mass or rarely as a complication of pseudomyxoma peritonei,We report a case who presented with lump abdomen and ascitis and revealed a tiny infiltrativegrowth at the base of appendix at laparotomy

  14. 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.

  15. 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.

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

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    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.

  17. 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.

  18. From colleague to patient: ethical challenges in integrated primary care.

    Science.gov (United States)

    Kanzler, Kathryn E; Goodie, Jeffrey L; Hunter, Christopher L; Glotfelter, Michael Ann; Bodart, Jennifer J

    2013-03-01

    Ethical codes and guidelines for mental health professionals focus on traditional avenues of practice, leaving considerable gaps for clinicians in unique settings, such as behavioral health providers in integrated primary care. In this article, an ethical scenario is presented, where a behavioral health provider is faced with a colleague physician seeking assistance for emotional distress. The scenario highlights important ethical questions about multiple relationships/conflict of interest, impaired colleagues, informed consent, and confidentiality. We review gaps in ethical guidance pertinent to the scenario and provide an eight-step rubric for ethical clinical decision making in integrated primary care.

  19. 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.

  20. Left-sided omental torsion with inguinal hernia

    Institute of Scientific and Technical Information of China (English)

    Yasumitsu Hirano; Kaeko Oyama; Hiroshi Nozawa; Takuo Hara; Koichi Nakada; Masahiro Hada; Takeshi Takagi; Makoto Hirano

    2006-01-01

    We report a case of surgically proved left-sided torsion of the greater omentum that caused secondary by untreated inguinal hernia. Case A 36-year-old man presented to our hospital with abdominal pain. He had been diagnosed with a left inguinal hernia, but he had not received any treatments. Contrast-enhanced computed tomography (CT) of the abdomen showed a large fat density mass below the Sigmoid colon and left inguinal hernia with incarcerated fat. Exploratory laparotomy revealed torsion of the greater omentum with small bloody ascites. The greater omentum was twisted into one and a half circles and entered into a left inguinal hernia. An omentectomy with a repair of left inguinal hernia was performed. A resected omentum was submitted for pathological examination, which showed hemorrhagic infarction. Omental torsion is a rare cause of acute abdominal pain but should be included in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.

  1. 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.…

  2. Administration to innovation: the evolving management challenge in primary care.

    Science.gov (United States)

    Laing, A; Marnoch, G; McKee, L; Joshi, R; Reid, J

    1997-01-01

    The concept of the primary health-care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care-led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health-care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. Focusing on the career backgrounds of practice managers, their range of responsibilities, and their involvement in innovation in general practice, presents a preliminary account of a chief scientist office-funded project examining the role being played by practice managers in primary health-care innovation. More specifically, utilizing data gained from the ongoing study, contextualizes the role played by practice managers in the primary health-care team. By exploring the business environment surrounding the NHS general practice, the research seeks to understand the evolving world of the practice manager. Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research.

  3. 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.

  4. A Challenging Case of Primary Breast Hodgkin's Lymphoma

    Science.gov (United States)

    ZARNESCU, Narcis Octavian; ILIESIU, Andreea; PROCOP, Alexandru; TAMPA, Mircea; MATEI, Clara; SAJIN, Maria; COSTACHE, Mariana; DUMITRU, Adrian; LAZAROIU, Anca Mihaela

    2015-01-01

    Primary breast lymphoma (PBL) is a rare entity accounting for less than 1% of all breast malignancies. Diagnostic criteria for primary Hodgkin's lymphoma of the breast are: the presence of sufficient tissue for diagnosis, close interaction between mammary tissue and lymphomatous infiltrate and no evidence or prior diagnosis of widespread lymphoma. Our case illustrates an unusual presentation of Hodgkin's lymphoma of the breast: clinically as inflammatory breast cancer and core biopsy as granulomatous mastitis, the final diagnosis requiring surgical biopsy. Current information regarding this entity is scant, mainly build upon its rarity. In this paper we assess the clinical presentation, the step-by-step diagnosis, the treatment and the importance of immunohistochemistry in this uncommon condition. PMID:26225149

  5. Measurement of cold challenge responses in primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis.

    OpenAIRE

    O'Reilly, D; Taylor, L.; el-Hadidy, K; Jayson, M I

    1992-01-01

    Using computed thermography continuous temperature recordings were made before and after cold challenge of the fingers of control subjects and patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis. Basal skin temperature measurements (Tpre) were significantly lower in patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis than in the controls. Temperatures immediately after cold challenge (T0) wer...

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. Metastasis of a Prostatic Carcinoma along an Omental Graft in a Dog

    Directory of Open Access Journals (Sweden)

    Terry M. Jacobs

    2013-01-01

    Full Text Available An 11-year-old male American Bulldog was presented for hematuria and tenesmus. It had been treated for chronic bacterial prostatitis with abscessation two years earlier and underwent castration and a prostatic omentalization procedure. There was no histologic evidence of prostatic neoplasia at that time. On physical examination, an enlarged prostate was found by rectal palpation, and it was characterized with ultrasonography and computed tomography. Surgical biopsies were obtained, and histopathology identified prostatic adenocarcinoma. It received carprofen and mitoxantrone chemotherapy in addition to palliative radiation therapy; it was euthanized six weeks later due to a progression of clinical signs. Necropsy findings included marked localized expansion of the prostatic tumor and dissemination of prostatic carcinoma cells throughout the peritoneal cavity along the omental graft with infiltration onto the serosal surfaces of most abdominal viscera and fat. This case represents a previously unreported potential complication of the omentalization procedure wherein carcinoma cells from a prostatic tumor that independently arose after omentalization may have metastasized along the surgically created omental graft.

  12. The challenges of pain management in primary care: a pan-European survey

    Directory of Open Access Journals (Sweden)

    Johnson M

    2013-05-01

    Full Text Available Martin Johnson,1 Beverly Collett,2 José M Castro-Lopes3On behalf of OPENMinds Primary Care1Community Pain Medicine, Cardiff University, Cardiff, UK; 2Pain Management Service, University Hospitals of Leicester NHS Trust, Leicester, UK; 3Department of Experimental Biology, Faculty of Medicine of the University of Porto, Porto, PortugalBackground: The OPENMinds Primary Care group is a group of European primary care physicians (PCPs with an interest in pain management, formed to improve the understanding and management of chronic pain in primary care.Objective: A survey was conducted to assess the challenges of chronic nonmalignant pain (CNMP management in primary care in Europe, focusing particularly on pain assessment, opioid therapy, and educational needs.Methods: A questionnaire was developed for online use by PCPs in 13 European countries (Belgium, Denmark, France, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Spain, Sweden, and the UK.Results: A total of 1309 PCPs completed the questionnaire, approximately 100 from each country. Most PCPs (84% perceived CNMP to be one of the most challenging conditions to treat, yet a low priority within healthcare systems. Only 48% of PCPs used pain assessment tools, and 81% considered chronic pain and its impact on quality of life to be underassessed in primary care. PCPs were less confident about prescribing strong opioids for CNMP than for use in cancer pain. Most PCPs (84% considered their initial training on CNMP was not comprehensive, with 89% recognizing a need for more education on the topic.Conclusion: These findings reveal that PCPs in Europe find CNMP a challenge to treat. Areas to address with training include underuse of pain assessment tools and lack of confidence in use of opioid therapy. Guidelines on CNMP management in primary care would be welcomed. The insights gained should provide the basis for future initiatives to support primary care management of chronic pain

  13. Educational challenges of internal migrant girls: a case study among primary school children in Turkey

    NARCIS (Netherlands)

    Altinyelken, H.K.

    2009-01-01

    This article seeks to investigate education-related challenges encountered by internal migrant girls studying at primary schools in Turkey. From the perspectives of participants, the emerging themes included adaptation, language, low socio-economic status, peer relations, discrimination and bullying

  14. 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

  15. Pragmatic trials in primary care: Methodological challenges and solutions demonstrated by the DIAMOND-study

    NARCIS (Netherlands)

    Fransen, G.A.J.; Marrewijk, C.J. van; Mujakovic, S.; Muris, J.W.M.; Laheij, R.J.F.; Numans, M.E.; Wit, N.J. de; Samsom, M.; Jansen, J.B.M.J.; Knottnerus, J.A.

    2007-01-01

    BACKGROUND: Pragmatic randomised controlled trials are often used in primary care to evaluate the effect of a treatment strategy. In these trials it is difficult to achieve both high internal validity and high generalisability. This article will discuss several methodological challenges in designing

  16. Preventing violence against women by challenging gender stereotypes in Scottish primary schools

    DEFF Research Database (Denmark)

    Fage-Butler, Antoinette Mary

    2016-01-01

    Gender violence is a major public health issue in Europe; it is normalized and partly legitimized by gender stereotypes. An example of a primary prevention education programme designed to challenge the attitudes that underpin gender violence, particularly violence against women, is the Zero...... Tolerance Respect (ZTR) programme developed for Scottish pupils. Given the importance of early preventative action in this area, this paper analyses how gender stereotypes were challenged in ZTR materials for primary pupils aged 10-12 years. Qualitative content analysis was used to analyse the content...... of the seven lessons in the ZTR primary school programme; the materials were also evaluated in relation to best practice within attitudinal change promotion. Analysis shows that ZTR empowers pupils to reflect on and confront gender stereotypes by developing pupils’ social awareness, as respect is characterized...

  17. General practitioners’ views on leadership roles and challenges in primary health care: a qualitative study

    Science.gov (United States)

    Spehar, Ivan; Sjøvik, Hege; Karevold, Knut Ivar; Rosvold, Elin Olaug; Frich, Jan C.

    2017-01-01

    Objective To explore general practitioners’ (GPs) views on leadership roles and leadership challenges in general practice and primary health care. Design We conducted focus groups (FGs) with 17 GPs. Setting Norwegian primary health care. Subjects 17 GPs who attended a 5 d course on leadership in primary health care. Results Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement. Conclusions GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance. Key points Little is known about doctors’ experiences and views about leadership in general practice and primary health care. Our study suggests that: There is a lack of preparation and formal training for the leadership role. GPs experience tensions between the clinical and leadership role. GPs recognize leadership challenges at a system level and that doctors should take on leadership roles in primary health care. PMID:28277051

  18. 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...

  19. Laparoscopic Harvest of Omental Flaps for Reconstruction of Complex Mediastinal Wounds

    Science.gov (United States)

    Salameh, Jihad R.; Chock, Deborah A.; Gonzalez, John J.; Koneru, Suresh; Glass, Jeffrey L.

    2003-01-01

    Background: Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often high-risk patients, thus making it the procedure of last resort. Methods: The charts of all patients who underwent a laparoscopic omental harvest at the Texas Endosurgery Institute were retrospectively reviewed. Results: Seven patients, 4 males and 3 females with an average age of 65.1±6.3 years, with complex mediastinal wounds following coronary artery bypass grafting were studied. All patients underwent laparoscopic harvest of omental flaps based on the right gastroepiploic artery (3), the left gastroepiploic artery (1) or both (3), along with pectoralis major myocutaneous advancement flaps in 5 patients and partial-thickness skin graft and a vacuum-assisted closure device in 2 patients. The average operative time for the entire procedure was 196±54 minutes. Enteric feedings could be tolerated early postoperatively with a mean of 3.8 days. One death (14.2%) occurred. All surviving patients had excellent wound healing results at a mean follow-up of 19.1 months. Conclusion: Laparoscopic harvest of omental flaps for the reconstruction of complex mediastinal wounds is a valid and potentially less morbid alternative for the treatment of this infrequent but disastrous complication of open heart surgery. PMID:14626397

  20. Resternal closure versus pectoral muscle flap following omental flap in treatment of deep sternal wound infection

    Directory of Open Access Journals (Sweden)

    Fouad Rassekh

    2016-05-01

    Conclusion: Omental flap is safe, easy and effective technique in management of mediastinitis with DSWI following open heart surgery in CABG patients either this procedure was followed by reclosure of the sternum or bilateral pectoral flap. However, reclosure of the sternum is more physiological and less invasive than doing bilateral pectoral flap leaving the sternum unclosed.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Healthcare professionals' accounts of challenges in managing motor neurone disease in primary healthcare: a qualitative study.

    Science.gov (United States)

    Lerum, Sverre Vigeland; Solbraekke, Kari Nyheim; Frich, Jan C

    2017-02-22

    Motor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis and respiratory failure, with a life expectancy of 2-4 years. In order to better understand how MND is managed in the community, we conducted a qualitative study to explore the challenges healthcare professionals encounter when managing MND in primary healthcare. Based on data from 15 semi-structured interviews with primary healthcare professionals in Norway, we found that MND is viewed as a condition that requires exceptional effort and detailed planning. Healthcare professionals reported five main challenges in managing MND in primary healthcare: (i) building relationships with those giving and receiving care in the home; (ii) preventing caregiver burnout and breakdown; (iii) providing tailored care; (iv) ensuring good working conditions in patients' homes; and (v) recruiting and retaining qualified nursing assistants. Healthcare professionals reported needing working conditions that allow them to tailor their approach to the personal, emotional and existential nature of care preferences of those living with MND. However, people with MND and their families were sometimes perceived by healthcare professionals to prefer a strictly task-focused relationship with care providers. Such relationships limited the healthcare professionals' control over the MND trajectory and their capacity to prevent family caregiver burnout and breakdown. Adequate resources, along with training and support of nursing assistants, may increase the continuity of nursing assistants. Responsiveness to patient and family needs may enhance collaboration and promote tailored primary care and support for patients with MND and their families.

  7. A Diagnostic Dilemma of Recurrent Disseminated Peritoneal Leiomyomatosis with Hypertrophied Omental Vessels: Imaging and Embolization of Omental Branches with Positive Outcome

    Science.gov (United States)

    Mohan, Chander; Hans, Deepak; Vora, Maulik

    2017-01-01

    We present a case report of recurrent disseminated peritoneal leiomyomatosis in a 30-year-old female with a past history of laparoscopic myomectomy by a technique of morcellation for a large fibroid in 2014. After one year she presented in 2015 with a well-defined oval shaped fibroid along the anterior abdominal wall, which was supplied by the 10th intercostal artery and a branch of right internal mammary artery. She was again presented after 1 year in 2016 with a large pelvic-abdominal fibroid with blood supply from the omental artery, a branch from the right gastroepiploic artery, and sigmoid branches of inferior mesenteric artery.

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

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    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.

  9. Facing the challenges of the One-Tablet-Per-Child policy in Thai primary school education

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    Ratchada Viriyapong

    2013-10-01

    Full Text Available The Ministry of Education in Thailand is currently distributing tablets to all first year primary (Prathom 1 school children across the country as part of the government’s “One Tablet Per Child” (OTPC project to improve education. Early indications suggest that there are many unexplored issues in designing and implementing tablet activities for such a large and varied group of students and so far there is a lack of evaluation on the effectiveness of the tablet activities. In this article, the authors propose four challenges for the improving Thailand’s OTPC project, consisting of: developing contextualised content, ensuring usability, providing teacher support, and assessing learning outcomes. A case study on developing science activities for first year primary school children on the OTPC devices is the basis for presenting possible solutions to the four challenges. In presenting a solution to the challenge of providing teacher support, an architecture is described for collecting data from student interactions with the tablet in order to analysis the current progress of students while in a live classroom setting. From tests in three local Thai schools, the authors evaluate the case study from both student and teacher perspectives. In concluding the paper, a framework for guiding mobile learning innovation is utilised to review the qualities and shortcomings of the case study.

  10. Pragmatic trials in primary care. Methodological challenges and solutions demonstrated by the DIAMOND-study

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    Samsom Melvin

    2007-04-01

    Full Text Available Abstract Background Pragmatic randomised controlled trials are often used in primary care to evaluate the effect of a treatment strategy. In these trials it is difficult to achieve both high internal validity and high generalisability. This article will discuss several methodological challenges in designing and conducting a pragmatic primary care based randomised controlled trial, based on our experiences in the DIAMOND-study and will discuss the rationale behind the choices we made. From the successes as well as the problems we experienced the quality of future pragmatic trials may benefit. Discussion The first challenge concerned choosing the clinically most relevant interventions to compare and enable blinded comparison, since two interventions had very different appearances. By adding treatment steps to one treatment arm and adding placebo to both treatment arms both internal and external validity were optimized. Nevertheless, although blinding is essential for a high internal validity, it should be warily considered in a pragmatic trial because it decreases external validity. Choosing and recruiting a representative selection of participants was the second challenge. We succeeded in retrieving a representative relatively large patient sample by carefully choosing (few inclusion and exclusion criteria, by random selection, by paying much attention to participant recruitment and taking the participant's reasons to participate into account. Good and regular contact with the GPs and patients was to our opinion essential. The third challenge was to choose the primary outcome, which needed to reflect effectiveness of the treatment in every day practice. We also designed our protocol to follow every day practice as much as possible, although standardized treatment is usually preferred in trials. The aim of this was our fourth challenge: to limit the number of protocol deviations and increase external validity. Summary It is challenging to design

  11. Omental Herniation: A Rare Complication of Vacuum-Assisted Closure of Infected Sternotomy Wound

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    Philemon Gukop

    2012-01-01

    Full Text Available Vacuum-assisted closure (VAC has recently been adopted as an acceptable modality for management of sternotomy wound infections. Although generally efficacious, the use of negative pressure devices has been associated with complications such as bleeding, retention of sponge, and empyema. We report the first case of greater omental hernia as a rare complication of vacuum-assisted closure of sternal wound infection following coronary artery bypass grafting.

  12. 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.

  13. Language barriers within primary care consultations: an increasing challenge needing new solutions.

    Science.gov (United States)

    Li, Shuangyu; Pearson, David; Escott, Sarah

    2010-11-01

    International migration is an increasing global phenomenon, particularly noticeable in the UK where removing barriers to travel and residence within an expanded European Union has brought a huge increase in new arrivals. Migration has increased the number of medical consultations where language barriers occur. This paper summarises findings from a review of the literature and explores the challenges posed within these medical consultations, particularly those in primary care. It highlights limitations to current consultation models and educational interventions to improve consultations across language barriers, and suggests future solutions to those problems.

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

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    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.

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

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    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.

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

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    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

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

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    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.

  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. Challenges for a New Bilingual Program: Implementing the International Baccalaureate Primary Years Programme in Four Colombian Schools

    Science.gov (United States)

    Lochmiller, Chad R.; Lucero, Audrey; Lester, Jessica Nina

    2016-01-01

    The International Baccalaureate (IB) has expanded in Latin America. Drawing from a larger multi-sited qualitative case study, we examined the challenges associated with the implementation of the IB Primary Years Programme (PYP) in a Colombian and bilingual context. Findings highlight (1) the intersecting nature of challenges associated with the…

  20. 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

  1. Segmental omental infarction in childhood: a typical case diagnosed by CT allowing successful conservative treatment

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    Coulier, Bruno [Clinique St. Luc, Department of Diagnostic Radiology, Bouge (Belgium)

    2006-02-01

    Segmental omental infarction (SOI) is an uncommon cause of right lower quadrant pain in children that is often misdiagnosed as appendicitis. During the last decade, imaging findings of SOI have proved to be sufficiently typical to avoid unnecessary surgery in the majority of reported adult patients. The condition has a spontaneous favourable evolution under medical treatment. In children the surgical option remains controversial. We report a typical case of SOI in a 10-year-old boy. The diagnosis was suspected by sonography, unambiguously confirmed by multidetector CT and successfully treated conservatively. This report emphasizes the use of CT in selected acute abdominal situations, peculiarly in obese children, to avoid unnecessary surgery. (orig.)

  2. Characterisation of 11β-hydroxysteroid dehydrogenase 1 in human orbital adipose tissue: a comparison with subcutaneous and omental fat

    Science.gov (United States)

    Bujalska, Iwona J; Durrani, Omar M; Abbott, Joseph; Onyimba, Claire U; Khosla, Pamela; Moosavi, Areeb H; Reuser, Tristan T Q; Stewart, Paul M; Tomlinson, Jeremy W; Walker, Elizabeth A; Rauz, Saaeha

    2007-01-01

    Glucocorticoids (GCs) have a profound effect on adipose biology increasing tissue mass causing central obesity. The pre-receptor regulation of GCs by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) that activates cortisol from cortisone has been postulated as a fundamental mechanism underlying the metabolic syndrome mediating adipocyte hyperplasia and hypertrophy in the omental (OM) depot. Orbital adipose tissue (OF) is the site of intense inflammation and tissue remodelling in several orbital inflammatory disease states. In this study, we describe features of the GC metabolic pathways in normal human OF depot and compare it with subcutaneous (SC) and OM depots. Using an automated histological characterisation technique, OF adipocytes were found to be significantly smaller (parameters: area, maximum diameter and perimeter) than OM and SC adipocytes (P<0·001). Although immunohistochemical analyses demonstrated resident CD68+ cells in all three whole tissue adipose depots, OF CD68 mRNA and protein expression exceeded that of OM and SC (mRNA, P<0·05; protein, P<0·001). In addition, there was higher expression of glucocorticoid receptor (GR)α mRNA in the OF whole tissue depot (P<0·05). Conversely, 11β-HSD1 mRNA together with the markers of late adipocyte differentiation (FABP4 and G3PDH) were significantly lower in OF. Primary cultures of OF preadipocytes demonstrated predominant 11β-HSD1 oxo-reductase activity with minimal dehydrogenase activity. Orbital adipocytes are smaller, less differentiated, and express low levels of 11β-HSD1 but abundant GRα compared with SC and OM. OF harbours a large CD68+ population. These characteristics define an orbital microenvironment that has the potential to respond to sight-threatening orbital inflammatory disease. PMID:17283228

  3. Characterisation of 11beta-hydroxysteroid dehydrogenase 1 in human orbital adipose tissue: a comparison with subcutaneous and omental fat.

    Science.gov (United States)

    Bujalska, Iwona J; Durrani, Omar M; Abbott, Joseph; Onyimba, Claire U; Khosla, Pamela; Moosavi, Areeb H; Reuser, Tristan T Q; Stewart, Paul M; Tomlinson, Jeremy W; Walker, Elizabeth A; Rauz, Saaeha

    2007-02-01

    Glucocorticoids (GCs) have a profound effect on adipose biology increasing tissue mass causing central obesity. The pre-receptor regulation of GCs by 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) that activates cortisol from cortisone has been postulated as a fundamental mechanism underlying the metabolic syndrome mediating adipocyte hyperplasia and hypertrophy in the omental (OM) depot. Orbital adipose tissue (OF) is the site of intense inflammation and tissue remodelling in several orbital inflammatory disease states. In this study, we describe features of the GC metabolic pathways in normal human OF depot and compare it with subcutaneous (SC) and OM depots. Using an automated histological characterisation technique, OF adipocytes were found to be significantly smaller (parameters: area, maximum diameter and perimeter) than OM and SC adipocytes (P<0 x 001). Although immunohistochemical analyses demonstrated resident CD68+ cells in all three whole tissue adipose depots, OF CD68 mRNA and protein expression exceeded that of OM and SC (mRNA, P<0 x 05; protein, P<0 x 001). In addition, there was higher expression of glucocorticoid receptor (GR)alpha mRNA in the OF whole tissue depot (P<0 x 05). Conversely, 11beta-HSD1 mRNA together with the markers of late adipocyte differentiation (FABP4 and G3PDH) were significantly lower in OF. Primary cultures of OF preadipocytes demonstrated predominant 11beta-HSD1 oxo-reductase activity with minimal dehydrogenase activity. Orbital adipocytes are smaller, less differentiated, and express low levels of 11beta-HSD1 but abundant GRalpha compared with SC and OM. OF harbours a large CD68+ population. These characteristics define an orbital microenvironment that has the potential to respond to sight-threatening orbital inflammatory disease.

  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

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    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. Fragile X premutation in women: recognizing the health challenges beyond primary ovarian insufficiency.

    Science.gov (United States)

    Hoyos, Luis R; Thakur, Mili

    2016-12-19

    Fragile X premutation carriers have 55-200 CGG repeats in the 5' untranslated region of the FMR1 gene. Women with this premutation face many physical and emotional challenges in their life. Approximately 20% of these women will develop fragile X-associated primary ovarian insufficiency (FXPOI). In addition, they suffer from increased rates of menstrual dysfunction, diminished ovarian reserve, reduction in age of menopause, infertility, dizygotic twinning, and risk of having an offspring with a premutation or full mutation. Consequent chronic hypoestrogenism may result in impaired bone health and increased cardiovascular risk. Neuropsychiatric issues include risk of developing fragile X-associated tremor/ataxia syndrome, neuropathy, musculoskeletal problems, increased prevalence of anxiety, depression, and sleep disturbances independent of the stress of raising an offspring with fragile X syndrome and higher risk of postpartum depression. Some studies have reported a higher prevalence of thyroid abnormalities and hypertension in these women. Reproductive health providers play an important role in the health supervision of women with fragile X premutation. Awareness of these risks and correlation of the various manifestations could help in early diagnosis and coordination of care and services for these women and their families. This paper reviews current evidence regarding the possible conditions that may present in women with premutation-sized repeats beyond FXPOI.

  9. Discriminatory metabolic and inflammatory parameters in serum and omental adipose tissue of obese patients with different insulin sensitivity

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    Marian Khatib

    2014-09-01

    Conclusions: The study highlighted the predictive value of serum bile acids in identifying obese patients at high risk. Secondly, omental adipose tissue ADAM17 was revealed as a novel and strongest independent predictor for higher insulin resistance in morbidly obese patients.

  10. 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...

  11. 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…

  12. Wound care by district nurses at primary healthcare centres: a challenging task without authority or resources.

    Science.gov (United States)

    Friman, Anne; Klang, Birgitta; Ebbeskog, Britt

    2011-09-01

    There is a lack of studies that describes how district nurses experience the care they provide in connection with wound care. The aim of this study was therefore to describe district nurses experiences of their nursing actions when treating patients with different kinds of wounds at primary healthcare centres and in the home care in order to increase understanding of this kind of care. A qualitative, descriptive study was conducted, with interviews of eight district nurses. Data were analysed using qualitative content analysis. Three themes and nine sub-themes were identified. The first theme included two sub-themes which revealed that in performing wound care district nurses feel responsible for administering wound care, and they feel confident in making independent assessments. The second theme included three sub-themes which revealed that district nurses endeavour to assess all aspects of their patient's situation and to maintain continuity in both their contact with the patient and the treatment. A treatment plan for wound care and regular reports were identified as being important in collaboration with other healthcare professionals. District nurses wanted their own procedure for referral to facilitate the patient's direct contact with a dermatologist. The third theme included four sub-themes which revealed difficulties associated with ambiguous organisation. Lack of time led to the dressing of wounds being delegated to nursing assistants. Limited access to treatment rooms and equipment made wound care difficult and inefficient. Wound care in the home care was regarded as challenging due to the lack of equipment, and poor lighting, ergonomics and hygiene. The results of this study thus identified the aspirations of district nurses to provide expert wound care while working independently. However, these aspirations were aggravated by organisational shortcomings, such as a lack of authority and the resources required to carry out their nursing actions optimally.

  13. 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...... at a size of 24g to be subjected to an experimental challenge with VHSV. The setup included 7 aquaria with 100 fish in each: 2 aquaria with 100 vaccinated fish (+VHS-challenge), 2 aquaria with 100 naïve fish (+ VHS-challenge), 2 aquaria with 50 vaccinated + 50 naïve fish (+VHS-challenge), and 1 aquarium...

  14. Moving On: The Challenges for Foreign Language Learning on Transition from Primary to Secondary School

    Science.gov (United States)

    Hunt, Marilyn; Barnes, Ann; Powell, Bob; Martin, Cynthia

    2008-01-01

    Europe's commitment to language learning has resulted in higher percentages of pupils studying foreign languages during primary education. In England, recent policy decisions to expand foreign language learning at primary level by 2010 create major implications for transition to secondary. This paper presents findings on transition issues from…

  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. Creating a Project on Difference Equations with Primary Sources: Challenges and Opportunities

    Science.gov (United States)

    Ruch, David

    2014-01-01

    This article discusses the creation of a student project about linear difference equations using primary sources. Early 18th-century developments in the area are outlined, focusing on efforts by Abraham De Moivre (1667-1754) and Daniel Bernoulli (1700-1782). It is explained how primary sources from these authors can be used to cover material…

  17. The Challenges of Primary Sources, Collaboration, and the K-16 Elizabeth Murray Project

    Science.gov (United States)

    Cleary, Patricia; Neumann, David

    2009-01-01

    In recent years, the use of primary sources in the history and social studies classroom has been increasingly promoted as a necessary and welcome practice, one designed to improve the quality of history education and to encourage student interest and engagement. Although some K-12 educators have been wary of adopting the use of primary sources,…

  18. Propofol treatment modulates neurite extension regulated by immunologically challenged rat primary astrocytes: a possible role of PAI-1.

    Science.gov (United States)

    Ko, Hyun Myung; Joo, So Hyun; Lee, Sung Hoon; Kim, Hee Jin; Lee, Seung-Hyun; Cheong, Jae Hoon; Ryu, Jong Hoon; Kim, Jeong Min; Koo, Bon-Nyeo; Shin, Chan Young

    2015-04-01

    Propofol, a widely used anesthetic, regulates neurological processes including neurotoxicity, neuroprotection, glial activation, synaptic plasticity and neuronal maturation. Tissue plasminogen activator/tissue plasminogen activator inhibitor-1 (tPA/PAI-1) in CNS acts as a neuromodulator regulating synaptic plasticity, neurite outgrowth, seizure spreading and cell survival. Here, we investigated the effects of propofol on tPA/PAI-1 system using cultured neurons and astrocytes and their role in the regulation of neurite extension. Cultured rat primary astrocytes were treated with propofol (1-10 µM) and LPS (10 ng/ml). The expression of functional tPA/PAI-1 was examined by casein zymography, Western blot and RT-PCR. Alternatively, culture supernatants were added to cultured rat primary neuron to investigate the effects on neurite extension. Propofol alone did not affect tPA activity in rat primary cortical neuron. Similarly, propofol alone changed neither tPA nor PAI-1 activity in rat primary astrocytes. In immunologically challenged situation using LPS, propofol synergistically increased expression of PAI-1 in rat primary astrocytes without affecting tPA expression in a manner dependent on MAPKs activation. Increased expression of PAI-1 reduced tPA activity in LPS plus propofol-treated rat primary astrocytes. Consistent with the critical role of tPA activity in the regulation of neurite extension (Cho et al. 2013), the diminished tPA activity in astrocyte culture supernatants resulted in decreased neurite extension when administered to cultured rat primary cortical neuron. The results from the present study suggest that propofol, especially in immunologically-challenged situation, dysregulates tPA/PAI-1 system in brain. Whether the dysregulated tPA/PAI-1 activity adversely affects neural differentiation as well as regeneration of neuron in vivo should be empirically determined in the future.

  19. Perceived challenges and opportunities arising from integration of mental health into primary care: a cross-sectional survey of primary health care workers in south-west Ethiopia

    OpenAIRE

    Abera, Mubarek; Tesfaye, Markos; Belachew, Tefera; Hanlon, Charlotte

    2014-01-01

    Background: The WHO's mental health Gap Action Programme seeks to narrow the treatment gap for mental disorders by advocating integration of mental health into primary health care (PHC). This study aimed to assess the challenges and opportunities of this approach from the perspective of PHC workers in a sub-Saharan African country.Methods: A facility-based cross-sectional survey of 151 PHC workers was conducted from 1(st) to 30(th) November 2011 in Jimma zone, south-west Ethiopia. A structure...

  20. 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.

  1. 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)

  2. Ultrasound criteria and guided fine-needle aspiration diagnostic yields in small animal peritoneal, mesenteric and omental disease.

    Science.gov (United States)

    Feeney, Daniel A; Ober, Christopher P; Snyder, Laura A; Hill, Sara A; Jessen, Carl R

    2013-01-01

    Peritoneal, mesenteric, and omental diseases are important causes of morbidity and mortality in humans and animals, although information in the veterinary literature is limited. The purposes of this retrospective study were to determine whether objectively applied ultrasound interpretive criteria are statistically useful in differentiating among cytologically defined normal, inflammatory, and neoplastic peritoneal conditions in dogs and cats. A second goal was to determine the cytologically interpretable yield on ultrasound-guided, fine-needle sampling of peritoneal, mesenteric, or omental structures. Sonographic criteria agreed upon by the authors were retrospectively and independently applied by two radiologists to the available ultrasound images without knowledge of the cytologic diagnosis and statistically compared to the ultrasound-guided, fine-needle aspiration cytologic interpretations. A total of 72 dogs and 49 cats with abdominal peritoneal, mesenteric, or omental (peritoneal) surface or effusive disease and 17 dogs and 3 cats with no cytologic evidence of inflammation or neoplasia were included. The optimized, ultrasound criteria-based statistical model created independently for each radiologist yielded an equation-based diagnostic category placement accuracy of 63.2-69.9% across the two involved radiologists. Regional organ-associated masses or nodules as well as aggregated bowel and peritoneal thickening were more associated with peritoneal neoplasia whereas localized, severely complex fluid collections were more associated with inflammatory peritoneal disease. The cytologically interpretable yield for ultrasound-guided fine-needle sampling was 72.3% with no difference between species, making this a worthwhile clinical procedure.

  3. 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.

  4. 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.

  5. 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…

  6. Expectations and Challenges: The Implementation of Mobile Devices in a Scottish Primary School

    Science.gov (United States)

    Cornelius, Sarah; Shanks, Rachel

    2017-01-01

    This article provides a case study of the implementation of iPod Touches on a one-to-one basis in a Scottish primary school. It focuses on teachers' expectations for the project and the realisation (or otherwise) of these expectations. Findings suggest that the iPods offered opportunities for resource provision, interactive learning and extension…

  7. 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…

  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. 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...... facilitators are important drivers of the change process and that easy-to-use tools are requested from the involved company actors. Given that the interventions in the selected companies are conducted successfully we argue that a new organizational capability to address work-related stress in a collective...... 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...

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. Presence of the cannabinoid receptors, CB1 and CB2, in human omental and subcutaneous adipocytes.

    Science.gov (United States)

    Roche, Régis; Hoareau, Laurence; Bes-Houtmann, Sandrine; Gonthier, Marie-Paule; Laborde, Christine; Baron, Jean-François; Haffaf, Yacine; Cesari, Maya; Festy, Franck

    2006-08-01

    To investigate the expression of the endocannabinoid 1 and 2 receptors by human adipocyte cells of omental and subcutaneous fat tissue, as well as to determine whether these receptors are functional. The expression of CB1 and CB2 receptors on human adipocytes was analyzed by western blotting, immunohistology and immunocytology. We also investigated intracytoplasmic cyclic AMP level modulation following CB1 and CB2 receptor stimulation by an enzymatic immuno assay. All mature adipocytes, from visceral (epiploon) and subcutaneous fat tissue, express CB1 and CB2 on their plasma membranes. We also demonstrate in this study that adipocyte precursors (pre-adipocytes) express CB1 and CB2 on their plasma membranes and that both receptors are functional. Activation of CB1 increases intracytoplasmic cyclic AMP whilst CB2 activation leads to a cyclic AMP decrease. Here we demonstrate, for the first time, that adipocytes of human adipose tissue (mature adipocytes and pre-adipocytes) express functional plasma membrane CB1 and CB2 receptors. Their physiological role on the adipose tissue is not known. However, their major involvement in the physiology of other tissues leads us to suppose that they could play a significant role in the homeostasis of the energy balance and/or in the regulation of adipose tissue inflammation.

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 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.

  1. 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.

  2. Challenging pseudoscientific and paranormal beliefs held by some pre-service primary teachers

    Science.gov (United States)

    Happs, John C.

    1991-12-01

    The widespread public acceptance of many paranormal and pseudoscientific claims should be of some concern to science educators who are striving to produce a scientifically literate community. There is ample evidence to show that students at all levels of our education system believe in aspects of pseudoscience based on claims and assumptions that are in conflict with accumulated scientific knowledge and a rigorous methodology. A survey was designed to assess primary and secondary science teacher-trainees' views. Afterwards 60 students were introduced to the notion of a ‘fair test’ and what constitutes ‘evidence’. Demonstrations of psychic powers were provided and a video shown of professional water-diviners repeatedly failing to locate water under controlled conditions. A re-survey, 3 months later, indicated a rejection of many prior beliefs. However, almost half of the group retained their beliefs in miracles and E.S.P. whilst more than 40% retained their belief in visitors from outer space and that the solar system was created by a supernatural force.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

    Directory of Open Access Journals (Sweden)

    Davide Strambo

    2017-01-01

    Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

  5. [Preventing deaths from dengue: a space and challenge for primary health care].

    Science.gov (United States)

    Martínez Torres, Eric

    2006-07-01

    Dengue is an arthropod-borne viral disease whose frequency has increased steadily in the Americas over the past 25 years. The type of dengue that carries the highest mortality is the clinical variant known as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Even though no vaccine or drug against the disease is available, successful management consists of preventing serious illness through patient follow-up and monitoring danger signals so as to be able to initiate aggressive intravenous rehydration and prevent shock or treat it early and successfully. These measures are also useful in preventing other complications, such as massive hemorrhage, disseminated intravascular coagulation, multiple organ failure, and respiratory failure due to non-cardiogenic pulmonary edema. Primary health care (PHC) settings and the community are ideal spaces for this type of preventive management based on health education and active case detection. It involves training all medical and nursing staff, students, and community health workers, as well as reorganizing health care in PHC units and hospitals and redistributing available resources during a dengue epidemic.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Foscolo, Sylvain; Mandry, Damien; Galloy, Marie-Agnes; Claudon, Michel [University of Nancy, Department of Radiology, Children' s Hospital, Vandoeuvre les Nancy (France); Champigneulles, Jacqueline [University of Nancy, Department of Pathology, Children' s Hospital, Vandoeuvre les Nancy (France); Miscault, Godefroy de [University of Nancy, Department of Paediatric Surgery, Children' s Hospital, Vandoeuvre les Nancy (France)

    2007-06-15

    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.)

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  10. 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 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...... 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...

  11. Knowledge of primary health care and career choice at primary health care settings among final year medical students - challenges to human resources for health in Vietnam.

    Science.gov (United States)

    Giang, Kim Bao; Minh, Hoang Van; Hien, Nguyen Van; Ngoc, Nguyen Minh; Hinh, Nguyen Duc

    2015-01-01

    There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC.

  12. [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.

  13. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement

    Science.gov (United States)

    Lofters, AK; Vahabi, M; Prakash, V; Banerjee, L; Bansal, P; Goel, S; Dunn, S

    2017-01-01

    Background Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach. Materials and methods Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months. Results Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties. Discussion Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as

  14. mTOR inhibition with rapamycin causes impaired insulin signalling and glucose uptake in human subcutaneous and omental adipocytes.

    Science.gov (United States)

    Pereira, Maria J; Palming, Jenny; Rizell, Magnus; Aureliano, Manuel; Carvalho, Eugénia; Svensson, Maria K; Eriksson, Jan W

    2012-05-15

    Rapamycin is an immunosuppressive agent used after organ transplantation, but its molecular effects on glucose metabolism needs further evaluation. We explored rapamycin effects on glucose uptake and insulin signalling proteins in adipocytes obtained via subcutaneous (n=62) and omental (n=10) fat biopsies in human donors. At therapeutic concentration (0.01 μM) rapamycin reduced basal and insulin-stimulated glucose uptake by 20-30%, after short-term (15 min) or long-term (20 h) culture of subcutaneous (n=23 and n=10) and omental adipocytes (n=6 and n=7). Rapamycin reduced PKB Ser473 and AS160 Thr642 phosphorylation, and IRS2 protein levels in subcutaneous adipocytes. Additionally, it reduced mTOR-raptor, mTOR-rictor and mTOR-Sin1 interactions, suggesting decreased mTORC1 and mTORC2 formation. Rapamycin also reduced IR Tyr1146 and IRS1 Ser307/Ser616/Ser636 phosphorylation, whereas no effects were observed on the insulin stimulated IRS1-Tyr and TSC2 Thr1462 phosphorylation. This is the first study to show that rapamycin reduces glucose uptake in human adipocytes through impaired insulin signalling and this may contribute to the development of insulin resistance associated with rapamycin therapy.

  15. 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.

  16. 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.

  17. 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

  18. Critical Home-Based Challenges Inhibiting Effective Participation of Pupils in Rural Public Primary Schools in Narok North Sub-County, Narok County, Kenya

    Science.gov (United States)

    Mwanik, Kantim; Orodho, John Aluko

    2016-01-01

    The thrust of this study was to examine the critical challenges inhibiting effective participation in education by pupils from rural public primary schools in Central Division, Narok North Sub-County, in Narok County, Kenya. The study adopted a descriptive cross-sectional research design. Combinations of stratified and purposive sampling…

  19. Construction and Validation of a Survey Instrument to Determine the Gender-Related Challenges Faced by Pre-Service Male Primary Teachers

    Science.gov (United States)

    Cruickshank, Vaughan; Pedersen, Scott; Hill, Allen; Callingham, Rosemary

    2015-01-01

    The gender-related challenges facing males entering the primary-school teaching profession have been well documented in the academic literature over recent decades. The majority of these data have come about through qualitative reports. Whilst qualitative methods provide important perspectives into these issues, the use of valid and reliable…

  20. PROBLEMS AND CHALLENGES OF LEARNING THROUGH A SECOND LANGUAGE: THE CASE OF TEACHING OF SCIENCE AND MATHEMATICS IN ENGLISH IN THE MALAYSIAN PRIMARY SCHOOLS

    Directory of Open Access Journals (Sweden)

    Tan Yao Sua

    2007-01-01

    Full Text Available In 2003, there was a significant change in the language policy in theMalaysian education system whereby the Malaysian government decidedto introduce English as a language medium to teach science andmathematics at all levels of the education system in stages. The aim of the policy was to arrest declining standards of English amongMalaysian students. The implementation of this policy was mostcontentious at the primary school level involving two different models of implementation: bilingual model for the Chinese primary school and maximum exposure model for the national school and the Tamil primary school. This paper examines the problems and challenges of implementing the policy of teaching science and mathematics in English in the Malaysian primary schools, which entails learning through a second language. It looks at some of the theoretical constructs pertaining to choice of language as well as learning through a second language. These theoretical constructs offer some perspective lights on the implementation of the policy of teaching science and mathematics in English in the Malaysian primary schools by highlighting its strengths and weaknesses. Based on these theoretical constructs, this paper posits the bilingual model adopted by the Chinese primary schools as a better model to facilitate learning through a second language during the earlyyears of schooling.

  1. 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.

  2. 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.

  3. 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.

  4. Omental and pleural milky spots: different reactivity patterns in mice infected with Schistosoma mansoni reveals coelomic compartmentalisation

    Directory of Open Access Journals (Sweden)

    Mônica S Panasco

    2010-07-01

    Full Text Available In vertebrate animals, pleural and peritoneal cavities are repositories of milky spots (MS, which constitute an organised coelom-associated lymphomyeloid tissue that is intensively activated by Schistosoma mansoni infection. This study compared the reactive patterns of peritoneal MS to pleural MS and concluded from histological analysis that they represent independent responsive compartments. Whole omentum, lungs and the entire mediastinum of 54 S. mansoni-infected mice were studied morphologically. The omental MS of infected animals were highly activated, modulating from myeloid-lymphocytic (60 days of infection to lymphomyeloid (90 days of infection and lymphocytic or lymphoplasmacytic (160 days of infection types. The non-lymphoid component predominated in the acute phase of infection and was expressed by monocytopoietic, eosinopoietic and neutropoietic foci, with isolated megakaryocytes and small foci of late normoblasts and mast cells. Nevertheless, pleural or thoracic MS of infected mice were monotonous, consisting of small and medium lymphocytes with few mast and plasma cells and no myeloid component. Our data indicate that compartmentalisation of the MS response is dependent on the lymphatic vascularisation of each coelomic cavity, limiting the effects or consequences of any stimulating or aggressive agents, as is the case with S. mansoni infection.

  5. 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…

  6. What Is a Principal's Quality Mark? Issues and Challenges in Leadership Progression among Primary Teachers in Jamaica

    Science.gov (United States)

    Miller, Paul

    2014-01-01

    Perceptions about teacher progression among Jamaica's primary school teachers should force society to stop and ask itself several questions. Are these perceptions accurate? If not, how did these perceptions emerge and what can national leaders and those in positions of authority do to "manage" if not resolve these perceptions? If there…

  7. 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…

  8. 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.

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

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    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.

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

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    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. [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.

  12. 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.

  13. Diverse heterologous primary infections radically alter immunodominance hierarchies and clinical outcomes following H7N9 influenza challenge in mice.

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    Susu Duan

    2015-02-01

    Full Text Available The recent emergence of a novel H7N9 influenza A virus (IAV causing severe human infections in China raises concerns about a possible pandemic. The lack of pre-existing neutralizing antibodies in the broader population highlights the potential protective role of IAV-specific CD8(+ cytotoxic T lymphocyte (CTL memory specific for epitopes conserved between H7N9 and previously encountered IAVs. In the present study, the heterosubtypic immunity generated by prior H9N2 or H1N1 infections significantly, but variably, reduced morbidity and mortality, pulmonary virus load and time to clearance in mice challenged with the H7N9 virus. In all cases, the recall of established CTL memory was characterized by earlier, greater airway infiltration of effectors targeting the conserved or cross-reactive H7N9 IAV peptides; though, depending on the priming IAV, each case was accompanied by distinct CTL epitope immunodominance hierarchies for the prominent K(bPB(1703, D(bPA(224, and D(bNP(366 epitopes. While the presence of conserved, variable, or cross-reactive epitopes between the priming H9N2 and H1N1 and the challenge H7N9 IAVs clearly influenced any change in the immunodominance hierarchy, the changing patterns were not tied solely to epitope conservation. Furthermore, the total size of the IAV-specific memory CTL pool after priming was a better predictor of favorable outcomes than the extent of epitope conservation or secondary CTL expansion. Modifying the size of the memory CTL pool significantly altered its subsequent protective efficacy on disease severity or virus clearance, confirming the important role of heterologous priming. These findings establish that both the protective efficacy of heterosubtypic immunity and CTL immunodominance hierarchies are reflective of the immunological history of the host, a finding that has implications for understanding human CTL responses and the rational design of CTL-mediated vaccines.

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

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    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.

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

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    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.

  16. 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.

  17. Estudo da viabilidade do enxerto de ovário na bolsa omental de ratos utilizando Ciclosporina A

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    Brito Nara Macedo Botelho

    2005-01-01

    Full Text Available OBJETIVO: Estudo comparativo do enxerto autólogo e heterólogo de ovário na bolsa omental de ratas, utilizando ciclosporina A. MÉTODOS: No presente estudo, foram utilizadas 20 ratas distribuídas randomicamente em quatro grupos, denominados grupo controle (animais submetidos à ooforectomia; grupo A (enxerto autólogo de ovário; grupo H (enxerto heterólogo de ovário; e grupo C (enxerto heterólogo de ovário e tratamento com ciclosporina A. Todos os animais foram submetidos à ooforectomia bilateral. Um dos ovários removidos foi individualizado e enxertado no omento maior do animal. Os animais do grupo C receberam a dose de 10mg/kg/dia de ciclosporina por via subcutânea durante todo o período do experimento. Após um período de 33 dias, todos os animais foram submetidos a uma nova intervenção cirúrgica para identificação do leito receptor e retirada do ovário transplantado, além do útero e da vagina, seguido de eutanásia. As peças foram submetidas a processamento histológico e coloras pela hematoxilina eosina. RESULTADOS: Todos os grupos apresentaram epitélios vaginal e uterino com 1 a 2 fileiras de células cúbicas ou cilíndricas simples, núcleo arredondado e central. Houve também grande reação inflamatória em todo o enxerto, com áreas de necrose. Ocorreu óbito de um animal do grupo C no 20º dia do experimento. CONCLUSÃO: Conclui-se que o enxerto de ovário íntegro realizado em omento maior de ratas nesta amostra, independente do uso da Ciclosporina, não mostrou-se viável.

  18. Prevention of mother-to-child HIV transmission at primary health care level in Moshi urban Tanzania: uptake challenges and transmission rate

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    Sia E. Msuya M

    2014-01-01

    Full Text Available BACKGROUND:Tanzania has extended prevention of mother-to-child HIV transmission (PMTCT services to primary health care clinics (PHC. Information on challenges and rates of MTCTC of HIV at this level is limited. The study aimed to describe theuptake of PMTCT interventions and MTCT rates at 18 months post-delivery. METHODS:Pregnant women,in their 3rd trimester (N=2654,attending 2 primary health facilities in Moshi were recruited. They were interviewed, tested and women-infant pairs were followed-up for 18 months post-delivery, at which point the exposed children were tested for HIV. RESULTS:Of the 2654 women, 99% accepted testing, 93% returned for their HIV-test results and 7% (184 were HIV-positive. Of the 184 HIV-positive women, 93% (171/184 came for test-results, 71% (130/184 took anti-retroviral prophylaxis (sdNVP in labor and 59% (103/175 infants received ARV (sdNVP prophylaxis. HIV-testing at 18 months was conducted for 68% of the exposed infants. The rate of MTCT of HIV was 15.8%. CONCLUSION: Nearly 40% of infants do not receive ARV prophylaxis and there is high rate of loss to follow-up after delivery, which needs urgent improvements.The high transmission rate support testing of exposed-children earlier due to high number of deaths among children < 18 months and missed opportunity to offer early ART care.

  19. [A challenge to primary open-angle glaucoma including normal-pressure. Clinical problems and their scientific solution].

    Science.gov (United States)

    Sugiyama, Kazuhisa

    2012-03-01

    Primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG), is reported by the Tajimi Study to afflict 3.9% of the total population, and this represents about 80% of all total glaucoma cases which, in total, afflict 5.0% of the population. We tried to analyze the clinical problems relating to POAG by looking at the pathogenesis, intraocular pressure (IOP), therapy, neuroprotection and surgery of the disease. To elucidate the pathogenesis of glaucoma progression, we measured retinal nerve fiber layer defect (RNFLD) angles', and divided the NTG cases into 2 groups, enlarged RNFLD and stable RNFLD. Disc hemorrhages were found to be significantly more frequent in the enlarged group than in the stable group. RNFLD was enlarged in the direction of disc hemorrhage in over 80% of the eyes. In the majority of the eyes of the enlarged group, the enlargement of RNFLD was toward the fovea. The enlargement of RNFLD in NTG was closely associated with disc hemorrhage and the deterioration of the visual field. We developed a simultaneous structure and function evaluation technique combining spectral-domain (SD) optical coherence tomography (OCT) and fundus-oriented perimeters for the detection of visual field abnormalities in the RNFLD area. We superimposed the ganglion cell complex map obtained by SD-OCT on the fundus-oriented perimeter image. We observed very early or preperimetric normal pressure glaucoma as well as disc hemorrhage adjacent to the borders of the RNFLD. The borderline of the RNFLD seemed to be the thinnest RNFL and had the lowest retinal sensitivity (Active site for RNFLD progression). To clarify the role of the circadian clock genes in the generation of a 24-hour IOP rhythm, we used the microneedle method to measure the IOP at eight time points daily, both in wild type mice and Cry-deficient (Cry 1-/-Cry 2-/-) mice. In the wild-type mice living in light-dark conditions, the pressure measured in the light phase was significantly lower than in

  20. 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.

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

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    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.

  2. 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

    OpenAIRE

    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 experie...

  3. 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。

  4. 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

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    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

  5. Primary Yolk Sac Tumor of the Omentum: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Chang Kyu; Oh, Young Taik; Jung, Dae Chul [Dept. of Radiology, Research Institue of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Bae, Yoon Sung [Dept. of Pathology, Yensei University College of Medicine, Seoul (Korea, Republic of)

    2012-01-15

    A 32-year-old woman had been referred to our hospital for lower abdominal pain. Pelvic ultrasonography and magnetic resonance imaging revealed a huge solid mass with an internal cystic portion. The patient underwent a staging laparotomy and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic lymph nodes sampling, and total omentectomy. At staging laparotomy, a large omental mass was found. The tumor displayed the typical histological patterns observed in the yolk sac tumor. The alpha-fetoprotein (AFP) serum value on the 10th day after surgery was 11,576.67 IU/mL and decreased to 6.46 IU/mL after chemotherapy. At the end of the treatment, all the findings, including the AFP level, were normal. We report a case of primary yolk sac tumor of the omentum in a 32-year-old woman.

  6. 网膜淋巴瘤阴囊转移一例报告并文献复习%Omental Lymphoma Complicated with Scrotum Metastasis: a Case Report and the Literature Review

    Institute of Scientific and Technical Information of China (English)

    王彦丽; 王炳元; 王军; 阙雪梅

    2011-01-01

    目的 提高对网膜淋巴瘤的认识.方法 回顾分析1例网膜淋巴瘤阴囊转移的诊治经过.患者无明显诱因出现腹胀,伴乏力,饮食欠佳.首次行腹部超声示肝实质回声增强,腹腔积液.先后3次检查腹腔积液,均为渗出液.渐出现阴囊肿胀.全腹增强CT扫描见右侧中腹局部小肠管壁增厚,网膜多发结节、增厚,可见"网膜饼"形成,有腹腔积液和左侧胸腔积液.腹部超声提示右上腹网膜厚0.8~2.0 cm,回声不均,可见低回声区,范围2.6 cm×1.4 cm,左上腹网膜厚0.5~0.9 cm,增厚网膜内可见点条状血流,盆腔积液深度为3.0 cm.于超声引导下行网膜活检.病理诊断为非霍奇金B细胞淋巴瘤.结果 建议转入血液内科化疗,但患者由于经济原因放弃治疗,出院后失访.结论 淋巴瘤侵犯部位不同,其首发症状多种多样,缺乏特异性,给临床诊断带来困难,对于出现不明原因网膜增厚者,应考虑到淋巴瘤可能,及早行网膜活检,以便早期明确诊断,减少误诊误治.%Objective To improve the cognition of great omental lymphoma with initial manifestation of omenfum thickening.Methods One case of B-cell lymphoma with great omental thicking was restrospecively analyzed and the literature review was conducted.The patient had abdominal distension with fatigue and anorexia.The abdominal ultrasound showed echo-enhancement of hepatic parenchyma and ascites.The characteristics of ascites by peritonrocentesis showed exudates in three different times.Gradually his scrotum began swelling.Then an enhanced abdominal computed tomography (CT) scan demonstrated thickening of the small intestine wall in the right lunber region, as well as in ascites and left pleural effusion.Omental involvement was apparent, manifested by nodules, thickening, as well as "omental caking".Abdominal ultrasound was performed again and a 0.8 ~ 2.0 cm omental thickening in the right upper quadrant was detected with irregular echo and

  7. Permeating the Social Justice Ideals of Equality and Equity within the Context of Early Years: Challenges for Leadership in Multi-Cultural and Mono-Cultural Primary Schools

    Science.gov (United States)

    Mistry, Malini; Sood, Krishan

    2015-01-01

    This paper explores the ideology of social justice through links between equality and equity within Early Years and what remain the challenges for leadership. Questionnaires and interviews in English multi-cultural and mono-cultural schools with Early Years age phases were conducted. The findings showed that the ideology of social justice,…

  8. 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…

  9. 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.

  10. PROBLEMS AND CHALLENGES OF LEARNING THROUGH A SECOND LANGUAGE: THE CASE OF TEACHING OF SCIENCE AND MATHEMATICS IN ENGLISH IN THE MALAYSIAN PRIMARY SCHOOLS

    OpenAIRE

    Tan Yao Sua; Santhiram R. Raman

    2007-01-01

    In 2003, there was a significant change in the language policy in theMalaysian education system whereby the Malaysian government decidedto introduce English as a language medium to teach science andmathematics at all levels of the education system in stages. The aim of the policy was to arrest declining standards of English amongMalaysian students. The implementation of this policy was mostcontentious at the primary school level involving two different models of implementation: bilingual mode...

  11. 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.

  12. 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.

  13. 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

  14. Bilateral ovarian primary Burkitt′s lymphoma in a child: A clinico-radio-pathological evaluation

    Directory of Open Access Journals (Sweden)

    Gujarathi Aditi

    2015-01-01

    Full Text Available Ovarian neoplasms are rare in children. Though ovarian involvement by malignant lymphoma is known to occur in late stages of disseminated nodal disease, primary ovarian lymphoma is a rare entity. We came across a case of a 9-year-old female who came with complaints of dull aching abdominal pain, mainly in the suprapubic region, low grade fever and abdominal distension since 20 days. Ultrasonography revealed two well-defined, mixed echogenic masses in both adnexae. Multiple well-defined mixed echogenic lesions were also seen on the surface of liver with omental thickening and nodularity. Computerized tomography as well as magnetic resonance imaging was done for further evaluation. Ultrasound guided biopsy was performed. The diagnosis of Burkitt′s lymphoma involving bilateral ovaries was established after histological, immunohistochemistry, and tumor markers correlation.

  15. 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.”

  16. 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

  17. Primary fibromyalgia

    DEFF Research Database (Denmark)

    Jacobsen, S; Jensen, L T; Foldager, M

    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....

  18. 沙培林免疫诱导大鼠大网膜Ⅰ型乳斑变化的研究%Development of Rats Omental Type Imilky Spots Induced by Immuno- stimulator Sapylin

    Institute of Scientific and Technical Information of China (English)

    李尚胜; 黄允宁

    2011-01-01

    目的 观察炎症状态下,大鼠大网膜Ⅰ型乳斑面积、数量及巨噬细胞超微结构的变化,探讨Ⅰ型乳斑在腹腔中的作用.方法 SD大鼠腹腔注射沙培林诱导免疫反应,微粒子活性炭和HE染色双重标记大网膜乳斑,Image-Pro Plus软件测定Ⅰ型乳斑的数量和面积,电镜观察两组Ⅰ型乳斑内巨噬细胞的超微结构.结果 实验组与对照组相比,Ⅰ型乳斑面积显著增大[(0.316±0.066)mm2比(0.102±0.041)mm2,P<0.01],Ⅰ型乳斑数量显著增多[(11.053±1.543)个/cm2比(1.913±0.851)个/cm2,P<0.01].实验组Ⅰ型乳斑巨噬细胞内的线粒体、溶酶体、高尔基体等细胞器丰富,粗面内质网肿胀扩张,伪足粗大密集.结论 沙培林使Ⅰ型乳斑数量增多、面积增大,并能够激活Ⅰ型乳斑内的巨噬细胞,表明Ⅰ型乳斑在腹腔内起到重要的免疫功能.%Objective To investigate the changes of rats omental type Imilky spots in area, volume and ultrastructure of macrophages in inflammatory status , and to observe the function of type Ⅰ milky spots.Methods SD rats induced immune response by intraperitoneal injection of Sapylin.Double - labeling of rats omental milky spots with activated carbon and HE staining, measuring the number and the area of type Ⅰ milky spots by Image - pro Plus software, observing the differences in ultrastructure between two groups of type Ⅰ milky spots byelectron microscope.Results Compared with the control group, the area of the type Ⅰ milky spots in experimental group was significantly larger [(0.316 ± 0.066)mm2 vs (0.102 ± 0.041 )mm2, P < 0.01], the number of type Ⅰ milky spots in experimental group was significantly increased [( 11.053 ± 1.543 ) per cm2 vs ( 1.913 ±0.851 )per cm2, P <0.01].Experimental group had lots of mitochondrias, lysosomes, golgi apparatus and other organelles in macrophages of type Ⅰ milky spots, the rough endoplasmic reticulums were expansion, pseudopods were enlarged and

  19. Simple omental diaphragmatic hernia: the diagnosic value of multiplanar reformation in multi-slice spiral CT examination%MSCT多平面重组诊断单纯性横膈网膜疝

    Institute of Scientific and Technical Information of China (English)

    毛齐心; 曹和涛

    2014-01-01

    目的 探讨MSCT多平面重组(multiple planar reconstruction,MPR)诊断单纯性横膈网膜疝(simple omental diaphragmatic hernia,SODH)的价值.方法 31例SODH均行MSCT容积扫描并作亚毫米重组,3名不知手术结果的高年资医师回顾性分析横断位和MPR图像,以发现膈肌中断缺损、膈上脂肪疝囊、“狭颈征”及“阳性血管征”作为诊断SODH依据;横断位及MPR征象显示及诊断差异采用x2检验.结果 31例SODH中Bochdalek疝15例、Morgagni疝4例、医源性膈疝3例、食管裂孔疝6例及腔静脉裂孔疝3例,膈肌中断缺损、膈上疝囊、“狭颈征”及“阳性血管征”横轴位和MPR依次分别显示:6例和22例(x2=16.67,P<0.01)、31例和31例、6例和28例(x2=31.52,P<0.01)及3例和11例(x2 =5.90,P<0.05).横轴位诊断12例,MPR全部明确诊断(x2 =27.40,P<0.01).结论 MSCT MPR清晰显示SODH多种特征性征象,对诊断具有决定意义.

  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. Primary hyperparathyroidism

    OpenAIRE

    Madkhali, Tarıq; Alhefdhi, Amal; Chen, Herbert; Elfenbein, Dawn

    2016-01-01

    Primary hyperparathyroidism is a common endocrine disorder caused by overactivation of parathyroid glands resulting in excessive release of parathyroid hormone. The resultant hypercalcemia leads to a myriad of symptoms. Primary hyperparathyroidism may increase a patient’s morbidity and even mortality if left untreated. During the last few decades, disease presentation has shifted from the classic presentation of severe bone and kidney manifestations to most patients now being diagnosed on rou...

  2. Challenged Pragmatism

    DEFF Research Database (Denmark)

    Christoffersen, Lisbet; Vinding, Niels Valdemar

    2013-01-01

    of religious faith have made religious claims and thereby challenged a secular understanding of the Danish labour market. This raises the question of the extent to which the religion of the individual can be accepted in the general public sphere. At the same time, religious ethos organisations have argued...

  3. Restoration of a fractured primary incisor.

    Science.gov (United States)

    Romero, M; Saez, M; Cabrerizo, C

    2001-01-01

    Esthetic restoration on primary teeth has been a special challenge to pediatric dentists. Composite restorations are the most often used treatment for decay and fractures of primary teeth, however, there are other possible alternatives. We present a case in which we have used an acrylic crown to treat a fractured primary incisor in a 1.8 years old child.

  4. Primary peritoneal adenocarcinoma as content of an incarcerated umbilical hernia: A case-report and review of the literature

    Science.gov (United States)

    Varga-Szabó, D.; Papadakis, M.; Pröpper, S.; Zirngibl, H.

    2015-01-01

    Introduction Umbilical hernia is a common finding in many cases, posing potentially life-threatening complications, such as incarceration or strangulation. The presence of malignancy in hernia sacs is, however, rather rare. Presentation of case Here we report on a case of primary peritoneal adenocarcinoma found through histological examination of omental tissue, resected due to an incarcerated umbilical hernia of an 84-years-old woman. There was no macroscopic sign of malignancy during operation; only after routine examination of histological sections the diagnosis was found. Discussion To our knowledge this is the first report of primary peritoneal cancer as content of an umbilical hernia. This is a rare neoplasm and histologically identical to epithelial ovarian carcinoma. For this reason, the diagnosis is usually based on the histological finding and exclusion of a primary ovarian tumor. Primary peritoneal cancer has a poor outcome in general. Early diagnosis is, therefore, essential for effective treatment. Conclusion Histological analysis of resected hernia sac or content should be performed routinely to discover malignant diseases in the background of a hernia. PMID:26748210

  5. 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 th...... 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.......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...

  6. 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.)

  7. 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.

  8. [Primary hyperaldosteronism

    NARCIS (Netherlands)

    Meiracker, A.H. van den; Deinum, J.

    2003-01-01

    Primary hyperaldosteronism (PHA), autonomic secretion of aldosterone by the adrenal gland, is rare. PHA usually results in therapy-resistant hypertension and is often but not always accompanied by hypokalaemia. Common causes of PHA are an aldosterone-producing adenoma, idiopathic aldosterone hyperse

  9. 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

  10. 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...... and the cultures of the new habitat. European horizons—frames of mind, historical memories, and expectations at the level of groups or communities, at the national level, and at the general European level—are at odds. Analyzing a series of issues in European countries from Turkey to Spain and from Scandinavia...

  11. 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...

  12. 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

  13. 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.

  14. Asperger's syndrome – elementary school challenges

    OpenAIRE

    Zorman, Alja

    2014-01-01

    The purpose of this thesis is to introduce primary school challenges and reactions that occur when a student with Asperger's syndrome enters school. In the theoretical part, I define Asperger's syndrome and autism, introduce the law applying to students with Asperger's syndrome, describe the challenges in the school environment and focus on teachers and their process of accepting assistance. I also focus on where the student integrates, if he is unsuccessful in primary school. In the empirica...

  15. Scrapheap Challenge

    CERN Document Server

    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, ...

  16. Methodological Challenges in Researching Inclusive School Cultures

    Science.gov (United States)

    Nind, Melanie; Benjamin, Shereen; Sheehy, Kieron; Collins, Janet; Hall, Kathy

    2004-01-01

    This article addresses the methodological challenges faced in a pilot study of the processes and cultures of inclusion and exclusion in two primary school classrooms. The authors, who were the research team, engaged with a range of practical and ethical challenges, some of which face any researcher entering classroom contexts and some of which…

  17. 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…

  18. 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

  19. 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

  20. Primary Hyperoxaluria

    Directory of Open Access Journals (Sweden)

    Jérôme Harambat

    2011-01-01

    Full Text Available Primary hyperoxalurias (PH are inborn errors in the metabolism of glyoxylate and oxalate. PH type 1, the most common form, is an autosomal recessive disorder caused by a deficiency of the liver-specific enzyme alanine, glyoxylate aminotransferase (AGT resulting in overproduction and excessive urinary excretion of oxalate. Recurrent urolithiasis and nephrocalcinosis are the hallmarks of the disease. As glomerular filtration rate decreases due to progressive renal damage, oxalate accumulates leading to systemic oxalosis. Diagnosis is often delayed and is based on clinical and sonographic findings, urinary oxalate assessment, DNA analysis, and, if necessary, direct AGT activity measurement in liver biopsy tissue. Early initiation of conservative treatment, including high fluid intake, inhibitors of calcium oxalate crystallization, and pyridoxine in responsive cases, can help to maintain renal function in compliant subjects. In end-stage renal disease patients, the best outcomes have been achieved with combined liver-kidney transplantation which corrects the enzyme defect.

  1. 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

  2. The Global Energy Challenge

    DEFF Research Database (Denmark)

    Connolly, David

    2011-01-01

    This report gives a brief overview of the global energy challenge and subsequently outlines how and where renewable energy could be developed to solve these issues. The report does not go into a lot of detail on these issues and hence, it is meant as an overview only. The report begins by outlining...... the causes of global climate change, concluding that energy-related emissions are the primary contributors to the problem. As a result, global energy production is analysed in more detail, discussing how it has evolved over the last 30 years and also, how it is expected to evolve in the coming 30 years....... Afterwards, the security of the world’s energy supply is investigated and it becomes clear that there is both an inevitable shortage of fossil fuels and a dangerous separation of supply and demand. The final topic discussed is renewable energy, since it is one sustainable solution to the global energy...

  3. Production of TNF-a by primary cultures of human keratinocytes challenged with Loxosceles gaucho venom Produção de TNF-a por queratinócitos humanos em cultura primária após agressão com veneno de Loxosceles gaucho

    Directory of Open Access Journals (Sweden)

    Ceila M.S. MÁLAQUE

    1999-05-01

    Full Text Available Primary cultures of human keratinocytes were challenged with increasing doses from 10 ng/mL to 2 mg/mL of Loxosceles gaucho venom, responsible for dermonecrotic lesion in humans. TNF-a was investigated by bioassay and ELISA in the supernatant of the cultures challenged with 100 ng/mL, 500 ng/mL, 1 and 2 mg/mL of venom. TNF-a was detected by bioassay in the supernatant of cultures challenged with 100 ng/mL, after 6 h. The cytokine was detected by ELISA in the supernatant of the cells challenged with doses of l mg/mL, after 6 and 12 h. The results point out the capacity of this venom to activate the keratinocytes in primary cultures to produce TNF-a. The production of cytokines could contribute to the local inflammatory process in patients bitten by Loxosceles sp.Culturas primárias de queratinócitos humanos foram incubadas com veneno de aranha Loxosceles gaucho, que possui atividade esfingomielinase D, responsável por lesão dermo-necrótica nos acidentes humanos. As células das culturas primárias foram agredidas com o veneno em doses crescentes de 10 ng/mL a 2 µg/mL. No sobrenadante das culturas agredidas com 100 ng/mL, 500 ng/mL, 1 e 2 µg/mL da toxina, foi pesquisada a presença de TNF-a através de bioensaio e ELISA. Com 100 ng/mL, foi detectado TNF-a no sobrenadante após 6 h, no bioensaio; usando o teste de ELISA, detectou-se a citocina no sobrenadante de células agredidas com doses de 1 µg/mL, após 6 e 12 h. Os resultados apontam para a capacidade deste veneno em ativar os queratinócitos em cultura, levando-os a produzir TNF-a. É provável que a produção de citocinas ative as células endoteliais, auxiliando na localização do processo inflamatório.

  4. Primary immunodeficiency

    Directory of Open Access Journals (Sweden)

    McCusker Christine

    2011-11-01

    Full Text Available Abstract Primary immunodeficiency disorder (PID refers to a heterogeneous group of over 130 disorders that result from defects in immune system development and/or function. PIDs are broadly classified as disorders of adaptive immunity (i.e., T-cell, B-cell or combined immunodeficiencies or of innate immunity (e.g., phagocyte and complement disorders. Although the clinical manifestations of PIDs are highly variable, most disorders involve at least an increased susceptibility to infection. Early diagnosis and treatment are imperative for preventing significant disease-associated morbidity and, therefore, consultation with a clinical immunologist is essential. PIDs should be suspected in patients with: recurrent sinus or ear infections or pneumonias within a 1 year period; failure to thrive; poor response to prolonged use of antibiotics; persistent thrush or skin abscesses; or a family history of PID. Patients with multiple autoimmune diseases should also be evaluated. Diagnostic testing often involves lymphocyte proliferation assays, flow cytometry, measurement of serum immunoglobulin (Ig levels, assessment of serum specific antibody titers in response to vaccine antigens, neutrophil function assays, stimulation assays for cytokine responses, and complement studies. The treatment of PIDs is complex and generally requires both supportive and definitive strategies. Ig replacement therapy is the mainstay of therapy for B-cell disorders, and is also an important supportive treatment for many patients with combined immunodeficiency disorders. The heterogeneous group of disorders involving the T-cell arm of the adaptive system, such as severe combined immunodeficiency (SCID, require immune reconstitution as soon as possible. The treatment of innate immunodeficiency disorders varies depending on the type of defect, but may involve antifungal and antibiotic prophylaxis, cytokine replacement, vaccinations and bone marrow transplantation. This article

  5. 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.

  6. 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

  7. [Primary lipodystrophies].

    Science.gov (United States)

    Capeau, J; Magré, J; Lascols, O; Caron, M; Béréziat, V; Vigouroux, C

    2007-02-01

    Primary lipodystrophies represent a heterogeneous group of very rare diseases with a prevalence of less than 1 case for 100.000, inherited or acquired, caracterized by a loss of body fat either generalized or localized (lipoatrophy). In some forms, lipoatrophy is associated with a selective hypertrophy of other fat depots. Clinical signs of insulin resistance are often present: acanthosis nigricans, signs of hyperandrogenism. All lipodystrophies are associated with dysmetabolic alterations with insulin resistance, altered glucose tolerance or diabetes and hypertriglyceridemia leading to a risk of acute pancreatitis. Chronic complications are those resulting from diabetes involving the retina, kidney and nerves, cardiovascular complications and steatotic liver lesions that could result in cirrhosis. Genetic forms of generalized lipodystrophy (or Berardinelli-Seip syndrome) result, in most cases, from recessive mutations in one of two genes: either BSCL2 coding seipin or BSCL1 coding AGPAT2, an acyl-transferase involved in triglyceride synthesis. Acquired generalized lipodystrophy (Lawrence syndrome) is of unknown origin but is sometimes associated with signs of autoimmunity. Partial lipodystrophies can be familial with dominant transmission. Heterozygous mutations have been identified in the LMNA gene encoding nuclear lamin A/C belonging to the nuclear lamina, or in PPARG encoding the adipogenic transcription factor PPARgamma. Some less typical lipodystrophies, associated with signs of premature aging, have been linked to mutations in LMNA or in the ZMPSTE24 gene encoding the protease responsible for the maturation of prelamin A into lamin A. Acquired partial lipodystrophy (Barraquer-Simons syndrome) is characterized by cephalothoracic fat loss. Its aetiology is unknown but mutations in LMNB2, encoding the lamina protein lamin B2, could represent susceptibility factors. Highly active antiretroviral treatments for HIV infection are currently the most frequent cause

  8. 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

  9. 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

  10. 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

  11. Thank You, Challenges!

    Institute of Scientific and Technical Information of China (English)

    陈晨; 陈传光

    2016-01-01

    A person may meet many challenges in his or her life.Some people think challenges are terrible.But I think they’re great.And I want to say,"Thank you,challenges!"For some people,it’s hard to face the challenges because they are afraid of failing in the end.However,it’s necessary for a person to face the challenges.Challenges are good to~①you.

  12. 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.

  13. 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.

  14. 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…

  15. 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.

  16. 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

  17. The future and primary care.

    Science.gov (United States)

    Alpert, J J

    1994-12-01

    Primary care is about the intimate contact that takes place when a patient comes to the physician because that individual is concerned that he or she, son or daughter, parent or grandparent is sick, or is well and wants to stay well. Our history has been that we have paid attention to important problems but we have missed so far on primary care as a megatrend. As noted, one of our most important societal megatrends is proverty and how poverty places children at risk. Poverty and primary care are linked. The reality that all of our citizens do not have access to primary care is not just our failure but it is society's as well. We pediatricians face many problems. In developing solutions, historically our profession has never lost sight of the fact that we are a helping and caring discipline. We are an advocate for the poor, advocates for children, advocates for community, and that is a large job. But the challenge is real, and we do not have much time. Now is not the time to be timid. We need to achieve consensus, accepting and acting on the megatrend of securing the future for primary care.

  18. 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.

  19. 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...

  20. National Drug IQ Challenge

    Science.gov (United States)

    ... Reto nacional del coeficiente intelectual (CI) sobre las drogas y el alcohol 2016 National Drug IQ Challenge ... Reto nacional del coeficiente intelectual (CI) sobre las drogas y el alcohol 2015 National Drug IQ Challenge ...

  1. Challenges for IT-supported shared care

    DEFF Research Database (Denmark)

    Granlien, Maren Fich; Simonsen, Jesper

    2007-01-01

    Purpose: To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study: The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions...... of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion: The two cases faced...... the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general...

  2. 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…

  3. [Esthetic restorations of primary anterior teeth].

    Science.gov (United States)

    Elqadir, A Jamil; Shapira, J; Ziskind, K; Ram, D

    2013-04-01

    Esthetic treatment of primary teeth is one of the greatest challenges to pediatric dentists. A variety of restorative options using full coverage are available for anterior primary teeth. In the last half century the emphasis on treatment of severely decayed primary teeth shifted from extraction to restoration. In the past, restorations consisted of placement of stainless steel crowns on severely decayed teeth. However, they are esthetically unacceptable today. Over the last decade parents expect a higher esthetic standard for their children's primary teeth. Thus, the restoration should provide esthetic appearance and durability in addition to restoring function. The purpose of this review is to describe the types of full coverage options for anterior primary teeth currently available.

  4. Atenção primária em saúde: um estudo multidimensional sobre os desafios e potencialidades na Região Metropolitana de São Paulo (SP, Brasil Primary healthcare: a multidimensional study on challenges and potential in the São Paulo Metropolitan Region (SP, Brazil

    Directory of Open Access Journals (Sweden)

    Luiza Sterman Heimann

    2011-06-01

    Full Text Available Este artigo apresenta resultados de estudo de caso na Região Metropolitana de São Paulo (SP desenvolvido no âmbito de estudo multicêntrico na Argentina, no Brasil, no Paraguai e no Uruguai. O objetivo é analisar a Atenção Primária em Saúde (APS como estratégia para alcançar sistemas integrais e universais. A abordagem metodológica se pautou em cinco dimensões de análise: condução política; financiamento; provisão; integralidade e intersetorialidade. As técnicas incluíram revisão bibliográfica, análise documental e entrevistas com informantes-chave: gestores, especialistas, usuários e profissionais. Os resultados foram organizados em função dos desafios e das possibilidades da APS como estruturante do sistema segundo as cinco dimensões. Das entrevistas emergiram: distintas interpretações do conceito e papel da APS e o consenso como porta de entrada do sistema; debilidades no financiamento; desafios na gestão do trabalho e a necessidade de novo desenho jurídico-institucional para a gestão regional. Como potencialidades: a extensão de cobertura/universalidade, base da organização do sistema, na vinculação com o território e na compreensão das especificidades da população.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

  5. 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.

  6. A Canadian Effort to Address Fractions Teaching and Learning Challenges

    Science.gov (United States)

    Yearley, Shelley; Bruce, Catherine D.

    2014-01-01

    Teaching and learning fraction concepts provides challenges in primary schools all over the world. In this article, Shelley Yearley and Catherine Bruce describe a fractions-based research project conducted in Ontario, Canada.

  7. 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.

  8. Diagnosing deep venous thrombosis in primary care

    NARCIS (Netherlands)

    Oudega, Rudolphus

    2005-01-01

    In patients suspected of deep venous thrombosis (DVT) in primary care, it is a challenge to discriminate the patients with DVT from those without DVT. The risk of missing the diagnosis and the risk of unnecessary referral and treatment with a potential harmful therapy has to be balanced by the prima

  9. Primary total elbow arthroplasty

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2013-01-01

    Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head

  10. 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).

  11. 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, ...

  12. Primary Meningeal Rhabdomyosarcoma

    OpenAIRE

    2011-01-01

    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 imagin...

  13. Primary Hyperparathyroidism: An Overview

    OpenAIRE

    Jessica MacKenzie-Feder; Sandra Sirrs; Donald Anderson; Jibran Sharif; Aneal Khan

    2011-01-01

    Primary hyperparathyroidism is a common condition that affects 0.3% of the general population. Primary and tertiary care specialists can encounter patients with primary hyperparathyroidism, and prompt recognition and treatment can greatly reduce morbidity and mortality from this disease. In this paper we will review the basic physiology of calcium homeostasis and then consider genetic associations as well as common etiologies and presentations of primary hyperparathyroidism. We will consider...

  14. 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.

  15. 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…

  16. Investigating Primary Source Literacy

    Science.gov (United States)

    Archer, Joanne; Hanlon, Ann M.; Levine, Jennie A.

    2009-01-01

    Primary source research requires students to acquire specialized research skills. This paper presents results from a user study testing the effectiveness of a Web guide designed to convey the concepts behind "primary source literacy". The study also evaluated students' strengths and weaknesses when conducting primary source research. (Contains 3…

  17. Supporting Teachers in Structuring Mathematics Lessons Involving Challenging Tasks

    Science.gov (United States)

    Sullivan, Peter; Askew, Mike; Cheeseman, Jill; Clarke, Doug; Mornane, Angela; Roche, Anne; Walker, Nadia

    2015-01-01

    The following is a report on an investigation into ways of supporting teachers in converting challenging mathematics tasks into classroom lessons and supporting students in engaging with those tasks. Groups of primary and secondary teachers, respectively, were provided with documentation of ten lessons built around challenging tasks. Teachers…

  18. Primary Hyperparathyroidism: An Overview

    Directory of Open Access Journals (Sweden)

    Jessica MacKenzie-Feder

    2011-01-01

    Full Text Available Primary hyperparathyroidism is a common condition that affects 0.3% of the general population. Primary and tertiary care specialists can encounter patients with primary hyperparathyroidism, and prompt recognition and treatment can greatly reduce morbidity and mortality from this disease. In this paper we will review the basic physiology of calcium homeostasis and then consider genetic associations as well as common etiologies and presentations of primary hyperparathyroidism. We will consider emerging trends in detection and measurement of parathyroid hormone as well as available imaging modalities for the parathyroid glands. Surgical indications and approach will be reviewed as well as medical management of primary hyperparathyroidism with bisphosphonates and calcimimetics.

  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. Where Cultural Games Count: The Voices of Primary Classroom Teachers

    Science.gov (United States)

    Nabie, Michael Johnson

    2015-01-01

    This study explored Ghanaian primary school teachers' values and challenges of integrating cultural games in teaching mathematics. Using an In-depth conversational interview, ten (10) certificated teachers' voices on the values and challenges of integrating games were examined. Thematic data analysis was applied to the qualitative data from the…

  1. Modified Anchor Shaped Post Core Design for Primary Anterior Teeth

    OpenAIRE

    R. Rajesh; Kusai Baroudi; K. Bala Kasi Reddy; Praveen, B. H.; V. Sumanth Kumar; Amit, S

    2014-01-01

    Restoring severely damaged primary anterior teeth is challenging to pedodontist. Many materials are tried as a post core but each one of them has its own drawbacks. This a case report describing a technique to restore severely damaged primary anterior teeth with a modified anchor shaped post. This technique is not only simple and inexpensive but also produces better retention.

  2. Modified Anchor Shaped Post Core Design for Primary Anterior Teeth

    Directory of Open Access Journals (Sweden)

    R. Rajesh

    2014-01-01

    Full Text Available Restoring severely damaged primary anterior teeth is challenging to pedodontist. Many materials are tried as a post core but each one of them has its own drawbacks. This a case report describing a technique to restore severely damaged primary anterior teeth with a modified anchor shaped post. This technique is not only simple and inexpensive but also produces better retention.

  3. Modified anchor shaped post core design for primary anterior teeth.

    Science.gov (United States)

    Rajesh, R; Baroudi, Kusai; Reddy, K Bala Kasi; Praveen, B H; Kumar, V Sumanth; Amit, S

    2014-01-01

    Restoring severely damaged primary anterior teeth is challenging to pedodontist. Many materials are tried as a post core but each one of them has its own drawbacks. This a case report describing a technique to restore severely damaged primary anterior teeth with a modified anchor shaped post. This technique is not only simple and inexpensive but also produces better retention.

  4. Extracting Primary Objects by Video Co-Segmentation

    NARCIS (Netherlands)

    Lou, Z.; Gevers, T.

    2014-01-01

    Video object segmentation is a challenging problem. Without human annotation or other prior information, it is hard to select a meaningful primary object from a single video, so extracting the primary object across videos is a more promising approach. However, existing algorithms consider the proble

  5. 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

  6. 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.

  7. 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.

  8. Indirect airway challenges

    NARCIS (Netherlands)

    Joos, GF; O'Connor, B; Anderson, SD; Chung, F; Cockcroft, DW; Dahlen, B; DiMaria, G; Foresi, A; Hargreave, FE; Holgate, ST; Inman, M; Lotvall, J; Magnussen, H; Polosa, R; Postma, DS; Riedler, J

    2003-01-01

    Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Di

  9. 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…

  10. 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…

  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. 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.

  13. Primary Intraosseous Meningioma.

    Science.gov (United States)

    Chen, Thomas C

    2016-04-01

    Primary intraosseous meningiomas are a subtype of primary extradural meningiomas. They represent approximately two-thirds of extradural meningiomas and fewer than 2% of meningiomas overall. These tumors originate within the bones of the skull and can have a clinical presentation and radiographic differential diagnosis different from those for intradural meningiomas. Primary intraosseous meningiomas are classified based on location and histopathologic characteristics. Treatment is primarily surgical resection with wide margins if possible. Sparse literature exists regarding the use of adjuvant therapies. The literature regarding primary intraosseous meningiomas consists primarily of clinical case reports and case series. This literature is reviewed and summarized in this article.

  14. Hyperaldosteronism - primary and secondary

    Science.gov (United States)

    Primary and secondary hyperaldosteronism have common symptoms, including: High blood pressure High level of calcium in the blood Fatigue Headache Muscle weakness Numbness Paralysis that comes and goes

  15. What Makes Primary Classteachers Special? Exploring the Features of Expertise in the Primary Classroom

    Science.gov (United States)

    Eaude, Tony

    2014-01-01

    This article explores the nature of teacher expertise in the primary school classroom, drawing on theoretical models of expertise and of teaching expertise. It challenges simplistic models of an "outstanding" or "master" teacher to argue that since teacher expertise is both situated and prototypical, it is manifested in…

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. Primary hypoparathyroidism in a dog

    Directory of Open Access Journals (Sweden)

    Mateus do Amaral Freitas

    2014-02-01

    Full Text Available The hypoparathyroidism is a rare endocrinopathy reported in dogs, caused by a deficiency in the synthesis of parathyroid hormone (PTH. The lack of PTH causes hypocalcemia and hyperphosphatemia, resulting in a series of neurological and neuromuscular disorders. Unlike most endocrinopathies, hypoparathyroidism is a disease in which the exogenous hormone replacement is not being viable, becoming the treatment a challenge. The present report aims to describe a case of primary hypoparathyroidism in a Schnauzer dog with seizures and neuromuscular disorders, and successful treatment employed, this being the first case, according to the literature, of hypoparathyroidism diagnosed in Brazil. The hypoparathyroidism should be considered as a differential diagnosis in cases of seizure. A complete neurological evaluation and determination of serum ionized calcium and parathyroid hormone are essential for the diagnosis of this disease. Early diagnosis may improve the quality of life of affected animals, since after the initiation of therapy, there is complete remission of clinical signs.

  1. 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...

  2. 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.

  3. Big data challenges

    DEFF Research Database (Denmark)

    Bachlechner, Daniel; Leimbach, Timo

    2016-01-01

    Although reports on big data success stories have been accumulating in the media, most organizations dealing with high-volume, high-velocity and high-variety information assets still face challenges. Only a thorough understanding of these challenges puts organizations into a position in which...... they can make an informed decision for or against big data, and, if the decision is positive, overcome the challenges smoothly. The combination of a series of interviews with leading experts from enterprises, associations and research institutions, and focused literature reviews allowed not only...... framework are also relevant. For large enterprises and startups specialized in big data, it is typically easier to overcome the challenges than it is for other enterprises and public administration bodies....

  4. 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.

  5. 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)

  6. 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.

  7. 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.

  8. 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…

  9. Using Primary Source Documents.

    Science.gov (United States)

    Mintz, Steven

    2003-01-01

    Explores the use of primary sources when teaching about U.S. slavery. Includes primary sources from the Gilder Lehrman Documents Collection (New York Historical Society) to teach about the role of slaves in the Revolutionary War, such as a proclamation from Lord Dunmore offering freedom to slaves who joined his army. (CMK)

  10. Free Primary Education and Implementation in Kenya

    Directory of Open Access Journals (Sweden)

    Benta A. Abuya

    2015-02-01

    Full Text Available Free primary education policy has substantially increased school enrollment rates in Sub-Saharan African countries. The success and sustainability depend on teachers’ perception, motivation, and proper implementation of the policy in the classroom. Few studies focus on teachers’ experiences and challenges in the process of implementing the policy. The current study presents theoretical reviews using the “bottom-up,” “top-down,” and incremental policy frameworks. The study used a desk review of the documents from the Ministry of Education and other published materials from an Education Research Program in Kenya. Findings suggest that there is no adequate empirical study to support the views and assertions concerning teachers’ experiences and motivation toward the implementation of free universal primary education policy in Kenya. There is a need for empirical research and programs to understand teachers’ experiences and challenges in translating education policy into practices.

  11. 78 FR 19742 - Centennial Challenges: 2014 Night Rover Challenge

    Science.gov (United States)

    2013-04-02

    ... Rover Challenge purse is $1,500,000 (one million five hundred thousand U.S. dollars). Prizes will be... SPACE ADMINISTRATION Centennial Challenges: 2014 Night Rover Challenge AGENCY: National Aeronautics and Space Administration (NASA). ACTION: Notice of Centennial Challenges 2014 Night Rover Challenge....

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. Government Funding on Access to Secondary Education in Kenya: Challenges and Prospects

    Science.gov (United States)

    Ndiku, J. Mualuko; Muhavi, S. Lucy

    2013-01-01

    One of the major challenges facing secondary education sub-sector in Kenya over the years is low transition rate from primary to secondary level of education. This has contributed to low enrolment at secondary schools with a wide gap existing between primary and secondary enrolment. With the introduction of Free Primary Education in 2003, the gap…

  17. 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...

  18. Histoplasmosis - acute (primary) pulmonary

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000098.htm Histoplasmosis - acute (primary) pulmonary To use the sharing features on this page, please enable JavaScript. Acute pulmonary histoplasmosis is a respiratory infection that is caused by ...

  19. 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.

  20. 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 ...

  1. Primary meningeal rhabdomyosarcoma.

    Science.gov (United States)

    Palta, Manisha; Riedel, Richard F; Vredenburgh, James J; Cummings, Thomas J; Green, Scott; Chang, Zheng; Kirkpatrick, John P

    2011-01-01

    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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. The Dirty Water Challenge

    Science.gov (United States)

    Walker, Mark; Kremer, Angelika; Schluter, Kirsten

    2007-01-01

    "The Dirty Water Challenge" is a fun activity that teaches children about their environment in an engaging and practical way. Inquiry is embedded within the practical--students have to design, plan, and then build their own design of water filter. Students are exposed to important concepts from a variety of scientific disciplines, including how…

  7. 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,…

  8. 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.

  9. 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.

  10. 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…

  11. Challenges in data science

    DEFF Research Database (Denmark)

    Carbone, Anna; Jensen, M.; Sato, Aki-Hiro

    2016-01-01

    The ability to process and manage large data volumes has been proven to be not enough to tackle the current challenges presented by "Big Data". Deep insight is required for understanding interactions among connected systems, space- and time-dependent heterogeneous data structures. Emergence...

  12. Challenges of CE

    NARCIS (Netherlands)

    Verhagen, Wim J.C.; Stjepandić, Josip; Wognum, Nel

    2015-01-01

    Despite a long pedigree and many positive reports on its use and benefits, concurrent engineering (CE) and its associated research (sub)domains still experience significant development. In this final chapter, a socio-technical framework is applied to classify and analyze challenges identified as

  13. 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...

  14. Kayak Design Challenge

    Science.gov (United States)

    Wood, Anson

    2011-01-01

    Living in the Adirondack Park and being an avid outdoorsman has often resulted in the author's love of the outdoors working its way into class projects. In 2010, the author gave a group of 25 students in grades 9-12 a challenge that required them to design and construct a prototype inexpensive, lightweight kayak for backpackers and fisherman. In…

  15. 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...

  16. The blind hens’ challenge

    DEFF Research Database (Denmark)

    Sandøe, Peter; Hocking, Paul M.; Forkman, Björn

    2014-01-01

    repellent, yet 'welfare-only' positions appear to be committed to endorsing this possibility if it produces welfare gains. We call this the 'Blind Hens' Challenge'. In this paper, we argue that there are both empirical and theoretical reasons why even those adopting 'welfare-only' views should be concerned...

  17. 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.

  18. 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

  19. 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.

  20. 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…

  1. 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...

  2. India's Higher Education Challenges

    Science.gov (United States)

    Altbach, Philip G.

    2014-01-01

    India, with the world's second largest higher education system and a rapidly growing economy as one of the BRIC nations, faces significant challenges in building both capacity and excellence in higher education. India's higher education system is characterized by "islands of excellence in a sea of mediocrity." The mainstream universities…

  3. 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. Ab...

  4. 81 FR 54853 - Notice of Centennial Challenges Space Robotics Challenge

    Science.gov (United States)

    2016-08-17

    ... Space Robotics Challenge AGENCY: National Aeronautics and Space Administration (NASA). NOTICE: (16-056). ACTION: Notice of Centennial Challenges Space Robotics Challenge. SUMMARY: This notice is issued in accordance with 51 U.S.C. 20144(c). The Space Robotics Challenge is open and teams that wish to compete...

  5. 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...

  6. 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...

  7. 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.

  8. 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.

  9. Pilot Implementation of Health Information Systems: Issues and challenges

    DEFF Research Database (Denmark)

    Bansler, Jørgen Peter; Havn, Erling C.

    2010-01-01

    Objectives: This study aims to explore the issues and challenges involved in designing and organizing pilot implementations of health information systems (HIS). Pilot implementations are a widely used approach for identifying design flaws and implementation issues before full-scale deployment...... implementation of an electronic Pregnancy Record (ePR) in Denmark. Our primary data collection methods comprised participant observations, semi-structured interviews and document analyses. Results: Based on a comprehensive evaluation of the implementation process, we identify three major challenges...

  10. 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. ...

  11. 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.

  12. 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.

  13. 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.

  14. Melatonin for primary insomnia?

    Science.gov (United States)

    2009-07-01

    Melatonin, a hormone produced by the pineal gland, has a key role in regulating circadian rhythms, most importantly, the sleep-wake cycle. Melatonin's action has led to its being tried as a treatment for a wide range of sleep disorders, such as jet lag, primary insomnia, sleep-wake cycle disruption and sleep problems in children with neuro-developmental disorders. Until recently, it had not been licensed in the UK for any indication. Prolonged-release melatonin (Circadin - Lundbeck) has now been licensed as a treatment for primary insomnia. Here we consider whether this product has a place in the management of people with this condition.

  15. 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...

  16. 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...

  17. 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 procedure...... 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.......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...

  18. GREEN BUILDING CHALLENGE 2005

    OpenAIRE

    López de Asiaín, Jaime; Alvarez-Ude, Luis

    2005-01-01

    Green Building Challenge 2005 forma part d'un projecte de cooperació entre diferents països (més de 20 en l'actualitat) que té per objectiu el desenvolupament d'una metodologia d'avaluació del comportament ecològic dels edificis i els resultats se presentaran en una conferència internacional a celebrar a Tòquio (Japó) a la finals de l'any 2005: Sustainable Building 2005. Green Building Challenge 2005 forma parte de un proyecto de cooperación entre distintos países (más de 20 en la actualid...

  19. 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...

  20. 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...

  1. 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....

  2. 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.

  3. Challenges to Resistance Welding

    DEFF Research Database (Denmark)

    Song, Quanfeng

    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...... 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...

  4. Supernova Photometric Classification Challenge

    CERN Document Server

    Kessler, Richard; Jha, Saurabh; Kuhlmann, Stephen

    2010-01-01

    We have publicly released a blinded mix of simulated SNe, with types (Ia, Ib, Ic, II) selected in proportion to their expected rate. The simulation is realized in the griz filters of the Dark Energy Survey (DES) with realistic observing conditions (sky noise, point spread function and atmospheric transparency) based on years of recorded conditions at the DES site. Simulations of non-Ia type SNe are based on spectroscopically confirmed light curves that include unpublished non-Ia samples donated from the Carnegie Supernova Project (CSP), the Supernova Legacy Survey (SNLS), and the Sloan Digital Sky Survey-II (SDSS-II). We challenge scientists to run their classification algorithms and report a type for each SN. A spectroscopically confirmed subset is provided for training. The goals of this challenge are to (1) learn the relative strengths and weaknesses of the different classification algorithms, (2) use the results to improve classification algorithms, and (3) understand what spectroscopically confirmed sub-...

  5. Ireland's Competitiveness Challenge 2011

    OpenAIRE

    2012-01-01

    The NCC publishes two annual competitiveness reports. Ireland's Competitiveness Challenge focuses on the national competitiveness issues of most importance to the enterprise sector and identifies policy recommendations required to address these issues. The report focuses on pursuing policies to improve competitiveness, particularly those to reduce the cost base for enterprise, to enhance the performance of the entire education system, and to deliver meaningful public sector reform. Ireland's ...

  6. 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

  7. Managing the Fukushima Challenge

    OpenAIRE

    Suzuki, Atsuyuki

    2014-01-01

    The Fukushima Daiichi accident raises a fundamental question: Can science and technology prevent the inevitability of serious accidents, especially those with low probabilities and high consequences? This question reminds us of a longstanding challenge with the trans-sciences, originally addressed by Alvin Weinberg well before the Three Mile Island and Chernobyl accidents. This article, revisiting Weinberg's issue, aims at gaining insights from the accident with a special emphasis on the soci...

  8. 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.

  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. Bioinformatics Challenge Days

    Science.gov (United States)

    2013-12-30

    concentrations 3. Genome Assembly for the Clinic: Performing de novo assembly from clinical samples with an emphasis on pathogen identification 4...The Illumina Genome Analyzer II was used. The sample contained 1.4 Gbp of data. DE NOVO GENETIC ASSEMBLY (BCD1, 2) The same datasets were used...Challenge (BCD1) 21   From Metagenomic Sample to Useful Visual (BCD1, 2) 21   De Novo Genetic Assembly (BCD1, 2) 22   Identifying Markers of Genetic

  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. 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.

  13. EDMS implementation challenge.

    Science.gov (United States)

    De La Torre, Marta

    2002-08-01

    The challenges faced by facilities wishing to implement an electronic medical record system are complex and overwhelming. Issues such as customer acceptance, basic computer skills, and a thorough understanding of how the new system will impact work processes must be considered and acted upon. Acceptance and active support are necessary from Senior Administration and key departments to enable this project to achieve measurable success. This article details one hospital's "journey" through design and successful implementation of an electronic medical record system.

  14. 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...

  15. 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.

  16. Veteran, Primary Care Provider, and Specialist Satisfaction With Electronic Consultation

    OpenAIRE

    2015-01-01

    Background Access to specialty care is challenging for veterans in rural locations. To address this challenge, in December 2009, the Veterans Affairs (VA) Pittsburgh Healthcare System (VAPHS) implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients with enhanced specialty care access. Objective The aim of this quality improvement (QI) project evaluation was to: (1) assess satisfaction with the e-consult process, and (2) identify perceive...

  17. Choice and privatisation in Swedish primary care.

    Science.gov (United States)

    Anell, Anders

    2011-10-01

    In 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.

  18. Young adult palliative care: challenges and opportunities.

    Science.gov (United States)

    Clark, Jennifer K; Fasciano, Karen

    2015-02-01

    Young adulthood is a time of immense growth and possibilities. As a result, it is also a time when serious illness can have profound effects. This review examines the current data pertinent to young adult palliative care and discusses the challenges and opportunities where palliative medicine can enhance the care provided to this growing and vulnerable population. From the data, 2 primary themes emerged (1) ongoing young adult development not only generates unique biologic disease burdens and clinical treatment options but also requires frequent assessment and promotion and (2) binary health care systems often leave young adults without access to developmentally appropriate health care. Given its interdisciplinary approach, palliative care is uniquely poised to address the challenges known to caring for the seriously ill young adult.

  19. Green tribology: principles, research areas and challenges.

    Science.gov (United States)

    Nosonovsky, Michael; Bhushan, Bharat

    2010-10-28

    In this introductory paper for the Theme Issue on green tribology, we discuss the concept of green tribology and its relation to other areas of tribology as well as other 'green' disciplines, namely, green engineering and green chemistry. We formulate the 12 principles of green tribology: the minimization of (i) friction and (ii) wear, (iii) the reduction or complete elimination of lubrication, including self-lubrication, (iv) natural and (v) biodegradable lubrication, (vi) using sustainable chemistry and engineering principles, (vii) biomimetic approaches, (viii) surface texturing, (ix) environmental implications of coatings, (x) real-time monitoring, (xi) design for degradation, and (xii) sustainable energy applications. We further define three areas of green tribology: (i) biomimetics for tribological applications, (ii) environment-friendly lubrication, and (iii) the tribology of renewable-energy application. The integration of these areas remains a primary challenge for this novel area of research. We also discuss the challenges of green tribology and future directions of research.

  20. 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.

  1. 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.

  2. Primary diffuse leptomeningeal gliosarcomatosis.

    Science.gov (United States)

    Moon, Ju Hyung; Kim, Se Hoon; Kim, Eui Hyun; Kang, Seok-Gu; Chang, Jong Hee

    2015-04-01

    Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare condition with a fatal outcome, characterized by diffuse infiltration of the leptomeninges by neoplastic glial cells without evidence of primary tumor in the brain or spinal cord parenchyma. In particular, PDLG histologically diagnosed as gliosarcoma is extremely rare, with only 2 cases reported to date. We report a case of primary diffuse leptomeningeal gliosarcomatosis. A 68-year-old man presented with fever, chilling, headache, and a brief episode of mental deterioration. Initial T1-weighted post-contrast brain magnetic resonance imaging (MRI) showed diffuse leptomeningeal enhancement without a definite intraparenchymal lesion. Based on clinical and imaging findings, antiviral treatment was initiated. Despite the treatment, the patient's neurologic symptoms and mental status progressively deteriorated and follow-up MRI showed rapid progression of the disease. A meningeal biopsy revealed gliosarcoma and was conclusive for the diagnosis of primary diffuse leptomeningeal gliosarcomatosis. We suggest the inclusion of PDLG in the potential differential diagnosis of patients who present with nonspecific neurologic symptoms in the presence of leptomeningeal involvement on MRI.

  3. Primary ectopic frontotemporal craniopharyngioma

    Science.gov (United States)

    Ortega-Porcayo, Luis Alberto; Ponce-Gómez, Juan Antonio; Martínez-Moreno, Mauricio; Portocarrero-Ortíz, Lesly; Tena-Suck, Martha Lilia; Gómez-Amador, Juan Luis

    2015-01-01

    Introduction Primary ectopic craniopharyngiomas have only rarely been reported. Craniopharyngiomas involve usually the sellar and suprasellar region, but can be originated from cell remnants of the obliterated craniopharyngeal duct or metaplastic change of andenohypophyseal cells. We present the first case of a primary ectopic frontotemporal craniopharyngioma. Presentation of case A 35-year old woman presented with a one-year history of headache and diplopia. MRI showed a large frontotemporal cystic lesion. Tumor resection was performed with a keyhole endoscopic frontal lateral approach. The pathological features showed an adamantinomatous craniopharyngioma with a cholesterol granuloma reaction. Discussion There have been reported different localizations for primary ectopic craniopharyngioma. Our case presented a lobulated frontotemporal cystic mass formed by a dense eosinophilic proteinaceous material dystrophic calcifications and cholesterol crystals, with epithelial remnants. No tumor regrowth was observed in the magnetic resonance image 27 months postoperatively. Conclusion Primary ectopic craniopharyngioma is a rare entity with a pathogenesis that remains uncertain. This is an unusual anatomic location associated with unique clinical findings. PMID:25725331

  4. 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.

  5. 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…

  6. 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...

  7. 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…

  8. 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...

  9. Primary Pulmonary Hodgkin Lymphoma

    OpenAIRE

    Shumaila Tanveer; Ahmed El Damati; Ayman El Baz; Ahmed Alsayyah; Tarek ElSharkawy; Mohamed Regal

    2015-01-01

    Primary pulmonary Hodgkin lymphoma (PPHL) is a rare disease. Herein, we report a case of PPHL with diagnostic concerns encountered during initial evaluation which is of paramount importance to keep the differential diagnosis in cases with high index of sus- picion for this rare entity.

  10. 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...

  11. Primary cultures of astrocytes

    DEFF Research Database (Denmark)

    Lange, Sofie C; Bak, Lasse Kristoffer; Waagepetersen, Helle S;

    2012-01-01

    During the past few decades of astrocyte research it has become increasingly clear that astrocytes have taken a central position in all central nervous system activities. Much of our new understanding of astrocytes has been derived from studies conducted with primary cultures of astrocytes. Such ...

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. Nanotechnology: Opportunities and Challenges

    Science.gov (United States)

    Meyyappan, Meyya

    2003-01-01

    Nanotechnology seeks to exploit novel physical, chemical, biological, mechanical, electrical, and other properties, which arise primarily due to the nanoscale nature of certain materials. A key example is carbon nanotubes (CNTs) which exhibit unique electrical and extraordinary mechanical properties and offer remarkable potential for revolutionary applications in electronics devices, computing, and data storage technology, sensors, composites, nanoelectromechanical systems (NEMS), and as tip in scanning probe microscopy (SPM) for imaging and nanolithography. Thus the CNT synthesis, characterization, and applications touch upon all disciplines of science and engineering. This presentation will provide an overview and progress report on this and other major research candidates in Nanotechnology and address opportunities and challenges ahead.

  17. 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

  18. 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.

  19. 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).

  20. 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

  1. Challenges in Distributed Leadership: Evidence from the Perspective of Headteachers

    Science.gov (United States)

    Tahir, Lokman Mohd; Lee, Sui Liang; Musah, Mohammed Borhandden; Jaffri, Hadijah; Said, Mohd Nihra Haruzuan Mohamad; Yasin, Mohd Hanafi Mohd

    2016-01-01

    Purpose: The purpose of this paper is to investigate the issues and challenges faced by headteachers in practicing the suggested distributed leadership (DL) approach in three primary schools to their middle layer leaders. Design/methodology/approach: The study employed a case study design and data were collected through semi-structured interviews.…

  2. 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…

  3. 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…

  4. 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.)

  5. 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.

  6. Primary hyperparathyroidism and nephrolithiasis.

    Science.gov (United States)

    Vestergaard, Peter

    2015-05-01

    Calcifications in the kidneys may occur in the parenchyma (nephrocalcinosis), pelvis renis (nephrolithiasis) or ureters (ureterolithiasis). Several factors may protect against stone formation or promote precipitation of stones. Most stones contain calcium, and the hypercalciuria seen in primary hyperparathyroidism is a contributing factor to stone formation in the kidneys and urinary tract. In early case series, renal stone formation was frequent, whereas the proportion of patients with symptomatic renal stones has declined in recent years. However, a substantial proportion of patients presents with asymptomatic nephrocalcinosis or nephrolithiasis. Before diagnosis and treatment of primary hyperparathyroidism, renal stone events are more frequent than in the general population. However, even after surgical cure, an increased rate of renal stone events may be seen. This may to some extent be the result of stones or calcifications already present at the time of diagnosis or sequelae to prior stones such as infections or ureter strictures.

  7. Acupuncture in primary care.

    Science.gov (United States)

    Mao, Jun J; Kapur, Rahul

    2010-03-01

    Acupuncture, an ancient traditional Chinese medical therapy, is used widely around the world. When practiced by a certified provider, it is safe and patients often find it calming and relaxing. Animal and human studies have found a physiologic basis for acupuncture needling in that it affects the complex central and peripheral neurohormonal network. Although it is unclear whether acupuncture is beneficial over sham/placebo acupuncture, acupuncture care yields clinically relevant short- and long-term benefits for low back pain, knee osteoarthritis, chronic neck pain, and headache. The integration of acupuncture into a primary care setting also appears to be cost-effective. The practice of acupuncture in primary care requires rigorous training, financial discipline, and good communication skills. When done correctly, acupuncture is beneficial for both patients and providers.

  8. [Basics of primary immunodeficiencies].

    Science.gov (United States)

    Hernández-Martínez, Claudia; Espinosa-Rosales, Francisco; Espinosa-Padilla, Sara Elva; Hernández-Martínez, Ana Rosa; Blancas-Galicia, Lizbeth

    2016-01-01

    Primary immunodeficiencies (PID) are a heterogeneous group of inherited disorders, the etiology are the defects in the development or function of the immune system. The principal PID manifestations are the infections in early age, malignancy and diseases of immune dysregulation as autoimmunity and allergy. PIDs are genetics disorders and most of them are inherited as autosomal recessive, also this group of diseases is more prevalent in males and in childhood. The antibody immunodeficiency is the PID more common in adults. The more frequent disorders are the infections in the respiratory tract, abscesses, candidiasis, diarrhea, BCGosis etc. Initial approach included a complete blood count and quantification of immunoglobulins. The delay in diagnosis could be explained due to a perception that the recurrent infections are normal process or think that they are exclusively of childhood. The early diagnosis of PID by primary care physicians is important to opportune treatment and better prognosis.

  9. 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.

  10. 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.

  11. 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.

  12. ATLAS Data Challenge 1

    CERN Document Server

    Poulard, G

    2003-01-01

    In 2002 the ATLAS experiment started a series of Data Challenges (DC) of which the 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 (HLT) and physics communities, and the production of those samples as a world-wide distributed activity. The first phase of DC1 was run during summer 2002, and involved 39 institutes in 18 countries. More than 10 million physics events and 30 million single particle events were fully simulated. Over a period of about 40 calendar days 71000 CPU-days were used producing 30 Tbytes of data in about 35000 partitions. In the second phase the next processing step was performed with the participation of 56 institutes in 21 countries (~ 4000 processors used in parallel). The basic elements of ...

  13. 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).

  14. 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.

  15. 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,...

  16. 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.

  17. 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 ...

  18. Therapeutic challenges of urosepsis.

    Science.gov (United States)

    Wagenlehner, F M E; Pilatz, A; Naber, K G; Weidner, W

    2008-10-01

    Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community or nosocomial acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The treatment of urosepsis comprises four major aspects: Early goal directed therapy, early optimal pharmacodynamic exposure to antimicrobials, early control of the complicating factor in the urinary tract and specific sepsis therapy. Following these prerequisites there appear two major challenges that need to be addressed: Firstly, time from admission to therapy is critical; the shorter the time to effective treatment, the higher the success rate. This aspect has to become incorporated into the organisational process. Secondly, adequate initial antibiotic therapy has to be insured. This goal implies however, a wide array of measures to ensure rational antibiotic policy. Both challenges are best targeted if an interdisciplinary approach at any level of the process is established, encompassing urologists, intensive care specialists, radiologists, microbiologists and clinical pharmacologists working tightly together at any time.

  19. 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.

  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. Primary stabbing headache.

    Science.gov (United States)

    Pareja, Juan A; Sjaastad, Ottar

    2010-01-01

    Primary stabbing headache is characterized by transient, cephalic ultrashort stabs of pain. It is a frequent complaint with a prevalence of 35.2%, a female preponderance, and a mean age of onset of 28 years (Vågå study). Attacks are generally characterized by moderate to severe, jabbing or stabbing pain, lasting from a fraction of a second to 3s. Attack frequency is generally low, with one or a few attacks per day. The paroxysms generally occur spontaneously, during daytime. Most patients exhibit a sporadic pattern, with an erratic, unpredictable alternation between symptomatic and non-symptomatic periods. Paroxysms are almost invariably unilateral. Temporal and fronto-ocular areas are most frequently affected. Attacks tend to move from one area to another, in either the same or the opposite hemicranium. Jabs may be accompanied by a shock-like feeling and even by head movement - "jolts" -or vocalization. On rare occasions, conjunctival hemorrhage and monocular vision loss have been described as associated features. Primary stabbing headache may concur, synchronously or independently, with other primary headaches. In contrast to what is the case in adults, in childhood it is not usually associated with other headaches. Treatment is rarely necessary. Indomethacin, 75-150 mg daily, may seem to be of some avail. Celecoxib, nifedipine, melatonin, and gabapentin have been reported to be effective in isolated cases and small series of patients. The drug studies need corroboration.

  2. 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.

  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. Achieving Value in Primary Care: The Primary Care Value Model.

    Science.gov (United States)

    Rollow, William; Cucchiara, Peter

    2016-03-01

    The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation.

  5. Primary Connections: Simulating the Classroom in Initial Teacher Education

    Science.gov (United States)

    Hume, Anne Christine

    2012-06-01

    The challenge of preparing novice primary teachers for teaching in an educational environment, where science education has low status and many teachers have limited science content knowledge and lack the confidence to teach science, is great. This paper reports on an innovation involving a sustained simulation in an undergraduate science education course as a mediational tool to connect two communities of practice—initial teacher education and expert primary science teaching. The course lecturer and student teachers role-played the expert classroom teacher and primary students (Years 7/8) respectively in an attempt to gain insights into teaching and learning through authentic activity that models good practice in primary science teaching and learning. Activity theory was used to help frame and analyse the data. Findings from the first trial indicate that the simulation was very effective in initiating science pedagogical content knowledge (PCK) development of primary student teachers.

  6. 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

  7. 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.

  8. WCET Tool Challenge 2011: Report

    DEFF Research Database (Denmark)

    Bonenfant, Armelle; Cassé, Hugues; Bünte, Sven;

    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 k...

  9. Energy Challenges for ICT

    DEFF Research Database (Denmark)

    Fagas, Giorgos; Gallagher, John Patrick; Gammaitoni, Luca

    2017-01-01

    The energy consumption from the expanding use of information and communications technology (ICT) is unsustainable with present drivers, and it will impact heavily on the future climate change. However, ICT devices have the potential to contribute significantly to the reduction of CO2 emission...... the energy sustainability of ICT and capture the full potential of ICT in resource efficiency, a multidisciplinary ICT-energy community needs to be brought together covering devices, microarchitectures, ultra large-scale integration (ULSI), high-performance computing (HPC), energy harvesting, energy storage......, system design, embedded systems, efficient electronics, static analysis, and computation. In this chapter, we introduce challenges and opportunities in this emerging field and a common framework to strive towards energy-sustainable ICT....

  10. 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.

  11. 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...

  12. 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.

  13. 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...

  14. 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.

  15. Ayurveda research: Ontological challenges

    Directory of Open Access Journals (Sweden)

    Jayakrishna Nayak

    2012-01-01

    Full Text Available Collaborative research involving Ayurveda and the current sciences is undoubtedly an imperative and is emerging as an exciting horizon, particularly in basic sciences. Some work in this direction is already going on and outcomes are awaited with bated breath. For instance the ′ASIIA (A Science Initiative In Ayurveda′ projects of Dept of Science and Technology, Govt of India, which include studies such as Ayurvedic Prakriti and Genetics. Further intense and sustained collaborative research needs to overcome a subtle and fundamental challenge-the ontologic divide between Ayurveda and all the current sciences. Ontology, fundamentally, means existence; elaborated, ontology is a particular perspective of an object of existence and the vocabulary developed to share that perspective. The same object of existence is susceptible to several ontologies. Ayurveda and modern biomedical as well as other sciences belong to different ontologies, and as such, collaborative research cannot be carried out at required levels until a mutually acceptable vocabulary is developed.

  16. 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.

  17. Ayurveda research: Ontological challenges.

    Science.gov (United States)

    Nayak, Jayakrishna

    2012-01-01

    Collaborative research involving Ayurveda and the current sciences is undoubtedly an imperative and is emerging as an exciting horizon, particularly in basic sciences. Some work in this direction is already going on and outcomes are awaited with bated breath. For instance the 'ASIIA (A Science Initiative In Ayurveda)' projects of Dept of Science and Technology, Govt of India, which include studies such as Ayurvedic Prakriti and Genetics. Further intense and sustained collaborative research needs to overcome a subtle and fundamental challenge-the ontologic divide between Ayurveda and all the current sciences. Ontology, fundamentally, means existence; elaborated, ontology is a particular perspective of an object of existence and the vocabulary developed to share that perspective. The same object of existence is susceptible to several ontologies. Ayurveda and modern biomedical as well as other sciences belong to different ontologies, and as such, collaborative research cannot be carried out at required levels until a mutually acceptable vocabulary is developed.

  18. Addressing the terawatt challenge

    DEFF Research Database (Denmark)

    Vesborg, Peter C. K.; Jaramillo, Thomas F.

    2012-01-01

    The energy infrastructure for fossil fuels is well-established, accounting for approximately 87% of the 16 TW of power consumed globally. For renewable and sustainable energy conversion technologies to play a relevant role at the terrestrial scale, they must be able to scale to the TW level...... of deployment. This would place a significant demand on the current and future supply of raw materials (chemical elements) used by those technologies. Oftentimes, the average crustal abundance of a chemical element is cited as a measure of its scalability, however another important metric for scalability...... is the existence (of lack thereof) of mineable ores with a high concentration of the targeted element. This paper aims to provide an overview of the availability of all elements. This is accomplished via a compilation of data for global primary production rates for each element, as a measure of availability...

  19. 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…

  20. The natural history of primary progressive multiple sclerosis

    NARCIS (Netherlands)

    Koch, Marcus; Kingwell, Elaine; Rieckmann, Peter; Tremlett, Helen

    2009-01-01

    Background: Primary progressive multiple sclerosis (PPMS) carries the worst prognosis of the multiple sclerosis (MS) subtypes and is currently untreatable. A previous analysis of the British Columbia MS database challenged the view that disability progression is rapid in PPMS, but identified few pre

  1. Elicitation of Specific Syntactic Structures in Primary Progressive Aphasia

    Science.gov (United States)

    DeLeon, Jessica; Gesierich, Benno; Besbris, Max; Ogar, Jennifer; Henry, Maya L.; Miller, Bruce L.; Gorno-Tempini, Maria Luisa; Wilson, Stephen M.

    2012-01-01

    Many patients with primary progressive aphasia (PPA) are impaired in syntactic production. Because most previous studies of expressive syntax in PPA have relied on quantitative analysis of connected speech samples, which is a relatively unconstrained task, it is not well understood which specific syntactic structures are most challenging for these…

  2. Primary Connections: Simulating the Classroom in Initial Teacher Education

    Science.gov (United States)

    Hume, Anne Christine

    2012-01-01

    The challenge of preparing novice primary teachers for teaching in an educational environment, where science education has low status and many teachers have limited science content knowledge and lack the confidence to teach science, is great. This paper reports on an innovation involving a sustained simulation in an undergraduate science education…

  3. 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…

  4. 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.

  5. 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…

  6. 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.)

  7. Bilateral primary breast lymphoma

    Institute of Scientific and Technical Information of China (English)

    Jung Im Yi; Byung Joo Chae; Ja Seong Bae; Bong Joo Kang; Ahwon Lee; Byung Joo Song; Sang Seol Jung

    2010-01-01

    @@ Primary breast lymphoma (PBL) is rare, accounting for 0.04%-0.50% of breast malignancies and 1.7% of extranodal lymphoma.1,2 The originally described diagnostic criteria for PBL2 remains the standard definition for this disease. These criteria are breast location as the clinical site of presentation, absence of history of previous lymphoma or evidence of widespread disease at diagnosis, close association of lymphoma with breast tissue in pathologic specimens, and involvement of ipsilateral lymph nodes if they develop simultaneously with PBL.

  8. Primary leptomeningeal melanoma.

    Science.gov (United States)

    Xie, Zhao-Yu; Hsieh, Kevin Li-Chun; Tsang, Yuk-Ming; Cheung, Wing-Keung; Hsieh, Chen-Hsi

    2014-06-01

    Primary melanoma of the central nervous system is a rare melanocytic tumor typically located in the leptomeninges. We report a 57-year-old woman with an intracranial leptomeningeal melanoma who presented with myoclonic seizures. Brain CT scan and MRI revealed a hemorrhagic intracranial tumor. The tumor was completely removed and leptomeningeal melanoma was proven pathologically. Follow-up imaging studies up to 19 months showed no recurrence of the disease. Here we present radiological, gross, and pathological images of leptomeningeal melanoma, discuss its characteristics, and review the relevant literature.

  9. Epigenetics and primary care.

    Science.gov (United States)

    Wright, Robert; Saul, Robert A

    2013-12-01

    Epigenetics, the study of functionally relevant chemical modifications to DNA that do not involve a change in the DNA nucleotide sequence, is at the interface between research and clinical medicine. Research on epigenetic marks, which regulate gene expression independently of the underlying genetic code, has dramatically changed our understanding of the interplay between genes and the environment. This interplay alters human biology and developmental trajectories, and can lead to programmed human disease years after the environmental exposure. In addition, epigenetic marks are potentially heritable. In this article, we discuss the underlying concepts of epigenetics and address its current and potential applicability for primary care providers.

  10. 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)

  11. Primary Pancreatic Lymphomas

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2006-05-01

    Full Text Available Extranodal non-Hodgkin’s lymphomas (NHLs represent up to 30-40% of all NHL cases. The gastrointestinal tract is the most commonly involved extranodal site; accounting for about half of such cases [1]. Stomach and the small intestine constitute the most common gastrointestinal sites. Secondary invasion of the pancreas from contiguous, retroperitoneal lymph node disease is the prevalent mode of involvement. Secondary involvement of the pancreas from the duodenum or adjacent peripancreatic lymphadenopathy is well-known. Primary pancreatic lymphoma (PPL is an extremely rare disease [2]. PPL can present as an isolated mass mimicking pancreatic carcinoma. However, unlike carcinomas, PPL are potentially treatable [3].

  12. 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.

  13. Teacher of primary English

    CERN Multimedia

    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 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...... prevention of ASCVD with statins was superior to the trial-based and hybrid approaches. Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches, while treating fewer people compared with the trial-based approach....

  15. Primary health care staff's perception of childhood tuberculosis

    DEFF Research Database (Denmark)

    Bjerrum, Stephanie; Rose, Michala Vaaben; Bygbjerg, Ib Christian;

    2012-01-01

    Background: Diagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study...... explored primary health care staff’s perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania. Methods: We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health...... staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis. Results: Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely...

  16. Diagnostic strategies in children with chronic gastrointestinal symptoms in primary care

    NARCIS (Netherlands)

    Holtman, Geeske Atje

    2016-01-01

    Chronic or recurrent gastrointestinal symptoms are common presentations among children in primary care. Because symptoms of functional gastrointestinal disorders may be indistinguishable from inflammatory bowel disease (IBD), it is a diagnostic challenge for clinicians to differentiate between them

  17. Multimorbidity, service organization and clinical decision making in primary care: a qualitative study.

    NARCIS (Netherlands)

    Bower, P.; Macdonald, W.; Harkness, E.; Gask, L.; Kendrick, T.; Valderas, J.M.; Dickens, C.; Blakeman, T.; Sibbald, B.S.

    2011-01-01

    BACKGROUND: Primary care professionals often manage patients with multiple long-term health conditions, but managing multimorbidity is challenging given time and resource constraints and interactions between conditions. OBJECTIVE: To explore GP and nurse perceptions of multimorbidity and the influen

  18. Primary pulmonary choriocarcinoma

    Science.gov (United States)

    Snoj, Ziga; Kocijancic, Igor

    2017-01-01

    Abstract Background The aim of the study was to establish whether there are different clinical entities of primary pulmonary choriocarcinoma (PPC) that deserve different diagnostic approach and the most optimal treatment. Patients and methods A systematic review with PubMed search was conducted to identify studies that reported cases of PPC. The eligibility criteria were histological diagnosis of pulmonary choriocarcinoma and thorough examination of the reproductive organs to exclude potential primary choriocarcinoma in the gonads. Furthermore, to illustrate the review we additionally present a patient referred at our institution. Results 55 cases (17 men) were included in the review with a median age of 34 years. Women with the history of gestational event showed better survival outcome than women without the history of gestational event. Patients treated with combined modality treatment (surgery and chemotherapy) survived longer than the patients without combined modality treatment. Furthermore, multivariate analysis of prognostic factors showed that the combined modality treatment had independent prognostic significance. Size of the tumour showed significant prognostic influence in univariate and multivariate analysis. Conclusions PPC is an extreme rarity with variable clinical characteristics and outcome. It is important to capture and treat patients in the early stages of the disease. Women with the history of gestational event may show better survival, therefore genetic examination could help us to predict patient’s prognosis. Surgery followed by adjuvant chemotherapy appears to represent the best treatment for PPC.

  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 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.

  1. Musculoskeletal challenges of osteoporosis.

    Science.gov (United States)

    Sinaki, M

    1998-06-01

    Reduction in the biomechanical competence of the axial skeleton can result in challenging complications. Osteoporosis consists of a heterogeneous group of syndromes in which bone mass per unit volume is reduced in otherwise normal bone, which results in more fragile bone. The geriatric population has an increased risk for debilitating postural changes because of several factors. The two most apparent factors are involutional loss of functional muscle motor units and the greater prevalence of osteoporosis in this population. Obviously, the main objective of rehabilitation is to prevent fractures rather than to treat the complications. These complications can vary from "silent" compression fractures of vertebral bodies, to sacral insufficiency fractures, to "breath-taking" fractures of the spine or femoral neck. The exponential loss of bone at the postmenopausal stage is not accompanied by an incremental loss of muscle strength. The loss of muscle strength follows a more gradual course and is not affected significantly by a sudden hormonal decline, as is the case with bone loss. This muscle loss may contribute to osteoporosis-related skeletal disfigurations. In men and women, the combination of aging and reduction of physical activity can affect musculoskeletal health, and contribute to the development of bone fragility. The parallel decline in muscle mass and bone mass with age is more than a coincidence, and inactivity may explain some of the bone loss previously associated with aging per se. Kyphotic postural change is the most physically disfiguring and psychologically damaging effect of osteoporosis and can contribute to an increment in vertebral fractures and the risk of falling. Axial skeletal fractures, such as fracture of the sacral alae (sacral insufficiency fracture) and pubic rami, may not be found until radiographic changes are detected. Management of chronic pain should include not only improvement of muscle strength and posture but also, at times

  2. 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....

  3. 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...

  4. Challenges in Mathematical Cognition

    Directory of Open Access Journals (Sweden)

    Lara Alcock

    2016-04-01

    Full Text Available This paper reports on a collaborative exercise designed to generate a coherent agenda for research on mathematical cognition. Following an established method, the exercise brought together 16 mathematical cognition researchers from across the fields of mathematics education, psychology and neuroscience. These participants engaged in a process in which they generated an initial list of research questions with the potential to significantly advance understanding of mathematical cognition, winnowed this list to a smaller set of priority questions, and refined the eventual questions to meet criteria related to clarity, specificity and practicability. The resulting list comprises 26 questions divided into six broad topic areas: elucidating the nature of mathematical thinking, mapping predictors and processes of competence development, charting developmental trajectories and their interactions, fostering conceptual understanding and procedural skill, designing effective interventions, and developing valid and reliable measures. In presenting these questions in this paper, we intend to support greater coherence in both investigation and reporting, to build a stronger base of information for consideration by policymakers, and to encourage researchers to take a consilient approach to addressing important challenges in mathematical cognition.

  5. Challenges in organ transplantation.

    Science.gov (United States)

    Beyar, Rafael

    2011-04-01

    Organ transplantation has progressed tremendously with improvements in surgical methods, organ preservation, and pharmaco-immunologic therapies and has become a critical pathway in the management of severe organ failure worldwide. The major sources of organs are deceased donors after brain death; however, a substantial number of organs come from live donations, and a significant number can also be obtained from non-heart-beating donors. Yet, despite progress in medical, pharmacologic, and surgical techniques, the shortage of organs is a worldwide problem that needs to be addressed internationally at the highest possible levels. This particular field involves medical ethics, religion, and society behavior and beliefs. Some of the critical ethical issues that require aggressive interference are organ trafficking, payments for organs, and the delicate balance in live donations between the benefit to the recipient and the possible harm to the donor and others. A major issue in organ transplantation is the definition of death and particularly brain death. Another major critical factor is the internal tendency of a specific society to donate organs. In the review below, we will discuss the various challenges that face organ donation worldwide, and particularly in Israel, and some proposed mechanisms to overcome this difficulty.

  6. Ribosomal Antibiotics: Contemporary Challenges

    Directory of Open Access Journals (Sweden)

    Tamar Auerbach-Nevo

    2016-06-01

    Full Text Available Most ribosomal antibiotics obstruct distinct ribosomal functions. In selected cases, in addition to paralyzing vital ribosomal tasks, some ribosomal antibiotics are involved in cellular regulation. Owing to the global rapid increase in the appearance of multi-drug resistance in pathogenic bacterial strains, and to the extremely slow progress in developing new antibiotics worldwide, it seems that, in addition to the traditional attempts at improving current antibiotics and the intensive screening for additional natural compounds, this field should undergo substantial conceptual revision. Here, we highlight several contemporary issues, including challenging the common preference of broad-range antibiotics; the marginal attention to alterations in the microbiome population resulting from antibiotics usage, and the insufficient awareness of ecological and environmental aspects of antibiotics usage. We also highlight recent advances in the identification of species-specific structural motifs that may be exploited for the design and the creation of novel, environmental friendly, degradable, antibiotic types, with a better distinction between pathogens and useful bacterial species in the microbiome. Thus, these studies are leading towards the design of “pathogen-specific antibiotics,” in contrast to the current preference of broad range antibiotics, partially because it requires significant efforts in speeding up the discovery of the unique species motifs as well as the clinical pathogen identification.

  7. Challenges in Piaget's legacy.

    Science.gov (United States)

    Bibace, Roger

    2013-03-01

    The publication of After Piaget (Martí and Rodríguez 2012) hopefully triggers a new effort to understand the richness of the efforts of that major psychologist of the 20th century. Piaget was consistently concerned with part/whole relationships throughout his life. He addressed this issue philosophically, epistemologically, and psychologically. Conceptually Piaget struggled with the issue of continuity/discontinuity in development and changed his mind about how to reconcile the discontinuities of stages with his concept of development. I also attribute his variability to the implications of his important work on perception, and to his willingness to get involved in widespread concrete applications of his approach to education including the education of children with special needs; his center for genetic epistemology, and his interest in psychoanalysis. Benefiting from all the authors of After Piaget, I want to point out that Piaget has identified many major issues that will continue to constitute challenges to psychology in this century. These include specifying terms such as 'development;' methodological issues such as sampling both quantitatively in one culture and across cultures; comprehensive inclusion of the psychological processes covered by introductory textbooks in psychology; and conceptual issues such as the relationships among all these parts within a whole. I make a distinction between an 'issue' and a 'problem'--problems have solutions; while issues refer to controversies in science generally as well as in psychology that have persisted for centuries.

  8. Challenges in Astronomy Education

    Science.gov (United States)

    De Greve, Jean-Pierre

    2010-11-01

    Astronomy is an attractive subject for education. It deals with fascination of the unknown and the unreachable, yet is uses tools, concepts and insights from various fundamental sciences such as mathematics, physics, chemistry, biology. Because of this it can be well used for introducing sciences to young people and to raise their interest in further studies in that direction. It is also an interesting subject for teaching as its different aspects (observation techniques, theory, data sampling and analysis, modelling,?) offer various didactical approaches towards different levels of pupils, students and different backgrounds. And it gives great opportunities to teach and demonstrate the essence of scientific research, through tutorials and projects. In this paper we discuss some of the challenges education in general, and astronomy in particular, faces in the coming decades, given the major geophysical and technological changes that can be deducted from our present knowledge. This defines a general, but very important background in terms of educational needs at various levels, and in geographical distribution of future efforts of the astronomical community. Special emphasis will be given to creative approaches to teaching, to strategies that are successful (such as the use of tutorials with element from computer games), and to initiatives complementary to the regular educational system. The programs developed by the IAU will be briefly highlighted.

  9. Osteomyelitis: a current challenge

    Directory of Open Access Journals (Sweden)

    Luciana Souza Jorge

    2010-06-01

    Full Text Available Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

  10. VISIR: Experiences and Challenges

    Directory of Open Access Journals (Sweden)

    Mohamed Tawfik

    2012-02-01

    Full Text Available It is of crucial importance the integration of practical sessions in engineering curricula owing to their significant role in understanding engineering concepts and scientific phenomena. However, the lack of practical sessions due to the high costs of the equipment and the unavailability of instructors has caused a significant declination in experimentation in engineering education. Remote laboratories have tackled this issues providing online reusable and shared workbenches unconstrained by neither geographical nor time considerations. Thereby, they have extremely proliferated among universities and integrated into engineering curricula over the last decade. This contribution compiles diverse experiences based on the deployment of the remote laboratory, Virtual Instrument Systems in Reality (VISIR, on the practices of undergraduate engineering grades at various universities within the VISIR community. It aims to show the impact of its usage on engineering education concerning the assessments of students and teachers as well. In addition, the paper address the next challenges and future works carried out at several universities within the VISIR community.

  11. DOE Energy Challenge Project

    Energy Technology Data Exchange (ETDEWEB)

    Frank Murray; Michael Schaepe

    2009-04-24

    Project Objectives: 1. Promote energy efficiency concepts in undergraduate and graduate education. 2. Stimulate and interest in pulp and paper industrial processes, which promote and encourage activities in the area of manufacturing design efficiency. 3. Attract both industrial and media attention. Background and executive Summary: In 1997, the Institute of Paper Science and Technology in conjunction with the U.S. Department of Energy developed a university design competition with an orientation to the Forest Products Industry. This university design competition is in direct alignment with DOE’s interests in instilling in undergraduate education the concepts of developing energy efficient processes, minimizing waste, and providing environmental benefits and in maintaining and enhancing the economic competitiveness of the U.S. forest products industry in a global environment. The primary focus of the competition is projects, which are aligned with the existing DOE Agenda 2020 program for the industry and the lines of research being established with the colleges comprising the Pulp and Paper Education and Research Alliance (PPERA). The six design competitions were held annually for the period 1999 through 2004.

  12. Primary and secondary stabbing headache.

    Science.gov (United States)

    Robbins, Matthew S; Evans, Randolph W

    2015-04-01

    Eight out of the 33 cases of primary stabbing headache seen in a general neurology clinic (40% have headache as their chief complaint) in the last 3.5 years are presented. The epidemiology, association with other primary headache disorders, secondary associations, testing, and treatment of primary stabbing headache are reviewed.

  13. Primary Teacher Education in Malaysia

    Science.gov (United States)

    Ching, Chin Phoi; Yee, Chin Peng

    2012-01-01

    In Malaysia the training of primary school teachers is solely carried out by teacher training institutes which offer the Bachelor of Teaching with Honors (Primary education) program and was first launched in 2007. This program prepares primary school teachers specializing in various subjects or major and is carried out in 27 teacher training…

  14. The Challenge of Change for Physical Education in the 1980's: A Biomechanical Viewpoint.

    Science.gov (United States)

    Hay, James G.

    The shifting emphasis in the field of physical education from exercise physiology to motor learning to biomechanics over the past several decades presents a challenge for shaping the future of physical education. The primary challenges involve matching the supply of graduates to the demand for their services, developing a sound philosophy relative…

  15. 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...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p ...: Hypertension Guideline recommendations that require joint agreements between professionals are less often adopted than simple, precise recommendations. More emphasis on effective multidisciplinary collaboration is needed....

  16. 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...... of an 80-year-old man with a 2 × 2 × 1 cm tumour located on the scalp. This tumour emerged over a period of 2 months. The tumour was radically excised, and histological examination revealed a cutaneous myoepithelial carcinoma. At an 18-month follow-up, no recurrence of the tumour was found. A systematic...... literature search identified 23 papers that reported 58 cases of cutaneous myoepitheliomas and myoepithelial carcinomas. All cases are reviewed in the presented paper. This case report and literature review serves to increase awareness regarding myoepithelial carcinomas. These tumours exhibit high metastatic...

  17. 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.

  18. 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

  19. 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...

  20. [Primary spontaneous pneumomediastinum].

    Science.gov (United States)

    Togashi, K; Hosaka, Y

    2007-12-01

    We report 5 cases of spontaneous pneumomediastinum. They were 4 men and 1 female with a mean age of 17 (14-25). Four patients developed sport-related pneumomediastinum and 1 patient had a karaoke-related condition. Primary spontaneous pneumomediasinum is a rare condition. In addition, there is no previous report describing karaoke-related spontaneous pneumomediastinum. Each of the patients experienced chest pain and/or neck pain before consulting our hospital. Chest roentgenogram and chest computed tomography showed pneumomediastinum without esophageal or tracheal injury. Four patients did not require hospitalization, but 1 patient was necessary to hospitalize for 7 days because of severe chest and neck pain. None of these 5 patients has had any recurrence for more than 1 year. Differentiating this entity from other diseases involving anterior chest pain is important.

  1. Primary ciliary dyskinesia

    Directory of Open Access Journals (Sweden)

    Plavec Goran

    2004-01-01

    Full Text Available In patients with chronic respiratory diseases that last since the early childhood, primary ciliary dyskinesia (PCD needs to be considered. Four patients reviewed in this paper were with typical disease history and clinical picture, as well as clear ciliary axonema damage. Complete examination was performed in all the patients, including bronchoscopy with bronchography, and the examination of the biopsy samples of respiratory airways’ mucous membrane, obtained by transmission electron microscope (TEM. In two of the patients spermatozoa were also examined by TEM. Large anatomic deffects of airways were found in all the patients, but pulmonary function was normal (except in one case, representing one of PCD’s significant characteristics. First two cases fulfilled the criteria for Kartagener’s syndrome, which was initially sufficient for the diagnosis of PCD.

  2. 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.

  3. Apoptosis in Primary Hyperparathyroidism.

    Science.gov (United States)

    Segiet, Oliwia Anna; Mielańczyk, Łukasz; Piecuch, Adam; Michalski, Marek; Tyczyński, Szczepan; Brzozowa-Zasada, Marlena; Deska, Mariusz; Wojnicz, Romuald

    2017-03-31

    Primary hyperparathyroidism (PHPT) is defined by inappropriate elevation of parathormone, caused by parathyroid hyperplasia, also known as multi-gland disease (MGD), parathyroid adenoma (PA), or parathyroid carcinoma (PC). Although several studies have already been conducted, there is a lack of a definite diagnostic marker, which could unambiguously distinguish MGD from PA or PC. The accurate and prompt diagnosis has the key meaning for effective treatment and follow-up. This review paper presents the role of apoptosis in PHPT. The comparison of the expression of Fas, TRAIL, BCL-2 family members, p53 in MGD, PA, and PC, among others, was described. The expression of described factors varies among proliferative lesions of parathyroid gland; therefore, these could serve as additional markers to assist in the diagnosis.

  4. 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.

  5. Diagnostic Challenges in AIH

    Directory of Open Access Journals (Sweden)

    A Taghavi Ardakani

    2014-04-01

    Full Text Available Autoimmune hepatitis is a chronic hepatitis that occurs in children and adults of all ages. Diagnosis is based upon characteristic serologic and histologic findings and the exclusion of other forms of chronic liver disease. Guidelines issued by the AASLD suggest the following diagnostic considerations: The diagnosis should be made in patients with compatible clinical signs, symptoms, and laboratory abnormalities. Other conditions that can cause chronic hepatitis should be excluded. In unclear cases a standardized scoring system should be used in the assessment. In those who are negative for conventional autoantibodies, additional autoantibodies should be sought. All patients with autoimmune hepatitis and inflammatory bowel disease should undergo cholangiographic studies to exclude primary sclerosing cholangitis.   Scoring systems- A scoring system developed and subsequently revised by the International Autoimmune Hepatitis Group to standardize the diagnosis with using simplified criteria based upon titers of autoantibodies, IgG levels, liver histology, and the exclusion of viral hepatitis. Autoantibodies: assign one point if the ANA or SMA are 1:40 OR assign two points if the ANA or SMA are ≥1:80 (OR if the LKM ≥1:40 OR if the SLA is positive. IgG: assign one point if the IgG is > the upper limit of normal OR assign two points if the IgG is >1.10 times the upper limit of normal. Liver histology: assign one point if the histological features are compatible with autoimmune hepatitis OR two points if the histological features are typical of autoimmune hepatitis. Absence of viral hepatitis A probable diagnosis of autoimmune hepatitis is made if the total points are six, while a definite diagnosis is made if the total points are ≥seven.  

  6. Establishing Primary Adult Fibroblast Cultures From Rodents

    Science.gov (United States)

    Seluanov, Andrei; Vaidya, Amita; Gorbunova, Vera

    2010-01-01

    The importance of using primary cells, rather than cancer cell lines, for biological studies is becoming widely recognized. Primary cells are preferred in studies of cell cycle control, apoptosis, and DNA repair, as cancer cells carry mutations in genes involved in these processes. Primary cells cannot be cultured indefinitely due to the onset of replicative senescence or aneuploidization. Hence, new cultures need to be established regularly. The procedure for isolation of rodent embryonic fibroblasts is well established, but isolating adult fibroblast cultures often presents a challenge. Adult rodent fibroblasts isolated from mouse models of human disease may be a preferred control when comparing them to fibroblasts from human patients. Furthermore, adult fibroblasts are the only available material when working with wild rodents where pregnant females cannot be easily obtained. Here we provide a protocol for isolation and culture of adult fibroblasts from rodent skin and lungs. We used this procedure successfully to isolate fibroblasts from over twenty rodent species from laboratory mice and rats to wild rodents such as beaver, porcupine, and squirrel. PMID:20972406

  7. [Short course for primary physicians care].

    Science.gov (United States)

    Eshet, I; Van Relta, R; Margalit, A; Baharir, Z

    1995-11-15

    This department of family medicine has been challenged with helping a group of Russian immigrant physicians find places in primary care clinics, quickly and at minimal expense. A 3-month course was set up based on the Family Practice Residency Syllabus and the SFATAM approach, led by teachers and tutors from our department. 30 newly immigrated Russian physicians participated. The course included: lectures and exercises in treatment and communication with patients with a variety of common medical problems in the primary care setting; improvement of fluency in Hebrew relevant to the work setting; and information on the function of primary care and professional clinics. Before-and-after questionnaires evaluating optimal use of a 10- minute meeting with a client presenting with headache were administered. The data showed that the physicians had learned to use more psychosocial diagnostic question and more psychosocial interventions. There was a cleared trend toward greater awareness of the patient's environment, his family, social connections and work. There was no change in biomedical inquiry and interventions but a clear trend to a decrease in recommendations for tests and in referrals. The authors recommend the following didactic tools: adopting a biopsychosocial attitude, active participation of students in the learning situation, working in small groups, use of simulations and video clips, and acquiring basic communication experience.

  8. 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…

  9. 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.

  10. 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 that…

  11. 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.

  12. 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.

  13. 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.

  14. Tools for primary care management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-01-01

    are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated......Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians...... affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician's IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD...

  15. Community nurses working in piloted primary care teams: Irish Republic.

    Science.gov (United States)

    Burke, Triona; O'Neill, Catherine

    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.

  16. 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.

  17. Quality in public services: the challenges of Primary Care Servicios públicos: los desafíos de la Atención Primaria Qualidade em serviços públicos: os desafios da Atenção Primária

    Directory of Open Access Journals (Sweden)

    Leonardo Cançado Monteiro Savassi

    2012-09-01

    Full Text Available The Brazilian Ministry of Health has signaled a policy of evaluating the quality of primary care through the 1654 decree of 19.07.2011. Any organizational change interferes with the culture of any institution, especially when this change is directed toward the issue of quality. It involves processes, internal resources and people, and cannot be artificially produced by the power of the pen. In the health sector, management based on quality involves changes in business focus and technology, supported the rescue of professional-patient relationship, in the form of compensation of physicians and teams, in the qualification and training of professional, in qualifications in their own management, and in active participation of health professionals in the Agreement on these goals and quality parameters. Other instruments of quality assessment have been established within the Primary Care in public health sub-system, and its follow-up was interrupted. Qualifying the Primary is not just about evaluation, but also the selection of qualified professionals, qualification of services, monitoring results and valuation of health professionals involved with the new culture.El Ministerio de Salud de Brasil ha dado señales de una política de evaluación de la calidad de la atención primaria a través del decreto 1654 de 19.07.2011. Cualquier cambio en la organización interfiere con la cultura de cualquier institución, sobre todo cuando este cambio se dirige hacia el tema de la calidad. Implica en procesos internos, recursos y personas, y no puede ser producido artificialmente por el poder de la pluma. En el sector de la salud, la administración basada en la gestión de calidad implica en cambios en el enfoque de negocio y la tecnología apoyada en lo rescate de la relación profesional-paciente, en la forma de compensación de equipos y médicos, en la cualificación y formación de los profesionales, en la cualificación en su propia gestión y en la

  18. Revascularização direta do miocárdio com artéria gastro-omental esquerda: estudo anatômico e histológico e relato de caso Direct myocardial revascularization with left gastroepiploic artery: anatomic and histologic study and case report

    Directory of Open Access Journals (Sweden)

    Miguel A Maluf

    1987-12-01

    Full Text Available A veia safena e a artéria mamária interna (AMI são os enxertos mais usados, até o momento, para a revascularização direta do miocárdio. O estudo de sua normalidade de fluxo, a longo prazo, tem mostrado melhor adaptabilidade dos pedículos arteriais. O estudo da viabilidade da artéria gastro-omental (AG-O, na revascularização direta do miocárdio, foi realizado mediante estudo anatômico em 25 cadáveres adultos, com idades entre 23 e 84 anos, material cedido pelo Departamento de Anatomia Patológica da Escola Paulista de Medicina. A tática cirúrgica consistiu na dissecção da AG-O esquerda, ligando suas colaterais e desligando-a da AG-O direita, ao nível do antro pilórico. Foram estudados os diâmetros da artéria e o comprimento do pedículo. A transferência para a cavidade pericárdica foi realizada rodando o pedículo pela frente do fundo gástrico e passando-o através do orifício praticado no diafragma, anastomosando-o com a artéria coronária direita ou ramos marginais da artéria circunflexa. O estuo histológico da estrutura da AG-O mostrou camada média de tipo músculo-elástico com baixa incidência de aterosclerose. A aplicação clínica desta técnica foi realizada numa paciente de 58 anos de idade, que apresentava ambas as veias safenas internas finas e fibrosadas. Foram dissecadas AMI esquerda, AMI direita e AG-O esquerda, revascularizando as artérias descendente anterior, coronária direita e marginal esquerda, respectivamente. Após evolução pós-operatória de 12 dias, sem intercorrências, foi realizada angiografia digital seletiva das artérias mamárias e esplénica, demonstrando a normalidade ao fluxo dos enxertos. Esta nova possibilidade de revascularização miocárdica constitui uma opção a mais, entre o elenco de alternativas de que o cirurgião dispõe, especialmente quando não existem possibilidades de escolha de enxertos venosos.The most used grafts for myocardial revascularization are

  19. Liquid cathode primary batteries

    Science.gov (United States)

    Schlaikjer, Carl R.

    1985-03-01

    Lithium/liquid cathode/carbon primary batteries offer from 3 to 6 times the volumetric energy density of zinc/alkaline manganese cells, improved stability during elevated temperature storage, satisfactory operation at temperatures from -40 to +150 °C, and efficient discharge at moderate rates. he lithium/sulfur dioxide cell is the most efficient system at temperatures below 0 °C. Although chemical reactions leading to electrolyte degradation and lithium corrosion are known, the rates of these reactions are slow. While the normal temperature cell reaction produces lithium dithionite, discharge at 60 °C leads to a reduction in capacity due to side reactions involving sulfur dioxide and discharge intermediates. Lithium/thionyl chloride and lithium/sulfuryl chloride cells have the highest practical gravimetric and volumetric energy densities when compared with aqueous and most other nonaqueous systems. For thionyl chloride, discharge proceeds through a series of intermediates to sulfur, sulfur dioxide and lithium chloride. Catalysis, leading to improved rate capability and capacity, has been achieved. The causes of rapid reactions leading to thermal runaway are thought to be chemical in nature. Lithium/sulfuryl chloride cells, which produce sulfur dioxide and lithium chloride on discharge, experience more extensive anode corrosion. An inorganic cosolvent and suitable salt are capable of alleviating this corrosion. Calcium/oxyhalide cells have been studied because of their promise of increased safety without substantial sacrifice of energy density relative to lithium cells. Anode corrosion, particularly during discharge, has delayed practical development.

  20. 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.

  1. The primary hyperoxalurias.

    Science.gov (United States)

    Bobrowski, Amy E; Langman, Craig B

    2008-03-01

    The primary hyperoxalurias (PHs) are rare autosomal-recessive inborn errors of metabolism. In the most severe form (type 1), recurrent kidney stones and progressive nephrocalcinosis lead to the loss of kidney function, accompanied by systemic oxalosis, and often requires dialysis and/or transplantation. The variety of genetic mutations leading to PH increasingly are being defined, resulting in the ability to diagnose most patients accurately via minimally invasive means. During and after definitive diagnosis, supportive therapies with pyridoxine supplementation, urinary crystallization inhibitors, and hydration should be used, but have varying success. Emerging information about the renal tubular and intestinal transport of oxalate is leading to increasing evidence to support the use of oxalate-degrading bacteria (probiotics) and enzymes in the treatment of PH. Organ transplantation historically has offered the only potential cure for PH, and may include kidney-alone, combined liver-kidney, or pre-emptive liver-alone transplantation. Exciting new approaches in the treatment of type 1 PH, however, are under investigation. These include the restoration of defective enzymatic activity through the use of chemical chaperones, hepatocyte cell transplantation, or enzyme replacement by recombinant gene therapy. These novel approaches illustrate the goal for the ideal treatment of PH: correcting the genetic defect without exposing patients to the life-long risks associated with organ transplantation.

  2. Primary pulmonary hypertension.

    Science.gov (United States)

    Rashid, A; Lehrman, S; Romano, P; Frishman, W; Dobkin, J; Reichel, J

    2000-01-01

    Primary pulmonary hypertension (PPH) is a condition characterized by sustained elevation of pulmonary artery pressure (PAP) without demonstrable cause. The most common symptom at presentation is dyspnea. Other complaints include fatigue, chest pain, syncope, leg edema, and palpitations. Right heart catheterization is diagnostic, showing a mean PAP >25 mmHg at rest and >30 mmHg during exercise, with a normal pulmonary capillary wedge pressure. In the National Institutes of Health-PPH registry, the median survival period was 2.8 years. Treatment is aimed at lowering PAP, increasing cardiac output, and decreasing in situ thrombosis. Vasodilators have been used with some success in the treatment of PPH. They include prostacyclin, calcium-channel blockers, nitric oxide and adenosine. Anticoagulation has also been advised for the prevention of deep vein thrombosis, pulmonary embolism, and in situ thromboses of the lungs. New drug treatments under investigation include L-arginine, plasma endothelin-I, and bosentan. Use of oxygen, digoxin, and diuretics for symptomatic relief have also been recommended. Patients with severe PPH refractory to medical management should be considered for surgery.

  3. 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.

  4. 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.

  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. Liquid cathode primary batteries

    Energy Technology Data Exchange (ETDEWEB)

    Schlaikjer, C.R.

    1985-01-15

    Lithium/liquid cathode/carbon primary batteries offer from 3 to 6 times the volumetric energy density of zinc/alkaline manganese cells, improved stability during elevated temperature storage, satisfactory operation at temperatures from -40 to +150/sup 0/C, and efficient discharge at moderate rates. The lithium/sulfur dioxide cell is the most efficient system at temperatures below 0/sup 0/C. Although chemical reactions leading to electrolyte degradation and lithium corrosion are known, the rates of these reactions are slow. While the normal temperature cell reaction produces lithium dithionite, discharge at 60/sup 0/C leads to a reduction in capacity due to side reactions involving sulfur dioxide and discharge intermediates. Lithium/thionyl chloride and lithium/sulfuryl chloride cells have the highest practical gravimetric and volumetric energy densities when compared with aqueous and most other nonaqueous systems. For thionyl chloride, discharge proceeds through a series of intermediates to sulfur, sulfur dioxide and lithium chloride. Catalysis, leading to improved rate capability and capacity, has been achieved. The causes of rapid reactions leading to thermal runaway are thought to be chemical in nature. Lithium/sulfuryl chloride cells, which produce sulfur dioxide and lithium chloride on discharge, experience more extensive anode corrosion. An inorganic cosolvent and suitable salt are capable of alleviating this corrosion. Calcium/oxyhalide cells have been studied because of their promise of increased safety without substantial sacrifice of energy density relative to lithium cells. Anode corrosion, particularly during discharge, has delayed practical development.

  7. Comparing varieties of in-service English Language Training for primary school teachers in Norway

    OpenAIRE

    2014-01-01

    International trends show the formal teaching of English starting at an increasingly early age. This presents challenges for national education systems and in particular, for primary schools and for primary school teachers who are not necessarily trained as English teachers. The present study investigates two different ways of organising and designing in-service educational training (INSET) in Norway for those primary school teachers who currently teach English without any formal training as ...

  8. Implementing genetic education in primary care: the Gen-Equip programme.

    Science.gov (United States)

    Paneque, Milena; Cornel, Martina C; Curtisova, Vaclava; Houwink, Elisa; Jackson, Leigh; Kent, Alastair; Lunt, Peter; Macek, Milan; Stefansdottir, Vigdis; Turchetti, Daniela; Skirton, Heather

    2017-03-13

    Genetics and genomics are increasingly relevant to primary healthcare but training is unavailable to many practitioners. Education that can be accessed by practitioners without cost or travel is essential. The Gen-Equip project was formed to provide effective education in genetics for primary healthcare in Europe and so improve patient care. Partners include patient representatives and specialists in genetics and primary care from six countries. Here, we report the progress and challenges involved in creating a European online educational program in genetics.

  9. Challenging High-Ability Students

    Science.gov (United States)

    Scager, Karin; Akkerman, Sanne F.; Pilot, Albert; Wubbels, Theo

    2014-01-01

    The existing literature on indicators of an optimal learning environment for high-ability students frequently discusses the concept of challenge. It is, however, not clear what, precisely, constitutes appropriate challenge for these students. In this study, the authors examined an undergraduate honours course, Advanced Cell Biology, which has…

  10. Organizational leadership: meeting the challenge.

    Science.gov (United States)

    Hart, A L

    1994-06-01

    Leadership can be learned. Knowledge of leadership theories can serve as basis for developing skills and techniques. Style, trait, and transformational leadership can be applied in both health care institutions and professional associations. Organizational leadership is challenging, but those challenges can help individual nurses grow in the leadership skills that will continue to be demanded in the ever changing healthcare arena.

  11. Statistics Poster Challenge for Schools

    Science.gov (United States)

    Payne, Brad; Freeman, Jenny; Stillman, Eleanor

    2013-01-01

    The analysis and interpretation of data are important life skills. A poster challenge for schoolchildren provides an innovative outlet for these skills and demonstrates their relevance to daily life. We discuss our Statistics Poster Challenge and the lessons we have learned.

  12. Challenging high-ability students

    NARCIS (Netherlands)

    Scager, Karin; Akkerman, Sanne F.; Pilot, Albert; Wubbels, Theo; Hafd Onderwijsadvies en training; Leerstoel Vermunt; Faculteit Sociale Wetenschappen; LS Wubbels; Education and Learning: Development in Interaction

    2014-01-01

    The existing literature on indicators of an optimal learning environment for high-ability students frequently discusses the concept of challenge. It is, however, not clear what, precisely, constitutes appropriate challenge for these students. In this study, the authors examined an undergraduate hono

  13. IT Challenges for Space Medicine

    Science.gov (United States)

    Johnson-Throop, Kathy

    2010-01-01

    This viewgraph presentation reviews the various Information Technology challenges for aerospace medicine. The contents include: 1) Space Medicine Activities; 2) Private Medical Information; 3) Lifetime Surveillance of Astronaut Health; 4) Mission Medical Support; 5) Data Repositories for Research; 6) Data Input and Output; 7) Finding Data/Information; 8) Summary of Challenges; and 9) Solutions and questions.

  14. Challenges Facing Group Work Online

    Science.gov (United States)

    Chang, Bo; Kang, Haijun

    2016-01-01

    Online group work can be complicated because of its asynchronous characteristics and lack of physical presence, and its requirements for skills in handling technology, human relationships, and content-related tasks. This study focuses on the administrative, logistical and relationship-related challenges in online group work. Challenges in areas…

  15. Interior Design: Challenges and Solutions.

    Science.gov (United States)

    School Planning and Management, 1999

    1999-01-01

    Presents solutions to architectural challenges in school interior design; these solutions made the indoor environments more conducive and attractive for learning. Addresses four challenges: making a long corridor look less like a tunnel; maintaining tradition and minimizing cost in a new athletic facility; designing a kindergarten that is secure…

  16. Exploring the challenges of making data physical

    DEFF Research Database (Denmark)

    Alexander, Jason; Jansen, Yvonne; Hornbæk, Kasper

    2015-01-01

    representations of data and their support for cognition, communication, learning, problem solving and decision making. As physical artifacts, data physicalizations can tap more deeply into our perceptual exploration skills than classical computer setups, while their dynamic physicality alleviates some of the main......Physical representations of data have existed for thousands of years. However, it is only now that advances in digital fabrication, actuated tangible interfaces, and shape-changing displays can support the emerging area of 'Data Physicalization': the study of computer-supported, physical....... The primary goal of this workshop is to bring together practitioners from a diverse range of communities to explore the challenges in 'making data physical' and to set a research roadmap for the next years....

  17. Successes and challenges: clarity of definition required.

    Science.gov (United States)

    Peachey, David K

    2013-01-01

    In the lead paper, Tomblin Murphy and MacKenzie advocate the application of population health needs in the planning and delivery of clinical services across Canadian healthcare systems. The authors are correct in urging the minimal use, if not abandonment, of legacy demand data as a relevant predictor for advancing a more effective and sustainable healthcare system. The primary challenge for a reader of their paper is the confusion of terminology and a resulting dissonance among the title, the abstract and the content. Expectations created by the title are not attained due to the unfortunate interchangeability of key phrases and the propriety of the case studies selected as examples. This commentary focuses on the choice of language and concerns of secondary uncertainty between "needs" and process management; this is framed by a brief review of terminology and the principles that underpin needs-based models.

  18. Radioecological challenges for mining

    Energy Technology Data Exchange (ETDEWEB)

    Vesterbacka, P.; Ikaeheimonen, T.K.; Solatie, D. [Radiation and Nuclear Safety Authority (Finland)

    2014-07-01

    In Finland, mining became popular in the mid-1990's when the mining amendments to the law made the mining activities easier for foreign companies. Also the price of the minerals rose and mining in Finland became economically profitable. Expanding mining industry brought new challenges to radiation safety aspect since radioactive substances occur in nearly all minerals. In Finnish soil and bedrock the average crystal abundance of uranium and thorium are 2.8 ppm and 10 ppm, respectively. It cannot be predicted beforehand how radionuclides behave in the mining processes which why they need to be taken into account in mining activities. Radiation and Nuclear Safety Authority (STUK) has given a national guide ST 12.1 based on the Finnish Radiation Act. The guide sets the limits for radiation doses to the public also from mining activities. In general, no measures to limit the radiation exposure are needed, if the dose from the operation liable to cause exposure to natural radiation is no greater than 0.1 mSv per year above the natural background radiation dose. If the exposure of the public may be higher than 0.1 mSv per year, the responsible party must provide STUK a plan describing the measures by which the radiation exposure is to be kept as low as is reasonably achievable. In that case the mining company responsible company has to make a radiological baseline study. The baseline study must focus on the environment that the mining activities may impact. The study describes the occurrence of natural radioactivity in the environment before any mining activities are started. The baseline study lasts usually for two to three years in natural circumstances. Based on the baseline study measurements, detailed information of the existing levels of radioactivity in the environment can be attained. Once the mining activities begin, it is important that the limits are set for the wastewater discharges to the environment and environmental surveillance in the vicinity of

  19. Scientific challenges in sustainable energy technology

    Science.gov (United States)

    Lewis, Nathan

    2006-04-01

    We describe and evaluate the technical, political, and economic challenges involved with widespread adoption of renewable energy technologies. First, we estimate fossil fuel resources and reserves and, together with the current and projected global primary power production rates, estimate the remaining years of oil, gas, and coal. We then compare the conventional price of fossil energy with that from renewable energy technologies (wind, solar thermal, solar electric, biomass, hydroelectric, and geothermal) to evaluate the potential for a transition to renewable energy in the next 20-50 years. Secondly, we evaluate - per the Intergovernmental Panel on Climate Change - the greenhouse constraint on carbon-based power consumption as an unpriced externality to fossil-fuel use, considering global population growth, increased global gross domestic product, and increased energy efficiency per unit GDP. This constraint is projected to drive the demand for carbon-free power well beyond that produced by conventional supply/demand pricing tradeoffs, to levels far greater than current renewable energy demand. Thirdly, we evaluate the level and timescale of R&D investment needed to produce the required quantity of carbon-free power by the 2050 timeframe. Fourth, we evaluate the energy potential of various renewable energy resources to ascertain which resources are adequately available globally to support the projected demand. Fifth, we evaluate the challenges to the chemical sciences to enable the cost-effective production of carbon-free power required. Finally, we discuss the effects of a change in primary power technology on the energy supply infrastructure and discuss the impact of such a change on the modes of energy consumption by the energy consumer and additional demands on the chemical sciences to support such a transition in energy supply.

  20. EEG and eye tracking demonstrate vigilance enhancement with challenge integration

    Directory of Open Access Journals (Sweden)

    Indu Prasad Bodala

    2016-06-01

    Full Text Available 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 < 0.05 in each case. Relative delta band power of EEG also shows statistically significant suppression on the frontoparietal and occipital cortices due to challenge integration (p < 0.05. Saccade amplitude, saccade velocity and blink rate obtained from eye tracking data exhibit statistically significant changes during the challenge phase of the experiment (p < 0.05 in each case. From the correlation analysis between the statistically significant measures of eye tracking and 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

  1. Primary nucleation of lithium carbonate

    Institute of Scientific and Technical Information of China (English)

    Yuzhu SUN; Xingfu SONG; Jin WANG; Yan LUO; Jianguo YU

    2009-01-01

    A set of laser apparatus was used to explore the induction period and the primary nucleation of lithium carbonate. Results show that the induction period increases with the decrease of supersaturation, temperature and stirring speed. Through the classical theory of primary nucleation, many important properties involved in primary nucleation under different conditions were obtained quantitatively, including the interfacial tension between solid and liquid, contact angle, critical nucleus size, critical nuleation free energy etc.

  2. Primary medulla oblongata teratomas.

    Science.gov (United States)

    Li, Da; Hao, Shu-Yu; Wu, Zhen; Zhang, Li-Wei; Zhang, Jun-Ting

    2014-09-01

    Medulla oblongata teratomas are rare. The authors report 2 new cases of teratomas that occurred exclusively in the medulla oblongata. The first case was in a 9-year-old boy who presented with a 6-month history of neck pain and repeated paroxysmal vomiting. Based on preoperative radiographic findings, the initial diagnosis was of an intraaxial medulla oblongata hemangioblastoma. Intraoperatively, the cystic component of the tumor was gray, gelatinous, and soft in consistency. The solid component was light pink, rubbery, and nodular in appearance, with an identifiable boundary. The lesion was completely removed. Histopathological investigation revealed a mature teratoma. Postoperatively, the patient was supported with ventilator assistance and received a tracheotomy, but died of intracranial infection. The second case was in a 10-year-old boy with intermittent headache for 1 month. Radiographs revealed an exophytic cystic and solid lesion with dorsal involvement of the medulla oblongata. The lesion was predominantly solid, pinkish gray, tenacious, and moderately vascularized, with clearly delineated surgical dissection planes. The histopathological examination confirmed a diagnosis of immature teratoma. Total resection was achieved, followed by postoperative chemotherapy. He was alive without recurrence of the lesion or symptoms at 59 months after surgery. Resection of medulla oblongata teratoma is challenging, with inherent surgical risks that are contingent on the tumor growth pattern. Teratomas should be considered in the differential diagnosis of brainstem lesions. Chemotherapy has been suggested for immature teratomas. Long-term follow-up and larger studies of teratomas in unusual locations are required to improve practitioners' understanding of this disease's treatment and outcomes.

  3. The ethics of complex relationships in primary care behavioral health.

    Science.gov (United States)

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically.

  4. Team effectiveness in academic primary health care teams.

    Science.gov (United States)

    Delva, Dianne; Jamieson, Margaret; Lemieux, Melissa

    2008-12-01

    Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.

  5. Primary biliary cirrhosis

    Directory of Open Access Journals (Sweden)

    Heathcote E Jenny

    2008-01-01

    Full Text Available Abstract Primary biliary cirrhosis (PBC is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic bile ducts that may eventually lead to liver failure. Affected individuals are usually in their fifth to seventh decades of life at time of diagnosis, and 90% are women. Annual incidence is estimated between 0.7 and 49 cases per million-population and prevalence between 6.7 and 940 cases per million-population (depending on age and sex. The majority of patients are asymptomatic at diagnosis, however, some patients present with symptoms of fatigue and/or pruritus. Patients may even present with ascites, hepatic encephalopathy and/or esophageal variceal hemorrhage. PBC is associated with other autoimmune diseases such as Sjogren's syndrome, scleroderma, Raynaud's phenomenon and CREST syndrome and is regarded as an organ specific autoimmune disease. Genetic susceptibility as a predisposing factor for PBC has been suggested. Environmental factors may have potential causative role (infection, chemicals, smoking. Diagnosis is based on a combination of clinical features, abnormal liver biochemical pattern in a cholestatic picture persisting for more than six months and presence of detectable antimitochondrial antibodies (AMA in serum. All AMA negative patients with cholestatic liver disease should be carefully evaluated with cholangiography and liver biopsy. Ursodeoxycholic acid (UDCA is the only currently known medication that can slow the disease progression. Patients, particularly those who start UDCA treatment at early-stage disease and who respond in terms of improvement of the liver biochemistry, have a good prognosis. Liver transplantation is usually an option for patients with liver failure and the outcome is 70% survival at 7 years. Recently, animal models have been discovered that may provide a new insight into the pathogenesis of this disease and facilitate appreciation for

  6. Primary erythromelalgia: a review.

    Science.gov (United States)

    Tang, Zhaoli; Chen, Zhao; Tang, Beisha; Jiang, Hong

    2015-09-30

    Primary erythromelalgia (PE ORPHA90026) is a rare autosomal dominant neuropathy characterized by the combination of recurrent burning pain, warmth and redness of the extremities. The incidence rate of PE ranges from 0.36 to 1.1 per 100,000 persons. Gender ratio differs according to different studies and no evidence showed a gender preference. Clinical onset of PE is often in the first decade of life. Burning pain is the most predominant symptom and is usually caused and precipitated by warmth and physical activities. Reported cases of PE contain both inherited and sporadic forms. Genetic etiology of PE is mutations on SCN9A, the encoding gene of a voltage-gated sodium channel subtype Nav1.7. Diagnosis of PE is made upon clinical manifestations and screening for mutations on SCN9A. Exclusion of several other treatable diseases/secondary erythromelalgia is also necessary because of the lack of biomarkers specifically for PE. Differential diagnoses can include Fabry disease, cellulites, Raynaud phenomenon, vasculitis and so on. Diagnostic methods often involve complete blood count, imaging studies and thermograph. Treatment for PE is unsatisfactory and highly individualized. Frequently used pain relieving drugs involve sodium channel blockers such as lidocaine, carbamazepine and mexiletine. Novel drugs such as PF-05089771 and TV-45070 could be promising in ameliorating pain symptoms due to their Nav1.7 selectivity. Patients' symptoms often worsen over time and many patients develop ulcerations and gangrenes caused by excessive exposure to low temperature in order to relieve pain. This review mainly focuses on PE and the causative gene SCN9A--its mutations and their effects on Nav1.7 channels' electrophysiological properties. We propose a genotype-channelopathy-phenotype correlation network underlying PE etiology which could provide guidance for future therapeutics.

  7. 76 FR 41526 - Centennial Challenges 2011 Strong Tether Challenge

    Science.gov (United States)

    2011-07-14

    ... register. Centennial Challenges is a program of prize competitions to stimulate innovation in technologies...,000 (two million U.S. dollars). Incremental prizes will be offered for entries that meet...

  8. Oral food challenges in children

    Directory of Open Access Journals (Sweden)

    Hye Yung Yum

    2011-01-01

    Full Text Available Many patients assume that allergic reactions against foods are responsible for triggering or worsening their allergic symptoms. Therefore, it is important to identify patients who would benefit from an elimination diet, while avoiding unnecessary dietary restrictions. The diagnosis of food allergy depends on the thorough review of the patients's medical history, results of supplemented trials of dietary elimination, and in vivo and in vitro tests for measuring specific IgE levels. However, in some cases the reliability of such procedures is suboptimal. Oral food challenges are procedures employed for making an accurate diagnosis of immediate and occasionally delayed adverse reactions to foods. The timing and type of the challenge, preparation of patients, foods to be tested, and dosing schedule should be determined on the basis of the patient's history, age, and experience. Although double-blind, placebo-controlled food challenges(DBPCFC are used to establish definitively if a food is the cause of adverse reactions, they are time-consuming, expensive and troublesome for physician and patients. In practice, An open challenge controlled by trained personnel is sufficient especially in infants and young children. The interpretation of the results and follow-up after a challenge are also important. Since theses challenges are relatively safe and informative, controlled oral food challenges could become the measure of choice in children.

  9. [Latin American social medicine: contributions and challenges].

    Science.gov (United States)

    Iriart, Celia; Waitzkin, Howard; Breilh, Jaime; Estrada, Alfredo; Merhy, Emerson Elías

    2002-08-01

    This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.

  10. Public Health Challenges and Priorities for Kazakhstan

    Directory of Open Access Journals (Sweden)

    Altyn Aringazina

    2012-11-01

    Full Text Available The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Alma-Ata, which was adopted at the International Conference on Primary Health Care convened in Kazakhstan in 1978, facilitating population-wide lifestyle and behavioral change to reduce risk factors for chronic and communicable diseases, as well as injuries, remains a high priority for emerging health care reforms and the new public health. This paper reviews the current public health challenges in Kazakhstan and describes five priorities for building public health capacity that are now being developed and undertaken at the Kazakhstan School of Public Health to strengthen population health in the country and the Central Asian Region.

  11. An Investigation Into the Challenges of Joint Basing

    Science.gov (United States)

    2014-06-19

    have hindered true cost savings from being realized. This research leverages the Delphi Method in capturing and ranking the top issues to aid...issues. The Delphi method utilizes both a qualitative (questionnaire) and quantitative (statistical analysis of answers) tool that leverages human...The primary method by which insights were gathered on joint basing challenges was the Delphi Method . The Delphi Method was developed by the RAND

  12. Challenges with Tertiary-Level Mechatronic Fluid Power

    DEFF Research Database (Denmark)

    Dransfield, Peter; Conrad, Finn

    1996-01-01

    As authors we take the view that mechatronics, as it relates to fluid power, has three levels which we designate as primary, secondary and tertiary. A brief review of the current status of fluid power, hydraulic and pneumatic, and of electronic control of it is presented and discussed. The focus...... is then on tertiary-level mechatronic fluid power and the challenges to it being applied successfully....

  13. The Leadership Challenge Activities Book

    CERN Document Server

    Kouzes, James M; Biech, Elaine

    2010-01-01

    ACTIVE Learning for Exemplary Leaders. The best leaders are the best learners. This evidence-based truth has been a foundational principle of The Leadership Challenge since it was first published nearly twenty-five years ago. In this new work, bestselling Leadership Challenge authors Jim Kouzes and Barry Posner team up with experiential learning expert Elaine Biech to bring today's leaders over 100 engaging activities designed to expand and accelerate their leadership development efforts. Grounded in The Five Practices of Exemplary Leadership® model, The Leadership Challenge Activities Book in

  14. Energy challenges. A European answer

    Energy Technology Data Exchange (ETDEWEB)

    Berge, Hans ten [EURELECTRIC, Brussels (Belgium)

    2013-02-01

    The European electricity sector is facing four main challenges: a very challenging investment climate, relatively low electricity demand, the continued expansion of electricity from subsidised renewable energy sources, and the unexpected weakness of the EU Emissions Trading System (ETS). EURELECTRIC's answers to these challenges revolve around a more consistent framework with the ETS as the key driver of decarbonisation, the integration of renewables into the market and a less distortive approach to their development, a renewed focus on energy infrastructure as a means of completing the internal energy market, and an improved strategy for RD and D.

  15. Challenges in aerospace medicine education.

    Science.gov (United States)

    Grenon, S Marlene; Saary, Joan

    2011-11-01

    Aerospace medicine training and research represents a dream for many and a challenge for most. In Canada, although some opportunities exist for the pursuit of education and research in the aerospace medicine field, they are limited despite the importance of this field for enabling safe human space exploration. In this commentary, we aim to identify some of the challenges facing individuals wishing to get involved in the field as well as the causal factors for these challenges. We also explore strategies to mitigate against these.

  16. Opportunities and challenges in biological lignin valorization.

    Science.gov (United States)

    Beckham, Gregg T; Johnson, Christopher W; Karp, Eric M; Salvachúa, Davinia; Vardon, Derek R

    2016-12-01

    Lignin is a primary component of lignocellulosic biomass that is an underutilized feedstock in the growing biofuels industry. Despite the fact that lignin depolymerization has long been studied, the intrinsic heterogeneity of lignin typically leads to heterogeneous streams of aromatic compounds, which in turn present significant technical challenges when attempting to produce lignin-derived chemicals where purity is often a concern. In Nature, microorganisms often encounter this same problem during biomass turnover wherein powerful oxidative enzymes produce heterogeneous slates of aromatics compounds. Some microbes have evolved metabolic pathways to convert these aromatic species via 'upper pathways' into central intermediates, which can then be funneled through 'lower pathways' into central carbon metabolism in a process we dubbed 'biological funneling'. This funneling approach offers a direct, biological solution to overcome heterogeneity problems in lignin valorization for the modern biorefinery. Coupled to targeted separations and downstream chemical catalysis, this concept offers the ability to produce a wide range of molecules from lignin. This perspective describes research opportunities and challenges ahead for this new field of research, which holds significant promise towards a biorefinery concept wherein polysaccharides and lignin are treated as equally valuable feedstocks. In particular, we discuss tailoring the lignin substrate for microbial utilization, host selection for biological funneling, ligninolytic enzyme-microbe synergy, metabolic engineering, expanding substrate specificity for biological funneling, and process integration, each of which presents key challenges. Ultimately, for biological solutions to lignin valorization to be viable, multiple questions in each of these areas will need to be addressed, making biological lignin valorization a multidisciplinary, co-design problem.

  17. Opportunities and challenges in biological lignin valorization

    Energy Technology Data Exchange (ETDEWEB)

    Beckham, Gregg T.; Johnson, Christopher W.; Karp, Eric M.; Salvachúa, Davinia; Vardon, Derek R.

    2016-12-01

    Lignin is a primary component of lignocellulosic biomass that is an underutilized feedstock in the growing biofuels industry. Despite the fact that lignin depolymerization has long been studied, the intrinsic heterogeneity of lignin typically leads to heterogeneous streams of aromatic compounds, which in turn present significant technical challenges when attempting to produce lignin-derived chemicals where purity is often a concern. In Nature, microorganisms often encounter this same problem during biomass turnover wherein powerful oxidative enzymes produce heterogeneous slates of aromatics compounds. Some microbes have evolved metabolic pathways to convert these aromatic species via ‘upper pathways’ into central intermediates, which can then be funneled through ‘lower pathways’ into central carbon metabolism in a process we dubbed ‘biological funneling’. This funneling approach offers a direct, biological solution to overcome heterogeneity problems in lignin valorization for the modern biorefinery. Coupled to targeted separations and downstream chemical catalysis, this concept offers the ability to produce a wide range of molecules from lignin. This perspective describes research opportunities and challenges ahead for this new field of research, which holds significant promise towards a biorefinery concept wherein polysaccharides and lignin are treated as equally valuable feedstocks. In particular, we discuss tailoring the lignin substrate for microbial utilization, host selection for biological funneling, ligninolytic enzyme–microbe synergy, metabolic engineering, expanding substrate specificity for biological funneling, and process integration, each of which presents key challenges. Ultimately, for biological solutions to lignin valorization to be viable, multiple questions in each of these areas will need to be addressed, making biological lignin valorization a multidisciplinary, co-design problem.

  18. Advances in Primary Central Nervous System Lymphoma.

    Science.gov (United States)

    Patrick, Lauren B; Mohile, Nimish A

    2015-12-01

    Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma that is limited to the CNS. Although novel imaging techniques aid in discriminating lymphoma from other brain tumors, definitive diagnosis requires brain biopsy, vitreoretinal biopsy, or cerebrospinal fluid analysis. Survival rates in clinical studies have improved over the past 20 years due to the addition of high-dose methotrexate-based chemotherapy regimens to whole-brain radiotherapy. Long-term survival, however, is complicated by clinically devastating delayed neurotoxicity. Newer regimens are attempting to reduce or eliminate radiotherapy from first-line treatment with chemotherapy dose intensification. Significant advances have also been made in the fields of pathobiology and treatment, with more targeted treatments on the horizon. The rarity of the disease makes conducting of prospective clinical trials challenging, requiring collaborative efforts between institutions. This review highlights recent advances in the biology, detection, and treatment of PCNSL in immunocompetent patients.

  19. Primary Graft Failure after Heart Transplantation

    Directory of Open Access Journals (Sweden)

    Arjun Iyer

    2011-01-01

    Full Text Available Primary graft failure (PGF is a devastating complication that occurs in the immediate postoperative period following heart transplantation. It manifests as severe ventricular dysfunction of the donor graft and carries significant mortality and morbidity. In the last decade, advances in pharmacological treatment and mechanical circulatory support have improved the outlook for heart transplant recipients who develop this complication. Despite these advances in treatment, PGF is still the leading cause of death in the first 30 days after transplantation. In today's climate of significant organ shortages and growing waiting lists, transplant units worldwide have increasingly utilised “marginal donors” to try and bridge the gap between “supply and demand.” One of the costs of this strategy has been an increased incidence of PGF. As the threat of PGF increases, the challenges of predicting and preventing its occurrence, as well as the identification of more effective treatment modalities, are vital areas of active research and development.

  20. Physical Literacy in Danish Primary School

    DEFF Research Database (Denmark)

    Jensen, Jens-Ole

    2016-01-01

    In the last decade there has been an increasing international interest in the concept of physical literacy as a way to articulate the objectives of physical education and as a way to verbalize the idea of being physically educated throughout life. In general, research on the concept of physical...... the demand of verbalization. Anyway, a new school law was implemented in the Danish primary and secondary school system in August 2014. The main purposes of the law is to challenge every pupil to become as skilled as possible, lower the consequences of social background in order to achieve better results...... in the late afternoon. The observations were mainly non-participating but at some occasions the researcher was participating in activities and games. The observations were written down as field notes (Emerson et al. 2011) and photos were taken to support the field notes. During the observation a special...