Current state of information technology use in a US primary care practice-based research network.

Science.gov (United States)

Andrews, James E; Pearce, Kevin A; Sydney, Carey; Ireson, Carol; Love, Margaret

2004-01-01

To examine the current levels of information technology (IT) use in a primary care practice-based research network (PBRN) in order to inform future development of its infrastructure. Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN),as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. Response rates for the surveys were 46% (n = 68) for the office managers and 51% (n = 116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

Preparing nursing students for enhanced roles in primary care: The current state of prelicensure and RN-to-BSN education.

Science.gov (United States)

Wojnar, Danuta M; Whelan, Ellen Marie

With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education. Copyright © 2016 Elsevier Inc. All rights reserved.

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

Science.gov (United States)

Hill, Jonathan C.; Foster, Nadine E.; Protheroe, Joanne

2017-01-01

Background & aims Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Methods A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. Results Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. Conclusion This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most

Modeling of the development of humus horizons in soils of Crimea

Science.gov (United States)

Ergina, E. I.

2017-01-01

Current approaches to the simulation of pedogenesis processes in time are considered. Models for the formation of humus horizon on parent rocks of different genesis in Crimea are presented. Formation rates of humus horizons have been determined, which allows developing the remediation strategies for mining dumps of mineral deposits in Crimea.

[Current status of malaria control knowledge awareness of primary and sec- ondary school students in Xuzhou City].

Science.gov (United States)

Sun, Xing-sheng; Li, Li; Zhang, Kan-kan

2015-12-01

To understand the current status of malaria control knowledge awareness of primary and secondary school students and its influencing factors in Yunlong District, Xuzhou City, so as to provide the evidence for improving the malaria prevention work. A total of 800 students from 4 urban and rural primary and secondary schools were randomly selected and investigated with questionnaires. The total awareness rate of malaria control knowledge was 61.27%, and the awareness rates of symptoms of malaria and malaria prevention were only 38.99% and 57.59% respectively. The main approach of obtaining the malaria control knowledge was media (51.52%). The univariate analysis showed that sex, area and different education levels affected the awareness rates of malaria control knowledge (P knowledge of country students was lower than that of urban students (P knowledge of the secondary school students was higher than that of the primary school students (P knowledge of primary and secondary school students in Yunlong District is lower than that required by the national standard. Therefore, the health education of malaria control should be strengthened, especially in countryside school students and primary school students.

Primary energy use for heating in the Swedish building sector-Current trends and proposed target

International Nuclear Information System (INIS)

Johansson, P.; Nylander, A.; Johnsson, F.

2007-01-01

One goal of the Swedish energy policy is to reduce the amount of electricity used for heating in the building sector. This means to reduce the primary energy used for heating which in this paper is analyzed in the context of various heating technologies and CO 2 emissions. The analysis is applied to a region in Sweden (southern Sweden) for which detailed information on the energy infrastructure (the capital stock of the buildings and heating systems together with geographical variations in heat intensity) is available from a previous work [Johansson, P., Nylander, A., Johnsson, F., 2005. Electricity dependency and CO 2 emissions from heating in the Swedish building sector-current trends in conflict with governmental policy? Energy policy] and which is large enough to be assumed representative for Sweden as a whole. The detailed mapping of the energy infrastructure allows a good estimate on the rate at which the energy system can be expected to be replaced with respect to economical lifetime of the capital stock (the year 2025 in this case). Two scenarios are investigated; a target scenario for which energy savings are employed (e.g. improving climate shell in buildings) and oil and most of the electricity used for heating purposes are phased out and a second for which the current trend in the heating market continues. In the target scenario it is shown that although only applying commercially competitive heating technologies, it is possible to achieve a 47% reduction in primary energy use for heating with a 34% decrease in heat demand together with significant reduction in CO 2 emissions. However, the scenario which continues the current trends on the heating market instead yields an increase (of about 10%) in primary energy use (reduction in conversion efficiency) of the heating system of the region over the period studied, in spite of a slight decrease in heat demand (9%, mainly due to energy efficiency measures) as well as in CO 2 emissions. In light of the

Huntington's disease: current epidemiology and pharmacological management in UK primary care.

Science.gov (United States)

Sackley, Catherine; Hoppitt, Thomas J; Calvert, Melanie; Gill, Paramjit; Eaton, Benjamin; Yao, Guiqing; Pall, Hardev

2011-01-01

Recent debate suggests Huntington's disease (HD) may be more prevalent than previously reported. In addition, relatively little is known about current disease management. This study aims to provide epidemiological data and describe the pharmacological management of HD in the United Kingdom. A primary care research database was accessed to identify incident and prevalent HD cases between January 1, 2004, and December 31, 2008. Patients with Read codes denoting a definite diagnosis or possible diagnosis, and undiagnosed patients with a positive family history were identified. A subset of patients with a definite diagnosis and prescribed medication indicating symptom onset was also identified. Epidemiological data were estimated. Pharmacological prescriptions to HD patients from 2004 to 2008 were identified, and prescription frequencies were grouped according to the British National Formulary categories. HD incidence estimates ranged from 0.44 to 0.78 per 100,000 person-years, and HD prevalence ranged from 5.96 to 6.54 per 100,000 of the population. Forty-four percent of pharmacological prescriptions targeted the central nervous system. Nearly half of the HD patients were prescribed antidepressants, and over 40% were prescribed analgesics. Although prevalence estimates fell short of figures suggested in recent debate, it is feasible that the true prevalence may be much higher than previously reported. Pharmacological management appears to rely heavily on central nervous system drugs and nutrition support. Many of these drugs are prescribed to HD patients for reasons other than the medication's primary use. Further work is required to evaluate the impact of alternative management strategies, such as therapist intervention, counselling, and organisation support, on the patients' quality of life. Copyright © 2011 S. Karger AG, Basel.

Counterintuitive effects of global warming-induced wind patterns on primary production in the Northern Humboldt Current System.

Science.gov (United States)

Mogollón, Rodrigo; R Calil, Paulo H

2018-04-14

It has been hypothesized that global warming will strengthen upwelling-favorable winds in the Northern Humboldt Current System (NHCS) as a consequence of the increase of the land-sea thermal gradient along the Peruvian coast. The effect of strengthened winds in this region is assessed with the use of a coupled physical-biogeochemical model forced with projected and climatological winds. Strengthened winds induce an increase in primary production of 2% per latitudinal degree from 9.5°S to 5°S. In some important coastal upwelling sites primary production is reduced. This is due to a complex balance between nutrient availability, nutrient use efficiency, as well as eddy- and wind-driven factors. Mesoscale activity induces a net offshore transport of inorganic nutrients, thus reducing primary production in the coastal upwelling region. Wind mixing, in general disadvantageous for primary producers, leads to shorter residence times in the southern and central coastal zones. Overall, instead of a proportional enhancement in primary production due to increased winds, the NHCS becomes only 5% more productive (+5 mol C m -2 year -1 ), 10% less limited by nutrients and 15% less efficient due to eddy-driven effects. It is found that regions with a initial strong nutrient limitation are more efficient in terms of nutrient assimilation which makes them more resilient in face of the acceleration of the upwelling circulation. © 2018 John Wiley & Sons Ltd.

[Out-of-hours primary care in Germany: general practitioners' views on the current situation].

Science.gov (United States)

Frankenhauser-Mannuß, J; Goetz, K; Scheuer, M; Szescenyi, J; Leutgeb, R

2014-07-01

The aim of this study was to explore views, experiences und perspectives of German GPs related to current out-of-hours service provision covering both urban and rural settings. In the context of the international project EurOOHnet (European Research Network for Out-of-Hours Primary Health Care) the German members (of EurOOHnet) developed a questionnaire about organisational structures, infrastructure requirements and the procedures of information flow between regular care and out-of-hours care in 2011. This questionnaire was adopted in every participating country. A comprehensive postal questionnaire was sent to 410 feneral practice cooperatives in Germany. Qualitative content analysis and an inductive reasoning process, supported by the use of Atlas.ti, were used to identify key themes from responses to open-ended questions in the survey. Results were grouped into 3 overarching categories and each of these were grouped into 3 sub-categories. The questionnaire response rate was 44% (181/410). The analysis identified organisational issues (e. g., financing) and infrastructure barriers (e. g., lack of motivated GPs for out-of-hours care) as key themes. Significantly, different priorities between rural and urban GPs were identified. In particular, rural GPs highlighted shortages of GPs and distance between the GP practice and patients' residence as concerning factors impacting on out-of-hours care. Based on reported views from survey respondents, urban and rural primary care service needs vary significantly and, therefore, different solutions are needed to improve out-of-hours primary care and optimise service quality. © Georg Thieme Verlag KG Stuttgart · New York.

Simple WZW currents

International Nuclear Information System (INIS)

Fuchs, J.

1990-08-01

A complete classification of simple currents of WZW theory is obtained. The proof is based on an analysis of the quantum dimensions of the primary fields. Simple currents are precisely the primaries with unit quantum dimension; for WZW theories explicit formulae for the quantum dimensions can be derived so that an identification of the fields with unit quantum dimension is possible. (author). 19 refs.; 2 tabs

Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

Science.gov (United States)

Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

2013-01-01

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

Pain management in primary care – current perspectives | Meyer ...

African Journals Online (AJOL)

According to a 1998 World Health Organization Survey of 26 000 primary care ... in pain medicine and continue to follow the biomedical approach, which ... The modern paradigm of pain management has moved from this biomedical to the ...

Self-reported interoceptive awareness in primary care patients with past or current low back pain

Directory of Open Access Journals (Sweden)

Mehling WE

2013-05-01

Full Text Available Wolf E Mehling,1,2 Jennifer Daubenmier,1,3 Cynthia J Price,5 Mike Acree,1 Elizabeth Bartmess,1 Anita L Stewart41Osher Center for Integrative Medicine, 2Department of Family and Community Medicine, 3Department of Medicine, 4School of Nursing, Institute for Health and Aging, University of California, San Francisco, CA, 5School of Nursing, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USABackground: Mind–body interactions play a major role in the prognosis of chronic pain, and mind–body therapies such as meditation, yoga, Tai Chi, and Feldenkrais presumably provide benefits for pain patients. The Multidimensional Assessment of Interoceptive Awareness (MAIA scales, designed to measure key aspects of mind–body interaction, were developed and validated with individuals practicing mind–body therapies, but have never been used in pain patients.Methods: We administered the MAIA to primary care patients with past or current low back pain and explored differences in the performance of the MAIA scales between this and the original validation sample. We compared scale means, exploratory item cluster and confirmatory factor analyses, scale–scale correlations, and internal-consistency reliability between the two samples and explored correlations with validity measures.Results: Responses were analyzed from 435 patients, of whom 40% reported current pain. Cross-sectional comparison between the two groups showed marked differences in eight aspects of interoceptive awareness. Factor and cluster analyses generally confirmed the conceptual model with its eight dimensions in a pain population. Correlations with validity measures were in the expected direction. Internal-consistency reliability was good for six of eight MAIA scales. We provided specific suggestions for their further development.Conclusion: Self-reported aspects of interoceptive awareness differ between primary care patients with past or current

PRESCRIBING OF ANTIHYPERTENSIVE AGENTS IN PUBLIC PRIMARY CARE CLINICS – IS IT IN ACCORDANCE WITH CURRENT EVIDENCE?

Directory of Open Access Journals (Sweden)

SAJARI J

2010-01-01

Full Text Available Background: Large population surveys in Malaysia have consistently shown minimal improvement of blood pressure control rates over the last 10 years. Poor adherence to antihypertensive medication has been recognized as a major reason for poor control of hypertension. This study aimed to describe the prescribing pattern of antihypertensive agents in 2 public primary care clinics and assess its appropriateness in relation to current evidence and guidelines. Methods: A cross-sectional survey to describe the prescribing pattern of antihypertensive agents was carried out in 2 publicprimary care clinics in Selangor from May to June 2009. Hypertensive patients on pharmacological treatment for ≥1 year who attended the clinics within the study period of 7 weeks were selected. Appropriate use of antihypertensive agents was defined based on current evidence and the recommendations by the Malaysian Clinical Practice Guidelines (CPG on the Management of Hypertension, 2008. Data were obtained from patients’ medical records and were analysed using the SPSS software version 16.0. Results: A total of 400 hypertensive patients on treatment were included. Mean age was 59.5 years (SD ±10.9, range 28 to91 years, of which 52.8% were females and 47.2% were males. With regards to pharmacotherapy, 45.7% were on monotherapy,43.3% were on 2 agents and 11.0% were on ≥3 agents. Target blood pressure of <140/90mmHg was achieved in 51.4% of patients on monotherapy, and 33.2% of patients on combination of ≥2 agents. The commonest monotherapy agents being prescribed were β-blockers (atenolol or propranolol, followed by the short-acting calcium channel blocker (nifedipine. The commonest combination of 2-drug therapy prescribed was β-blockers and short-acting calcium channel blocker. Conclusion: This study shows that the prescribing pattern of antihypertensive agents in the 2 primary care clinics was not in accordance with current evidence and guidelines. �

A three-port direct current converter

DEFF Research Database (Denmark)

2016-01-01

circuit comprises a connection between the at least one input direct current source and the at least one storage battery, the primary side circuit configured for operating as a buck converter; a second magnetic component serially coupled to the first single magnetic component, wherein the first and second...... magnetic components are configured to perform a voltage step-up, wherein the secondary side circuit comprises a connection between the at least one storage battery and at least one load, the secondary side configured for operating as a tapped boost converter; wherein the three-port direct current converter......The three-port direct current converter comprising: at least one input direct current source; at least one storage battery; a primary side circuit; a secondary side circuit; a first single magnetic component shared by the primary side circuit and the secondary side circuit, wherein the primary side...

Adaptive threshold hunting for the effects of transcranial direct current stimulation on primary motor cortex inhibition.

Science.gov (United States)

Mooney, Ronan A; Cirillo, John; Byblow, Winston D

2018-06-01

Primary motor cortex excitability can be modulated by anodal and cathodal transcranial direct current stimulation (tDCS). These neuromodulatory effects may, in part, be dependent on modulation within gamma-aminobutyric acid (GABA)-mediated inhibitory networks. GABAergic function can be quantified non-invasively using adaptive threshold hunting paired-pulse transcranial magnetic stimulation (TMS). The previous studies have used TMS with posterior-anterior (PA) induced current to assess tDCS effects on inhibition. However, TMS with anterior-posterior (AP) induced current in the brain provides a more robust measure of GABA-mediated inhibition. The aim of the present study was to assess the modulation of corticomotor excitability and inhibition after anodal and cathodal tDCS using TMS with PA- and AP-induced current. In 16 young adults (26 ± 1 years), we investigated the response to anodal, cathodal, and sham tDCS in a repeated-measures double-blinded crossover design. Adaptive threshold hunting paired-pulse TMS with PA- and AP-induced current was used to examine separate interneuronal populations within M1 and their influence on corticomotor excitability and short- and long-interval inhibition (SICI and LICI) for up to 60 min after tDCS. Unexpectedly, cathodal tDCS increased corticomotor excitability assessed with AP (P = 0.047) but not PA stimulation (P = 0.74). SICI AP was reduced after anodal tDCS compared with sham (P = 0.040). Pearson's correlations indicated that SICI AP and LICI AP modulation was associated with corticomotor excitability after anodal (P = 0.027) and cathodal tDCS (P = 0.042). The after-effects of tDCS on corticomotor excitability may depend on the direction of the TMS-induced current used to make assessments, and on modulation within GABA-mediated inhibitory circuits.

Transformer current sensor for superconducting magnetic coils

Science.gov (United States)

Shen, S.S.; Wilson, C.T.

1985-04-16

The present invention is a current transformer for operating currents larger than 2kA (two kiloamps) that is capable of detecting a millivolt level resistive voltage in the presence of a large inductive voltage. Specifically, the present invention includes substantially cylindrical primary turns arranged to carry a primary current and substantially cylindrical secondary turns arranged coaxially with and only partially within the primary turns, the secondary turns including an active winding and a dummy winding, the active and dummy windings being coaxial, longitudinally separated and arranged to mutually cancel voltages excited by commonly experienced magnetic fields, the active winding but not the dummy winding being arranged within the primary turns.

Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

Directory of Open Access Journals (Sweden)

Christos Lionis

2009-07-01

Full Text Available Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

Textural and isotopic evidence for Ca-Mg carbonate pedogenesis

Science.gov (United States)

Diaz-Hernandez, J. L.; Sánchez-Navas, A.; Delgado, A.; Yepes, J.; Garcia-Casco, A.

2018-02-01

Models for evaluating the terrestrial carbon cycle must take into account not only soil organic carbon, represented by a mixture of plant and animal remains, but also soil inorganic carbon, contained in minerals, mainly in calcite and dolomite. Thick soil caliches derived from weathering of mafic and ultramafic rocks must be considered as sinks for carbon storage in soils. The formation of calcite and dolomite from pedogenic alteration of volcanic tephras under an aridic moisture regime is studied in an unusually thick 3-m soil profile on Gran Canaria island (Canary Islands, Spain). The biological activity of the pedogenic environment (soil respiration) releases CO2 incorporated as dissolved inorganic carbon (DIC) in waters. It drives the formation of low-magnesian calcite and calcian dolomite over basaltic substrates, with a δ13C negative signature (-8 to -6‰ vs. V-PDB). Precipitation of authigenic carbonates in the soil is accompanied by the formation of Mg-rich clay minerals and quartz after the weathering of basalts. Mineralogical, textural, compositional, and isotopic variations throughout the soil profile studied indicate that dolomite formed at greater depths and earlier than the calcite. The isotopic signatures of the surficial calcite and deeper dolomite crusts are primary and resulted from the dissolution-precipitation cycles that led to the formation of both types of caliches under different physicochemical conditions. Dolomite formed within a clay-rich matrix through diffusive transport of reactants. It is precipitated from water with more negative δ18O values (-1.5 to -3.5‰ vs. V-SMOW) in the subsoil compared to those of water in equilibrium with surficial calcite. Thus, calcite precipitated after dolomite, and directly from percolating solutions in equilibrium with vadose water enriched in δ18O (-0.5 to +1.5‰) due to the evaporation processes. The accumulation of inorganic carbon reaches 586.1 kg m-2 in the soil studied, which means that the

Treatment for primary hypothyroidism: current approaches and future possibilities

OpenAIRE

Chakera, Ali J; Pearce, Simon HS; Vaidya, Bijay

2011-01-01

Ali J Chakera1, Simon HS Pearce2, Bijay Vaidya11Department of Endocrinology, Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter, 2Endocrine Unit, Royal Victoria Infirmary and Newcastle University, Newcastle upon Tyne, UKAbstract: Primary hypothyroidism is the most common endocrine disease. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with this condition who are suboptimally treated. Even in those people ...

Test result communication in primary care: a survey of current practice.

Science.gov (United States)

Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

2015-11-01

The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the

Tepetates del glacis de Buenavista, MoreIos: interacción de procesos geomorfológicos y pedogenéticos

Directory of Open Access Journals (Sweden)

Guadalupe Escamilla

2002-01-01

Full Text Available A study of tepetates found in the Glacis de Buenavista, Morelos is hereby presented. The section of study (Ahuatenco includes a sequence of seven indurate horizons (tepetate layers, underlying a polygenetic and well-developed Luvisol. In this work tepetates are considered as products of erosion-sedimentation and pedogenetic processes. Therefore they are interpreted as paleosols with different degrees of development. Macro and micromorphologic evidences indicate that the tepetate profile is constituted by a mixture of fresh coarse volcanic material, redeposited fragments of soil and pedogenetic features, which include: clay cutans, Fe-Mn nodules, weathered primary minerals and phytoliths accumulated within the layer matrix. These properties show that tepetates were exposed at the surface for a sufficient time to allow pedogenesis. The tepetates parent material are volcanic ashes derived from volcanic events, and eroded Bt-horizon remains from the upper portions that were redeposited along with volcanic materials. Because of the presence of these Bt-horizon fragments the clay content in indurate materials is high (47%, but they display a contrasting distribution, showing lithological and textural discontinuities, so each layer is likely to represent a different stage of landscape evolution. The degree of alteration observed for the different layers vary, as well as the stability periods under which pedogenesis occurs.

Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.

Science.gov (United States)

Loresto, Figaro L; Jupiter, Daniel; Kuo, Yong-Fang

2017-06-01

Few studies have examined differences in functional, cognitive, and psychological factors between patients utilizing only nurse practitioners (NPs) and those utilizing only primary care medical doctors (PCMDs) for primary care. Patients utilizing NP-only or PCMD-only models for primary care will be characterized and compared in terms of functional, cognitive, and psychological factors. Cohorts were obtained from the Medicare Current Beneficiary Survey linked to Medicare claims data. Weighted analysis was conducted to compare the patients within the two care models in terms of functional, cognitive, and psychological factors. From 2007 to 2013, there was a 170% increase in patients utilizing only NPs for primary care. In terms of health status, patients utilizing only NPs in their primary care were not statistically different from patients utilizing only PCMDs. There is a perception that NPs, as compared with PCMDs, tend to provide care to healthier patients. Our results are contrary to this perception. In terms of health status, NP-only patients are similar to PCMD-only patients. Results of this study may inform research comparing NP-only care and PCMD-only care using Medicare and the utilization of NPs in primary care. ©2017 American Association of Nurse Practitioners.

Adenosine A₂A receptors inhibit delayed rectifier potassium currents and cell differentiation in primary purified oligodendrocyte cultures.

Science.gov (United States)

Coppi, Elisabetta; Cellai, Lucrezia; Maraula, Giovanna; Pugliese, Anna Maria; Pedata, Felicita

2013-10-01

Oligodendrocyte progenitor cells (OPCs) are a population of cycling cells which persist in the adult central nervous system (CNS) where, under opportune stimuli, they differentiate into mature myelinating oligodendrocytes. Adenosine A(2A) receptors are Gs-coupled P1 purinergic receptors which are widely distributed throughout the CNS. It has been demonstrated that OPCs express A(2A) receptors, but their functional role in these cells remains elusive. Oligodendrocytes express distinct voltage-gated ion channels depending on their maturation. Here, by electrophysiological recordings coupled with immunocytochemical labeling, we studied the effects of adenosine A(2A) receptors on membrane currents and differentiation of purified primary OPCs isolated from the rat cortex. We found that the selective A(2A) agonist, CGS21680, inhibits sustained, delayed rectifier, K(+) currents (I(K)) without modifying transient (I(A)) conductances. The effect was observed in all cells tested, independently from time in culture. CGS21680 inhibition of I(K) current was concentration-dependent (10-200 nM) and blocked in the presence of the selective A(2A) antagonist SCH58261 (100 nM). It is known that I(K) currents play an important role during OPC development since their block decreases cell proliferation and differentiation. In light of these data, our further aim was to investigate whether A(2A) receptors modulate these processes. CGS21680, applied at 100 nM in the culture medium of oligodendrocyte cultures, inhibits OPC differentiation (an effect prevented by SCH58261) without affecting cell proliferation. Data demonstrate that cultured OPCs express functional A(2A) receptors whose activation negatively modulate I(K) currents. We propose that, by this mechanism, A(2A) adenosine receptors inhibit OPC differentiation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Clinical pathways for primary care: current use, interest and perceived usability.

Science.gov (United States)

Waters, Richard C; Toy, Jennifer M; Drechsler, Adam

2018-02-26

Translating clinical evidence to daily practice remains a challenge and may improve with clinical pathways. We assessed interest in and usability of clinical pathways by primary care professionals. An online survey was created. Interest in pathways for patient care and learning was assessed at start and finish. Participants completed baseline questions then pathway-associated question sets related to management of 2 chronic diseases. Perceived pathway usability was assessed using the system usability scale. Accuracy and confidence of answers was compared for baseline and pathway-assisted questions. Of 115 participants, 17.4% had used clinical pathways, the lowest of decision support tool types surveyed. Accuracy and confidence in answers significantly improved for all pathways. Interest in using pathways daily or weekly was above 75% for the respondents. There is low utilization of, but high interest in, clinical pathways by primary care clinicians. Pathways improve accuracy and confidence in answering written clinical questions.

Primary Prevention of Sexual Violence in Aotearoa New Zealand.

Science.gov (United States)

Dickson, Sandra; Willis, Gwenda M

2017-03-01

The extensive and sometimes profoundly damaging effects of sexual violence and large numbers of victims necessitate dedicated attention to primary prevention efforts. Few studies have examined the scope of current prevention activities or their fit with empirical research into effective prevention strategies. The current article presents findings from a survey of primary prevention activities in non-Māori and bicultural communities within Aotearoa New Zealand. Forty-four respondents representing 42 agencies responded to a comprehensive survey that canvased types of sexual violence primary prevention activities undertaken, sexual violence primary prevention programs, and barriers and supports to sexual violence prevention work. Consistent with findings from previous international surveys, the focus of primary prevention work in New Zealand was on sexual violence education and increasing awareness. Findings are discussed in the context of the sexual violence prevention literature and what works in prevention more broadly to help identify promising initiatives as well as gaps in current practices. Recommendations for advancing sexual violence primary prevention research are also provided.

[Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

Science.gov (United States)

Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

2017-10-01

The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Science.gov (United States)

Chin, Garwin; Wright, David J.; Snir, Nimrod; Schwarzkopf, Ran

2018-01-01

Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. PMID:26387923

An Evaluation of Primary English Textbooks in Vietnam: A Sociolinguistic Perspective

Science.gov (United States)

Dang, Tu Cam Thi; Seals, Corinne

2018-01-01

This article delves into the issue of incorporating sociolinguistic aspects of language and culture into the current primary English textbooks in Vietnam. The authors first provide an overview of primary English teaching in the Vietnamese setting and then evaluate the current primary English textbooks in relation to the objectives of foreign…

Current problems of teaching spelling in the first cycle of Primary Education

Directory of Open Access Journals (Sweden)

Martha Valcárcel González

2005-12-01

Full Text Available This article presents from the theoretical point of view the spelling problem as one of the main difficulties that there is in Primary Education and in which teachers intensively work searching for solutions.

Primary Immune Deficiency Treatment Consortium (PIDTC) report

NARCIS (Netherlands)

L.M. Griffith (Linda); M. Cowan (Morton); L.D. Notarangelo (Luigi Daniele); R. Kohn (Robert); J. Puck (Jennifer); S.-Y. Pai (Sung-Yun); B. Ballard (Barbara); S.C. Bauer (Sarah); J. Bleesing (Jack); M. Boyle (Marcia); R.W. Brower (Ronald); R.H. Buckley (Rebecca); M. van der Burg (Mirjam); L.M. Burroughs (Lauri); F. Candotti (Fabio); A. Cant (Andrew); T. Chatila (Talal); C. Cunningham-Rundles (Charlotte); M.C. Dinauer (Mary); J. Dvorak (Jennie); A. Filipovich (Alexandra); L.A. Fleisher (Lee); H.B. Gaspar (Bobby); T. Gungor (Tayfun); E. Haddad (Elie); E. Hovermale (Emily); F. Huang (Faith); A. Hurley (Alan); M. Hurley (Mary); S.K. Iyengar (Sudha); E.M. Kang (Elizabeth); B.R. Logan (Brent); J.R. Long-Boyle (Janel); H. Malech (Harry); S.A. McGhee (Sean); S. Modell (Sieglinde); S. Modell (Sieglinde); H.D. Ochs (Hans); R.J. O'Reilly (Richard); R. Parkman (Robertson); D. Rawlings (D.); J.M. Routes (John); P. Shearer (P.); T.N. Small (Trudy); H. Smith (H.); K.E. Sullivan (Kathleen); P. Szabolcs (Paul); A.J. Thrasher (Adrian); D. Torgerson; P. Veys (Paul); K. Weinberg (Kenneth); J.C. Zuniga-Pflucker (Juan Carlos)

2014-01-01

textabstractThe Primary Immune Deficiency Treatment Consortium (PIDTC) is a network of 33 centers in North America that study the treatment of rare and severe primary immunodeficiency diseases. Current protocols address the natural history of patients treated for severe combined immunodeficiency

Program Development for Primary School Teachers' Critical Thinking

Science.gov (United States)

Boonjeam, Waraporn; Tesaputa, Kowat; Sri-ampai, Anan

2017-01-01

The objectives of this research were: 1) to study the elements and indicators of primary school teachers' critical thinking, 2) to study current situation, desirable situation, development technique, and need for developing the primary school teachers' critical thinking, 3) to develop the program for developing the primary school teachers'…

Integration of public health and primary care: A systematic review of the current literature in primary care physician mediated childhood obesity interventions.

Science.gov (United States)

Bhuyan, Soumitra S; Chandak, Aastha; Smith, Patti; Carlton, Erik L; Duncan, Kenric; Gentry, Daniel

2015-01-01

Childhood obesity, with its growing prevalence, detrimental effects on population health and economic burden, is an important public health issue in the United States and worldwide. There is need for expansion of the role of primary care physicians in obesity interventions. The primary aim of this review is to explore primary care physician (PCP) mediated interventions targeting childhood obesity and assess the roles played by physicians in the interventions. A systematic review of the literature published between January 2007 and October 2014 was conducted using a combination of keywords like "childhood obesity", "paediatric obesity", "childhood overweight", "paediatric overweight", "primary care physician", "primary care settings", "healthcare teams", and "community resources" from MEDLINE and CINAHL during November 2014. Author name(s), publication year, sample size, patient's age, study and follow-up duration, intervention components, role of PCP, members of the healthcare team, and outcomes were extracted for this review. Nine studies were included in the review. PCP-mediated interventions were composed of behavioural, education and technological interventions or a combination of these. Most interventions led to positive changes in Body Mass Index (BMI), healthier lifestyles and increased satisfaction among parents. PCPs participated in screening and diagnosing, making referrals for intervention, providing nutrition counselling, and promoting physical activity. PCPs, Dietitians and nurses were often part of the healthcare team. PCP-mediated interventions have the potential to effectively curb childhood obesity. However, there is a further need for training of PCPs, and explain new types of interventions such as the use of technology. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Primary prevention of diabetes mellitus: current strategies and future trends

Directory of Open Access Journals (Sweden)

Prasanta K. Bhattacharya

2016-04-01

Full Text Available Aim of this paper is to find evidence for primary prevention of type-2 diabetes mellitus (T2DM from epidemiological studies and clinical trials, and the feasibility of applying these interventions in resource limited countries. T2DM, which accounts for more than nine-tenths of all diabetics, results from inadequate insulin secretion or underlying insulin resistance. The prevalence of diabetes, mainly T2DM, has increased rapidly during the last few decades worldwide. Since the genetic background is unlikely to change during this short time period, the growing epidemic of T2DM is more likely due to changes in environmental or lifestyle risk factors including obesity, physical inactivity, smoking, alcohol and stress. The scope and feasibility for primary prevention of T2DM is based on elimination of these risk factors. This evidence that T2DM is preventable comes from epidemiologic studies and clinical trials of effect of lifestyle changes and drugs in development of T2DM. The positive effects are more profound and safer with lifestyle modifications (LSM compared to medications. This is shown to be effective globally, across various ethnicities and races and sustainable on long-term follow-up. However, there is a major challenge in translating this evidence into economically viable and sustained community programs, as these LSM interventions are expensive, even from western standards point of view. Future plan should focus on health education of the public, improving the national capacity to detect and manage the environmental risks including strategies to reduce stress, and development of innovative, cost effective, and scalable methodologies.

Dual-hemisphere transcranial direct current stimulation over primary motor cortex enhances consolidation of a ballistic thumb movement.

Science.gov (United States)

Koyama, Soichiro; Tanaka, Satoshi; Tanabe, Shigeo; Sadato, Norihiro

2015-02-19

Transcranial direct current stimulation (tDCS) is a noninvasive technique that modulates motor performance and learning. Previous studies have shown that tDCS over the primary motor cortex (M1) can facilitate consolidation of various motor skills. However, the effect of tDCS on consolidation of newly learned ballistic movements remains unknown. The present study tested the hypothesis that tDCS over M1 enhances consolidation of ballistic thumb movements in healthy adults. Twenty-eight healthy subjects participated in an experiment with a single-blind, sham-controlled, between-group design. Fourteen subjects practiced a ballistic movement with their left thumb during dual-hemisphere tDCS. Subjects received 1mA anodal tDCS over the contralateral M1 and 1mA cathodal tDCS over the ipsilateral M1 for 25min during the training session. The remaining 14 subjects underwent identical training sessions, except that dual-hemisphere tDCS was applied for only the first 15s (sham group). All subjects performed the task again at 1h and 24h later. Primary measurements examined improvement in peak acceleration of the ballistic thumb movement at 1h and 24h after stimulation. Improved peak acceleration was significantly greater in the tDCS group (144.2±15.1%) than in the sham group (98.7±9.1%) (Pballistic thumb movement in healthy adults. Dual-hemisphere tDCS over M1 may be useful to improve elemental motor behaviors, such as ballistic movements, in patients with subcortical strokes. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Transcranial direct current stimulation of the primary motor cortex improves word-retrieval in older adults.

Directory of Open Access Journals (Sweden)

Marcus eMeinzer

2014-09-01

Full Text Available Language facilitation by transcranial direct current stimulation (tDCS in healthy individuals has generated hope that tDCS may also allow improving language impairment after stroke (aphasia. However, current stimulation protocols have yielded variable results and may require identification of residual language cortex using functional magnetic resonance imaging (fMRI, which complicates incorporation into clinical practice. Based on previous behavioral studies that demonstrated improved language processing by motor system pre-activation, the present study assessed whether tDCS administered to the primary motor cortex (M1 can enhance language functions.This proof-of-concept study employed a sham-tDCS controlled, cross-over, within-subject design and assessed the impact of unilateral excitatory (anodal and bihemispheric (dual tDCS in eighteen healthy older adults during semantic word-retrieval and motor speech tasks. Simultaneous fMRI scrutinized the neural mechanisms underlying tDCS effects.Both active tDCS conditions significantly improved word-retrieval compared to sham-tDCS. The direct comparison of activity elicited by word-retrieval vs. motor-speech trials revealed bilateral frontal activity increases during both anodal- and dual-tDCS compared to sham-tDCS. This effect was driven by more pronounced deactivation of frontal regions during the motor-speech task, while activity during word-retrieval trials was unaffected by the stimulation. No effects were found in M1 and secondary motor regions.Our results show that tDCS administered to M1 can improve word-retrieval in healthy individuals, thereby providing a rationale to explore whether M1-tDCS may offer a novel approach to improve language functions in aphasia. fMRI revealed neural facilitation specifically during motor speech trials, which may have reduced switching costs between the overlapping neural systems for lexical retrieval and speech processing, thereby resulting in improved

Transcranial direct current stimulation of the primary motor cortex improves word-retrieval in older adults.

Science.gov (United States)

Meinzer, Marcus; Lindenberg, Robert; Sieg, Mira M; Nachtigall, Laura; Ulm, Lena; Flöel, Agnes

2014-01-01

Language facilitation by transcranial direct current stimulation (tDCS) in healthy individuals has generated hope that tDCS may also allow improving language impairment after stroke (aphasia). However, current stimulation protocols have yielded variable results and may require identification of residual language cortex using functional magnetic resonance imaging (fMRI), which complicates incorporation into clinical practice. Based on previous behavioral studies that demonstrated improved language processing by motor system pre-activation, the present study assessed whether tDCS administered to the primary motor cortex (M1) can enhance language functions. This proof-of-concept study employed a sham-tDCS controlled, cross-over, within-subject design and assessed the impact of unilateral excitatory (anodal) and bihemispheric (dual) tDCS in 18 healthy older adults during semantic word-retrieval and motor speech tasks. Simultaneous fMRI scrutinized the neural mechanisms underlying tDCS effects. Both active tDCS conditions significantly improved word-retrieval compared to sham-tDCS. The direct comparison of activity elicited by word-retrieval vs. motor-speech trials revealed bilateral frontal activity increases during both anodal- and dual-tDCS compared to sham-tDCS. This effect was driven by more pronounced deactivation of frontal regions during the motor-speech task, while activity during word-retrieval trials was unaffected by the stimulation. No effects were found in M1 and secondary motor regions. Our results show that tDCS administered to M1 can improve word-retrieval in healthy individuals, thereby providing a rationale to explore whether M1-tDCS may offer a novel approach to improve language functions in aphasia. Functional magnetic resonance imaging revealed neural facilitation specifically during motor speech trials, which may have reduced switching costs between the overlapping neural systems for lexical retrieval and speech processing, thereby resulting in

Critical current measurement in superconducting rings using an automatic inductive technique

International Nuclear Information System (INIS)

Gonzalez-Jorge, H.; Linares, B.; Quelle, I.; Carballo, E.; Romani, L.; Domarco, G.

2007-01-01

A measurement technique was developed to identify the critical current of superconducting rings. It is based on the detection of the voltage on a secondary coil when the current induced in the superconductor by a primary one go beyond to the critical value. The technique uses a DC power supply to control the AC current circulating by the primary circuit. Such circuit mainly consists on an AC power supply which gives a constant AC voltage, a primary inducting coil and a control coil with iron core. The AC current circulating by this circuit is modified with the change in the impedance of the control coil due to the fact of the DC current supplied by the power supply in parallel with it

Isolated primary lymphedema tarda of the upper limb.

Science.gov (United States)

Shariati, Farzaneh; Ravari, Hasan; Kazemzadeh, Gholamhossein; Sadeghi, Ramin

2013-03-01

Primary lymphedema tarda is considered as a congenital disease with late presentation. Primary lymphedema tarda usually affects lower limbs, and primary lymphedema tarda of the upper limbs usually accompanies lower limb lymphedema. In the current case report, we present an 80-year-old male patient with isolated left upper limb swelling that lymphoscintigraphy imaging proved to be lymphedema.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

Science.gov (United States)

Gordon, Christopher J; Aggar, Christina; Williams, Anna M; Walker, Lynne; Willcock, Simon M; Bloomfield, Jacqueline

2014-01-01

This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team - but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future. This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered. A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost

Current treatment of low grade astrocytoma

DEFF Research Database (Denmark)

Pedersen, Christina Louise; Romner, Bertil

2013-01-01

Through a comprehensive review of the current literature, the present article investigates several aspects of low grade astrocytomas (LGA), including prognostic factors, treatment strategies and follow-up regimes. LGA are in general relatively slow-growing primary brain tumours, but they have a v...... effective in discriminating between tumour progression and radiation necrosis. The research into biomarkers is currently limited with regards to their applications in LGA diagnostics, and therefore further studies including larger patient populations are needed.......Through a comprehensive review of the current literature, the present article investigates several aspects of low grade astrocytomas (LGA), including prognostic factors, treatment strategies and follow-up regimes. LGA are in general relatively slow-growing primary brain tumours, but they have...... as the course of disease. The current literature seems to support the idea that treatment with radical tumour resection, where possible, yields better long term outcome for patients with LGA. However, adjuvant therapy is often necessary. Administering early postoperative radiotherapy to patients with partially...

Lower Cretaceous paleo-Vertisols and sedimentary interrelationships in stacked alluvial sequences, Utah, USA

Science.gov (United States)

Joeckel, R. M.; Ludvigson, G. A.; Kirkland, J. I.

2017-11-01

The Yellow Cat Member of the Cedar Mountain Formation in Poison Strip, Utah, USA, consists of stacked, erosionally bounded alluvial sequences dominated by massive mudstones (lithofacies Fm) with paleo-Vertisols. Sediment bodies within these sequences grade vertically and laterally into each other at pedogenic boundaries, across which color, texture, and structures (sedimentary vs. pedogenic) change. Slickensides, unfilled (sealed) cracks, carbonate-filled cracks, and deeper cracks filled with sandstone; the latter features suggest thorough desiccation during aridification. Thin sandstones (Sms) in some sequences, typically as well as laminated to massive mudstones (Flm) with which they are interbedded in some cases, are interpreted as avulsion deposits. The termini of many beds of these lithofacies curve upward, parallel to nearby pedogenic slickensides, as the features we call ;turnups.; Turnups are overlain or surrounded by paleosols, but strata sheltered underneath beds with turnups retain primary sedimentary fabrics. Turnups were produced by movement along slickensides during pedogenesis, by differential compaction alongside pre-existing gilgai microhighs, or by a combination of both. Palustrine carbonates (lithofacies C) appear only in the highest or next-highest alluvial sequences, along with a deep paleo-Vertisol that exhibits partially preserved microrelief at the base of the overlying Poison Strip Member. The attributes of the Yellow Cat Member suggest comparatively low accommodation, slow accumulation, long hiatuses in clastic sedimentation, and substantial time intervals of subaerial exposure and pedogenesis; it appears to be distinct among the members of the Cedar Mountain Formation in these respects.

Transcranial direct current stimulation over the primary motor vs prefrontal cortex in refractory chronic migraine: A pilot randomized controlled trial.

Science.gov (United States)

Andrade, Suellen Marinho; de Brito Aranha, Renata Emanuela Lyra; de Oliveira, Eliane Araújo; de Mendonça, Camila Teresa Ponce Leon; Martins, Wanessa Kallyne Nascimento; Alves, Nelson Torro; Fernández-Calvo, Bernardino

2017-07-15

Although transcranial direct current stimulation (tDCS) represents a therapeutic option for the prophylaxis of chronic migraine, the target area for application of the electrical current to the cortex has not yet been well established. Here we sought to determine whether a treatment protocol involving 12 sessions of 2mA, 20min anodal stimulation of the left primary motor (M1) or dorsolateral prefrontal cortex (DLPFC) could offer clinical benefits in the management of pain from migraine. Thirteen participants were assessed before and after treatment, using the Headache Impact Test-6, Visual Analogue Scale and Medical Outcomes Study 36 - Item Short - Form Health Survey. After treatment, group DLPFC exhibited a better performance compared with groups M1 and sham. On intragroup comparison, groups DLPFC and M1 exhibited a greater reduction in headache impact and pain intensity and a higher quality of life after treatment. No significant change was found in group sham. The participants in group M1 exhibited more adverse effects, especially headache, heartburn, and sleepiness, than did those in the other two groups. Transcranial direct current stimulation is a safe and efficacious technique for treating chronic migraine. However, it should be kept in mind that the site of cortical stimulation might modulate the patient's response to treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Current distribution tomography for determination of internal current density distributions

International Nuclear Information System (INIS)

Gailey, P.C.

1993-01-01

A method is presented for determination of current densities inside a cylindrical object using measurements of the magnetic fields outside the object. The cross section of the object is discretized with the current assumed constant over each defined region. Magnetic fields outside the object are related to the internal current densities through a geometry matrix which can be inverted to yield a solution for the current densities in terms of the measured fields. The primary limitation of this technique results from singularities in the geometry matrix that arise due to cylindrical symmetry of the problem. Methods for circumventing the singularities to obtain information about the distribution of current densities are discussed. This process of current distribution tomography is designed to determine internal body current densities using measurements of the external magnetic field distribution. It is non-invasive, and relatively simple to implement. Although related to a more general study of magnetic imaging which has been used to investigate endogenous currents in the brain and other parts of the body, it is restricted to currents either applied directly or induced by exposure to an external field. The research is related to public concern about the possibility of health effects resulting from exposure to power frequency electric and magnetic fields

Multitarget transcranial direct current stimulation for freezing of gait in Parkinson's disease.

Science.gov (United States)

Dagan, Moria; Herman, Talia; Harrison, Rachel; Zhou, Junhong; Giladi, Nir; Ruffini, Giulio; Manor, Brad; Hausdorff, Jeffrey M

2018-04-01

Recent findings suggest that transcranial direct current stimulation of the primary motor cortex may ameliorate freezing of gait. However, the effects of multitarget simultaneous stimulation of motor and cognitive networks are mostly unknown. The objective of this study was to evaluate the effects of multitarget transcranial direct current stimulation of the primary motor cortex and left dorsolateral prefrontal cortex on freezing of gait and related outcomes. Twenty patients with Parkinson's disease and freezing of gait received 20 minutes of transcranial direct current stimulation on 3 separate visits. Transcranial direct current stimulation targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously, primary motor cortex only, or sham stimulation (order randomized and double-blinded assessments). Participants completed a freezing of gait-provoking test, the Timed Up and Go, and the Stroop test before and after each transcranial direct current stimulation session. Performance on the freezing of gait-provoking test (P = 0.010), Timed Up and Go (P = 0.006), and the Stroop test (P = 0.016) improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after primary motor cortex only or sham stimulation. Transcranial direct current stimulation designed to simultaneously target motor and cognitive regions apparently induces immediate aftereffects in the brain that translate into reduced freezing of gait and improvements in executive function and mobility. © 2018 International Parkinson and Movement Disorder Society. © 2018 International Parkinson and Movement Disorder Society.

Development of Educational Management System in Small Primary School

Science.gov (United States)

Alsammarry, Yupayao; Sirisuthi, Chaiyuth; Duangcharthom, Surat

2016-01-01

The purposes of the research were: (1) to study the factors of Educational Management System in Small Primary School; (2) to investigate current situations problems and guidelines of developing educational management in small primary school; (3) to develop Educational Management System in Small Primary School; and (4) to examine the results of…

Cosmic-ray antimatter - A primary origin hypothesis

Science.gov (United States)

Stecker, F. W.; Protheroe, R. J.; Kazanas, D.

1983-01-01

The present investigation is concerned with the possibility that the observed cosmic-ray protons are of primary extragalactic origin, taking into account the significance of the current antiproton data. Attention is given to questions regarding primary antiprotons, antihelium fluxes, and the propagation of extragalactic cosmic rays. It is concluded that the primary origin hypothesis should be considered as a serious alternative explanation for the cosmic-ray antiproton fluxes. Such extragalactic primary origin can be considered in the context of a baryon symmetric domain cosmology. The fluxes and propagation characteristics suggested are found to be in rough agreement with the present antiproton data.

Allegheny County Primary Care Access

Data.gov (United States)

Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The data on health care facilities includes the name and location of all the hospitals and primary care facilities in Allegheny County. The current listing of...

Onsite-effects of dual-hemisphere versus conventional single-hemisphere transcranial direct current stimulation

Science.gov (United States)

Kwon, Yong Hyun; Jang, Sung Ho

2012-01-01

We performed functional MRI examinations in six right-handed healthy subjects. During functional MRI scanning, transcranial direct current stimulation was delivered with the anode over the right primary sensorimotor cortex and the cathode over the left primary sensorimotor cortex using dual-hemispheric transcranial direct current stimulation. This was compared to a cathode over the left supraorbital area using conventional single-hemispheric transcranial direct current stimulation. Voxel counts and blood oxygenation level-dependent signal intensities in the right primary sensorimotor cortex regions were estimated and compared between the two transcranial direct current stimulation conditions. Our results showed that dual-hemispheric transcranial direct current stimulation induced greater cortical activities than single-hemispheric transcranial direct current stimulation. These findings suggest that dual-hemispheric transcranial direct current stimulation may provide more effective cortical stimulation than single-hemispheric transcranial direct current stimulation. PMID:25624815

Assertion based verification methodology for HDL designs of primary sodium pump speed and eddy current flow measurement systems of PFBR

International Nuclear Information System (INIS)

Misra, M.K.; Menon, Saritha P.; Thirugnana Murthy, D.

2013-01-01

With the growing complexity and size of digital designs, functional verification has become a huge challenge. The validation and testing process accounts for a significant percentage of the overall development effort and cost for electronic systems. Many studies have shown that up to 70% of the design development time and resources are spent on functional verification. Functional errors manifest themselves very early in the design flow, and unless they are detected upfront, they can result in severe consequences - both financially and from a safety viewpoint. This paper covers the various types of verification methodologies and focuses on Assertion Based Verification Methodology for HDL designs, taking as case studies, the Primary Sodium Pump Speed and Eddy Current Flow Measurement Systems of PFBR. (author)

Current Management of Primary Central Nervous System Lymphoma

International Nuclear Information System (INIS)

Schultz, Christopher J.; Bovi, Joseph

2010-01-01

Primary central nervous cell lymphoma (PCNSL) is an uncommon neoplasm of the brain, leptomeninges, and rarely the spinal cord. Initially thought to be characteristically associated with congenital, iatrogenic, or acquired immunosuppression, PCNSL is now recognized with increasing frequency in immunocompetent individuals. The role of surgery is limited to establishing diagnosis, as PCNSL is often multifocal with a propensity to involve the subarachnoid space. A whole-brain radiation volume has empirically been used to adequately address the multifocal tumor frequently encountered at the time of PCNSL diagnosis. Despite high rates of response after whole-brain radiotherapy (WBRT), rapid recurrence is common and long-term survival is the exception. Chemotherapy alone or in combination with WBRT has more recently become the treatment of choice. Most effective regimens contain high-dose methotrexate and or other agents that are capable of penetrating the blood-brain barrier. High response rates and improved survival with the use of chemotherapy has led to treatment strategies that defer or eliminate WBRT in hopes of lessening the risk of neurotoxicity attributed to WBRT. Unfortunately, elimination of WBRT is also associated with a higher rate of relapse. Combined chemotherapy and WBRT regimens are now being explored that use lower total doses of radiation and altered fractionation schedules with the aim of maintaining high rates of tumor control while minimizing neurotoxicity. Pretreatment, multifactor prognostic indices have recently been described that may allow selection of treatment regimens that strike an appropriate balance of risk and benefit for the individual PCNSL patient.

Current Trends in Neonatal Tracheostomy.

Science.gov (United States)

Isaiah, Amal; Moyer, Kelly; Pereira, Kevin D

2016-08-01

The indications for neonatal tracheostomy may have changed with current noninvasive respiratory therapies compared with previous decades. To study the current trends in neonatal tracheostomy and identify the primary indication for the procedure and risk factors for failed extubation. This retrospective medical record review included 47 neonates who underwent tracheostomy from January 1, 2009, to December 31, 2013, at the University of Maryland Children's Hospital. Group 1 included infants undergoing tracheostomy for the primary indication of upper airway obstruction; group 2, infants with primary pulmonary disease. Data on weight, gestational age, comorbid conditions, congenital abnormalities, complications, outcomes, and indications for tracheostomy were compared statistically between groups. Differences in gestational age, birth weight, and age at tracheostomy. Among the 47 infants included in the study (30 boys; 17 girls, mean [SD] age, 113 [73] days), 31 (66%) demonstrated anatomical causes of airway obstruction, and 16 (34%) had significant pulmonary disease. Among infants with anatomical causes, subglottic stenosis represented the largest group (11 of 31 [35%]). The mean age at the time of tracheostomy was significantly lower in the group with airway obstruction (98.9 vs 146.9 days; difference, 48 [95% CI, 4.8-91.2] days; P = .04). No procedure-related morbidity or mortality was encountered. Anatomical upper airway obstruction may be returning as the most common indication for a neonatal tracheostomy, thereby supporting the belief that current respiratory therapies have lowered the burden of chronic lung disease and the need for prolonged ventilatory care.

Summarizing primary and secondary effects

DEFF Research Database (Denmark)

Karlson, Kristian Bernt

2013-01-01

Current methods for decomposing class differentials in educational decisions into primary and secondary effects produce many parameters, rendering them ill-equipped for parsimonious comparisons across countries or birth cohorts. This paper develops a parametric method that provides an optimal...... summary of primary and secondary effects across discrete class origins. Under the testable assumption that the pattern of effects of class origins on academic ability is proportional to the pattern of effects of class origins on educational choice net of academic ability, the method returns a single...

Primary Prevention of Eating Disorders.

Science.gov (United States)

Shisslak, Catherine M.; And Others

1987-01-01

Summarizes current understanding of anorexia nervosa and bulimia (clinical symptoms and outcome, prevalence and risk factors), offering suggestions for the primary prevention of these disorders at the individual, family, and community levels, and emphasizing prevention in the schools. (Author/KS)

Primary Teacher Education in England: 40 Years On

Science.gov (United States)

Murray, Jean; Passy, Rowena

2014-01-01

This article examines the relationship between pre-service teacher education (ITE) for primary schooling and primary teaching in England between 1974 and 2014, and explores the "fitness of purpose" of the current system of preparing teachers for the classrooms of the twenty-first century. Our historical analysis suggests that, despite 40…

Frequency-Controlled Current-Fed Resonant Converter with No Input Ripple Current

Directory of Open Access Journals (Sweden)

Bor-Ren Lin

2018-02-01

Full Text Available This paper studies a frequency-controlled current-fed resonant circuit. The adopted direct current (DC-to-DC converter contains two boost circuits and a resonant circuit on the primary side. First, two boost circuits are connected in parallel to achieve voltage step-up and reduce input ripple current by using interleaved pulse-width modulation. Therefore, the size and current rating of boost inductors are decreased in the proposed converter. Second, the boost voltage is connected to the resonant circuit to realize the mechanism of the zero-voltage switching of all active switches and zero-current switching of all diodes. Two boost circuits and a resonant circuit use the same power devices in order to lessen the switch counts. The voltage doubler topology is adopted on the secondary side (high-voltage side. Therefore, the voltage rating of diodes on the high-voltage side is clamped at output voltage. The feasibility of the studied circuit is confirmed by the experimental tests with a 1 kW prototype circuit.

Intraseasonal variability of upper-ocean currents and photosynthetic primary production along the U.S. west coast associated with the Madden-Julian Oscillation

Science.gov (United States)

Barrett, B.; Davies, A. R.; Steppe, C. N.; Hackbarth, C.

2017-12-01

In the first part of this study, time-lagged composites of upper-ocean currents from February to May of 1993-2016 were binned by active phase of the leading atmospheric mode of intraseasonal variability, the Madden-Julian Oscillation (MJO). Seven days after the convectively active phase of the MJO enters the tropical Indian Ocean, anomalously strong south-southeastward upper-ocean currents are observed along the majority of U.S. west coast. Seven days after the convectively active phase enters the tropical western Pacific Ocean, upper-ocean current anomalies reverse along the U.S. west coast, with weaker southward flow. A physical pathway to the ocean was found for both of these: (a) tropical MJO convection modulates upper-tropospheric heights and circulation over the Pacific Ocean; (b) those anomalous atmospheric heights adjust the strength and position of the Aleutian Low and Hawaiian High; (c) surface winds change in response to the adjusted atmospheric pressure patterns; and (d) those surface winds project onto upper-ocean currents. In the second part of this study, we investigated if the MJO modulated intraseasonal variability of surface wind forcing and upper-ocean currents projected onto phytoplankton abundance along the U.S. west coast. Following a similar methodology, time-lagged, level 3 chlorophyll-a satellite products (a proxy for photosynthetic primary production) were binned by active MJO phase and analyzed for statistical significance using the Student's t test. Results suggest that intraseasonal variability of biological production along the U.S. west coast may be linked to the MJO, particularly since the time scale of the life cycle of phytoplankton is similar to the time scale of the MJO.

Teaching and Learning Mathematics from Primary Historical Sources

Science.gov (United States)

Barnett, Janet Heine; Lodder, Jerry; Pengelley, David

2016-01-01

Why would anyone think of teaching and learning mathematics directly from primary historical sources? We aim to answer this question while sharing our own experiences, and those of our students across several decades. We will first describe the evolution of our motivation for teaching with primary sources, and our current view of the advantages…

Embracing a diversified future for US primary care.

Science.gov (United States)

Hoff, Timothy

2013-01-01

Although less focused upon given the current emphasis on the patient-centered medical home innovation, the future for US primary care is arguably one that will be characterized by diversity in service delivery structures and personnel. The drivers of this diversity include increased patient demand requiring a larger number of primary care access points; the need for lower-cost delivery structures that can flourish in a low-margin business model; greater interest in primary care delivery by retailers and hospitals that see their involvement as a means to enhance their core business goals; the increased desire by non-physician providers to gain work independence; and a growing cadre of younger PCPs whose career and job preferences leave them open to working in a variety of different settings and structures. A key issue to ask of a more diversified primary care system is whether or not it will be characterized by competition or cooperation. While a competitive system would not be unexpected given historical and current trends, such a system would likely stunt the prospects for a full revitalization of US primary care. However, there is reason to believe that a cooperative system is possible and would be advantageous, given the mutual dependencies that already exist among primary care stakeholders, and additional steps that could be taken to enhance such dependencies even more into the future.

Management of primary adrenal insufficiency: Review of current clinical practice in a developed and a developing country

Directory of Open Access Journals (Sweden)

Uzma Khan

2017-01-01

Full Text Available Treatment of primary adrenal insufficiency (PAI requires lifelong hormone replacement with glucocorticoids (GCs and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with this life-threatening condition, management of PAI continues to be challenging. The obstacles for clinicians appear to vary widely across the globe. While optimization and individualization of therapy after diagnosis of PAI remain the main challenges for clinicians in the developed world, doctors in a developing country face problems at almost every stage from the diagnosis to the treatment and follow-up of these patients; cost of therapy, lack of resources, and funding are the main hindrances. Adherence to therapy and patient education are found to be common issues in most parts of the world. This commentary highlights the challenges from both developed and developing country's perspective in treating PAI; it also provides an update on current management scenario and future treatment options.

Management of Primary Adrenal Insufficiency: Review of Current Clinical Practice in a Developed and a Developing Country.

Science.gov (United States)

Khan, Uzma; Lakhani, Om J

2017-01-01

Treatment of primary adrenal insufficiency (PAI) requires lifelong hormone replacement with glucocorticoids (GCs) and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with this life-threatening condition, management of PAI continues to be challenging. The obstacles for clinicians appear to vary widely across the globe. While optimization and individualization of therapy after diagnosis of PAI remain the main challenges for clinicians in the developed world, doctors in a developing country face problems at almost every stage from the diagnosis to the treatment and follow-up of these patients; cost of therapy, lack of resources, and funding are the main hindrances. Adherence to therapy and patient education are found to be common issues in most parts of the world. This commentary highlights the challenges from both developed and developing country's perspective in treating PAI; it also provides an update on current management scenario and future treatment options.

The Primary Dental Care Workforce.

Science.gov (United States)

Neenan, M. Elaine; And Others

1993-01-01

A study describes the characteristics of the current primary dental care workforce (dentists, hygienists, assistants), its distribution, and its delivery system in private and public sectors. Graduate dental school enrollments, trends in patient visits, employment patterns, state dental activities, and workforce issues related to health care…

Onsite-effects of dual-hemisphere versus conventional single-hemisphere transcranial direct current stimulation

OpenAIRE

Kwon, Yong Hyun; Jang, Sung Ho

2012-01-01

We performed functional MRI examinations in six right-handed healthy subjects. During functional MRI scanning, transcranial direct current stimulation was delivered with the anode over the right primary sensorimotor cortex and the cathode over the left primary sensorimotor cortex using dual-hemispheric transcranial direct current stimulation. This was compared to a cathode over the left supraorbital area using conventional single-hemispheric transcranial direct current stimulation. Voxel coun...

Current practice and developmental efforts for leak detection in US reactor primary systems

International Nuclear Information System (INIS)

Kupperman, D.S.; Claytor, T.N.

1985-07-01

Current leak detection practices in 74 operating nuclear reactors have been reviewed. Existing leak detection systems are adequate to ensure a leak-before-break scenario in most situations, but no currently available, single method combines optimal leakage detection sensitivity, leak-locating ability, and leakage measurement accuracy. Simply tightening current leakage limits may produce an unacceptably large number of unnecessary shutdowns. The use of commercially available acoustic monitoring systems or moisture-sensitive tape may improve leak detection capability at specific sites. However, neither of these methods currently provides source discrimination (e.g., to distinguish between leaks from pipe cracks and valves) or leak-rate information (a small leak may saturate the system). A field-implementable acoustic leak detection system is being developed to address these limitations. 5 refs., 3 figs

Primary breast tuberculosis. A case report

International Nuclear Information System (INIS)

Filippou, D.C.; Rizos, S.; Nissiotis, A.

2003-01-01

Background. The differential diagnosis of primary breast tuberculosis with other benign or malignant conditions can be difficult with the current imaging techniques that used to recognize breast pathologies. In many cases mammographic and ultrasound characteristics of breast tuberculosis are similar to those of breast cancer. Case report. We present a case of primary breast tuberculosis, with no previous history of the disease, which was diagnosed during the operation. Conclusions. Primary breast tuberculosis can be misdiagnosed. In these cases a tuberculosis infection history is negative, the mammographic and radiological findings obscure and the mass can be misdiagnosed as carcinoma. The diagnosis is achieved after the surgical removal of the mass and histological examination of the specimen. (author)

Healthcare is primary

Directory of Open Access Journals (Sweden)

Raman Kumar

2015-01-01

Full Text Available 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.

Current and future impact of osteoarthritis on health care

DEFF Research Database (Denmark)

Turkiewicz, A; Petersson, I F; Björk, J

2014-01-01

OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking. METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary and specia......OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking. METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary...

Intensity-Modulated Radiation Therapy for Primary Brain Tumors

Institute of Scientific and Technical Information of China (English)

Zhong-min Wang

2004-01-01

Radiation therapy has been used to treat primary brain tumors as standard primary and/or adjunctive therapies for decades. It is difficult for conventional radiotherapy to deliver a lethal dose of radiation to the tumors while sparing surrounding normal brain due to complicated structures and multifunction in human brain. With the understanding of radiation physics and computer technology, a number of novel and more precise radiotherapies have been developed in recent years. Intensity modulated radiotherapy (IMRT) is one of these strategies. The use of IMRT in the treatment of primary brain tumors is being increasing nowadays. It shows great promise for some of primary brain tumors and also presents some problems, This review highlights current IMRT in the treatment of mainly primary brain tumors.

Neutral currents, supernovae neutrinos, and nucleosynthesis

International Nuclear Information System (INIS)

Haxton, W.C.

1988-01-01

The inelastic interactions of neutrinos during stellar collapse and neutron star cooling are discussed. The primary mechanism for dissipative neutrino reactions is nuclear excitation by neutral current scattering, a process not included in standard descriptions of supernovae. Charge-current and neutral current ''preheating'' of iron lying outside the shock front appears to be significant in the few milliseconds near shock breakout. This could help produce a more energetic shock. During the cooling phase, the neutral current interactions of muon and taon neutrinos appear to be responsible for some interesting nucleosynthesis. I discuss two examples the production of fluorine and neutrino-induced r-process nucleosynthesis. 26 refs., 1 fig., 3 tabs

Position paper - primary ventilation system configuration

International Nuclear Information System (INIS)

Dalpiaz, E.L.

1994-06-01

The purpose of this paper is to develop and document a position on the configuration of the primary ventilation system. This configuration will be used on the waste storage tanks currently being designed for the Multi-Function Waste Tank Facility. The primary ventilation system provides a single treatment train and exhaust fan for each waste storage tank. The ventilation systems from each of two tanks are grouped with an additional treatment train and exhaust fan that function as backup to either of the two systems

Retail clinics versus traditional primary care: Employee satisfaction guaranteed?

Science.gov (United States)

Lelli, Vanessa R; Hickman, Ronald L; Savrin, Carol L; Peterson, Rachel A

2015-09-01

To examine if differences exist in the levels of autonomy and job satisfaction among primary care nurse practitioners (NPs) employed in retail clinics versus traditional primary care settings. Data were collected from 310 primary care NPs who attended the American Association of NP's 28th Annual Conference in June 2013. Participants completed a demographic form, the Misener NP Job Satisfaction Scale, and the Dempster Practice Behavior Scale. Overall, there were no differences in job satisfaction or autonomy among NPs by practice setting. Retail NPs felt less valued and were less satisfied with social interaction, but more satisfied with benefits compared to NPs in traditional settings. NPs working in retail clinics were less likely to have intentions to leave current position compared to NPs in traditional practice settings. The results of this study enhance our current understanding of the linkages between levels of autonomy, job satisfaction, and practice setting among primary care NPs. The findings of this descriptive study offer valuable insights for stakeholders devoted to the development of the primary care workforce and identify modifiable factors that may influence retention and turnover rates among NPs. ©2015 American Association of Nurse Practitioners.

Commissioning and equity in primary care in Australia: Views from Primary Health Networks.

Science.gov (United States)

Henderson, Julie; Javanparast, Sara; MacKean, Tamara; Freeman, Toby; Baum, Fran; Ziersch, Anna

2018-01-01

This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context. © 2017 John Wiley & Sons Ltd.

Edge scour in current adjacent to stone covers

DEFF Research Database (Denmark)

Petersen, Thor Ugelvig; Sumer, B. Mutlu; Meyer, Knud Erik

The present paper reports some early results of an experimental investigation of edge scour in currents. Two kinds of measurements are made (1) Particle Image Velocimetry (PIV) measurements of secondary currents that take place near a junction between the stone cover and the sand bed in a clear......-water experiment; and (2) scour measurements in actual scour experiment in the live-bed regime. The early results indicate that edge scour in a steady current propagating in-line with a stone layer is caused by the combined action of two effects; (1) Primary flow and (2) Secondary flow. The primary flow stirs up...... the sediment and puts into suspension, and the secondary flow carries it away from the junction between the stone layer and the sand bed, resulting in a scour hole forming adjacent to the toe of the stone layer....

Fibromyalgia: management strategies for primary care providers.

Science.gov (United States)

Arnold, L M; Gebke, K B; Choy, E H S

2016-02-01

Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. © 2016 John Wiley & Sons Ltd.

Flux consumption, current ramp-up and current diffusion in Tore Supra non-inductive Lower Hybrid scenarios

International Nuclear Information System (INIS)

Kazarian, F.; Litaudon, X.; Moreau, D.; Arslanbekov, R.; Hoang, G.T.; Joffrin, E.; Peysson, Y.; Allibert, J.P.; Ane, J.M.; Bremond, S.

1995-01-01

The main objective of the Lower Hybrid (LH) experiments performed on Tore Supra is to provide large flux savings for long pulse operation while controlling the plasma current density profile. This goal will be best achieved by applying LH wave directly during the current ramp-up phase. Experiments have been performed where a large fraction of the current is driven non-inductively during the ramp-up phase. A theoretical flux consumption scaling is presented and compared to experimental data. The time evolutions of the current density profiles are analysed with a new current diffusion code (CRONOS). In view to achieve fully non-inductive current drive discharges in a fast, systematic and reproducible way, experiments where the primary voltage is imposed have been carried out. In a complementary approach, an appropriate transformer flux feedback scheme has been also studied. (author) 6 refs.; 6 figs

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

International Nuclear Information System (INIS)

Salihoglu, Gueray

2010-01-01

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

Surgery of Primary Melanomas

Energy Technology Data Exchange (ETDEWEB)

Rutkowski, Piotr, E-mail: rutkowskip@coi.waw.pl; Zdzienicki, Marcin; Nowecki, Zbigniew I. [Soft Tissue/Bone Sarcoma and Melanoma Department, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Akkooi, Alexander C. J. van [Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

2010-05-11

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

Surgery of Primary Melanomas

International Nuclear Information System (INIS)

Rutkowski, Piotr; Zdzienicki, Marcin; Nowecki, Zbigniew I.; Akkooi, Alexander C. J. van

2010-01-01

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

Surgery of Primary Melanomas

Directory of Open Access Journals (Sweden)

Piotr Rutkowski

2010-05-01

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

Impact of Diabetes on Long-Term Outcome After Primary Angioplasty

DEFF Research Database (Denmark)

De Luca, Giuseppe; Dirksen, Maurits T; Spaulding, Christian

2012-01-01

Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal sten...

The Development of Visionary Leadership Administrators in Thai Primary School

Science.gov (United States)

Yordsala, Suwit; Tesaputa, Kowat; Sri-Ampai, Anan

2014-01-01

This research aimed: 1) to investigate the current situations and needs in developing visionary leadership of Thai primary school administrators; 2) to develop visionary leadership development program of Thai primary school administrators, and; 3) to evaluate the implementation of the developed program of administrators visionary leadership…

Cardiovascular Risk in Primary Hyperaldosteronism.

Science.gov (United States)

Prejbisz, A; Warchoł-Celińska, E; Lenders, J W M; Januszewicz, A

2015-12-01

After the first cases of primary aldosteronism were described and characterized by Conn, a substantial body of experimental and clinical evidence about the long-term effects of excess aldosterone on the cardiovascular system was gathered over the last 5 decades. The prevalence of primary aldosteronism varies considerably between different studies among hypertensive patients, depending on patient selection, the used diagnostic methods, and the severity of hypertension. Prevalence rates vary from 4.6 to 16.6% in those studies in which confirmatory tests to diagnose primary aldosteronism were used. There is also growing evidence indicating that prolonged exposure to elevated aldosterone concentrations is associated with target organ damage in the heart, kidney, and arterial wall, and high cardiovascular risk in patients with primary aldosteronism. Therefore, the aim of treatment should not be confined to BP normalization and hypokalemia correction, but rather should focus on restoring the deleterious effects of excess aldosterone on the cardiovascular system. Current evidence convincingly demonstrates that both surgical and medical treatment strategies beneficially affect cardiovascular outcomes and mortality in the long term. Further studies can be expected to provide better insight into the relationship between cardiovascular risk and complications and the genetic background of primary aldosteronism. © Georg Thieme Verlag KG Stuttgart · New York.

Hardwood lumber supply chain: current status and market opportunities

Science.gov (United States)

Urs Buehlmann; Matthew Bumgardner; Al Schuler; Mark Barford

2007-01-01

The membership of the Appalachian Hardwood Manufacturers Association was surveyed in 2005 to determine the current status of large Appalachian sawmills. The primary focus was to assess the impacts of globalization on primary manufacturing, but attention was also paid to general issues affecting the hardwood lumber supply chain-from concerns over forest health and log...

EPRI PWR primary water chemistry guidelines revision

International Nuclear Information System (INIS)

McElrath, Joel; Fruzzetti, Keith

2014-01-01

EPRI periodically updates the PWR Primary Water Chemistry Guidelines as new information becomes available and as required by NEI 97-06 (Steam Generator Program Guidelines) and NEI 03-08 (Guideline for the Management of Materials Issues). The last revision of the PWR water chemistry guidelines identified an optimum primary water chemistry program based on then-current understanding of research and field information. This new revision provides further details with regard to primary water stress corrosion cracking (PWSCC), fuel integrity, and shutdown dose rates. A committee of industry experts, including utility specialists, nuclear steam supply system (NSSS) and fuel vendor representatives, Institute of Nuclear Power Operations (INPO) representatives, consultants, and EPRI staff collaborated in reviewing the available data on primary water chemistry, reactor water coolant system materials issues, fuel integrity and performance issues, and radiation dose rate issues. From the data, the committee updated the water chemistry guidelines that all PWR nuclear plants should adopt. The committee revised guidance with regard to optimization to reflect industry experience gained since the publication of Revision 6. Among the changes, the technical information regarding the impact of zinc injection on PWSCC initiation and dose rate reduction has been updated to reflect the current level of knowledge within the industry. Similarly, industry experience with elevated lithium concentrations with regard to fuel performance and radiation dose rates has been updated to reflect data collected to date. Recognizing that each nuclear plant owner has a unique set of design, operating, and corporate concerns, the guidelines committee has retained a method for plant-specific optimization. Revision 7 of the Pressurized Water Reactor Primary Water Chemistry Guidelines provides guidance for PWR primary systems of all manufacture and design. The guidelines continue to emphasize plant

A Short-Current Control Method for Constant Frequency Current-Fed Wireless Power Transfer Systems

Directory of Open Access Journals (Sweden)

Yanling Li

2017-04-01

Full Text Available Frequency drift is a serious problem in Current-Fed Wireless Power Transfer (WPT systems. When the operating frequency is drifting from the inherent Zero Voltage Switching (ZVS frequency of resonant network, large short currents will appear and damage the switches. In this paper, an inductance-dampening method is proposed to inhibit short currents and achieve constant-frequency operation. By adding a small auxiliary series inductance in the primary resonant network, short currents are greatly attenuated to a safe level. The operation principle and steady-state analysis of the system are provided. An overlapping time self-regulating circuit is designed to guarantee ZVS running. The range of auxiliary inductances is discussed and its critical value is calculated exactly. The design methodology is described and a design example is presented. Finally, a prototype is built and the experimental results verify the proposed method.

The Current Practices and Problems of School Based Supervision in ...

African Journals Online (AJOL)

The purpose of this study was to identify the current practice and problems of school based supervision in government primary schools of Jile Timuga Woreda of Oromia Zone. A descriptive survey design of research methodology was employed. Regarding sampling, there were 39 primary schools grouped in 10 cluster ...

Impact Of Secondary-Primary Pumps Operating Sequence On The Electrical Power Supply System

International Nuclear Information System (INIS)

Suwoto; Rusdiyanto; Kiswanto

2001-01-01

The operating procedure of the reactor cooling system has decided that the primary cooling pump should be operated before secondary cooling pump as known primary-secondary pumps operating sequence. This decision is based on consideration that starting current of the primary pump is higher than secondary pump. Therefore, the primary-secondary pumps operating sequence can avoid the power supply system failure. However, this operating procedure has to take a consequence that in case of primary pump failure, the shutdown time period of the reaktor to be longer caused to re operate the primary pump has required that the running secondary pump should be shutted off. To solve this problem, an impact analysis of the secondary-primary pumps operating sequence on the electric power supply system was carried out to identify the revision possibility of the cooling pump operating procedure. The analysis by discussion of the measuring results of the secondary and primary pump starting current related to another electrical loads has been measured. From discussion it can be concluded that secondary-primary pumps operating sequence has no impact to failure in electric power supply system

Current practice and developmental efforts for leak detection in U.S. reactor primary systems

International Nuclear Information System (INIS)

Kupperman, D.S.; Claytor, T.N.

1986-01-01

Current leak detection practices in 74 operating nuclear reactors have been reviewed. Existing leak detection systems are adequate to ensure a leak-before-break scenario in most situations, but no currently available, single method combines optimal leakage detection sensitivity, leak-locating ability, and leakage measurement accuracy. Simply tightening current leakage limits may produce an unacceptably large number of unnecessary shutdowns. The use of commercially available acoustic monitoring systems or moisture-sensitive tape may improve leak detection capability at specific sites. However, neither of these methods currently provides source discrimination (e.g., to distinguish between leaks from pipe cracks and valves) or leak-rate information (a small leak may saturate the system). A field-implementable acoustic leak detection system is being developed to address these limitations. 5 refs.

Primary health services at district level in South Africa: a critique of the primary health care approach

Directory of Open Access Journals (Sweden)

Dookie Sunitha

2012-07-01

Full Text Available Abstract Background The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa’s progress and attempts at implementing primary health care, various factors still limit its success. Discussion Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied. There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation. Summary A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.

Onsite-effects of dual-hemisphere versus conventional single-hemisphere transcranial direct current stimulation: A functional MRI study.

Science.gov (United States)

Kwon, Yong Hyun; Jang, Sung Ho

2012-08-25

We performed functional MRI examinations in six right-handed healthy subjects. During functional MRI scanning, transcranial direct current stimulation was delivered with the anode over the right primary sensorimotor cortex and the cathode over the left primary sensorimotor cortex using dual-hemispheric transcranial direct current stimulation. This was compared to a cathode over the left supraorbital area using conventional single-hemispheric transcranial direct current stimulation. Voxel counts and blood oxygenation level-dependent signal intensities in the right primary sensorimotor cortex regions were estimated and compared between the two transcranial direct current stimulation conditions. Our results showed that dual-hemispheric transcranial direct current stimulation induced greater cortical activities than single-hemispheric transcranial direct current stimulation. These findings suggest that dual-hemispheric transcranial direct current stimulation may provide more effective cortical stimulation than single-hemispheric transcranial direct current stimulation.

Primary Anorectal Melanoma

Directory of Open Access Journals (Sweden)

Maliha Khan

2014-03-01

Full Text Available Primary malignant melanoma of the anus and rectum is a rare and aggressive neoplasm that tends to invade locally and metastasize early in the course of the disease. It is often misdiagnosed as hemorrhoids or as one of the other benign anorectal conditions and is thus linked to an overall poor prognosis and a 5-year survival rate of less than 20%. Optimal treatment is still controversial, and current evidence does not show any preferential survival benefit from abdominoperineal resection over wide local excision. Chemotherapy or radiotherapy may be used for advanced disease. We report a 71-year-old female presenting with painful bowel movements and blood in stools. She was eventually found to have a mass arising from the anorectal junction with regional lymph node involvement. The patient underwent an abdominoperineal resection and is currently scheduled for chemotherapy.

The effect of lavender aromatherapy on the pain severity of primary ...

African Journals Online (AJOL)

Background: Primary dysmenorrhea is the most common complaint in adolescents and adult young women that disturbs their daily life performance. Aim: The current study investigated the effect of lavender aromatherapy on pain severity in primary dysmenorrhea. Subjects and Methods: This triple‑blind randomized clinical ...

Electric current precedes emergence of a lateral root in higher plants.

Science.gov (United States)

Hamada, S; Ezaki, S; Hayashi, K; Toko, K; Yamafuji, K

1992-10-01

Stable electrochemical patterns appear spontaneously around roots of higher plants and are closely related to growth. An electric potential pattern accompanied by lateral root emergence was measured along the surface of the primary root of adzuki bean (Phaseolus angularis) over 21 h using a microelectrode manipulated by a newly developed apparatus. The electric potential became lower at the point where a lateral root emerged. This change preceded the emergence of the lateral root by about 10 h. A theory is presented for calculating two-dimensional patterns of electric potential and electric current density around the primary root (and a lateral root) using only data on the one-dimensional electric potential measured near the surface of the primary root. The development of the lateral root inside the primary root is associated with the influx of electric current of about 0.7 muA.cm(-2) at the surface.

Tidal current energy resource assessment in Ireland: Current status and future update

International Nuclear Information System (INIS)

O'Rourke, Fergal; Boyle, Fergal; Reynolds, Anthony

2010-01-01

Interest in renewable energy in Ireland has increased continually over the past decade. This interest is due primarily to security of supply issues and the effects of climate change. Ireland imports over 90% of its primary energy consumption, mostly in the form of fossil fuels. The exploitation of Ireland's vast indigenous renewable energy resources is required in order to reduce this over-dependence on fossil fuel imports to meet energy demand. Various targets have been set by the Irish government to incorporate renewable energy technologies into Ireland's energy market. As a result of these targets, the development in wind energy has increased substantially over the past decade; however this method of energy extraction is intermittent and unpredictable. Ireland has an excellent tidal current energy resource and the use of this resource will assist in the development of a sustainable energy future. Energy extraction using tidal current energy technologies offers a vast and predictable energy resource. This paper reviews the currently accepted tidal current energy resource assessment for Ireland. This assessment was compiled by Sustainable Energy Ireland in a report in 2004. The assessment employed a 2-dimensional numerical model of the tidal current velocities around Ireland, and from this numerical model the theoretical tidal current energy resource was identified. With the introduction of constraints and limitations, the technical, practical, accessible and viable tidal current energy resources were obtained. The paper discusses why the assessment needs updating including the effect on the assessment of the current stage of development of tidal current turbines and their deployment technology. (author)

Return currents in solar flares - Collisionless effects

Science.gov (United States)

Rowland, H. L.; Vlahos, L.

1985-01-01

If the primary, precipitating electrons in a solar flare are unstable to beam plasma interactions, it is shown that strong Langmuir turbulence can seriously modify the way in which a return current is carried by the background plasma. In particular, the return (or reverse) current will not be carried by the bulk of the electrons, but by a small number of high velocity electrons. For beam/plasma densities greater than 0.01, this can reduce the effects of collisions on the return current. For higher density beams where the return current could be unstable to current driven instabilities, the effects of strong turbulence anomalous resistivity is shown to prevent the appearance of such instabilities. Again in this regime, how the return current is carried is determined by the beam generated strong turbulence.

Palaeopedogenic features and their palaeoclimatological significance for the nevremont formation (Lower Givetian), the Northern Ardennes, Belgium

NARCIS (Netherlands)

Molenaar, N.

1984-01-01

The lower member of the Nèvremont Formation is characterized by the frequent occurrence of pedogenic features, which suggest intermittent exposure of the fluvial depositional environment. The evidence for pedogenesis comprises horizons of calcite glaebules and nodular calcrete, haematite

Disaster and primary health care utilization: a 4 year follow-up.

NARCIS (Netherlands)

Dorn, T.; Yzermans, J.; Kerssens, J.; Veen, P. ten

2005-01-01

Background: Although crucial for the management of the post-disaster phase, the impact of disasters on primary health care utilization is largely unknown. Often, pre-disaster base-line data is lacking. The current study quantified primary health care utilization after a major fire disaster in The

Models for Primary Eye Care Services in India

Directory of Open Access Journals (Sweden)

Vasundhra Misra

2015-01-01

In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

Patterns of and reasons for electronic cigarette use in primary care patients.

Science.gov (United States)

Kalkhoran, Sara; Alvarado, Nicholas; Vijayaraghavan, Maya; Lum, Paula J; Yuan, Patrick; Satterfield, Jason M

2017-10-01

Electronic cigarette (e-cigarette) use is rising in both the general and clinical populations. Little is known about e-cigarette use in primary care, where physicians report discussing e-cigarette use with patients. Identify how and why smokers in primary care use e-cigarettes. Cross-sectional secondary data analysis from a randomized controlled trial of a tablet intervention to deliver the 5As for smoking cessation in primary care. Current smokers aged 18 and older in three primary care clinics in San Francisco, CA (N = 788). Patients reported sociodemographics, cigarette smoking habits, quitting readiness, and ever and current use of e-cigarettes. We also asked reasons they have used or would use e-cigarettes. ICD-9 codes from the medical record determined comorbidities. Fifty-two percent (n = 408) of patients reported ever using an e-cigarette, and 20% (n = 154) reported past-30-day use. Ever e-cigarette use was associated with younger age and negatively associated with being seen at practices at a public safety-net hospital compared to a practice at University-affiliated hospital. The most common reason for having used e-cigarettes among ever e-cigarette users, and for interest in future use of e-cigarettes among never e-cigarette users, was to cut down cigarette use. The mean number of days of e-cigarette use in the past 30 increased with duration of e-cigarette use. Most current e-cigarette users did not know the nicotine content of their e-cigarettes. Over half of smokers in primary care have ever used e-cigarettes, and one-fifth are currently using them. Most reported using e-cigarettes to cut down or quit cigarettes. Primary care providers should be prepared to discuss e-cigarettes with patients. Screening for e-cigarette use may help identify and treat patients interested in changing their cigarette smoking habits.

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...... for any of the primary headaches that can guide preventative drug discovery and development. Primary headache disorder subtypes despite common phenotypic presentation are undoubtedly heterogeneous in their pathophysiology as judged by the variability of response to headache medicines. Sub......, despite having promising effects in basic pain models, have not delivered efficacy in the clinic. Future efforts may triage novel physiological mediators using human experimental models of headache pain to support drug discovery strategies that target active pathways pharmacologically....

Primary Esophageal Motility Disorders: Beyond Achalasia.

Science.gov (United States)

Schlottmann, Francisco; Patti, Marco G

2017-06-30

The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esophagus, absent contractility) and minor disorders of peristalsis (ineffective esophageal motility, fragmented peristalsis). The aim of this study was to review the current diagnosis and management of esophageal motility disorders other than achalasia.

Primary Meningococcal Polyarthritis in an Adult Woman

Directory of Open Access Journals (Sweden)

José Celso Giordan Cavalcanti Sarinho

2015-01-01

Full Text Available Primary joint infection caused by the Gram-negative bacteria Neisseria meningitidis is rare. Normally, joint involvement comes secondary to meningitis or severe sepsis caused by this agent. When primary arthritis is seen, monoarthritis is the most common presentation. A meningococcal polyarthritis is described in less than 10 case reports according to current literature. This case report aims to briefly review this rare clinical event in an adult woman with no previous history of rheumatological disease. Early diagnosis of polyarthritis caused by meningococcal bacteria usually present a good prognosis when properly treated.

Primary care in Switzerland gains strength.

Science.gov (United States)

Djalali, Sima; Meier, Tatjana; Hasler, Susann; Rosemann, Thomas; Tandjung, Ryan

2015-06-01

Although there is widespread agreement on health- and cost-related benefits of strong primary care in health systems, little is known about the development of the primary care status over time in specific countries, especially in countries with a traditionally weak primary care sector such as Switzerland. The aim of our study was to assess the current strength of primary care in the Swiss health care system and to compare it with published results of earlier primary care assessments in Switzerland and other countries. A survey of experts and stakeholders with insights into the Swiss health care system was carried out between February and March 2014. The study was designed as mixed-modes survey with a self-administered questionnaire based on a set of 15 indicators for the assessment of primary care strength. Forty representatives of Swiss primary and secondary care, patient associations, funders, health care authority, policy makers and experts in health services research were addressed. Concordance between the indicators of a strong primary care system and the real situation in Swiss primary care was rated with 0-2 points (low-high concordance). A response rate of 62.5% was achieved. Participants rated concordance with five indicators as 0 (low), with seven indicators as 1 (medium) and with three indicators as 2 (high). In sum, Switzerland achieved 13 of 30 possible points. Low scores were assigned because of the following characteristics of Swiss primary care: inequitable local distribution of medical resources, relatively low earnings of primary care practitioners compared to specialists, low priority of primary care in medical education and training, lack of formal guidelines for information transfer between primary care practitioners and specialists and disregard of clinical routine data in the context of medical service planning. Compared to results of an earlier assessment in Switzerland, an improvement of seven indicators could be stated since 1995. As a

Paudorf locus typicus (Lower Austria) revisited – The potential of the classic loess outcrop for Middle to Late Pleistocene landscape reconstructions

DEFF Research Database (Denmark)

Sprafke, Tobias; Terhorst, Birgit; Peticzka, Robert

2013-01-01

periglacial conditions reflected in eolian silt and fine sand accumulation, admixture of local material during (mostly solifluidal) redeposition and in situ processes. Horizons with signs of pedogenesis, particularly the two pedocomplexes, document longer phases of stability; the stages of development can...

Explaining the de-prioritization of primary prevention: Physicians' perceptions of their role in the delivery of primary care

Directory of Open Access Journals (Sweden)

Kuo Christina L

2003-05-01

Full Text Available Abstract Background While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. Methods A focus group with regional primary care physician (PCP Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. Results The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. Conclusions The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration.

Low-leakage, high-current power crowbar transformer

International Nuclear Information System (INIS)

Buck, R.T.; Galbraith, J.D.; Nunnally, W.C.

1979-01-01

The design, fabrication, and testing of two sizes of power crowbar transformers for the ZT-40 Toroidal Z-Pinch experiment at the Los Alamos Scientific Laboratory are described. Low-leakage transformers in series with the poloidal and the toroidal field coils are used to sustain magnetic field currents initially produced by 50-kV capacitor banks. The transformer primaries are driven by cost-effective, ignitron-switched, 10-kV high-density capacitor banks. The transformer secondaries, in series with the field coils, provide from 1,000 to 1,500 V to cancel the resistive voltage drop in the coil circuits. Prototype transformers, with a total leakage inductance measured in the secondary of 5 nH, have been tested with peak secondary currents in excess of 600 kA resulting from a 10-kV primary charge voltage. The test procedures and results and the mechanical construction details are presented

Diabetes management in an Australian primary care population.

Science.gov (United States)

Krass, I; Hebing, R; Mitchell, B; Hughes, J; Peterson, G; Song, Y J C; Stewart, K; Armour, C L

2011-12-01

Worldwide studies have shown that significant proportions of patients with type 2 diabetes (T2DM) do not meet targets for glycaemic control, blood pressure (BP) and lipids, putting them at higher risk of developing complications. However, little is known about medicines management in Australian primary care populations with T2DM. The aim of this study was to (i) describe the management of a large group of patients in primary care, (ii) identify areas for improvement in management and (iii) determine any relationship between adherence and glycaemic, BP and lipid control. This was a retrospective, epidemiological study of primary care patients with T2DM diabetes, with HbA(1c) of >7%, recruited in 90 Australian community pharmacies. Data collected included demographic details, diabetes history, current medication regimen, height, weight, BP, physical activity and smoking status. Of the 430 patients, 98% used antidiabetics, 80% antihypertensives, 73% lipid lowering drugs and 38% aspirin. BP and all lipid targets were met by only 21% and 14% of the treated patients and 21% and 12% of the untreated patients respectively. Medication adherence was related to better glycaemic control (P = 0.04). An evidence-base prescribing practice gap was seen in this Australian primary care population of T2DM patients. Patients were undertreated with antihypertensive and lipid lowering medication, and several subgroups with co-morbidities were not receiving the recommended pharmacotherapy. Interventions are required to redress the current evidence-base prescribing practice gap in disease management in primary care. © 2011 Blackwell Publishing Ltd.

Barriers to Implementation of Primary Percutaneous Coronary Intervention in Europe

DEFF Research Database (Denmark)

Laut, Kristina Grønborg; Pedersen, Alma Becic; Lash, Timothy

2011-01-01

Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI and there are large ...... is needed. Keywords Primary percutaneous coronary intervention, acute ST-elevation myocardial infarction, implementation, practice variation, registry data......Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI and there are large...... the diffusion of PPCI in Europe. The lack of complete implementation and large national and regional differences arise from the interplay between technology, patients, policy makers, culture and resources. Explanations for the variation in treatment access still remain a puzzle and access to valid data...

Children thermal comfort in primary schools in Ho Chi Minh City in Vietnam

OpenAIRE

Le, Thi Ho Vi; Gillott, Mark C.; Rodrigues, Lucélia Taranto

2017-01-01

Indoor environmental quality significantly impacts on students’ performance and productivity, particularly thermal comfort levels. Currently in Vietnam, very few studies have dealt with the issue and the current trend is to install energy-intensive air-conditioning in primary schools as this is perceived as more comfortable. In this study, the authors investigated the users’ perceptions of thermal comfort in three primary schools in Ho Chi Minh City during the mid-season (September 2015) and ...

Development of Effective Academic Affairs Administration System in Thai Primary Schools

Science.gov (United States)

Thongnoi, Niratchakorn; Srisa-ard, Boonchom; Sri-ampai, Anan

2013-01-01

This research aimed to: 1) study current situations and problems of academic affairs administration system in Primary Schools. 2) develop an effective academic affairs administration system, and 3) evaluate the implementation of the developed system in the primary school, Thailand. Research and Development (R&D) was employed which consisted of…

[Current situation and existing problems of acupuncture for primary hypertension].

Science.gov (United States)

Zhang, Lili; Wei, Pengfei; Chen, Shaozong

2018-03-12

To analyze the present situation and existing problems of acupuncture for primary hypertension (PH) based on clinical research literature in recent 20 years. The clinical research literature regarding acupuncture for PH were searched from China National Knowledge Infrastructure (CNKI), VIP data network (VIP) and Wanfang database from 1997 through 2016; a total of 218 papers met the inclusive criteria. Microsoft Excel and Apriori algorithm of SPSS Clementine software were applied to analyze the data. The main acupoints of acupuncture for PH were Taichong (LR 3), Quchi (LI 11), Zusanli (ST 36) and Hegu (LI 4), but its support degree was only 12.21%. 127 papers were randomized controlled trials, accounting for 58.26%. 158 papers had clear diagnostic criteria, accounting for 72.48%. 138 papers had clear efficacy evaluation criteria, accounting for 63.30%. Only 5.05% of the papers were classified as high-quality literature by using Jadad scale. In recent 20 years, some rules existed in acupoint selection for PH, but the support degree was low so it could not accurately guide clinical treatment. Although the clinical literature quality of acupuncture for PH was gradually increasing, the proportion of high-quality literature was low, therefore modern medical research model and foreign similar research should be followed to design a more rigorous trial protocol. As a result, the quality of clinical research is increased to provide reference for future clinical treatment.

Current pulse shaping of the load current on PTS

Directory of Open Access Journals (Sweden)

Minghe Xia

2016-02-01

Full Text Available The typical rise time of PTS machine is ∼110 ns with about 10 MA peak current under short pulse mode when all 24 modules discharge simultaneously. By distributing the trigger times of 12 laser beams logically and adjusting the statues of the pulse output switches, longer rise-time pulse can be obtained on the PTS facility. Based on the required pulse shape, whole circuit simulations will be used to calculate the trigger times of each laser triggering gas switch and the status of the pulse output switches. The rise time of the current is determined by the time difference between the first and last trigged laser triggering gas switches. In order to trigger the laser triggering gas switch, sufficient laser power is needed to be sent into the gap of the gas switches. The gas pressure and voltage difference on the two electrodes of the gas switches also affect the triggering of the gas switches, and the voltage added on the gas switch is determined by its transition time. Traditionally the trigger time difference should be less than the transition time of the two neighboring modules. A new simulation model of PTS shows one can break this transition time limits. Series of current pulse shaping experiments have been investigated on the PTS (Primary Test Stand. As results, more than 5 MA peak current were successfully achieved on the load with a rise time of 600 ns. This study and experiments of the pulse shaping on PTS demonstrate the adaptable ability of the PTS for offering different waveform of mega ampere current pulse for different research purpose.

Microstructures and critical currents in high-Tc superconductors

International Nuclear Information System (INIS)

Suenaga, Masaki

1998-01-01

Microstructural defects are the primary determining factors for the values of critical-current densities in a high T c superconductor after the electronic anisotropy along the a-b plane and the c-direction. A review is made to assess firstly what would be the maximum achievable critical-current density in YBa 2 Cu 3 O 7 if nearly ideal pinning sites were introduced and secondly what types of pinning defects are currently introduced or exist in YBa 2 Cu 3 O 7 and how effective are these in pinning vortices

Diabetes care: model for the future of primary care.

Science.gov (United States)

Posey, L Michael; Tanzi, Maria G

2010-01-01

To review relevant trends threatening primary care and the evidence supporting use of nonphysicians in primary and chronic care of patients with diabetes. Current medical and pharmacy literature as selected by authors. The care needed by patients with diabetes does not fit well into our current medical model for primary care, and an adequate supply of physicians is not likely to be available for primary care roles in coming years. Patients with diabetes who are placed on evidence-based regimens, are educated about their disease, are coached in ways that motivate them to lose weight and adopt other therapeutic lifestyle changes, and are adhering to and persisting with therapy will soon have improved clinical parameters. These quickly translate into fewer hospitalizations and emergency department visits. A growing body of literature supports the use of pharmacists and other nonphysicians in meeting the needs of patients with diabetes. Pharmacists should join nurse practitioners, specially trained nurses, and physician assistants as integral members of the health care team in providing care to patients with diabetes and, by logical extension, other chronic conditions. Demand for primary care is likely to outstrip the available supply of generalist physicians in the coming years. In addition to nurse practitioners and physician assistants, pharmacists should be considered for key roles in future interdisciplinary teams that triage and provide direct care to patients, including those with diabetes and other chronic conditions.

Climate controls on late Pleistocene landscape evolution of the Okhombe valley, KwaZulu-Natal, South Africa

NARCIS (Netherlands)

Temme, A.J.A.M.; Baartman, J.E.M.; Botha, G.A.; Veldkamp, A.; Jongmans, A.G.; Wallinga, J.

2008-01-01

Hillslopes in central and western parts of KwaZulu-Natal, South Africa are often mantled by colluvial sediments of the Masotcheni Formation. These sediments have accreted in response to several cycles of deposition, pedogenesis and incomplete erosion. Climatic controls on these cycles are

Knowledge and perception of domestic violence among primary ...

African Journals Online (AJOL)

Najwa I. AbuTaleb

2012-01-16

Jan 16, 2012 ... ... of domestic violence among primary care physicians and nurses: A comparative study ... or psychological harm by current or former partner or spouse.1–3 ..... mainly from medical school, 13.3% in training workshop, 20.7%.

A programmable controller for constant primary peak current in capacitor charging fet switcher for nova

International Nuclear Information System (INIS)

Mihalka, A.

1983-01-01

New switching power supplies were designed for the 10 mm laser amplifiers in the Nova master oscillator room. The flashlamp supply must be repeatable. Therefore, the authors designed a constant current, linearly charging power supply. Since it is a capacitor, the load varies through-out the charge cycle. At first the load is great, and DI/DT of load current is at a maximum. As the capacitor charges the initial conditions for each cycle change, the power supply in effect sees a smaller capacitance, and DI/DT decreases. We need a way of gradually increasing the on-time of the current pulses so that the transistors in the power bridge are turned off when they reach their maximum peak current. The normal current sense response of the control chip is not fast enough to be useful for the application. The deadtime, or the time that all the bridge transistors are turned off, is fixed so that as the pulse width varies so does the period. We end up with a constant peak current, switching power supply whose frequency varies from 50 khz to 20 khz. Finally, an overcurrent latch protects the transistors from bridge or transformer faults. the circuit is described and results are shown

Primary ovarian insufficiency: an update

Directory of Open Access Journals (Sweden)

Cox L

2014-02-01

Full Text Available Leticia Cox, James H LiuUH Case Medical Center, MacDonald Women's Hospital, Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Department of Reproductive Biology, Cleveland, OH, USAAbstract: Primary ovarian insufficiency is a condition that represents impaired ovarian function on a continuum with intermittent ovulation. This condition commonly leads to premature menopause, defined as cessation of ovulation prior to the age of 40 years. Because there are potential immediate and long-term consequences of hypoestrogenism, a timely diagnosis is invaluable. This comprehensive review will discuss identifiable causes for primary ovarian insufficiency, including genetic disorders and metabolic abnormalities, as well as review current strategies for diagnosis, evaluation, and management of women with this condition.Keywords: premature ovarian failure, premature menopause, ovarian dysfunction

Integration of Mental Health into Primary Health Care in a rural ...

African Journals Online (AJOL)

Objective: Mental health has been identified as a major priority in the Ugandan Health Sector Strategic Plan. Efforts are currently underway to integrate mental health services into the Primary Health Care system. In this study, we report aspects of the integration of mental health into primary health care in one rural district in ...

Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective 'mystery shopper' study in UK primary care.

Science.gov (United States)

Stevens, Sarah L; McManus, Richard J; Stevens, Richard John

2018-04-12

Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. (1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment. Primary care. Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Proportion of patients having BP measured according to guidelines. 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669).

Science.gov (United States)

Bishop, Annette; Wynne-Jones, Gwenllian; Lawton, Sarah A; van der Windt, Danielle; Main, Chris; Sowden, Gail; Burton, A Kim; Lewis, Martyn; Jowett, Sue; Sanders, Tom; Hay, Elaine M; Foster, Nadine E

2014-07-10

Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Current Controlled Trials ISRCTN52269669.

Hot-spots of primary productivity: An Alternative interpretation to Conventional upwelling models

Science.gov (United States)

van Ruth, Paul D.; Ganf, George G.; Ward, Tim M.

2010-12-01

The eastern Great Australian Bight (EGAB) forms part of the Southern and Indian Oceans and is an area of high ecological and economic importance. Although it supports a commercial fishery, quantitative estimates of the primary productivity underlying this industry are open to debate. Estimates range from 500 mg C m -2 day -1. Part of this variation may be due to the unique upwelling circulation of shelf waters in summer/autumn (November-April), which shares some similarities with highly productive eastern boundary current upwelling systems, but differs due to the influence of a northern boundary current, the Flinders current, and a wide continental shelf. This study examines spatial variations in primary productivity in the EGAB during the upwelling seasons of 2005 and 2006. Daily integral productivity calculated using the vertically generalised production model (VGPM) showed a high degree of spatial variation. Productivity was low (modelled with the VGPM, which uses surface measures of phytoplankton biomass to calculate productivity. Macro-nutrient concentrations could not be used to explain the difference in the low and high productivities (silica > 1 μmol L -1, nitrate/nitrite > 0.4 μmol L -1, phosphate > 0.1 μmol L -1). Mixing patterns or micro-nutrient concentrations are possible explanations for spatial variations in primary productivity in the EGAB. On a global scale, daily rates of primary productivity of the EGAB lie between the highly productive eastern boundary current upwelling systems, and less productive coastal regions of western and south eastern Australia, and the oligotrophic ocean. However, daily productivity rates in the upwelling hotspots of the EGAB rival productivities in Benguela and Humboldt currents.

Current state of information technology use in a US primary care practice-based research network

Directory of Open Access Journals (Sweden)

James Andrews

2004-02-01

Conclusion While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

Teacher feedback during active learning: current practices in primary schools.

Science.gov (United States)

van den Bergh, Linda; Ros, Anje; Beijaard, Douwe

2013-06-01

Feedback is one of the most powerful tools, which teachers can use to enhance student learning. It appears difficult for teachers to give qualitatively good feedback, especially during active learning. In this context, teachers should provide facilitative feedback that is focused on the development of meta-cognition and social learning. The purpose of the present study is to contribute to the existing knowledge about feedback and to give directions to improve teacher feedback in the context of active learning. The participants comprised 32 teachers who practiced active learning in the domain of environmental studies in the sixth, seventh, or eighth grade of 13 Dutch primary schools. A total of 1,465 teacher-student interactions were examined. Video observations were made of active learning lessons in the domain of environmental studies. A category system was developed based on the literature and empirical data. Teacher-student interactions were assessed using this system. Results. About half of the teacher-student interactions contained feedback. This feedback was usually focused on the tasks that were being performed by the students and on the ways in which these tasks were processed. Only 5% of the feedback was explicitly related to a learning goal. In their feedback, the teachers were directing (rather than facilitating) the learning processes. During active learning, feedback on meta-cognition and social learning is important. Feedback should be explicitly related to learning goals. In practice, these kinds of feedback appear to be scarce. Therefore, giving feedback during active learning seems to be an important topic for teachers' professional development. © 2012 The British Psychological Society.

Design Aspects and Test of an Inductive Fault Current Limiter

Directory of Open Access Journals (Sweden)

Arsénio Pedro

2014-05-01

Full Text Available Magnetic shielding inductive fault current limiters with high temperature superconducting tapes are considered as emerging devices that provide technology for the advent of modern power grids. The development of such limiters requires magnetic iron cores and leads to several design challenges regarding the constitutive parts of the limiter, namely the primary and secondary windings. Preliminary tests in a laboratory scale prototype have been carried out considering an assembly designed for simplicity in which the optimization of the magnetic coupling between the primary and secondary was not the main focus. This work addresses the design configuration of an inductive current limiter prototype regarding the assembly of the primary and secondary windings in the core. The prototype is based on a closed magnetic core wound by a primary, built from a normal electric conductor, and a short-circuited secondary, built from first generation superconducting tape. Four different design configurations are considered. Through experimental tests, the performance of such prototype is discussed and compared, in terms of normal and fault operation regimes. The results show that all the configurations assure effective magnetic shielding at normal operation regime, however, at fault operation regime, there are differences among configurations.

Current Approaches to the Management of Pediatric Overweight and Obesity

Science.gov (United States)

Ridolfi, Danielle R.; Hayes, Jacqueline F.; St Paul, Michelle; Wilfley, Denise E.

2015-01-01

Opinion Statement Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective, low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers hold an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. key aspects of effective treatment include: early intervention, moderate- to high-intensity intervention of sufficient duration, multi-component intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multi-component behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management. PMID:25205083

The effect of increased primary schooling on adult women's HIV status in Malawi and Uganda: Universal Primary Education as a natural experiment.

Science.gov (United States)

Behrman, Julia Andrea

2015-02-01

This paper explores the causal relationship between primary schooling and adult HIV status in Malawi and Uganda, two East African countries with some of the highest HIV infection rates in the world. Using data from the 2010 Malawi Demographic Health Survey and the 2011 Uganda AIDS Indicator Survey, the paper takes advantage of a natural experiment, the implementation of Universal Primary Education policies in the mid 1990s. An instrumented regression discontinuity approach is used to model the relationship between increased primary schooling and adult women's HIV status. Results indicate that a one-year increase in schooling decreases the probability of an adult woman testing positive for HIV by 0.06 (p primary schooling positively affects women's literacy and spousal schooling attainment in Malawi and age of marriage and current household wealth in Uganda. However primary schooling has no effect on recent (adult) sexual behavior. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.

A Multi-Antenna Framework for Spectrum Reuse Based on Primary-Secondary Cooperation

KAUST Repository

Bakr, Omar; Johnson, Mark; Wild, Ben; Ramchandran, Kannan

2008-01-01

This paper proposes a new framework for spectrum reuse. Existing architectures have centered on secondary users (cognitive radios) that can reliably sense primary users and opportunistically transmit, without directly interacting with the primary system. We present a paradigm in which the primary and secondary systems cooperate, to minimize interference to primary users and provide predictable access for secondary users. Because this architecture gives the primary system full control over spectrum sharing, it could be more favorable in the current economic and political environment. We illustrate a concrete instance of our framework by showing how secondary radios can reuse the entire uplink channel of a cellular network, with only modest changes to the primary infrastructure. ©2008 IEEE.

A Multi-Antenna Framework for Spectrum Reuse Based on Primary-Secondary Cooperation

KAUST Repository

Bakr, Omar

2008-10-01

This paper proposes a new framework for spectrum reuse. Existing architectures have centered on secondary users (cognitive radios) that can reliably sense primary users and opportunistically transmit, without directly interacting with the primary system. We present a paradigm in which the primary and secondary systems cooperate, to minimize interference to primary users and provide predictable access for secondary users. Because this architecture gives the primary system full control over spectrum sharing, it could be more favorable in the current economic and political environment. We illustrate a concrete instance of our framework by showing how secondary radios can reuse the entire uplink channel of a cellular network, with only modest changes to the primary infrastructure. ©2008 IEEE.

Effects of transcranial direct current stimulation on language improvement and cortical activation in nonfluent variant primary progressive aphasia.

Science.gov (United States)

Wang, Jie; Wu, Dongyu; Chen, Yan; Yuan, Ying; Zhang, Meikui

2013-08-09

We investigate the effects of transcranial direct current stimulation (tDCS) on language improvement and cortical activation in nonfluent variant primary progressive aphasia (nfvPPA). A 67-year-old woman diagnosed as nfvPPA received sham-tDCS for 5 days over the left posterior perisylvian region (PPR) in the morning and over left Broca's area in the afternoon in Phases A1 and A2, and tDCS for 5 days with an anodal electrode over the left PPR in the morning and over left Broca's area in the afternoon in Phases B1 and B2. Auditory word comprehension, picture naming, oral word reading and word repetition subtests of the Psycholinguistic Assessment in Chinese Aphasia (PACA) were administered before and after each phase. The EEG nonlinear index of approximate entropy (ApEn) was calculated before Phase A1, and after Phases B1 and B2. Our findings revealed that the patient improved greatly in the four subtests after A-tDCS and ApEn indices increased in stimulated areas and non-stimulated areas. We demonstrated that anodal tDCS over the left PPR and Broca's area can improve language performance of nfvPPA. tDCS may be used as an alternative therapeutic tool for PPA. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The connection between the primary care and the physical activity sector: professionals’ perceptions

Directory of Open Access Journals (Sweden)

Karlijn E. F. Leenaars

2016-09-01

Full Text Available Abstract Background To stimulate physical activity (PA and guide primary care patients towards local PA facilities, Care Sport Connectors (CSC, to whom a broker role has been ascribed, were introduced in 2012 in the Netherlands. The aim of this study is to assess perceptions of primary care, welfare, and sport professionals towards the CSC role and the connection between the primary care and the PA sector. Methods Nine focus groups were held with primary care, welfare and sport professionals within the CSC network. In these focus groups the CSC role and the connection between the sectors were discussed. Both top-down and bottom-up codes were used to analyse the focus groups. Results Professionals ascribed three roles to the CSC: 1 broker role, 2 referral, 3 facilitator. Professionals were enthusiastic about how the current connection was established. However, barriers relating to their own sector were currently hindering the connection: primary care professionals’ lack of time, money and knowledge, and the lack of suitable PA activities and instructors for the target group. Conclusions This study provides further insight into the CSC role and the connection between the sectors from the point of view of primary care, welfare, and sport professionals. Professionals found the CSC role promising, but barriers are currently hindering the collaboration between both sectors. More time for the CSC and changes in the way the primary care and PA sector are organized seem to be necessary to overcome the identified barriers and to make a success of the connection. Trial registration Dutch Trial register NTR4986 . Registered 14 December 2014.

Primary Esophageal Motility Disorders: Beyond Achalasia

OpenAIRE

Schlottmann, Francisco; Patti, Marco G.

2017-01-01

The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esoph...

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

Primary Geography in the Republic of Ireland: Practices, Issues and Possible Futures

Science.gov (United States)

Pike, Susan

2015-01-01

In the Republic of Ireland, geography is recognized as an important subject for children to learn and all pupils take it throughout their primary school years. The current curriculum, the Primary School Curriculum-Geography, follows a tradition of innovative, child-centered geography curricula in Ireland. This article outlines the history of…

[Development of current smallpox vaccines].

Science.gov (United States)

Maksiutov, R A; Gavrilova, E V; Shchelkunov, S N

2011-01-01

The review gives data on the history of smallpox vaccination and shows the high topicality of designing the current safe vaccines against orthopoxviruses. Four generations of live smallpox, protein subunit, and DNA vaccines are considered. Analysis of the data published leads to the conclusion that it is promising to use the up-to-date generations of safe smallpox subunit or DNA vaccines for mass primary immunization with possible further revaccination with classical live vaccine.

Analysis on current limiting characteristics of a transformer type SFCL with two triggering current levels

International Nuclear Information System (INIS)

Lim, Sung-Hun; Ko, Seckcheol; Han, Tae-Hee

2013-01-01

Highlights: ► We suggested the transformer type SFCL with two triggering current levels. ► The short-circuit tests for the suggested SFCL was executed. ► The fault angle as the fault conditions to verify its operation was selected. ► The usefulness of the suggested SFCL was confirmed through the short-circuit test. -- Abstract: In this paper, the transformer type superconducting fault current limiter (SFCL) with two triggering current levels was suggested and its current limiting characteristics were analyzed. The structure of the suggested transformer type SFCL with two triggering current levels largely consists of two parts. One is the transformer with two magnetically coupled coils, which correspond to the primary winding and the secondary one connected with one high-T C superconducting (HTSC) element. The other is third coil, or, another secondary winding with one HTSC element, which is wound on the same iron core together with two coils. This suggested transformer type SFCL can limit the fault current by generating its limiting impedance with two different amplitudes, which are dependent on the initial amplitude of the fault current in case of the fault occurrence. To confirm the usefulness of the proposed SFCL, the current limiting tests of the SFCL according to the fault angle, one of the effective fault conditions to affect the amplitude of the initial fault current, were carried out and its effective limiting operations were discussed

Current Issues in the Presentation of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Fourth International Workshop

Science.gov (United States)

Clarke, Bart L.; Peacock, Munro; Bandeira, Francisco; Boutroy, Stephanie; Cusano, Natalie E.; Dempster, David; Lewiecki, E. Michael; Liu, Jian-Min; Minisola, Salvatore; Rejnmark, Lars; Silva, Barbara C.; Walker, Marcella D.; Bilezikian, John P.

2014-01-01

Objective: This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT. Participants: This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. Evidence: Data from the 5-year period between 2008 and 2013 were presented and discussed to determine whether they support changes in recommendations for surgery or nonsurgical follow-up. Consensus Process: Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was undertaken. After extensive review and discussion, the subgroup came to agreement on what changes in the recommendations for surgery or nonsurgical follow-up of asymptomatic PHPT should be made to the Expert Panel. Conclusions: 1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism) is increasing, data on the clinical presentation and natural history of this phenotype are limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current data do not support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomical or functional abnormalities. 6) Some patients with mild PHPT

Prediction of primary vs secondary hypertension in children.

Science.gov (United States)

Baracco, Rossana; Kapur, Gaurav; Mattoo, Tej; Jain, Amrish; Valentini, Rudolph; Ahmed, Maheen; Thomas, Ronald

2012-05-01

Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. © 2012 Wiley Periodicals, Inc.

Are chiropractors in the uk primary healthcare or primary contact practitioners?: a mixed methods study

Directory of Open Access Journals (Sweden)

Jones-Harris Amanda R

2010-10-01

Full Text Available Abstract Background One of the debates regarding the role of chiropractors is whether or not they should be considered as primary healthcare practitioners. Primary care is often used to describe chiropractic but without any definition of what is meant by the term. Primary healthcare itself has many definitions and this adds to the problem. Existing research literature, based mostly in the USA, suggests that the use of the title "primary healthcare professional" by chiropractors is central to the identity of the profession. It has also been suggested that the concept of primary care is misused by chiropractors because they have not examined the concept in detail and thus do not understand it. For the sake of quality of patient care and for the legitimacy of the profession, chiropractors in the UK need to agree on their healthcare role. This study aimed to examine the opinions of chiropractors towards the use of the term primary healthcare when applied to chiropractic practice within the UK. Methods A sequential study of exploratory design was used; this model is characterised by an initial phase of qualitative data collection and analysis that precedes and informs the quantitative phase of data collection and analysis. In this study, interviews with members of chiropractic teaching faculty were used to inform the development of a questionnaire used to survey the opinions of chiropractors in the UK. Results There was a general consensus of opinion that chiropractors are primary contact practitioners, who work in a primary healthcare setting and that to be able to fulfil this healthcare role, chiropractors must be able to diagnose patients and refer when required. Participants did not feel that chiropractors are able to treat all of the most common medical conditions that present in a primary healthcare setting. Conclusions The findings of this study suggest that chiropractors in the UK view their role as one of a primary contact healthcare

ROMANIAN PUPILS AT THE SPANISH PRIMARY SCHOOLS: CONTINUITIES AND DISCONTINUITIES BETWEEN FORMER AND CURRENT EDUCATIONAL EXPERIENCES

Directory of Open Access Journals (Sweden)

Georgeta Ion

2011-07-01

Full Text Available During the last few years, East-Europeans, predominantly Romanians, have become the second largest cultural minority in Catalonia (Spain. Spanish educational institutions now have students from more than twenty different cultures. This paper focuses on the educational background and the factors which characterize the educational experience of Romanian students prior to attending schools in Spain, and how this affects their experiences into Catalonian primary schools. Twenty seven interviews were undertaken, of Catalonian and Romanian teachers, of experts and parents from the host primary schools where the proportion of Romanian students was highest. Two focus-group sessions were carried out with school teachers from Romania. The analysis shows that there is some consistency between educational practices and values in Romania and the practices and values of the host schools. The ability of children to assimilate into the host school is directly influenced by their previous experience in the schools in their country of origin.

A new look at soil phenoforms – Definition, identification, mapping

NARCIS (Netherlands)

Rossiter, David; Bouma, J.

2018-01-01

The soil genoform vs. soil phenoform distinction was suggested twenty years ago by Droogers and Bouma to recognize management-induced differences among pedons with the same long-term pedogenesis and included in the same soil map unit, these changes being sufficient to cause

The Effect of Soil Properties on Metal Bioavailability: Field Scale Validation to Support Regulatory Acceptance

Science.gov (United States)

2013-06-01

Chadwich, 2004, Surface charge evolution of mineral-organic complexes during pedogenesis in Hawaiian basalt : Geochimica et Cosmochimica Acta, v. 68, p...Acids, % 0.82 Phenylalanine, % 1.22 Polyunsaturated Fatty Acids, % 1.98 Tyrosine, % 1.03 Threonine, % 0.88 Tryptophan, % 0.32 Fiber (max), % 6.8 Valine

Seismic proving test of BWR primary loop recirculation system

International Nuclear Information System (INIS)

Sato, H.; Shigeta, M.; Karasawa, Y.

1987-01-01

The seismic proving test of BWR Primary Loop Recirculation system is the second test to use the large-scale, high-performance vibration table of Tadotsu Engineering Laboratory. The purpose of this test is to prove the seismic reliability of the primary loop recirculation system (PLR), one of the most important safety components in the BWR nuclear plants, and also to confirm the adequacy of seismic analysis method used in the current seismic design. To achieve the purpose, the test was conducted under conditions and scale as near as possible to actual systems. The strength proving test was carried out with the test model mounted on the vibration table in consideration of basic design earthquake ground motions and other conditions to confirm the soundness of structure and the strength against earthquakes. Detailed analysis and analytic evaluation of the data obtained from the test was conducted to confirm the adequacy of the seismic analysis method and earthquake response analysis method used in the current seismic design. Then, on the basis of the results obtained, the seismic safety and reliability of BWR primary loop recirculation of the actual plants was fully evaluated

Outdoor Primary Education in Bangladesh. Experiments and Innovations in Education No. 40.

Science.gov (United States)

Choudhury, M. Khashruzzaman; Obaidullah, A. K. M.

A brief description of the development, implementation, and evaluation of the Outdoor Primary Education project in Bangladesh is presented in this booklet. A description of the development of the current primary education system in Bangladesh along with a description of the reasons that led to the development of the project are briefly provided in…

Quantitative pulsed eddy current analysis

International Nuclear Information System (INIS)

Morris, R.A.

1975-01-01

The potential of pulsed eddy current testing for furnishing more information than conventional single-frequency eddy current methods has been known for some time. However, a fundamental problem has been analyzing the pulse shape with sufficient precision to produce accurate quantitative results. Accordingly, the primary goal of this investigation was to: demonstrate ways of digitizing the short pulses encountered in PEC testing, and to develop empirical analysis techniques that would predict some of the parameters (e.g., depth) of simple types of defect. This report describes a digitizing technique using a computer and either a conventional nuclear ADC or a fast transient analyzer; the computer software used to collect and analyze pulses; and some of the results obtained. (U.S.)

Teachers' perceptions on primary science teaching

Science.gov (United States)

Kijkuakul, Sirinapa

2018-01-01

This qualitative research aimed to review what primary teachers think about how to teach science in rural school contexts. Three primary schools in Thailand were purposively chosen for this study. Eleven primary science teachers of these schools were the research participants. Questionnaires, interviews, and observations were implemented to reveal the primary school teachers' educational backgrounds, science teaching context, and need for self-driven professional development. Content and discourse analysis indicated that the non-science educational background and the science teaching context implied a need for self-driven professional development. The non-science educational background teachers were generally unfamiliar with the current national science curriculum, and that they would not be comfortable when the researcher observed their science teaching practice. They also believed that experimentation was the only one strategy for teaching science, and that the priority for their teaching support was teaching media rather than their understanding of scientific concepts or teaching strategies. As implication of this research, subsequent developments on science teacher profession in rural context, therefore, need to promote teachers' understandings of nature of science and technological and pedagogical content knowledge. In addition, they should be challenged to practice on critically participatory action research for academic growth and professional learning community.

Soil fertility shapes belowground food webs across a regional climate gradient.

Science.gov (United States)

Laliberté, Etienne; Kardol, Paul; Didham, Raphael K; Teste, François P; Turner, Benjamin L; Wardle, David A

2017-10-01

Changes in soil fertility during pedogenesis affect the quantity and quality of resources entering the belowground subsystem. Climate governs pedogenesis, yet how climate modulates responses of soil food webs to soil ageing remains unexplored because of the paucity of appropriate model systems. We characterised soil food webs along each of four retrogressive soil chronosequences situated across a strong regional climate gradient to show that belowground communities are predominantly shaped by changes in fertility rather than climate. Basal consumers showed hump-shaped responses to soil ageing, which were propagated to higher-order consumers. There was a shift in dominance from bacterial to fungal energy channels with increasing soil age, while the root energy channel was most important in intermediate-aged soils. Our study highlights the overarching importance of soil fertility in regulating soil food webs, and indicates that belowground food webs will respond more strongly to shifts in soil resources than climate change. © 2017 John Wiley & Sons Ltd/CNRS.

Resilience of primary healthcare professionals: a systematic review.

Science.gov (United States)

Robertson, Helen D; Elliott, Alison M; Burton, Christopher; Iversen, Lisa; Murchie, Peter; Porteous, Terry; Matheson, Catriona

2016-06-01

Modern demands and challenges among healthcare professionals can be particularly stressful and resilience is increasingly necessary to maintain an effective, adaptable, and sustainable workforce. However, definitions of, and associations with, resilience have not been examined within the primary care context. To examine definitions and measures of resilience, identify characteristics and components, and synthesise current evidence about resilience in primary healthcare professionals. A systematic review was undertaken to identify studies relating to the primary care setting. Ovid(®), Embase(®), CINAHL, PsycINFO, and Scopus databases were searched in December 2014. Text selections and data extraction were conducted by paired reviewers working independently. Data were extracted on health professional resilience definitions and associated factors. Thirteen studies met the inclusion criteria: eight were quantitative, four qualitative, and one was an intervention study. Resilience, although multifaceted, was commonly defined as involving positive adaptation to adversity. Interactions were identified between personal growth and accomplishment in resilient physicians. Resilience, high persistence, high self-directedness, and low avoidance of challenges were strongly correlated; resilience had significant associations with traits supporting high function levels associated with demanding health professional roles. Current resilience measures do not allow for these different aspects in the primary care context. Health professional resilience is multifaceted, combining discrete personal traits alongside personal, social, and workplace features. A measure for health professional resilience should be developed and validated that may be used in future quantitative research to measure the effect of an intervention to promote it. © British Journal of General Practice 2016.

Resilience of primary healthcare professionals: a systematic review

Science.gov (United States)

Robertson, Helen D; Elliott, Alison M; Burton, Christopher; Iversen, Lisa; Murchie, Peter; Porteous, Terry; Matheson, Catriona

2016-01-01

Background Modern demands and challenges among healthcare professionals can be particularly stressful and resilience is increasingly necessary to maintain an effective, adaptable, and sustainable workforce. However, definitions of, and associations with, resilience have not been examined within the primary care context. Aim To examine definitions and measures of resilience, identify characteristics and components, and synthesise current evidence about resilience in primary healthcare professionals. Design and setting A systematic review was undertaken to identify studies relating to the primary care setting. Method Ovid®, Embase®, CINAHL, PsycINFO, and Scopus databases were searched in December 2014. Text selections and data extraction were conducted by paired reviewers working independently. Data were extracted on health professional resilience definitions and associated factors. Results Thirteen studies met the inclusion criteria: eight were quantitative, four qualitative, and one was an intervention study. Resilience, although multifaceted, was commonly defined as involving positive adaptation to adversity. Interactions were identified between personal growth and accomplishment in resilient physicians. Resilience, high persistence, high self-directedness, and low avoidance of challenges were strongly correlated; resilience had significant associations with traits supporting high function levels associated with demanding health professional roles. Current resilience measures do not allow for these different aspects in the primary care context. Conclusion Health professional resilience is multifaceted, combining discrete personal traits alongside personal, social, and workplace features. A measure for health professional resilience should be developed and validated that may be used in future quantitative research to measure the effect of an intervention to promote it. PMID:27162208

Do Offshore Wind Farms Influence Marine Primary Production?

Science.gov (United States)

Tweddle, J. F.; Murray, R. B. O.; Gubbins, M.; Scott, B. E.

2016-02-01

Primary producers (phytoplankton) form the basis of marine food-webs, supporting production of higher trophic levels, and act as a sink of CO2. We considered the impact of proposed large scale offshore wind farms in moderately deep waters (> 45 m) off the east coast of Scotland on rates of primary production. A 2 stage modelling process was used, employing state-of-the-art 3-D hydrographic models with the ability to capture flow at the spatial resolution of 10 m combined with 1-D vertical modelling using 7 years of local forcing data. Through influencing the strength of stratification via changes in current flow, large (100 m) modelled wind turbine foundations had a significant effect on primary producers, consistently reducing total annual primary production, although within the range of natural interannual variability. The percentage reduction was largest over submarine banks less than 54 m in depth, and was outside the range of natural interannual variability. Smaller (10 m) turbine foundations had no discernible effect on total annual primary production. The results indicate that smaller foundations should be favored as a mitigation measure, in terms of effects on primary production, and this type of analysis should be considered within sectoral planning and licensing processes for future renewable energy developments.

Improving medication safety in primary care. A review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

NARCIS (Netherlands)

Lainer, M.; Vogele, A.; Wensing, M.; Sonnichsen, A.

2015-01-01

BACKGROUND: Drug treatment is an important clinical process in primary care that is associated with risk of error and adverse events. OBJECTIVE: To review currently available research evidence on the topic and to develop a framework, which can help to guide improvement of medication safety. METHODS:

Primary care in a new era: disillusion and dissolution?.

Science.gov (United States)

Sandy, Lewis G; Schroeder, Steven A

2003-02-04

The current dilemmas in primary care stem from 1) the unintended consequences of forces thought to promote primary care and 2) the "disruptive technologies of care" that attack the very function and concept of primary care itself. This paper suggests that these forces, in combination with "tiering" in the health insurance market, could lead to the dissolution of primary care as a single concept, to be replaced by alignment of clinicians by economic niche. Evidence already exists in the marketplace for both tiering of health insurance benefits and corresponding practice changes within primary care. In the future, primary care for the top tier will cater to the affluent as "full-service brokers" and will be delivered by a wide variety of clinicians. The middle tier will continue to grapple with tensions created by patient demand and bureaucratic systems but will remain most closely aligned to primary care as a concept. The lower tier will become increasingly concerned with community health and social justice. Each primary care specialty will adapt in a unique way to a tiered world, with general internal medicine facing the most challenges. Given this forecast for the future, those concerned about primary care should focus less on workforce issues and more on macro health care financing and organization issues (such as Medicare reform); appropriate training models; and the development of a conception of primary care that emphasizes values and ethos, not just function.

Battery effect in 'electric current arising from unpolarized polyvinyl ...

Indian Academy of Sciences (India)

Unknown

metal systems are ... The system would thus approach a primary battery, with the generation of. 'spontaneous' current, albeit low. In such a situation, to invoke work functions of pure, film-free (as ... ctrodes embedded in low resistance electrolytes.

Primary tuberculosis of the glans penis.

Science.gov (United States)

Jimenez Parra, Jose David; Alvarez Bandres, Silvia; Garcia Garcia, Diego; Torres Varas, Lorena; Sotil Arrieta, Amaia; Jimenez Calvo, Jesus

2014-03-01

Tuberculosis of the penis is an extremely rare disease with few cases reported in the literature. We present the case of a 64 year-old man with a whitish papular-ampullary eruption in the glans penis. After antibiotic/antimycotic therapy and several topical ointments for 3 months without response he was referred to our Department. Biopsy of the ulceration edge was performed and pathology result showed a chronic granulomatous inflammatory necrotizing lesion with granulomatous vasculitis lesions, without tumor infiltration. Systemic examination to rule out other tuberculosis foci was negative. With de suspicion of primary tuberculosis of the glans penis, anti tuberculosis therapy with Isoniazid and Piridoxine was started. Within a period of five months the ulceration healed significantly. Currently, the patient is still asymptomatic without glans penis lesions. Primary glans penis tuberculosis is a rare disease, but we must consider it (both primary and secondary forms) to try to avoid diagnostic delays that may cause prejudice for the patient. This condition promptly responds to anti tuberculosis therapy as evidenced by our case and many other reports.

Resource Loss Moderates the Association Between Child Abuse and Current PTSD Symptoms Among Women in Primary-Care Settings.

Science.gov (United States)

Costa, Eleonora C V; Guimarães, Sara; Ferreira, Domingos; Pereira, M Graça

2016-09-01

This study examined if abuse during childhood, rape in adulthood, and loss of resources predict a woman's probability of reporting symptoms of posttraumatic stress disorder (PTSD), and whether resource loss moderates the association between reporting childhood abuse and PTSD symptoms. The sample included 767 women and was collected in publicly funded primary-care settings. Women who reported having been abused during childhood also reported more resource loss, more acute PTSD symptoms, and having suffered more adult rape than those who reported no childhood abuse. Hierarchical logistic regression yielded a two-variable additive model in which child abuse and adult rape predict the probability of reporting or not any PTSD symptoms, explaining 59.7% of the variance. Women abused as children were 1 to 2 times more likely to report PTSD symptoms, with sexual abuse during childhood contributing most strongly to this result. Similarly, women reporting adult rape were almost twice as likely to report symptoms of PTSD as those not reporting it. Resource loss was unexpectedly not among the predictors but a moderation analysis showed that such loss moderated the association between child abuse and current PTSD symptoms, with resource loss increasing the number and severity of PTSD symptoms in women who also reported childhood abuse. The findings highlight the importance of early assessment and intervention in providing mental health care to abused, neglected, and impoverished women to help them prevent and reverse resource loss and revictimization.

Designing display primaries with currently available light sources for UHDTV wide-gamut system colorimetry.

Science.gov (United States)

Masaoka, Kenichiro; Nishida, Yukihiro; Sugawara, Masayuki

2014-08-11

The wide-gamut system colorimetry has been standardized for ultra-high definition television (UHDTV). The chromaticities of the primaries are designed to lie on the spectral locus to cover major standard system colorimetries and real object colors. Although monochromatic light sources are required for a display to perfectly fulfill the system colorimetry, highly saturated emission colors using recent quantum dot technology may effectively achieve the wide gamut. This paper presents simulation results on the chromaticities of highly saturated non-monochromatic light sources and gamut coverage of real object colors to be considered in designing wide-gamut displays with color filters for the UHDTV.

Primary health care facility infrastructure and services and the ...

African Journals Online (AJOL)

... Research Council ae Currently from Cape Peninsula University of Technology ... Keywords: primary health care facilities; nutritional status; children; caregivers' rural; South Africa ... underlying causes of malnutrition in children, while poor food quality, .... Information on PHC facility infrastructure and services was obtained.

Psycho-social correlates of stressful experiences among primary ...

African Journals Online (AJOL)

The study was guided by Social Cognitive Theory, employed to examine the psycho-social environments of serving primary school teachers in Olugbo-Less City, Odeda Local Government Area of Ogun State, Nigeria. 100 rural active teachers currently undergoing in-service training in Ogun State Universal Basic Education ...

Microstructural factors influencing critical-current densities of high-temperature superconductors

International Nuclear Information System (INIS)

Suenaga, M.

1992-01-01

Microstructural defects are the primary determining factors for the values of critical current densities in superconductors. A review is made to assess, (1) what would be the maximum achievable critical-current density in the oxide superconductors if nearly ideal pinning sites were introduced? and (2) what types of pinning defects are currently introduced in these superconductors and how effective are these in pinning the vortices? Only the case where the applied field is parallel to the c-axis is considered here

Superconductive AC current limiter

International Nuclear Information System (INIS)

Bekhaled, M.

1987-01-01

This patent describes an AC current limiter for a power transport line including a power supply circuit and feeding a load circuit via an overload circuit-breaker member. The limiter comprises a transformer having a primary winding connected in series between the power supply circuit and the load circuit and at least one secondary winding of superconductor material contained in a cryogenic enclosure and short-circuited on itself. The leakage reactance of the transformer as seen from the primary winding is low, and the resistance of the at least one secondary winding when in the non-superconducting state and as seen from the primary is much greater than the nominal impedance of the transformer. The improvement whereby the at least one secondary winding of the transformer comprises an active winding in association with a set of auxiliary windings. The set of auxiliary windings is constituted by an even number of series-connected auxiliary windings wound in opposite directions, with the total number of turns in one direction being equal to the total number of turns in the opposite direction, and with the thermal capacity of the secondary winding as a whole being sufficiently high to limit the expansion thereof to a value which remains small during the time it takes the circuit-breaking member to operate

Clinical effectiveness of primary and secondary headache treatment by transcranial direct current stimulation

Directory of Open Access Journals (Sweden)

Dmitry ePinchuk

2013-03-01

Full Text Available The clinical effectiveness of headache treatment by transcranial direct current stimulation with various locations of stimulating electrodes on the scalp was analyzed retrospectively. The results of the treatment were analyzed in 90 patients aged from 19 to 54 years (48 patients had migraine without aura, 32 – frequent episodic tension-type headaches, 10 – chronic tension-type headaches and in 44 adolescents aged 11 – 16 years with chronic posttraumatic headaches after a mild head injury. Clinical effectiveness of tDCS with 70 – 150 µA current for 30 – 45 minutes via 6.25 cm2 stimulating electrodes is comparable to that of modern pharmacological drugs, with no negative side effects. The obtained result has been maintained on average from 5 to 9 months. It has been demonstrated that effectiveness depends on localization of stimulating electrodes used for different types of headaches.

Performance analysis of multi-primary color display based on OLEDs/PLEDs

Science.gov (United States)

Xiong, Yan; Deng, Fei; Xu, Shan; Gao, Shufang

2017-09-01

A multi-primary color display, such as the six-primary color format, is a solution in expanding the color gamut of a full-color flat panel display. The performance of a multi-primary color display based on organic/polymer light-emitting diodes was analyzed in this study using the fitting curves of the characteristics of devices (i.e., current density, voltage, luminance). A white emitter was introduced into a six-primary color format to form a seven-primary color format that contributes to energy saving, and the ratio of power efficiency of a seven-primary color display to that of a six-primary color display would increase from 1.027 to 1.061 by using emitting diodes with different electroluminescent efficiencies. Different color matching schemes of the seven-primary color format display were compared in a uniform color space, and the scheme of the color reproduction did not significantly affect the display performance. Although seven- and six-primary color format displays benefit a full-color display with higher quality, they are less efficient than three-primary (i.e., red (R), green (G), and blue (B), RGB) and four-primary (i.e., RGB+white, RGBW) color format displays. For the seven-primary color formats considered in this study, the advantages of white-primary-added display with efficiently developed light-emitting devices were more evident than the format without a white primary.

0.20-m (8-in.) primary burner development report

International Nuclear Information System (INIS)

Stula, R.T.; Young, D.T.; Rode, J.S.

1977-12-01

High-Temperature Gas-Cooled Reactors (HTGRs) utilize graphite-base fuels. Fluidized-bed burners are being employed successfully in the experimental reprocessing of these fuels. The primary fluidized-bed burner is a unit operation in the reprocessing flowsheet in which the graphite moderator is removed. A detailed description of the development status of the 0.20-m (8-in.) diameter primary fluidized-bed burner as of July 1, 1977 is presented. Experimental work to date performed in 0.10; 0.20; and 0.40-m (4, 8, and 16 in.) diameter primary burners has demonstrated the feasibility of the primary burning process and, at the same time, has defined more clearly the areas in which additional experimental work is required. The design and recent operating history of the 0.20-m-diameter burner are discussed, with emphasis placed upon the evolution of the current design and operating philosophy

Development of Program to Enhance Team Building Leadership Skills of Primary School Administrators

Science.gov (United States)

Sairam, Boonchauy; Sirisuthi, Chaiyuth; Wisetrinthong, Kanjana

2017-01-01

Team building leadership skills are important to understandings of how the primary school administrators might work towards creating more effective teamwork in the school. This research aimed 1) to study the components of team building leadership skills needed for primary school administrators, 2) to examine the current states and desirable…

Coupled Environmental Processes and Long-term Performance of Landfill Covers in the northern Mojave Desert

Energy Technology Data Exchange (ETDEWEB)

David Shafer; Michael Young; Stephen Zitzer; Eric McDonald; Todd Caldwell

2004-05-12

Evapotransiration (ET) covers have gained widespread acceptance as a closure feature for waste disposal sites, particularly in the arid and semi-arid regions of the southwestern U.S. But as landforms, ET covers are subject to change over time because of processes such as pedogenesis, hydrologic processes, vegetation establishment and change, and biological processes. To better understand the effects of coupled process changes to ET covers, a series of four primary analog sites in Yucca Flat on the Nevada Test Site, along with measurements and observations from other locations in the Mojave Desert, were selected to evaluate changes in ET covers over time. The analog sites, of varying ages, were selected to address changes in the early post-institutional control period, the 1,000-year compliance period for disposal of low-level and mixed low-level waste, and the 10,000-year compliance period for transuranic waste sites.

Coupled Environmental Processes and Long-term Performance of Landfill Covers in the northern Mojave Desert

International Nuclear Information System (INIS)

David Shafer; Michael Young; Stephen Zitzer; Eric McDonald; Todd Caldwell

2004-01-01

Evapotransiration (ET) covers have gained widespread acceptance as a closure feature for waste disposal sites, particularly in the arid and semi-arid regions of the southwestern U.S. But as landforms, ET covers are subject to change over time because of processes such as pedogenesis, hydrologic processes, vegetation establishment and change, and biological processes. To better understand the effects of coupled process changes to ET covers, a series of four primary analog sites in Yucca Flat on the Nevada Test Site, along with measurements and observations from other locations in the Mojave Desert, were selected to evaluate changes in ET covers over time. The analog sites, of varying ages, were selected to address changes in the early post-institutional control period, the 1,000-year compliance period for disposal of low-level and mixed low-level waste, and the 10,000-year compliance period for transuranic waste sites

An analysis of thermal comfort in primary schools in Vietnam

OpenAIRE

Le, Thi Ho Vi; Gillott, Mark C.; Rodrigues, Lucélia Taranto

2017-01-01

There is a trend of installing air conditioning systems in public primary schools that are currently naturally ventilated in Vietnam. A previous study conducted by the authors provided evidence that there is limited need for air conditioning in Vietnamese mid-season and the hottest season.\\ud \\ud In this study, the authors investigated thermal comfort and users’ perceptions in three primary schools in Ho Chi Minh City during the hottest season (April 2016) and the coldest season (December 201...

Current treatment options with immunoglobulin G for the individualization of care in patients with primary immunodeficiency disease.

Science.gov (United States)

Jolles, S; Orange, J S; Gardulf, A; Stein, M R; Shapiro, R; Borte, M; Berger, M

2015-02-01

Primary antibody deficiencies require lifelong replacement therapy with immunoglobulin (Ig)G to reduce the incidence and severity of infections. Both subcutaneous and intravenous routes of administering IgG can be effective and well tolerated. Treatment regimens can be individualized to provide optimal medical and quality-of-life outcomes in infants, children, adults and elderly people. Frequency, dose, route of administration, home or infusion-centre administration, and the use of self- or health-professional-administered infusion can be tailored to suit individual patient needs and circumstances. Patient education is needed to understand the disease and the importance of continuous therapy. Both the subcutaneous and intravenous routes have advantages and disadvantages, which should be considered in selecting each patient's treatment regimen. The subcutaneous route is attractive to many patients because of a reduced incidence of systemic adverse events, flexibility in scheduling and its comparative ease of administration, at home or in a clinic. Self-infusion regimens, however, require independence and self-reliance, good compliance on the part of the patient/parent and the confidence of the physician and the nurse. Intravenous administration in a clinic setting may be more appropriate in patients with reduced manual dexterity, reluctance to self-administer or a lack of self-reliance, and intravenous administration at home for those with good venous access who prefer less frequent treatments. Both therapy approaches have been demonstrated to provide protection from infections and improve health-related quality of life. Data supporting current options in IgG replacement are presented, and considerations in choosing between the two routes of therapy are discussed. © 2014 British Society for Immunology.

Primary School Principals' Job Satisfaction and Occupational Stress

Science.gov (United States)

Darmody, Merike; Smyth, Emer

2016-01-01

Purpose: The purpose of this paper is to explore the factors associated with occupational stress and job satisfaction among Irish primary school principals. A principal's job has become increasingly demanding and complex in recent decades. However, there is little current research into their levels of stress and job satisfaction, particularly…

Preclinical Validation of Salivary Biomarkers for Primary Sjogren's Syndrome

NARCIS (Netherlands)

Hu, Shen; Gao, Kai; Pollard, Rodney; Arellano-Garcia, Martha; Zhou, Hui; Zhang, Lei; Elashoff, David; Kallenberg, Cees G. M.; Vissink, Arjan; Wong, David T.

2010-01-01

Objective. Sjogren's syndrome (SS) is a systemic autoimmune disease with a variety of presenting symptoms that may delay its diagnosis. We previously discovered a number of candidate salivary biomarkers for primary SS using both mass spectrometry and expression microarray analysis. In the current

Detection of the pedogenic magnetic fraction in volcanic soils developed on basalts using frequency-dependent magnetic susceptibility: comparison of two instruments

Science.gov (United States)

Grison, Hana; Petrovsky, Eduard; Kapicka, Ales; Hanzlikova, Hana

2017-05-01

In studies of the magnetic properties of soils, the frequency-dependent magnetic susceptibility percentage (χFD%) is often used for the identification of ultrafine magnetically superparamagnetic/stable single-domain (SP/SSD) particles. This parameter is commonly used as an indicator for increased pedogenesis. In strongly magnetic soils, the SP/SSD magnetic signal (mostly bio-pedogenic) may be masked by lithological signals; making pedogenesis hard to detect. In this study, we compare results for the detection of ultrafine SP/SSD magnetic particles in andic soils using two instruments: a Bartington MS2B dual-frequency meter and an AGICO Kappabridge MFK1-FA. In particular, the study focuses on the effect of pedogenesis by investigating the relationship between specific soil magnetic and chemical properties (soil organic carbon and pHH2O). The values of χFD% obtained with the MS2B varied from 2.4 to 5.9 per cent, and mass-specific magnetic susceptibility (χLF) from 283 to 1688 × 10-8 m3 kg-1, while values of χFD% and χLF obtained with the MFK1-FA varied from 2.7 to 8.2 per cent and from 299 to 1859 × 10-8 m3 kg-1, respectively. Our results suggest that the detection of the SP/SSD magnetic fraction can be accomplished by comparing relative trends of χFD% along the soil profile. Moreover, the discrimination between bio-pedogenic and lithogenic magnetic contributions in the SP/SSD fraction is possible by comparing the χFD% and χLF data determined in the fine earth (<2 mm) and the coarse fraction (4-10 mm) samples down the soil profile.

Current status of theranostics in prostate cancer

Energy Technology Data Exchange (ETDEWEB)

Virgolini, Irene; Decristoforo, Clemens; Uprimny, Christian [Medical University of Innsbruck, Department of Nuclear Medicine, Innsbruck (Austria); Haug, Alexander [Medical University of Vienna, Department of Radiology and Nuclear Medicine, Vienna (Austria); Fanti, Stefano [University of Bologna, S. Orsola Hospital Bologna, Nuclear Medicine Unit, Bologna (Italy)

2018-03-15

The aim of this review is to report on the current status of prostate-specific membrane antigen (PSMA)-directed theranostics in prostate cancer (PC) patients. The value of {sup 68}Ga-PSMA-directed PET imaging as a diagnostic procedure for primary and recurrent PC as well as the role of evolving PSMA radioligand therapy (PRLT) in castration-resistant (CR)PC is assessed. The most eminent data from mostly retrospective studies currently available on theranostics of prostate cancer are discussed. The current knowledge on {sup 68}Ga-PSMA PET/CT implicates that primary staging with PET/CT is meaningful in patients with high-risk PC and that the combination with pelvic multi parametric (mp)MR (or PET/mpMR) reaches the highest impact on patient management. There may be a place for {sup 68}Ga-PSMA PET/CT in intermediate-risk PC patients as well, however, only a few data are available at the moment. In secondary staging for local recurrence, {sup 68}Ga-PSMA PET/mpMR is superior to PET/CT, whereas for distant recurrence, PET/CT has equivalent results and is faster and cheaper compared to PET/mpMR. {sup 68}Ga-PSMA PET/CT is superior to {sup 18}F / {sup 11}Choline PET/CT in primary staging as well as in secondary staging. In patients with biochemical relapse, PET/CT positivity is directly associated with prostate-specific antigen (PSA) increase and amounts to roughly 50% when PSA is raised to ≤0.5 ng/ml and to ≥90% above 1 ng/ml. Significant clinical results have so far been achieved with the subsequent use of radiolabeled PSMA ligands in the treatment of CRPC. Accumulated activities of 30 to 50 GBq of {sup 177}Lu-PSMA ligands seem to be clinically safe with biochemical response and PERCIST/RECIST response in around 75% of patients along with xerostomia in 5-10% of patients as the only notable side effect. On the basis of the current literature, we conclude that PSMA-directed theranostics do have a major clinical impact in diagnosis and therapy of PC patients. We recommend

Effects of Ketamine on Neuronal Spontaneous Excitatory Postsynaptic Currents and Miniature Excitatory Postsynaptic Currents in the Somatosensory Cortex of Rats

Directory of Open Access Journals (Sweden)

Chengdong Yuan

2016-07-01

Full Text Available Background: Ketamine is a commonly used intravenous anesthetic which produces dissociation anesthesia, analgesia, and amnesia. The mechanism of ketamine-induced synaptic inhibition in high-level cortical areas is still unknown. We aimed to elucidate the effects of different concentrations of ketamine on the glutamatergic synaptic transmission of the neurons in the primary somatosensory cortex by using the whole-cell patch-clamp method. Methods: Sprague-Dawley rats (11–19 postnatal days, n=36 were used to obtain brain slices (300 μM. Spontaneous excitatory postsynaptic currents (data from 40 neurons were recorded at a command potential of -70 mV in the presence of bicuculline (a competitive antagonist of GABAA receptors, 30 μM and strychnine (glycine receptor antagonist, 30 μM. Miniature excitatory postsynaptic currents (data from 40 neurons were also recorded when 1 μM of tetrodotoxin was added into the artificial cerebrospinal fluid. We used GraphPad Prism5for statistical analysis. Significant differences in the mean amplitude and frequency were tested using the Student paired 2-tailed t test. Values of P<0.05 were considered significant. Results: Different concentrations of ketamine inhibited the frequency and amplitude of the spontaneous excitatory postsynaptic currents as well as the amplitude of the miniature excitatory postsynaptic currents in a concentration-dependent manner, but they exerted no significant effect on the frequency of the miniature excitatory postsynaptic currents. Conclusion: Ketamine inhibited the excitatory synaptic transmission of the neurons in the primary somatosensory cortex. The inhibition may have been mediated by a reduction in the sensitivity of the postsynaptic glutamatergic receptors.

Energy sector in Ecuador: Current status

International Nuclear Information System (INIS)

Pelaez-Samaniego, M.R.; Garcia-Perez, M.; Cortez, L.A.B.; Oscullo, J.; Olmedo, G.

2007-01-01

This paper describes the current energy sector in Ecuador, its present structure, the oil industry, subsidies, and renewable energy, focusing on the evolution and reform of the electricity sector. Currently, 86% of the primary energy originates from nonrenewable sources. In 2005, the gross electricity generation was 15 127 GWh (45.5% hydropower, 43.11% thermal, and 11.39% imported). Ecuador is the fifth largest oil producer in South America but lacks sufficient oil refining capacity. Reserves of natural gas (NG) are small, and most of NG is produced from oil fields without energy recovery. Several projects are underway to increase the utilization of NG and renewable energies to meet Ecuador commitments to the Kyoto Protocol

Production regimes in four eastern boundary current systems

Science.gov (United States)

Carr, M. E.; Kearns, E. J.

2003-01-01

High productivity (maxima 3 g C m(sup -2)day(sup -1)) of the Eastern Boundary Currents (EBCs), i.e. the California, Peru-Humboldt, Canary and Benguela Currents, is driven by a combination of local forcing and large-scale circulation. The characteristics of the deep water brought to the surface by upwelling favorable winds depend on the large-scale circulation patterns. Here we use a new hydrographic and nutrient climatology together with satellite measurements ofthe wind vector, sea-surface temperature (SST), chlorophyll concentration, and primary production modeled from ocean color to quantify the meridional and seasonal patterns of upwelling dynamics and biological response. The unprecedented combination of data sets allows us to describe objectively the variability for small regions within each current and to characterize the governing factors for biological production. The temporal and spatial environmental variability was due in most regions to large-scale circulation, alone or in combination with offshore transport (local forcing). The observed meridional and seasonal patterns of biomass and primary production were most highlycorrelated to components representing large-scale circulation. The biomass sustained by a given nutrient concentration in the Atlantic EBCs was twice as large as that of the Pacific EBCs. This apparent greater efficiency may be due toavailability of iron, physical retention, or differences in planktonic community structure.

[Study of spectrum drifting of primary colors and its impact on color rendering properties].

Science.gov (United States)

Cui, Xiao-yan; Zhang, Xiao-dong

2012-08-01

LEDs are currently used widely to display text, graphics and images in large screens. With red, green and blue LEDs as three primary colors, color rendition will be realized through color mixing. However, LEDs' spectrum will produce drifts with the changes in the temperature environment. With the changes in the driving current simulating changes in the temperature, the three primary color LEDs' spectral drifts were tested, and the drift characteristics of the three primary colors were obtained respectively. Based on the typical characteristics of the LEDs and the differences between LEDs with different colors in composition and molecular structure, the paper analyzed the reason for the spectrum drifts and the drift characteristics of different color LEDs, and proposed the equations of spectrum drifts. Putting the experimental data into the spectrum drift equations, the paper analyzed the impacts of primary colors on the mixed color, pointed out a way to reduce the chromatic aberration, and provided the theory for engineering application of color LEDs.

International survey of primary and revision total knee replacement

NARCIS (Netherlands)

Kurtz, Steven M.; Ong, Kevin L.; Lau, Edmund; Widmer, Marcel; Maravic, Milka; Gomez-Barrena, Enrique; de Pina, Maria de Fatima; Manno, Valerio; Torre, Marina; Walter, William L.; de Steiger, Richard; Geesink, Rudolph G. T.; Peltola, Mikko; Roeder, Christoph

2011-01-01

Total knee arthroplasty (TKA) is currently the international standard of care for treating degenerative and rheumatologic knee joint disease, as well as certain knee joint fractures. We sought to answer the following three research questions: (1) What is the international variance in primary and

Non-traditional Manifestations of Primary Hyperparathyroidism

Science.gov (United States)

Walker, Marcella Donovan; Rubin, Mishaela; Silverberg, Shonni J.

2012-01-01

Classical primary hyperparathyroidism was previously a multi-systemic, symptomatic disorder not only with overt skeletal and renal complications, but also with neuropsychological, cardiovascular, gastrointestinal and rheumatic effects. The presentation of primary hyperparathyroidism has evolved and today most patients are “asymptomatic”. Osteitis fibrosa cystica is rarely seen today and nephrolithiasis is less common. Gastrointestinal and rheumatic symptoms are not part of the clinical spectrum of modern PHPT. It remains unclear whether neuropsychological symptoms and cardiovascular disease, neither of which are currently indications for recommending parathyroidectomy, are part of the modern phenotype of primary hyperparathyroidism. A number of observational studies suggest that mild PHPT is associated with depression, decreased quality of life, and changes in cognition but limited data from randomized, controlled trials have not indicated consistent benefits after surgery. The increased cardiovascular morbidity and mortality in severe PHPT has not been definitively demonstrated in mild disease, though there is some evidence for more subtle cardiovascular abnormalities, such as increased vascular stiffness, among others. Results from observational studies that have assessed the effect of parathyroidectomy upon cardiovascular health have been conflicting. The single randomized controlled trial in this area did not demonstrate that parathyroidectomy was beneficial. Despite recent progress in these areas, more data from rigorously designed studies are needed in order to better inform the clinical management of patients with asymptomatic primary hyperparathyroidism. PMID:23374740

Organisation and quality of primary surgical intervention for ovarian cancer in Denmark

DEFF Research Database (Denmark)

Marx, Charlotte; Bendixen, Anette; Høgdall, Claus

2007-01-01

The positive effect on survival of maximal primary cytoreductive surgery for ovarian cancer is well established, and the highest rates of optimal cytoreduction are achieved by gynecological oncologists. Danish women have not only one of the highest incidences of ovarian cancer, but also the highest...... mortality rate. From 1981 to 1989, the overall Danish optimal debulking rate was 25% in patients with stage III and IV tumors. The primary aim of the present study was, therefore, to evaluate the organisation and quality of current primary surgical intervention for ovarian cancer in Denmark....

Implementation strategies for collaborative primary care-mental health models.

Science.gov (United States)

Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold

2013-09-01

Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.

Analyzing water soluble soil organics as Trifluoroacetyl derivatives by liquid state proton nuclear magnetic resonance

Science.gov (United States)

Felipe Garza Sanchez; Zakiya Holmes Leggett; Sabapathy Sankar

2005-01-01

In forested ecosystems, water soluble organics play an important role in soil processes including carbon and nutrient turnover, microbial activity and pedogenesis. The quantity and quality (i.e., chemistry) of these materials is sensitive to land management practices. Monitoring alterations in the chemistry of water soluble organics resulting from land management...

Quality assurance for primary batteries. Qualitaetssicherung fuer Primaerbatterien

Energy Technology Data Exchange (ETDEWEB)

Ruedinger, G [Varta AG, Ellwangen (Germany, F.R.)

1989-11-01

Apart from a few applications in tube sets, the use of primary batteries was limited until well into the fifties to the current supply of lighting units, predominantly of flashlights. Only with the invention of the transistor and of integrated circuits, the primary battery took an important place among electric components. As a consequence, this component had to meet much different requirements. In order to ensure the quality of an article produced in enormous quantities - several hundred million units per year with a great variety of types, with nine different systems and of approx. 100 different types - it became indispensable to set up a well equipped quality assurance system. (orig.).

Primary repair of colon injuries: clinical study of nonselective approach.

Science.gov (United States)

Lazovic, Ranko G; Barisic, Goran I; Krivokapic, Zoran V

2010-12-02

This study was designed to determine the role of primary repair and to investigate the possibility of expanding indications for primary repair of colon injuries using nonselective approach. Two groups of patients were analyzed. Retrospective (RS) group included 30 patients managed by primary repair or two stage surgical procedure according to criteria published by Stone (S/F) and Flint (Fl). In this group 18 patients were managed by primary repair. Prospective (PR) group included 33 patients with primary repair as a first choice procedure. In this group, primary repair was performed in 30 cases. Groups were comparable regarding age, sex, and indexes of trauma severity. Time between injury and surgery was shorter in PR group, (1.3 vs. 3.1 hours). Stab wounds were more frequent in PR group (9:2), and iatrogenic lesions in RS group (6:2). Associated injuries were similar, as well as segmental distribution of colon injuries. S/F criteria and Flint grading were similar.In RS group 15 primary repairs were successful, while in two cases relaparotomy and colostomy was performed due to anastomotic leakage. One patient died. In PR group, 25 primary repairs were successful, with 2 immediate and 3 postoperative (7-10 days) deaths, with no evidence of anastomotic leakage. Results of this study justify more liberal use of primary repair in early management of colon injuries. Current Controlled Trials ISRCTN94682396.

Primary Parallel Isolated Boost Converter with Bidirectional Operation

DEFF Research Database (Denmark)

Hernandez Botella, Juan Carlos; Mira Albert, Maria del Carmen; Sen, Gökhan

2012-01-01

This paper presents a bidirectional dc/dc converter operated with batteries both in the input and output. Primary parallel isolated boost converter (PPIBC) with transformer series connection on the high voltage side is preferred due to its ability to handle high currents in the low voltage side. ...... and output battery banks with a defined ramp....

Current status of Enterobius vermicularis infection in primary schoolchildren in Miaoli County and Taichung County, Taiwan.

Science.gov (United States)

Wang, Cheng-Chieh; Lee, Yuan-Fang; Chang, Chih-Cheng; Lee, Nie-Sue; Chen, Po-Yen; Huang, Fang-Liang; Liou, Nuo-Wei

2009-10-01

No epidemiological survey of the prevalence of Enterobius vermicularis infection in Miaoli County and Taichung County has been conducted. This epidemiological survey was performed to describe the profile of E. vermicularis infection in schoolchildren in Miaoli County and Taichung County. The first part of this study was conducted between November 2005 and February 2006 in Miaoli County. 44,071 primary schoolchildren from 18 districts were examined by 2 consecutive-day adhesive cellophane perianal swabs to estimate the infection rate. The second part was performed between October 2006 and January 2007 in Taichung County. 24,382 primary schoolchildren from 14 districts were examined. In Miaoli County, the infection rate was 2.39% (1054/44,071). The infection rate was highest in the Taian (6.69%; 20/299), Shytarn (4.49%; 11/245), and Dahu townships (3.6%; 40/1111). In Taichung County, the infection rate was 2.95% (720/24,382). The infection rate was highest in the Da-an (5.46%; 26/476) and Heping townships (4.48%; 9/201). The infection rate for a family with > or =3 children was significantly higher than that for a family with pinworm infection among the groups surveyed.

Primary care management of food allergy and food intolerance.

Science.gov (United States)

Garzon, Dawn Lee; Kempker, Tara; Piel, Pamela

2011-12-16

The incidence of food allergies is steadily increasing. Due to potentially life-threatening complications, it is important that primary care providers recognize and appropriately manage these disorders. This article includes a discussion of the current evidence-based guidelines for the diagnosis, screening, and management of food allergies.

Comparison of Attitude of Primary Health Care Physicians and ...

African Journals Online (AJOL)

Background: Domestic violence (DV) against women has increased during the past few years and became an important public health problem. Personal values and beliefs of primary health care workers can affect both diagnostic and management procedures adopted to deal with battered women. Objectives: The current ...

Towards a data publishing framework for primary biodiversity data

DEFF Research Database (Denmark)

Ingwersen, Peter; Chavan, Vishwas S

2009-01-01

  Background Currently primary scientific data, especially that dealing with biodiversity, is neither easily discoverable nor accessible. Amongst several impediments, one is a lack of professional recognition of scientific data publishing efforts. A possible solution is establishment of a ‘Data...... Publishing Framework' which would encourage and recognise investments and efforts by institutions and individuals towards management, and publishing of primary scientific data potentially on a par with recognitions received for scholarly publications.   Discussion This paper reviews the state......-of-the-art of primary biodiversity data publishing, and conceptualises a ‘Data Publishing Framework' that would help incentivise efforts and investments by institutions and individuals in facilitating free and open access to biodiversity data. It further postulates the institutionalisation of  a ‘Data Usage Index (DUI...

Current /sup 14/C methods for measuring primary production: gross underestimates in oceanic waters

Energy Technology Data Exchange (ETDEWEB)

Gieskes, W W.C.; Kraay, G W; Baars, M A [Netherlands Institute for Sea Research, Texel, Netherlands

1979-10-01

The amount of organic matter produced through autotrophic processes in the euphotic zone of the tropical open ocean and available for respiration of autotrophs and heterotrophs was at least 5 to 15 times higher than values derived from the common /sup 14/C method suggested. The new estimates are based on measurements of /sup 14/C incorporation in organic matter of ocean samples incubated in bottles of up to 4 litres. Oceanic phytoplankton appeared to have a high growth rate, with generation times of hours, not days. High heterotrophic activity, finding its expression in high dark fixation rates of /sup 14/C, took place in conjunction with this high primary production of organic matter.

Medication safety programs in primary care: a scoping review.

Science.gov (United States)

Khalil, Hanan; Shahid, Monica; Roughead, Libby

2017-10-01

Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome

Mineralogy and pedogenesis in a soil chronosequence on a ...

African Journals Online (AJOL)

Studies on soils of the floodplain of lower Niger river are scanty although this floodplain forms a very important agricultural resource base in Nigeria. The objective of this study is to provide comprehensive information on the characteristics of the soils with respect to their mineralogy and the effect of seasonal flooding on their ...

Reconstructing Quaternary pedogenesis in a paleosol sequence in Hungary

Energy Technology Data Exchange (ETDEWEB)

Uveges, J.B.; Horvath, Z.; Micheli, E.; Mindszenty, A.; Nemeth, T. [Szent Istvan University, Godollo (Hungary). Dept. of Agricultural Chemistry & Soil Science

2003-07-01

In addition to conducting field observations, mineralogical, chemical, and micromorphological analyses, and scanning electron microscope studies were carried out to reconstruct soil forming processes in a paleosol profile sequence located in an open-cast lignite mine in North Central Hungary (Visonta, pediment of the Matra Mountains). Based on these investigations, several different, sometimes contradictory processes were identified: bioturbation on various scales, shrinking-swelling, leaching, CaCO{sub 3} and Fe-oxide precipitation, erosion, sedimentation, weathering, clay mineral transformation, clay illuviation, organic matter accumulations, reduction and oxidation, and frost action. Joint occurrence of these phenomena indicates environmental changes during the formation of the studied sequence. Many of these processes overlap and might have occurred several times. The presence of erosional surfaces makes it more difficult to establish the exact age of this complex formation. All observations suggest that sedimentation and soil formation on the Matra pediment were not continuous during the Quaternary Period

A single-question screening test for drug use in primary care.

Science.gov (United States)

Smith, Peter C; Schmidt, Susan M; Allensworth-Davies, Donald; Saitz, Richard

2010-07-12

Drug use (illicit drug use and nonmedical use of prescription drugs) is common but underrecognized in primary care settings. We validated a single-question screening test for drug use and drug use disorders in primary care. Adult patients recruited from primary care waiting rooms were asked the single screening question, "How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?" A response of at least 1 time was considered positive for drug use. They were also asked the 10-item Drug Abuse Screening Test (DAST-10). The reference standard was the presence or absence of current (past year) drug use or a drug use disorder (abuse or dependence) as determined by a standardized diagnostic interview. Drug use was also determined by oral fluid testing for common drugs of abuse. Of 394 eligible primary care patients, 286 (73%) completed the interview. The single screening question was 100% sensitive (95% confidence interval [CI], 90.6%-100%) and 73.5% specific (95% CI, 67.7%-78.6%) for the detection of a drug use disorder. It was less sensitive for the detection of self-reported current drug use (92.9%; 95% CI, 86.1%-96.5%) and drug use detected by oral fluid testing or self-report (81.8%; 95% CI, 72.5%-88.5%). Test characteristics were similar to those of the DAST-10 and were affected very little by participant demographic characteristics. The single screening question accurately identified drug use in this sample of primary care patients, supporting the usefulness of this brief screen in primary care.

Primary Radiation Damage in Materials. Review of Current Understanding and Proposed New Standard Displacement Damage Model to Incorporate in Cascade Defect Production Efficiency and Mixing Effects

International Nuclear Information System (INIS)

Nordlund, Kai; Sand, Andrea E.; Granberg, Fredric; Zinkle, Steven J.; Stoller, Roger; Averback, Robert S.; Suzudo, Tomoaki; Malerba, Lorenzo; Banhart, Florian; Weber, William J.; Willaime, Francois; Dudarev, Sergei; Simeone, David

2015-01-01

Under the auspices of the NEA Nuclear Science Committee (NSC), the Working Party on Multi-scale Modelling of Fuels and Structural Materials for Nuclear Systems (WPMM) was established in 2008 to assess the scientific and engineering aspects of fuels and structural materials, aiming at evaluating multi-scale models and simulations as validated predictive tools for the design of nuclear systems, fuel fabrication and performance. The WPMM's objective is to promote the exchange of information on models and simulations of nuclear materials, theoretical and computational methods, experimental validation, and related topics. It also provides member countries with up-to-date information, shared data, models and expertise. The WPMM Expert Group on Primary Radiation Damage (PRD) was established in 2009 to determine the limitations of the NRT-dpa standard, in the light of both atomistic simulations and known experimental discrepancies, to revisit the NRT-dpa standard and to examine the possibility of proposing a new improved standard of primary damage characteristics. This report reviews the current understanding of primary radiation damage from neutrons, ions and electrons (excluding photons, atomic clusters and more exotic particles), with emphasis on the range of validity of the 'displacement per atom' (dpa) concept in all major classes of materials with the exception of organics. The report also introduces an 'athermal recombination-corrected dpa' (arc-dpa) relation that uses a relatively simple functional to address the well-known issue that 'displacement per atom' (dpa) overestimates damage production in metals under energetic displacement cascade conditions, as well as a 'replacements-per-atom' (rpa) equation, also using a relatively simple functional, that accounts for the fact that dpa is understood to severely underestimate actual atom relocation (ion beam mixing) in metals. (authors)

Investigating and stimulating primary teachers’ attitudes towards science: Summary of a large-scale research project

NARCIS (Netherlands)

Walma van der Molen, Julie Henriëtte; van Aalderen-Smeets, Sandra

2013-01-01

Attention to the attitudes of primary teachers towards science is of fundamental importance to research on primary science education. The current article describes a large-scale research project that aims to overcome three main shortcomings in attitude research, i.e. lack of a strong theoretical

Are the current recommendations for the use of aspirin in primary prevention of cardiovascular disease applicable in low-income countries?

Directory of Open Access Journals (Sweden)

Noubiap JJ

2015-08-01

Full Text Available Jean Jacques N Noubiap,1,2 Jobert Richie N Nansseu3,41Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; 2Medical Diagnostic Center, Yaoundé, Cameroon; 3Sickle Cell Disease Unit, Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon; 4Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CameroonAbstract: Although evidence has accumulated that long-term aspirin therapy is beneficial in secondary prevention of cardiovascular disease (CVD, a lot of controversies persist regarding the benefit of aspirin use in primary prevention of CVD. In low-income countries (LIC specifically, the decision to prescribe aspirin for primary CVD prevention is more problematic, as there is a dearth of evidence in this regard. Aspirin has been shown to have relative beneficial effects in preventing a first myocardial infarction, but not stroke. However, as stroke is the prevailing CVD in many LIC, especially in Africa, the benefit of aspirin in these settings is therefore questionable. Indeed, there is no published trial that has evaluated the benefits and risks of continuous aspirin therapy in populations of LIC. Furthermore, though cardiovascular risk assessment is crucial in decision-making for the use of aspirin in primary prevention of CVD, there are no risk assessment tools that have been validated in African populations. Studies are urgently warranted, to determine the usefulness of aspirin in primary prevention of CVD in low-income settings where the drug is highly available and affordable, as CVD is becoming the leading cause of deaths in LIC.Keywords: aspirin, cardiovascular disease, primary prevention, low-income countries

An apology for primary repair of tetralogy of Fallot.

Science.gov (United States)

Van Arsdell, Glen; Yun, Tae-Jin

2005-01-01

The first repair of tetralogy of Fallot (TOF) was 50 years ago, so it would seem that the details for optimal management strategies would be clear. Timing of repair and operative repair strategy for TOF are still a source of debate. Varying institutions have published excellent outcomes with a primary repair strategy or a selective staged repair strategy. In this article, the current and historic strategy for repair of TOF at the Hospital for Sick Children in Toronto is delineated along with associated outcomes. Data from our institution indicate a clear survival advantage for primary repair of TOF.

Magnesium-aerial primary current source

Directory of Open Access Journals (Sweden)

Barba I. N.

2007-12-01

Full Text Available Novel metal-air chemical power sources (CPS 3,0-ВМБ-7,5 have been developed. They have an unlimited shelf life and, even after decades of storage, give almost 100% of the designed capacity. These sources are water-activated. An aqueous salt solution is used as an electrolyte. Such sources are designed for single continuous or discontinuous discharge. The paper presents electrochemical reactions at the electrodes during CPS discharge. Comparison of electrical characteristics of the developed power source and various types of "dry cells" has shown that the developed sources have higher energy characteristics.

3-D time-domain induced polarization tomography: a new approach based on a source current density formulation

Science.gov (United States)

Soueid Ahmed, A.; Revil, A.

2018-04-01

Induced polarization (IP) of porous rocks can be associated with a secondary source current density, which is proportional to both the intrinsic chargeability and the primary (applied) current density. This gives the possibility of reformulating the time domain induced polarization (TDIP) problem as a time-dependent self-potential-type problem. This new approach implies a change of strategy regarding data acquisition and inversion, allowing major time savings for both. For inverting TDIP data, we first retrieve the electrical resistivity distribution. Then, we use this electrical resistivity distribution to reconstruct the primary current density during the injection/retrieval of the (primary) current between the current electrodes A and B. The time-lapse secondary source current density distribution is determined given the primary source current density and a distribution of chargeability (forward modelling step). The inverse problem is linear between the secondary voltages (measured at all the electrodes) and the computed secondary source current density. A kernel matrix relating the secondary observed voltages data to the source current density model is computed once (using the electrical conductivity distribution), and then used throughout the inversion process. This recovered source current density model is in turn used to estimate the time-dependent chargeability (normalized voltages) in each cell of the domain of interest. Assuming a Cole-Cole model for simplicity, we can reconstruct the 3-D distributions of the relaxation time τ and the Cole-Cole exponent c by fitting the intrinsic chargeability decay curve to a Cole-Cole relaxation model for each cell. Two simple cases are studied in details to explain this new approach. In the first case, we estimate the Cole-Cole parameters as well as the source current density field from a synthetic TDIP data set. Our approach is successfully able to reveal the presence of the anomaly and to invert its Cole

Diverticular Disease in the Primary Care Setting.

Science.gov (United States)

Wensaas, Knut-Arne; Hungin, Amrit Pali

2016-10-01

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

Repetitive Transcranial Direct Current Stimulation Induced Excitability Changes of Primary Visual Cortex and Visual Learning Effects-A Pilot Study.

Science.gov (United States)

Sczesny-Kaiser, Matthias; Beckhaus, Katharina; Dinse, Hubert R; Schwenkreis, Peter; Tegenthoff, Martin; Höffken, Oliver

2016-01-01

Studies on noninvasive motor cortex stimulation and motor learning demonstrated cortical excitability as a marker for a learning effect. Transcranial direct current stimulation (tDCS) is a non-invasive tool to modulate cortical excitability. It is as yet unknown how tDCS-induced excitability changes and perceptual learning in visual cortex correlate. Our study aimed to examine the influence of tDCS on visual perceptual learning in healthy humans. Additionally, we measured excitability in primary visual cortex (V1). We hypothesized that anodal tDCS would improve and cathodal tDCS would have minor or no effects on visual learning. Anodal, cathodal or sham tDCS were applied over V1 in a randomized, double-blinded design over four consecutive days (n = 30). During 20 min of tDCS, subjects had to learn a visual orientation-discrimination task (ODT). Excitability parameters were measured by analyzing paired-stimulation behavior of visual-evoked potentials (ps-VEP) and by measuring phosphene thresholds (PTs) before and after the stimulation period of 4 days. Compared with sham-tDCS, anodal tDCS led to an improvement of visual discrimination learning (p learning effect. For cathodal tDCS, no significant effects on learning or on excitability could be seen. Our results showed that anodal tDCS over V1 resulted in improved visual perceptual learning and increased cortical excitability. tDCS is a promising tool to alter V1 excitability and, hence, perceptual visual learning.

Non-Music Specialist Trainee Primary School Teachers' Confidence in Teaching Music in the Classroom

Science.gov (United States)

Seddon, Frederick; Biasutti, Michele

2008-01-01

Prior research has revealed that non-music specialist trainee primary school teachers lack confidence in teaching music in spite of changes to teacher training and the introduction of music in the National Curriculum in England. The current study investigated the effects on non-music specialist trainee primary teachers' confidence to teach music…

[Current evidence on the motivational interview in the approach to health care problems in primary care].

Science.gov (United States)

Bóveda Fontán, Julia; Pérula de Torres, Luis Ángel; Campiñez Navarro, Manuel; Bosch Fontcuberta, Josep M; Barragán Brun, Nieves; Prados Castillejo, Jose Antonio

2013-11-01

The motivational interview has been widely used as a clinical method to promote behavioural changes in patients, helping them to resolve their ambivalence to obtain their own motivations. In the present article, a review is made of the main meta-analyses and systematic and narrative reviews on the efficacy of the motivational interview in the primary health care environment. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Properties of Red Sea coastal currents

KAUST Repository

Churchill, J.H.

2014-02-14

Properties of coastal flows of the central Red Sea are examined using 2 years of velocity data acquired off the coast of Saudi Arabia near 22 °N. The tidal flow is found to be very weak. The strongest tidal constituent, the M2 tide, has a magnitude of order 4 cm s−1. Energetic near-inertial and diurnal period motions are observed. These are surface-intensified currents, reaching magnitudes of >10 cm s−1. Although the diurnal currents appear to be principally wind-driven, their relationship with the surface wind stress record is complex. Less than 50% of the diurnal current variance is related to the diurnal wind stress through linear correlation. Correlation analysis reveals a classical upwelling/downwelling response to the alongshore wind stress. However, less than 30% of the overall sub-inertial variance can be accounted for by this response. The action of basin-scale eddies, impinging on the coastal zone, is implicated as a primary mechanism for driving coastal flows.

Comparison of pulsed fluoroscopy by direct control using a grid-controlled x-ray tube with pulsed fluoroscopy by primary control

International Nuclear Information System (INIS)

Chida, Koichi; Zuguchi, Masayuki; Ito, Daisuke; Sato, Kunihiko; Shimura, Hirotaka; Sasaki, Masatoshi

2001-01-01

Interventional radiology (IVR) procedures may involve high radiation doses that are potentially harmful to the patient. In IVR procedures, pulsed fluoroscopy can greatly decrease the radiation that the physician and patient receive. There are two types of pulsed fluoroscopy: direct control and primary (indirect) control. The purpose of this study was to compare pulsed fluoroscopy by direct control, using a grid-controlled x-ray tube, with pulsed fluoroscopy using primary control. For both types of pulsed fluoroscopy, we measured the waveforms (x-ray tube voltage, x-ray tube current, and x-ray output) and the relative radiation dose. In addition, we compared the decrease in radiation during pulsed fluoroscopy using a care filter. The studies were performed using a Siemens Bicor Plus x-ray System (direct control) and a Siemens Multistar Plus x-ray System (primary control). Using primary pulse control, a 50% decrease in the x-ray output waveform took approximately 0.5-1.0 msec, or longer with a lower x-ray tube current. Using direct pulse control, a 50% decrease in the x-ray output waveform took approximately 0.1 msec, and was independent of x-ray tube current. The rate of radiation reduction with primary pulse control using the care filter with a lower x-ray tube current had a slope exceeding 10%. Pulsed fluoroscopy by direct control using a grid-controlled x-ray tube permits an optimal radiation dose. To decrease the radiation in primary pulse control, a care filter must be used, particularly with a lower x-ray tube current. (author)

Trends in Current Issues, Y2K-2005

Science.gov (United States)

Maltz, Leslie; DeBlois, Peter B.

2005-01-01

EDUCAUSE inaugurated its annual Current Issues Survey in 2000 by asking the primary representatives, typically CIOs, of its member institutions to identify up to three critical IT issues (five starting in 2004) from among 30 to 40 in response to each of four questions. The survey response rate has typically been 35 to 40 percent, with a…

Socioeconomic multi-domain health inequalities in Dutch primary school children

NARCIS (Netherlands)

Vermeiren, Angelique P.; Willeboordse, Maartje; Oosterhoff, Marije; Bartelink, Nina; Muris, Peter; Bosma, Hans

2018-01-01

Background: This study assesses socio-economic health inequalities (SEHI) over primary school-age (4- to 12-years old) across 13 outcomes (i.e. body-mass index [BMI], handgrip strength, cardiovascular fitness, current physical conditions, moderate to vigorous physical activity, sleep duration, daily

Online Learning Integrity Approaches: Current Practices and Future Solutions

Science.gov (United States)

Lee-Post, Anita; Hapke, Holly

2017-01-01

The primary objective of this paper is to help institutions respond to the stipulation of the Higher Education Opportunity Act of 2008 by adopting cost-effective academic integrity solutions without compromising the convenience and flexibility of online learning. Current user authentication solutions such as user ID and password, security…

Primary repair of colon injuries: clinical study of nonselective approach

Directory of Open Access Journals (Sweden)

Krivokapic Zoran V

2010-12-01

Full Text Available Abstract Background This study was designed to determine the role of primary repair and to investigate the possibility of expanding indications for primary repair of colon injuries using nonselective approach. Methods Two groups of patients were analyzed. Retrospective (RS group included 30 patients managed by primary repair or two stage surgical procedure according to criteria published by Stone (S/F and Flint (Fl. In this group 18 patients were managed by primary repair. Prospective (PR group included 33 patients with primary repair as a first choice procedure. In this group, primary repair was performed in 30 cases. Results Groups were comparable regarding age, sex, and indexes of trauma severity. Time between injury and surgery was shorter in PR group, (1.3 vs. 3.1 hours. Stab wounds were more frequent in PR group (9:2, and iatrogenic lesions in RS group (6:2. Associated injuries were similar, as well as segmental distribution of colon injuries. S/F criteria and Flint grading were similar. In RS group 15 primary repairs were successful, while in two cases relaparotomy and colostomy was performed due to anastomotic leakage. One patient died. In PR group, 25 primary repairs were successful, with 2 immediate and 3 postoperative (7-10 days deaths, with no evidence of anastomotic leakage. Conclusions Results of this study justify more liberal use of primary repair in early management of colon injuries. Trial registration Current Controlled Trials ISRCTN94682396

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

2015-03-01

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.

Practicing health promotion in primary care -a reflective enquiry.

Science.gov (United States)

Pati, S; Chauhan, A S; Mahapatra, S; Sinha, R; Pati, S

2017-12-01

Health promotion is an integral part of routine clinical practice. The physicians' role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha. An exploratory study was planned between the months of January - February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice. The study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education. We concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.

Characteristic time for halo current growth and rotation

Energy Technology Data Exchange (ETDEWEB)

Boozer, Allen H., E-mail: ahb17@columbia.edu [Department of Applied Physics and Applied Mathematics, Columbia University, New York, New York 10027 (United States)

2015-10-15

A halo current flows for part of its path through the plasma edge and for part through the chamber walls and during tokamak disruptions can be as large as tenths of the plasma current. The primary interest in halo currents is the large force that they can exert on machine components particularly if the toriodal rotation of the halo current resonates with a natural oscillation frequency of the tokamak device. Halo currents arise when required to slow down the growth of a kink that is too unstable to be stabilized by the chamber walls. The width of the current channel in the halo plasma is comparable to the amplitude of the kink, and the halo current grows linearly, not exponentially, in time. The current density in the halo is comparable to that of the main plasma body. The rocket force due to plasma flowing out of the halo and recombining on the chamber walls can cause the non-axisymmetric magnetic structure produced by the kink to rotate toroidally at a speed comparable to the halo speed of sound. Gerhardt's observations of the halo current in NSTX shot 141 687 [Nucl. Fusion 53, 023005 (2013)] illustrate many features of the theory of halo currents and are discussed as a summary of the theory.

[Statins and ASS for primary prevention of cardiovascular and cerebrovascular disease].

Science.gov (United States)

Goltz, L; Bodechtel, U; Siepmann, T

2014-02-01

Whereas statins and acetylsalicylic acid (ASA) are considered gold standard for secondary prevention following myocardial infarction or atherotrombotic stroke, there are inconsistent data on the use of these drugs for primary prevention in patients with increased cardiovascular risk. Some meta-analyses indicated that the use of statins and ASA for primary prevention of cardiovascular disease can reduce the risk of cardiovascular events such as ischemic stroke or myocardial infarction. However, the effects of primary prevention with statins and ASA on mortality varied in the data included in these meta-analyses. Therefore the guidelines of the German College of General Practitioners and Family Physicians recommend primary prevention with statins and ASA only in those patients who have a 10-year risk of cardiovascular events which exceeds 20 %. Divergently, primary prevention with ASA is not recommended by the European Society of Cardiology. Observational studies suggested that treatment success of primary prevention with statins and ASA depends on various factors such as adherence to medication and prescription behavior of physicians. This review summarizes the current literature on primary prevention of cardiovascular events with ASA and statins. © Georg Thieme Verlag KG Stuttgart · New York.

Current Therapeutic Strategies and Novel Approaches in Osteosarcoma

International Nuclear Information System (INIS)

Ando, Kosei; Heymann, Marie-Françoise; Stresing, Verena; Mori, Kanji; Rédini, Françoise; Heymann, Dominique

2013-01-01

Osteosarcoma is the most frequent malignant primary bone tumor and a main cause of cancer-related death in children and adolescents. Although long-term survival in localized osteosarcoma has improved to about 60% during the 1960s and 1970s, long-term survival in both localized and metastatic osteosarcoma has stagnated in the past several decades. Thus, current conventional therapy consists of multi-agent chemotherapy, surgery and radiation, which is not fully adequate for osteosarcoma treatment. Innovative drugs and approaches are needed to further improve outcome in osteosarcoma patients. This review describes the current management of osteosarcoma as well as potential new therapies

Application-oriented research on plasma channeling of a large pulsed current

International Nuclear Information System (INIS)

Liu Jingye

2000-01-01

Utilizing the avalanche effect of plasma produced by the collision of energetic primary electrons with hydrogen molecules in a plasma, channeling of a large pulsed current is achieved, with the plasma acting as the carrier

Net primary productivity of subalpine meadows in Yosemite National Park in relation to climate variability

Science.gov (United States)

Peggy E. Moore; Jan W. van Wagtendonk; Julie L. Yee; Mitchel P. McClaran; David N. Cole; Neil K. McDougald; Matthew L. Brooks

2013-01-01

Subalpine meadows are some of the most ecologically important components of mountain landscapes, and primary productivity is important to the maintenance of meadow functions. Understanding how changes in primary productivity are associated with variability in moisture and temperature will become increasingly important with current and anticipated changes in climate....

Investigation of Current Situation of Learning Motivation, Social Anxiety and Loneliness of the Left-behind Children in Rural Primary School

OpenAIRE

Zhang Biyun; Xu Ming

2015-01-01

Objective: To understand the situation of learning motivation, social anxiety and loneliness of the left-behind children. Method: Selecting three rural primary schools in Xian’an District of Xianning City to investigate left-behind situation, learning motivation, social anxiety and loneliness of pupils in Grades 4 to 6 in rural primary school in Xian’an District by the use of the MAAT-I-A which is revised by Zhou Bucheng, the Social Anxiety Scale for Children (SASC) and the Children’s Lonelin...

Comparing primary energy attributed to renewable energy with primary energy equivalent to determine carbon abatement in a national context.

Science.gov (United States)

Gallachóir, Brian P O; O'Leary, Fergal; Bazilian, Morgan; Howley, Martin; McKeogh, Eamon J

2006-01-01

The current conventional approach to determining the primary energy associated with non-combustible renewable energy (RE) sources such as wind energy and hydro power is to equate the electricity generated from these sources with the primary energy supply. This paper compares this with an approach that was formerly used by the IEA, in which the primary energy equivalent attributed to renewable energy was equated with the fossil fuel energy it displaces. Difficulties with implementing this approach in a meaningful way for international comparisons lead to most international organisations abandoning the primary energy equivalent methodology. It has recently re-emerged in prominence however, as efforts grow to develop baseline procedures for quantifying the greenhouse gas (GHG) emissions avoided by renewable energy within the context of the Kyoto Protocol credit trading mechanisms. This paper discusses the primary energy equivalent approach and in particular the distinctions between displacing fossil fuel energy in existing plant or in new plant. The approach is then extended provide insight into future primary energy displacement by renewable energy and to quantify the amount of CO2 emissions avoided by renewable energy. The usefulness of this approach in quantifying the benefits of renewable energy is also discussed in an energy policy context, with regard to increasing security of energy supply as well as reducing energy-related GHG (and other) emissions. The approach is applied in a national context and Ireland is case study country selected for this research. The choice of Ireland is interesting in two respects. The first relates to the high proportion of electricity only fossil fuel plants in Ireland resulting in a significant variation between primary energy and primary energy equivalent. The second concerns Ireland's poor performance to date in limiting GHG emissions in line with its Kyoto target and points to the need for techniques to quantify the potential

Primary pipe rupture accident analysis for the Clinch River Breeder Reactor

Energy Technology Data Exchange (ETDEWEB)

Albright, D.C.; Bari, R.A.

1976-04-01

In this report, the thermal transient response of the CRBR to a severe primary coolant flow perturbation, initiated by a rupture of the primary heat transport system piping, is analyzed. This hypothetical accident is studied under the further assumption that the plant protection system does function according to current design descriptions for the CRBR. Although a brief discussion of an unprotected (no scram) pipe rupture accident is presented, the major emphasis of the present report is on the protected accident.

Primary pipe rupture accident analysis for the Clinch River Breeder Reactor

International Nuclear Information System (INIS)

Albright, D.C.; Bari, R.A.

1976-04-01

In this report, the thermal transient response of the CRBR to a severe primary coolant flow perturbation, initiated by a rupture of the primary heat transport system piping, is analyzed. This hypothetical accident is studied under the further assumption that the plant protection system does function according to current design descriptions for the CRBR. Although a brief discussion of an unprotected (no scram) pipe rupture accident is presented, the major emphasis of the present report is on the protected accident

Effects of magnetic core geometry on false detection in residual current sensor

International Nuclear Information System (INIS)

Colin, Bruno; Chillet, Christian; Kedous-Lebouc, Afef; Mas, Patrick

2006-01-01

Under high-supply current, residual circuit breakers are subject to abnormal tripping, caused by false residual currents. Geometric or magnetic anomalies in the circuit breaker ring core seem to be responsible for these abnormal currents. This paper studies a few anomalies (spiral shape effect, conductor eccentricity, lamination effect) and calculates different contributions using the finite element simulations. The results show that the ring core, made of thin wound magnetic tape, is particularly sensitive to primary conductor eccentricity

Programmable controller with overcurrent latch for constant primary peak current in capacitor-charging FET switcher for Nova

International Nuclear Information System (INIS)

Mihalka, A.M.

1983-01-01

New switching power supplies were designed for the 10 mm laser amplifiers in the Nova Master Oscillator Room. The flashlamp supply must be repratable. Therefore, we designed a constant current, linearly charging power supply. Since it is a capacitor, the load varies throughout the charge cycle. At first the load is great, and di/dt of load current is at a maximum. As the capacitor charges the initial conditions for each cycle change, the power supply in effect sees a smaller capacitance, and di/dt decreases. We need a way of gradually increasing the on-time of the current pulses so that the transistors in the power bridge are turned off when they reach their maximum peak current. The normal current sense response of the control chip is not fast enough to be useful for our application. The deadtime, or the time that all the bridge transistors are turned off, is fixed so that as the pulse width varies so does the period. We end up with a constant peak current, switching power supply whose frequency varies from 50 khz to 20 khz. Finally, an overcurrent latch protects the transistors from bridge or transformer faults. The circuit is described and results are shown

Meson exchange current (MEC) models in neutrino interaction generators

International Nuclear Information System (INIS)

Katori, Teppei

2015-01-01

Understanding of the so-called 2 particle-2 hole (2p-2h) effect is an urgent program in neutrino interaction physics for current and future oscillation experiments. Such processes are believed to be responsible for the event excesses observed by recent neutrino experiments. The 2p-2h effect is dominated by the meson exchange current (MEC), and is accompanied by a 2-nucleon emission from the primary vertex, instead of a single nucleon emission from the charged-current quasi-elastic (CCQE) interaction. Current and future high resolution experiments can potentially nail down this effect. For this reason, there are world wide efforts to model and implement this process in neutrino interaction simulations. In these proceedings, I would like to describe how this channel is modeled in neutrino interaction generators

Investigating and Stimulating Primary Teachers' Attitudes Towards Science: Summary of a Large-Scale Research Project

Science.gov (United States)

Walma van der Molen, Juliette; van Aalderen-Smeets, Sandra

2013-01-01

Attention to the attitudes of primary teachers towards science is of fundamental importance to research on primary science education. The current article describes a large-scale research project that aims to overcome three main shortcomings in attitude research, i.e. lack of a strong theoretical concept of attitude, methodological flaws in…

Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers: Implications for Early Intervention Professionals

Science.gov (United States)

Porter, Sallie; Qureshi, Rubab; Caldwell, Barbara Ann; Echevarria, Mercedes; Dubbs, William B.; Sullivan, Margaret W.

2016-01-01

This study used a survey approach to investigate current developmental surveillance and developmental screening practices by pediatric primary care providers in a diverse New Jersey county. A total of 217 providers were contacted with a final sample size of 57 pediatric primary care respondents from 13 different municipalities. Most providers…

Oncology in primary health care

International Nuclear Information System (INIS)

Mendoza del Pino, Mario Valentín

2009-01-01

The book O ncology in the primary health care , constitutes an important contribution to the prevention and treatment of cancer, from a very comprehensive assessment. It's a disease that is the second leading cause of death in our country, to much pain and suffering is for the patient and their family. The book has a very useful for basic health equipment approach, since it emphasizes that cancer can be prevented if achieved in the population changes in lifestyle. The book is valued not correct food as responsible for one third of all cancers. Currently important research being developed in relation to psiconeuroinmuno-Endocrinology, who is studying the association between psychological factors and the development of cancer valuing that kept stress and depression reduces the antitumor activity of the immune system; that made programs with encouraging results where the treatment of cancer has joined elements of psychotherapy, immunotherapy and the use of the biotherapy. The focus of the book fills an important place in the primary health care and is an indispensable guide for professionals at this level of care (author)

Primary care in a post-communist country 10 years later: comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004.

NARCIS (Netherlands)

Liseckiene, I.; Boerma, W.G.W.; Milasauskiene, Z.; Valius, L.; Miseviciene, I.; Groenewegen, P.P.

2007-01-01

OBJECTIVES: The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account

Lithium Carbon Monofluoride: The Next Primary Chemistry for Soldier Portable Power Sources

National Research Council Canada - National Science Library

Suszko, Arek

2006-01-01

.... Current lithium-ion rechargeable battery technologies have a specific energy of 170 Watthours/ kilogram and state-of-the-art primary lithium-based systems have a specific energy approaching 200 Watt-hours/kilogram...

Alcohol use and alcohol use disorder among male outpatients in a primary care setting in rural Puducherry

Directory of Open Access Journals (Sweden)

Akkilagunta Sujiv

2015-01-01

Full Text Available Context: Alcohol use contributes to considerable morbidity and mortality worldwide. Screening for alcohol use and alcohol use disorder (AUD at the primary care level can help in reducing this burden. While several community studies have been conducted to estimate the AUD, there apparently are no studies on opportunistic screening in a primary care setting in India. Aims: The aim was to estimate the prevalence of alcohol use and AUD in a primary care setting. Settings and Design: A hospital-based cross-sectional study was conducted among adult male outpatients in a primary care setting in Puducherry, South India. Subjects and Methods: Male outpatients aged 18 and above were interviewed for alcohol use. Current alcohol users were screened for AUD using World Health Organization - AUD identification test (AUDIT questionnaire, respectively. Statistical Analysis Used: Proportions were used to describe the study population and the main study findings. The Chi-square test was used to find out the association between sociodemographic factors and alcohol use. Results: Of 256 subjects studied, 39.8% were found to be current alcohol users and 10.9% had AUD (AUDIT score ≥8. The sociodemographic factors did not show any association with an alcohol use in the current setting. Conclusion: Based on the findings of the present study, four current alcohol users are to be screened to identify one patient with AUD. Screening at the primary health care level can help in identifying the risk group and thus help in reducing the morbidity and mortality due to alcohol use in the population.

Observation and analysis of halo current in EAST

Science.gov (United States)

Chen, Da-Long; Shen, Biao; Qian, Jin-Ping; Sun, You-Wen; Liu, Guang-Jun; Shi, Tong-Hui; Zhuang, Hui-Dong; Xiao, Bing-Jia

2014-06-01

Plasma in a typically elongated cross-section tokamak (for example, EAST) is inherently unstable against vertical displacement. When plasma loses the vertical position control, it moves downward or upward, leading to disruption, and a large halo current is generated helically in EAST typically in the scrape-off layer. When flowing into the vacuum vessel through in-vessel components, the halo current will give rise to a large J × B force acting on the vessel and the in-vessel components. In EAST VDE experiment, part of the eddy current is measured in halo sensors, due to the large loop voltage. Primary experimental data demonstrate that the halo current first lands on the outer plate and then flows clockwise, and the analysis of the information indicates that the maximum halo current estimated in EAST is about 0.4 times the plasma current and the maximum value of TPF × Ih/IP0 is 0.65, furthermore Ih/Ip0 and TPF × Ih/Ip0 tend to increase with the increase of Ip0. The test of the strong gas injection system shows good success in increasing the radiated power, which may be effective in reducing the halo current.

Why primary care practices should become digital health information hubs for their patients.

Science.gov (United States)

Baird, Aaron; Nowak, Samantha

2014-11-25

Two interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible. We contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive. We view

Primary cilium - antenna-like structure on the surface of most mammalian cell types

International Nuclear Information System (INIS)

Dvorak, J; Kasaova, L; Filip, S; Petera, J; Sitorova, V; Nikolov, D Hadzi; Ryska, A; Mokry, J; Richter, I

2011-01-01

The primary cilium is a sensory solitary non-motile microtubule-based organelle protruding in the quiescent phase of the cell cycle from the surface of the majority of human cells, including embryonic cells, stem cells and stromal cells of malignant tumors. The presence of a primary cilium on the surface of a cell is transient, limited to the quiescent G 1 (G 0 ) phase and the beginning of the S phase of the cell cycle. The primary cilium is formed from the mother centriole. Primary cilia are key coordinators of signaling pathways during development and tissue homeostasis and, when deffective, they are a major cause of human diseases and developmental disorders, now commonly referred to as ciliopathies. Most cancer cells do not possess a primary cilium. The loss of the primary cilium is a regular feature of neoplastic transformation in the majority of solid tumors. The primary cilium could serve as a tumor suppressor organelle. The aim of this paper was to provide a review of the current knowledge of the primary cilium.

Primary cilium - antenna-like structure on the surface of most mammalian cell types

Science.gov (United States)

Dvorak, J.; Sitorova, V.; Hadzi Nikolov, D.; Mokry, J.; Richter, I.; Kasaova, L.; Filip, S.; Ryska, A.; Petera, J.

2011-12-01

The primary cilium is a sensory solitary non-motile microtubule-based organelle protruding in the quiescent phase of the cell cycle from the surface of the majority of human cells, including embryonic cells, stem cells and stromal cells of malignant tumors. The presence of a primary cilium on the surface of a cell is transient, limited to the quiescent G1(G0) phase and the beginning of the S phase of the cell cycle. The primary cilium is formed from the mother centriole. Primary cilia are key coordinators of signaling pathways during development and tissue homeostasis and, when deffective, they are a major cause of human diseases and developmental disorders, now commonly referred to as ciliopathies. Most cancer cells do not possess a primary cilium. The loss of the primary cilium is a regular feature of neoplastic transformation in the majority of solid tumors. The primary cilium could serve as a tumor suppressor organelle. The aim of this paper was to provide a review of the current knowledge of the primary cilium.

The Quest for Strategic Malaysian Quality National Primary School Leaders

Science.gov (United States)

Ali, Hairuddin Mohd

2012-01-01

Purpose: The purpose of this paper is to investigate the nine-point strategic leadership characteristics of Malaysian Quality National Primary School Leaders (QNPSL) and to indicate the implications of these findings for the current educational management and leadership practices in their quest for Malaysian quality education.…

Conversion total hip arthroplasty: Primary or revision total hip arthroplasty

Science.gov (United States)

Schwarzkopf, Ran; Baghoolizadeh, Mahta

2015-01-01

Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties. PMID:26601055

Is There an Association Between Smoking Status and Prosthetic Joint Infection After Primary Total Joint Arthroplasty?

Science.gov (United States)

Gonzalez, Amanda I; Luime, Jolanda J; Uçkay, Ilker; Hannouche, Didier; Hoffmeyer, Pierre; Lübbeke, Anne

2018-02-23

Recent reports highlighted the association between smoking and higher risk of postsurgical infections. The aim was to compare the incidence of prosthetic joint infection after primary total joint arthroplasty (TJA) according to smoking status. A prospective hospital registry-based cohort study was performed including all primary knee and hip TJAs performed between March 1996 and December 2013. Smoking status preoperatively was classified into never, former, and current smoker. Incidence rates and hazard ratios (HRs) for prosthetic joint infection according to smoking status were assessed within the first year and beyond. We included 8559 primary TJAs (mean age 69.5 years), and median follow-up was 67 months. There were 5722 never, 1315 former, and 1522 current smokers. Incidence rates of infection within the first year for never, former, and current smokers were, respectively, 4.7, 10.1, and 10.9 cases/1000 person-years, comparing ever vs never smokers, crude and adjusted HRs were 2.35 (95% confidence interval [CI] 1.39-3.98) and 1.8 (95% CI 1.04-3.2). Beyond the first year, crude and adjusted HRs were 1.37 (95% CI 0.78-2.39) and 1.12 (95% CI 0.61-2.04). Smoking increased the infection risk about 1.8 times after primary hip or knee TJA in both current and former smokers. Beyond the first year, the infection risk was similar to never smokers. Copyright © 2018 Elsevier Inc. All rights reserved.

Working Alongside Scientists: Impacts on Primary Teacher Beliefs and Knowledge about Science and Science Education

Science.gov (United States)

Anderson, Dayle; Moeed, Azra

2017-01-01

Current curriculum demands require primary teachers to teach about the Nature of Science; yet, few primary teachers have had opportunity to learn about science as a discipline. Prior schooling and vicarious experiences of science may shape their beliefs about science and, as a result, their science teaching. This qualitative study describes the…

Transmission Level High Temperature Superconducting Fault Current Limiter

Energy Technology Data Exchange (ETDEWEB)

Stewart, Gary [SuperPower, Inc., Schenectady, NY (United States)

2016-10-05

The primary objective of this project was to demonstrate the feasibility and reliability of utilizing high-temperature superconducting (HTS) materials in a Transmission Level Superconducting Fault Current Limiter (SFCL) application. During the project, the type of high-temperature superconducting material used evolved from 1^st generation (1G) BSCCO-2212 melt cast bulk high-temperature superconductors to 2^nd generation (2G) YBCO-based high-temperature superconducting tape. The SFCL employed SuperPower's “Matrix” technology, that offers modular features to enable scale up to transmission voltage levels. The SFCL consists of individual modules that contain elements and parallel inductors that assist in carrying the current during the fault. A number of these modules are arranged in an m x n array to form the current-limiting matrix.

Comparison between Primary Teacher Educators' and Primary School Teachers' Beliefs of Primary Geography Education Quality

Science.gov (United States)

Bent, Gert Jan; Bakx, Anouke; den Brok, Perry

2016-01-01

In this study teacher educators' beliefs concerning primary geography education have been investigated and compared with primary school teachers' beliefs. In this study 45 teacher educators and 489 primary school teachers completed a questionnaire, and nine teacher educators have been interviewed as well. It has been found that teacher educators…

MD1878: Operation with primary collimators at tighter settings

CERN Document Server

AUTHOR|(CDS)2078850; Amorim, David; Biancacci, Nicolo; Bruce, Roderik; Buffat, Xavier; Carver, Lee Robert; Fiascaris, Maria; Mereghetti, Alessio; Redaelli, Stefano; Rossi, Roberto; Salvachua Ferrando, Belen Maria; Soderen, Martin; Trad, Georges; CERN. Geneva. ATS Department

2017-01-01

Primary (TCP) collimators of the betatron cleaning insertion determine the betatron cut of the LHC beam. During the 2016 they were set at 5.5 nominal beam sigmas at 6.5 TeV (i.e. by using a normalized emittance ε* = 3:5 μm is used). Reducing their settings is a possible way to push the ß* at the LHC, which depends on the collimation hierarchy. This study aims at understanding possible limitations of operating the LHC with tighter settings of the primary collimators. This is a crucial input to the choice of operational configuration in terms of ß* at the LHC as well as at the HL-LHC. This study follows a successful MD done in block 3 to understand limitations from TCP impedance [1]. The outcome of this MD can also have an impact for the design of the FCC collimation system, which is currently based on the present TCP gaps. Studies of beam stability as a function of octupole current, transverse feedback gain (ADT) and transverse separation at the IPs were also carried out.

Central Cemento-Ossifying Fibroma: Primary Odontogenic or Osseous Neoplasm?

Science.gov (United States)

Woo, Sook-Bin

2015-12-01

Currently, central cemento-ossifying fibroma is classified by the World Health Organization as a primary bone-forming tumor of the jaws. However, histopathologically, it is often indistinguishable from cemento-osseous dysplasias in that it forms osteoid and cementicles (cementum droplets) in varying proportions. It is believed that pluripotent cells within the periodontal membrane can be stimulated to produce either osteoid or woven bone and cementicles when stimulated. If this is true, cemento-ossifying fibroma would be better classified as a primary odontogenic neoplasm arising from the periodontal ligament. Cemento-ossifying fibromas also do not occur in the long bones. The present report compares several entities that fall within the diagnostic realm of benign fibro-osseous lesions and reviews the evidence for reclassifying central cemento-ossifying fibroma as a primary odontogenic neoplasm. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Comments about the use of a Zig-Zag transformer to reduce the neutral current created by unbalanced nonlinear loads

International Nuclear Information System (INIS)

Beverly, L.; Hance, R.; Kristalinski, A.; Visser, A.

1993-09-01

The subject of AC line currents with high harmonic content and the potential for overloaded neutral wires caused by the non-linear loading of electronic power supplies has become one of the most popular and at the same time a very complex topic among electrical engineers. Different solutions are offered for this problem. Some examples are specially designed K-rated AC distribution transformers, delta connected primary windings, and L-C tuned filters. All of the above methods have some limitations. For instance, a K-rated transformer does not eliminate harmonics, but transmits them into the feeder. Neutral currents that flow from various loads to the K-rated transformer are still very high. These K-rated transformers are more expensive and are larger in physical size than conventional transformers. The delta connected primary of a power distribution transformer can only eliminate triplen harmonics for balanced loads. Neutral currents caused by the loads are not eliminated. The primary side circuit breaker may also not protect a transformer against overcurrents because the circuit breaker will not see the triplen harmonic current that is circulating in the primary of the transformer. L-C filters can create undesirable resonances, which will lead to an increase in harmonic currents. Another solution is to use a number of small Zig-Zag transformers to reduce the neutral current. This is attractive for the following reasons: relatively low cost, simplicity, ease of installation on existing distribution systems, ability to keep neutral currents local thus eliminating the need for larger neutral wires, and the ability to improve the fundamental load current balance as well

[Quality Indicators of Primary Health Care Facilities in Austria].

Science.gov (United States)

Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

2017-07-11

Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

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.

A primary mirror metrology system for the GMT

Science.gov (United States)

Rakich, A.

2016-07-01

The Giant Magellan Telescope (GMT)1 is a 25 m "doubly segmented" telescope composed of seven 8.4 m "unit Gregorian telescopes", on a common mount. Each primary and secondary mirror segment will ideally lie on the geometrical surface of the corresponding rotationally symmetrical full aperture optical element. Therefore, each primary and conjugated secondary mirror segment will feed a common instrument interface, their focal planes co-aligned and cophased. First light with a subset of four unit telescopes is currently scheduled for 2022. The project is currently considering an important aspect of the assembly, integration and verification (AIV) phase of the project. This paper will discuss a dedicated system to directly characterize the on-sky performance of the M1 segments, independently of the M2 subsystem. A Primary Mirror Metrology System (PMS) is proposed. The main purpose of this system will be to he4lp determine the rotation axis of an instrument rotator (the Gregorian Instrument Rotator or GIR in this case) and then to characterize the deflections and deformations of the M1 segments with respect to this axis as a function of gravity and temperature. The metrology system will incorporate a small (180 mm diameter largest element) prime focus corrector (PFC) that simultaneously feeds a risk reduction during AIV; it allows an on-sky characterization of the primary mirror segments and cells, without the complications of other optical elements. The PMS enables a very useful alignment strategy that constrains each primary mirror segments' optical axes to follow the GIR axis to within a few arc seconds. An additional attractive feature of the incorporation of the PMS into the AIV plan, is that it allows first on-sky telescope operations to occur with a system of considerably less optical and control complexity than the final doubly segmented Gregorian telescope configuration. This paper first discusses the strategic rationale for a PMS. Next the system itself is

Health effects of freshwater bathing among primary school children; Design for a randomised exposure study

NARCIS (Netherlands)

Asperen IA van; Medema GJ; Havelaar AH; Borgdorff MW; CIE; MGB

1997-01-01

To study the health effects of bathing in freshwaters that meet current water quality standard, large epidemiological studies are needed. A design is presented of a study among primary school children, that aims to evaluate current water quality standard. The study concerns a randomised exposure

Attitude of Primary Health Care Nurses in Kuwait Towards Domestic ...

African Journals Online (AJOL)

Background: Domestic violence against women is an important public health problem. Battered women attend primary health care centers seeking for both medical treatment and support. Nurses with a positive attitude play a key role to deal with victimized women. Objectives: The current study was formulated to reveal ...

Voltage-regulating constant-current sources in a linear induction accelerator

International Nuclear Information System (INIS)

Zhao Juan; Cao Kefeng; Deng Jianjun; Zhu Lijun; Yang Jia; Ye Chao; Huang Bin; Cao Ningxiang; Dong Jinxuan; Zhang Jichang; Yu Zhiguo; Chen Min

2002-01-01

Constant-current Sources are one of key units in a linear induction accelerator. The requirements for the sources are to supply stable direct current of high power for the induction coil, be easy to computer-control and highly stable and reliable. Applying the technique of linear current source regulating in series, the primary voltage of the power transformer is regulated through an MJYS-JL-350A type three-phase alterative voltage-regulating module. The output current variation is 300-500 A when the load variation is 0.06-0.1 Ω and the voltage drop of the regulator tube is controlled within 8 V±2V when the variation of mains voltage is in ±10%. Both the current ripple and stability meet the technical requirements. The constant-current sources are controlled through an industrial controller. For each of the constant-current sources has a smallest system comprised of 8051 which is communication-controlled through a RS-485 interface, the sources can be controlled remotely

Current sensorless quick charger for lithium-ion batteries

International Nuclear Information System (INIS)

Tsang, K.M.; Chan, W.L.

2011-01-01

An efficient, simple and low cost quick charger based on the double-loop controller is proposed for the charging of lithium-ion (Li-ion) batteries. With positive and negative feedback of the battery voltage, charging profile similar to the constant current and constant voltage (CC-CV) charging strategy can be performed without actually sensing the charging current. The charging time can easily be shortened by raising the level of saturation in the primary voltage control loop. Experimental results are included to demonstrate the effectiveness of the battery charger. The charger could be a low cost and high performance replacement for existing Li-ion battery chargers.

Transformer core modeling for magnetizing inrush current investigation

Directory of Open Access Journals (Sweden)

A.Yahiou

2014-03-01

Full Text Available The inrush currents generated during an energization of power transformer can reach very high values and may cause many problems in power system. This magnetizing inrush current which occurs at the time of energization of a transformer is due to temporary overfluxing in the transformer core. Its magnitude mainly depends on switching parameters such as the resistance of the primary winding and the point-on-voltage wave (switching angle. This paper describes a system for measuring the inrush current which is composed principally of an acquisition card (EAGLE, and LabVIEW code. The system is also capable of presetting various combinations of switching parameters for the energization of a 2 kVA transformer via an electronic card. Moreover, an algorithm for calculating the saturation curve is presented taking the iron core reactive losses into account, thereby producing a nonlinear inductance. This curve is used to simulate the magnetizing inrush current using the ATP-EMTP software.

Augmentation of spelling therapy with transcranial direct current stimulation in primary progressive aphasia: Preliminary results and challenges.

Science.gov (United States)

Tsapkini, Kyrana; Frangakis, Constantine; Gomez, Yessenia; Davis, Cameron; Hillis, Argye E

Primary progressive aphasia (PPA) is a neurodegenerative disease that primarily affects language functions and often begins in the fifth or sixth decade of life. The devastating effects on work and family life call for the investigation of treatment alternatives. In this article, we present new data indicating that neuromodulatory treatment, using transcranial direct current stimulation (tDCS) combined with a spelling intervention, shows some promise for maintaining or even improving language, at least temporarily, in PPA. The main aim of the present article is to determine whether tDCS plus spelling intervention is more effective than spelling intervention alone in treating written language in PPA. We also asked whether the effects of tDCS are sustained longer than the effects of spelling intervention alone. We present data from six PPA participants who underwent anodal tDCS or sham plus spelling intervention in a within-subject crossover design. Each stimulation condition lasted 3 weeks or a total of 15 sessions with a 2-month interval in between. Participants were evaluated on treatment tasks as well as on other language and cognitive tasks at 2-week and 2-month follow-up intervals after each stimulation condition. All participants showed improvement in spelling (with sham or tDCS). There was no difference in the treated items between the two conditions. There was, however, consistent and significant improvement for untrained items only in the tDCS plus spelling intervention condition. Furthermore, the improvement lasted longer in the tDCS plus spelling intervention condition compared to sham plus spelling intervention condition. Neuromodulation with tDCS offers promise as a means of augmenting language therapy to improve written language function at least temporarily in PPA. The consistent finding of generalisation of treatment benefits to untreated items and the superior sustainability of treatment effects with tDCS justifies further investigations. However

Causes of primary amenorrhea: a report of 295 cases in Thailand.

Science.gov (United States)

Tanmahasamut, Prasong; Rattanachaiyanont, Manee; Dangrat, Chongdee; Indhavivadhana, Suchada; Angsuwattana, Surasak; Techatraisak, Kitirat

2012-01-01

The aim of this study was to determine the prevalence of etiologic causes of primary amenorrhea in Thailand. A retrospective study was performed using 295 complete medical records of women with primary amenorrhea who attended the Gynecologic Endocrinology Clinic, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand from September 1992 to February 2009. The three most common causes of primary amenorrhea were Müllerian agenesis (39.7%), gonadal dysgenesis (35.3%), and hypogonadotropic hypogonadism (9.2%). Amongst 88 cases of gonadal dysgenesis, 59 cases (67.0%) incurred abnormal karyotype including 45X (n=21), mosaic (n=31), and others (n=7). The present study has currently been the largest case series of primary amenorrhea. Müllerian agenesis is the most prevalent cause in our study, while gonadal dysgenesis is the most common cause in the largest-scale study in the USA. Hence, racial, genetic and environmental factors could play roles in the cause of primary amenorrhea. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

Management of primary adrenal insufficiency: Review of current clinical practice in a developed and a developing country

OpenAIRE

Uzma Khan; Om J Lakhani

2017-01-01

Treatment of primary adrenal insufficiency (PAI) requires lifelong hormone replacement with glucocorticoids (GCs) and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with t...

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. © 2016 Annals of Family Medicine, Inc.

[Specificities of the logopenic variant of primary progressive aphasia].

Science.gov (United States)

Magnin, E; Teichmann, M; Martinaud, O; Moreaud, O; Ryff, I; Belliard, S; Pariente, J; Moulin, T; Vandel, P; Démonet, J-F

2015-01-01

The logopenic variant of primary progressive aphasia is a syndrome with neuropsychological and linguistic specificities, including phonological loop impairment for which diagnosis is currently mainly based on the exclusion of the two other variants, semantic and nonfluent/agrammatic primary progressive aphasia. The syndrome may be underdiagnosed due (1) to mild language difficulties during the early stages of the disease or (2) to being mistaken for mild cognitive impairment or Alzheimer's disease when the evaluation of episodic memory is based on verbal material and (3) finally, it is not uncommon that the disorders are attributed to psychiatric co-morbidities such as, for example, anxiety. Moreover, compared to other variants of primary progressive aphasia, brain abnormalities are different. The left temporoparietal junction is initially affected. Neuropathology and biomarkers (cerebrospinal fluid, molecular amyloid nuclear imaging) frequently reveal Alzheimer's disease. Consequently this variant of primary progressive aphasia does not fall under the traditional concept of frontotemporal lobar degeneration. These distinctive features highlight the utility of correct diagnosis, classification, and use of biomarkers to show the neuropathological processes underlying logopenic primary progressive aphasia. The logopenic variant of primary progressive aphasia is a specific form of Alzheimer's disease frequently presenting a rapid decline; specific linguistic therapies are needed. Further investigation of this syndrome is needed to refine screening, improve diagnostic criteria and better understand the epidemiology and the biological mechanisms involved. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Differences in the symptom profile of methamphetamine-related psychosis and primary psychotic disorders.

Science.gov (United States)

McKetin, Rebecca; Baker, Amanda L; Dawe, Sharon; Voce, Alexandra; Lubman, Dan I

2017-05-01

We examined the lifetime experience of hallucinations and delusions associated with transient methamphetamine-related psychosis (MAP), persistent MAP and primary psychosis among a cohort of dependent methamphetamine users. Participants were classified as having (a) no current psychotic symptoms, (n=110); (b) psychotic symptoms only when using methamphetamine (transient MAP, n=85); (c) psychotic symptoms both when using methamphetamine and when abstaining from methamphetamine (persistent MAP, n=37), or (d) meeting DSM-IV criteria for lifetime schizophrenia or mania (primary psychosis, n=52). Current psychotic symptoms were classified as a score of 4 or more on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations or unusual thought content in the past month. Lifetime psychotic diagnoses and symptoms were assessed using the Composite International Diagnostic Interview. Transient MAP was associated with persecutory delusions and tactile hallucinations (compared to the no symptom group). Persistent MAP was additionally associated with delusions of reference, thought interference and complex auditory, visual, olfactory and tactile hallucinations, while primary psychosis was also associated with delusions of thought projection, erotomania and passivity. The presence of non-persecutory delusions and hallucinations across various modalities is a marker for persistent MAP or primary psychosis in people who use methamphetamine. Copyright © 2017. Published by Elsevier B.V.

An Effect of the Co-Operative Network Model for Students' Quality in Thai Primary Schools

Science.gov (United States)

Khanthaphum, Udomsin; Tesaputa, Kowat; Weangsamoot, Visoot

2016-01-01

This research aimed: 1) to study the current and desirable states of the co-operative network in developing the learners' quality in Thai primary schools, 2) to develop a model of the co-operative network in developing the learners' quality, and 3) to examine the results of implementation of the co-operative network model in the primary school.…

The european primary care monitor: structure, process and outcome indicators

Directory of Open Access Journals (Sweden)

Wilson Andrew

2010-10-01

Full Text Available Abstract Background Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. Methods A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1 the dimensions of primary care and their relevance to outcomes at (primary health system level; (2 essential features per dimension; (3 applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems. Results The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators

Feasibility Study for an Off-Post, Primary Care Clinic at Fort Campbell, Kentucky

National Research Council Canada - National Science Library

Kvalevog, Kristen J

2005-01-01

.... Over 90,679 beneficiaries currently live in -the-Fort Campbell-catchment area and receive primary care at Blanchfield Army Community Hospital through the Red, White, Blue, Gold, and Young Eagle Clinics...

Online diagnoses of high current-density beams

International Nuclear Information System (INIS)

Gilpatrick, J.D.

1994-01-01

Los Alamos National Laboratory has proposed several CW-proton-beam facilities for production of tritium or transmutation of nuclear waste with beam-current densities greater than 5 mA/mm 2 . The primary beam-diagnostics-instrumentation requirement for these facilities is provision of sufficient beam information to understand and minimize beam-loss. To accomplish this task, the beam-diagnostics instrumentation must measure beam parameters such as the centroids and profiles, total integrated current, and particle loss. Noninterceptive techniques must be used for diagnosis of high-intensity CW beam at low energies due to the large quantity of power deposited in an interceptive diagnostic device by the beam. Transverse and longitudinal centroid measurements have been developed for bunched beams by measuring and processing image currents on the accelerator walls. Transverse beam-profile measurement-techniques have also been developed using the interaction of the particle beam with the background gases near the beam region. This paper will discuss these noninterceptive diagnostic Techniques

Exploration of funding models to support hybridisation of Australian primary health care organisations.

Science.gov (United States)

Reddy, Sandeep

2017-09-01

Primary Health Care (PHC) funding in Australia is complex and fragmented. The focus of PHC funding in Australia has been on volume rather than comprehensive primary care and continuous quality improvement. As PHC in Australia is increasingly delivered by hybrid style organisations, an appropriate funding model that matches this set-up while addressing current issues with PHC funding is required. This article discusses and proposes an appropriate funding model for hybrid PHC organisations.

Transcranial direct current stimulation on primary sensorimotor area has no effect in patients with drug-naïve restless legs syndrome: a proof-of-concept clinical trial.

Science.gov (United States)

Koo, Yong Seo; Kim, Sung Min; Lee, Chany; Lee, Byeong Uk; Moon, Ye Ji; Cho, Yong Won; Im, Chang-Hwan; Choi, Jeong Woo; Kim, Kyung Hwan; Jung, Ki-Young

2015-02-01

To evaluate the efficacy of transcranial direct current stimulation (tDCS) in people with drug-naïve restless legs syndrome (RLS). A two-week, double-blind, randomized, sham-controlled trial was performed. Thirty-three females with RLS were recruited. Participants received five sessions of tDCS using cathodal, anodal or sham stimulation. They were assessed at baseline (T0), three days (T1) and 13 days (T2) after the end of tDCS. Primary outcomes included the International RLS Group Rating Scale (IRLS) and the Clinical Global Impressions-Improvement (CGI-I). Secondary outcomes included the Patient Global Impression scale, the Pittsburgh Sleep Quality Index, the Medical Outcome Study sleep subscales, and the Beck Depression Inventory. Objective neurophysiological changes were assessed using event-related desynchronization/synchronization (ERD/ERS) of electroencephalography. The changes in the IRLS scores, as well as the responder rate in the CGI-I scale, did not differ significantly among the groups. There was also no significant difference in any of the secondary outcome measures and ERD/ERS among the groups. Transcranial direct current stimulation with electrodes on the sensorimotor areas showed no significant effect in people with drug-naïve RLS. Copyright © 2014 Elsevier B.V. All rights reserved.

Modular constraints on conformal field theories with currents

Science.gov (United States)

Bae, Jin-Beom; Lee, Sungjay; Song, Jaewon

2017-12-01

We study constraints coming from the modular invariance of the partition function of two-dimensional conformal field theories. We constrain the spectrum of CFTs in the presence of holomorphic and anti-holomorphic currents using the semi-definite programming. In particular, we find the bounds on the twist gap for the non-current primaries depend dramatically on the presence of holomorphic currents, showing numerous kinks and peaks. Various rational CFTs are realized at the numerical boundary of the twist gap, saturating the upper limits on the degeneracies. Such theories include Wess-Zumino-Witten models for the Deligne's exceptional series, the Monster CFT and the Baby Monster CFT. We also study modular constraints imposed by W -algebras of various type and observe that the bounds on the gap depend on the choice of W -algebra in the small central charge region.

Primary and secondary prevention of breast cancer.

Science.gov (United States)

Kolak, Agnieszka; Kamińska, Marzena; Sygit, Katarzyna; Budny, Agnieszka; Surdyka, Dariusz; Kukiełka-Budny, Bożena; Burdan, Franciszek

2017-12-23

Breast cancer is the most common cancer among women and is the second cancer frequently occurring worldwide of newly-diagnosed cancers. There is much evidence showing the influence of life style and environmental factors on the development of mammary gland cancer (high-fat diet, alcohol consumption, lack of physical exercise), the elimination of which (primary prevention) may contribute to a decrease in morbidity and mortality. Secondary prevention, comprising diagnostic tests (e.g. mammography, ultrasonography, magnetic resonance imaging, breast self-examination, as well as modern and more precise imaging methods) help the early detection of tumours or lesions predisposing to tumours. The aim of this study paper is to review current knowledge and reports regarding primary and secondary prevention of breast cancer. It is estimated that nearly 70% of malign tumours are caused by environmental factors, whereas in breast cancer this percentage reaches 90-95%. There are national programmes established in many countries to fight cancer, where both types of prevention are stressed as serving to decrease morbidity and mortality due to cancers. Cancer prevention is currently playing a key role in the fight against the disease. Behaviour modification, as well as greater awareness among women regarding breast cancer, may significantly contribute towards reducing the incidence of this cancer. Another important aspect is the number of women undergoing diagnostic tests, which still remains at an unsatisfactory level.

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....

The care of constipated children in primary care in different countries

NARCIS (Netherlands)

Burgers, Rosa; Bonanno, Elvira; Madarena, Elisa; Graziano, Francesca; Pensabene, Licia; Gardner, William; Mousa, Hayat; Benninga, Marc A.; Di Lorenzo, Carlo

2012-01-01

Aim: To investigate and compare the approach to childhood constipation by primary care physicians (PCP) in three Western countries to give insight into adherence to current guidelines and in actual care. Methods: Prospective study utilizing a two-page survey regarding the approach to children

Job monitoring on the WLCG scope: Current status and new strategy

International Nuclear Information System (INIS)

Andreeva, Julia; Casey, James; Gaidioz, Benjamin; Karavakis, Edward; Kokoszkiewicz, Lukasz; Lanciotti, Elisa; Maier, Gerhild; Rodrigues, Daniele Filipe Rocha Da Cuhna; Rocha, Ricardo; Saiz, Pablo; Sidorova, Irina; Boehm, Max; Belov, Sergey; Tikhonenko, Elena; Dvorak, Frantisek; Krenek, Ales; Mulac, Milas; Sitera, Jiri; Kodolova, Olga; Vaibhav, Kumar

2010-01-01

Job processing and data transfer are the main computing activities on the WLCG infrastructure. Reliable monitoring of the job processing on the WLCG scope is a complicated task due to the complexity of the infrastructure itself and the diversity of the currently used job submission methods. The paper will describe current status and the new strategy for the job monitoring on the WLCG scope, covering primary information sources, job status changes publishing, transport mechanism and visualization.

Methodological Approaches in Conducting Overviews: Current State in HTA Agencies

Science.gov (United States)

Pieper, Dawid; Antoine, Sunya-Lee; Morfeld, Jana-Carina; Mathes, Tim; Eikermann, Michaela

2014-01-01

Objectives: Overviews search for reviews rather than for primary studies. They might have the potential to support decision making within a shorter time frame by reducing production time. We aimed to summarize available instructions for authors intending to conduct overviews as well as the currently applied methodology of overviews in…

Investigation of Current Situation of Learning Motivation, Social Anxiety and Loneliness of the Left-behind Children in Rural Primary School

Directory of Open Access Journals (Sweden)

Zhang Biyun

2015-01-01

Full Text Available Objective: To understand the situation of learning motivation, social anxiety and loneliness of the left-behind children. Method: Selecting three rural primary schools in Xian’an District of Xianning City to investigate left-behind situation, learning motivation, social anxiety and loneliness of pupils in Grades 4 to 6 in rural primary school in Xian’an District by the use of the MAAT-I-A which is revised by Zhou Bucheng, the Social Anxiety Scale for Children (SASC and the Children’s Loneliness Scale (CLS. Results: (1 The learning motivation of the left-behind children in rural primary school is in a slightly higher medium level. Social anxiety is significantly higher than normal level in Chinese city, and the level of loneliness of about 1/5 of the left-behind children is relatively high. (2 The score of learning motivation, social anxiety and loneliness of the left-behind children in the level of knowledge learning has significant grade differences, without significant gender differences. (3 The level of learning motivation, social anxiety and loneliness of the left-behind children is slightly higher than that of non-left-behind children, but both differences are not significant.

Primary School Pre-Service Mathematics Teachers' Views on Mathematical Modeling

Science.gov (United States)

Karali, Diren; Durmus, Soner

2015-01-01

The current study aimed to identify the views of pre-service teachers, who attended a primary school mathematics teaching department but did not take mathematical modeling courses. The mathematical modeling activity used by the pre-service teachers was developed with regards to the modeling activities utilized by Lesh and Doerr (2003) in their…

Improving Services for Women with Depression in Primary Care Settings

Science.gov (United States)

Katon, Wayne J.; Ludman, Evette J.

2003-01-01

Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early…

Project Design Concept - Primary Ventilation System

International Nuclear Information System (INIS)

MCGREW, D.L.

2000-01-01

Tank Farm Restoration and Safe Operation (TFRSO), Project W-3 14 was established to provide upgrades that would improve the reliability and extend the system life of portions of the waste transfer, electrical, ventilation, instrumentation and control systems for the Hanford Site Tank Farms. An assessment of the tank farm system was conducted and the results are documented in system assessment reports. Based on the deficiencies identified in the tank farm system assessment reports, and additional requirements analysis performed in support of the River Protection Project (RPP), an approved scope for the TFRSO effort was developed and documented in the Upgrade Scope Summary Report (USSR), WHC-SD-W314-RPT-003, Rev. 4. The USSR establishes the need for the upgrades and identifies the specific equipment to be addressed by this project. This Project Design Concept (PDC) is in support of the Phase 2 upgrades and provides an overall description of the operations concept for the W-314 Primary Ventilation Systems. Actual specifications, test requirements, and procedures are not included in this PDC. The PDC is a ''living'' document, which will be updated throughout the design development process to provide a progressively more detailed description of the W-314 Primary Ventilation Systems design. The Phase 2 upgrades to the Primary Ventilation Systems shall ensure that the applicable current requirements are met for: Regulatory Compliance; Safety; Mission Requirements; Reliability; and Operational Requirements

Primary ciliary dyskinesia: clinical and genetic aspects

Directory of Open Access Journals (Sweden)

E. D’Auria

2012-06-01

Full Text Available Primary ciliary dyskinesia (PCD is a rare, genetically heterogeneous disease, characterized by ciliary disfunction and impaired mucociliary clearance, resulting in a range of clinical manifestations such as chronic bronchitis, bronchiectasis, chronic rhino-sinusitis, chronic otitis media, situs viscerum inversus in almost 40-50% of cases and male infertility. The triad situs viscerum inversus, bronchiectasis and sinusitis is known as Kartagener syndrome. Up to now little is known about genetic, diagnostic and therapeutic aspects of primary motile ciliary diseases in children: for this reason, diagnosis is generally delayed and almost all treatments for PCD are not based on randomized studies but extrapolated from cystic fibrosis guidelines. The aim of this review is to propose to pediatricians a summary of current clinical and diagnostic evidence to obtain better knoledwge of this condition. The earlier diagnosis and the right treatment are both crucial to improve the prognosis of PCD.

[The current state and prospectives of military endocrinology].

Science.gov (United States)

Nagibovich, O A; Golota, A S; Krassiĭ, A B

2014-10-01

The article is dedicated to the current state and prospectives of military endocrinology demonstrated on the examples of the endocrinology services of armed forces of Serbia, Poland, France, and USA. It is shown that this branch of military healthcare receives much attention abroad. The prospectives of military endocrinology are demonstrated in the context of two nosological forms which dominate in this section of military medicine, namely, primary hypothyroidism an diabetes mellitus.

Toward precision medicine in primary biliary cholangitis.

Science.gov (United States)

Carbone, Marco; Ronca, Vincenzo; Bruno, Savino; Invernizzi, Pietro; Mells, George F

2016-08-01

Primary biliary cholangitis is a chronic, cholestatic liver disease characterized by a heterogeneous presentation, symptomatology, disease progression and response to therapy. In contrast, clinical management and treatment of PBC is homogeneous with a 'one size fits all' approach. The evolving research landscape, with the emergence of the -omics field and the availability of large patient cohorts are creating a unique opportunity of translational epidemiology. Furthermore, several novel disease and symptom-modifying agents for PBC are currently in development. The time is therefore ripe for precision medicine in PBC. In this manuscript we describe the concept of precision medicine; review current approaches to risk-stratification in PBC, and speculate how precision medicine in PBC might develop in the near future. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Eolian dust dispersal patterns since the last glacial period in eastern Central Asia: insights from a loess-paleosol sequence in the Ili Basin

Directory of Open Access Journals (Sweden)

Y. Li

2018-03-01

Full Text Available The extensive loess deposits of the Eurasian mid-latitudes provide important terrestrial archives of Quaternary climatic change. As yet, however, loess records in Central Asia are poorly understood. Here we investigate the grain size and magnetic characteristics of loess from the Nilka (NLK section in the Ili Basin of eastern Central Asia. Weak pedogenesis suggested by frequency-dependent magnetic susceptibility (χfd% and magnetic susceptibility (MS peaks in primary loess suggest that MS is more strongly influenced by allogenetic magnetic minerals than pedogenesis, and may therefore be used to indicate wind strength. This is supported by the close correlation between variations in MS and proportions of the sand-sized fraction. To further explore the temporal variability in dust transport patterns, we identified three grain size end-members (EM1, mode size 47.5 µm; EM2, 33.6 µm; EM3, 18.9 µm which represent distinct aerodynamic environments. EM1 and EM2 are inferred to represent grain size fractions transported from proximal sources in short-term, near-surface suspension during dust outbreaks. EM3 appears to represent a continuous background dust fraction under non-dust storm conditions. Of the three end-members, EM1 is most likely the most sensitive recorder of wind strength. We compare our EM1 proportions with mean grain size from the Jingyuan section in the Chinese loess plateau, and assess these in the context of modern and Holocene climate data. Our research suggests that the Siberian High pressure system is the dominant influence on wind dynamics, resulting in loess deposition in the eastern Ili Basin. Six millennial-scale cooling (Heinrich events can be identified in the NLK loess records. Our grain size data support the hypothesis that the Siberian High acts as teleconnection between the climatic systems of the North Atlantic and East Asia in the high northern latitudes, but not for the mid-latitude westerlies.

Eolian dust dispersal patterns since the last glacial period in eastern Central Asia: insights from a loess-paleosol sequence in the Ili Basin

Science.gov (United States)

Li, Yue; Song, Yougui; Fitzsimmons, Kathryn E.; Chang, Hong; Orozbaev, Rustam; Li, Xinxin

2018-03-01

The extensive loess deposits of the Eurasian mid-latitudes provide important terrestrial archives of Quaternary climatic change. As yet, however, loess records in Central Asia are poorly understood. Here we investigate the grain size and magnetic characteristics of loess from the Nilka (NLK) section in the Ili Basin of eastern Central Asia. Weak pedogenesis suggested by frequency-dependent magnetic susceptibility (χfd%) and magnetic susceptibility (MS) peaks in primary loess suggest that MS is more strongly influenced by allogenetic magnetic minerals than pedogenesis, and may therefore be used to indicate wind strength. This is supported by the close correlation between variations in MS and proportions of the sand-sized fraction. To further explore the temporal variability in dust transport patterns, we identified three grain size end-members (EM1, mode size 47.5 µm; EM2, 33.6 µm; EM3, 18.9 µm) which represent distinct aerodynamic environments. EM1 and EM2 are inferred to represent grain size fractions transported from proximal sources in short-term, near-surface suspension during dust outbreaks. EM3 appears to represent a continuous background dust fraction under non-dust storm conditions. Of the three end-members, EM1 is most likely the most sensitive recorder of wind strength. We compare our EM1 proportions with mean grain size from the Jingyuan section in the Chinese loess plateau, and assess these in the context of modern and Holocene climate data. Our research suggests that the Siberian High pressure system is the dominant influence on wind dynamics, resulting in loess deposition in the eastern Ili Basin. Six millennial-scale cooling (Heinrich) events can be identified in the NLK loess records. Our grain size data support the hypothesis that the Siberian High acts as teleconnection between the climatic systems of the North Atlantic and East Asia in the high northern latitudes, but not for the mid-latitude westerlies.

Mineral formation and organo-mineral controls on the bioavailability of carbon at the terrestrial-aquatic interface

Science.gov (United States)

Rod, K. A.; Smith, A. P.; Renslow, R.

2016-12-01

Recent evidence highlights the importance of organo-mineral interactions in regulating the source or sink capacity of soil. High surface area soils, such as allophane-rich or clay-rich soils, retain organic matter (OM) via sorption to mineral surfaces which can also contribute physical isolation in interlayer spaces. Despite the direct correlation between mineral surfaces and OM accumulation, the pedogenic processes controlling the abundance of reactive surface areas and their distribution in the mineral matrix remains unclear. As global soil temperatures rise, the dissolution of primary minerals and formation of new secondary minerals may be thermodynamically favored as part of soil weathering process. Newly formed minerals can supply surfaces for organo-metallic bonding and may, therefore, stabilize OM by surface bonding and physical exclusion. This is especially relevant in environments that intersect terrestrial and aquatic systems, such as the capillary fringe zone in riparian ecosystems. To test the mechanisms of mineral surface area protection of OM, we facilitated secondary precipitation of alumino-silicates in the presence of OM held at two different temperatures in natural Nisqually River sediments (Mt Rainier, WA). This was a three month reaction intended to simulate early pedogenesis. To tease out the influence of mineral surface area increase during pedogenesis, we incubated the sediments at two different soil moisture contents to induce biodegradation. We measured OM desorption, biodegradation, and the molecular composition of mineral-associated OM both prior to and following the temperature manipulation. To simulate the saturation of capillary fringe sediment and associated transport and reaction of OM, column experiments were conducted using the reacted sediments. More co-precipitation was observed in the 20°C solution compared to the 4°C reacted solution suggesting that warming trends alter mineral development and may remove more OM from solution

Common Genetic Determinants of Intraocular Pressure and Primary Open-Angle Glaucoma

NARCIS (Netherlands)

van Koolwijk, Leonieke M. E.; Ramdas, Wishal D.; Ikram, M. Kamran; Jansonius, Nomdo M.; Pasutto, Francesca; Hysi, Pirro G.; Macgregor, Stuart; Janssen, Sarah F.; Hewitt, Alex W.; Viswanathan, Ananth C.; ten Brink, Jacoline B.; Hosseini, S. Mohsen; Amin, Najaf; Despriet, Dominiek D. G.; Willemse-Assink, Jacqueline J. M.; Kramer, Rogier; Rivadeneira, Fernando; Struchalin, Maksim; Aulchenko, Yurii S.; Weisschuh, Nicole; Zenkel, Matthias; Mardin, Christian Y.; Gramer, Eugen; Welge-Luessen, Ulrich; Montgomery, Grant W.; Carbonaro, Francis; Young, Terri L.; Bellenguez, Celine; McGuffin, Peter; Foster, Paul J.; Topouzis, Fotis; Mitchell, Paul; Wang, Jie Jin; Wong, Tien Y.; Czudowska, Monika A.; Hofman, Albert; Uitterlinden, Andre G.; Wolfs, Roger C. W.; de Jong, Paulus T. V. M.; Oostra, Ben A.; Paterson, Andrew D.; Mackey, David A.; Bergen, Arthur A. B.; Reis, Andre; Hammond, Christopher J.; Vingerling, Johannes R.; Lemij, Hans G.; Klaver, Caroline C. W.; van Duijn, Cornelia M.

2012-01-01

Intraocular pressure (IOP) is a highly heritable risk factor for primary open-angle glaucoma and is the only target for current glaucoma therapy. The genetic factors which determine IOP are largely unknown. We performed a genome-wide association study for IOP in 11,972 participants from 4

Training doctors for primary care in China: Transformation of general practice education.

Science.gov (United States)

Li, Donald

2016-01-01

China is known for developing a cadre of "Barefoot Doctors" to address her rural healthcare needs in past. The tradition of barefoot doctors has inspired similar developments in several other countries across world. Recently China has embarked upon an ambitious new mission to create a primary care workforce consisting of trained general practitioners having international standard skillsets. This editorial provides an insight into the current status of policy deliberations with regards to training of primary care doctors and a new surge in general practice education in China.

Multiple modes of action potential initiation and propagation in mitral cell primary dendrite

DEFF Research Database (Denmark)

Chen, Wei R; Shen, Gongyu Y; Shepherd, Gordon M

2002-01-01

recordings with computational modeling to analyze action-potential initiation and propagation in the primary dendrite. In response to depolarizing current injection or distal olfactory nerve input, fast Na(+) action potentials were recorded along the entire length of the primary dendritic trunk. With weak......-to-moderate olfactory nerve input, an action potential was initiated near the soma and then back-propagated into the primary dendrite. As olfactory nerve input increased, the initiation site suddenly shifted to the distal primary dendrite. Multi-compartmental modeling indicated that this abrupt shift of the spike......-initiation site reflected an independent thresholding mechanism in the distal dendrite. When strong olfactory nerve excitation was paired with strong inhibition to the mitral cell basal secondary dendrites, a small fast prepotential was recorded at the soma, which indicated that an action potential was initiated...

Current distribution in triodes neglecting space charge and initial velocities

NARCIS (Netherlands)

Hamaker, H.C.

1950-01-01

A theory of the current distribution in triodes with positive grid is developed on the assumption that space charge and the initial velocities of both primary and secondary electrons may be neglected. This theory, which is originally due to De Lussanct de la Sablonière, has been put in a more lucid

Nurse practitioner caseload in primary health care: Scoping review.

Science.gov (United States)

Martin-Misener, Ruth; Kilpatrick, Kelley; Donald, Faith; Bryant-Lukosius, Denise; Rayner, Jennifer; Valaitis, Ruta; Carter, Nancy; Miller, Patricia A; Landry, Véronique; Harbman, Patricia; Charbonneau-Smith, Renee; McKinlay, R James; Ziegler, Erin; Boesveld, Sarah; Lamb, Alyson

2016-10-01

To identify recommendations for determining patient panel/caseload size for nurse practitioners in community-based primary health care settings. Scoping review of the international published and grey literature. The search included electronic databases, international professional and governmental websites, contact with experts, and hand searches of reference lists. Eligible papers had to (a) address caseload or patient panels for nurse practitioners in community-based primary health care settings serving an all-ages population; and (b) be published in English or French between January 2000 and July 2014. Level one testing included title and abstract screening by two team members. Relevant papers were retained for full text review in level two testing, and reviewed by two team members. A third reviewer acted as a tiebreaker. Data were extracted using a structured extraction form by one team member and verified by a second member. Descriptive statistics were estimated. Content analysis was used for qualitative data. We identified 111 peer-reviewed articles and grey literature documents. Most of the papers were published in Canada and the United States after 2010. Current methods to determine panel/caseload size use large administrative databases, provider work hours and the average number of patient visits. Most of the papers addressing the topic of patient panel/caseload size in community-based primary health care were descriptive. The average number of patients seen by nurse practitioners per day varied considerably within and between countries; an average of 9-15 patients per day was common. Patient characteristics (e.g., age, gender) and health conditions (e.g., multiple chronic conditions) appear to influence patient panel/caseload size. Very few studies used validated tools to classify patient acuity levels or disease burden scores. The measurement of productivity and the determination of panel/caseload size is complex. Current metrics may not capture

Long-Term Performance of Primary and Secondary Electroactive Biofilms Using Layered Corrugated Carbon Electrodes

International Nuclear Information System (INIS)

Baudler, André; Riedl, Sebastian; Schröder, Uwe

2014-01-01

The performance of primary and secondary electroactive biofilms grown on layered corrugated carbon (LCC) electrodes was studied over a period of several months. With an average projected current density of 6.7 mA cm −2 , the studied secondary electroactive biofilms outperformed the primary biofilms (3.0 mA cm −2 ) over the entire experimental period. At the same time, both, primary and secondary biofilms, exhibited a constant Coulomb efficiency of about 89%. The study further illustrates that three-dimensional electrodes such as LCC allow a sustained long-term performance without significant decrease in electrode performance.

Long-Term Performance of Primary and Secondary Electroactive Biofilms Using Layered Corrugated Carbon Electrodes

Energy Technology Data Exchange (ETDEWEB)

Baudler, André; Riedl, Sebastian; Schröder, Uwe, E-mail: uwe.schroeder@tu-bs.de [Institute of Environmental and Sustainable Chemistry, Technische Universität Braunschweig, Braunschweig (Germany)

2014-07-30

The performance of primary and secondary electroactive biofilms grown on layered corrugated carbon (LCC) electrodes was studied over a period of several months. With an average projected current density of 6.7 mA cm{sup −2}, the studied secondary electroactive biofilms outperformed the primary biofilms (3.0 mA cm{sup −2}) over the entire experimental period. At the same time, both, primary and secondary biofilms, exhibited a constant Coulomb efficiency of about 89%. The study further illustrates that three-dimensional electrodes such as LCC allow a sustained long-term performance without significant decrease in electrode performance.

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. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Differential Gene Expression in Primary Breast Tumors Associated with Lymph Node Metastasis

International Nuclear Information System (INIS)

Ellsworth, R.E.; Field, L.A.; Kane, J.L.; Love, B.; Hooke, J.A.; Shriver, C.D.

2011-01-01

Lymph node status remains one of the most useful prognostic indicators in breast cancer; however, current methods to assess nodal status disrupt the lymphatic system and may lead to secondary complications. Identification of molecular signatures discriminating lymph node-positive from lymph node-negative primary tumors would allow for stratification of patients requiring surgical assesment of lymph nodes. Primary breast tumors from women with negative (n=41) and positive (n=35) lymph node status matched for possible confounding factors were subjected to laser micro dissection and gene expression data generated. Although ANOVA analysis (P 1.5) revealed 13 differentially expressed genes, hierarchical clustering classified 90% of node-negative but only 66% of node-positive tumors correctly. The inability to derive molecular profiles of metastasis in primary tumors may reflect tumor heterogeneity, paucity of cells within the primary tumor with metastatic potential, influence of the microenvironment, or inherited host susceptibility to metastasis

Differential Gene Expression in Primary Breast Tumors Associated with Lymph Node Metastasis

Science.gov (United States)

Ellsworth, Rachel E.; Field, Lori A.; Love, Brad; Kane, Jennifer L.; Hooke, Jeffrey A.; Shriver, Craig D.

2011-01-01

Lymph node status remains one of the most useful prognostic indicators in breast cancer; however, current methods to assess nodal status disrupt the lymphatic system and may lead to secondary complications. Identification of molecular signatures discriminating lymph node-positive from lymph node-negative primary tumors would allow for stratification of patients requiring surgical assesment of lymph nodes. Primary breast tumors from women with negative (n = 41) and positive (n = 35) lymph node status matched for possible confounding factors were subjected to laser microdissection and gene expression data generated. Although ANOVA analysis (P 1.5) revealed 13 differentially expressed genes, hierarchical clustering classified 90% of node-negative but only 66% of node-positive tumors correctly. The inability to derive molecular profiles of metastasis in primary tumors may reflect tumor heterogeneity, paucity of cells within the primary tumor with metastatic potential, influence of the microenvironment, or inherited host susceptibility to metastasis. PMID:22295210

Differential Gene Expression in Primary Breast Tumors Associated with Lymph Node Metastasis

Directory of Open Access Journals (Sweden)

Rachel E. Ellsworth

2011-01-01

Full Text Available Lymph node status remains one of the most useful prognostic indicators in breast cancer; however, current methods to assess nodal status disrupt the lymphatic system and may lead to secondary complications. Identification of molecular signatures discriminating lymph node-positive from lymph node-negative primary tumors would allow for stratification of patients requiring surgical assesment of lymph nodes. Primary breast tumors from women with negative (=41 and positive (=35 lymph node status matched for possible confounding factors were subjected to laser microdissection and gene expression data generated. Although ANOVA analysis (1.5 revealed 13 differentially expressed genes, hierarchical clustering classified 90% of node-negative but only 66% of node-positive tumors correctly. The inability to derive molecular profiles of metastasis in primary tumors may reflect tumor heterogeneity, paucity of cells within the primary tumor with metastatic potential, influence of the microenvironment, or inherited host susceptibility to metastasis.

Space-charge-limited currents in electron-irradiated dielectrics

International Nuclear Information System (INIS)

Nunes de Oliveira, L.; Gross, B.

1975-01-01

This paper develops the theory of steady-state currents generated in a dielectric placed between positively or negatively biased electrodes and irradiated with a partially penetrating electron beam. The dielectric is divided into an irradiated region (IR), which extends from the electrode of incidence to the extrapolated range of the beam, and a nonirradiated region (NIR). In the IR the primary beam generates an electron-hole plasma. Its end plane acts as a virtual electrode embedded in the dielectric. Currents are space-charge limited in the NIR and Ohmic in the IR which is characterized by a uniform radiation-induced conductivity. Depending on the polarity of the electrode bias, electrons or holes are drawn from the IR into the NIR. The theory correctly predicts an apparent threshold effect for the inset of steady-state currents: the current amplitudes remain small as long as the electron range is smaller than half the sample thickness, and increase strongly only afterwards. Calculated current curves for different beam energies are in satisfactory agreement with experimental results. The role of the electron beam as a virtual electrode is discussed

Gender Differences in the Primary Representational System according to Neurolinguistic Programming.

Science.gov (United States)

Cassiere, M. F.; And Others

Neurolinguistic Programming (NLP) is a currently popular therapeutic modality in which individuals organize information through three basic sensory systems, one of which is the Primary Representational System (PRS). This study was designed to investigate gender differences in PRS according to the predicate preference method. It was expected that…

Primary electric propulsion thrust subsystem definition

Science.gov (United States)

Masek, T. D.; Ward, J. W.; Kami, S.

1975-01-01

A review is presented of the current status of primary propulsion thrust subsystem (TSS) performance, packaging considerations, and certain operational characteristics. Thrust subsystem related work from recent studies by Jet Propulsion Laboratories (JPL), Rockwell and Boeing is discussed. Existing performance for 30-cm thrusters, power processors and TSS is present along with projections for future improvements. Results of analyses to determine (1) magnetic field distributions resulting from an array of thrusters, (2) thruster emitted particle flux distributions from an array of thrusters, and (3) TSS element failure rates are described to indicate the availability of analytical tools for evaluation of TSS designs.

Implantable Cardioverter-defibrillator Therapy for Hypertrophic Cardiomyopathy: Usefulness in Primary and Secondary Prevention.

Science.gov (United States)

Sarrias, Axel; Galve, Enrique; Sabaté, Xavier; Moya, Àngel; Anguera, Ignacio; Núñez, Elaine; Villuendas, Roger; Alcalde, Óscar; García-Dorado, David

2015-06-01

Hypertrophic cardiomyopathy is a frequent cause of sudden death. Clinical practice guidelines indicate defibrillator implantation for primary prevention in patients with 1 or more risk factors and for secondary prevention in patients with a history of aborted sudden death or sustained ventricular arrhythmias. The aim of the present study was to analyze the follow-up of patients who received an implantable defibrillator following the current guidelines in nonreferral centers for this disease. This retrospective observational study included all patients who underwent defibrillator implantation between January 1996 and December 2012 in 3 centers in the province of Barcelona. The study included 69 patients (mean age [standard deviation], 44.8 [17] years; 79.3% men), 48 in primary prevention and 21 in secondary prevention. The mean number of risk factors per patient was 1.8 in the primary prevention group and 0.5 in the secondary prevention group (P=.029). The median follow-up duration was 40.5 months. The appropriate therapy rate was 32.7/100 patient-years in secondary prevention and 1.7/100 patient-years in primary prevention (P<.001). Overall mortality was 10.1%. Implant-related complications were experienced by 8.7% of patients, and 13% had inappropriate defibrillator discharges. In patients with a defibrillator for primary prevention, the appropriate therapy rate is extremely low, indicating the low predictive power of the current risk stratification criteria. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Amenorrhea - primary

Science.gov (United States)

... of periods - primary Images Primary amenorrhea Normal uterine anatomy (cut section) Absence of menstruation (amenorrhea) References Bulun SE. The physiology and pathology of the female reproductive axis. In: ...

Axillary node metastatic carcinoma without definitive primary: a case report

Directory of Open Access Journals (Sweden)

Spencer R. Anderson

2016-01-01

Full Text Available Cancer of unknown primary (CUP is the finding of a metastatic cancerous lesion without an established primary source localized within the body. CUP can be of any cancer cell type, however, adenocarcinoma is most often identified by histology. Up to 5% of all malignant diagnoses are classified as CUP. PET is an imaging modality often utilized to distinguish a primary source in the setting of CUP, yet often a primary is never identified. CUP can be further stratified using specific qualifiers as favorable and unfavorable, indicating the potential therapeutic response to treatment regimens. Treatment approach to CUP relies heavily on the cell type identified by histology, the location of the lesion, and the amount of spread within the body. In the typical setting and presentation, per current literature, CUP arises in the 7th decade of life in patients with multiple comorbidities, and often has a poor prognostic value. This case report identifies an atypical presentation of CUP, a 38-year-old Caucasian female with an axillary mobile mass, and no associated systemic symptoms. Biopsy of the node and immunohistochemical staining showed histology consistent with metastatic carcinoma. Mammography, MRI, and PET scan found no evidence of tumor primary or distant metastasis. Further staining confirmed metastatic carcinoma consistent with breast origin, without an established breast primary. As in this case, CUP may present in an atypical manner, warranting a thorough investigation aiming to identify the tumor primary to aid in identification of a proper treatment regimen and approach.

Data for spatial characterization of AC signal propagation over primary neuron dendrites

Directory of Open Access Journals (Sweden)

Hojeong Kim

2016-03-01

Full Text Available Action potentials generated near the soma propagate not only into the axonal nerve connecting to the adjacent neurons but also into the dendrites interacting with a diversity of synaptic inputs as well as voltage gated ion channels. Measuring voltage attenuation factors between the soma and all single points of the dendrites in the anatomically reconstructed primary neurons with the same cable properties, we report the signal propagation data showing how the alternating current (AC signal such as action potentials back-propagates over the dendrites among different types of primary neurons. Fitting equations and their parameter values for the data are also presented to quantitatively capture the spatial profile of AC signal propagation from the soma to the dendrites in primary neurons. Our data is supplemental to our original study for the dependency of dendritic signal propagation and excitability, and their relationship on the cell type-specific structure in primary neurons (DOI: 10.1016/j.neulet.2015.10.017 [1]. Keywords: Primary neurons, Dendritic signal processing, AC signal propagation, Voltage attenuation analysis

Addressing the primary care physician shortage in an evolving medical workforce

Directory of Open Access Journals (Sweden)

Lakhan Shaheen E

2009-05-01

Full Text Available Abstract Background Primary care physicians have been shown to play an important role in the general health of the communities in which they serve. In spite of their importance, however, there has been a decrease in the number of physicians interested in pursuing primary care fields, while the proportion of specialists continues to increase. The prediction of an overall physician shortage only augments this issue in the US, where this uneven distribution is particularly evident. As such, serious effort to increase the number of practicing primary care physicians is both necessary and beneficial for meeting this country's health care needs. Discussion There are several factors at play which contribute to the decrease in the number of practicing physicians in primary specialties. Lifestyle concerns, such as schedule and income, as well as the lack of prestige associated with this field seem to be among the most prevalent reasons cited for the diminishing interest. Multifaceted concerns such as these, however, are difficult to adequately invalidate; doing so would not only require a great deal research, but also a good deal of time – a resource which is in short supply given the current physician shortage being faced. Thus, a more immediate solution may lie in the increased recruitment and continued support of those individuals who are already associated with primary care service. This is particularly relevant given the Association of American Medical College's goal of increasing medical school enrollment by 15% over the next 10 years. Several groups have been shown to be large contributors to primary care in the US. Here, we focus on three such groups: minority students, International Medical Graduates (IMGs and Osteopathic Physicians (DOs. Although these groups are highly diverse individually, they all share the distinction of being underutilized in regard to the current primary care shortages faced. Thus, through more fully accentuating these

Isotopic studies of Yucca Mountain soil fluids and carbonate pedogenesis

International Nuclear Information System (INIS)

McConnaughey, T.A.; Whelan, J.F.; Wickland, K.P.; Moscati, R.J.

1994-01-01

Secondary carbonates occurring within the soils, faults, and subsurface fractures of Yucca Mountain contain some of the best available records of paleoclimate and palehydrology for the potential radioactive waste repository site. This article discusses conceptual and analytical advances being made with regard to the interpretation of stable isotope data from pedogenic carbonates, specifically related to the 13 C content of soil CO 2 , CaCO 3 , precipitation mechanisms, and isotopic fractionations between parent fluids and precipitating carbonates. The 13 C content of soil carbon dioxide from Yucca Mountain and vicinity shows most of the usual patterns expected in such contexts: Decreasing 13 C content with depth decreasing 13 C with altitude and reduced 13 C during spring. These patterns exist within the domain of a noisy data set; soil and vegetational heterogeneities, weather, and other factors apparently contribute to isotopic variability in the system. Several soil calcification mechanisms appear to be important, involving characteristic physical and chemical environments and isotopic fractionations. When CO 2 loss from thin soil solutions is an important driving factor, carbonates may contain excess heavy isotopes, compared to equilibrium precipitation with soil fluids. When root calcification serves as a proton generator for plant absorption of soil nutrients, heavy isotope deficiencies are likely. Successive cycles of dissolution and reprecipitation mix and redistribute pedogenic carbonates, and tend to isotopically homogenize and equilibrate pedogenic carbonates with soil fluids

A Review of Hepatitis C Virus (HCV) and the Current Management ...

African Journals Online (AJOL)

Background: Chronic Hepatitis C virus (HCV) is the primary cause of cirrhosis, hepatocellular carcinoma (HCC), and end- stage liver disease. The addition of protease inhibitor with peginterferon alfa and ribavirin (triple therapy) for genotype 1 infected patients, are the current standard of care. Method: Data was sourced ...

Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

OpenAIRE

Worrall, A.; Rea, J. N.; Ben-Shlomo, Y.

1997-01-01

OBJECTIVE: To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. DESIGN: Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. SETTING: Inner city group practice with a socio...

Primary explosives

Energy Technology Data Exchange (ETDEWEB)

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

2013-06-01

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

High Critical Current Coated Conductors

Energy Technology Data Exchange (ETDEWEB)

Paranthaman, M. P.; Selvamanickam, V. (SuperPower, Inc.)

2011-12-27

One of the important critical needs that came out of the DOE’s coated conductor workshop was to develop a high throughput and economic deposition process for YBCO. Metal-organic chemical vapor deposition (MOCVD) technique, the most critical steps in high technical micro fabrications, has been widely employed in semiconductor industry for various thin film growth. SuperPower has demonstrated that (Y,Gd)BCO films can be deposited rapid with world record performance. In addition to high critical current density with increased film thickness, flux pinning properties of REBCO films needs to be improved to meet the DOE requirements for various electric-power equipments. We have shown that doping with Zr can result in BZO nanocolumns, but at substantially reduced deposition rate. The primary purpose of this subtask is to develop high current density MOCVD-REBCO coated conductors based on the ion-beam assisted (IBAD)-MgO deposition process. Another purpose of this subtask is to investigate HTS conductor design optimization (maximize Je) with emphasis on stability and protection issues, and ac loss for REBCO coated conductors.

Job satisfaction among primary care physicians: results of a survey.

Science.gov (United States)

Behmann, Mareike; Schmiemann, Guido; Lingner, Heidrun; Kühne, Franziska; Hummers-Pradier, Eva; Schneider, Nils

2012-03-01

A shortage of primary care physicians (PCPs) seems likely in Germany in the near future and already exists in some parts of the country. Many currently practicing PCPs will soon reach retirement age, and recruiting young physicians for family practice is difficult. The attractiveness of primary care for young physicians depends on the job satisfaction of currently practicing PCPs. We studied job satisfaction among PCPs in Lower Saxony, a large federal state in Germany. In 2009, we sent a standardized written questionnaire on overall job satisfaction and on particular aspects of medical practice to 3296 randomly chosen PCPs and internists in family practice in Lower Saxony (50% of the entire target population). 1106 physicians (34%) responded; their mean age was 52, and 69% were men. 64% said they were satisfied or very satisfied with their job overall. There were particularly high rates of satisfaction with patient contact (91%) and working atmosphere (87% satisfied or very satisfied). In contrast, there were high rates of dissatisfaction with administrative tasks (75% dissatisfied or not at all satisfied). The results were more indifferent concerning payment and work life balance. Overall, younger PCPs and physicians just entering practice were more satisfied than their older colleagues who had been in practice longer. PCPs are satisfied with their job overall. However, there is significant dissatisfaction with administrative tasks. Improvements in this area may contribute to making primary care more attractive to young physicians.

Substance use among persons with homeless experience in primary care.

Science.gov (United States)

Stringfellow, Erin J; Kim, Theresa W; Gordon, Adam J; Pollio, David E; Grucza, Richard A; Austin, Erika L; Johnson, N Kay; Kertesz, Stefan G

2016-01-01

Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.

PRIMARY STUDENTS' STEREOTYPIC IMAGE OF INVENTOR IN KOREA

Directory of Open Access Journals (Sweden)

Eunsang Lee

2018-04-01

Full Text Available The purpose of this research is to compare the previous stereotypes of the scientist image and the current stereotypes of the inventor image among Korean students. For this purpose, three primary schools located in the metropolitan area of Korea were selected under a convenience sampling method, with one class selected for each of the 2nd, 4th, and 6th grades of each school. The conclusions of this research are as follows. First, analyzing students' stereotypes of the inventor image showed that older students had more stereotypes about inventors than younger students did. Second, as a result of analyzing the images according to each indicator, Korean students were found to have stereotypes about the inventor. Third, the symbol of research was expressed together with one of the science-related experiment tool and the making-related experiment tool. Fourth, primary students perceived the inventor as mainly male. Male students mostly drew male inventors and female students mostly drew female inventors. Based on the conclusions obtained through this research, various educational implications to be reflected in primary technology education were suggested to escape the stereotypes of the inventor’s image.

Automorphism modular invariants of current algebras

International Nuclear Information System (INIS)

Gannon, T.; Walton, M.A.

1996-01-01

We consider those two-dimensional rational conformal field theories (RCFTs) whose chiral algebras, when maximally extended, are isomorphic to the current algebra formed from some untwisted affine Lie algebra at fixed level. In this case the partition function is specified by an automorphism of the fusion ring and corresponding symmetry of the Kac-Peterson modular matrices. We classify all such partition functions when the underlying finite-dimensional Lie algebra is simple. This gives all possible spectra for this class of RCFTs. While accomplishing this, we also find the primary fields with second smallest quantum dimension. (orig.). With 3 tabs

Solar flares through electric current interaction

International Nuclear Information System (INIS)

De Jager, C.

1988-01-01

The fundamental hypothesis by Alfven and Carlqvist (1967) that solar flares are related to electrical currents in the solar chromosphere and low corona is investigated in the light of modern observations. The authors confirm the important role of currents in solar flares. There must be tens of such current loops (flux threads) in any flare, and this explains the hierarchy of bursts in flares. The authors summarize quantitative data on energies, numbers of particles involved and characteristic times. A special case is the high-energy flare: this one may originate in the same way as less energetic ones, but it occurs in regions with higher magnetic field strength. Because of the high particle energies involved their emission seats live only very briefly; hence the area of emission coincides virtually with the seat of the instability. These flares are therefore the best examples for studying the primary instability leading to the flare. Finally, the authors compare the merits of the original Alfven-Carlqvist idea (that flares originate by current interruption) with the one that they are due to interaction (reconnection) between two or more fluxthreads. The authors conclude that a final decision cannot yet by made, although the observed extremely short time constants of flare bursts seem to demand a reconnection-type instability rather than interruption of a circuit

[PRIMARY HEADACHE IN CHILDREN AND ADOLESCENTS--DIAGNOSIS AND TREATMENT].

Science.gov (United States)

Matar, Amal Khourieh; Kerem, Nogah C; Srugo, Isaac; Genizi, Jacob

2015-12-01

Primary headaches are one of the most common disorders of childhood, with migraine and tension type headaches (TTHs) being the most frequent ones. In spite of their prevalence, there is paucity of knowledge regarding the underlying pathophysiological mechanisms that cause headaches and regarding the unique aspects of headaches in children and adolescents. To review the literature and summarize the knowledge regarding clinical features, diagnosis and management of primary headache in children and adolescents, mainly migraine and TTH. Most of our current knowledge regarding primary headaches in children and adolescents is driven from extrapolations from studies that were conducted with adult patients. Therefore, it needs to be validated for the different age groups. Migraines may be diagnosed effectively based on the 2nd edition of the International Classification of Headache Disorders (ICHD-II), however, TTH is diagnosed mainly by the absence of features found in other headache types. Treatment strategies for primary headaches vary according to patient's age, family structure, culture and beliefs, headache diagnosis, and based on the disability the headache imposes on the patient's daily living. It was shown that a multidisciplinary approach, that includes continuing counseling, education, and reassurance, in combination with pharmacological and non-pharmacological treatment, is an effective strategy for children and adolescents suffering from primary headaches. Further studies are needed to enrich our knowledge about the pathophysiological mechanisms that cause headaches in children and adolescents and to develop efficient strategies to alleviate their burden.

Exploring weight loss services in primary care and staff views on using a web-based programme.

Science.gov (United States)

Ware, Lisa J; Williams, Sarah; Bradbury, Katherine; Brant, Catherine; Little, Paul; Hobbs, F D Richard; Yardley, Lucy

2012-01-01

Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of e-health into primary care may face challenges. To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery. Focus groups were conducted with primary care physicians, nurses and healthcare assistants (n = 36) involved in delivering weight loss services. Data were analysed using inductive thematic analysis. Participants thought that primary care should be involved in delivering weight management, especially when weight was aggravating health problems. However, they felt under-resourced to deliver these services and unsure as to the effectiveness of their input, as routine services were not evaluated. Beliefs that current services were ineffective resulted in staff reluctance to allocate more resources. Participants were hopeful that supplementing practice with a web-based weight management programme would enhance patient services and promote service evaluation. Although primary care staff felt they should deliver weight loss services, low levels of faith in the efficacy of current treatments resulted in provision of under-resourced and 'ad hoc' services. Integration of a web-based weight loss programme that promotes service evaluation and provides a cost-effective option for supporting patients may encourage practices to invest more in weight management services.

Exploring weight loss services in primary care and staff views on using a web-based programme

Directory of Open Access Journals (Sweden)

Lisa J Ware

2013-09-01

Full Text Available Background Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of ehealth into primary care may face challenges.Objectives To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery.Methods Focus groups were conducted with primary care physicians, nurses and healthcare assistants (n = 36 involved in delivering weight loss services. Data were analysed using inductive thematic analysis.Results Participants thought that primary care should be involved in delivering weight management, especially when weight was aggravating health problems. However, they felt under-resourced to deliver these services and unsure as to the effectiveness of their input, as routine services were not evaluated. Beliefs that current services were ineffective resulted in staff reluctance to allocate more resources. Participants were hopeful that supplementing practice with a web-based weight management programme would enhance patient services and promote service evaluation.Conclusions Although primary care staff felt they should deliver weight loss services, low levels of faith in the efficacy of current treatments resulted in provision of under-resourced and ‘ad hoc’ services. Integration of a web-based weight loss programme that promotes service evaluation and provides a cost-effective option for supporting patients may encourage practices to invest more in weight management services.

Status and costs of primary prevention for ischemic stroke in China.

Science.gov (United States)

Zhao, J J; He, G Q; Gong, S Y; He, L

2013-10-01

Despite the benefits in reducing the risk of stroke, primary prevention is not well translated into practice. We sought to evaluate patient compliance with guidelines and the cost of primary stroke prevention in southwest China. We consecutively enrolled 305 patients with headaches and/or dizziness who were at high risk of stroke from our hospital. We retrospectively obtained their information, including the extent of their knowledge of stroke risk factors, adherence to guidelines, medications taken, and costs of primary prevention for stroke within the past year. Only 45.9% of patients had any knowledge of primary prevention, and only 17.0% had completely followed guidelines. Moreover, 79.0% of the patients were using medications, but only 39.3% took their medication as recommended. In patients who took medication, 89.6% were prescribed by physicians. The annual costs of primary prevention were estimated to be US$517.8 per capita, which included direct medical costs (US$435.4), direct non-medical costs (US$18.1), and indirect costs (US$64.3). Costs in the hypertension group were less than those reported by a similar international study. Although our population sample may not be representative of the population at high risk of stroke in China, it is appropriate for the evaluation of our primary prevention system. Primary prevention for stroke in southwest China is very challenging, with few medical resource investments. There is a current urgency to improve patient knowledge of primary prevention, which would bridge the gaps between guidelines and practice and increase medical resource investments. Copyright © 2013 Elsevier Ltd. All rights reserved.

Empirical and dynamic primary energy factors

International Nuclear Information System (INIS)

Wilby, Mark Richard; Rodríguez González, Ana Belén; Vinagre Díaz, Juan José

2014-01-01

Current legislation, standards, and scientific research in the field of energy efficiency often make use of PEFs (primary energy factors). The measures employed are usually fixed and based on theoretical calculations. However given the intrinsically variable nature of energy systems, these PEFs should rely on empirical data and evolve in time. Otherwise the obtained efficiencies may not be representative of the actual energy system. In addition, incorrect PEFs may cause a negative effect on the energy efficiency measures. For instance, imposing a high value on the PEF of electricity may discourage the use of renewable energy sources, which have an actual value close to 1. In order to provide a solution to this issue, we propose an application of the Energy Networks (ENs), described in a previous work, to calculate dynamic PEFs based on empirical data. An EN represents an entire energy system both numerically and graphically, from its primary energy sources to their final energy forms, and consuming sectors. Using ENs we can calculate the PEF of any energy form and depict it in a simple and meaningful graph that shows the details of the contribution of each primary energy and the efficiency of the associated process. The analysis of these PEFs leads to significant conclusions regarding the energy models adopted among countries, their evolution in time, the selection of viable ways to improve efficiency, and the detection of best practices that could contribute to the overall energy efficiency targets. - Highlights: • Primary Energy Factors (PEFs) are foundation of much energy legislation and research. • Traditionally, they have been treated as geotemporally invariant. • This work provides a systematic and transparent methodology for adding variability. • It also shows the variability between regions due to market, policy, and technology. • Finally it demonstrates the utility of extended PEFs as a tool in their own right

Multiple primary cancer

International Nuclear Information System (INIS)

Jung, Gyu Sik; Lee, Ouk; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duck

1989-01-01

It is rare for one human being to be afflicted with more than one cancer. However with further advances in therapeutic regimens, histopathologic observation, diagnostic modalities, and increased curiosity, there are increasing number of case reports of multiple primary cancer. The present study evaluates 25 histologically confirmed cases of multiple primary cancer from 1974 to 1988 at Kosin Medical Center. The most frequent site of the first primary cancer in male was stomach and in female, uterine cervix. The first primary cancer in female occurred in endocrine-related organs (breast, uterus and thyroid) in 63.6 percent. Synchronous cancers are diagnosed simultaneously or within an interval of about six months and synchronous cancers were 16 out of 25 cases. Metachronous cancers are diagnosed at interval of more than six months. There were 9 metachronous cancers and average interval between the first and second primary cancer was 22.8 months. The incidence of multiple primary cancer was 0.11 percent. The average age was 51.9 years at the time of the first primary cancer (53.1 years in male and 50.3 years in female). CT scan was most helpful in early detection of multiple primary cancers facilitating biopsy and surgery. Multiple primary cancers are beyond the medical curiosity. Early diagnosis of the disease and careful follow-up study, based on an awareness of the possibility of second cancers, will substantially increase the survival of these patients

Overview of the current National Primary Drinking Water Regulations and regulation development process

International Nuclear Information System (INIS)

Cotruvo, J.A.; Regelski, M.

1989-01-01

The promulgation of the National Primary Drinking Water Regulations (NPDWR) follows specific steps. First, the Advance Notice of Proposed Rule Making (ANPRM) is published. Second, the EPA, as mandated by the SDWA Amendments, proposes maximum contaminant levels (MCLs), (enforceable standards) and maximum contaminant level goals (MCLGs) simultaneously. The Office of Drinking Water developed a six-phase schedule that has attempted to parallel the SDWA-specified deadlines: Phase I - Voltile organic chemicals - July 8, 1987; Phase II - Synthetic organic chemicals and inorganic chemicals - June 1989, microbials and surface water treatment - June 1989, and Lead/copper - December 1988; Phase III - Radionuclides - December 1988; Phase IV - Disinfectants and disinfection by-products - June 1989; Phase V - Other inorganic chemicals, synthetic organic chemicals, and pesticides - June 1989; and Phase VI - 25 additional chemicals - January 199. In selecting contaminants for regulation, the most relevant criteria are (1) potential health risk; (2) ability to detect a contaminant in the drinking water; and (3) occurrence or potential occurrence in drinking water. The EPA uses a three category approach for setting maximum contaminant level goals for carcinogens: Category I, strong evidence of carcinogenicity-zero; Category II, equivocal evidence - reference dose (RfD) approach or 0.00001 to 0.000001 cancer risk range; and Category III, inadequate or no evidence from animal studies - RfD approach. 10 refs., 5 tabs

Effectiveness of direct-current cardioversion for treatment of supraventricular tachyarrhythmias, in particular atrial fibrillation, in surgical intensive care patients.

Science.gov (United States)

Mayr, Andreas; Ritsch, Nicole; Knotzer, Hans; Dünser, Martin; Schobersberger, Wolfgang; Ulmer, Hanno; Mutz, Norbert; Hasibeder, Walter

2003-02-01

To evaluate primary success rate and effectiveness of direct-current cardioversion in postoperative critically ill patients with new-onset supraventricular tachyarrhythmias. Prospective intervention study. Twelve-bed surgical intensive care unit in a university teaching hospital. Thirty-seven consecutive, adult surgical intensive care unit patients with new-onset supraventricular tachyarrhythmias without previous history of tachyarrhythmias. Direct-current cardioversion using a monophasic, damped sinus-wave defibrillator. Energy levels used were 50, 100, 200, and 300 J for regular supraventricular tachyarrhythmias (n = 6) and 100, 200, and 360 J for irregular supraventricular tachyarrhythmias (n = 31). None of the patients was hypoxic, hypokalemic, or hypomagnesemic at onset of supraventricular tachyarrhythmia. Direct-current cardioversion restored sinus rhythm in 13 of 37 patients (35% primary responders). Most patients responded to the first or second direct-current cardioversion shock. Only one of 25 patients requiring more than two direct-current cardioversion shocks converted into sinus rhythm. Primary responders were significantly younger and demonstrated significant differences in arterial Po2 values at onset of supraventricular tachyarrhythmias compared with nonresponders. At 24 and 48 hrs, only six (16%) and five (13.5%) patients remained in sinus rhythm, respectively. In contrast to recent literature, direct-current cardioversion proved to be an ineffective method for treatment of new-onset supraventricular tachyarrhythmias and, in particular, atrial fibrillation with a rapid ventricular response in surgical intensive care unit patients.

Attitudes About and Practices of Health Promotion and Prevention Among Primary Care Providers.

Science.gov (United States)

Luquis, Raffy R; Paz, Harold L

2015-09-01

The Patient Protection and Affordable Care Act's emphasis on health promotion and prevention activities required an examination of the current practices of primary care providers in these areas. A total of 196 primary care providers completed a survey to assess current health promotion and prevention attitudes, practices, and barriers. Results of this study showed that family physicians in Pennsylvania recognize the importance of and their role in providing health promotion and prevention and offer advice in key behavioral and disease prevention areas. Results from the study suggest that their ability to provide these services is hindered by a lack of time and the heavy workload. Although most family physicians provided advice to patients in several health promotion and prevention areas, few participants reported that they referred patients to other health professionals. Finally, when it comes to preventive services, participants ranked blood pressure screening, tobacco use screening, and tobacco use cessation interventions as the most important services. Effective implementation of the Patient Protection and Affordable Care Act will require necessary resources and support of primary care providers to help patients achieve healthier lives. © 2014 Society for Public Health Education.

Refurbishment of the IEAR1 primary coolant system piping supports

International Nuclear Information System (INIS)

Fainer, Gerson; Faloppa, Altair A.; Oliveira, Carlos A. de; Mattar Neto, Miguel

2015-01-01

A partial replacement of the IEA-R1 piping system was concluded in 2014. This paper presents the study and the structural analysis of the IEA-R1 primary circuit piping supports, considering all the changes involved in the replacement. The IEA-R1 is a nuclear reactor for research purposes designed by Babcox-Willcox that is operated by IPEN since 1957. The reactor life management and modernization program is being conducted for the last two decades and already resulted in a series of changes, especially on the reactor coolant system. This set of components, divided in primary and secondary circuit, is responsible for the circulation of water into the core to remove heat. In the ageing management program that includes regular inspection, some degradation was observed in the primary piping system. As result, the renewing of the piping system was conducted in 2014. Moreover the poor condition of some original piping supports gave rise to the refurbishment of all piping supports. The aim of the present work is to review the design of the primary system piping supports taking into account the current conditions after the changes and refurbishment. (author)

Increased EEG sigma and beta power during NREM sleep in primary insomnia.

Science.gov (United States)

Spiegelhalder, Kai; Regen, Wolfram; Feige, Bernd; Holz, Johannes; Piosczyk, Hannah; Baglioni, Chiara; Riemann, Dieter; Nissen, Christoph

2012-12-01

The hyperarousal model of primary insomnia suggests that a deficit of attenuating arousal during sleep might cause the experience of non-restorative sleep. In the current study, we examined EEG spectral power values for standard frequency bands as indices of cortical arousal and sleep protecting mechanisms during sleep in 25 patients with primary insomnia and 29 good sleeper controls. Patients with primary insomnia demonstrated significantly elevated spectral power values in the EEG beta and sigma frequency band during NREM stage 2 sleep. No differences were observed in other frequency bands or during REM sleep. Based on prior studies suggesting that EEG beta activity represents a marker of cortical arousal and EEG sleep spindle (sigma) activity is an index of sleep protective mechanisms, our findings may provide further evidence for the concept that a simultaneous activation of wake-promoting and sleep-protecting neural activity patterns contributes to the experience of non-restorative sleep in primary insomnia. Copyright © 2012 Elsevier B.V. All rights reserved.

Interprofessional primary care team meetings: a qualitative approach comparing observations with personal opinions

NARCIS (Netherlands)

Trudy van der Weijden; Jerôme Jean Jacques van Dongen; Stephanie Anna Lenzen; Anna Beurskens; Ramon Daniëls; Marloes Amantia van Bokhoven

2017-01-01

Background: The number of people with multiple chronic conditions requiring primary care services increases. Professionals from different disciplines collaborate and coordinate care to deal with the complex health care needs. There is lack of information on current practices regarding

Fission product plateout and liftoff in the MHTGR primary system: A review

International Nuclear Information System (INIS)

Wichner, R.P.

1991-04-01

A review is presented of the technical basis for predicting radioactivity release resulting from depressurization of an MHTGR primary system. Consideration is restricted to so called dry events with no involvement of the steam system. The various types of deposition mechanisms effective for iodine, cesium, strontium, and silver are discussed in terms of their chemical characteristics and the nature of the materials in the primary system. Emphasis is given to iodine behavior, including means for estimating the quantity available for release, the types of plateout locations in the primary system, and the effect of dust on distribution and release. The behavior of fission products cesium, strontium, and silver in such accidents is presented qualitatively. A major part of the review deals with expected dust levels, types, and transport. Available information on the level and nature of dust in the HTGR primary system is reviewed. A summary is presented of dust deposition and liftoff mechanisms. It was concluded that recent approaches to dust liftoff modeling, based on turbulent burst concepts for removal from surfaces, probably offer advantages over the current shear ratio approach. This study concludes that iodine releases from dry depressurization events are likely to be extremely low, on the order of millicuries, due to a predictably low degree of chemical desorption, a low degree of dust liftoff, and a low involvement of iodine with dust. It was also concluded that deposition mechanisms controlling the distribution of fission product material in the primary system, and hence also controlling the degree of liftoff, depend strongly on the chemical nature of the individual elements. Therefore contrary to the current practice, both plateout and liftoff models should reflect those unique chemical and physical properties. 56 refs., 16 figs., 23 tabs

Development of a Proactive Care Program (U-CARE) to Preserve Physical Functioning of Frail Older People in Primary Care

NARCIS (Netherlands)

Bleijenberg, N.; Ten Dam, V.H.; Drubbel, I.; Numans, M.E.; De Wit, N.J.; Schuurmans, M.J.

2013-01-01

Purpose: Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in

Management of Current Psychiatric Disorders

Science.gov (United States)

Carbonnel, François; David, Michel; Norton, Joanna; Bourrel, Gérard; Boulenger, Jean-Philippe; Capdevielle, Delphine

2016-01-01

Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.

Normocalcemic Primary Hyperparathyroidism

Science.gov (United States)

Cusano, Natalie E.; Silverberg, Shonni J.; Bilezikian, John P.

2013-01-01

Primary hyperparathyroidism, a common endocrine disorder, is traditionally defined by hypercalcemia and elevated levels of parathyroid hormone (PTH). A newer presentation of primary hyperparathyroidism has been described over the past decade, in which PTH is elevated but serum calcium is consistently normal, in the absence of secondary causes of hyperparathyroidism, such as renal disease or vitamin D deficiency. Recognition of this phenotype of primary hyperparathyroidism, normocalcemic primary hyperparathyroidism, supports a biphasic chronological time course in some individuals in which PTH levels are first elevated but serum calcium is normal, followed by the development of frank hypercalcemia. This review focuses on the available literature regarding this newly described phenotype of primary hyperparathyroidism. PMID:23374739

Flow and edge scour in current adjacent to stone covers

DEFF Research Database (Denmark)

Petersen, Thor U.; Sumer, B. Mutlu; Bøgelund, Jon

2015-01-01

This paper presents the results of an experimental investigation on edge scour adjacent to a stone cover laid on a sandy bed. The three-dimensional flow over the edge of the stone layer has been investigated by the use of particle image velocimetry. The flow measurements show a significant amount...... of turbulence in the primary flow near the junction between the stone layer and the sand bed and the formation of complex secondary-flow structures. The results show that the flow and the edge scour process in a steady current are governed by the size of the roughness elements and to some extent the side slope...... of the berm. The edge scour is caused by the combined action of the primary flow and the secondary flow. The primary flow stirs up the sediment and puts it into suspension, and the secondary flow carries it away from the junction between the stone layer and the sand bed, resulting in a scour hole forming...

Musical Style Preferences and Aural Discrimination Skills of Primary Grade School Children.

Science.gov (United States)

May, William V.

1985-01-01

Most primary-grade children were found to prefer current popular musical styles--rock, country and western, and easy listening pop. Music preferences of males and females generally were the same. There were no differences in racial group preferences for musical excerpts without racially identifying elements. (RM)

A snapshot of the organization and provision of primary care in Turkey

Science.gov (United States)

2011-01-01

Background This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. Methods The WHO Primary Care Evaluation Tool was implemented in two provinces (Bolu and Eskişehir) in Turkey in 2007/08. The Tool consists of three parts: a national questionnaire concerning the organisation and financing of primary care; a questionnaire for family doctors; and a questionnaire for patients who visit a family health centre. Results Primary care has just recently become an official health policy priority with the introduction of a family medicine scheme. Although the supply of family doctors (FDs) has improved, they are geographically uneven distributed, and nationwide shortages of primary care staff remain. Coordination of care could be improved and quality control mechanisms were lacking. However, patients were very satisfied with the treatment by FDs. Conclusions The study provides an overview of the current state of PC in Turkey for two provinces with newly introduced family medicine, by using a structured approach to evaluate the essential functions of PC, including governance, financing, resource generation, as well as the characteristics of a "good" service delivery system (as being accessible, comprehensive, coordinated and continuous). PMID:21542904

Diversification of the Primary Antibody Repertoire by AID-Mediated Gene Conversion.

Science.gov (United States)

Lanning, Dennis K; Knight, Katherine L

2015-01-01

Gene conversion, mediated by activation-induced cytidine deaminase (AID), has been found to contribute to generation of the primary antibody repertoire in several vertebrate species. Generation of the primary antibody repertoire by gene conversion of immunoglobulin (Ig) genes occurs primarily in gut-associated lymphoid tissues (GALT) and is best described in chicken and rabbit. Here, we discuss current knowledge of the mechanism of gene conversion as well as the contribution of the microbiota in promoting gene conversion of Ig genes. Finally, we propose that the antibody diversification strategy used in GALT species, such as chicken and rabbit, is conserved in a subset of human and mouse B cells.

[SEMERGEN positioning for the treatment of alcohol disorders in primary care].

Science.gov (United States)

Arbesú, José Ángel; Gual, Antoni; Casquero, Rafael; Bobes, Julio; Ortega, Patricia

2015-12-01

The present manuscript is based on the recommendations of a panel of health care professionals, including several experts in primary health care, psychiatry and addictions. The participants are recognized specialists in the treatment of alcohol use disorder. The panel met in Barcelona on 2015 April 22 with the aims of evaluating the current management of alcohol use disorder in primary health care and developing a strategy to address this problem, basing on the evidence and the recommendations of the scientific societies and national and international organizations. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN). All rights reserved.

Stemless shoulder arthroplasty: current status.

Science.gov (United States)

Churchill, R Sean

2014-09-01

Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral stem has become progressively shorter to help combat stem-related complications. Currently, there are several companies who have developed and marketed a stemless humeral arthroplasty component. Manufacturers' data for 5 stemless shoulder arthroplasty components currently on the market were analyzed and reviewed. A literature review of short-term results for stemless shoulder arthroplasty was completed. Of the stemless shoulder arthroplasty systems available on the market, 3 are currently undergoing clinical trials in the United States. The Tornier Simpliciti (Tornier, Edina, MN, USA) clinical trial began in 2011. The study with 2-year minimum follow-up results is scheduled for completion in November 2014. The Arthrex Eclipse (Arthrex, Naples, FL, USA) clinical trial was started in January 2013. The tentative study completion date is 2017. The Biomet Nano (Biomet, Warsaw, IN, USA) clinical trial began in October 2013 and also has a tentative completion date of 2017. No other clinical trial is currently under way in the United States. Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty. Radiographic analysis indicates implant stability without migration or subsidence at 2- to 3-year minimum follow-up.. Several stemless shoulder arthroplasty implants are available outside the United States. Early clinical and radiographic results are promising, but well-designed clinical studies and midterm results are lacking. Three clinical trials are currently under way in the United States with initial availability for use anticipated in 2015. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Electromotive force analysis of current transformer during lightning surge inflow using Fourier series expansion

Directory of Open Access Journals (Sweden)

Youngsun Kim

2017-05-01

Full Text Available The most common structure used for current transformers (CTs consists of secondary windings around a ferromagnetic core past the primary current being measured. A CT used as a surge protection device (SPD may experience large inrushes of current, like surges. However, when a large current flows into the primary winding, measuring the magnitude of the current is difficult because the ferromagnetic core becomes magnetically saturated. Several approaches to reduce the saturation effect are described in the literature. A Rogowski coil is representative of several devices that measure large currents. It is an electrical device that measures alternating current (AC or high-frequency current. However, such devices are very expensive in application. In addition, the volume of a CT must be increased to measure sufficiently large currents, but for installation spaces that are too small, other methods must be used. To solve this problem, it is necessary to analyze the magnetic field and electromotive force (EMF characteristics when designing a CT. Thus, we proposed an analysis method for the CT under an inrush current using the time-domain finite element method (TDFEM. The input source current of a surge waveform is expanded by a Fourier series to obtain an instantaneous value. An FEM model of the device is derived in a two-dimensional system and coupled with EMF circuits. The time-derivative term in the differential equation is solved in each time step by the finite difference method. It is concluded that the proposed algorithm is useful for analyzing CT characteristics, including the field distribution. Consequently, the proposed algorithm yields a reference for obtaining the effects of design parameters and magnetic materials for special shapes and sizes before the CT is designed and manufactured.

Electromotive force analysis of current transformer during lightning surge inflow using Fourier series expansion

Science.gov (United States)

Kim, Youngsun

2017-05-01

The most common structure used for current transformers (CTs) consists of secondary windings around a ferromagnetic core past the primary current being measured. A CT used as a surge protection device (SPD) may experience large inrushes of current, like surges. However, when a large current flows into the primary winding, measuring the magnitude of the current is difficult because the ferromagnetic core becomes magnetically saturated. Several approaches to reduce the saturation effect are described in the literature. A Rogowski coil is representative of several devices that measure large currents. It is an electrical device that measures alternating current (AC) or high-frequency current. However, such devices are very expensive in application. In addition, the volume of a CT must be increased to measure sufficiently large currents, but for installation spaces that are too small, other methods must be used. To solve this problem, it is necessary to analyze the magnetic field and electromotive force (EMF) characteristics when designing a CT. Thus, we proposed an analysis method for the CT under an inrush current using the time-domain finite element method (TDFEM). The input source current of a surge waveform is expanded by a Fourier series to obtain an instantaneous value. An FEM model of the device is derived in a two-dimensional system and coupled with EMF circuits. The time-derivative term in the differential equation is solved in each time step by the finite difference method. It is concluded that the proposed algorithm is useful for analyzing CT characteristics, including the field distribution. Consequently, the proposed algorithm yields a reference for obtaining the effects of design parameters and magnetic materials for special shapes and sizes before the CT is designed and manufactured.

The primary care amplification model: taking the best of primary care forward

Directory of Open Access Journals (Sweden)

Nicholson Caroline

2008-12-01

Full Text Available Abstract Background Primary care internationally is approaching a new paradigm. The change agenda implicit in this threatens to de-stabilise and challenge established general practice and primary care. Discussion The Primary Care Amplification Model offers a means to harness the change agenda by 'amplifying' the strengths of established general practices around a 'beacon' practice. Conclusion Such 'beacon' practices can provide a mustering point for an expanded scope of practice for primary care, integrated primary/secondary service delivery, interprofessional learning, relevant local clinical research, and a focus on local service innovation, enhancing rather than fragmenting the collective capacity of existing primary care.

Ultrastructural characterization of primary cilia in pathologically characterized human glioblastoma multiforme (GBM) tumors.

Science.gov (United States)

Moser, Joanna J; Fritzler, Marvin J; Rattner, Jerome B

2014-01-01

Primary cilia are non-motile sensory cytoplasmic organelles that are involved in cell cycle progression. Ultrastructurally, the primary cilium region is complex, with normal ciliogenesis progressing through five distinct morphological stages in human astrocytes. Defects in early stages of ciliogenesis are key features of astrocytoma/glioblastoma cell lines and provided the impetus for the current study which describes the morphology of primary cilia in molecularly characterized human glioblastoma multiforme (GBM) tumors. Seven surgically resected human GBM tissue samples were molecularly characterized according to IDH1/2 mutation status, EGFR amplification status and MGMT promoter methylation status and were examined for primary cilia expression and structure using indirect immunofluorescence and electron microscopy. We report for the first time that primary cilia are disrupted in the early stages of ciliogenesis in human GBM tumors. We confirm that immature primary cilia and basal bodies/centrioles have aberrant ciliogenesis characteristics including absent paired vesicles, misshaped/swollen vesicular hats, abnormal configuration of distal appendages, and discontinuity of centriole microtubular blades. Additionally, the transition zone plate is able to form in the absence of paired vesicles on the distal end of the basal body and when a cilium progresses beyond the early stages of ciliogenesis, it has electron dense material clumped along the transition zone and a darkening of the microtubules at the proximal end of the cilium. Primary cilia play a role in a variety of human cancers. Previously primary cilia structure was perturbed in cultured cell lines derived from astrocytomas/glioblastomas; however there was always some question as to whether these findings were a cell culture phenomena. In this study we confirm that disruptions in ciliogenesis at early stages do occur in GBM tumors and that these ultrastructural findings bear resemblance to those previously

ENREGISTREMENT STRATIGRAPHIQUE DES PHASES D'EMERSION SUR LES PLATES-FORMES CARBONATEES Une étude intégrée à l'affleurement et en sismique de la plate-forme cénomanienne d'Oman (Formation Natih)

OpenAIRE

Grélaud , Carine

2005-01-01

Subaerial exposure of carbonate platforms is generally recorded by karstification and pedogenesis, whereas erosion features such as incisions along emersion surfaces have seldom been observed and studied. However, the recognition of incisions and the characterization of their fill may facilitate sequence boundary definition and hierarchy, especially along exposure surfaces which do not otherwise present clear petrographic evidence for emersion. Within the Natih Formation (Late Albian-Early Tu...

Pattern of Primary Nocturnal Enuresis in Primary School Children ...

African Journals Online (AJOL)

Pattern of Primary Nocturnal Enuresis in Primary School Children (First Grade) in ... The control group consisting of 100 age-matched non-enuretic children ... was insignificantly associated with a positive family history, family size or birth rank.

Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

Science.gov (United States)

Berenson, Robert A.; Schoenbaum, Stephen C.; Gardner, Laurence B.

2007-01-01

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed. PMID:17356977

Performance of the ATLAS primary vertex reconstruction algorithms

CERN Document Server

Zhang, Matt

2017-01-01

The reconstruction of primary vertices in the busy, high pile up environment of the LHC is a challenging task. The challenges and novel methods developed by the ATLAS experiment to reconstruct vertices in such environments will be presented. Such advances in vertex seeding include methods taken from medical imagining, which allow for reconstruction of very nearby vertices will be highlighted. The performance of the current vertexing algorithms using early Run-2 data will be presented and compared to results from simulation.

The assessment and treatment of back and neck pain: an initial investigation in a primary care practice-based research network.

Science.gov (United States)

Fischbein, Rebecca; McCormick, Kenelm; Selius, Brian A; Labuda Schrop, Susan; Hewit, Michael; Baughman, Kristin; Meeker, James

2015-09-01

The purpose of this study was to conduct an exploratory examination of the current state of non-malignant acute and chronic back and neck pain assessment and management among primary care providers in a multi-site, practice-based research network. Acute and chronic pain are distinct conditions that often require different assessment and management approaches, however, little research has examined assessment and management of acute and chronic pain as separate conditions. The large majority of patients with acute and chronic back and neck pain are managed in primary care settings. Given the differences between acute and chronic pain, it is necessary to identify differences in patient characteristics, practitioner evaluation, treatment and management in primary care settings. Over a two-week period, 24 practitioners in a multi-site practice-based research network completed 196 data cards about 39 patients experiencing acute back and neck pain and 157 patients suffering from chronic back and neck pain. Findings There were significant differences between the patients experiencing acute and chronic pain in regards to practitioner evaluation, current medication management and current treatment for depression. In addition, diagnostics differed between patients experiencing acute versus chronic back and neck pain. Further, primary care providers' review of online drug monitoring program reports during the current visit was associated with current medication management using short term opioids, long-term opioids or tramadol. Most research examining acute and chronic pain focuses on the low back. Additional research needs to be conducted to explore and compare acute and chronic pain across the whole spine.

Trauma and posttraumatic stress disorder in a rural primary care population in South Africa.

Science.gov (United States)

Peltzer, K; Seakamela, M J; Manganye, L; Mamiane, K G; Motsei, M S; Mathebula, T T M

2007-06-01

The aim of this study was to assess trauma events experienced and PTSD among 250 consecutive rural primary clinic patients (all Black Africans, 24% male and 76% female; M age 31.1 yr., SD = 11.8; range 18-65 years) in South Africa using the Trauma History Questionnaire and the PTSD Checklist-Civilian Version, interview administered. Results indicated that the mean number of traumatic events reported was 3.5 (SD = 2.9, range = 0-19) and was significantly higher among men (M= 4.9, SD = 3.5) than women (M = 3.0, SD = 2.6). Among the most frequently endorsed traumas among men were seeing someone seriously injured or killed (60%), serious accident (43.3%), and seeing dead bodies (43.3%), and among women natural disaster (mostly floods) (51.6%), news of a serious injury, life-threatening illness or unexpected death of someone close (31.1%), and seeing someone seriously injured or killed (30%). A current diagnosis of PTSD was found in 12.4% of the sample. Trauma incidence figures were high (M = 3.5) and were comparable with an urban Xhosa primary care population in South Africa (M = 3.8). A current indicative diagnosis of PTSD of 12.4% also compares with other studies; 19.9% among urban Xhosa primary care patients and 11.8% among American primary care patients.

Enhanced primary and secondary performance through cognitive relaying and leveraging primary feedback

KAUST Repository

Hamza, Doha R.

2014-06-01

We consider a spectrum-sharing system, where the primary terminal operates in a time-slotted fashion and is active only when it has a packet to send. The secondary terminal uses spectrum sensing results and the primary automatic repeat request (ARQ) feedback to access the channel probabilistically. To enhance the primary\\'s system performance, the secondary user (SU) acts as a relay for the primary user (PU) in the event of transmission failure on the direct link of the latter. Closed-form expressions for the primary and secondary throughputs are obtained for the described scheme. The optimal medium access probabilities are then obtained by maximizing the secondary throughput subject to constraints that guarantee the stability of the considered queues, a minimum primary throughput, and a maximum primary queueing delay. The results clearly indicate the benefits of cognitive relaying in enhancing the throughput performance for both the PU and SU. Furthermore, by guaranteeing minimum rate and maximum delay requirements, our scheme is shown to provide a definitive notion of protection for the licensed users of the network. © 2013 IEEE.

Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study.

Science.gov (United States)

Kaski, D; Dominguez, R O; Allum, J H; Islam, A F; Bronstein, A M

2014-11-01

To improve gait and balance in patients with Parkinson's disease by combining anodal transcranial direct current stimulation with physical training. In a double-blind design, one group (physical training; n = 8) underwent gait and balance training during transcranial direct current stimulation (tDCS; real/sham). Real stimulation consisted of 15 minutes of 2 mA transcranial direct current stimulation over primary motor and premotor cortex. For sham, the current was switched off after 30 seconds. Patients received the opposite stimulation (sham/real) with physical training one week later; the second group (No physical training; n = 8) received stimulation (real/sham) but no training, and also repeated a sequential transcranial direct current stimulation session one week later (sham/real). Hospital Srio Libanes, Buenos Aires, Argentina. Sixteen community-dwelling patients with Parkinson's disease. Transcranial direct current stimulation with and without concomitant physical training. Gait velocity (primary gait outcome), stride length, timed 6-minute walk test, Timed Up and Go Test (secondary outcomes), and performance on the pull test (primary balance outcome). Transcranial direct current stimulation with physical training increased gait velocity (mean = 29.5%, SD = 13; p transcranial direct current stimulation alone. There was no isolated benefit of transcranial direct current stimulation alone. Although physical training improved gait velocity (mean = 15.5%, SD = 12.3; p = 0.03), these effects were comparatively less than with combined tDCS + physical therapy (p stimulation-related improvements were seen in patients with more advanced disease. Anodal transcranial direct current stimulation during physical training improves gait and balance in patients with Parkinson's disease. Power calculations revealed that 14 patients per treatment arm (α = 0.05; power = 0.8) are required for a definitive trial. © The Author(s) 2014.

Creative Partnerships? Cultural Policy and Inclusive Arts Practice in One Primary School

Science.gov (United States)

Hall, Christine; Thomson, Pat

2007-01-01

This article traces the "cultural turn" in UK educational policy through an analysis of the Creative Partnerships policy (New Labour's "flagship programme in the cultural education field") and a consideration of an arts project funded under this initiative in one primary school. It argues that current educational policy…

Primary neural leprosy: systematic review

Directory of Open Access Journals (Sweden)

Jose Antonio Garbino

2013-06-01

Full Text Available The authors proposed a systematic review on the current concepts of primary neural leprosy by consulting the following online databases: MEDLINE, Lilacs/SciELO, and Embase. Selected studies were classified based on the degree of recommendation and levels of scientific evidence according to the “Oxford Centre for Evidence-based Medicine”. The following aspects were reviewed: cutaneous clinical and laboratorial investigations, i.e. skin clinical exam, smears, and biopsy, and Mitsuda's reaction; neurological investigation (anamnesis, electromyography and nerve biopsy; serological investigation and molecular testing, i.e. serological testing for the detection of the phenolic glycolipid 1 (PGL-I and the polymerase chain reaction (PCR; and treatment (classification criteria for the definition of specific treatment, steroid treatment, and cure criteria.

Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction

NARCIS (Netherlands)

Hofbauer, Marcus; Muller, Bart; Murawski, Christopher D.; Baraga, Michael; van Eck, Carola Franziska; Fu, Freddie H.

2013-01-01

The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. Based on the current literature of

An evaluation of an integrated primary care approach to improve well-being among frail community-dwelling older people

OpenAIRE

Vestjens, Lotte; Murray Cramm, Jane; Nieboer, Anna Petra

2016-01-01

Introduction: A major challenge in primary health care is the substantial increase of the proportion of frail older persons with long-term conditions and multiple complex needs. The traditional primary care system in the Netherlands is fragmented and reactive. Consequently, current primary health care is not able to cope effectively with the increasing demands for health and social care, and to improve well-being among frail community-living older people. This calls for a fundamental transfor...

Experience of primary care among homeless individuals with mental health conditions.

Directory of Open Access Journals (Sweden)

Joya G Chrystal

Full Text Available The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA, one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366 were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005, with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score. Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

Experience of Primary Care among Homeless Individuals with Mental Health Conditions

Science.gov (United States)

Chrystal, Joya G.; Glover, Dawn L.; Young, Alexander S.; Whelan, Fiona; Austin, Erika L.; Johnson, Nancy K.; Pollio, David E.; Holt, Cheryl L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa A.; Daigle, Shanette G.; Steward, Jocelyn L.; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers. PMID:25659142

Recent Primary Production and Small Phytoplankton Contribution in the Yellow Sea during the Summer in 2016

Science.gov (United States)

Jang, Hyo Keun; Kang, Jae Jung; Lee, Jae Hyung; Kim, Myungjoon; Ahn, So Hyun; Jeong, Jin-Yong; Yun, Mi Sun; Han, In-Seong; Lee, Sang Heon

2018-05-01

The high nutrient concentration associated with the mixing dynamics of two warm and cold water masses supports high primary production in the Yellow Sea. Although various environmental changes have been reported, no recent information on small phytoplankton contribution to the total primary production as an important indicator for marine ecosystem changes is currently available in the Yellow Sea. The major objective of this study is to determine the small (values decades ago. The higher contributions of small phytoplankton to the total chlorophyll a concentration and primary production might be caused by P-limited conditions and this resulted in lower chlorophyll a concentration and total primary production in this study compared to previous studies.

Evaluation of high-energy lithium thionyl chloride primary cells

Science.gov (United States)

Frank, H. A.

1980-02-01

An advanced commercial primary lithium cell (LiSoCl2) was evaluated in order to establish baseline data for improved lithium batteries for aerospace applications. The cell tested had nominal capacity of 6 Ah. Maximum energy density at low rates (less than C/30, where C is the cell capacity in amp-hrs and 30 corresponds to a 30 hr discharge time) was found to be near 300 Wh/kg. An equation which predicts the operating voltage of these cells as a function of current and state of charge is presented. Heat generation rates of these cells were determined as a function of current in a calorimeter. It was found that heat rates could be theoretically predicted with some degree of accuracy at currents less than 1 amp or the C/6 rate. No explosions were observed in the cells during the condition of overdischarge or reversal nor during high rate discharge. It was found, however, that the cells can vent when overdischarge currents are greater than C/30 and when discharge rates are greater than 1.5C.

Shell Inspection History and Current CMM Inspection Efforts

Energy Technology Data Exchange (ETDEWEB)

Montano, Joshua Daniel [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-01-26

The following report provides a review of past and current CMM Shell Inspection efforts. Calibration of the Sheffield rotary contour gauge has expired and the primary inspector, Matthew Naranjo, has retired. Efforts within the Inspection team are transitioning from maintaining and training new inspectors on Sheffield to off-the-shelf CMM technology. Although inspection of a shell has many requirements, the scope of the data presented in this report focuses on the inner contour, outer contour, radial wall thickness and mass comparisons.

A survey of synthetic cannabinoid consumption by current cannabis users.

Science.gov (United States)

Gunderson, Erik W; Haughey, Heather M; Ait-Daoud, Nassima; Joshi, Amruta S; Hart, Carl L

2014-01-01

Despite growing concern about the increased rates of synthetic cannabinoid (SC) use and their effects, only limited data are available that addresses these issues. This study assessed the extent of SC product use and reported effects among a cohort of adult marijuana and tobacco users. A brief telephone interview was conducted with individuals who had given permission to be contacted for future research while screening for a cannabis/nicotine dependence medication development study (NCT01204723). Respondents (N = 42; 88% participation rate) were primarily young adults, male, racially diverse, and high school graduates. Nearly all currently smoked tobacco and cannabis, with 86% smoking cannabis on 5 or more days per week. Nearly all (91%) were familiar with SC products, half (50%) reported smoking SC products previously, and a substantial minority (24%) reported current use (i.e., past month). Despite a federal ban on 5 common SCs, which went into effect on March 1, 2011, a number of respondents reported continued SC product use. Common reasons reported for use included, but were not limited to, seeking a new "high" similar to that produced by marijuana and avoiding drug use detection via a positive urine screen. The primary side effects were trouble thinking clearly, headache, dry mouth, and anxiety. No significant differences were found between synthetic cannabinoid product users (ever or current) and nonusers by demographics or other characteristics. Among current marijuana and tobacco users, SC product consumption was common and persisted despite a federal ban. The primary reasons for the use of SC-containing products seem to be to evade drug detection and to experience a marijuana-like high.

The Difficulties Experienced by Teachers in the Process of Primary Reading and Writing Instruction and Their Solution Offers for Eliminating These Difficulties

Science.gov (United States)

Gündogmus, Hatice Degirmenci

2018-01-01

The purpose of the current research is to identify the difficulties that primary school teachers experience in the primary reading and writing instruction, and to find out their solution offers for eliminating these difficulties. The study group of the research is composed of 51 primary school teachers selected by criterion sampling as a type of…

Responding to intimate partner violence: Healthcare providers' current practices and views on integrating a safety decision aid into primary care settings.

Science.gov (United States)

Alvarez, Carmen; Debnam, Katrina; Clough, Amber; Alexander, Kamila; Glass, Nancy E

2018-04-01

Supportive care for survivors of intimate partner violence (IPV) remains limited in primary care settings. Low-income and Spanish-speaking survivors of IPV are even more disadvantaged, given the dearth of linguistically and culturally appropriate interventions for IPV. We conducted semi-structured individual interviews with 17 healthcare workers, including physicians, nurses, and social workers, to describe how healthcare workers serving primarily low-income, Latina populations are currently screening and responding to IPV disclosure, and to explore the acceptability of integrating an interactive, personalized safety decision aid application-myPlan app-into the clinic setting. Despite recognition of IPV as a problem, none of the clinical sites had a protocol to guide screening and response to IPV disclosure. Screening practices varied across the sites, sometimes conducted by medical assistants prior to the provider visit and other times by the physician or nurse provider. When IPV was disclosed, it was often during assessment for a presenting problem such as poor sleep or anxiety. Most healthcare workers felt that clinical and community resources were limited for their patients experiencing IPV. The "warm hand-off" to a social worker was the most common response strategy when possible; otherwise, women were given information about available resources such as hotlines and safe houses. We discuss structural, family, and individual barriers to accessing safety resources for underserved women and review how an easily accessible safety decision app, such as myPlan, could be a resource for women to safely tailor an action plan for her situation. © 2018 Wiley Periodicals, Inc.

[State of internal communication in primary care].

Science.gov (United States)

Ballvé Moreno, José Luis; Pujol Ribó, Gloria; Romaguera Lliso, Amparo; Bonet Esteve, Anna; Rafecas Ruiz, Montserrat; Zarza Carretero, Elvira

2008-08-01

To study internal communication between primary care health professionals Cross-sectional, descriptive. Catalan Health Institute Costa de Ponent Primary Care Area, Spain. All workers in the area (n=3565). Three part questionnaire: a) sociodemographic questions; b) questions scoring from 0 to 10 the current importance and operation of certain aspects; and c) questions on new communication tools. Of those sent a questionnaire, 39% (n=1388) responded, with a mean age of 43.2 years (95% CI, 42.75- 43.65), 28.9% being male. The major differences between importance and current events were said to be "to be informed of projects before they appear in the communication media," "by official routes and not by rumour," and "to be aware of projects of other teams." The least communicated within teams. The doctors considered upward communication to be more important. Doctors are those who appreciate communication within teams better and the professionals of the users services unit (UAU) less so. Doctors are the ones who give more importance to being informed of projects at the time. 55% do not use the intranet, mainly due to lack of time. The second reason is that they find it difficult. Sixty-two per cent read e-mail >2-3 times per week. Eighty-nine per cent want an electronic bulletin. The older workers use new technologies less. Downward, upward, and sideways communication needs to be improved, particularly upwards by doctors, and that of the teams for the UAU professionals. Intranet tools must be provided that make the work easier and training in handling new technologies must be offered.

Primary ovarian malignant melanoma

Directory of Open Access Journals (Sweden)

Kostov Miloš

2010-01-01

Full Text Available Background. Primary ovarian malignant melanoma is extremely rare. It usually appears in the wall of a dermoid cyst or is associated with another teratomatous component. Metastatic primary malignant melanoma to ovary from a primary melanoma elsewhere is well known and has been often reported especially in autopsy studies. Case report. We presented a case of primary ovarian malignant melanoma in a 45- year old woman, with no evidence of extraovarian primary melanoma nor teratomatous component. The tumor was unilateral, macroscopically on section presented as solid mass, dark brown to black color. Microscopically, tumor cells showed positive immunohistochemical reaction for HMB-45, melan-A and S-100 protein, and negative immunoreactivity for estrogen and progesteron receptors. Conclusion. Differentiate metastatic melanoma from rare primary ovarian malignant melanoma, in some of cases may be a histopathological diagnostic problem. Histopathological diagnosis of primary ovarian malignant melanoma should be confirmed by immunohistochemical analyses and detailed clinical search for an occult primary tumor.

Brentuximab Vedotin Treatment for Primary Refractory Hodgkin Lymphoma

Directory of Open Access Journals (Sweden)

Hung-Bo Wu

2013-01-01

Full Text Available Up to 40% of patients with advanced Hodgkin lymphoma (HL become refractory or relapsed after current standard chemotherapy, among which primary refractory HL confers a particularly poor outcome. With intensive salvage chemotherapy and autologous stem cell transplantation, the long-term remission rate for these patients was only 30%, but more selective treatments with higher therapeutic index are needed. We report the experience of using a new anti-CD30 immunotoxin, brentuximab vedotin, in salvage treatment of a 30-year-old woman with primary refractory Hodgkin lymphoma. The patient presented with SVC syndrome due to the bulky mediastinal tumor and was confirmed to have classical Hodgkin lymphoma, nodular sclerosis type, stage IIIA. The tumor responded to induction chemotherapy transiently, but local progression was noted during subsequent cycles of treatment. Salvage radiotherapy to the mediastinal tumor, obtained no remission but was followed by rapid in-field progression and then lung metastasis. She declined stem cell transplantation and received salvage brentuximab vedotin (BV therapy, which induced dramatic shrinkage of tumor without significant side effects. Serial followup of PET/CT imaging confirmed a rapid and continuous complete remission for 12 months. Although durability of the remission needs further observation, this case illustrates the excellent efficacy of brentuximab vedotin in primary refractory Hodgkin lymphoma.

An empirical model for salt removal percentage in water under the effect of different current intensities of current carrying coil at different flow rates

Directory of Open Access Journals (Sweden)

Rameen S. AbdelHady

2011-10-01

Full Text Available The magnetic treatment of hard water is an alternative, simple approach by which the hard water that needs to be treated flows through a magnetic field. This field is created by inducing current in a coil wrapped around a pipe. Consequently some of its properties, such as total dissolved salts (TDS, conductivity (Ec and PH change. The primary purpose of hard water treatment is to decrease TDS in the incoming liquid stream. Using performance data from the application of different magnetic field densities on the different flow levels of water, empirical mathematical models were developed relating the salt removal percentage (SRP to operating flow rate and current of the coil. The obtained experimental results showed that the SRP increased with increasing the current at low flow rates (up to 0.75 ml/s.

Left ventricular remodelling in chronic primary mitral regurgitation: implications for medical therapy.

Science.gov (United States)

McCutcheon, Keir; Manga, Pravin

Surgical repair or replacement of the mitral valve is currently the only recommended therapy for severe primary mitral regurgitation. The chronic elevation of wall stress caused by the resulting volume overload leads to structural remodelling of the muscular, vascular and extracellular matrix components of the myocardium. These changes are initially compensatory but in the long term have detrimental effects, which ultimately result in heart failure. Understanding the changes that occur in the myocardium due to volume overload at the molecular and cellular level may lead to medical interventions, which potentially could delay or prevent the adverse left ventricular remodelling associated with primary mitral regurgitation. The pathophysiological changes involved in left ventricular remodelling in response to chronic primary mitral regurgitation and the evidence for potential medical therapy, in particular beta-adrenergic blockers, are the focus of this review.

Utilization of Routine Primary Care Services Among Dancers.

Science.gov (United States)

Alimena, Stephanie; Air, Mary E; Gribbin, Caitlin; Manejias, Elizabeth

2016-01-01

This study examines the current utilization of primary and preventive health care services among dancers in order to assess their self-reported primary care needs. Participants were 37 dancers from a variety of dance backgrounds who presented for a free dancer health screening in a large US metropolitan area (30 females, 7 males; mean age: 27.5 ± 7.4 years; age range: 19 to 49 years; mean years of professional dancing: 6.4 ± 5.4 years). Dancers were screened for use of primary care, mental health, and women's health resources using the Health Screen for Professional Dancers developed by the Task Force on Dancer Health. Most dancers had health insurance (62.2%), but within the last 2 years, only approximately half of them (54.1%) reported having a physical examination by a physician. Within the last year, 54.1% of dancers had had a dental check-up, and 56.7% of female dancers received gynecologic care. Thirty percent of female participants indicated irregular menstrual cycles, 16.7% had never been to a gynecologist, and 16.7% were taking birth control. Utilization of calcium and vitamin D supplementation was 27.0% and 29.7%, respectively, and 73.0% were interested in nutritional counseling. A high rate of psychological fatigue and sleep deprivation was found (35.1%), along with a concomitant high rate of self-reported need for mental health counseling (29.7%). Cigarette and recreational drug use was low (5.4% and 5.4%); however, 32.4% engaged in binge drinking within the last year (based on the CDC definition). These findings indicate that dancers infrequently access primary care services, despite high self-reported need for nutritional, mental, and menstrual health counseling and treatment. More studies are warranted to understand dancers' primary health care seeking behavior.

Prediction of dementia in primary care patients.

Directory of Open Access Journals (Sweden)

Frank Jessen

Full Text Available BACKGROUND: Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. METHODOLOGY/PRINCIPAL FINDINGS: We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe. After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort. Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV and 97.8% negative predictive value of (NPV for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort the PPV for AD was 39.1% (52% for any dementia in the test cohort. CONCLUSIONS: The prediction score has useful prediction accuracy. It can define individuals (1 sensitively for low cost-low risk interventions, or (2 more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs.

Advances in primary recovery: centrifugation and membrane technology.

Science.gov (United States)

Roush, David J; Lu, Yuefeng

2008-01-01

recovery processes has become substantially more complicated. Ironically, the application of classical chemical engineering approaches to overcome issues in primary recovery and purification (e.g., turbidity and trace impurity removal) are just recently gaining attention. Some of these techniques (e.g., membrane cascades, pretreatment, precipitation, and the use of affinity tags) are now seen almost as disruptive technologies. This paper will review the current and potential future state of research on primary recovery, including relevant papers presented at the 234th American Chemical Society (ACS) National Meeting in Boston.

Time is up: increasing shadow price of time in primary-care office visits.

Science.gov (United States)

Tai-Seale, Ming; McGuire, Thomas

2012-04-01

A physician's own time is a scarce resource in primary care, and the physician must constantly evaluate the gain from spending more time with the current patient against moving to address the health-care needs of the next. We formulate and test two alternative hypotheses. The first hypothesis is based on the premise that with time so scarce, physicians equalize the marginal value of time across patients. The second, alternative hypothesis states that physicians allocate the same time to each patient, regardless of how much the patient benefits from the time at the margin. For our empirical work, we examine the presence of a sharply increasing subjective shadow price of time around the 'target' time using video recordings of 385 visits by elderly patients to their primary care physician. We structure the data at the 'topic' level and find evidence consistent with the alternative hypothesis. Specifically, time elapsed within a visit is a very strong determinant of the current topic being the 'last topic'. This finding implies the physician's shadow price of time is rising during the course of a visit. We consider whether dislodging a target-time mentality from physicians (and patients) might contribute to more productive primary care practice. Copyright © 2011 John Wiley & Sons, Ltd.

Nuclear Power and Resource Efficiency—A Proposal for a Revised Primary Energy Factor

Directory of Open Access Journals (Sweden)

Ola Eriksson

2017-06-01

Full Text Available Measuring resource efficiency can be achieved using different methods, of which primary energy demand is commonly used. The primary energy factor (PEF is a figure describing how much energy from primary resources is being used per unit of energy delivered. The PEF for nuclear power is typically 3, which refers to thermal energy released from fission in relation to electricity generated. Fuel losses are not accounted for. However; nuclear waste represents an energy loss, as current plans for nuclear waste management mostly include final disposal. Based on a literature review and mathematical calculations of the power-to-fuel ratio for nuclear power, PEF values for the open nuclear fuel cycle (NFC option of nuclear power and different power mixes are calculated. These calculations indicate that a more correct PEF for nuclear power would be 60 (range 32–88; for electricity in Sweden (41% nuclear power PEF would change from 1.8 to 25.5, and the average PEF for electricity in the European Union (EU would change from 2.5 to 18. The results illustrate the poor resource efficiency of nuclear power, which paves the way for the fourth generation of nuclear power and illustrates the policy implication of using PEFs which are inconsistent with current waste management plans.

On the interpretation of total current spectroscopy (TCS) spectra from MoS2 crystals

International Nuclear Information System (INIS)

Mohamed, M.H.; Moeller, P.J.

1981-01-01

Total Current Spectroscopy (TCS) spectra from MoS 2 (0001) face for three different angles of incidence of the primary beam with respect to the c-axis as well as TCS spectrum from an edge surface cut perpendicularly to the (001) face of a molybdenite crystal are given. Energy positions of the TCS structure are found to be independent of the variations in the angle of incidence of the primary beam and also of the change of crystal face. From this it is concluded that the fine structure in the TCS spectra from molybdenite crystal for the primary energies studied is due to electron-electron scattering and not to Bragg interference effects. (author)

Interlibrary loan in primary access libraries: challenging the traditional view.

Science.gov (United States)

Dudden, R F; Coldren, S; Condon, J E; Katsh, S; Reiter, C M; Roth, P L

2000-10-01

up in the ILL hierarchy and highlighting the contribution made by CCML primary access libraries (H2). CCML primary access libraries borrow and lend in amounts that are proportional to their collection size, rather than overtaxing libraries at higher levels in the ILL hierarchy with large numbers of requests (H3). The main limitations of this study were the small sample size and the use of data collected for another purpose, the CCML ILL survey. The findings suggest that there is little evidence to support several commonly held beliefs regarding ILL system use by primary access libraries. In addition to validating the important contributions made by primary access libraries to the national ILL system, baseline data that can be used to benchmark current practice performance are provided.

Systemic treatment of cancer of unknown primary origin

International Nuclear Information System (INIS)

Reckova, M.

2013-01-01

Cancer of unknown primary origin (CUP) comprises a heterogenous group of cancers with distinct biology and prognosis. There is, however, a specific group of patients with curable diseases, or incurable diseases with good prognosis. The main aim of treatment in the group of patients with CUP is timely initiation of therapy in the cases of curable disease. There is no known standard of care in the cases of CUP with poor prognosis, but most frequently, platinum-based regimens are used. In the cases of specific immunohistochemistry (IHC) or molecular gene expression profile, there are used the treatment regimens similar to those used in the patients with known primary tumor and similar IHC or molecular profile. Currently, most of data in patients with CUP are from phase II clinical trials. Thus proficiently designed phase III randomized clinical trials with translation research is priority, with aim to improve our knowledge and personalize treatment of such heterogenous group of patients as is a group of patients with CUP. (author)

[Implementation of evidence based medicine in primary care].

Science.gov (United States)

Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas

2009-01-01

The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.

Using attachment theory in medical settings: implications for primary care physicians.

Science.gov (United States)

Hooper, Lisa M; Tomek, Sara; Newman, Caroline R

2012-02-01

Mental health researchers, clinicians and clinical psychologists have long considered a good provider-patient relationship to be an important factor for positive treatment outcomes in a range of therapeutic settings. However, primary care physicians have been slow to consider how attachment theory may be used in the context of patient care in medical settings. In the current article, John Bowlby's attachment theory and proposed attachment styles are proffered as a framework to better understand patient behaviors, patient communication styles with physicians and the physician-patient relationship in medical settings. The authors recommend how primary care physicians and other health care providers can translate attachment theory to enhance practice behaviors and health-related communications in medical settings.

Teachers' reflections on distributive leadership in public primary schools in Soweto

Directory of Open Access Journals (Sweden)

Suraiya R Naicker

2013-01-01

Full Text Available Schooling has become increasingly complex in purpose and structure and therefore requires appropriate forms of leadership to address this challenge. One current leadership approach that is receiving national and global attention is distributive leadership. A qualitative approach was employed to investigate teachers' experiences and perceptions of the practice of distributive leadership in public primary schools in Soweto. Soweto is a township in Johannesburg, South Africa, which comprises predominantly black African residents. The findings revealed that leadership in Soweto primary schools is rooted in classical leadership practices and that any potential for the practice of distributive leadership is hindered by autocratic styles of leadership, hierarchical structures, and non-participative decision-making.

Braverman, Foucault and the Labor Process: Framing the Current High-Skills Debate

Science.gov (United States)

Lewis, Theodore

2007-01-01

This article examines the current high-skills discourse against the backdrop of labor process theory. It draws on the theoretical debate between Harry Braverman and Michael Foucault, supplementing the traditional treatment of the labor process with Foucauldian insights. The primary argument is that especially in the market-led economies, current…

Current-voltage relationship in the auroral particle acceleration region

Directory of Open Access Journals (Sweden)

M. Morooka

2004-11-01

Full Text Available The current-voltage relationship in the auroral particle acceleration region has been studied statistically by the Akebono (EXOS-D satellite in terms of the charge carriers of the upward field-aligned current. The Akebono satellite often observed field-aligned currents which were significantly larger than the model value predicted by Knight (1973. We compared the upward field-aligned current estimated by three different methods, and found that low-energy electrons often play an important role as additional current carriers, together with the high-energy primary electrons which are expected from Knight's relation. Such additional currents have been observed especially at high and middle altitudes of the particle acceleration region. Some particular features of electron distribution functions, such as "cylindrical distribution functions" and "electron conics", have often been observed coinciding with the additional currents. They indicated time variability of the particle acceleration region. Therefore, we have concluded that the low-energy electrons within the "forbidden" region of electron phase space in the stationary model often contribute to charge carriers of the current because of the rapid time variability of the particle acceleration region. "Cylindrical distribution functions" are expected to be found below the time-varying potential difference. We statistically examined the locations of "cylindrical distribution function", and found that their altitudes are related to the location where the additional currents have been observed. This result is consistent with the idea that the low-energy electrons can also carry significant current when the acceleration region changes in time.

Rocket-based measurement of Birkeland currents in an active post-midnight aurora

International Nuclear Information System (INIS)

Coley, W.R.

1979-01-01

At 10:45 U.T. on March 1, 1976, an instrumented payload was launched by a Nike-Tomahawk rocket from Poker Flat, Alaska. The payload passed over auroral breakup activity that had a visual intensity of about 150 kR. An electron detector covering the 8 to 10 keV energy range observed electron precipitation while a cesium vapor vector magnetometer measured magnetic perturbations along the vehicle trajectory. From the magnetic measurements a current system consisting of horizontal electrojets and two pairs of oppositely directed field-aligned current sheets was inferred. The total current density carried by these sheets is much larger than that carried by the energetic electrons alone; hence, other particles are the primary current carriers. Data provided by the Chatanika radar facility are used along with other ground-based data to obtain electric fields conductivity estimates, and current densities, which are compared to the currents measured by the flight magnetometer. Results indicate that the ionosphere acts as an electrical load, providing the closing current for Birkeland current flow being generated out in the magnetosphere

Understanding and treatment of chronic abdominal pain in pediatric primary care.

Science.gov (United States)

Schurman, Jennifer Verrill; Kessler, Emily D; Friesen, Craig A

2014-10-01

This study examined the practices used by primary care pediatricians to assess and treat chronic abdominal pain (CAP), as an initial step in guiding clinical practice guideline (CPG) development. A survey was mailed to a random sample of office-based pediatrician members (primary care pediatricians [PCPs]) of the American Medical Association. PCPs (n = 470) provided information about the typical presentation of CAP, assessment/treatment approaches used in their own practice, their definition of a functional gastrointestinal disorder (FGID), and their familiarity with the Rome Criteria for diagnosing FGIDs. Substantial variability among PCPs was noted across all these areas. Results suggest that perceptions and practices of pediatric CAP vary widely among PCPs; no single standard of care emerged to guide development of a CPG for this population. Future research should evaluate the efficacy of specific strategies currently in use to identify potential opportunities for improving assessment and treatment of CAP in pediatric primary care. © The Author(s) 2014.

Email communication at the medical primary-secondary care interface: a qualitative exploration.

Science.gov (United States)

Sampson, Rod; Barbour, Rosaline; Wilson, Philip

2016-07-01

There is little published research into the influence of email communication between primary and secondary care clinicians on patient care. To explore the use of email communication between clinicians across the primary- secondary care interface, and how this may relate to patient care. A qualitative study involving primary and secondary care services in the NHS Highland Health Board area, Scotland. Ten GPs and 12 hospital consultants were purposively sampled to reflect diversity. Eligible clinicians were invited to take part in a semi-structured interview. Data were analysed using a thematic analysis approach. Key themes that emerged for clinicians included general perceptions of email; using email in practice (managing workload, impact on patient journeys, and 'quick answers'); system issues (variability and governance); relational aspects; and email skills. Email communication between primary and secondary care clinicians generally has a positive impact on patient access to specialist expertise. Governance issues around the use of clinical email need to be defined. There may currently be a two-tier health service for those patients (and their GPs) requiring 'quick answers'. © British Journal of General Practice 2016.

An evaluation of selection criteria on primary water chemistry parameters for SMART

International Nuclear Information System (INIS)

Choi, B. S.; Kim, S. H.; Yun, J. H.; Bae, Y. Y.; Gee, S. G.

2003-01-01

The selection criteria on the primary water chemistry of SMART by comparing the chemical design features with those of the current operating PWRs is analyzed. The most essential differences in water chemistry between the PWRs and SMART reactor is characterized by the presence of boron in water. SMART is boron free reactor, and the ammonia is used as a pH reagent. In SMART reactor hydrogen gas is not added to the primary coolant, but is normally generated from the radiolysis of ammonia of the coolant passes through the core. Ammonia is added once per shift because SMART reactor has no letdown and charging system during power operation. Because of these competing processes, the concentrations of hydrogen, nitrogen and ammonia in the primary coolant are steady state concentrations, which depend on the decomposition/combination rate of ammonia. Ammonia chemistry in SMART reactor has many advantages in that no hydrogen gas injection is needed to control the dissolved oxygen in primary coolant because of spontaneous generation of hydrogen and nitrogen produced by the reaction of ammonia decomposition

Enhanced primary and secondary performance through cognitive relaying and leveraging primary feedback

KAUST Repository

Hamza, Doha R.; Aï ssa, Sonia

2014-01-01

We consider a spectrum-sharing system, where the primary terminal operates in a time-slotted fashion and is active only when it has a packet to send. The secondary terminal uses spectrum sensing results and the primary automatic repeat request (ARQ) feedback to access the channel probabilistically. To enhance the primary's system performance, the secondary user (SU) acts as a relay for the primary user (PU) in the event of transmission failure on the direct link of the latter. Closed-form expressions for the primary and secondary throughputs are obtained for the described scheme. The optimal medium access probabilities are then obtained by maximizing the secondary throughput subject to constraints that guarantee the stability of the considered queues, a minimum primary throughput, and a maximum primary queueing delay. The results clearly indicate the benefits of cognitive relaying in enhancing the throughput performance for both the PU and SU. Furthermore, by guaranteeing minimum rate and maximum delay requirements, our scheme is shown to provide a definitive notion of protection for the licensed users of the network. © 2013 IEEE.

Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

Energy Technology Data Exchange (ETDEWEB)

Rim, Chai Hong; Seong, Jin Sil [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2016-09-15

In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.

Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

International Nuclear Information System (INIS)

Rim, Chai Hong; Seong, Jin Sil

2016-01-01

In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy

A review on primary progressive aphasia

Directory of Open Access Journals (Sweden)

Gabriel C Léger

2007-01-01

Full Text Available Gabriel C Léger1,2, Nancy Johnson31Neurology Service, Hôtel-Dieu du Centre Hospitalier de l’Univertité de Montréal, Montréal, Québec, Canada; 2Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; 3Cognitive Neurology and Alzheimer’s Disease Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USAAbstract: Primary progressive aphasia (PPA is a neurodegenerative disease of insidious onset presenting with progressive isolated loss of language function, without significant impairment in other cognitive domains. Current diagnostic criteria require the language dysfunction to remain isolated for at least two years, and to remain the salient feature as the disease progresses, usually to involve other domains such as behavior, executive functions, and judgment. Although PPA in its early stages can usually be differentiated from probable Alzheimer’s disease (PRAD and the behavioral variant of frontotemporal lobar degeneration by the absence of significant changes in memory and behavior, and the preservation of activities daily living, progression of the disease often leads to deficits more consistent with the latter. Underlying etiologies remain heterogeneous: the neuropathological characteristics associated with frontotemporal lobar degeneration, cortocobasal degeneration, and motor neuron disease are usually found. There is a strong genetic susceptibility with affliction of first-degree relatives with similar disease in up to 40 to 50% in some series. Pathogenic mutations in genes coding for the proteins tau and progranulin have been isolated. These are leading to a better understanding of the neuropathological mechanisms and hopefully targeted disease-modifying therapy. Current therapy is limited to improving mood symptoms and targeting behavior changes as they develop. Referral to specialized centers where speech therapy, counseling, and education

General practitioners versus other physicians in the quality of primary care: a cross-sectional study in Guangdong Province, China.

Science.gov (United States)

Zou, Yaming; Zhang, Xiao; Hao, Yuantao; Shi, Leiyu; Hu, Ruwei

2015-10-09

The primary care in China can be provided by general practitioners (GPs) and other physicians (non-GPs). However, China's general practice system has never been really established. Chinese patients tend to consider the quality of primary care provided by GPs much lower than that of non-GPs. Besides, many GPs presently prefer leaving their own positions and seeking better development in big hospitals, which has made the already weak GP system weaker. Yet, few studies have specially compared the quality of primary care provided by Chinese GPs and other physicians and no studies have explored the independent predictors of Chinese GPs' intentions to stay on their current job. In this study, we aimed to compare the quality of primary care offered by GPs with non-GPs and to explore the independent predictors of GPs' future work intentions. This cross-sectional study applied multi-stage random cluster sampling methodology. The data were collected from November 2013 to September 2014 in Guangdong Province. In total, 401 effective questionnaires were selected from the physicians. Quality of primary care was assessed using the Primary Care Assessment Tool (PCAT) Provider Part, representing six primary care domains: ongoing care, coordination (i.e., referrals and information systems), comprehensiveness (i.e., service available and service provided), family-centeredness, community orientation and cultural competence. Of 401 participating physicians, 163 (40.6 %) were GPs. The total PCAT score was 26.32 ± 2.24 which was the sum score of the six domains and represent the quality of primary care. GPs achieved significantly different total scores and scores on three individual scales: comprehensiveness: service available, comprehensiveness: service provided and community orientation. Multiple linear regressions revealed GPs had a higher total score and scores for comprehensiveness: service provided and community orientation after adjusting for sociodemographic characteristics

Distributed Secondary Control for DC Microgrid Applications with Enhanced Current Sharing Accuracy

DEFF Research Database (Denmark)

Lu, Xiaonan; Guerrero, Josep M.; Sun, Kai

2013-01-01

With the consideration of line resistances in a dc microgrid, the current sharing accuracy is lowered down, since the dc output voltage cannot be exactly the same for different interfacing converters. Meanwhile, the dc bus voltage deviation is involved by using droop control. In this paper...... control diagram is accomplished and the requirement of distributed configuration in a microgrid is satisfied. The experimental validation based on a 2×2.2 kW prototype was implemented to demonstrate the proposed approach......., a distributed secondary control method is proposed. Droop control is employed as the primary control method for load current sharing. Meanwhile, the dc output voltage and current in each module is transferred to the others by the low bandwidth communication (LBC) network. Average voltage and current controllers...

First examples of intramolecular addition of primary amidyl radicals to olefins

Energy Technology Data Exchange (ETDEWEB)

Gaudreault, P.; Drouin, C.; Lessard, J. [Sherbrooke Univ., PQ (Canada). Dept. de Chimie

2005-07-01

This paper presents the first examples of radical cyclization involving a primary amidyl radical and a pendant olefin. Amidyl radicals have attracted interest in terms of their structure, reactivity, and ways to generate them. The intramolecular addition of an amidyl radical on a pendant olefin appears to be a powerful synthetic tool for creating nitrogen-containing heterocycles. Although several examples of cyclization involving secondary amidyl radicals are cited in the the literature, there are no examples of a successful cyclization involving a primary amidyl radical. This is because all attempts to prepare the usual radical precursors have failed when applied to olefinic primary amides. This study reveals that N-(phenylthio) derivatives of olefinic primary amides can be easily prepared and that nitrogen heterocycles resulting from their radical cyclization can be obtained in good to very good yields. Four olefinic primary amides were chosen as models for radical cyclization of primary amidyl radicals. They were prepared from the corresponding carboxylic acids via the acid chlorides. Conversion of primary amides into suitable amidyl radical precursors was also examined. The study showed that N-(phenylthio) amides could be easily prepared by following a slightly modified protocol developed by Esker and Newcomb, by reacting the anion of the amide with phenylsulfenyl chloride. In particular, olefinic N-(phenylthio) amides were prepared and used as primary amidyl radical precursors in a reaction with a solution of 2,2'-azobis(isobutyronitrile) in catalytic quantities and tributyltin hydride in benzene. The resulting yields of cyclic products ranged from 63 to 85 per cent. The intent of the study was to demonstrate that it is no longer necessary to prepare an N-protected precursor and then remove the protecting group after cyclization. Further studies are currently underway. 10 refs., 1 tab.

Transcranial Direct Current Stimulation over the Medial Prefrontal Cortex and Left Primary Motor Cortex (mPFC-lPMC) Affects Subjective Beauty but Not Ugliness

Science.gov (United States)

Nakamura, Koyo; Kawabata, Hideaki

2015-01-01

Neuroaesthetics has been searching for the neural bases of the subjective experience of beauty. It has been demonstrated that neural activities in the medial prefrontal cortex (mPFC) and the left primary motor cortex (lPMC) correlate with the subjective experience of beauty. Although beauty and ugliness seem to be semantically and conceptually opposite, it is still unknown whether these two evaluations represent extreme opposites in unitary or bivariate dimensions. In this study, we applied transcranial direct current stimulation (tDCS) to examine whether non-invasive brain stimulation modulates two types of esthetic evaluation; evaluating beauty and ugliness. Participants rated the subjective beauty and ugliness of abstract paintings before and after the application of tDCS. Application of cathodal tDCS over the mPFC with anode electrode over the lPMC, which induced temporal inhibition of neural excitability of the mPFC, led to a decrease in beauty ratings but not ugliness ratings. There were no changes in ratings of both beauty and ugliness when applying anodal tDCS or sham stimulation over the mPFC. Results from our experiment indicate that the mPFC and the lPMC have a causal role in generating the subjective experience of beauty, with beauty and ugliness evaluations constituting two distinct dimensions. PMID:26696865

Primary care validation of a single-question alcohol screening test.

Science.gov (United States)

Smith, Peter C; Schmidt, Susan M; Allensworth-Davies, Donald; Saitz, Richard

2009-07-01

Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings. To validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Cross-sectional study. Adult English-speaking patients recruited from primary care waiting rooms. Participants were asked the single screening question, “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of 1 or greater [corrected] is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method. Of 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics. The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.

US approaches to physician payment: the deconstruction of primary care.

Science.gov (United States)

Berenson, Robert A; Rich, Eugene C

2010-06-01

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

Belongingness in Early Secondary School: Key Factors that Primary and Secondary Schools Need to Consider.

Directory of Open Access Journals (Sweden)

Sharmila Vaz

Full Text Available It is unknown if, and how, students redefine their sense of school belongingness after negotiating the transition to secondary school. The current study used longitudinal data from 266 students with, and without, disabilities who negotiated the transition from 52 primary schools to 152 secondary schools. The study presents the 13 most significant personal student and contextual factors associated with belongingness in the first year of secondary school. Student perception of school belongingness was found to be stable across the transition. No variability in school belongingness due to gender, disability or household-socio-economic status (SES was noted. Primary school belongingness accounted for 22% of the variability in secondary school belongingness. Several personal student factors (competence, coping skills and school factors (low-level classroom task-goal orientation, which influenced belongingness in primary school, continued to influence belongingness in secondary school. In secondary school, effort-goal orientation of the student and perception of their school's tolerance to disability were each associated with perception of school belongingness. Family factors did not influence belongingness in secondary school. Findings of the current study highlight the need for primary schools to foster belongingness among their students at an early age, and transfer students' belongingness profiles as part of the hand-over documentation. Most of the factors that influenced school belongingness before and after the transition to secondary are amenable to change.

VVER operational experience - effect of preconditioning and primary water chemistry on radioactivity build-up

International Nuclear Information System (INIS)

Zmitko, M.; Kysela, J.; Dudjakova, K.; Martykan, M.; Janesik, J.; Hanus, V.; Marcinsky, P.

2004-01-01

The primary coolant technology approaches currently used in VVER units are reviewed and compared with those used in PWR units. Standard and modified water chemistries differing in boron-potassium control are discussed. Preparation of the VVER Primary Water Chemistry Guidelines in the Czech Republic is noted. Operational experience of some VVER units, operated in the Czech Republic and Slovakia, in the field of the primary water chemistry, and radioactivity transport and build-up are presented. In Mochovce and Temelin units, a surface preconditioning (passivation) procedure has been applied during hot functional tests. The main principles of the controlled primary water chemistry applied during the hot functional tests are reviewed and importance of the water chemistry, technological and other relevant parameters is stressed regarding to the quality of the passive layer formed on the primary system surfaces. The first operational experience obtained in the course of beginning of these units operation is presented mainly with respect to the corrosion products coolant and surface activities. Effect of the initial passivation performed during hot functional tests and the primary water chemistry on corrosion products radioactivity level and radiation situation is discussed. (author)

Primary Prevention of Cardiovascular Disease

Directory of Open Access Journals (Sweden)

Danny J. Eapen, MD

2016-09-01

Full Text Available Cardiovascular disease (CVD is the leading cause of death worldwide. This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors. Dietary modification, weight loss, exercise, and tobacco use cessation are specific areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level. Specific areas requiring management include dyslipidemia, hypertension, physical activity, diabetes, aspirin use, and alcohol intake. These preventive efforts have major public health implications. As the global population continues to grow, health care expenditures will also rise, with the potential to eventually overwhelm the health care system. Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals, communities, and nations.

Prescribing pattern of general practitioners for osteoarthritis in primary care settings in Bolu, Turkey

International Nuclear Information System (INIS)

Kartal, M.; Maral, I.; Coskun, O.

2007-01-01

Objective was to assess the drug preferences of primary care physicians for osteoarthritis (OA) in comparison with the current guidelines and their reflections in the cost of prescriptions. Data were collected from all primary health care centers in Bolu, Turkey during from November 2002 from patient polyclinic logbooks. Drugs prescribed were classified according to the Anatomical Therapeutical Chemical Classification system for comparison purposes. Gender, age and health insurance of patients were analyzed for drug preferences and costs. Forty-eight primary care physicians prescribed 1047 drugs for 507 OA patients with total cost of $10,254. Anti-inflammatory and antirheumatic products were the leading group accounting for 59.6% of the prescribed drugs, and 84.1% of the total expenditure. Paracetamol, the most commonly recommended in the guidelines, constituted 6.9% of all prescribed drugs and 0.9% of the total cost. Drug preferences showed a statistical difference among the health insurance types while drugs cost showed statistical significance among the gender and health insurance types. Cyclooygenase-2-specific inhibitors were the most commonly prescribed subgroup, constituting 23.2% of prescribed drugs and 62.6% of the total expenditure. Paracetamol in practice was not the first-line drug preferred by primary care physicians. Drug prescription data showed that the preference of drugs was affected by health insurance types and the gender of patients in favor of expensive new drugs. There is a need for improvement of drug prescriptions to reflect current recommendations and guidelines. (author)

A Hierarchical Control Scheme for Reactive Power and Harmonic Current Sharing in Islanded Microgrids

DEFF Research Database (Denmark)

Lorzadeh, Iman; Firoozabadi, Mehdi Savaghebi; Askarian Abyaneh, Hossein

2015-01-01

In this paper, a hierarchical control scheme consisting of primary and secondary levels is proposed for achieving accurate reactive power and harmonic currents sharing among interface inverters of distributed generators (DGs) in islanded microgrids. Firstly, fundamental and main harmonic componen...

Influence of Waveform and Current Direction on Short-Interval Intracortical Facilitation

DEFF Research Database (Denmark)

Delvendahl, Igor; Lindemann, Hannes; Jung, Nikolai H

2014-01-01

-posterior (AP) current direction (AP-AP or PA-PA), whereas current direction was reversed between first and second pulse for half-sine paired-pulse stimulation (PA-AP and AP-PA). RESULTS: Monophasic AP-AP stimulation resulted in stronger early SICF at 1.4 ms relative to late SICF at 2.8 and 4.4 ms, whereas...... monophasic PA-PA stimulation produced SICF of comparable size at all three peaks. With half-sine stimulation the third SICF peak was reduced for PA-AP current orientation compared with AP-PA. CONCLUSION: SICF elicited using monophasic as well as half-sine pulses is affected by current direction at clearly......BACKGROUND: Transcranial magnetic stimulation (TMS) of the human primary motor hand area (M1-HAND) can produce multiple descending volleys in fast-conducting corticospinal neurons, especially so-called indirect waves (I-waves) resulting from trans-synaptic excitation. Facilitatory interaction...

Control Strategies for Islanded Microgrid using Enhanced Hierarchical Control Structure with Multiple Current-Loop Damping Schemes

DEFF Research Database (Denmark)

Han, Yang; Shen, Pan; Zhao, Xin

2017-01-01

In this paper, the modeling, controller design, and stability analysis of the islanded microgrid (MG) using enhanced hierarchical control structure with multiple current loop damping schemes is proposed. The islanded MG is consisted of the parallel-connected voltage source inverters using LCL...... output filters, and the proposed control structure includes: the primary control with additional phase-shift loop, the secondary control for voltage amplitude and frequency restoration, the virtual impedance loops which contains virtual positive- and negative-sequence impedance loops at fundamental...... frequency, and virtual variable harmonic impedance loop at harmonic frequencies, and the inner voltage and current loop controllers. A small-signal model for the primary and secondary controls with additional phase-shift loop is presented, which shows an over-damped feature from eigenvalue analysis...

Swine brucellosis: current perspectives

Directory of Open Access Journals (Sweden)

Olsen SC

2016-12-01

Full Text Available SC Olsen, FM Tatum Infectious Bacterial Diseases of Livestock Research Unit, National Animal Disease Center, Agricultural Research Service, United States Department of Agriculture, Ames, IA, USA Abstract: Brucella suis is a significant zoonotic species that is present in domestic livestock and wildlife in many countries worldwide. Transmission from animal reservoirs is the source of human infection as human-to-human transmission is very rare. Although swine brucellosis causes economic losses in domestic livestock, preventing human infection is the primary reason for its emphasis in disease control programs. Although disease prevalence varies worldwide, in areas outside of Europe, swine brucellosis is predominantly caused by B. suis biovars 1 and 3. In Europe, swine are predominantly infected with biovar 2 which is much less pathogenic in humans. In many areas worldwide, feral or wild populations of swine are important reservoir hosts. Like other Brucella spp. in their natural host, B. suis has developed mechanisms to survive in an intracellular environment and evade immune detection. Limitations in sensitivity and specificity of current diagnostics require use at a herd level, rather for individual animals. There is currently no commercial vaccine approved for preventing brucellosis in swine. Although not feasible in all situations, whole-herd depopulation is the most effective regulatory mechanism to control swine brucellosis. Keywords: livestock, transmission, pathogenicity, vaccine, host, infection

Membrane systems and their use in nuclear power plants. Treatment of primary coolant

Energy Technology Data Exchange (ETDEWEB)

Kus, Pavel; Bartova, Sarka; Skala, Martin; Vonkova, Katerina [Research Centre Rez, Husinec-Rez (Czech Republic). Technological Circuits Innovation Dept.; Zach, Vaclav; Kopa, Roman [CEZ a.s., Temelin (Czech Republic). Nuclear Power Plant Temelin

2016-03-15

In nuclear power plants, drained primary coolant containing boric acid is currently treated in the system of evaporators and by ion exchangers. Replacement of the system of evaporators by membrane system (MS) will result in lower operating cost mainly due to lower operation temperature. In membrane systems the feed primary coolant is separated into two output streams: retentate and permeate. Retentate stream consists of the concentrated boric acid solution together with other components, while permeate stream consists of purified water. Results are presented achieved by testing a pilot-plant unit of reverse osmosis in nuclear power plant (NPP) Temelin.

Primary Alcohols from Terminal Olefins: Formal Anti-Markovnikov Hydration via Triple Relay Catalysis

KAUST Repository

Dong, G.

2011-09-15

Alcohol synthesis is critical to the chemical and pharmaceutical industries. The addition of water across olefins to form primary alcohols (anti-Markovnikov olefin hydration) would be a broadly useful reaction but has largely proven elusive; an indirect hydroboration/oxidation sequence requiring stoichiometric borane and oxidant is currently the most practical methodology. Here, we report a more direct approach with the use of a triple relay catalysis system that couples palladium-catalyzed oxidation, acid-catalyzed hydrolysis, and ruthenium-catalyzed reduction cycles. Aryl-substituted terminal olefins are converted to primary alcohols by net reaction with water in good yield and excellent regioselectivity.

What Comes after Ursodeoxycholic Acid in Primary Biliary Cholangitis?

Science.gov (United States)

Wong, Lin Lee; Hegade, Vinod S; Jones, David E J

2017-01-01

Primary biliary cholangitis (PBC) is a rare autoimmune liver disease characterized by chronic cholestasis. Treatment with the accepted primary therapy ursodeoxycholic acid (UDCA) has been shown to be associated with delayed disease progression probably through reduced impact of cholestatic injury on the target biliary epithelial cells. Patients with inadequate response to UDCA (which can be identified through validated biochemical criteria) are at increased risk of disease progression, need for liver transplantation, and death. Obeticholic acid (OCA) is a farnesoid X receptor (FXR) agonist which has been evaluated as a second-line therapy in PBC and has been recently licensed by the Food and Drug Administration and European Medicines Agency for use in patients showing an inadequate response to UDCA or who are unable to tolerate it. Although evidence for biochemical improvement by OCA is compelling, there is, as yet, no evidence that OCA improves hard clinical outcomes or quality of life. In addition, OCA may not be suitable for PBC patients with pruritus as it can worsen the symptom. Other novel agents currently in clinical development may have better side-effect profile. Fibrates have the potential but currently lack high quality evidence to support their routine clinical use in PBC. Symptom management of PBC is challenging and ASBT inhibitors and rituximab are being evaluated for pruritus and fatigue, respectively. © 2017 S. Karger AG, Basel.

Patient Factors Associated with Guideline-concordant Treatment of Anxiety and Depression in Primary Care

NARCIS (Netherlands)

Prins, Marijn A.; Verhaak, Peter F. M.; Smolders, Mirrian; Laurant, Miranda G. H.; van der Meer, Klaas; Spreeuwenberg, Peter; van Marwijk, Harm W. J.; Penninx, Brenda W. J. H.; Bensing, Jozien M.

To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Seven hundred and twenty-one patients with a current

Predicting Trophic Interactions and Habitat Utilization in the California Current Ecosystem

Science.gov (United States)

2015-09-30

Foraging patterns: model-data comparison . Simulated (colored circles) and observed (black circles) foraging locations for male sea lion individuals off...focusing on trophic interactions affecting habitat utilization and foraging patterns of California sea lions (CSL) in the California Current Large Marine...by considering patterns of covariability between environmental variables (e.g., temperature, primary production) and foraging patterns and success of

An RF ion source based primary ion gun for secondary ion mass spectroscopy

International Nuclear Information System (INIS)

Menon, Ranjini; Nabhiraj, P.Y.; Bhandari, R.K.

2011-01-01

In this article we present the design, development and characterization of an RF plasma based ion gun as a primary ion gun for SIMS application. RF ion sources, in particular Inductively Coupled Plasma (ICP) ion sources are superior compared to LMIS and duoplasmtron ion sources since they are filamentless, can produce ions of gaseous elements. At the same time, ICP ion sources offer high angular current density which is an important factor in producing high current in small spot size on the target. These high current microprobes improve the signal to noise ratio by three orders as compared to low current ion sources such as LMIS. In addition, the high current microprobes have higher surface and depth profiling speeds. In this article we describe a simple ion source in its very basic form, two lens optical column and characteristics of microprobe

Current fusion power plant design concepts

International Nuclear Information System (INIS)

Gore, B.F.; Murphy, E.S.

1976-09-01

Nine current U.S. designs for fusion power plants are described in this document. Summary tabulations include a tenth concept, for which the design document was unavailable during preparation of the descriptions. The information contained in the descriptions was used to define an envelope of fusion power plant characteristics which formed the basis for definition of reference first commercial fusion power plant design. A brief prose summary of primary plant features introduces each of the descriptions contained in the body of this document. In addition, summary tables are presented. These tables summarize in side-by-side fashion, plant parameters, processes, combinations of materials used, requirements for construction materials, requirements for replacement materials during operation, and production of wastes

Research activity and capacity in primary healthcare: the REACH study: a survey.

LENUS (Irish Health Repository)

Glynn, Liam G

2009-01-01

BACKGROUND: Despite increased investment in primary care research and development (R&D), the level of engagement of primary healthcare professionals with research remains poor. The aim of this study is to assess the level of research activity and capacity for research among primary healthcare professionals in a health authority of over one million people in a mixed urban\\/rural setting in the West of Ireland. METHODS: A questionnaire, incorporating the R+D Culture Index, was sent to primary healthcare professionals in the HSE Western Region. Baseline characteristics were analysed with the use of one-way ANOVA and Chi-square test and the dependence of R&D Culture Index score on all sixteen available covariates was examined using multiple regression and regression tree modelling. RESULTS: There was a 54% response rate to the questionnaire. Primary healthcare professionals appeared to have an interest in and awareness of the importance of research in primary care but just 15% were found to be research active in this study. A more positive attitude towards an R&D culture was associated with having had previous research training, being currently involved in research and with not being a general practitioner (GP) (p < 0.001), but much variability in the R&D culture index score remained unexplained. CONCLUSION: Despite awareness of the importance of R&D in primary care and investment therein, primary healthcare professionals remain largely unengaged with the R&D process. This study highlights the issues that need to be addressed in order to encourage a shift towards a culture of R&D in primary care: lack of research training particularly in basic research skills and increased opportunities for research involvement. The use of the R&D Culture Index may enable groups to be identified that may be more research interested and can therefore be targeted in any future R&D strategy.

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.

Factors associated with job satisfaction by Chinese primary care providers.

Science.gov (United States)

Shi, Leiyu; Song, Kuimeng; Rane, Sarika; Sun, Xiaojie; Li, Hui; Meng, Qingyue

2014-01-01

This study provides a snapshot of the current state of primary care workforce (PCW) serving China's grassroots communities and examines the factors associated with their job satisfaction. Data for the study were from the 2011 China Primary Care Workforce Survey, a nationally representative survey that provides the most current assessment of community-based PCW. Outcome measures included 12 items on job satisfaction. Covariates included intrinsic and extrinsic factors associated with job satisfaction. In addition, PCW type (i.e., physicians, nurses, public health, and village doctors) and practice setting (i.e., rural versus urban) were included to identify potential differences due to the type of PCW and practice settings. The overall satisfaction level is rather low with only 47.6% of the Chinese PCW reporting either satisfied or very satisfied with their job. PCW are least satisfied with their income level (only 8.6% are either satisfied or very satisfied), benefits (12.8%), and professional development (19.5%). They (particularly village doctors) are also dissatisfied with their workload (37.2%). Lower income and higher workload are the two major contributing factors toward job dissatisfaction. To improve the general satisfaction level, policymakers must provide better pay and benefits and more opportunities for career development, particularly for village doctors.

Accounting for graduate medical education production of primary care physicians and general surgeons: timing of measurement matters.

Science.gov (United States)

Petterson, Stephen; Burke, Matthew; Phillips, Robert; Teevan, Bridget

2011-05-01

Legislation proposed in 2009 to expand GME set institutional primary care and general surgery production eligibility thresholds at 25% at entry into training. The authors measured institutions' production of primary care physicians and general surgeons on completion of first residency versus two to four years after graduation to inform debate and explore residency expansion and physician workforce implications. Production of primary care physicians and general surgeons was assessed by retrospective analysis of the 2009 American Medical Association Masterfile, which includes physicians' training institution, residency specialty, and year of completion for up to six training experiences. The authors measured production rates for each institution based on physicians completing their first residency during 2005-2007 in family or internal medicine, pediatrics, or general surgery. They then reassessed rates to account for those who completed additional training. They compared these rates with proposed expansion eligibility thresholds and current workforce needs. Of 116,004 physicians completing their first residency, 54,245 (46.8%) were in primary care and general surgery. Of 683 training institutions, 586 met the 25% threshold for expansion eligibility. At two to four years out, only 29,963 physicians (25.8%) remained in primary care or general surgery, and 135 institutions lost eligibility. A 35% threshold eliminated 314 institutions collectively training 93,774 residents (80.8%). Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. Copyright © by the Association of American medical Colleges.

Short-rotation coppicing in France. Current state of research and prospects for future development

Energy Technology Data Exchange (ETDEWEB)

Bonduelle, P. (Association Foret Cellulose, Trelaze (France)); Bouvarel, L. (Institut National de la Recherche Agronomique, Olivet (France). Unite Experimentale Biomasse, Forestiere et Foret Paysanne); Petit, H. (Association pour la Rationalisation et la Mecanisation de l' Exploitation Forestiere, Fontainebleau (France)); Pierson, J. (Cellulose des Ardennes, Montemedy (France)); Savanne, D. (Agence de l' Environnement et de la Maitrise de l' Energie, 75 - Paris (France)); Sourie, J.C. (Institut National de la Recherche Agronomique, Grignon (France). Station d' Economie et de Sociologie Rurales)

1992-01-01

This article analyzes the current context and the prospects for crop development as well as offering a number of examples of short rotation coppicing projects. The industrial outlets created through state aid remain the primary driving force behind plantations at this time. (author)

Current density monitor for intense relativistic electron beams

International Nuclear Information System (INIS)

Fiorito, R.B.; Raleigh, M.; Seltzer, S.M.

1986-01-01

We describe a new type of electric probe which is capable of measuring the time-resolved current density profile of a stable, reproducible, high-energy (>4-MeV) high-current (>1-kA) electron beam. The sensing element of this probe is an open-ended but capped-off 50-Ω coaxial line constructed of graphite. The graphite sensor is 4.3 mm in diameter, 6 cm long, and is range thin to the primary beam electrons. The probe produces a signal proportional to the intercepted beam current. When the sensor is scanned radially through the beam during repeated pulses, a curve of signal versus depth of insertion is produced from which the radial current density profile can be determined. Measurements are presented of the profile of the electron beam from the Experimental Test Accelerator (4.5 MeV, 10 kA) at Lawrence Livermore National Laboratory. Good agreement is shown between measurements made with this probe and the beam radius as predicted by transport codes. The advantage of the electric probe lies in its ruggedness, simplicity, inherent fast rise time, and low cost. In contrast to other systems it requires no radiation shielding, water cooling, or auxiliary support equipment to operate in an intense beam environment

Surgical adhesives in ophthalmology: history and current trends.

Science.gov (United States)

Guhan, Samantha; Peng, Si-Liang; Janbatian, Hrag; Saadeh, Stephanie; Greenstein, Stephen; Al Bahrani, Faisal; Fadlallah, Ali; Yeh, Tsai-Chu; Melki, Samir A

2018-03-26

Tissue adhesives are gaining popularity in ophthalmology, as they could potentially reduce the complications associated with current surgical methods. An ideal tissue adhesive should have superior tensile strength, be non-toxic and anti-inflammatory, improve efficiency and be cost-effective. Both synthetic and biological glues are available. The primary synthetic glues include cyanoacrylate and the recently introduced polyethylene glycol (PEG) derivatives, while most biological glues are composed of fibrin. Cyanoacrylate has a high tensile strength, but rapidly polymerises upon contact with any fluid and has been associated with histotoxicity. Fibrin induces less toxic and inflammatory reactions, and its polymerisation time can be controlled. Tensile strength studies have shown that fibrin is not as strong as cyanoacrylate. While more research is needed, PEG variants currently appear to have the most promise. These glues are non-toxic, strong and time-effective. Through MEDLINE and internet searches, this paper presents a systematic review of the current applications of surgical adhesives to corneal, glaucoma, retinal, cataract and strabismus surgeries. Our review suggests that surgical adhesives have promise to reduce problems in current ophthalmic surgical procedures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Current Account and Real Exchange Rate Dynamics in Indonesia

Directory of Open Access Journals (Sweden)

Firman Mochtar

2015-07-01

Full Text Available We analyze the role of both permanent and temporary factors in affecting the Indonesian current account and real exchange dynamics before and after 2000. Adopting Lee and Chinn (1998; 2006 approach as well as Chinn et al. (2007, two results stand out. First, we confirm that the behavior of the real exchange rate has altered since 2000. Identifications show that permanent shocks are the primary causes for the movement of the real exchange rate after 2000, while in the period before 2000, the Indonesian real exchange rate changes are characterized by greater dominance of temporary shocks. The apparent change in the real exchange rate behavior may be strongly justified by the implementation of free-floating exchange rate system since August 1997. Second, the shift of the real exchange rate behavior after 2000 does not necessarily affect the current account dynamics. Empirical evidence confirms that the variance of current account post 2000 remains largely due to temporary shocks. Albeit having increasing influence, permanent shocks have insignificant effect in explaining fluctuations of the current account. In this sense, the current account surplus after 2000 is attributed largely to nominal variables such as price increase, while the impact of productivity improvement is still limited.

Investigation of the primary plasticisers present in polyvinyl chloride (PVC) products currently authorised as food contact materials.

Science.gov (United States)

Carlos, Katherine S; de Jager, Lowri S; Begley, Timothy H

2018-03-15

PVC is a common food contact material that is usually plasticised to increase its flexibility. Phthalates are one class of chemical compounds that are often used as plasticisers in PVC in a wide range of industries. They may be used in packaging materials for foods and can also be found in components of certain food processing equipment such as conveyor belts and tubing. Transfer of plasticisers from packaging to foods can occur. In recent years, there has been increased interest in understanding the health effects of phthalates, as well as the possible human exposure levels. However, there is limited information available about the routes of exposure to phthalates. In July 2014, the Chronic Hazard Advisory Panel (CHAP) produced a report for the U.S. Consumer Product Safety Commission detailing the potential health hazards of phthalates and phthalate alternatives. This report listed diet as one factor contributing greater than or equal to 10% of total phthalate exposure. As a result of this report, the U.S. Food and Drug Administration (FDA) is interested in determining the types of the primary plasticiser present in food packaging and processing materials as well as their concentrations. An investigation was conducted of 56 different samples of PVC food packaging and food processing materials available in the US market using a solvent extraction and GC-MS analysis. Nine different plasticisers including three phthalates, di(2-ethylhexyl) phthalate, diisononyl phthalate and diisodecyl phthalate, were identified in the products tested. The plasticiser concentrations ranged from 1 to 53% depending on the types of food contact materials and the type of plasticiser. Overall, it appears that manufacturers are switching away from phthalates as their primary plasticiser to alternate compounds such as ESBO, ATBC, DEHT, DINCH, DEHA and DINA.

Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education.

Science.gov (United States)

Hallinan, Christine M; Hegarty, Kelsey L

2016-01-01

The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the

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.

A Brief Survey of English Education of Tibetan Primary School in Ganzi County

Science.gov (United States)

He, Xiaojun; Lazo, Xia

2015-01-01

The current social backgrounds have made English learning become an important part in every Chinese student's life. Tibetan students begin to study Tibetan, Chinese and English from primary school. However, in many Chinese ethnic-minorities areas like Tibetan areas, English education is facing many problems and challenges, especially the English…

Waste management in primary healthcare centres of Iran.

Science.gov (United States)

Mesdaghinia, Alireza; Naddafi, Kazem; Mahvi, Amir Hossein; Saeedi, Reza

2009-06-01

The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient(-1) day(-1) and 26 L outpatient(-1) day(-1), respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices.

HPV primary cervical screening in England: Women's awareness and attitudes.

Science.gov (United States)

Patel, Hersha; Moss, Esther L; Sherman, Susan M

2018-03-09

Primary human papillomavirus (HPV) cervical screening is due to be implemented in England within the next 2 years; however, the acceptability of HPV testing as the primary screening test is unclear. This study explores women's awareness and attitudes toward HPV testing/screening. Qualitative interviews (semistructured and focus group) were conducted with 46 women (aged 25-65 years) from community and secondary care settings. Data were analyzed by using the inductive-framework method. Women were unaware that cervical screening currently includes HPV testing and lacked HPV-related knowledge. Emotions of shock, fear, and anxiety were reported upon receiving a positive HPV result. For women in long-term relationships, the realization that HPV is a sexually transmitted infection was seen as a barrier to primary HPV testing. Knowledge that HPV testing is a screening test to prevent cervical cancer did not change their attitudes. Women debated the need for continued screening following a negative result. Women feared judgment by the community if they participated with primary HPV screening because they were being tested for a sexually transmitted infection, with the possible attendant perception that they had adopted a high-risk lifestyle in comparison to nonattenders. The acceptability of HPV testing may be a limiting factor in encouraging participation with screening in the future. Copyright © 2018 John Wiley & Sons, Ltd.

Characterization of primary cutaneous CD8+/CD30+ lymphoproliferative disorders.

Science.gov (United States)

Martires, Kathryn J; Ra, Seong; Abdulla, Farah; Cassarino, David S

2015-11-01

CD30 primary cutaneous lymphoproliferative diseases include both lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma (PCALCL). The neoplastic cell of most primary CD30 lymphoproliferative disorders is CD4 positive. The terminology LyP "type D" has been used to describe a growing number of cases of LyP with a predominantly CD8 infiltrate. PCALCL with a CD8 phenotype has also been described, which presents a particularly difficult diagnostic and management challenge, given the difficulty in distinguishing it histologically from other cytotoxic lymphomas such as primary cutaneous aggressive epidermotropic CD8 cytotoxic T-cell lymphoma and CD8 gamma/delta and natural killer/T-cell lymphoma. We report 7 additional cases of these rare cutaneous CD8/CD30 lymphoproliferative disorders. We also present a unique case of CD8/CD30 LyP with histologic similarities to LyP type B. In all 7 of our cases of CD8 LyP and CD8 anaplastic large cell lymphoma, we found focal to diffuse MUM-1 positivity. We propose that MUM-1 may represent an adjunctive marker for CD8 lymphoproliferative disease. Finally, we review the current literature on cases of CD8 LyP and PCALCL. For the 106 cases examined, we found similar clinical and histologic features to those reported for traditional CD4CD30 LyP and PCALCL.

African Primary Care Research: qualitative interviewing in primary care.

Science.gov (United States)

Reid, Steve; Mash, Bob

2014-06-05

This article is part of a series on African Primary Care Research and focuses on the topic of qualitative interviewing in primary care. In particular it looks at issues of study design, sample size, sampling and interviewing in relation to individual and focus group interviews.There is a particular focus on helping postgraduate students at a Masters level to write their research proposals.

Current practice trends in allergy: results of a united states survey of otolaryngologists, allergist-immunologists, and primary care physicians.

Science.gov (United States)

Ryan, Matthew W; Marple, Bradley F; Leatherman, Bryan; Mims, J Whit; Fornadley, John; Veling, Maria; Lin, Sandra Y

2014-10-01

Clinical practices for the diagnosis and treatment of allergic disease evolve over time in response to a variety of forces. The techniques used by various physician specialties are not clearly defined and may vary from published descriptions or recommendations in the literature. This work is a Web-based survey enrolling 250 U.S. physicians in the following specialties: otolaryngology (ENT), allergy-immunology (A/I), and primary care (PCP). Respondents reported that skin-prick testing is the most common diagnostic testing method, followed by in vitro specific immunoglobulin E (IgE) testing. ENTs were more likely to use intradermal testing compared to other specialties (p = 0.0003 vs A/I; p 60). Significant use of home immunotherapy injections (defined as >10% of immunotherapy patients) ranged from 27% to 36% of physicians, with no statistically significant difference noted based upon specialty. PCPs reported greater use of sublingual immunotherapy (PCP, 68%; A/I, 45%; otolaryngology, 35%; A/I vs PCP, p = 0.005; ENT vs PCP p allergy testing and treatment methods are employed by U.S. physicians, with some differences noted based upon specialty. Home immunotherapy continues to be employed in allergy practices, and sublingual immunotherapy is a common form of delivery, especially in primary care practices. © 2014 ARS-AAOA, LLC.

Assessing Lebanon's wildfire potential in association with current and future climatic conditions

Science.gov (United States)

George H. Mitri; Mireille G. Jazi; David McWethy

2015-01-01

The increasing occurrence and extent of large-scale wildfires in the Mediterranean have been linked to extended periods of warm and dry weather. We set out to assess Lebanon's wildfire potential in association with current and future climatic conditions. The Keetch-Byram Drought Index (KBDI) was the primary climate variable used in our evaluation of climate/fire...

Primary Progressive Aphasia

Science.gov (United States)

... which cause different symptoms. Semantic variant primary progressive aphasia Symptoms include these difficulties: Comprehending spoken or written ... word meanings Naming objects Logopenic variant primary progressive aphasia Symptoms include: Having difficulty retrieving words Frequently pausing ...

Access to primary energy sources - the basis of national energy security

Science.gov (United States)

Szlązak, Jan; Szlązak, Rafał A.

2017-11-01

National energy security is of fundamental importance for economic development of a country. To ensure such safety energy raw material, also called primary energy sources, are necessary. Currently in Poland primary energy sources include mainly fossil fuels, such as hard coal, brown coal, natural gas and crude oil. Other sources, e.g. renewable energy sources account for c. 15% in the energy mix. Primary energy sources are used to produce mainly electricity, which is considered as the cleanest form of energy. Poland does not have, unfortunately, sufficient energy sources and is forced to import some of them, mainly natural gas and crude oil. The article presents an insightful analysis of energy raw material reserves possessed by Poland and their structure taking account of the requirements applicable in the European Union, in particular, those related to environmental protection. The article also describes demand for electricity now and in the perspective of 2030. Primary energy sources necessary for its production have also been given. The article also includes the possibilities for the use of renewable energy sources in Poland, however, climatic conditions there are not are not particularly favourable to it. All the issues addressed in the article are summed up and ended with conclusions.

Additional requirements for leak-before-break application to primary coolant piping in Belgium

Energy Technology Data Exchange (ETDEWEB)

Roussel, G. [AIB Vincotte Nuclear, Brussels (Belgium)

1997-04-01

Leak-Before-Break (LBB) technology has not been applied in the first design of the seven Pressurized Water Reactors the Belgian utility is currently operating. The design basis of these plants required to consider the dynamic effects associated with the ruptures to be postulated in the high energy piping. The application of the LBB technology to the existing plants has been recently approved by the Belgian Safety Authorities but with a limitation to the primary coolant loop. LBB analysis has been initiated for the Doel 3 and Tihange 2 plants to allow the withdrawal of some of the reactor coolant pump snubbers at both plants and not reinstall some of the restraints after steam generator replacement at Doel 3. LBB analysis was also found beneficial to demonstrate the acceptability of the primary components and piping to the new conditions resulting from power uprating and stretch-out operation. LBB analysis has been subsequently performed on the primary coolant loop of the Tihange I plant and is currently being performed for the Doel 4 plant. Application of the LBB to the primary coolant loop is based in Belgium on the U.S. Nuclear Regulatory Commission requirements. However the Belgian Safety Authorities required some additional analyses and put some restrictions on the benefits of the LBB analysis to maintain the global safety of the plant at a sufficient level. This paper develops the main steps of the safety evaluation performed by the Belgian Safety Authorities for accepting the application of the LBB technology to existing plants and summarizes the requirements asked for in addition to the U.S. Nuclear Regulatory Commission rules.

An Asymptotic and Stochastic Theory for the Effects of Surface Gravity Waves on Currents and Infragravity Waves

Science.gov (United States)

McWilliams, J. C.; Lane, E.; Melville, K.; Restrepo, J.; Sullivan, P.

2004-12-01

Oceanic surface gravity waves are approximately irrotational, weakly nonlinear, and conservative, and they have a much shorter time scale than oceanic currents and longer waves (e.g., infragravity waves) --- except where the primary surface waves break. This provides a framework for an asymptotic theory, based on separation of time (and space) scales, of wave-averaged effects associated with the conservative primary wave dynamics combined with a stochastic representation of the momentum transfer and induced mixing associated with non-conservative wave breaking. Such a theory requires only modest information about the primary wave field from measurements or operational model forecasts and thus avoids the enormous burden of calculating the waves on their intrinsically small space and time scales. For the conservative effects, the result is a vortex force associated with the primary wave's Stokes drift; a wave-averaged Bernoulli head and sea-level set-up; and an incremental material advection by the Stokes drift. This can be compared to the "radiation stress" formalism of Longuet-Higgins, Stewart, and Hasselmann; it is shown to be a preferable representation since the radiation stress is trivial at its apparent leading order. For the non-conservative breaking effects, a population of stochastic impulses is added to the current and infragravity momentum equations with distribution functions taken from measurements. In offshore wind-wave equilibria, these impulses replace the conventional surface wind stress and cause significant differences in the surface boundary layer currents and entrainment rate, particularly when acting in combination with the conservative vortex force. In the surf zone, where breaking associated with shoaling removes nearly all of the primary wave momentum and energy, the stochastic forcing plays an analogous role as the widely used nearshore radiation stress parameterizations. This talk describes the theoretical framework and presents some

Medical home capabilities of primary care practices that serve sociodemographically vulnerable neighborhoods.

Science.gov (United States)

Friedberg, Mark W; Coltin, Kathryn L; Safran, Dana Gelb; Dresser, Marguerite; Schneider, Eric C

2010-06-14

Under current medical home proposals, primary care practices using specific structural capabilities will receive enhanced payments. Some practices disproportionately serve sociodemographically vulnerable neighborhoods. If these practices lack medical home capabilities, their ineligibility for enhanced payments could worsen disparities in care. Via survey, 308 Massachusetts primary care practices reported their use of 13 structural capabilities commonly included in medical home proposals. Using geocoded US Census data, we constructed racial/ethnic minority and economic disadvantage indices to describe the neighborhood served by each practice. We compared the structural capabilities of "disproportionate-share" practices (those in the most sociodemographically vulnerable quintile on each index) and others. Racial/ethnic disproportionate-share practices were more likely than others to have staff assisting patient self-management (69% vs 55%; P = .003), on-site language interpreters (54% vs 26%; P primary care practices serving sociodemographically vulnerable neighborhoods were more likely than other practices to have structural capabilities commonly included in medical home proposals. Payments tied to these capabilities may aid practices serving vulnerable populations.

The Professional Development Needs of Special Needs Assistants in Irish Post-Primary Schools

Science.gov (United States)

Kerins, Pauline; Casserly, Ann Marie; Deacy, Evelyn; Harvey, Deirdre; McDonagh, Dolores; Tiernan, Bairbre

2018-01-01

According to government policy in Ireland, special needs assistants (SNAs) may be employed in post-primary schools to support students deemed to have chronic and serious care needs. There is currently no national policy regarding the continuing professional development (CPD) of SNAs, to meet the requirements of their role. This study investigated…

Primary loop simulation of the SP-100 space nuclear reactor

International Nuclear Information System (INIS)

Borges, Eduardo M.; Braz Filho, Francisco A.; Guimaraes, Lamartine N.F.

2011-01-01

Between 1983 and 1992 the SP-100 space nuclear reactor development project for electric power generation in a range of 100 to 1000 kWh was conducted in the USA. Several configurations were studied to satisfy different mission objectives and power systems. In this reactor the heat is generated in a compact core and refrigerated by liquid lithium, the primary loops flow are controlled by thermoelectric electromagnetic pumps (EMTE), and thermoelectric converters produce direct current energy. To define the system operation point for an operating nominal power, it is necessary the simulation of the thermal-hydraulic components of the space nuclear reactor. In this paper the BEMTE-3 computer code is used to EMTE pump design performance evaluation to a thermalhydraulic primary loop configuration, and comparison of the system operation points of SP-100 reactor to two thermal powers, with satisfactory results. (author)

Current Situation of Treatment for Anaphylaxis in a Japanese Pediatric Emergency Center.

Science.gov (United States)

Ninchoji, Takeshi; Iwatani, Sota; Nishiyama, Masahiro; Kamiyoshi, Naohiro; Taniguchi-Ikeda, Mariko; Morisada, Naoya; Ishibashi, Kazuto; Iijima, Kazumoto; Ishida, Akihito; Morioka, Ichiro

2018-04-01

Anaphylaxis is a systemic allergic reaction that sometimes requires prompt treatment with intramuscular adrenaline. The aim of the study was to investigate the current situation regarding anaphylaxis treatment in a representative pediatric primary emergency facility in Japan. We retrospectively examined the medical records dating from April 2011 through March 2014 from Kobe Children's Primary Emergency Medical Center, where general pediatricians work on a part-time basis. Clinical characteristics and current treatments for patients with anaphylaxis who presented to the facility were investigated. Furthermore, we compared the clinical characteristics between anaphylaxis patients given intramuscular adrenaline and those not given it. During the study period, 217 patients were diagnosed with anaphylaxis. The median Sampson grade at the time of visit was 2, and 90 patients (41%) were grade 4 or higher. No patients received self-intramuscular injected adrenaline before arrival at our emergency medical center because none of the patients had been prescribed it. Further treatment during the visit was provided to 128 patients (59%), with only 17 (8%) receiving intramuscular adrenaline. Patients given intramuscular adrenaline had significantly lower peripheral saturation of oxygen at the visit (P = 0.025) and more frequent transfer to a referral hospital (P < 0.001) than those not given intramuscular adrenaline. Education for Japanese pediatric practitioners and patients is warranted, because no patients used self-intramuscular injected adrenaline as a prehospital treatment for anaphylaxis, and only severely affected patients who needed oxygen therapy or hospitalization received intramuscular adrenaline in a pediatric primary emergency setting.

Report on the Current Technical Issues on ASME Nuclear Code and Standard

International Nuclear Information System (INIS)

Koo, Gyeong Hoi; Lee, B. S.; Yoo, S. H.

2008-11-01

This report describes the analysis on the current revision movement related to the mechanical design issues of the U.S ASME nuclear code and standard. ASME nuclear mechanical design in this report is composed of the nuclear material, primary system, secondary system and high temperature reactor. This report includes the countermeasures based on the ASME Code meeting for current issues of each major field. KAMC(ASME Mirror Committee) of this project is willing to reflect a standpoint of the domestic nuclear industry on ASME nuclear mechanical design and play a technical bridge role for the domestic nuclear industry in ASME Codes application

Primary repair of penetrating colon injuries: a systematic review.

Science.gov (United States)

Singer, Marc A; Nelson, Richard L

2002-12-01

.25-0.76) all significantly favored primary repair. Meta-analysis of currently published randomized, controlled trials favors primary repair over fecal diversion for penetrating colon injuries.

Radiation risk - historical perspective and current issues

Energy Technology Data Exchange (ETDEWEB)

Kellerer, Albrecht M. [Strahlenbiologisches Institut, Ludwig-Maximilians-Universitaet, Munich, Germany and Institute for Radiation Biology, GSF-National Research Center for Environment and Health, Neuherberg (Germany)

2002-09-01

The assessment of radiation risk needs to be seen against the background of a historical development that has reversed the initial belief in a general beneficial effect of radiation to apprehension and fear. Numerical risk estimates are, today, based on large epidemiological studies, and the observations on the A-bomb survivors are outlined as the primary source of information. Since the epidemiological findings are obtained from relatively high radiation exposures, extrapolations are required to the much lower doses that are relevant to radiation protection. The evolution of extrapolation procedures up to current attempts at mechanistic modelling is outlined, and some of the open issues are reviewed. (author)

Radiation risk - historical perspective and current issues

International Nuclear Information System (INIS)

Kellerer, Albrecht M.

2002-01-01

The assessment of radiation risk needs to be seen against the background of a historical development that has reversed the initial belief in a general beneficial effect of radiation to apprehension and fear. Numerical risk estimates are, today, based on large epidemiological studies, and the observations on the A-bomb survivors are outlined as the primary source of information. Since the epidemiological findings are obtained from relatively high radiation exposures, extrapolations are required to the much lower doses that are relevant to radiation protection. The evolution of extrapolation procedures up to current attempts at mechanistic modelling is outlined, and some of the open issues are reviewed. (author)

Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

Science.gov (United States)

Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen

2016-12-01

Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. This was a qualitative study based on semi-structured, in-person interviews. Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue

Renal impairment as a surgical indication in primary hyperparathyroidism: do the data support this recommendation?

Science.gov (United States)

Hendrickson, Chase D; Castro Pereira, Daniel J; Comi, Richard J

2014-08-01

Management of primary hyperparathyroidism has evolved over the past two decades, yet impaired renal function has consistently been a surgical indication. This recommendation has been based upon the historical association between primary hyperparathyroidism and renal impairment, and a review of the literature is needed to determine whether such a recommendation is warranted. PubMed was utilized to identify English-language articles published between January 1990 and February 2014 using keywords related to hyperparathyroidism and renal function. The keywords were "primary hyperparathyroidism," "surgery," "parathyroidectomy," "kidney," "renal," "glomerular filtration rate," and "creatinine." Of the 1926 articles obtained with this search, all articles germane to the topic that quantified the relationship between primary hyperparathyroidism and renal function were included. All references within these articles were investigated for inclusion. When helpful, data tables were constructed to summarize the results succinctly. A secondary elevation of PTH levels has not been consistently shown to occur at the threshold currently indicated for surgical intervention. While renal impairment is seen with more significant disease, mild asymptomatic primary hyperparathyroidism has not been conclusively associated with renal impairment. Furthermore, there is no evidence to suggest that surgically curing primary hyperparathyroidism via a parathyroidectomy has any impact upon renal function.

Pathogenesis, diagnosis and management of primary melanoma of the colon

Directory of Open Access Journals (Sweden)

Imam Ayesha

2011-02-01

. Chemotherapeutic agents including interferons, cytokines, biological agents and radiation therapy for brain metastases have been reported as adjuvant and palliative options while considering malignant melanomas in general. The average recurrence-free interval was 2.59 years. Nine of the 12 reports documented follow-up in their patients. Two of these 9 (22.2% patients died. Conclusions Primary melanoma of the colon is a rare clinical entity. Whenever a seemingly primary melanoma is detected in an atypical location such as the colon, it is prudent to conduct a thorough clinical investigation to consider the possibility of metastatic disease. Further studies are needed to document the long term follow-up, survival advantage and safety of the management approaches employed in patients with primary colonic melanoma. Based on current data, surgical resection appears to be appropriate management for primary colonic melanomas; unless the disease has metastasized to distant sites where surgery may have a limited palliative role.

Primary School Environment Trend, Class-Ratio and Head Teachers Overcrowded Classrooms Management Strategies in Northern Senatorial District of Ondo State, Nigeria

Science.gov (United States)

Babatunde, Ehinola Gabriel

2015-01-01

Primary school Enrolment Trend, Class-Ratio and Head Teachers overcrowded classrooms management strategies in Northern Senatorial District of Ondo State, Nigeria was investigated. The purpose of the study is to examine the current enrolment trend in public primary schools in northern senatorial District of Ondo State. Also, is to ascertain the…

Plant physiology meets phytopathology: plant primary metabolism and plant-pathogen interactions.

Science.gov (United States)

Berger, Susanne; Sinha, Alok K; Roitsch, Thomas

2007-01-01

Phytopathogen infection leads to changes in secondary metabolism based on the induction of defence programmes as well as to changes in primary metabolism which affect growth and development of the plant. Therefore, pathogen attack causes crop yield losses even in interactions which do not end up with disease or death of the plant. While the regulation of defence responses has been intensively studied for decades, less is known about the effects of pathogen infection on primary metabolism. Recently, interest in this research area has been growing, and aspects of photosynthesis, assimilate partitioning, and source-sink regulation in different types of plant-pathogen interactions have been investigated. Similarly, phytopathological studies take into consideration the physiological status of the infected tissues to elucidate the fine-tuned infection mechanisms. The aim of this review is to give a summary of recent advances in the mutual interrelation between primary metabolism and pathogen infection, as well as to indicate current developments in non-invasive techniques and important strategies of combining modern molecular and physiological techniques with phytopathology for future investigations.

Interventions for primary (intrinsic tracheomalacia in children

Directory of Open Access Journals (Sweden)

Vikas Goyal

Full Text Available BACKGROUNDTracheomalacia, a disorder of the large airways where the trachea is deformed or malformed during respiration, is commonly seen in tertiary paediatric practice. It is associated with a wide spectrum of respiratory symptoms from life-threatening recurrent apnoea to common respiratory symptoms such as chronic cough and wheeze. Current practice following diagnosis of tracheomalacia includes medical approaches aimed at reducing associated symptoms of tracheomalacia, ventilation modalities of continuous positive airway pressure (CPAP and bi-level positive airway pressure (BiPAP, and surgical approaches aimed at improving the calibre of the airway (airway stenting, aortopexy, tracheopexy.OBJECTIVESTo evaluate the efficacy of medical and surgical therapies for children with intrinsic (primary tracheomalacia.METHODSSearchThe Cochrane Airways Group searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Airways Group's Specialized Register, Medline and Embase databases. The Cochrane Airways Group performed the latest searches in March 2012.Selection criteriaAll randomized controlled trials (RCTs of therapies related to symptoms associated with primary or intrinsic tracheomalacia.Data collection and analysisTwo reviewers extracted data from the included study independently and resolved disagreements by consensus.MAIN RESULTSWe included one RCT that compared nebulized recombinant human deoxyribonuclease (rhDNase with placebo in 40 children with airway malacia and a respiratory tract infection. We assessed it to be a RCT with overall low risk of bias. Data analyzed in this review showed that there was no significant difference between groups for the primary outcome of proportion cough-free at two weeks (odds ratio (OR 1.38; 95% confidence interval (CI 0.37 to 5.14. However, the mean change in night time cough diary scores significantly favoured the placebo group (mean difference (MD 1.00; 95% CI 0.17 to 1.83, P = 0

Plug-and-play control and consensus algorithms for current sharing in DC microgrids

DEFF Research Database (Denmark)

Tucci, Michele; Meng, Lexuan; Guerrero, Josep M.

2017-01-01

In this paper, we propose a secondary consensus-based control layer for current sharing and voltage balancing in DC microGrids (mGs). Differently from existing approaches based on droop control, we assume decentralized Plug-and-Play (PnP) regulators at the primary level, as they provide voltage...... functions (Tucci et al., 2016a). Besides showing stability, current sharing, and voltage balancing in the asymptotic régime, we describe how to design secondary controllers in a PnP fashion when Distributed Generation Units (DGUs) are added or removed. Theoretical results are complemented by simulations...

[Hypertension: once primary, always primary?

NARCIS (Netherlands)

Braam, R.L.; Pieters, G.F.F.M.; Thien, Th.

2002-01-01

Three patients diagnosed with primary hypertension suddenly developed hard-to-treat blood pressure after several years of stable blood pressure. One patient, a man aged 48 years, had developed a renal artery stenosis, which had not been present five years earlier. The other two patients, a man aged

An improved current control scheme for grid-connected DG unit based distribution system harmonic compensation

DEFF Research Database (Denmark)

He, Jinwei; Wei Li, Yun; Wang, Xiongfei

2013-01-01

In order to utilize DG unit interfacing converters to actively compensate distribution system harmonics, this paper proposes an enhanced current control approach. It seamlessly integrates system harmonic mitigation capabilities with the primary DG power generation function. As the proposed current...... controller has two well decoupled control branches to independently control fundamental and harmonic DG currents, phase-locked loops (PLL) and system harmonic component extractions can be avoided during system harmonic compensation. Moreover, a closed-loop power control scheme is also employed to derive...... the fundamental current reference. The proposed power control scheme effectively eliminates the impacts of steady-state fundamental current tracking errors in the DG units. Thus, an accurate power control is realized even when the harmonic compensation functions are activated. Experimental results from a single...

Ignition delay time measurements of primary reference fuel blends

KAUST Repository

Alabbad, Mohammed

2017-02-07

Ignition delay times of four different primary reference fuels (PRF), mixtures of n-heptane and iso-octane, were measured behind reflected shock waves in a high-pressure shock tube facility. The PRFs were formulated to match the RON of two high-octane gasolines (RON 95 and 91) and two prospective low-octane naphtha fuels (RON 80 and 70). Experiments were carried out over a wide range of temperatures (700–1200K), pressures (10, 20, and 40bar) and equivalence ratios (0.5 and 1). Kinetic modeling predictions from four chemical kinetic mechanisms are compared with the experimental data. Ignition delay correlations are developed to reproduce the measured ignition delay times. Brute force sensitivity analyses are carried out to identify reactions that affect ignition delay times at specific temperature, pressure and equivalence ratio. The large experimental data set provided in the current work will serve as a benchmark for the validation of chemical kinetic mechanisms of primary reference fuel blends.

Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report

Directory of Open Access Journals (Sweden)

Yueh-Hua Chung

2004-04-01

Full Text Available Development of hyperthyroidism following primary hypothyroidism is uncommon, and only a few documented cases have been reported. Alterations in thyroid-stimulating hormone receptor antibodies in serum are currently considered to play the main role in the pathophysiology, but the exact mechanism is still unknown. Here, we report the case of a 60-year-old man with disturbed consciousness due to hyponatremia. Thyroid function tests showed primary hypothyroidism with a high anti-microsomal antibody titer (1:6,400. The patient experienced weight loss and exophthalmos 6 years later. Serum thyroid hormone levels were increased and thyroxine treatment was discontinued, but the patient remained thyrotoxic 2 months later. 131I thyroid uptake was 40.9% at 24 hours, and bilateral thyroid lobes were not enlarged with diffuse radioactivity. Six months later, the patient was still thyrotoxic and therapy with methimazole 10 mg/day was started. He is now taking methimazole and is euthyroid.

Ignition delay time measurements of primary reference fuel blends

KAUST Repository

Alabbad, Mohammed; Javed, Tamour; Khaled, Fathi; Badra, Jihad; Farooq, Aamir

2017-01-01

Ignition delay times of four different primary reference fuels (PRF), mixtures of n-heptane and iso-octane, were measured behind reflected shock waves in a high-pressure shock tube facility. The PRFs were formulated to match the RON of two high-octane gasolines (RON 95 and 91) and two prospective low-octane naphtha fuels (RON 80 and 70). Experiments were carried out over a wide range of temperatures (700–1200K), pressures (10, 20, and 40bar) and equivalence ratios (0.5 and 1). Kinetic modeling predictions from four chemical kinetic mechanisms are compared with the experimental data. Ignition delay correlations are developed to reproduce the measured ignition delay times. Brute force sensitivity analyses are carried out to identify reactions that affect ignition delay times at specific temperature, pressure and equivalence ratio. The large experimental data set provided in the current work will serve as a benchmark for the validation of chemical kinetic mechanisms of primary reference fuel blends.

Farm work-related asthma among US primary farm operators.

Science.gov (United States)

Mazurek, Jacek M; White, Gretchen E; Rodman, Chad; Schleiff, Patricia L

2015-01-01

The objective of this study was to estimate the prevalence of current asthma and the proportion of current asthma that is related to work on the farm among primary farm operators. The 2011 Farm and Ranch Safety Survey data were used to produce estimates and prevalence odds ratios. An estimated 5.1% of farm operators had asthma. Of these, 15.4% had farm work-related asthma. Among operators with farm work-related asthma, 54.8% (95% confidence interval [CI]: 41.8%-68.2%) had an asthma attack in the prior 12 months and 33.3% (95% CI: 21.2%-45.4%) had an asthma attack that occurred while doing farm work. Of those who had an asthma attack that occurred while doing farm work, 65.0% associated their asthma attack with plant/tree materials. This study provides updated information on asthma and the proportion of current asthma that is related to work on the farm and identifies certain groups of farm operators that might benefit from workplace asthma prevention intervention.

Patterns of primary production in the Red Sea

Digital Repository Service at National Institute of Oceanography (India)

Qurban, M.A.; Wafar, M.; Jyothibabu, R.; Manikandan, K.P.

for bio- phic stations occupied in e Indian Ocean (source - et al., 1995), remotely-sensed (CZCS) chlorophyll data were used to make deductions on rates of primary production at basin-scale. The conclusion consistently arrived at from all earlier studies... acquired along the axis of the basin in the 2013 cruise, Wafar et al. (2016a) identified alternating zonal currents at six locations – 18–18.5°N, 19–20.5°N, 22°N, 24°N, 24.5°N and 26°N - and concluded that they represent three successive anticyclonic cells...

Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

Science.gov (United States)

Willcox, Merlin L; Peersman, Wim; Daou, Pierre; Diakité, Chiaka; Bajunirwe, Francis; Mubangizi, Vincent; Mahmoud, Eman Hassan; Moosa, Shabir; Phaladze, Nthabiseng; Nkomazana, Oathokwa; Khogali, Mustafa; Diallo, Drissa; De Maeseneer, Jan; Mant, David

2015-09-10

The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources

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…

Current lead thermal analysis code 'CURRENT'

International Nuclear Information System (INIS)

Yamaguchi, Masahito; Tada, Eisuke; Shimamoto, Susumu; Hata, Kenichiro.

1985-08-01

Large gas-cooled current lead with the capacity more than 30 kA and 22 kV is required for superconducting toroidal and poloidal coils for fusion application. The current lead is used to carry electrical current from the power supply system at room temperature to the superconducting coil at 4 K. Accordingly, the thermal performance of the current lead is significantly important to determine the heat load requirements of the coil system at 4 K. Japan Atomic Energy Research Institute (JAERI) has being developed the large gas-cooled current leads with the optimum condition in which the heat load is around 1 W per 1 kA at 4 K. In order to design the current lead with the optimum thermal performances, JAERI developed thermal analysis code named as ''CURRENT'' which can theoretically calculate the optimum geometric shape and cooling conditions of the current lead. The basic equations and the instruction manual of the analysis code are described in this report. (author)

Postconditioning during primary percutaneous coronary intervention: a review and meta-analysis

DEFF Research Database (Denmark)

Hansen, Peter Riis; Thibault, Helene; Abdulla, Jawdat

2010-01-01

Myocardial postconditioning (POC), defined as intermittent interruptions of blood flow at the onset of reperfusion after sustained ischemia, may attenuate reperfusion injury. In order to weigh the current evidence linking POC to reduction of myocardial infarct size in patients with ST-segment ele......-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), we performed a systematic review and meta-analysis of the available data from small randomised trials....

Prevalence of problem alcohol use among patients attending primary care for methadone treatment

LENUS (Irish Health Repository)

Ryder, Niamh

2009-06-11

Abstract Background Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed todetermine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. Methods We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. Results We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28–41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. Conclusion Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make

Prevalence of problem alcohol use among patients attending primary care for methadone treatment.

LENUS (Irish Health Repository)

Ryder, Niamh

2012-02-01

BACKGROUND: Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed to determine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. METHODS: We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. RESULTS: We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28-41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. CONCLUSION: Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this

Quiet ionospheric currents of the southern hemisphere derived from geomagnetic records

International Nuclear Information System (INIS)

Campbell, W.H.; Schiffmacher, E.R.

1988-01-01

This work describes the month-by-month behavior of the equivalent ionospheric current systems derived from spherical harmonic analyses of the quiet time geomagnetic field daily variations in 1965 at selected observatories representing the three southern global half-sector regions separately encompassing South America, Africa, and Australia. These external Sq current patterns were vortices having mid-latitude foci with midday summertime amplitudes reaching 16.2 x 10 4 A above the midnight level. The wintertime amplitudes were about 10 x 10 4 A smaller. At low latitudes there was a large intrusion of the opposite hemisphere external Sq current system into the wintertime hemisphere at prenoon hours, displacing the primary current vortex to later postnoon hours. The behavior of the southern hemisphere external currents were found to be seasonally similar to those of the northern hemisphere for the same year. The quiet year behavior was compared to the results for the 1958 active year determined earlier by Matsushita. The winter-to-summertime increase in focus current was found to be similar in amplitude for the 2 years. The active year summertime and equinoctial current focus amplitudes were about 2.3 times the amplitudes of corresponding months in the quiet year

Primary care in Caribbean Small Island Developing States

Directory of Open Access Journals (Sweden)

J.D. Kranenburg

2015-05-01

Full Text Available Caribbean Small Island Developing States (SIDS made good process on improving the health of their populations; but concerns exist when it comes to meeting changing health needs. Due to remoteness and limited resources it is difficult to respond to high rates of non-communicable diseases (NCDs. Furthermore, little is known about how primary care (PC is organised and how this responds to current health issues. This study focused on gaining insights in the organisation of PC of Caribbean SIDS based on currently available literature. This literature review was an explorative multiple case study, where structure of PC and health status of 16 Caribbean SIDS were reviewed using available scientific and grey literature between the years 1997 and 2014. Thirty documents were used to analyse 20 indicators for the dimensions “Structure of Primary Care” and “Health Status”. Results were mapped in order to identify if there is a possible relation between structures of PC to the health of the populations. When reviewing the structure of PC, the majority of information was available for “Economic conditions of PC” (78% and the least information was available for “Governance of PC” (40%. With regards to health status, all islands show improvements on “Life expectancy at birth” since 2007. In contrast, on average, the mortality due to NCDs did not improve. Saint Lucia performs best on “Structure of PC”. The British Virgin Islands have the best health status. When both dimensions were analysed, Saint Lucia performs best. There is still little known on the responsiveness of PC of Caribbean SIDS to NCDs. There is a need for elaborate research on: (1 If and how the functioning of these health systems relate to the health status; (2 What islands can learn from an analysis over time and what they can learn from cross-island analysis; and (3 Filling the gaps of knowledge which currently exist within this field of research.

Eddy current inspection of steam generator tubing plugs

International Nuclear Information System (INIS)

Cullen, W.K.

1990-01-01

In response to the issues raised regarding the integrity of nuclear steam generator tubing plugs manufactured from certain heats of Inconel 600, Westinghouse engineers have developed, qualified and implemented an eddy current inspection system for the in-place assessment of these plugs. The heart of the system is a robotic and effector which delivers an eddy current sensor through the reduced diameter of the plug expander and actuates the coil to physical contact with the expanded inside bore of the plug. Once deployed, the eddy current sensor is rotated along a helical path to produce a detailed scan of the plug surface above the final position of the expander. This testing produces an isometric display of degradation due to primary water stress corrosion cracking, on the inside surface of the plug. To date, successful inspections have been conducted at two nuclear units with two different robotic delivery systems. While designed specifically for mechanical plugs with a bottle bore cavity, the inspection system can also be used for expanded straight bore plugs. Details of the inspection system along with a discussion of qualification activities and actual field results are presented in this paper

Optimizing the Primary Prevention of Type-2 Diabetes in Primary Health Care

Science.gov (United States)

2017-08-18

Interprofessional Relations; Primary Health Care/Organization & Administration; Diabetes Mellitus, Type 2/Prevention & Control; Primary Prevention/Methods; Risk Reduction Behavior; Randomized Controlled Trial; Life Style

Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary.

Science.gov (United States)

Hannouf, M B; Winquist, E; Mahmud, S M; Brackstone, M; Sarma, S; Rodrigues, G; Rogan, P; Hoch, J S; Zaric, G S

2017-06-01

We aimed to investigate the cost-effectiveness of a 2000-gene-expression profiling (GEP) test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary (CUP). We built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP. The model was parameterized using follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. The 2000-GEP-based strategy compared to current clinical practice resulted in an incremental cost-effectiveness ratio (ICER) of $44,151 per quality-adjusted life years (QALY) gained. The total annual-budget impact was $36.2 million per year. A value-of-information analysis revealed that the expected value of perfect information about the test's clinical impact was $4.2 million per year. The 2000-GEP test should be considered for adoption in CUP. Field evaluations of the test are associated with a large societal benefit.

Primary Ewing's sarcoma of the skull: radical resection and immediate cranioplasty after chemotherapy. A technical note.

Science.gov (United States)

Castle, Maria; Rivero, Mónica; Marquez, Javier

2013-02-01

The current standard treatment of Ewing's sarcoma is chemotherapy followed by surgery, making an immediate cranial reconstruction in a one-step surgical procedure possible. We describe the technique used to repair a cranial defect after the resection of a primary Ewing's sarcoma of the skull in a one-step surgical procedure. Bone repair with a custom-made cranioplasty immediately after resection of a primary Ewing's sarcoma of the skull avoids deformities and late complications associated with reconstructive surgery after radiotherapy and not interfere with radiotherapy and neither with follow-up. A one-step surgical procedure after chemotherapy for primary Ewing's sarcoma of the skull could be safer, less aggressive and more radical; avoiding deformities and late complications.

Spelling rehabilitation using transcranial direct current (tDCS in primary progressive aphasia (PPA.

Directory of Open Access Journals (Sweden)

Constantine Frangakis

2014-04-01

Full Text Available Introduction: Spelling impairments are one of the first deficits that occur early in PPA and can usually predict the variant of PPA in which the patient may progress (Sepelyak et al., 2011. PPA is a neurodegenerative disease that affects people relatively early in life (between 55-65 years and therefore it is important to find ways to alleviate the symptoms or impede the degree of degeneration. We present and discuss new data indicating that a neuromodulatory treatment, using transcranial direct current stimulation (tDCS combined with a spelling intervention, shows promise for maintaining or even improving language abilities in PPA. The aim of this research is to determine whether tDCS plus language therapy is more effective than language therapy alone in treating written language deficits in PPA. Methods: Eight PPA participants underwent anodal tDCS or sham plus spelling intervention in a randomized order using a within-subject cross-over design. They were evaluated before, after, and at 2 weeks and 2 months post-intervention. Spelling intervention varied for each participant according to the main spelling deficit: 3 patients had phoneme-to-grapheme conversion (PGC intervention, 2 had lexical intervention and 3 had advanced PGC intervention (combined with written fluency and PGC practice. Four more patients have already finished the first period of stimulations (ether sham or tDCS and all their other sessions and evaluations will be completed in the next couple months. Analyses-Results: We analyzed the existing set of full data using both within-subject analyses (McNemar tests and across-subjects analyses while taking into account carry-over effects. We evaluated therapy effects by the Generalized Estimating Equation approach (Liang & Zeger, 1986. All participants showed improvement in spelling after spelling intervention in trained items (with either sham or tDCS. There was, however, a significant improvement for untrained items only in the t

Anodal transcranial direct current stimulation over the primary motor cortex does not enhance the learning benefits of self-controlled feedback schedules.

Science.gov (United States)

Carter, Michael J; Smith, Victoria; Carlsen, Anthony N; Ste-Marie, Diane M

2018-05-01

A distinct learning advantage has been shown when participants control their knowledge of results (KR) scheduling during practice compared to when the same KR schedule is imposed on the learner without choice (i.e., yoked schedules). Although the learning advantages of self-controlled KR schedules are well-documented, the brain regions contributing to these advantages remain unknown. Identifying key brain regions would not only advance our theoretical understanding of the mechanisms underlying self-controlled learning advantages, but would also highlight regions that could be targeted in more applied settings to boost the already beneficial effects of self-controlled KR schedules. Here, we investigated whether applying anodal transcranial direct current stimulation (tDCS) to the primary motor cortex (M1) would enhance the typically found benefits of learning a novel motor skill with a self-controlled KR schedule. Participants practiced a spatiotemporal task in one of four groups using a factorial combination of KR schedule (self-controlled vs. yoked) and tDCS (anodal vs. sham). Testing occurred on two consecutive days with spatial and temporal accuracy measured on both days and learning was assessed using 24-h retention and transfer tests without KR. All groups improved their performance in practice and a significant effect for practicing with a self-controlled KR schedule compared to a yoked schedule was found for temporal accuracy in transfer, but a similar advantage was not evident in retention. There were no significant differences as a function of KR schedule or tDCS for spatial accuracy in retention or transfer. The lack of a significant tDCS effect suggests that M1 may not strongly contribute to self-controlled KR learning advantages; however, caution is advised with this interpretation as typical self-controlled learning benefits were not strongly replicated in the present experiment.

Aliphatic, cyclic, and aromatic organic acids, vitamins, and carbohydrates in soil: a review.

Science.gov (United States)

Vranova, Valerie; Rejsek, Klement; Formanek, Pavel

2013-11-10

Organic acids, vitamins, and carbohydrates represent important organic compounds in soil. Aliphatic, cyclic, and aromatic organic acids play important roles in rhizosphere ecology, pedogenesis, food-web interactions, and decontamination of sites polluted by heavy metals and organic pollutants. Carbohydrates in soils can be used to estimate changes of soil organic matter due to management practices, whereas vitamins may play an important role in soil biological and biochemical processes. The aim of this work is to review current knowledge on aliphatic, cyclic, and aromatic organic acids, vitamins, and carbohydrates in soil and to identify directions for future research. Assessments of organic acids (aliphatic, cyclic, and aromatic) and carbohydrates, including their behaviour, have been reported in many works. However, knowledge on the occurrence and behaviour of D-enantiomers of organic acids, which may be abundant in soil, is currently lacking. Also, identification of the impact and mechanisms of environmental factors, such as soil water content, on carbohydrate status within soil organic matter remains to be determined. Finally, the occurrence of vitamins in soil and their role in biological and biochemical soil processes represent an important direction for future research.

Aliphatic, Cyclic, and Aromatic Organic Acids, Vitamins, and Carbohydrates in Soil: A Review

Directory of Open Access Journals (Sweden)

Valerie Vranova

2013-01-01

Full Text Available Organic acids, vitamins, and carbohydrates represent important organic compounds in soil. Aliphatic, cyclic, and aromatic organic acids play important roles in rhizosphere ecology, pedogenesis, food-web interactions, and decontamination of sites polluted by heavy metals and organic pollutants. Carbohydrates in soils can be used to estimate changes of soil organic matter due to management practices, whereas vitamins may play an important role in soil biological and biochemical processes. The aim of this work is to review current knowledge on aliphatic, cyclic, and aromatic organic acids, vitamins, and carbohydrates in soil and to identify directions for future research. Assessments of organic acids (aliphatic, cyclic, and aromatic and carbohydrates, including their behaviour, have been reported in many works. However, knowledge on the occurrence and behaviour of D-enantiomers of organic acids, which may be abundant in soil, is currently lacking. Also, identification of the impact and mechanisms of environmental factors, such as soil water content, on carbohydrate status within soil organic matter remains to be determined. Finally, the occurrence of vitamins in soil and their role in biological and biochemical soil processes represent an important direction for future research.