Developing the European Center of Competence on VVER-Type Nuclear Power Reactors

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Geraskin, Nikolay; Pironkov, Lyubomir; Kulikov, Evgeny; Glebov, Vasily

2017-01-01

This paper presents the results of the European educational projects CORONA and CORONA-II which are dedicated to preserving and further developing nuclear knowledge and competencies in the area of VVER-type nuclear power reactors technologies (Water-Water Energetic Reactor, WWER or VVER). The development of the European Center of Competence for…

Quality assessments for cancer centers in the European Union.

Science.gov (United States)

Wind, Anke; Rajan, Abinaya; van Harten, Wim H

2016-09-07

Cancer centers are pressured to deliver high-quality services that can be measured and improved, which has led to an increase of assessments in many countries. A critical area of quality improvement is to improve patient outcome. An overview of existing assessments can help stakeholders (e.g., healthcare professionals, managers and policy makers) improve the quality of cancer research and care and lead to patient benefits. This paper presents key aspects of assessments undertaken by European cancer centers, such as: are assessments mandatory or voluntary? Do they focus on evaluating research, care or both? And are they international or national? A survey was sent to 33 cancer centers in 28 European Union member states. Participants were asked to score the specifics for each assessment that they listed. Based on the responses from 19 cancer centers from 18 member states, we found 109 assessments. The numbers have steadily increased from 1990's till 2015. Although, a majority of assessments are on patient-care aspects (n = 45), it is unclear how many of those include assessing patient benefits. Only few assessments cover basic research. There is an increasing trend towards mixed assessments (i.e., combining research and patient-care aspects) The need for assessments in cancer centers is increasing. To improve efforts in the quality of research and patient care and to prevent new assessments that "reinvent the wheel", it is advised to start comparative research into the assessments that are likely to bring patient benefits and improve patient outcome. Do assessments provide consistent and reliable information that create added value for all key stakeholders?

Cones, Seeds, and Foliage of Tetraclinis Salicornioides (Cupressaceae) from the Oligocene and Miocene of Western North America: A Geographic Extension of the European Tertiary Species.

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Kvacek; Manchester; Schorn

2000-03-01

The cupressaceous genus Tetraclinis is recognized from the Oligocene and Miocene of western North America on the basis of co-occurring seed cones, seeds, and foliage branches. Morphological and anatomical comparisons with the two previously recognized European Tertiary species indicate that the North American specimens are morphologically inseparable from Tetraclinis salicornioides (Unger) Kvacek. The North American taxon is treated as a new variety, T. salicornioides (Unger) Kvacek var. praedecurrens (Knowlton) comb. et stat. nov., and is distinguished from the European representatives, T. salicornioides (Unger) Kvacek var. salicornioides, by slight anatomical differences in the leaf epidermis. Although cones and seeds of the fossil species are closely similar to those of extant Tetraclinis articulata, the foliage is more "spreading," composed of flattened segments with fused facial and lateral leaves that are apparently adaptive for a more mesic climate. The recognition of T. salicornioides in western North America along with the absence of Tetraclinis in the fossil and recent flora of eastern Asia provide evidence for communication of the species across the North Atlantic during the early or middle Tertiary.

Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in Those Without Evidence of Lyme Borreliosis.

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Zomer, Tizza P; Vermeeren, Yolande M; Landman, Gijs W; Zwerink, Marlies; van Hees, Babette C; van Bemmel, Thomas; van Kooten, Barend

2017-10-30

Controversy exists whether mood disorders, such as depression, are associated with Lyme borreliosis (LB). The study objective was to assess prevalence of depressive symptoms in subgroups of patients referred to a tertiary Lyme center, to investigate whether depressive symptoms can be used in clinical practice to discriminate for LB. This cohort study included adult patients who visited a tertiary Lyme center between January 2008 and December 2014. Prior to medical consultation, serum samples were taken and the Beck Depression Inventory II was completed to assess depressive symptoms. Lyme diagnosis was retrospectively extracted from the patient's medical record. Patients were classified based on clinical LB and serology results. Prevalence of moderate/severe depressive symptoms was calculated. Using logistic regression, odds ratios with 95% confidence intervals (CIs) were calculated for moderate/severe depressive symptoms. In total, 1454 patients were included. Prevalence of moderate/severe depressive symptoms was lowest in patients with no clinical LB and positive serology (15.3%), higher in patients with clinical LB with positive and negative serology (19.3% and 20.9% respectively), and highest in patients with no clinical LB and negative serology (29.3%). The odds ratio for moderate/severe depressive symptoms in patients with LB and positive serology was 0.71 (95% CI, .50-1.03) compared to patients with no LB and negative serology. The prevalence of depressive symptoms was similar in patients with LB compared to patients with no evidence of infection. This suggests that depressive symptoms cannot be used to discriminate for LB in a tertiary Lyme center. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Stroke Mortality in Intensive Care Unit from Tertiary Care Neurological Center

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Lekhjung Thapa

2013-06-01

Full Text Available Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by 6 months, and a half by 1 year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, intensive care unit has remained the choice for stroke patients’ care in developing countries. This study explores the mortality of stroke patients in intensive care unit setting in tertiary care neurological centre in a developing country. Methods: We collected data of stroke patients admitted in our ICU from August 2009 to Aug 2010 and analyzed. Results: Total 44 (10.25% patients were admitted for acute stroke. Age ranged from 17-93 years. Low GCS (Glasgow Coma Scale, uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3% patients had hemorrhagic stroke and 21(47.7% patients had ischemic stroke. 13 (29.54% patients of stroke died within 7 days, 9 (69.23% patients of hemorrhagic stroke died within 6 days, and 4 patients (30.76% of ischemic stroke died within 7 days. 6 (13.63% patients left hospital against medical advice. All of these patients had ischemic stroke. Conclusions: Stroke mortality in intensive care unit remains high despite of care in tertiary neurological center in resource poor settings. Stroke care unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countries Keywords: intensive care unit; mortality; stroke; stroke care unit.

Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center

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Adrienne Lebl

2016-04-01

Full Text Available Abstract Objective: To characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. Methods: Retrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. Results: Female patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%, urgency incontinence (56.0%, urinary retention (8.0%, nocturnal enuresis (70.0%, urinary tract infections (62.0%, constipation (62.0%, and fecal incontinence (16.0% were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. Conclusions: This subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment.

Risk Factors Predicting Mortality in Patients with Lung Abscess in a Public Tertiary Care Center in Karachi, Pakistan

OpenAIRE

Shaista Ghazal; Ashok Kumar; Binav Shrestha; Sana Sajid; Maria Malik; Nadeen Rizvi

2013-01-01

Introduction: Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. Methods: A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state...

Mortality and causes of death in children referred to a tertiary epilepsy center

DEFF Research Database (Denmark)

Grønborg, Sabine; Uldall, Peter

2014-01-01

BACKGROUND: Patients with epilepsy, including children, have an increased mortality rate when compared to the general population. Only few studies on causes of mortality in childhood epilepsy exist and pediatric SUDEP rate is under continuous discussion. AIM: To describe general mortality......, incidence of sudden unexpected death in epilepsy (SUDEP), causes of death and age distribution in a pediatric epilepsy patient population. METHODS: The study retrospectively examined the mortality and causes of death in 1974 patients with childhood-onset epilepsy at a tertiary epilepsy center in Denmark...... that underwent dietary epilepsy treatment was slightly higher than in the general cohort. There were no epilepsy-related deaths due to drowning. CONCLUSIONS: This study confirms that SUDEP must not be disregarded in the pediatric age group. The vast majority of SUDEP cases in this study displays numerous risk...

Xeroderma pigmentosum at a tertiary care center in Saudi Arabia.

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Alwatban, Lenah; Binamer, Yousef

2017-01-01

Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder caused by defective DNA repair that results in extreme sensitivity to ultraviolet (UV) rays. Depending on the type of XP, the disease may affect the skin, eyes and nervous system. Describe the dermatologic manifestations in patients suffering from XP. Retrospective, descriptive review of medical records. Dermatology clinic at tertiary care center in Riyadh. This study included Saudi patients with clinically confirmed XP. Demographic and clinical data including pathology and associated conditions and outcomes. Of 21 patients with XP, the most common manifestation was lentigines, affecting 18 patients (86%). The most common skin cancer was basal cell carcinoma followed by squamous cell carcinoma (SCC) affecting 15 (71.4%) and 9 (42.8%), respectively. Other skin findings included neurofibroma, trichilemmoma and seborrheic keratosis. Ocular involvement included photophobia, which was the most common finding followed by dryness and ocular malignancies. Two patients showed neurological involvement, which correlated with the type of mutation. Considering that XP is a rare genetic disease, this description of our patient population will aid in early recognition and diagnosis. Retrospective and small number of patients. Genetic analyses were done for only 5 of the 21 patients.

Project 'European Research Center for Air Pollution Abatement Measures'

International Nuclear Information System (INIS)

1985-04-01

During the 5-7th of March 1985 the first status report of the project 'European Research Center for Air Pollution Control Measures' took place in the Nuclear Research Center, Karlsruhe. Progress reports on the following topics assessment and analysis of the impacts of airborne pollutants on forest trees; distinction from other potential causes of recent forest dieback, research into atmospheric dispersion, conversion and deposition of airborne pollutants, development and optimization of industrial-technical processes to reduce or avoid emissions and providing instruments and making recommendations to the industrial and political sectors were presented. This volume is a collection of the work reported there. 42 papers were entered separately. (orig./MG) [de

Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

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Ruangkriengsin, Darat; Phisalprapa, Pochamana

2014-03-01

Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and costs, especially in tertiary care center Currently, there have not been many studies about the causes of prolonged hospitalization. Some identified causes could, however, be prevented and improved. To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more. Retrospective chart review study was conducted among all patients who were admitted for 7 days or more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications, discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged hospitalization at day 7, 14, 30, and 90 were assessed. Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%), and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage

Activities of an ethics consultation service in a Tertiary Military Medical Center.

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Waisel, D B; Vanscoy, S E; Tice, L H; Bulger, K L; Schmelz, J O; Perucca, P J

2000-07-01

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to have a mechanism to address issues of medical ethics. Most hospitals, especially those in the military, have an ethics committee composed solely of members who serve as an additional duty. To enhance the ethics consultation service, the 59th Medical Wing created a position under the chief of the medical staff for a full-time, fellowship-trained, medical ethicist. After establishment of this position, the number of consultations increased, a systematic program for caregiver education was developed and delivered, and an organizational presence was achieved by instituting positions on the institutional review board, the executive committee of the medical staff, and the credentials committee. Issues in medical care are becoming increasingly complicated, due in large part to financial stresses and technological advancements. Ethics consultation can help prevent and resolve many of these problems. This report discusses the activities of the first year of a full-time ethicist in a tertiary military medical center.

Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City

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Martinez JD

2016-07-01

Full Text Available Jaime D Martinez,1 Anat Galor,2,3 Nallely Ramos-Betancourt,1 Andrés Lisker-Cervantes,1 Francisco Beltrán,1 Jorge Ozorno-Zárate,1 Valeria Sánchez-Huerta,1 Marco-Antonio Torres-Vera,1 Everardo Hernández-Quintela1 1Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico, Universidad Nacional Autónoma de México, Mexico City, Mexico; 2Department of Ophthalmology, Miami Veterans Affairs Medical Center, 3Cornea and External Diseases Division, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA Purpose: The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE among patients attending a tertiary care ophthalmology center in Mexico.Methods: Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer’s test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected.Results: The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22% in our population than evaporative deficiency (94%. Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry

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

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Banjar Hanaa

2007-01-01

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

Indications for Corneal Transplantation at a Tertiary Referral Center in Tehran

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Mohammad Zare

2010-01-01

Full Text Available Purpose: To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period. Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. Results: During this period, 776 eyes of 756 patients (including 504 male subjects with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8% followed by bullous keratopathy (n=90, 11.6%, non-herpetic corneal scars (n=62, 8.0%, infectious corneal ulcers (n=61, 7.9%, previously failed grafts (n=61, 7.9%, endothelial and stromal corneal dystrophies (n=28, 3.6%, and trachoma keratopathy (n=26, 3.3%. Other indications including Terrien′s marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%, deep anterior lamellar keratoplasty (n=108, 13.9%, conventional lamellar keratoplasty (n=44, 5.7%, automated lamellar therapeutic keratoplasty (n=8, 1.0%, and Descemet stripping endothelial keratoplasty (n=6, 0.8% in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. Conclusion: In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium.

Patient Understanding of Hypoglycemia in Tertiary Referral Centers

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Nan Hee Cho

2018-02-01

Full Text Available BackgroundHypoglycemia is an important complication in the treatment of patients with diabetes. We surveyed the insight by patients with diabetes into hypoglycemia, their hypoglycemia avoidance behavior, and their level of worry regarding hypoglycemia.MethodsA survey of patients with diabetes, who had visited seven tertiary referral centers in Daegu or Gyeongsangbuk-do, Korea, between June 2014 and June 2015, was conducted. The survey contained questions about personal history, symptoms, educational experience, self-management, and attitudes about hypoglycemia.ResultsOf 758 participants, 471 (62.1% had experienced hypoglycemia, and 250 (32.9% had experienced hypoglycemia at least once in the month immediately preceding the study. Two hundred and forty-two (31.8% of the participants had received hypoglycemia education at least once, but only 148 (19.4% knew the exact definition of hypoglycemia. Hypoglycemic symptoms identified by the participants were dizziness (55.0%, sweating (53.8%, and tremor (40.8%. They mostly chose candy (62.1%, chocolate (37.7%, or juice (36.8% as food for recovering hypoglycemia. Participants who had experienced hypoglycemia had longer duration of diabetes and a higher proportion of insulin usage. The mean scores for hypoglycemia avoidance behavior and worry about hypoglycemia were 21.2±10.71 and 23.38±13.19, respectively. These scores tended to be higher for participants with higher than 8% of glycosylated hemoglobin, insulin use, and experience of emergency room visits.ConclusionMany patients had experienced hypoglycemia and worried about it. We recommend identifying patients that are anxious about hypoglycemia and educating them about what to do when they develop hypoglycemic symptoms, especially those who have a high risk of hypoglycemia.

Patient Understanding of Hypoglycemia in Tertiary Referral Centers.

Science.gov (United States)

Cho, Nan Hee; Kim, Nam Kyung; Han, Eugene; Hong, Jun Hwa; Jeon, Eon Ju; Moon, Jun Sung; Seo, Mi Hae; Lee, Ji Eun; Seo, Hyun Ae; Kim, Mi Kyung; Kim, Hye Soon

2018-02-01

Hypoglycemia is an important complication in the treatment of patients with diabetes. We surveyed the insight by patients with diabetes into hypoglycemia, their hypoglycemia avoidance behavior, and their level of worry regarding hypoglycemia. A survey of patients with diabetes, who had visited seven tertiary referral centers in Daegu or Gyeongsangbuk-do, Korea, between June 2014 and June 2015, was conducted. The survey contained questions about personal history, symptoms, educational experience, self-management, and attitudes about hypoglycemia. Of 758 participants, 471 (62.1%) had experienced hypoglycemia, and 250 (32.9%) had experienced hypoglycemia at least once in the month immediately preceding the study. Two hundred and forty-two (31.8%) of the participants had received hypoglycemia education at least once, but only 148 (19.4%) knew the exact definition of hypoglycemia. Hypoglycemic symptoms identified by the participants were dizziness (55.0%), sweating (53.8%), and tremor (40.8%). They mostly chose candy (62.1%), chocolate (37.7%), or juice (36.8%) as food for recovering hypoglycemia. Participants who had experienced hypoglycemia had longer duration of diabetes and a higher proportion of insulin usage. The mean scores for hypoglycemia avoidance behavior and worry about hypoglycemia were 21.2±10.71 and 23.38±13.19, respectively. These scores tended to be higher for participants with higher than 8% of glycosylated hemoglobin, insulin use, and experience of emergency room visits. Many patients had experienced hypoglycemia and worried about it. We recommend identifying patients that are anxious about hypoglycemia and educating them about what to do when they develop hypoglycemic symptoms, especially those who have a high risk of hypoglycemia. Copyright © 2018 Korean Diabetes Association

Impact of an Infection Control Program on the Prevalence of Nosocomial Infections at a Tertiary Care Center in Switzerland

OpenAIRE

Ebnöther, Corina; Tanner, Beate; Schmid, Flavia; Rocca, Vittoria La; Heinzer, Ivo; Bregenzer, Thomas

2017-01-01

Objective. To study the impact of a multimodal infection control program on the rate of nosocomial infections at a 550-bed tertiary care center. Methods. Before and after the implementation of an infection control program, the rate of nosocomial infection was recorded in time-interval prevalence studies. Hand hygiene compliance was studied before and after the intervention. As a surrogate marker of compliance, the amount of alcohol-based hand rub consumed before the intervention was compared ...

Snoring habits among healthy persons attending a tertiary care center in Chittagong, Bangladesh: A questionnaire-based study

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Rajat Sanker Roy Biswas

2017-01-01

Full Text Available Introduction: Snoring is a common health condition which is unexplored in the context of Bangladesh. Hence, the objective of the present study is to find out the frequency of snoring among the healthy Bangladeshi people attending tertiary care center in Chittagong using a questionnaire. Methods: It was a single center, cross-sectional study conducted in the Department of Internal Medicine of a tertiary care hospital of Bangladesh among 119 apparently healthy adults who were the attendants of patients. A “Snore Survey” questionnaire adopted from an Indian study which was based on Berlin questionnaire was used. Results: With a 88.1% valid response rate, present study included 63 (52.94% male and 56 (47.06% female. Among all, 47.9% of (57 individuals were <30 years of age. Majority (82.4% were recruited from urban locality. Frequency of snoring was 28 (23.5% of total individuals. Nearly 33.3% of males and 12.5% of females were snorers. The frequency of snoring ranged from daily (25.0% to monthly (28.6% episodes. Some had very loud (25.0% sound during sleep, and others had variable loudness. Male snorers were significantly taller, weighed more and had broader neck circumference than female (P < 0.05. Conclusion: Snoring is not an uncommon medical condition among healthy young people in Bangladesh. Considering the population of Bangladesh, the sample size is very small and a large scale study would certainly help create awareness among the patients as well as healthcare professionals about this neglected but very significant health problem.

Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

DEFF Research Database (Denmark)

Søholm, Helle; Kjaergaard, Jesper; Bro-Jeppesen, John

2015-01-01

(OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had...

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

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A. K. Maurya

2015-01-01

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

Combined Neutron Center for European Research and Technology

International Nuclear Information System (INIS)

Lagniel, Jean-Michel

2002-01-01

High-power proton linacs are needed as driver for several applications, namely transmutation of nuclear waste using Accelerator Driven Systems (ADS), spallation neutron sources (ESS in Europe) and other fields of basic and applied research (next generation of radioactive ion beam facilities, neutrino factories, muon colliders, irradiation facilities for material testing...). The possible synergies among these projects will be pointed out and the feasibility study of high-power proton linac used as driver of a multi-user facility (CONCERT) will be presented. There was excellent scientific, technical and economic reasons to study a Combined Neutron Center for European Research and Technology (CONCERT) based on a high-power proton accelerator. Such an installation would serve condensed matter studies by spallation neutron scattering, a technological irradiation tool and R and D facility for an hybrid reactor demonstrator, a radioactive ion beam facility for nuclear physics, R and D developments for a muon/neutrino facility. The installation could therefore constitute a European center of excellence in the field of neutronics where a large number of scientific and technical executives could be trained. The CONCERT Project Team has performed the feasibility study of such a multi-user facility with: - a review of the beam needs for the different applications, - an analyze of their compatibility, - the definition of the scope of a site-independent project, - a selection of the most appropriate options regarding scientific, technical, financial, organizational and administrative aspects, - an estimation of the costs for construction, operation and the needs in manpower. The conceptual design report [17] is sufficiently detailed to minimize contingencies on those parts of the project having a large potential impact in terms of performances, costs or delays. (author)

Analysis of 88 nephrectomies in a rural tertiary care center of India

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Biswajit Datta

2012-01-01

Full Text Available Nephrectomy is not an uncommon surgery in day-to-day practice of urology. Trauma is the most common cause of emergency nephrectomy. On the other hand, elective nephrectomy is done for both benign and malignant diseases of the kidney. This study has been performed to know the different causes of nephrectomy in a rural, tertiary care center of India. In our series, we have studied all the elective nephrectomies done in our hospital during a period of eight years. We have analyzed 88 cases of nephrectomies regarding their age, sex, laterality of disease, and histopathologic report of the nephrectomy specimens. Out of 88 cases, 61 were males and 27 were females. In our series, 62.5% cases of nephrectomies were done for benign causes and 37.5% cases for malignant causes. Among the benign causes, neglected pelviureteric junction obstruction was the leading cause, followed by calculus disease resulting in obstruction. On the other hand, renal cell carcinoma was the most common malignant pathology requiring nephrectomy.

Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center

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D. M. Hansra

2018-01-01

Full Text Available Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P≤0.05. Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.

Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India.

OpenAIRE

Sendhilkumar, M; Tripathy, JP; Harries, AD; Dongre, AR; Deepa, M; Vidyulatha, A; Poongothai, S; Venkatesan, U; Anjana, RM; Mohan, V

2017-01-01

Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels w...

Epilepsy diagnostic and treatment needs identified with a collaborative database involving tertiary centers in France.

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Chipaux, Mathilde; Szurhaj, William; Vercueil, Laurent; Milh, Mathieu; Villeneuve, Nathalie; Cances, Claude; Auvin, Stéphane; Chassagnon, Serge; Napuri, Sylvia; Allaire, Catherine; Derambure, Philippe; Marchal, Cécile; Caubel, Isabelle; Ricard-Mousnier, Brigitte; N'Guyen The Tich, Sylvie; Pinard, Jean-Marc; Bahi-Buisson, Nadia; de Baracé, Claire; Kahane, Philippe; Gautier, Agnès; Hamelin, Sophie; Coste-Zeitoun, Delphine; Rosenberg, Sarah-Dominique; Clerson, Pierre; Nabbout, Rima; Kuchenbuch, Mathieu; Picot, Marie-Christine; Kaminska, Anna

2016-05-01

To obtain perspective on epilepsy in patients referred to tertiary centers in France, and describe etiology, epilepsy syndromes, and identify factors of drug resistance and comorbidities. We performed a cross-sectional analysis of the characteristics of 5,794 pediatric and adult patients with epilepsy included in a collaborative database in France between 2007 and 2013. Comparisons between groups used Student's t-test or Fisher's exact test for binary or categorical variables. Factors associated with drug resistance and intellectual disability were evaluated in multi-adjusted logistic regression models. Mean age at inclusion was 17.9 years; children accounted for 67%. Epilepsy was unclassified in 20% of patients, and etiology was unknown in 65%, including those with idiopathic epilepsies. Etiologies differed significantly in adult- when compared to pediatric-onset epilepsy; however, among focal structural epilepsies, mesial temporal lobe epilepsy with hippocampal sclerosis began as often in the pediatric as in adult age range. Drug resistance concerned 53% of 4,210 patients evaluable for seizure control and was highest in progressive myoclonic epilepsy (89%), metabolic diseases (84%), focal cortical dysplasia (70%), other cortical malformations (69%), and mesial temporal lobe epilepsy with hippocampal sclerosis (67%). Fifty-nine percent of patients with focal structural epilepsy and 69% with epileptic encephalopathies were drug resistant; however, 40-50% of patients with West syndrome and epileptic encephalopathy with continuous spike-and-waves during sleep were seizure-free. Ages at onset in infancy and in young adults shared the highest risk of drug resistance. Epilepsy onset in infancy comprised the highest risk of intellectual disability, whereas specific cognitive impairment affected 36% of children with idiopathic focal epilepsy. Our study provides a snapshot on epilepsy in patients referred to tertiary centers and discloses needs for diagnosis and treatment

HIV-associated hematologic malignancies: Experience from a Tertiary Cancer Center in India.

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Reddy, Rakesh; Gogia, Ajay; Kumar, Lalit; Sharma, Atul; Bakhshi, Sameer; Sharma, Mehar C; Mallick, Saumyaranjan; Sahoo, Ranjit

2016-01-01

Data on HIV associated hematologic malignancies is sparse from India. This study attempts to analyze the spectrum and features of this disease at a tertiary cancer center in India. Retrospective study from case records of patients registered with a diagnosis of hematologic malignancy and HIV infection between January 2010 and June 2015. Thirteen cases of HIV associated hematologic malignancies were identified, six of them pediatric. HIV diagnosis was concurrent to diagnosis of cancer in 12 and preceded it in one of them. ECOG PS at presentation was >1 in all of them. All patients, except one, had B symptoms. Six of the patients had bulky disease and six are stage 4. Predominant extranodal disease was seen in 67% of them. NHL accounted for 10 of 13 patients and DLBCL-Germinal center was the most common subtype. Mean CD4+ cell count was 235/μL (range, 32-494). HAART could be given along with chemotherapy to 11 patients. Two-thirds of patients received standard doses of therapy. Chemo-toxicity required hospitalization in 58%. CR was achieved in 45% and 36% had progressive disease with first-line therapy. At the time of last follow up, 3 patients were alive with responsive disease, 2 in CR and 1 in PR. None of the pediatric patients were long time responders. These malignancies were of advanced stage and higher grade. Goal of therapy, in the HAART era, is curative. Pediatric patients had dismal outcome despite good chemotherapy and HAART. There is an urgent need to improve data collection for HIV related cancers in India.

A retrospective review of snake bite victims admitted in a tertiary ...

African Journals Online (AJOL)

Objective: Snake bite remains major public health problem worldwide. We present our experience with cases of snake bites managed in our tertiary care teaching center of South India. Materials and Methods: The details of all patients with snake bite admitted to a tertiary teaching care hospital from 2010 to 2012 were ...

Acute pancreatitis during pregnancy, 7-year experience of a tertiary referral center.

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Vilallonga, Ramón; Calero-Lillo, Aránzazu; Charco, Ramón; Balsells, Joaquim

2014-01-01

Acute pancreatitis is a common cause of acute abdomen in pregnant women. The purpose of this study was to determine the frequency at our institution and its management and outcomes. A retrospective analysis of a database of cases presented in 7 consecutive years at a tertiary center was performed. Between December 2002 and August 2009, there were 19 cases of acute pancreatitis in pregnant women, 85% with a biliary etiology. The highest frequency was in the third trimester of pregnancy (62.5% cases). In cases of gallstone pancreatitis, 43.6% of pregnant women had had previous episodes before pregnancy. A total of 52.6% of the patients were readmitted for a recurrent episode of pancreatitis during their pregnancy. Overall, 26.3% of the patients received antibiotic treatment and 26.3% parenteral nutrition. Laparoscopic cholecystectomy was performed during the 2nd trimester in two patients (10.5%). There was no significant maternal morbidity. Acute pancreatitis in pregnant women usually has a benign course with proper treatment. In cases of biliary origin, it appears that a surgical approach is suitable during the second trimester of pregnancy. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

Conventional versus molecular methods for diagnosis of tuberculosis in a tertiary care center: A study from Punjab

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Shavi Nagpal

2016-01-01

Full Text Available Background: A fast and accurate diagnosis is necessary to control and eliminate tuberculosis (TB. There have been various studies evaluating the efficacy of polymerase chain reaction (PCR testing in clinical practice. Most of these studies have found PCR as a useful tool to diagnose TB and more so for the extra-pulmonary cases. Aims and Objectives: The aim of the study was to evaluate the results of TB by real-time PCR versus the conventional methods of diagnosis in a tertiary care center in Punjab. Materials and Methods: This study was done in a tertiary care center of Punjab to look for the results of clinical samples tested for TB using PCR, Ziehl–Neelsen staining and culture on Lowenstein–Jensen medium. 16S rRNA gene was used for Mycobacterium tuberculosis detection in PCR. This study included all samples tested for TB from July 2015 to October 2015. Results: A total of 214 samples were tested for TB using smear microscopy, culture and PCR (including 194 [90.6%] extra-pulmonary and 20 [9.3%] pulmonary samples. These included 76 cerebrospinal fluid, 30 pleural fluid, 42 tissues, 17 ascitic fluid, 13 urine, 15 bronchoalveolar lavage (BAL, 16 pus, and 5 sputum samples. Smear microscopy was positive in a total of 4 samples out of 214 (1.8%, which included 2 sputum, 1 tissue, and 1 ascitic fluid samples, while culture was positive for 6 samples (2.8% which included 2 sputum, 1 pus, 1 BAL, 1 tissue, and 1 ascitic fluid sample. The TB PCR results were positive in a total of 71 (33.1% samples out of 214. In addition, three samples also tested positive for Mycobacteria other than TB. Conclusion: PCR is a very rapid and accurate diagnostic tool for early detection of TB in particularly for extrapulmonary TB.

Spectrum of interstitial lung diseases at a tertiary center in a developing country: A study of 803 subjects.

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Sahajal Dhooria

Full Text Available The spectrum of interstitial lung diseases (ILDs have mainly been reported from the developed countries; data from developing countries is sparse and conflicting. The aim of this study is to describe the distribution of various ILDs from a developing country.This is an analysis of prospectively collected clinical, radiological and histological data of consecutive subjects (age >12 years with ILDs from a single tertiary care medical center. The diagnosis of the specific subtype of ILD was made according to standard criteria for various ILDs.A total of 803 subjects (mean age, 50.6 years; 50.2% women were enrolled between March 2015 to February 2017 of which 566 (70.5% were diagnosed during the study period (incident cases. Sarcoidosis (42.2%, idiopathic pulmonary fibrosis (IPF, 21.2%, connective tissue disease (CTD-related ILDs (12.7%, hypersensitivity pneumonitis (10.7%, and non-IPF idiopathic interstitial pneumonias (9.2% were the most common ILDs. The spectrum of ILDs was not significantly different (p = 0.87 between incident and prevalent cases. A histopathological specimen was obtained in 49.9% of the subjects yielding a histologically confirmed diagnosis in 40.6%. A diagnostic procedure was not performed in 402 subjects; the most common reasons were presence of definite usual interstitial pneumonia pattern on high resolution computed tomography and patients' unwillingness to undergo the procedure.Sarcoidosis, IPF and CTD-ILDs were the most common ILDs seen at a tertiary center in northern India similar to the spectrum reported from developed countries. More studies are required from developing countries to ascertain the spectrum of ILDs in different geographic locales.

Assessment of chronic diarrhea in early infancy in Tehran Tertiary Care Center; Tehran-Iran

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Farzaneh Motamed

2015-03-01

Full Text Available Introduction Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was investigating chronic diarrhea, its etiologies, clinical features and outcomes in infancy.Materials and Methods Retrospective study investigating infants hospitalized in the gastroenterology department of Tehran tertiary care center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyzed by SPSS software,version 16.Results In this study, 63/9% of cases were female and 36/1% were male. 24 cases (66/7% had osmotic diarrhea and 11 (30/6% had secretory diarrhea. In this study there was no significant statistical correlation between type of diarrhea and sex, gestational Age, severity of dehydration, birth weight and nutrition. The majority of patients with osmotic (58/3% and secretory diarrhea (63/6%, had weight percentile below 3%, which showed a significant statistical difference (p value

Are clinical features able to predict Helicobacter pylori gastritis patterns? Evidence from tertiary centers.

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Carabotti, Marilia; Lahner, Edith; Porowska, Barbara; Colacci, Enzo; Trentino, Paolo; Annibale, Bruno; Severi, Carola

2014-12-01

Outcome of Helicobacter pylori infection is different according to gastritis extension (i.e. antrum-restricted gastritis or pangastritis). The aim of this study is to evaluate whether different gastritis patterns are associated with specific gastrointestinal symptoms or clinical signs that could be suggestive of the topography of gastritis. 236 consecutive symptomatic outpatients were recruited in two tertiary centers. They filled in a validated and self-administered Rome III modular symptomatic questionnaire, and underwent gastroscopy with histological sampling. 154 patients with Helicobacter pylori infection were included. Clinical presentation did not differ between antrum-restricted gastritis and pangastritis, gastro-esophageal reflux disease being present in 48.2 and 54.1 % of patients and dyspepsia in 51.8 and 45.9 %, respectively. However, pangastritis statistically differed from antrum-restricted gastritis in that the presence of clinical signs (p gastritis pattern whereas their association with signs, accurately detected, is indicative for the presence of pangastritis.

Integrated marketing sphere of physical culture and sports in terms of European integration Regional Center Research

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Oleksandr Popov

2015-06-01

Full Text Available Purpose: exposure of conceptual and strategic positions of the complex marketing of sphere of physical culture and sport in the conditions of European integration of regional center. Material and Methods: analysis of literary sources, analysis of documents of legislative, normatively-legal and programmatic maintenance, analysis of the systems, questioning as a questionnaire. Results: the analysis of the systems of terms of development of sphere of physical culture and sport is carried out by the study of modern tendencies, interests of young people and habitants of regional center; complex description of conceptual and strategic positions of the relatively complex marketing of sphere of physical culture and sport is presented in the conditions of European integration of regional center. Conclusions: it is set that the decision of tasks in relation to conditioning for development of sphere of physical culture and sport must come true with the observance of certain principles; got founding in relation to development of marketing plan of forming of sporting image Kharkiv.

Extremely elevated erythrocyte sedimentation rate. Etiology at a tertiary care center in Saudi Arabia

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Muhammad Yousuf; Javed Akhter; Khalid Al-Khairy; Mohammed A. Al-Saadan; Salih Bin-Salih

2010-01-01

To evaluate the etiology of extremely elevated erythrocyte sedimentation rate (ESR) in adolescents and adults at a tertiary care center. This retrospective, cross-sectional, observational study was carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia using the Westergren method of determining ESR in adolescents and adults aged >/=12 years. The patients included inpatients and outpatients with medical, surgical, and gynecological problems. During a period from June 2007 to October 2008, consecutive, non-repetitive patients with ESR >/=100 mm/hour were evaluated for possible etiology by checking the electronic and paper data file of each patient. During the study period, out of the 44,366 ESR tests carried out at this center, 1864 (4.2%) had an ESR >/=100 mm/hour belonging to 567 patients. Out of 508 patients fulfilling the study criteria, the main associated causes included: infections (38.6%), autoimmune diseases (15.9%), malignancy (15.4%), miscellaneous causes (10.2%), ischemic tissue injury or trauma (8.7%), and renal diseases (8.4%). Ten common individual causes included: rheumatoid arthritis (7.3%), osteomyelitis (6.9%), tuberculosis (5.5%), trauma (5.3%), lymphoma and sepsis of unknown origin (5.1%) each, urinary tract infection (4.7%), septic arthritis (3.1%), abscesses (2.8%), and pregnancy (2.2%). Fourteen (2.4%) patients had no known cause. Most of the patients with extreme ESR elevation have an underlying cause and a focused evaluation of such patients needs to be carried out to reach a diagnosis.

An Audit on the Appropriateness of Coronary Computed Tomography Angiography Referrals in a Tertiary Cardiac Center.

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Alderazi, Ahmed Ali; Lynch, Mary

2017-01-01

In response to growing concerns regarding the overuse of coronary computed tomography angiography (CCTA) in the clinical setting, multiple societies, including the American College of Cardiology Foundation, have jointly published revised criteria regarding the appropriate use of this imaging modality. However, previous research indicates significant discrepancies in the rate of adherence to these guidelines. To assess the appropriateness of CCTA referrals in a tertiary cardiac center in Bahrain. This retrospective clinical audit examined the records of patients referred to CCTA between the April 1, 2015 and December 31, 2015 in Mohammed bin Khalifa Cardiac Center. Using information from medical records, each case was meticulously audited against guidelines to categorize it as appropriate, inappropriate, or uncertain. Of the 234 records examined, 176 (75.2%) were appropriate, 47 (20.1%) were uncertain, and 11 (4.7%) were inappropriate. About 74.4% of all referrals were to investigate coronary artery disease (CAD). The most common indication that was deemed appropriate was the detection of CAD in the setting of suspected ischemic equivalent in patients with an intermediate pretest probability of CAD (65.9%). Most referrals deemed inappropriate were requested to detect CAD in asymptomatic patients at low or intermediate risk of CAD (63.6%). This audit demonstrates a relatively low rate of inappropriate CCTA referrals, indicating the appropriate and efficient use of this resource in the Mohammed bin Khalifa Cardiac Center. Agreement on and reclassification of "uncertain" cases by guideline authorities would facilitate a deeper understanding of referral appropriateness.

Perceptions of focused prenatal care among women attending two tertiary centers in Nigeria.

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Eleje, George U; Onwusulu, Daniel N; Ezeama, Chukwuemeka O; Afiadigwe, Evaristus A; Eke, Ahizechukwu C; Ikechebelu, Joseph I; Ugboaja, Joseph O; Okwuosa, Ayodele O

2015-11-01

To determine women's perceptions and expectations of focused prenatal care visits. The present questionnaire-based, cross-sectional survey was performed among pregnant women in their third trimester attending two tertiary health centers in southern Nigeria between January and March 2012. Obstetric data, histories, and information on preferences for prenatal visits were obtained using questionnaires. A total of 353 questionnaires were appropriately completed. Among 277 participants who stated a preference for the number of prenatal care visits, 241 (87.0%) reported a preference of more than four. Among 203 parous women, 132 (65.0%) had no previous negative obstetric experience. Only previous stillbirth (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.05-6.77; P = 0.039) among multiparous women, and HIV/AIDS (OR 0.27, 95% CI 0.06-1.17; P = 0.048) among all women were significantly associated with a preference for more prenatal visits. Previous negative obstetric experiences did not generally affect preference for prenatal visits. However, pregnant women expressed dissatisfaction with a reduced number of visits. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: An ESGICH survey.

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Navarro, David; San-Juan, Rafael; Manuel, Oriol; Giménez, Estela; Fernández-Ruiz, Mario; Hirsch, Hans H; Grossi, Paolo Antonio; Aguado, José María

2017-12-01

Scant information is available about how transplant centers are managing their use of quantitative molecular testing (QNAT) assays for active cytomegalovirus (CMV) infection monitoring in solid organ transplant (SOT) recipients. The current study was aimed at gathering information on current practices in the management of CMV infection across European centers in the era of molecular testing assays. A questionnaire-based cross-sectional survey study was conducted by the European Study Group of Infections in Immunocompromised Hosts (ESGICH) of the Society of Clinical Microbiology and Infectious Diseases (ESCMID). The invitation and a weekly reminder with a personal link to an Internet service provider (https://es.surveymonkey.com/) was sent to transplant physicians, transplant infectious diseases specialists, and clinical virologists working at 340 European transplant centers. Of the 1181 specialists surveyed, a total of 173 responded (14.8%): 73 transplant physicians, 57 transplant infectious diseases specialists, and 43 virologists from 173 institutions located at 23 different countries. The majority of centers used QNAT assays for active CMV infection monitoring. Most centers preferred commercially available real-time polymerase chain reaction (RT-PCR) assays over laboratory-developed procedures for quantifying CMV DNA load in whole blood or plasma. Use of a wide variety of DNA extraction platforms and RT-PCR assays was reported. All programs used antiviral prophylaxis, preemptive therapy, or both, according to current guidelines. However, the centers used different criteria for starting preemptive antiviral treatment, for monitoring systemic CMV DNA load, and for requesting genotypic assays to detect emerging CMV-resistant variants. Significant variation in CMV infection management in SOT recipients still remains across European centers in the era of molecular testing. International multicenter studies are required to achieve commutability of CMV testing and

Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center

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Priscila de Freitas-Lima

2013-11-01

Full Text Available Objective To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively. Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients. At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4–7.7. Conclusion The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system.

Glaucoma Blindness at a Tertiary Eye Care Center.

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Stone, Jordan S; Muir, Kelly W; Stinnett, Sandra S; Rosdahl, Jullia A

2015-01-01

Glaucoma is an important cause of irreversible blindness. This study describes the characteristics of a large, diverse group of glaucoma patients and evaluates associations between demographic and clinical characteristics and blindness. Data were gathered via retrospective chart review of patients (N = 1,454) who were seen between July 2007 and July 2010 by glaucoma service providers at Duke Eye Center. Visual acuity and visual field criteria were used to determine whether patients met the criteria for legal blindness. Descriptive and comparative statistical analyses were performed on the glaucoma patients who were not blind (n = 1,258) and those who were blind (n = 196). A subgroup analysis of only those patients with primary open-angle glaucoma was also performed. In this tertiary care population, 13% (n = 196) of glaucoma patients met criteria for legal blindness, nearly one-half of whom (n = 94) were blind from glaucoma, and another one-third of whom (n = 69) had glaucoma-related blindness. The most common glaucoma diagnosis at all levels of vision was primary open-angle glaucoma. A larger proportion of black patients compared with white patients demonstrated vision loss; the odds ratio (OR) for blindness was 2.25 (95% CI, 1.6-3.2) for black patients compared with white patients. The use of systemic antihypertensive medications was higher among patients who were blind compared with patients who were not blind (OR = 2.1; 95% CI, 1.4-3.1). A subgroup analysis including only patients with primary open-angle glaucoma showed similar results for both black race and use of systemic antihypertensive medications. The relationship between use of systemic antihypertensive medications and blindness was not different between black patients and white patients (interaction P = .268). Data were based on chart review, and associations may be confounded by unmeasured factors. Treated systemic hypertension may be correlated with blindness, and the cause cannot be explained solely

A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs.

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Gordon, John B; Colby, Holly H; Bartelt, Tera; Jablonski, Debra; Krauthoefer, Mary L; Havens, Peter

2007-10-01

To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes. Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005. A tertiary care center pediatric hospital and medical school serving urban and rural patients. A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program. Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician. Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments. A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000. This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.

Oral food challenge outcomes in a pediatric tertiary care center

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Abrams, Elissa M.; Becker, Allan B.

2017-01-01

Background Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity. Methods A retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010. Results 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge...

A STUDY OF PERINATAL OUTCOME IN TWIN GESTATION IN A TERTIARY CARE CENTER

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Rinku Girija

2017-02-01

Full Text Available BACKGROUND Perinatal mortality is an index of obstetric care. Twin pregnancy is a high-risk pregnancy since most often the foetus in born prematurely or retarded physically; it may turn out to be a dreaded event, especially in rare instances of simultaneous death of twins or death of one twin in mid trimester thereby worsening the prognosis of the surviving twin. The aim of the study is to study the perinatal mortality and morbidity of twin gestation and factors affecting the same in a tertiary care center. MATERIALS AND METHODS This is a prospective study. 100 successive cases of multiple pregnancy beyond 28 weeks of gestation admitted during the study period were followed from the antenatal period upon their admission to the antenatal ward and the labour room. 100 cases of singleton pregnancies during the same period taken as control. Detailed obstetric history, family history of twins, intake of ovulation inducing agents, time of diagnosis of twin pregnancy confirmed by USS examination were noted. Maternal antenatal complications like anaemia, hypertension, jaundice, etc. noted. The mode of onset of labour, presentation of foetus noted and if possible confirmed by USS, routine and special investigation like PIH profile, FBS, PPBS. Doppler USS done wherever necessary. Study Setting and Design- It is a prospective observational study of 100 consecutive twin gestations of gestational age 28 weeks and above at a tertiary care hospital attached to Government Medical College, Thiruvananthapuram, for a period of 6 months. Perinatal outcome including perinatal morbidity and mortality in relation to gestational age, mode of delivery, chorionicity, birth weight of the baby and NICU admission were analysed. RESULTS Data collected was analysed with descriptive statistics like percentage, proportion, rates, ratio and chi-square test. CONCLUSION In spite of so many advances in Obstetrics and Neonatology, the perinatal mortality and morbidity in twin

TB Risk Perceptions among Medical Residents at a Tertiary Care Center in India

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Geeta S. Pardeshi

2017-01-01

Full Text Available Setting. Government tertiary health care center in India. Objective. To understand the perceptions of medical residents about their risk of developing TB in the workplace. Design. Cross-sectional study in which a semistructured questionnaire which included an open-ended question to assess their main concerns regarding TB in workplace was used to collect data. Results. Out of 305 resident doctors approached, 263 (94% completed a structured questionnaire and 200 of these responded to an open-ended question. Daily exposure to TB was reported by 141 (64% residents, 13 (5% reported a prior history of TB, and 175 (69% respondents were aware of TB infection control guidelines. A majority reported concerns about acquiring TB (78% and drug-resistant TB (88%. The key themes identified were concerns about developing drug-resistant TB (n=100; 50%; disease and its clinical consequences (n=39; 20%; social and professional consequences (n=37; 19%; exposure to TB patients (n=32; 16%; poor infection control measures (n=27; 14%; and high workload and its health consequences (n=16; 8%. Conclusion. Though many resident doctors were aware of TB infection control guidelines, only few expressed concern about lack of TB infection control measures. Doctors need to be convinced of the importance of these measures which should be implemented urgently.

Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil.

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Schweiger, Cláudia; Manica, Denise; Becker, Carolina Fischer; Abreu, Larissa Santos Perez; Manzini, Michelle; Sekine, Leo; Kuhl, Gabriel

Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; pneurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

MONITORING OF THE CEPHALOSPORINS CONSUMPTION IN THE TERTIARY CARE HOSPITAL

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Radmila Veličković-Radovanović

2015-06-01

Full Text Available Irrational antibiotic consumption, especially in the case when there is no appropriate indication for its usage, may be one of the most crucial global issues for public health care, leading to bacterial resistance and the increase of indirect medical expenses. According to the report of the European program for the monitoring of the antibiotic consumption, Serbia is on the fifth place among the countries which are not members of EU. The goal of this work is the evaluation of antibiotic consumption in the Clinical Centre Niš, from 2007 to 2013, with the focus on the monitoring of the cephalosporins utilization, as they are one of the most prescribed groups of antibiotics in the tertiary health care. The utilization of antibiotics in the Clinical Center Niš in the observed period was obtained from the computerized database of the Department of Pharmacotherapy and expressed as defined daily dose (DDD per 100 bed/days (DBD. Our results showed that there was an increase in antibiotic use of the whole group of cephalosporins and penicillin as well as a reduction of quinolones consumption within the observed period. Our analysis showed that ceftriaxone was the most frequently prescribed cephalosporin, followed by cefuroxime. Although antibiotic therapy and prophylaxis in our hospital are in keeping with the recommended guidelines, the obtained results may suggest that cephalosporin consumption, and especially ceftriaxone consumption is higher than in other European countries.

Building the Nonuniversity, Tertiary Care Center Hepatobiliary and Pancreatic Surgery Practice: Structural and Financial Considerations.

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Baker, Erin H; Siddiqui, Imran; Vrochides, Dionisios; Iannitti, David A; Martinie, John B; Rorabaugh, Lauren; Jeyarajah, D Rohan; Swan, Ryan Z

2016-12-01

Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system.

[Assessment of patients with pressure sores admitted in a tertiary care center].

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Moro, Adriana; Maurici, Alice; do Valle, Juliana Barros; Zaclikevis, Viviane Renata; Kleinubing, Harry

2007-01-01

To determine the prevalence and analyze the profile of patients with pressure sores, focusing on risk factors, the patients' clinical characteristics at a tertiary care center, as well as stage and location of the lesions on the body. This was a cross sectional not controlled observational study, all patients admitted from April to June of 2005 were observed daily to identify all cases of pressure sores. The affected patients were evaluated by a standard questionnaire and the Scale of Braden was applied to define the risk of developing ulcers. Of the 690 patients admitted during the referred period, a prevalence of 5.9% of patients with lesions was observed, equivalent to 41 patients 63.9% of which were elderly and the average length of stay was 18 days. In the sample studied 41.5% of patients were found in the internal medicine section and the intensive care unit, ICU. The most common location for sores was the sacral area, corresponding to 73.1% of the patients, and stage II was the most frequent, observed in 58.5% of those patients. According to the Braden scale, most patients, 80.4%, had a high risk of developing pressure ulcers, compared to 9.7% of patients with moderate risk and 7.4% with low risk. The affected patients were at high risk of developing pressure sores. Prevalence of these lesions and the clinical and demographic profile of the affected patients are in accordance with the data in literature.

The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia

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Mohammad H. Al-Hemairi

2016-01-01

Full Text Available Introduction. Juvenile Idiopathic Arthritis (JIA is the most common chronic arthritis in children. Our aim is to describe demographic, clinical, and laboratory characteristics and treatment of JIA patients followed up in Pediatric Rheumatology clinic in a tertiary center in Saudi Arabia. Methods. Medical records of all patients who are followed up between January 2007 and January 2015 were retrospectively reviewed. Data were collected about demographic, clinical, and laboratory features and treatment. Results. Total patients were 82, males were 31 (37.8%, and mean age of JIA onset was 7.1 ± 3.6 yr. Mean follow-up duration was 2.67±1.6 yr. Systemic onset JIA (SoJIA was the commonest (36.5%, followed by polyarticular in 29.2% and oligoarticular in 28%. Large and small joints are involved in 76 (92% and 30 (36.6%, respectively. Main extra-articular feature was fever in 34 (41.4%. Uveitis was diagnosed in 7 (8.5% and in 5 (21.7% of oligoarticular JIA. Anemia was found in 49 (59.7%, high ESR in 45 (54.8%, and leukocytosis and thrombocytosis in 33 (40.2%. Positive ANA was found in 30 (36.5% mainly in oligoarticular subtype as 12 (52% patients (out of 23 had this positive test. 9 patients (10.9% required NSAIDs only, 6 patients (7.3% required NSAIDs and intra-articular steroids only, and 19 (23% required NSAIDs, methotrexate, steroids, and biologics. Conclusion. SoJIA is the most common JIA subtype in our study. A population based rather than a single center study will give more details about JIA characteristics in Saudi Arabia

A Retrospective Study on Snakebite Victims in a Tertiary Referral Center

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Nasim Zamani

2016-06-01

Full Text Available Background: Snakebite is a serious public health problem in the world. The annual incidence of snakebites ranges from 4.5-9.1 in 100,000 population in Iran. With regard to diversity of envenomation profiles in different geographical parts of Iran, the aim of this study was to determine the demographical data, clinical and laboratory findings, and the outcome of the snakebite victims referred to a tertiary referral hospital. Methods: In this retrospective, cross-sectional study in Loghman Hakim Hospital Poisoning Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, during a four-year period from March 2007 to March 2011. The demographic data, clinical manifestations, paraclinical findings, treatments performed before hospital admission, time elapsed between the bite and hospital admission, total dose of antivenom and the patients’ outcomes were investigated. Results: Seventy cases (58 males, 12 females were evaluated. Most of the cases (79% were older than 20 year old. The most common bite site was upper extremity (67%. Most of the patients were admitted within 5 h after the snakebite. The most common local and systemic manifestations were swelling (90%, pain (81.4%, nausea and vomiting (24.3%. Leukocytosis (35.7% and thrombocytopenia (25.7% were the most common laboratory abnormalities. Most of the patients (97.1% were treated with antivenom. Fifty percent of the patients only received 3-5 vials of antivenom. The mortality rate was 1.4%. Necrosis of the toes and compartment syndrome were the only serious complications. Conclusion: The findings emphasize the importance of early admission to the hospital and treatment with antivenom to avoid morbidity and mortality.

Lessons Learned from Delayed Versus Immediate Microsurgical Reconstruction of Complex Maxillectomy and Midfacial Defects: Experience in a Tertiary Center in Mexico.

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Santamaria, Eric; de la Concha, Erika

2016-10-01

Microsurgical reconstruction of complex midfacial and maxillectomy defects is among the most challenging procedures in plastic surgery, and it often requires composite flaps to improve functional and aesthetic results. Various factors have been identified as having influence in the outcome of microsurgical reconstruction. In this article, the authors present their experience with immediate and delayed reconstruction of complex maxillectomy defects in a tertiary center in Mexico. The authors present a total of 37 patients with microsurgical reconstruction of a complex maxillectomy defect; 13 patients had immediate and 24 had delayed reconstructions. The authors recommend doing immediate reconstruction when feasible. Copyright © 2016 Elsevier Inc. All rights reserved.

A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center of Himalayan Region

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Rakhee Sodhi

2016-03-01

Full Text Available Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47. Malignancy was diagnosed histopathologically in 70.2% (33/47 patients (both primary & metastatic pleural carcinoma and tuberculosis in 10.6% (5/47. There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion.

Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

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Cohen Eyal

2012-10-01

Full Text Available Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN, by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC. Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™], and family-centered care (MPOC-20®. Comparisons were made in equal (up to 1 year pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR $244 (981 per patient per month (PPPM pre-enrolment to $131 (355 PPPM post-enrolment (p=.007, driven primarily by fewer inpatient days in the tertiary care center (p=.006. Parents reported decreased out of pocket expenses (p© domains [Health Standardization Section (p=.04; Comfort and Emotions (p=.03], while total CPCHILD© score decreased between baseline and 1 year (p=.003. Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex

Fully digital data processing during cardiovascular implantable electronic device follow-up in a high-volume tertiary center.

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Staudacher, Ingo; Nalpathamkalam, Asha Roy; Uhlmann, Lorenz; Illg, Claudius; Seehausen, Sebastian; Akhavanpoor, Mohammadreza; Buchauer, Anke; Geis, Nicolas; Lugenbiel, Patrick; Schweizer, Patrick A; Xynogalos, Panagiotis; Zylla, Maura M; Scholz, Eberhard; Zitron, Edgar; Katus, Hugo A; Thomas, Dierk

2017-10-11

Increasing numbers of patients with cardiovascular implantable electronic devices (CIEDs) and limited follow-up capacities highlight unmet challenges in clinical electrophysiology. Integrated software (MediConnect ® ) enabling fully digital processing of device interrogation data has been commercially developed to facilitate follow-up visits. We sought to assess feasibility of fully digital data processing (FDDP) during ambulatory device follow-up in a high-volume tertiary hospital to provide guidance for future users of FDDP software. A total of 391 patients (mean age, 70 years) presenting to the outpatient department for routine device follow-up were analyzed (pacemaker, 44%; implantable cardioverter defibrillator, 39%; cardiac resynchronization therapy device, 16%). Quality of data transfer and follow-up duration were compared between digital (n = 265) and manual processing of device data (n = 126). Digital data import was successful, complete and correct in 82% of cases when early software versions were used. When using the most recent software version the rate of successful digital data import increased to 100%. Software-based import of interrogation data was complete and without failure in 97% of cases. The mean duration of a follow-up visit did not differ between the two groups (digital 18.7 min vs. manual data transfer 18.2 min). FDDP software was successfully implemented into the ambulatory follow-up of patients with implanted pacemakers and defibrillators. Digital data import into electronic patient management software was feasible and supported the physician's workflow. The total duration of follow-up visits comprising technical device interrogation and clinical actions was not affected in the present tertiary center outpatient cohort.

How Do Tertiary Dropouts Fare in the Labour Market? A Comparison between EU Countries

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Schnepf, Sylke V.

2017-01-01

Dropping out of university is regularly discussed as a negative indicator. However, research on actual career trajectories of dropouts is virtually non-existent. This study estimates the association between tertiary dropouts and career chances in 15 European countries. Using data from the 2011 Programme for the International Assessment of Adult…

Cross cultural comparison of constipation profiles at tertiary care centers between India and USA.

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Singh, P; Surana, R; Soni, S; Agnihotri, A; Ahuja, V; Makharia, G K; Staller, K; Kuo, B

2018-03-09

Despite potential differences in patient perception of chronic constipation (CC) in geographically and culturally distinct regions, head-to-head studies comparing the clinical profile, constipation severity, impact on quality of life (QOL) and economic impact are lacking. We conducted a cross-sectional cohort study of patients presenting with CC to tertiary care centers in the USA and India. Standardized instruments were used to assess constipation subtype, disease severity, disease-specific QOL, somatization, and psychiatric comorbidities. We used multivariable linear regression to determine the predictors of QOL and number of healthcare visits. Sixty-six and 98 patients with CC were enrolled in the USA and India, respectively. Indian patients with CC had significantly more frequent bowel movements/week compared to their USA counterparts (Median 5 vs 3, P USA compared to India (65.5% vs 48%, P = .04). Higher depression score (P = .001), more severe constipation symptoms (P = .001) and site of the study being USA (P = .008) independently predicted worse QOL. Indian patients (P USA suggesting significant differences in perception of CC in different geographic and cultural settings. QOL and economic impact related to constipation varies with geographic/cultural setting irrespective of other clinical and psychosomatic features. © 2018 John Wiley & Sons Ltd.

Pap Smear Abnormalities in Women Admitted to a Tertiary Health Center in Southeast Turkey

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Alev Ozer

2014-12-01

Full Text Available Aim: To analyze the cervical cytological abnormalities which are detected in women undergoing Pap screening in a tertiary health care center within Siirt, a southeastern province of Turkey. Material and Method: A total of 3000 women who underwent Pap screening at the study center between January 1, 2009 and December 31, 2009 were recruited for the study. The women who were diagnosed with benign epithelial changes, infectious alterations, as well as atypical squamous cells with undetermined significance (ASC-US, atypical squamous cells of high significance (ASC-H, and low-grade squamous intraepithelial lesion (LSIL were included. Results: Benign epithelial alterations, infectious changes, ASCUS, ASC-H, and LSIL were detected in 83.7%, 15.3%, 0.8%, 0.1% and 0.1% of the Pap smears respectively. A significant correlation was found between the patient age and the histopathological alterations in the Pap smears (r=0.072, p=0.001. Although no correlation could be detected between gravidity and Pap smear results (r=0.033, p=0.067, a significant correlation existed between parity and the histopathological findings within the Pap smears (r=0.051, p=0.005. Interestingly, the Pap smear results were found to be unrelated to socioeconomic status (r=0.088, p=0.168, education level (r=0.048, p=0.257, and smoking habit (r=0.086, p=0.077. Discussion: The present study has reported a value of 1.0% for the overall prevalence of cervical cytological abnormalities, which is much lower than in western countries. Thus, rather than being dependent on the data reported by clinical studies that have been conducted in western countries, Turkish health care policy should be based on the data obtained from national studies.

Long-term sequelae after lung abscess in children - Two tertiary centers' experience.

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Wojsyk-Banaszak, I; Krenke, K; Jończyk-Potoczna, K; Ksepko, K; Wielebska, A; Mikoś, M; Bręborowicz, A

2018-05-01

The aim of the study was to describe the epidemiology and clinical characteristic of children hospitalized with pneumonia complicated by lung abscess, as well as to evaluate the long-term sequelae of the disease. A retrospective review of medical records of all patients treated for pulmonary abscess in two tertiary centers was undertaken. Pulmonary function tests and lung ultrasound were performed at a follow-up. During the study period, 5151 children with pneumonia were admitted, and 49 (0.95%) cases were complicated with lung abscess. In 38 (77.5%) patients, lung abscess was treated solely with antibiotics, and in nine cases (16.3%) surgically. In 21 (51.21%) children complete radiological regression was documented. The mean time for radiological abnormalities regression was 84.14 ± 51.57 days, regardless of the treatment mode. Fifteen patients were followed up at 61.6 ± 28.3 months after discharge. Lung ultrasound revealed minor residual abnormalities: pleural thickening, subpleural consolidations and line B artefacts in 11 (73.3%) children. Pulmonary function tests results were abnormal in eight (53.3%) patients, the most frequent abnormality being hyperinflation. We did not find a restrictive disorder in any of the children. There were no deaths in our study. Lung abscess is a rare but severe complication of pneumonia in children. Most children recover uneventfully with no significant long-term pulmonary sequelae. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms.

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Kanafani, Zeina A; Kara, Layla; Hayek, Shady; Kanj, Souha S

2003-11-01

Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country. Prospective observational cohort study. The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries. All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed. Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate. Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.

Reverse Stage Shift at a Tertiary Care Center: Escalating Risk in Men Undergoing Radical Prostatectomy

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Silberstein, Jonathan L.; Vickers, Andrew J.; Power, Nicholas E.; Fine, Samson W.; Scardino, Peter T.; Eastham, James A.; Laudone, Vincent P.

2011-01-01

Purpose To evaluate changes in clinical and pathological characteristics of prostate cancer in patients treated surgically at a large tertiary care center in the context of increased use of active surveillance (AS) and minimally invasive surgery (MIS). Materials We performed retrospective review of 6,624 patients with localized prostate cancer who underwent radical prostatectomy from 2000–2010 at Memorial Sloan-Kettering Cancer Center. Patients were stratified by surgical approach (open, laparoscopic or robotic) and risk categories (low, intermediate, or high). Patients with low-risk disease, without intervention and minimum followup of 6 months were considered to have elected AS. Results AS cases increased from <20 per year between 2000–2004 to ≥100 per year between 2007–2009. Over the same decade MIS cases (laparoscopic or robotic) increased from zero to 63% of all surgical cases. The percentage of patients in intermediate- and high-risk categories increased over time, while the percentage in the low-risk category decreased (OR per year 0.91, 95% CI 0.89, 0.92, p <0.0005). The proportion of surgery patients with Gleason 6 tumors decreased over time (OR per year 0.87, 95% CI 0.85, 0.88; p <0.0005) while pathologic stage and Gleason score increased (p <0.0005). The proportion of low-risk cases decreased across all types of surgery, with the largest decrease in robotic surgery (p <0.0005). Conclusions We observed a reverse stage shift in patients undergoing radical prostatectomy since 2000 despite the introduction and rapid proliferation of MIS. These findings may be due to increased use of AS and institutional focus on treatment of higher-risk disease. PMID:21484780

Phylogenetic and paleobotanical evidence for late Miocene diversification of the Tertiary subtropical lineage of ivies (Hedera L., Araliaceae).

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Valcárcel, V; Guzmán, B; Medina, N G; Vargas, P; Wen, J

2017-06-22

post-Miocene lineages, with a similar role as consecutive centers of centrifugal dispersal (including islands) and speciation. The Miocene Asian extinction and European survival of Hedera question the general pattern of Tertiary regional extinction of temperate angiosperms in Europe while they survived in Asia. The Tortonian/Messinian diversification increase of ivies in the Mediterranean challenges the idea that this aridity period was responsible for the extinction of the Mediterranean subtropical Tertiary flora. Differential responses of Hedera to geographic barriers throughout its evolutionary history, linked to spatial isolation related to historical geologic and climatic constraints may have shaped diversification of ivies in concert with recurrent polyploidy.

Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center.

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Paudel, B; Shrestha, G K

Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.

Student-Centered European Education System as a Factor of Professional Competence of a Future Teacher's Personality

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Ivan Boychev

2015-08-01

Full Text Available Student-centered education system is seen as the most perspective didactic paradigm of future teachers’ training which directs institutes of higher education of our country towards the convergence with education system of Europe. Student-centered European education system shifts the focus at the educational process organization to the active didactic management and control, as well as the quality evaluation of future teachers’ independent work. It implies their active educational activities requiring substitution of monological presentation of teaching material in the form of informational lecture at its understanding at the form of pedagogics of creative cooperation and dialogue with teachers.

Profile of Microvascular Disease in Type 2 Diabetes in a Tertiary ...

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Background: Diabetes mellitus (DM) is a metabolic disorder complicated by microvascular and macrovascular diseases. The clinical profile of these complications has not been adequately studied in many tertiary health care centers in India. Aim: The authors studied the clinical profile of microvascular diabetes ...

Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil,

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Cláudia Schweiger

Full Text Available Abstract Introduction: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. Objective: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Methods: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. Results: 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%, followed by subglottic stenosis (16% and pharyngomalacia (11%. The mortality rate was 31%. By the end of this review, 35 children (28.4% had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77 ± 0.84 vs. 1.7 ± 1.00 comorbidities; p < 0.001. Conclusion: Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.

Prevalence of Falls and Its Associated Factors among Elderly Diabetes in a Tertiary Center, Malaysia

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A. K. Azidah

2012-01-01

Full Text Available The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel’s index. The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, P<0.05, age group more than 75 (OR: 2.97, P<0.05, retinopathy (OR: 2.19, P<0.05, and orthostatic hypotension (OR: 2.87, P<0.05 were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, P<0.05. In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score.

Assessment of ocular toxoplasmosis patients reported at a tertiary center in the northeast of Iran.

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Hosseini, Seyedeh Maryam; Moghaddas, Elham; Sharifi, Karim; Dadgar Moghaddam, Malihe; Shamsian, Seyed Aliakbar

2018-01-15

Ocular toxoplasmosis, which is caused by the single-cell parasite Toxoplasma gondii, is currently the most significant cause of posterior uveitis in the world. No previous studies have described the prevalence and clinical features of ocular toxoplasmosis in the northeast of Iran. The purpose of the current study was to address this gap. In this retrospective study, the medical records of 488 uveitis patients who presented to the Khatam-al-Anbia Eye Hospital of Mashhad University of Medical Sciences, a tertiary ophthalmology center in the northeast of Iran, between January 2013 and December 2015 were evaluated. The clinical features and risk factors of 99 (20%) consecutive patients with ocular toxoplasmosis were extracted. Ninety-nine including 53 (53.5%) female and 46 (46.5%) male patients with ocular toxoplasmosis were included in the analysis. Reduced vision (77%) and floaters (15.2%) were the most common presenting symptoms. The age category that was most affected by ocular toxoplasmosis was 20-40 years (range: 11-65 years) with a mean age of 27.2. All patients had retinochoroiditis, but just two had anterior uveitis. All of the extracted patients, with the exception of three patients, had unilateral involvement. None of the patients had any other medical disorders with the exception of one woman, who had diabetes. Only four recurring ocular toxoplasmosis patients were referred to the education hospital during the study. Serology data were available for just 32 patients, of which 31 (96.8%) were IgG positive, and 1 (3.2%) was IgM positive. Toxoplasma gondii was responsible for 20% of the patients of uveitis that presented to the largest ophthalmology center in the northeast of Iran. There is a high incidence of patients of ocular toxoplasmosis in the northeast of Iran, and it is a significant cause of uveitis and visual impairment in this area.

Neurological complications of dengue fever: Experience from a tertiary center of north India

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Rajesh Verma

2011-01-01

Full Text Available Introduction: Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever. Materials and Methods: The patients presenting with neurological complications with positive serology (IgM antibody for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations. Results: Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient. Conclusion: Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and outcome.

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Marcus, Nir; Ashkenazi, Shai; Yaari, Arnon; Samra, Zmira; Livni, Gilat

2005-07-01

Currently hospitalization for children with urinary tract infections (UTIs) is reserved for severe or complicated cases. Changes may have taken place in the characteristics and causative uropathogens of hospital-treated community-acquired UTI. To study children hospitalized in a tertiary center with community-acquired UTI, compare Escherichia coli and non-E. coli UTI, define predictors for non-E. coli UTI and elucidate the appropriate therapeutic approach. A prospective clinical and laboratory study from 2001 through 2002 in a tertiary pediatric medical center. Patients were divided by results of the urine culture into E. coli and non-E. coli UTI groups, which were compared. Of 175 episodes of culture-proved UTI, 70 (40%) were caused by non-E. coli pathogens. Non-E. coli UTI was more commonly found in children who were male (P = 0.005), who had underlying renal abnormalities (P = 0.0085) and who had received antibiotic therapy in the prior month (P = 0.0009). Non-E. coli uropathogens were often resistant to antibiotics usually recommended for initial therapy for UTI, including cephalosporins and aminoglycosides; 19% were initially treated with inappropriate empiric intravenous antibiotics (compared with 2% for E. coli UTI, P = 0.0001), with a longer hospitalization. Current treatment routines are often inappropriate for hospitalized children with non-E. coli UTI, which is relatively common in this population. The defined risk factors associated with non-E. coli UTIs and its antimicrobial resistance patterns should be considered to improve empiric antibiotic therapy for these infections.

Relationship between socioeconomic status and HIV infection in a rural tertiary health center

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Ogunmola OJ

2014-04-01

Full Text Available Olarinde Jeffrey Ogunmola,1 Yusuf Olatunji Oladosu,2 Michael Adeyemi Olamoyegun31Cardiac Care Centre, Department of Internal Medicine, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria, 2Department of Internal Medicine, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria, 3Endocrinology, Diabetes and Metabolism Unit, Department of Internal Medicine, Ladoke-Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, NigeriaBackground: There is a scarcity of data in rural health centers in Nigeria regarding the relationship between socioeconomic status (SES and HIV infection. We investigated this relationship using indicators of SES.Methods: An analytical case-control study was conducted in the HIV clinic of a rural tertiary health center. Data collection included demographic variables, educational attainment, employment status, monthly income, marital status, and religion. HIV was diagnosed by conventional methods. Data were analyzed with the SPSS version 16 software.Results: A total of 115 (48.5% HIV-negative subjects with a mean age of 35.49±7.63 years (range: 15–54 years, and 122 (51.5% HIV-positive subjects with a mean age of 36.35±8.31 years (range: 15–53 years were involved in the study. Participants consisted of 47 (40.9% men and 68 (59.1% women who were HIV negative. Those who were HIV positive consisted of 35 (28.7% men and 87 (71.3% women. Attainment of secondary school levels of education, and all categories of monthly income showed statistically significant relationships with HIV infection (P=0.018 and P<0.05, respectively after analysis using a logistic regression model. Employment status did not show any significant relationship with HIV infection.Conclusion: Our findings suggested that some indicators of SES are differently related to HIV infection. Prevalent HIV infections are now concentrated among those with low incomes. Urgent measures to improve HIV prevention among low income earners are

Obstetric and perinatal outcomes in IVF versus ICSI-conceived pregnancies at a tertiary care center--a pilot study.

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Nouri, Kazem; Ott, Johannes; Stoegbauer, Lucia; Pietrowski, Detlef; Frantal, Sophie; Walch, Katharina

2013-08-31

Although most pregnancies after IVF result in normal healthy outcomes, an increased risk for a number of obstetric and neonatal complications, compared to naturally conceived pregnancies, has been reported. While there are many studies that compare pregnancies after assisted reproductive techniques with spontaneously conceived pregnancies, fewer data are available that evaluate the differences between IVF and ICSI-conceived pregnancies. The aim of our present study was, therefore, to compare obstetric and perinatal outcomes in pregnancies conceived after in vitro fertilization (IVF) versus intracytoplasmatic sperm injection (ICSI). Three-hundred thirty four women who had become pregnant after an IVF or ICSI procedure resulted in a total of 530 children referred between 2003 und 2009 to the Department of Obstetrics and Gynecology of the Medical University of Vienna, a tertiary care center, and were included in this retrospective cohort study. We assessed maternal and fetal parameters in both groups (IVF and ICSI). The main study outcomes were preterm delivery, the need for neonatal intensive care, and congenital malformations. Moreover, we compared the course of pregnancy between both groups and the occurrence of complications that led to maternal hospitalization during pregnancy. There were 80 children conceived via ICSI and 450 children conceived via IVF.Mean gestational age was significantly lower in the ICSI group (p = 0.001). After ICSI, the birth weight (p = 0.008) and the mean APGAR values after 1 minute and after 10 minutes were lower compared to that of the IVF group (p = 0.016 and p = 0.047, respectively). Moreover, ICSI-conceived children had to be hospitalized more often at a neonatal intensive care unit (p = 0.004). There was no difference in pH of the umbilical artery or in major congenital malformations between the two groups. Pregnancy complications (i.e., premature rupture of membranes, cervical insufficiency, and premature

Risk factors predicting mortality in patients with lung abscess in a public tertiary care center in Karachi, Pakistan.

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Ghazal, Shaista; Kumar, Ashok; Shrestha, Binav; Sajid, Sana; Malik, Maria; Rizvi, Nadeen

2013-01-01

Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality. Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% (p=0.005) in patients with Hb less than or equal to 10 mg/dL. The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10 mg/dl) was statistically significant predictive factor for increased mortality.

Profile of angle closure in a tertiary care center in north India

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Ichhpujani Parul

2010-01-01

Full Text Available Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA, intraocular pressure (IOP, gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434 were diagnosed to have various subtypes of angle closure. Mean (±SD age at presentation was significantly higher for males (57.57 ± 11.62 years as compared to females (53.64 ± 10.67 years ( P < 0001. Primary angle closure glaucoma (PACG was most frequently diagnosed subtype (49.38% followed by Primary angle closure (PAC (39.68% and Primary angle closure suspect (PACS (10.93% respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction. Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical

The need for unique risk adjustment for surgical site infections at a high-volume, tertiary care center with inherent high-risk colorectal procedures.

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Gorgun, E; Benlice, C; Hammel, J; Hull, T; Stocchi, L

2017-08-01

The aim of the present study was to create a unique risk adjustment model for surgical site infection (SSI) in patients who underwent colorectal surgery (CRS) at the Cleveland Clinic (CC) with inherent high risk factors by using a nationwide database. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent CRS between 2005 and 2010. Initially, CC cases were identified from all NSQIP data according to case identifier and separated from the other NSQIP centers. Demographics, comorbidities, and outcomes were compared. Logistic regression analyses were used to assess the association between SSI and center-related factors. A total of 70,536 patients met the inclusion criteria and underwent CRS, 1090 patients (1.5%) at the CC and 69,446 patients (98.5%) at other centers. Male gender, work-relative value unit, diagnosis of inflammatory bowel disease, pouch formation, open surgery, steroid use, and preoperative radiotherapy rates were significantly higher in the CC cases. Overall morbidity and individual postoperative complication rates were found to be similar in the CC and other centers except for the following: organ-space SSI and sepsis rates (higher in the CC cases); and pneumonia and ventilator dependency rates (higher in the other centers). After covariate adjustment, the estimated degree of difference between the CC and other institutions with respect to organ-space SSI was reduced (OR 1.38, 95% CI 1.08-1.77). The unique risk adjustment strategy may provide center-specific comprehensive analysis, especially for hospitals that perform inherently high-risk procedures. Higher surgical complexity may be the reason for increased SSI rates in the NSQIP at tertiary care centers.

Mineral metabolism in European children living with a renal transplant: a European society for paediatric nephrology/european renal association-European dialysis and transplant association registry study

NARCIS (Netherlands)

Bonthuis, Marjolein; Busutti, Marco; van Stralen, Karlijn J.; Jager, Kitty J.; Baiko, Sergey; Bakkaloğlu, Sevcan; Battelino, Nina; Gaydarova, Maria; Gianoglio, Bruno; Parvex, Paloma; Gomes, Clara; Heaf, James G.; Podracka, Ludmila; Kuzmanovska, Dafina; Molchanova, Maria S.; Pankratenko, Tatiana E.; Papachristou, Fotios; Reusz, György; Sanahuja, Maria José; Shroff, Rukshana; Groothoff, Jaap W.; Schaefer, Franz; Verrina, Enrico

2015-01-01

Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal

Knowledge and Outcome Measure of HbA1c Testing in Asian Indian Patients with Type 2 Diabetes from a Tertiary Care Center

Science.gov (United States)

Kumpatla, Satyavani; Medempudi, Srikanth; Manoharan, Deepa; Viswanathan, Vijay

2010-01-01

Aim: HbA1c test is considered to be the reliable measure for evaluating long-term glycemic control in type 2 diabetes. The purpose of this study was to evaluate whether knowledge about HbA1c test is associated with a better glycemic control. Materials and Methods: We conducted a cross-sectional survey of 480 (M:F; 287:193) adults with type 2 diabetes attending a tertiary care center during a period of four months. Baseline demographic and clinical data of all the subjects was obtained. Subject’s knowledge about HbA1c test and their target goal was assessed using a questionnaire. Recent HbA1c results were obtained from medical records. Results: Seventy four per cent of the subjects had awareness about HbA1c test and about 43% of those who knew HbA1c test also knew their target goal. 33% remember their last HbA1c result. The mean A1C of Group A was significantly lower when compared with Group B (8.1 ± 1.7 vs 9.2 ± 1.9, P<0.0001). Group C had lower A1C levels compared to Group D (7.7 ± 1.4 vs 8.5 ± 1.9, p<0.0001). Patients who kept their HbA1c less than 7% were significantly higher in Group C than in Group D. (37.8 vs 12.7%, p<0.00001). Subjects had good glycemic control with increasing levels of awareness about HbA1c. Conclusion: Majority of the diabetic patients who attended the tertiary care center for diabetes care knew HbA1c test and half of them were aware about their target goal. Awareness about HbA1c had a positive impact on maintenance of better glycemic control. PMID:20922109

Pediatric echocardiograms performed at primary centers: Diagnostic errors and missing links!

International Nuclear Information System (INIS)

Saraf, Rahul P; Suresh, PV; Maheshwari, Sunita; Shah, Sejal S

2015-01-01

The present study was undertaken to assess the accuracy of pediatric echocardiograms done at non-tertiary centers and to evaluate the relationship of inaccurate interpretations with age, echocardiogram performer and complexity of congenital heart disease (CHD). The echocardiogram reports of 182 consecutive children with CHD (5 days-16 years) who were evaluated at a non-tertiary center and subsequently referred to our center were reviewed. Age of the child at echocardiogram, echocardiogram performer and complexity of CHD were noted. These reports were compared with echocardiogram done at our center. Discrepancies were noted and categorized. To assess our own error rate, we compared our echocardiogram reports with the findings obtained during surgery (n = 172), CT scan (n = 9) or cardiac catheterization reports (n = 1). Most of the children at the non-tertiary center (92%) underwent echocardiogram by personnel other than a pediatric cardiologist. Overall, diagnostic errors were found in 69/182 (38%) children. Moderate and major discrepancies affecting the final management were found in 42/182 (23%) children. Discrepancies were higher when the echocardiogram was done by personnel other than pediatric cardiologist (P < 0.01) and with moderate and high complexity lesions (P = 0.0001). There was no significant difference in proportion of these discrepancies in children ≤ 1 year vs. >1 year of age. A significant number of pediatric echocardiograms done at non-tertiary centers had discrepancies that affected the management of these children. More discrepancies were seen when the echocardiogram performer was not a pediatric cardiologist and with complex CHD

"WhatsApp"ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center.

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Khanna, Vishesh; Sambandam, Senthil N; Gul, Arif; Mounasamy, Varatharaj

2015-07-01

Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

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Maryse C Cnossen

Full Text Available The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI is low. Comparative effectiveness research (CER has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI study.We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions.All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%, designated as a level I trauma center (n = 48, 68% and situated in an urban location (n = 70, 99%. The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57% had a dedicated neuro-intensive care unit (ICU, 36 (51% had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45 of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers.Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.

Bioinformatics Meets Virology: The European Virus Bioinformatics Center's Second Annual Meeting.

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Ibrahim, Bashar; Arkhipova, Ksenia; Andeweg, Arno C; Posada-Céspedes, Susana; Enault, François; Gruber, Arthur; Koonin, Eugene V; Kupczok, Anne; Lemey, Philippe; McHardy, Alice C; McMahon, Dino P; Pickett, Brett E; Robertson, David L; Scheuermann, Richard H; Zhernakova, Alexandra; Zwart, Mark P; Schönhuth, Alexander; Dutilh, Bas E; Marz, Manja

2018-05-14

The Second Annual Meeting of the European Virus Bioinformatics Center (EVBC), held in Utrecht, Netherlands, focused on computational approaches in virology, with topics including (but not limited to) virus discovery, diagnostics, (meta-)genomics, modeling, epidemiology, molecular structure, evolution, and viral ecology. The goals of the Second Annual Meeting were threefold: (i) to bring together virologists and bioinformaticians from across the academic, industrial, professional, and training sectors to share best practice; (ii) to provide a meaningful and interactive scientific environment to promote discussion and collaboration between students, postdoctoral fellows, and both new and established investigators; (iii) to inspire and suggest new research directions and questions. Approximately 120 researchers from around the world attended the Second Annual Meeting of the EVBC this year, including 15 renowned international speakers. This report presents an overview of new developments and novel research findings that emerged during the meeting.

Risk of malignancy index used as a diagnostic tool in a tertiary centre for patients with a pelvic mass

DEFF Research Database (Denmark)

Håkansson, Fanny; Høgdall, Estrid V S; Nedergaard, Lotte

2012-01-01

Abstract Objective. Risk of malignancy index (RMI), based on a serum cancer antigen 125 level, ultrasound findings and menopausal status, is used to discriminate ovarian cancer from benign pelvic mass. In Denmark, patients with pelvic mass and RMI =200 are referred to tertiary gynecologic oncology...... the use of RMI =200 as a tool for preoperative identification of ovarian cancer at a tertiary center. Design. Prospective observational study. Setting. A tertiary center in Copenhagen, Denmark. Population. One thousand one hundred and fifty-nine women with pelvic mass. Methods. The RMI was calculated...... pelvic mass. Results. There were 778 women diagnosed with benign pelvic mass, while 251 had ovarian cancer and 74 had borderline ovarian tumor. Fifty-six women were diagnosed with other forms of cancer. Sensitivity and specificity for ovarian cancer vs. benign pelvic mass for RMI =200 were 92 and 82...

Transfusion of blood and blood component therapy for postpartum haemorrhage at a tertiary referral center

International Nuclear Information System (INIS)

Hussain, N.; Shah, T.; Shah, N.; Khan, N.H.

2011-01-01

Objective: To determine the practice of transfusion of blood and blood products in cases of postpartum haemorrhage, at a tertiary referral center. Methods: A retrospective study was conducted where medical records were reviewed for women, who either delivered or were admitted in labour suite with diagnosis of postpartum haemorrhage. The study period extended from Jan 2008 to Oct 2009. During a period of 22 months, records were reviewed for transfusion of blood and blood products in above group of women. Data were analyzed for descriptive statistics. Results: During the study period, a total of 4744 patients were admitted in the labour suite. A total of 113 (2.36%) women were diagnosed with Post partum haemorrhage. Uterine atony was the commonest cause of PPH, followed by genital tract trauma. A total of 81(71%) women received transfusion of blood and blood components (1.6%). The mean blood loss was 1088 ml (+- 584ml). Transfusion of blood and blood component therapy was significantly more in women who underwent caesarean section, compared to those women who delivered vaginally. There was one case of acute tubular necrosis due to PPH, and seven maternal deaths. The mean hospital stay was of +- 3 days. Conclusion: In this hospital based study, the prevalence of PPH was 2.36 +- %, and the rate of transfusion of blood and blood products was 1.6%.

Prevalence of Clostridium difficile toxinotypes in infected patients at a tertiary care center in Lebanon.

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Moukhaiber, Romy; Araj, George F; Kissoyan, Kohar Annie B; Cheaito, Katia A; Matar, Ghassan M

2015-07-30

Due to the increase in the incidence of Clostridium difficile associated diseases at a tertiary care center in Lebanon, this study was undertaken to determine the prevalent C. difficile toxinotypes. The immunocard method was used to test for toxins A and B in 88 collected stool samples, followed with API 20A to confirm for C. difficile. PCR amplification of the triose phosphate isomerase (tpi) gene, the toxin encoding genes tcdA, and tcdB, followed by toxinotyping, were performed on recovered isolates and stool specimens. Out of the 88 stool samples obtained, 30 (65.2%) were Immunocard positive, culture and or tpi positive for C. difficile. Of the 30 isolates, 4 were PCR negative for the tcdA and tcdB genes (A-B-), and 26 were PCR positive for the tcdA and / or tcdB genes with 4 being A+B+, 1 A+B-, and 21 A-B+. The results of toxinotyping showed that 2 isolates belonged to toxinotype 0, 4 to toxinotype XI, 2 to toxinotype XII, 1 to toxinotype XVI, 1(A+B-) and twenty (A-B+) designated as toxinotype 0-like. C. difficile was detected in 65.2% of patients' stools with prevalence of toxinotype 0-like. Identification of toxinotypes of C. difficile is important to determine the virulence potential of strains and control their spread.

Occupational hand dermatitis in a tertiary referral dermatology clinic in Taipei.

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Sun, C C; Guo, Y L; Lin, R S

1995-12-01

Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.

Emergent Awake tracheostomy--The five-year experience at an urban tertiary care center.

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Fang, Christina H; Friedman, Remy; White, Priscilla E; Mady, Leila J; Kalyoussef, Evelyne

2015-11-01

There are few studies that discuss the issues surrounding emergent awake tracheostomy. We aim to review the indications, anesthesia used, complications, and outcomes of patients undergoing urgent awake tracheostomy. Chart review. Medical charts of patients who underwent an emergent awake tracheostomy at our institution-affiliated tertiary care center over a 5-year period from 2009 to 2014 were reviewed. Data were collected from inpatient, outpatient, and operative records. Sixty-eight patients underwent emergent awake tracheostomy. Over half presented with hoarseness (n=37, 54.4%) and/or stridor (n=37, 54.4%). Acute upper airway obstruction secondary to malignancy was the most common indication and accounted for 58 cases (85.3%). Thirty-nine (70.1%) of the 55 patients with squamous cell carcinoma presented with advanced disease (stage III or IV). Other indications included glottic or subglottic stenosis (4.4%), failure to intubate (2.9%), and other (7.4%). Local anesthesia was used alone in 35.3% of cases and in combination with conscious sedation in 64.7% of cases. Mild bleeding occurred postoperatively in five patients (7.4%). There were no other postoperative complications. Nineteen patients were lost to follow-up. The mean follow-up of 49 patients was 7.2 weeks, ranging from 2 to 261 weeks. Long-term complications occurred in three patients and included tracheitis 7.4% and suprastomal granuloma 2.9%. Eleven patients (22%) were decannulated at a mean of 11.8 months following tracheostomy. Emergent awake tracheostomy should be considered in patients with impeding airway obstruction and is a safe and effective method to secure an airway in these patients. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Pediatric Mortality in a Rural Tertiary Care Center in Liberia

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Carmelle Tsai

2017-01-01

Full Text Available Liberia is a low‐income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post‐war and pre‐Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post‐war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric admissions. The most common cause of neonatal death was sepsis, and the most common cause of death under five years of age was malaria. The majority (82.0% of the deaths were in children under five. Pediatric mortality at this hospital was similar to other reported mortality six years post‐war, and lower than that reported immediately post‐war. Neonatal sepsis and malaria are two significant causes of pediatric mortality in this community and, therefore, further efforts to decrease childhood mortality should focus on these causes.

Omalizumab use during pregnancy for CIU: a tertiary care experience.

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Cuervo-Pardo, L; Barcena-Blanch, M; Radojicic, C

2016-07-01

The treatment of antihistamine and steroid resistant Chronic Idiopathic Urticaria (CIU) during pregnancy poses a challenge due to teratogenicity of immunosuppressants. Omalizumab is a recently FDA approved therapy for CIU and is classified as pregnancy category B. We present an initial series of subjects treated at a tertiary care center for antihistamine and steroid resistant CIU with omalizumab who became pregnant during therapy.

Thyroid Fine-Needle Aspiration under Ultrasound Guidance: Experience from an Academic Tertiary Care Center in Lebanon

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Rita Hajj Boutros

2017-07-01

Full Text Available Thyroid nodules are common. Malignancy was reported in only 5-15% of cases. Fine needle aspiration under US guidance (USG-FNA proved to be accurate for the detection of thyroid cancer. This is a retrospective review of 400 radiology and cytology USG-FNA reports, randomly selected among those done at the Radiology Department at a tertiary care center in Beirut during the last five years. The specimen was inadequate in 60 (12% of cases but FNA was repeated in 10 cases only. The final diagnosis was benign in 76.7% of cases, mostly in women. 35% of the malignant and 19% of the benign nodules were hypoechoic, p=0.03. No significant correlation was observed between malignancy and other ultrasonic characteristics. Hypoechogenecity was also more common in nodules with inadequate specimen (40% versus 21.4%, p=0.01. Age, gender, location and size of the nodule did not differ between groups of adequate and inadequate specimen. In conclusion, 3 out of 4 thyroid nodules referred for USG-FNA are benign, mostly in women. Inadequate specimen was observed in 12% of cases. Hypoechogenecity but not other ultrasonic characteristics was associated with malignancy and with test failure.   Key words: Thyroid nodule, fine needle aspirate, ultrasound guidance, thyroid cancer, inadequate.

Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience.

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Atiq, Muslim; Bhutani, Manoop S; Ross, William A; Raju, Gottumukkala S; Gong, Yun; Tamm, Eric P; Javle, Milind; Wang, Xuemei; Lee, Jeffrey H

2013-04-01

Metastatic lesions to the pancreas pose diagnostic challenges with regards to their differentiation from primary pancreatic cancer. Data on the yield of endoscopic ultrasonography (EUS)-guided fine-needle aspiration in detection of these lesions are limited. This is a retrospective review of 23 patients referred to a tertiary referral center for further evaluation of suspected pancreatic metastases. Main outcome measures were diagnostic yield of endoscopic ultrasonography-guided fine-needle aspiration in evaluation of metastatic lesions to the pancreas. Of 644 patients, 23 (3.6%) undergoing EUS of the pancreas were diagnosed to have metastatic disease to the pancreas based on clinical, radiological, and cytological results. Mean (SD) age was 64.3 (11.7) years. Of the 23 patients, 18 (78.3%) were asymptomatic. Mean (SD) size of lesion on EUS was 39.1 (19.9) mm. A diagnosis of malignant lesion was made in 21 of 23 cases, with a diagnostic accuracy of 91.3%. Metastatic lesions to the pancreas present as incidental, solitary mass lesions on staging or surveillance imaging. Endoscopic ultrasonography-guided fine-needle aspiration is an important tool in the characterization and further differentiation of metastatic lesions to the pancreas from primary pancreatic cancer.

Comparison of quality control for trauma management between Western and Eastern European trauma center

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Gambale Giorgio

2008-11-01

Full Text Available Abstract Background Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. Methods We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT. Results Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. Conclusion The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.

European type NPP electric power and vent systems. For safety improvement and proposal of international center

International Nuclear Information System (INIS)

Sugiyama, Kenichiro

2011-01-01

For prevention of reactor accidents of nuclear power plants, multiplicity and redundancy of emergency power would be most important. At station blackout accident, European type manually operated vent operation could minimize release amount of radioactive materials and keep safety of neighboring residents. After Fukushima Daiichi accident, nuclear power plants could not restart operation even after completion of periodical inspection. This article introduced European type emergency power and vent systems in Swiss, Sweden and Germany with state of nuclear power phaseout for reference at considering to upgrade safety and accident mitigation measures for better understanding of the public. In addition, it would be important to recover trust of nuclear technology to continue to disseminate latest information on new knowledge of accident site and decontamination technologies to domestic and overseas people. As its implementation, establishment of Fukushima international center was proposed. (T. Tanaka)

Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil,

OpenAIRE

Schweiger, Cláudia; Manica, Denise; Becker, Carolina Fischer; Abreu, Larissa Santos Perez; Manzini, Michelle; Sekine, Leo; Kuhl, Gabriel

2017-01-01

Abstract Introduction: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. Objective: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Methods: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care cen...

Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India.

Science.gov (United States)

Dadhwal, Vatsla; Sharma, Aparna; Khoiwal, Kavita; Deka, Dipika; Sarkar, Plaboni; Vanamail, P

2017-01-01

There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women. This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed. HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR. Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

Psycho-oncology: structure and profiles of European centers treating patients with gynecological cancer.

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Hasenburg, Annette; Amant, Frederic; Aerts, Leen; Pascal, Astrid; Achimas-Cadariu, Patriciu; Kesic, Vesna

2011-12-01

Psycho-oncological counseling should be an integrated part of modern cancer therapy. The aim of this study was to assess the structures and interests of psycho-oncology services within European Society of Gynecological Oncology (ESGO) centers. In 2010, a survey, which consisted of 15 questions regarding organization of psycho-oncological services and interests in training and research, was sent to all ESGO-accredited centers (n = 41). The response rate was 65.8% (27 centers). 96.3% (n = 26) of the surveys came from universities, and 3.7% (n = 1) came from nonacademic institutions. Most of the institutions (92.6%, n = 25) offer psycho-oncological care, mainly by psychologists (64%, n = 16) or psycho-oncologists (48%, n = 12). Fifty-two percent of patients are evaluated for sexual dysfunction as sequelae of their disease or treatment-related adverse effects. Fifty-two percent (n = 14) of institutions offer psychological support for cancer care providers. Eighty-five percent (n = 23) of all centers are interested in psycho-oncological training, and the preferred teaching tools are educational workshops (87%). The main issues of interest are sexual problems in patients with cancer, communication and interpersonal skills, responses of patients and their families, anxiety and adjustment disorders, and palliative care. Eighty-five percent (n = 17) of the 20 institutions look for research in the field of psycho-oncology, and 55% (n = 11) of those are already involved in some kind of research. Although psycho-oncological care is provided in most of the consulted ESGO accredited centers, almost 50% of women lack information about sexual problems. The results of the survey show the need for and interest in psycho-oncology training and research, including sexual dysfunction. Furthermore, psychological support should be offered to all cancer care providers.

Resistive plate chamber online data quality monitoring for the Compact Muon Solenoid at the European Center for Nuclear Research

CERN Document Server

Whitaker, William David

2008-01-01

A comprehensive, online, data quality monitoring software package has been developed for the muon system at the European Center for Nuclear Research's (CERN's) Compact Muon Solenoid (CMS) experiment. The package was written in Java, C++, and HTML. It provides real-time, RPC performance feedback in an easy to use graphic user interface (GUI).

Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience.

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Manjunath, C N; Srinivas, P; Ravindranath, K S; Dhanalakshmi, C

2014-01-01

Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo). Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort. In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease. RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Stereoinversion of tertiary alcohols to tertiary-alkyl isonitriles and amines.

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Pronin, Sergey V; Reiher, Christopher A; Shenvi, Ryan A

2013-09-12

The SN2 reaction (bimolecular nucleophilic substitution) is a well-known chemical transformation that can be used to join two smaller molecules together into a larger molecule or to exchange one functional group for another. The SN2 reaction proceeds in a very predictable manner: substitution occurs with inversion of stereochemistry, resulting from the 'backside attack' of the electrophilic carbon by the nucleophile. A significant limitation of the SN2 reaction is its intolerance for tertiary carbon atoms: whereas primary and secondary alcohols are viable precursor substrates, tertiary alcohols and their derivatives usually either fail to react or produce stereochemical mixtures of products. Here we report the stereochemical inversion of chiral tertiary alcohols with a nitrogenous nucleophile facilitated by a Lewis-acid-catalysed solvolysis. The method is chemoselective against secondary and primary alcohols, thereby complementing the selectivity of the SN2 reaction. Furthermore, this method for carbon-nitrogen bond formation mimics a putative biosynthetic step in the synthesis of marine terpenoids and enables their preparation from the corresponding terrestrial terpenes. We expect that the general attributes of the methodology will allow chiral tertiary alcohols to be considered viable substrates for stereoinversion reactions.

Demographic characteristics of chronic pancreatitis patients in the era of endosonography: Experience of a single tertiary referral center in Turkey.

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Şişman, Gürhan; Köroğlu, Emine; Erzin, Yusuf; Hatemi, İbrahim; Tuncer, Murat; Şentürk, Hakan

2016-05-01

There are no clinical data available about chronic pancreatitis (CP) on a series of patients of sufficient number in Turkey. In this study, the etiology and clinical features of CP were evaluated in one center, which is a tertiary referral hospital. The files of 168 patients who had been diagnosed with CP in our Medical Faculty between October 2007 and May 2013 were retrospectively analyzed. The etiological factors, symptoms, complications, and treatment methods were analyzed. The most common etiological factor was alcohol abuse (39%). The average age±SD was 46±15.2 years, and the male:female ratio was 4.2:1 (it was 2.6:1 for other etiologies except alcohol abuse and 15.5:1 in alcoholic CP patients, ppancreatic calcification (ppancreatic cancer was detected in four patients (2.3%). In majority of the CP patients, the etiology is alcohol abuse in Turkey. The development of diabetes is the most frequent complication of CP, which is independent of the etiology.

Young Vs Old Colorectal Cancer in Indian Subcontinent: a Tertiary Care Center Experience.

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Pokharkar, Ashish B; Bhandare, Manish; Patil, Prachi; Mehta, Shaesta; Engineer, Reena; Saklani, Avanish P

2017-12-01

This study aims to compare patient, tumor, treatment-related factors and survival between young (45 years) Indian colorectal cancer (CRC) patients. Total 778 patients of CRC were registered at tertiary cancer center in India between 1 August 2013 and 31 July 2014. Patients were followed up for median period of 27.73 months. Data regarding patient, tumor, treatment and survival-related factors were collected. Patients were divided in young (≤45 years) and old (>45 years) age groups. Statistical analysis was done with SPSS software version 23. Young age group patients presented more commonly with poor histology, node-positive disease, and rectal site. Younger age group patients received multiple lines of neoadjuvant treatment. There was no significant overall survival difference in both groups of patients. On stratified stage-wise analysis, no significant overall survival (OS) difference was found between two groups (young vs old-1- and 3-year OS: 85.2 and 61.5% vs 81.5 and 64.5%, respectively; P  = 0.881). On univariate analysis, gender, performance status, site, stage, differentiation, TRG, CRM status, signet ring type, and CEA level were significant prognostic factors. In disease-free survival (DFS) analysis, it is found that there is statistically significant difference in DFS (young vs old: 1 and 3 years; 77.6 and 62.8% vs 85.8 and 74.1%, respectively; P value, 0.02), but when OS was analyzed for same group of patient, there was no statistical difference ( P  = 0.302). This study confirms the high incidence rates of CRC in young Indian patients. There is no OS difference between two age groups. In operated group of patients, there is higher DFS in older patients but no OS advantage at 3 years follow-up. Further long-term follow-up is required to see any OS difference.

Perinatal Outcomes in Women with Preeclampsia: Experience of a Tertiary Referral Center

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Semra Eroglu

2015-11-01

, pregestational medical evaluation and regular antenatal follow-up visits especially for high-risk women should be emphasized. Whenever possible, women diagnosed with severe preeclampsia or HELLP syndrome should be transferred to a tertiary medical center with adequate capabilities for maternal and neonatal intensive care in order to decrease perinatal morbidities.

Indications and outcomes of pediatric keratoplasty in a tertiary eye care center: A retrospective review.

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Gulias-Cañizo, Rosario; Gonzalez-Salinas, Roberto; Hernandez-Zimbron, Luis Fernando; Hernandez-Quintela, Everardo; Sanchez-Huerta, Valeria

2017-11-01

To evaluate indications and outcomes of pediatric keratoplasty in a tertiary eye center, and identify factors that affect visual outcomes.We performed a retrospective review of penetrating keratoplasty in children aged 0 to 18 years between 1995 and 2011 in the Asociación para Evitar la Ceguera en México IAP, Hospital "Dr. Luis Sánchez Bulnes".A total of 574 penetrating keratoplasties were performed during the study interval. Median follow-up was 5.0 years. Main indications included keratoconus (55.58%), postherpetic scarring (9.58%), traumatic opacities (7.49%), and bullous keratopathy (6.09%). Rejection rates at 5 years were 27% overall, and among indications, keratoconus showed the best graft survival at 60-months follow-up (85%). The percentage of patients with best corrected visual acuity (BCVA) posttransplant >20/400 at 5 years in the nonrejection group was 81.25% and 82.74% in 10 years of age (YOA) groups, respectively, versus a BCVA posttransplant > 20/400 at 5 years in the rejection group of 53.68% and 51.72% in 10 YOA groups, respectively. There was a statistically significant reduced rejection rate between genders at 18 months of follow-up, favoring males.Despite being considered a high-risk procedure in children, penetrating keratoplasty can achieve good results, especially in patients with keratoconus. It can achieve significative improvements of visual acuity, provided there is an adequate follow-up and treatment adherence.

Secondary and tertiary hyperparathyroidism.

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Jamal, Sophie A; Miller, Paul D

2013-01-01

We reviewed the etiology and management of secondary and tertiary hyperparathyroidism. Secondary hyperparathyroidism is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus, most commonly low serum calcium. In secondary hyperparathyroidism, the serum calcium is normal and the PTH level is elevated. Tertiary hyperparathyroidism is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. Tertiary hyperparathyroidism typically occurs in men and women with chronic kidney disease usually after kidney transplant. The etiology and treatment of secondary hyperparathyroidism is relatively straightforward whereas data on the management of tertiary hyperparathyroidism is limited to a few small trials with short follow-up. Copyright © 2013 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Trends in one-year mortality for stroke in a tertiary academic center in Saudi Arabia: a 5-year retrospective analysis.

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Almekhlafi, Mohammed A

2016-01-01

Numerous studies have reported a decline in stroke-related mortality in developed countries. To assess trends in one-year mortality following a stroke diagnosis in Saudi Arabia. Retrospective longitudinal cohort study. Single tertiary care center from 2010 through 2014. All patients admitted with a primary admitting diagnosis of stroke. Demographic data (age, gender, nationality), risk factor profile, stroke subtypes, in-hospital complications and mortality data as well as cause of death were collected for all patients. A multivariable logistic regression model was used to assess factors associated with one-year mortality following a stroke admission. One-year mortality. In 548 patients with a mean age of 62.9 years (SD 16.9), the most frequent vascular risk factors were hypertension (90.6%), diabetes (65.5%), and hyperlipidemia (27.2%). Hemorrhagic stroke was diagnosed in 9.9%. The overall mortality risk was 26.9%. Non-Saudis had a significantly higher one-year mortality risk compared with Saudis (25% vs. 16.8%, respectively; P=.025). The most frequently reported causes of mortality were neurological and related to the underlying stroke (32%), sepsis (30%), and cardiac or other organ dysfunction-related (each 9%) in addition to other etiologies (collectively 9.5%) such as pulmonary embolism or an underlying malignancy. Significant predictors in the multivariate model were age (P stroke mortality in our center over the 5-year span. The establishment of stroke systems of care, use of thrombolytic agents, and opening of a stroke unit should play an important role in a decline in stroke mortality. Retrospective single center study. Mortality data were available only for patients who died in our hospital.

Quality of care indicators in inflammatory bowel disease in a tertiary referral center with open access and objective assessment policies.

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Gonczi, Lorant; Kurti, Zsuzsanna; Golovics, Petra Anna; Lovasz, Barbara Dorottya; Menyhart, Orsolya; Seres, Anna; Sumegi, Liza Dalma; Gal, Alexander; Ilias, Akos; Janos, Papp; Gecse, Krisztina Barbara; Bessisow, Talat; Afif, Waqqas; Bitton, Alain; Vegh, Zsuzsanna; Lakatos, Peter Laszlo

2018-01-01

In the management of inflammatory bowel diseases, there is considerable variation in quality of care. The aim of this study was to evaluate structural, access/process components and outcome quality indicators in our tertiary referral IBD center. In the first phase, structural/process components were assessed, followed by the second phase of formal evaluation of access and management on a set of consecutive IBD patients with and without active disease (248CD/125UC patients, median age 35/39 years). Structural/process components of our IBD center met the international recommendations. At or around the time of diagnosis usual procedures were full colonoscopy in all patients, with ileocolonoscopy/gastroscopy/CT/MRI in 81.8/45.5/66.1/49.6% of CD patients. A total of 86.7% of CD patients had any follow-up imaging evaluation or endoscopy. The median waiting time for non-emergency endoscopy/CT/MRI was 16/14/22 days. During the observational period patients with flares (CD/UC:50.6/54.6%) were seen by specialist at the IBD clinic within a median of 1day with same day laboratory assessment, abdominal US, CT scan/surgical consult and change in therapy if needed. Surgery and hospitalization rates were 20.1/1.4% and 17.3/3.2% of CD/UC patients. Our results highlight that structural components and processes applied in our center are in line with international recommendations, including an open clinic concept and fast track access to specialist consultation, endoscopy and imaging. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Utility and Actual Use of European and Spanish Guidelines on the Management of Endometrial Cancer Among Gynecologic Oncologists in Spain.

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Zapardiel, Ignacio; Blancafort, Claudia; Cibula, David; Jaunarena, Ibon; Gorostidi, Mikel; Gil-Moreno, Antonio; De Santiago, Javier

2017-07-01

The aim of the study was to analyze the current management of endometrial cancer across Spain and to evaluate the use and applicability of the national and international guidelines. An electronic 30-question survey was distributed among all Spanish Society of Obstetrics and Gynecology-registered specialists dedicated to gynecologic oncology in Spain by e-mail. Data were collected anonymously and analyzed using SPSS program. One hundred forty-five (17.8%) surveys were collected. Significant differences were observed between tertiary hospitals and secondary or private hospitals in terms of appropriate (according to European Society of Gynaecologic Oncology guidelines) nodal staging in low-risk cases (96 [95%] vs 27 [61.4%], respectively; P comparing centers with less than 20 cases per year to centers with more than 40 cases annually, with significant differences in the management of low-risk and intermediate-risk endometrial cancers. This cross-sectional study demonstrates a broad heterogeneity of care giving between the clinical national and international guidelines and the actual practice in Spain. Although most of the responders refer to base their endometrial cancer management on Spanish and European Society of Gynaecologic Oncology guidelines (64.1%), many discrepancies have been observed, mainly in the management of intermediate-risk cases and follow-up. It may be caused by the lack of consensus on certain points, lack of facilities in lower case load centers, and also due to disagreement or unawareness on the current knowledge.

Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan.

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Chhipa, Shaukat Ali; Hashmi, Farzeen K; Ali, Shehreen; Kamal, Mustafa; Ahmad, Khabir

2017-01-01

To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital. The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis. Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% (32/3437) persons had color vision deficiency with male being 1.4% and female 0.4%. Color vision deficiency was observed in 0.9% of candidates screened for pre-employment health check up in a tertiary care hospital. The color vision deficiency was predominantly present in male individuals.

Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: A single center experience

Science.gov (United States)

Manjunath, C.N.; Srinivas, P.; Ravindranath, K.S.; Dhanalakshmi, C.

2014-01-01

Background Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo). Methods Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort. Results In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease. Conclusion RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases. PMID:24973838

Prevalence of methicillin-resistant Staphylococcus aureus based on culture and PCR in inpatients at a tertiary care center in Tokyo, Japan.

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Taguchi, Hirokazu; Matsumoto, Tetsuya; Ishikawa, Hiroki; Ohta, Shoichi; Yukioka, Tetsuo

2012-10-01

We investigated active screening for colonization with methicillin-resistant Staphylococcus aureus (MRSA) on admission and weekly follow-up surveillance after admission to a tertiary care center (TCC) between June 2007 and 31 December 2007. Eleven percent (30/267) of patients were found to be positive for MRSA by polymerase chain reaction (PCR) and/or culture on admission; 5% (12/267) became positive during the TCC stay. The major primary diagnoses in MRSA-positive patients were pneumonia and cerebrovascular diseases. Twenty-two (52%) of 42 patients were found to be MRSA positive by both PCR and culture, compared with 19 (45%) of 42 who were PCR positive and culture negative. These findings suggest that active surveillance with PCR is highly sensitive and useful for the detection of MRSA colonization. To our knowledge, this is the first report of active surveillance of MRSA by PCR and bacterial culture in critically ill inpatients in Japan.

Four years prospective study of the maxillofacial trauma at a tertiary center in Western Nepal

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Rajib Khadka

2014-01-01

Full Text Available Purpose: This study was conducted to find the epidemiological characteristics of maxillofacial trauma in the Western region of Nepal. Materials and Methods: All the trauma patients attending the Department of Oral and Maxillofacial surgery in 4 years period at a tertiary center in Western Nepal were included in the study. The incidence, prevalence, age and sex distribution, etiologies and types as well as seasonal and daily variation of maxillofacial trauma were studied. Results: Maxillofacial trauma with male (71.55% predominance was seen. Road traffic accidents (RTA, 46.5% were the most common cause, and 41.65% of fracture cases due to RTA were under the influence of alcohol. Accidents were more common on the rural roads (38.9%, and majorities (43.3% were due to motorcycle accidents. They were more common on Friday (36.7% and in winter seasons (51.2%. The mandible fractures (65.85% were more common than midface fractures (53.58% and 19.44% of the fractures were combined fractures. Parasymphysis in mandible (32.16% and zygoma (39.09% in midface were the most common type of fracture. Conclusion: The increased incidence of maxillofacial trauma following RTA under the influence of alcohol noted in this study reveals the need for formulating preventive measures in the Western region of Nepal. Need to aware people to avoid drink and drive proper traffic management, prevention of carrying excessive passengers, especially on the rooftop of vehicles on the highway and disposal of out of date vehicles and timely maintenance of faulty roads is a must.

A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

Science.gov (United States)

Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

2013-11-01

Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Eastern Dimension of the European Neighbourhood Policy: Europeanization Mutual Trap

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V. A. Latkina

2014-01-01

Full Text Available The article analyses the Europeanization policy of the European Union towards the Eastern Partnership participant countries. Suffering from the lack of clear strategy and ultimate goal in the European Neighbourhood Policy the European Union enhances external democratization and its governance in post soviet states without immediate Union's membership perspective. Underestimation of common neighbourhood geopolitical duality in the context of growing rivalry between European (EU and Eurasian (Custom Union/Eurasian Economic Union integration gravitation centers presents the Eastern partners of the EU with a fierce dilemma of externally forced immediate geopolitical and civilizational choice while not all of them are well prepared to such a choice. The mutual Europeanization trap here to be studied both for the EU and its Eastern partners (involving Russia is a deficiency of regulating cooperation mechanism in the situation of European and Eurasian free trades zones overlapping. Vilnius Summit 2013 results test the "European aspirations" of the New Independent States and upset the ongoing process of the European Neighbourhood Policy in the context of growing economic interdependence in Wider Europe. Besides, the Ukrainian crisis escalation during 2014 as a new seat of tension provokes unbalance of the whole European security system and creates new dividing lines in Europe from Vancouver to Vladivostok.

Contact allergy to rubber accelerators remains prevalent: retrospective results from a tertiary clinic suggesting an association with facial dermatitis.

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Schwensen, J F; Menné, T; Johansen, J D; Thyssen, J P

2016-10-01

Chemicals used for the manufacturing of rubber are known causes of allergic contact dermatitis on the hands. Recent European studies have suggested a decrease in thiuram contact allergy. Moreover, while an association with hand dermatitis is well established, we have recently observed several clinical cases with allergic facial dermatitis to rubber. To evaluate temporal trends of contact allergy to rubber accelerators from the European baseline series in a tertiary patch test clinic in Denmark, and examine associations with anatomical locations of dermatitis. Patch test and clinical data collected in a Danish tertiary dermatology clinic in Gentofte, Herlev, Copenhagen between 1 January 2005 and 31 December 2014 were analysed. The following rubber accelerators or mixtures in petrolatum from the European baseline patch test series were included: thiuram mix 1.0%, mercaptobenzothiazole 2.0% and mercapto mix 1.0%. The overall prevalence of contact allergy to rubber accelerators was 3.1% with no significant change during the study period (P trend = 0.667). Contact allergy to thiuram mix was the most prevalent and was significantly associated with occupational contact dermatitis, hand dermatitis, age >40 years and facial dermatitis in adjusted binary logistic regression analysis. Current clinical relevance of contact allergy to thiuram mix was 59.3%. Patients with contact allergy to mercapto mix and mercaptobenzothiazole had a concomitant reaction to thiuram mix in 35.2% (19/54) and 35.4% (17/48) of the cases respectively. Contact allergy to rubber accelerators remains prevalent. Clinicians should be aware of the hitherto unexplored clinical association with facial dermatitis. © 2016 European Academy of Dermatology and Venereology.

A retrospective comparison of VLBW outcomes before and after implementing new delivery room guidelines at a regional tertiary care center.

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Wlodaver, A; Blunt, M; Satnes, K; Escobedo, M; Hallford, G; Szyld, E

2016-03-01

To evaluate the impact of implemented protocol changes on delivery room interventions and very low birth weight (VLBW) health outcomes. Retrospective study comparing birth characteristics, interventions and health outcomes of VLBW infants born in a tertiary care center before (calendar years 2008 to 2009) and after (calendar years 2012 to 2013) implementing new protocols using Chi-square analyses. Four hundred and nine were born before and 303 after changes were implemented. Postimplementation infants had more use of antenatal steroids (P=0.02), gestational age ⩽24 weeks (P=0.03) and birth weights between 501 and 750 g (P=0.04) and less oxygen administration (P=0.002), face mask ventilation (P=0.0001), surfactant use (P=0.0001), chest compressions (P=0.0001), intubation (P=0.002), epinephrine use (P=0.011), hypothermia (P=0.0001) and discharges home on supplemental oxygen (P=0.05). Changes creating a new delivery team, adopting new delivery practice guidelines and updating delivery room equipment resulted in positive outcomes for delivery room practices and patient outcomes.

Point prevalence survey of antimicrobial utilization in a Canadian tertiary-care teaching hospital

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Colin Lee

2015-06-01

Conclusion: This prospective point prevalence survey provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship initiatives. A multi-center point prevalence survey should be considered to identify patterns of antimicrobial use in Canada and to establish the first steps toward international antimicrobial surveillance.

Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center.

Science.gov (United States)

Kashef, Mohammad Amin; Friderici, Jennifer; Hernandez-Montfort, Jaime; Atreya, Auras R; Lindenauer, Peter; Lagu, Tara

2017-06-01

There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1-year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline-recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6-month readmission and 12-month mortality. IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation. Journal of Hospital Medicine 2017;12:414-420. © 2017 Society of Hospital Medicine

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

Science.gov (United States)

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

2017-06-20

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

Sociodemographic profile and psychiatric diagnosis of patients referred to consultation-liaison psychiatric services of general hospital psychiatric unit at a Tertiary Care Center

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Shri Gopal Goyal

2017-01-01

Full Text Available Context: Previous studies have reported high psychiatric comorbidity with physical illness. However, referral rate to consultation-liaison (C-L psychiatry from other departments is very low. There is a paucity of literature from India in this subspecialty of psychiatry. Aims: This study was conducted to assess the sociodemographic profile and psychiatric diagnosis of patients referred to C-L psychiatric services at a tertiary care center. Settings and Design: This was a descriptive cross-sectional study conducted in a tertiary care multispecialty teaching institution. Patients and Methods: The study population comprised all the patients who were referred for psychiatric consultation from other departments to C-L services of psychiatry department for 2 months. Information was collected using semi-structured pro forma, and diagnosis was made based on the International Classification of Diseases-10 criteria. Results: A total of 160 patients were referred for C-L psychiatric services. Majority of the patients were in the age group of 31–45 years, married, educated matriculation or beyond, belonged to Hindu religion, nuclear family, and residing in urban area. The maximum referrals were from internal medicine department (17.5 followed by nephrology (15.0% and neurology (10.6%. The most common psychiatric diagnosis was depression (12% followed by delirium (8%. The most common reason for seeking psychiatric consultation was psychiatric clearance of prospective kidney donor and bone marrow transplant/stem cell transplant recipient. Conclusions: Psychiatric comorbidity may present with chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric comorbidity.

Multi-center study on the characteristics and treatment strategies of patients with Graves' orbitopathy: the first European Group on Graves' Orbitopathy experience

NARCIS (Netherlands)

Prummel, Mark F.; Bakker, Annemieke; Wiersinga, Wilmar M.; Baldeschi, Lelio; Mourits, Maarten P.; Kendall-Taylor, Pat; Perros, Petros; Neoh, Chris; Dickinson, A. Jane; Lazarus, John H.; Lane, Carol M.; Heufelder, Armin E.; Kahaly, George J.; Pitz, Suzanne; Orgiazzi, Jacques; Hullo, Alain; Pinchera, Aldo; Marcocci, Claudio; Sartini, Maria S.; Rocchi, Roberto; Nardi, Marco; Krassas, Gerry E.; Halkias, A.

2003-01-01

To improve management of patients with Graves' orbitopathy, a multi-center collaborative approach is necessary in order to have large enough sample sizes for meaningful randomized clinical trials. This is hampered by a lack of consensus on how to investigate the eye condition. The European Group on

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

International Nuclear Information System (INIS)

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

2012-01-01

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

Indicators of malnutrition in children with cancer: A study of 690 patients from a tertiary care cancer center.

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Srivastava, R; Pushpam, D; Dhawan, D; Bakhshi, S

2015-01-01

Large data pertaining to indicators of malnutrition in children with cancer is lacking from India. In view of this, we prospectively analyzed consecutive de novo childhood patients with cancer presenting at a tertiary care center. Height and weight of each child (n = 690) were compared with World Health Organization child growth standards-2006 for that particular age and sex to get weight-for-age, height-for-age, and weight-for-height indices and below 2SD of the reference median on these indices were considered as underweight, stunted, and wasted, respectively. Body mass index (BMI) for age was also analyzed for thinness and obesity. Prevalence of malnutrition based on Z-score for weight-for-age, height-for-age, weight-for-height, and BMI-for-age was 30%, 31%, 35%, and 41%, respectively. Weight-for-age (underweight) was significantly associated (P = 0.018) with solid tumors. Height-for-age, weight-for-age, and BMI-for-age were significantly associated (P = 0.007, P = 0.016, and P ≤ 0.001, respectively) with rural community. Malnutrition was observed in approximately one-third of children with cancer. Malnutrition is associated with solid tumors and those coming from rural community. Wasting has a higher prevalence in children with cancer in <5 years of age group.

A Case Series of the Probability Density and Cumulative Distribution of Laryngeal Disease in a Tertiary Care Voice Center.

Science.gov (United States)

de la Fuente, Jaime; Garrett, C Gaelyn; Ossoff, Robert; Vinson, Kim; Francis, David O; Gelbard, Alexander

2017-11-01

To examine the distribution of clinic and operative pathology in a tertiary care laryngology practice. Probability density and cumulative distribution analyses (Pareto analysis) was used to rank order laryngeal conditions seen in an outpatient tertiary care laryngology practice and those requiring surgical intervention during a 3-year period. Among 3783 new clinic consultations and 1380 operative procedures, voice disorders were the most common primary diagnostic category seen in clinic (n = 3223), followed by airway (n = 374) and swallowing (n = 186) disorders. Within the voice strata, the most common primary ICD-9 code used was dysphonia (41%), followed by unilateral vocal fold paralysis (UVFP) (9%) and cough (7%). Among new voice patients, 45% were found to have a structural abnormality. The most common surgical indications were laryngotracheal stenosis (37%), followed by recurrent respiratory papillomatosis (18%) and UVFP (17%). Nearly 55% of patients presenting to a tertiary referral laryngology practice did not have an identifiable structural abnormality in the larynx on direct or indirect examination. The distribution of ICD-9 codes requiring surgical intervention was disparate from that seen in clinic. Application of the Pareto principle may improve resource allocation in laryngology, but these initial results require confirmation across multiple institutions.

Economics of Tertiary Education - Challenges and dynamics of the public tertiary education in Albania

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Gledian Llatja

2016-07-01

Full Text Available The tertiary education is a critic mechanism for the socio-economic progress, for individuals who aspire a brighter future and it is also considered an important catalyzer of the economic mobility (Department of Treasury and Department of Education, 2012, 2. Based on the positive role and impact that the tertiary education has on the sustainable development, President Obama once stated that it is of damage to treat education as a luxurious public service. In line with the general considerations about the tertiary education in the U.S. the parallel comparison with Albania comes as a direct interpretation of utopia in the education policy-making. As policies are usually drafted based on data and findings, in the case of Albania there is a lack of data on expenses on tertiary education as share of GDP. This stands also for the main limitation of the paper.

Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers: a retrospective data analysis

OpenAIRE

Vardavas, Constantine I.; Girvalaki, Charis; Filippidis, Filippos T; Oder, Mare; Kastanje, Ruth; de Vries, Irma; Scholtens, Lies; Annas, Anita; Plackova, Silvia; Turk, Rajka; Gruzdyte, Laima; Rato, F?tima; Genser, Dieter; Schiel, Helmut; Bal?zs, Andrea

2017-01-01

BACKGROUND: The use of e-cigarettes has increased during the past few years. Exposure to e-cigarette liquids, whether intentional or accidental, may lead to adverse events our aim was to assess factors associated with e-cigarette exposures across European Union Member States (EU MS). METHODS: A retrospective analysis of exposures associated with e-cigarettes reported to national poison centers was performed covering incidents from 2012 to March 2015 from 10 EU MS. De-identified and anonymous ...

Syn-kinematic palaeogeographic evolution of the West European Platform: correlation with Alpine plate collision and foreland deformation

NARCIS (Netherlands)

Sissingh, W.

Sequence stratigraphic correlations indicate that intermittent changes of the kinematic far-field stress-field regimes, and the associated geodynamic re-organisations at the plate-tectonic contacts of the African, Apulian, Iberian and European plates, affected the Tertiary palaeogeographic evolution

Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set.

Science.gov (United States)

Mehta, Chitra; George, Joby V; Mehta, Yatin; Wangmo, Namgyal

2015-08-01

Pressure ulcers is a frequent problem in hospitalized patients. Several prevalence studies have been conducted across the globe. Little information is available regarding prevalence of pressure ulcers in India. The aim was to identify the prevalence of pressure ulcers in one of the tertiary hospital in northern India and the factors associated with its development. A cross sectional point prevalence study. European Pressure Ulcer Advisory Panel (EPUAP) data collection form. Ethics approval was obtained prior to start of the study. Total of 358 patients were enrolled in the study. All patients above 18 years of age admitted in intensive care units and wards were included in the study. Patients admitted in emergency, day care, coronary care unit were excluded because of their short duration of hospital stay (varies from 24 to 72 h usually). All patients admitted before midnight on the predetermined day were included. The Braden scale was used to identify the risk of developing pressure ulcers. European Pressure ulcer advisory panel (EPUAP) minimum data set was used to collect prevalence data. The overall prevalence rate was 7.8%.The sacrum and heel were more commonly affected. Grade III pressure ulcers were the most common (42.8%). The pressure ulcer prevalence rate in our hospital was lower than that published in international studies. Severe forms of pressure ulcers were commonly encountered This data provides background information that may help us in developing protocols for applying effective practices for prevention of pressure ulcers. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000.

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Atasay, Begüm; Günlemez, Ayla; Unal, Sevim; Arsan, Saadet

2003-01-01

Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal intensive care unit of our hospital from 1997 to 2000. The ultimate goal of the study was to define a model for developing a regional database. Information on all very low birth weight (VLBW) admissions to a tertiary level neonatal intensive care unit (NICU) in Ankara between January 1997 and December 2000 was prospectively collected by three neonatologists using a standard manual of operation and definitions. The data consisted of patient information including sociodemographic characteristics; antenatal history; mode of delivery; APGAR scores; need for resuscitation; admission illness severity (Clinical Risk Index for Babies-CRIB) and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System-NTISS); selected NICU parameters and procedures such as respiratory support, surfactant therapy, and postnatal corticosteroid therapy; and selected patient outcomes such as intraventricular hemorrhage, septicemia, necrotizing enterecolitis, retinopathy of prematurity, and chronic lung disease. The number of VLBW admissions to the NICU was 133, with 51 (28.6%) referrals from other maternity centers. The mean birth weight and gestational age of the infants were 1175 +/- 252 g and 30.3 +/- 2.9 weeks, respectively. One hundred and seventeen of 133 cases (88.7%) received at least one antenatal care visit. The median CRIB and NTISS scores were 4.5 and 31, respectively. Antenatal steroids had been given to 74 (55.6%) infants. Surfactant treatment and respiratory support were given to 33 (24.8%) and 73 (54.8%) infants, respectively. Among selected outcomes, chronic lung disease (CLD), threshold retinopathy of prematurity (ROP), severe intraventricular hemorrhage (IVH > or = grade III), nosocomial infection and necrotizing enterocolitis (NEC) were encountered in 14 (12.6%), 9 (8.1%), 3 (2.2%), 34 (25.5%) and 35 (26

Encapsulating peritoneal sclerosis: experience of a tertiary referral center.

LENUS (Irish Health Repository)

Phelan, P J

2010-05-01

Encapsulating peritoneal sclerosis (EPS) is arguably the most serious complication of chronic peritoneal dialysis (PD) therapy with extremely high mortality rates. We aimed to establish the rates of EPS and factors associated with its development in a single center.

Bahrain’s tertiary education reform : a step towards sustainable economic development

OpenAIRE

Karolak, Magdalena

2012-01-01

Bahrain has been experiencing along with other Gulf Council Cooperation countries a rapid development of its tertiary sector of education. The 2000's were marked by a boom in education with the opening of twelve private universities in this country of roughly 1 million inhabitants. Some institutions were locally based, while others worked in affiliation with foreign based universities. It is in sharp contrast with the 1990's, when only three public universities served as centers of higher edu...

European Virtual Atomic And Molecular Data Center - VAMDC

Science.gov (United States)

Dimitrijevic, M. S.; Sahal-Brechot, S.; Kovacevic, A.; Jevremovic, D.; Popovic, L. C.

2010-07-01

Reliable atomic and molecular data are of great importance for different applications in astrophysics, atmospheric physics, fusion, environmental sciences, combustion chemistry, and in industrial applications from plasmas and lasers to lighting. Currently, very important resources of such data are highly fragmented, presented in different, nonstandardized ways, available through a variety of highly specialized and often poorly documented interfaces, so that the full exploitation of all their scientific worth is limited, hindering research in many topics like e.g. the characterization of extrasolar planets, understanding the chemistry of our local solar system and of the wider universe, the study of the terrestrial atmosphere and quantification of climate change; the development of the fusion rersearch, etc. The Virtual Atomic and Molecular Data Centre (http://www.vamdc.eu, VAMDC) is an European Union funded FP7 project aiming to build a secure, documented, flexible and interoperable e-science environment-based interface to existing atomic and molecular data. It will also provide a forum for training potential users and dissemination of expertise worldwide. Partners in the Consortium of the Project are: 1) Centre National de Recherche Scientifique - CNRS (Paris, Reims, Grenoble, Bordeaux, Dijon, Toulouse); 2) The Chancellor, Masters and Scholars of the University of Cambridge - CMSUC; 3) University College London - UCL; 4) Open University - OU; (Milton Keynes, England); 5) Universitaet Wien - UNIVIE; 6) Uppsala Universitet - UU; 7) Universitaet zu Koeln - KOLN; 8) Istituto Nazionale di Astrofisica - INAF (Catania, Cagliari); 9) Queen's University Belfast - QUB; 10) Astronomska Opservatorija - AOB (Belgrade, Serbia); 11) Institute of Spectroscopy RAS - ISRAN (Troitsk, Russia); 12) Russian Federal Nuclear Center - All-Russian Institute of Technical Physics - RFNC-VNIITF (Snezhinsk, Chelyabinsk Region, Russia; 13) Institute of Atmospheric Optics - IAO (Tomsk, Russia

Tertiary climatic fluctuations and methods of analysis of tertiary floras

Science.gov (United States)

Wolfe, J.A.

1971-01-01

On theoretical grounds, an analysis of the physiognomy of a Tertiary leaf assemblage is more direct and reliable than a circuitous floristic analysis in assigning thermal regimes to fossil assemblages. Using primarily foliar physiognomy and secondarily floristic composition, it can be shown that: (1) some middle latitude Tertiary assemblages probably lived under meteoroligically tropical climates; (2) a major and rapid climatic deterioration occurred in the Oligocene; and (3) a major climatic fluctuation probably occurred in the Late Eocene. These analyses thus substantiate the conclusions of several other paleobotanists regarding climatic fluctuations. Recent criticisms of these analyses are shown to be invalid and to be based largely on misinterpretations. ?? 1971.

Do Syrian refugees have increased risk for worser pregnancy outcomes? Results of a tertiary center in İstanbul.

Science.gov (United States)

Güngör, Emre Sinan; Seval, Olcay; İlhan, Gülşah; Verit, Fatma Ferda

2018-03-01

To compare obstetric and perinatal outcomes of Syrian refugee pregnants and Turkish counterparts who gave birth at a tertiary center in İstanbul. A retrospective study including the birth records of 704 Syrian refugees and 744 Turkish pregnant women between January 2016 and May 2017 were analyzed. Demographic data, obstetric and neonatal outcomes were compared. The primary aims of this study were to evaluate the pregnancy outcomes and cesarean rates between the groups. The secondary outcomes were the use of antenatal vitamin supplementation, hemoglobin-hematocrit values, and maternal complications. Our results showed that the use of folic acid and iron supplementation rates during pregnancy were similar between the groups (folic acid supplementation 8.1% vs 6.5%, p=0.264; iron supplementation 20.7% vs 19.6%, p=0.125; respectively for Turkish women and Syrian refugees). Cesarean rates were significantly higher for Turkish patients than in Syrian refugees (42.7% vs 32.7%; pyrian refugees (37.7±2.3 vs 36.4±2.3 weeks, pyrian refugees, respectively, p=0.105). Although obstetric complications were seen more often in Syrian refugees, it did not reach statistical difference (9.7% vs 8.1%, respectively, p=0.285). Syrian refugees use antenatal vitamin supplementations at similar rates to Turkish citizens and obstetric and perinatal outcomes are similar between the groups.

Risk factors for the acquisition of carbapenem-resistant Escherichia coli at a tertiary care center in South Korea: a matched case-control study.

Science.gov (United States)

Ahn, Jin Young; Song, Je Eun; Kim, Min Hyung; Choi, Heun; Kim, Jae Kyung; Ann, Hea Won; Kim, Jung Ho; Jeon, Yongduk; Jeong, Su Jin; Kim, Sun Bean; Ku, Nam Su; Han, Sang Hoon; Song, Young Goo; Yong, Dongeun; Lee, Kyungwon; Kim, June Myung; Choi, Jun Yong

2014-06-01

Carbapenem resistance among gram-negative bacilli is an emerging threat worldwide. The objective of this study was to identify risk factors for the acquisition of carbapenem-resistant Escherichia coli (CRE). We conducted a matched case-control study comprising 57 cases of acquisition of CRE and 114 controls (1:2 matched) selected from patients with a culture of carbapenem-susceptible E coli between January 2006 and December 2010 at a 2000-bed tertiary care center in South Korea. On univariate analysis, previous use of carbapenem (P carbapenem (odds ratio [OR], 4.56; 95% confidence interval [CI] 1.44-14.46; P = .01) and previous use of fluoroquinolone (OR, 2.81; 95% CI, 1.14-6.99; P = .03) were independent risk factors. At this institute, the antibiotic selective pressure of carbapenems and fluoroquinolones was shown to be an important risk factor for the acquisition of CRE. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Linear Accelerator Stereotactic Radiosurgery of Central Nervous System Arteriovenous Malformations: A 15-Year Analysis of Outcome-Related Factors in a Single Tertiary Center.

Science.gov (United States)

Thenier-Villa, José Luis; Galárraga-Campoverde, Raúl Alejandro; Martínez Rolán, Rosa María; De La Lama Zaragoza, Adolfo Ramón; Martínez Cueto, Pedro; Muñoz Garzón, Víctor; Salgado Fernández, Manuel; Conde Alonso, Cesáreo

2017-07-01

Linear accelerator stereotactic radiosurgery is one of the modalities available for the treatment of central nervous system arteriovenous malformations (AVMs). The aim of this study was to describe our 15-year experience with this technique in a single tertiary center and the analysis of outcome-related factors. From 1998 to 2013, 195 patients were treated with linear accelerator-based radiosurgery; we conducted a retrospective study collecting patient- and AVM-related variables. Treatment outcomes were obliteration, posttreatment hemorrhage, symptomatic radiation-induced changes, and 3-year neurologic status. We also analyzed prognostic factors of each outcome and predictability analysis of 5 scales: Spetzler-Martin grade, Lawton-Young supplementary and Lawton combined scores, radiosurgery-based AVM score, Virginia Radiosurgery AVM Scale, and Heidelberg score. Overall obliteration rate was 81%. Nidus diameter and venous drainage were predictive of obliteration (P linear accelerator-based radiosurgery is a useful, valid, effective, and safe modality for treatment of brain AVMs. Copyright © 2017 Elsevier Inc. All rights reserved.

Management of Placenta Invasion Anomaly and Cesarean Hysterectomy: Eight-year Experience of A Tertiary Center

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İbrahim Kalelioğllu

2013-09-01

Full Text Available Objective: We aimed to present our experience with the management of placenta invasion anomaly by reviewing clinical and operative features of the cases of cesarean hysterectomy performed due to placenta invasion anomaly. Methods: In this retropective study, the charts of all patients who underwent cesarean hysterectomy with an indication of placenta invasion anomaly in Istanbul Faculty of Medicine Department of Obstetrics and Gynecology between 2005 and 2012 were reviewed. Results: In this period a total of 85 patients underwent cesarean hysterectomy. 81 (95.3% cases had experienced at least one cesarean delivery before. Majority of the operations (82.4% were performed in elective conditions. In 16 (18.8% cases bilateral hypogastric artery ligation was carried out because of profuse bleeding. There were no mortalities in the intra- or postoperative period. In 18 (21.2% cases, intraoperative urology consultation was needed. Full- thickness bladder laceration occured in 17 patients, and partial cyctectomy was performed in one patient due to the placenta percreata invading posterior wall of the bladder. Transfusion was needed in 72 (84.7% cases during and 50 (58.8% patients after operation. Dilutional trombocytopenia developed in 17 (20% patients due to massive transfusion. Histopathologically the diganosis was placenta accreata in 55 (64.7%, placenta increata in 1 (1.2% and placenta percreata in 25 (29.4% patients. The incidence of placenta invasion anomaly rose from 0.2% (7/3435 in 2005-2006 up to 0.8% (37/4344 in 2011-2012. Conclusion: The incidence of placenta invasion anomaly is increasing progressively. Cesarean hysterectomy being its classical treatment is an operation with a high risk of morbidity and it should be performed by experienced teams after appropriate preparations in tertiary centers where multidiciplinary approach is possible.

Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions

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Boniface Eze

2010-09-01

Full Text Available Boniface Eze1, Kenneth Agu2, Jones Nwosu31Department of Ophthalmology, 2Department of Surgery, 3Department of Otorhinolaryngology, University of Nigeria Teaching Hospital (UNTH, Ituku-Ozalla, Enugu, Enugu State, Nigeria Objective: To assess the sociodemographic and clinical characteristics of patients discharged against medical advice (DAMA at the University of Nigeria Teaching Hospital (UNTH, Enugu, Nigeria.Methods: The UNTH’s admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P < 0.05 (one degree of freedom was considered statistically significant.Results: Of the 64,856 admissions (45.2% male, 54.8% female, 113 (0.002%; males: 54%, females: 46% were discharged against medical advice. DAMA rate was highest in Surgery (0.4%, and lowest in Obstetrics and Gynecology (0.1% and Pediatrics (0.1%. Infections (32.7%, trauma (29.2%, and cancer (16.8% were the leading diagnoses in patients DAMA. Financial constraints (37.2%, unsatisfactory response to treatment (17.7%, and dissatisfaction with hospital environment (15.0% were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P < 0.05, patients having high levels of formal education (P < 0.05, and those who had not been previously hospitalized (P < 0.05; but not with age (P = 0.398, gender (P = 0.489, or employment (P = 0.091.Conclusion: Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate. Keywords: discharge against medical advice, tertiary center, sociodemographic characteristics, clinical

Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center.

Science.gov (United States)

Bauer, Natasha Johan

2016-01-01

Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association. A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Just over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient's age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. These findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the effects of these changes.

Diagnostic yield in the evaluation of dysphagia: experience at a single tertiary care center.

Science.gov (United States)

Bill, J; Rajagopal, S; Kushnir, V; Gyawali, C P

2018-05-24

Evaluation of dysphagia typically starts with esophagogastroduodenoscopy (EGD); further testing is pursued if this is negative. When no mucosal, structural, or motor esophageal disorders are identified with persisting symptoms, functional dysphagia is considered. We evaluated outcomes in patients undergoing EGD for dysphagia, and estimated prevalence of functional dysphagia. The endoscopy database at single tertiary care center was interrogated to identify EGDs performed for an indication of 'dysphagia' over a 12-month period (2008-09). Electronic medical records were reviewed over the next 8 years to assess if an etiology was identified. Data were analyzed to assess the diagnostic yield of endoscopy and subsequent tests in the evaluation of dysphagia. Of 5486 EGDs, 822 (15.0%) were performed for dysphagia in 694 patients (58.4 ± 0.6 year, range: 18-95 year, 55.8% female). Of these, 529 (76.2%) had EGD findings that explained dysphagia; another 22 (3.2%) had findings on histopathology. Of the remainder 143 patients (20.6%) with normal index EGD, 38 (26.6%) patients underwent barium esophagram with 15 (39.5%) having abnormal studies. 19 patients (13.3%) underwent esophageal high resolution manometry with 12 (63.2%) being abnormal, and 7 had a mechanism for dysphagia on alternate testing. A repeat EGD was abnormal in 6 patients, while 45 patients were lost to follow-up. 42 patients had complete resolution of symptoms despite normal endoscopy, of which 30 were treated empirically with a proton pump inhibitor (PPI). Only 16 patients had no findings on evaluation, and had continued dysphagia symptoms, representing true functional dysphagia in 2.3% of all dysphagia patients and 11.2% of patients with normal EGD. Endoscopy remains the test with the highest yield (over 75%) for a diagnosis in patients presenting with dysphagia; secondary tests are useful when endoscopy does not provide a diagnosis. Benign strictures and GERD-related etiologies are leading causes; PPI

Detachment of Tertiary Dendrite Arms during Controlled Directional Solidification in Aluminum - 7 wt Percent Silicon Alloys: Observations from Ground-based and Microgravity Processed Samples

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Grugel, Richard N.; Erdman, Robert; Van Hoose, James R.; Tewari, Surendra; Poirier, David

2012-01-01

Electron Back Scattered Diffraction results from cross-sections of directionally solidified aluminum 7wt% silicon alloys unexpectedly revealed tertiary dendrite arms that were detached and mis-oriented from their parent arm. More surprisingly, the same phenomenon was observed in a sample similarly processed in the quiescent microgravity environment aboard the International Space Station (ISS) in support of the joint US-European MICAST investigation. The work presented here includes a brief introduction to MICAST and the directional solidification facilities, and their capabilities, available aboard the ISS. Results from the ground-based and microgravity processed samples are compared and possible mechanisms for the observed tertiary arm detachment are suggested.

Escherichia coli Sequence Type 131 H30 Is the Main Driver of Emerging Extended-Spectrum-β-Lactamase-Producing E. coli at a Tertiary Care Center.

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Johnson, James R; Johnston, Brian; Thuras, Paul; Launer, Bryn; Sokurenko, Evgeni V; Miller, Loren G

2016-01-01

The H 30 strain of Escherichia coli sequence type 131 (ST131- H 30) is a recently emerged, globally disseminated lineage associated with fluoroquinolone resistance and, via its H 30Rx subclone, the CTX-M-15 extended-spectrum beta-lactamase (ESBL). Here, we studied the clonal background and resistance characteristics of 109 consecutive recent E. coli clinical isolates (2015) and 41 historical ESBL-producing E. coli blood isolates (2004 to 2011) from a public tertiary care center in California with a rising prevalence of ESBL-producing E. coli isolates. Among the 2015 isolates, ST131, which was represented mainly by ST131- H 30, was the most common clonal lineage (23% overall). ST131- H 30 accounted for 47% (8/17) of ESBL-producing, 47% (14/30) of fluoroquinolone-resistant, and 33% (11/33) of multidrug-resistant isolates. ST131- H 30 also accounted for 53% (8/14) of dually fluoroquinolone-resistant, ESBL-producing isolates, with the remaining 47% comprised of diverse clonal groups that contributed a single isolate each. ST131- H 30Rx, with CTX-M-15, was the major ESBL producer (6/8) among ST131- H 30 isolates. ST131- H 30 and H 30Rx also dominated (46% and 37%, respectively) among the historical ESBL-producing isolates (2004 to 2011), without significant temporal shifts in relative prevalence. Thus, this medical center's recently emerging ESBL-producing E. coli strains, although multiclonal, are dominated by ST131- H 30 and H 30Rx, which are the only clonally expanded fluoroquinolone-resistant, ESBL-producing lineages. Measures to rapidly and effectively detect, treat, and control these highly successful lineages are needed. IMPORTANCE The ever-rising prevalence of resistance to first-line antibiotics among clinical Escherichia coli isolates leads to worse clinical outcomes and higher health care costs, thereby creating a need to discover its basis so that effective interventions can be developed. We found that the H 30 subset within E. coli sequence type 131

Clinical management of chronic hepatitis B infection: results from a registry at a German tertiary referral center.

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Demir, M; Nigemeier, J; Kütting, F; Bowe, A; Schramm, C; Hoffmann, V; Waldschmidt, D; Goeser, T; Steffen, H-M

2015-04-01

We studied a cohort of adult patients with chronic hepatitis B (CHB) infection, followed at a tertiary referral liver center in Germany over 12.5 years to analyze the clinical features and impact of management on disease progression and survival of CHB patients in general and of those with CHB and HCC in particular. We retrospectively evaluated the medical records of 242 adult (age ≥ 18 years) patients. CHB was defined as positive hepatitis B surface antigen (HBsAg) and/or HBV-DNA levels >10 IU/mL for at least 6 months. Patient demographics, HBV markers, antiviral treatment, laboratory parameters, liver imaging and histology were recorded for each visit. HCC patients were divided into two groups and separately analyzed (group 1: n = 24, HCC at first visit and group 2: n = 11, HCC during surveillance). The mean age was 44 years in CHB patients without HCC (63% male) and about 59 years in patients with HCC (77% male). Antiviral therapy was given to 59% of patients without HCC compared to only 25% in group 1 and 18% in group 2 with comparable median HBV DNA levels of approximately 36,000 IU/mL. There was no statistically significant difference concerning the HCC stages (Milan, UCSF, BCLC) at first diagnosis. Five-year survival was 19% in group 1 vs. 64% in group 2 (p = 0.019), with LTx performed in 12 vs. 45%, respectively. Surveillance of CHB patients did not result in early stage detection of HCC but in a higher likelihood to receive potentially curative treatments.

Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center.

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Jacob, Christian P; Romanos, Jasmin; Dempfle, Astrid; Heine, Monika; Windemuth-Kieselbach, Christine; Kruse, Anja; Reif, Andreas; Walitza, Susanne; Romanos, Marcel; Strobel, Alexander; Brocke, Burkhard; Schäfer, Helmut; Schmidtke, Armin; Böning, Jobst; Lesch, Klaus-Peter

2007-09-01

The prevalence and consequences of co-morbid axis-I and axis-II disorders as well as personality traits were examined in a large cohort of adult attention-deficit/hyperactivity disorder (AADHD) at a tertiary referral center. In- and outpatients referred for diagnostic assessment of AADHD were screened. 372 affected probands were examined by means of the Structured Clinical Interview of DSM-IV axis-I/II disorders, the Revised NEO Personality Inventory (NEO-PI-R), and the Tridimensional Personality Questionnaire (TPQ). Lifetime co-morbidity with mood disorders was 57.3%, with anxiety disorders 27.2%, and with substance use disorders 45.0%. The histrionic personality disorder (35.2%) was the most frequent personality disorder. AADHD patients exhibited significantly altered scores on most of the NEO-PI-R and TPQ personality dimensions. The extent of substance abuse and dependence, as well as the presence of antisocial personality disorder alone or the cumulative number of other specific personality disorders was associated with lower psychosocial status (pdisorders was remarkably prevalent. In AADHD co-morbid mood, anxiety, and personality disorders as well as substance abuse/dependence is likely to be predictive of poor outcome.

Gender Role Attitudes among Higher Education Students in a Borderland Central-Eastern European Region Called "Partium"

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Fényes, Hajnalka

2014-01-01

In this paper, we examine the attitudes towards gender roles among higher education students in a borderland Central-Eastern European region. We used the database of "The Impact of Tertiary Education on Regional Development" project (N = 602, 2010). We intend to determine what kind of attitudes towards gender roles the students identify…

Association Between Weekend and Holiday Admission with Pneumonia and Mortality in a Tertiary Center in Portugal: A Cross-Sectional Study.

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Cortes, Margarida Barreto; Fernandes, Samuel Raimundo; Aranha, Patricia; Avô, Luís Brito; Falcão, Luís Menezes

2017-05-31

Acute bacterial pneumonia is a common and potentially fatal disease where early recognition and treatment are crucial. Increasing medical literature suggests worse outcomes in patients admitted for medical and surgical conditions during the weekend. Little is known about this effect in patients with acute bacterial pneumonia. Obective: The aim of this study was to evaluate the impact of weekend and holiday hospital admission on the outcomes of acute bacterial pneumonia. Retrospective analysis of adult patients (> 18 years) with acute bacterial pneumonia collected from a tertiary referral center database. Length of stay, total cost, admission to intensive care unit, development of sepsis and organ failure, and mortality were compared between patients admitted on a weekday and patients admitted during a weekend or holiday. We analyzed 53 854 hospital admissions from 42 512 patients (median age 84.0 years, range 18 - 118 years), corresponding to 30 554 admissions during weekdays, 21 222 at weekends and 2078 during public holidays. Weekend and holiday admission was not associated with increased costs, length of stay, intensive care unit admission, development of sepsis, organ failure, and mortality. A weekend/holiday effect in acute bacterial pneumonia was not evident in our series.

Sociodemographic profile, clinical factors, and mode of attempt in suicide attempters in consultation liaison psychiatry in a tertiary care center

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Santosh Ramdurg

2011-01-01

Full Text Available Background: The objective was to study the sociodemographic data, psychiatric disorder, precipitating events, and mode of attempt in suicide attempted patients referred to consultation liaison psychiatric services. Settings and Design: A prospective study of 6-month duration was done in a tertiary care center in India. Materials and Methods: During the 6-month period all referrals were screened for the presence of suicide attempters in consultation liaison services. Those who fulfilled the criteria for suicide attempters were evaluated by using semistructured pro forma containing sociodemographic data, precipitating events, mode of attempt, and psychiatric diagnosis by using ICD-10. Results: The male-to-female ratio was similar. Adult age, urban background, employed, matriculation educated were more represented in this study. More than 80% of all attempters had psychiatric disorder. Majority had a precipitating event prior to suicide attempt. The most common method of attempt was by use of corrosive. Conclusions: Majority of suicide attempter patients had mental illness. Early identification and treatment of these disorders would have prevented morbidity and mortality associated with this. There is a need of proper education of relatives about keeping corrosive and other poisonous material away from patients as it was being commonest mode of attempt.

Role of Retinopathy of Prematurity (ROP) Tertiary Centers of Excellence in Capacity-building.

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Rani, Padmaja Kumari; Balakrishnanan, D; Padhi, T R; Jalali, Subhadra

2016-11-07

Tertiary Centres of Excellence in India have been at the forefront of the efforts against Retinopathy of Prematurity (ROP) - associated blindness. The epidemic of blindness from ROP; however, has now spread rapidly into large parts of interiors of developing countries due to improved newborn care facilities. Due to their knowledge and experience of more than a decade, these centres of excellence, both from child care and Ophthalmology care, now need to come forward in substantial measures and need to be supported by funds and programs so that concerns of neonatal eye-health, training, screening, prevention and treatment can get integrated and embedded into newborn critical care and health programs. This will protect newborn preterm survivors from losing the potentially good vision that they are born with, reduce the rapidly rising blindness epidemic, and also protect staff from potential high-value litigations.

Diversification Management at Tertiary Education Level: A Review

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Takwate, Kwaji Tizhe

2016-01-01

This paper examines the concept of management of diversification at tertiary education level in view of the growth of national secondary education system which vested high scramble for tertiary education was made in relation to question of access and expansion. This paper examines management of diversification at tertiary education level as a…

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

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

2001-01-01

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

Hypophyseal Involvement in Immunoglobulin G4-Related Disease: A Retrospective Study from a Single Tertiary Center

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Yang Liu

2018-01-01

Full Text Available This study aims to outline the clinical features and outcomes of IgG4-related hypophysitis (IgG4-RH patients in a tertiary medical center. We reviewed clinical manifestations and imaging and pituitary function tests at baseline, as well as during follow-up. Ten patients were included. The mean age at diagnosis of IgG4-RH was 48.4 (16.0–64.0 years. An average of 3 (0–9 extrapituitary organs were involved. Five patients had panhypopituitarism, three had only posterior hypopituitarism, one had only anterior hypopituitarism, and one had a normal pituitary function. One patient in our study had pituitary mass biopsy, lacking IgG4-positive cells despite lymphocyte infiltration forming an inflammatory pseudotumor. Five patients with a clinical course of IgG4-RH less than nine months and a whole course of IgG4-RD less than two years were managed with glucocorticoids, while three patients with a longer history were administered glucocorticoids plus immunosuppressive agents. One patient went through surgical excision, and one patient was lost to follow-up. All patients showed a prompt response clinically, but only three patients had normalized serum IgG4 levels. Two patients who took medications for less than six months relapsed. Conclusions. IgG4-RD is a broad disease, and all physicians involved have to be aware of the possibility of pituitary dysfunction. Younger patients should be expected. The histopathological feature of pituitary gland biopsy could be atypical. For patients with a longer history, the combination of GC and immunosuppressive agents is favorable. Early and adequate courses of treatment are crucial for the management of IgG4-RH. With GC and/or immunosuppressant treatment, however, pituitary function or diabetes insipidus did not improve considerably.

Oral food challenge outcomes in a pediatric tertiary care center.

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Abrams, Elissa M; Becker, Allan B

2017-01-01

Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity. A retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010. 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge failures. Children were more likely to fail an oral challenge if they were older (P = .04), had asthma (P = .001) or had atopic dermatitis (P = .03). Risk of challenge failure was significantly different between food allergens, with more failures noted for peanut than for tree nuts, milk or egg (P = .001). Among challenge failures, 19% met criteria for anaphylaxis. Significantly more tree nut and peanut challenges met criteria for anaphylaxis than milk or egg (P Skin test size and specific IgE level were significantly higher in those who failed oral challenges (P < .001). The highest rate of challenge failure and severity of failure was to cashew, with 63% of cashew challenges reacting, of which 80% met clinical criteria for anaphylaxis. The risk of challenge failure differed with type of food studied, with peanut and tree nut having a higher risk of challenge failure and anaphylaxis. Cashew in particular carried a high risk and caution must be exercised when performing these types of oral challenges in children.

Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center

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Bauer NJ

2016-05-01

Full Text Available Natasha Johan Bauer Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK Background: Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of ­England and the British Medical Association. Methods: A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Results: Just over half (52% of the time, no handover took place. The majority of handovers (64% occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient’s age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. Conclusion: These findings were presented to the department, and a handover proforma

Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria.

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Butali, Azeez; Ezeaka, Chinyere; Ekhaguere, Osayame; Weathers, Nancy; Ladd, Jenna; Fajolu, Iretiola; Esezobor, Christopher; Makwe, Christian; Odusanya, Bukola; Anorlu, Rose; Adeyemo, Wasiu; Iroha, Edna; Egri-Okwaji, Mathias; Adejumo, Prisca; Oyeneyin, Lawal; Abiodun, Moses; Badejoko, Bolaji; Ryckman, Kelli

2016-01-01

pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.

Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center.

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Prado, Bernard Lobato; Gomes, Diogo Bugano Diniz; Usón Júnior, Pedro Luiz Serrano; Taranto, Patricia; França, Monique Sedlmaier; Eiger, Daniel; Mariano, Rodrigo Coutinho; Hui, David; Del Giglio, Auro

2018-01-04

Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely worldwide. The aim of our study was to evaluate the frequency, clinical indications and outcomes of PS in advanced cancer patients admitted to our tertiary comprehensive cancer center. We retrospectively studied the use of PS in advanced cancer patients who died between March 1st, 2012 and December 31st, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms in the end of life. This study was approved by the Research Ethics Committee of our institution (project number 2481-15). During the study period, 552 cancer patients died at the institution and 374 met the inclusion criteria for this study. Main reason for exclusion was death in the Intensive Care Unit. Among all included patients, 54.2% (n = 203) received PS. Patients who received PS as compared to those not sedated were younger (67.8 vs. 76.4 years-old, p sedation were dyspnea (55%) and delirium (19.7%) and the most common drugs used were midazolam (52.7%) or midazolam and a neuroleptic (39.4%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range - IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9-3.0). Patient survival (length of hospital stay from admission to death) of those who had PS was more than the double of those who did not (33.6 days vs 16 days, p palliative care team was involved in the care of 12% (n = 25) of sedated patients. PS is a relatively common practice in the end-of-life of cancer patients at our hospital and it is not associated with shortening of hospital stay. Involvement of a dedicated palliative care team is strongly recommended if this procedure is being considered. Further research is needed to identify factors that may affect the frequency and outcomes associated with PS.

The impact of tertiary wastewater treatment on copper and zinc complexation.

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Constantino, C; Gardner, M; Comber, S D W; Scrimshaw, M D; Ellor, B

2015-01-01

Tightening quality standards for European waters has seen a move towards enhanced wastewater treatment technologies such as granulated organic carbon treatment and ozonation. Although these technologies are likely to be successful in degrading certain micro-organic contaminants, these may also destroy compounds which would otherwise complex and render metals significantly less toxic. This study examined the impact of enhanced tertiary treatment on the capacity of organic compounds within sewage effluents to complex copper and zinc. The data show that granulated organic carbon treatment removes a dissolved organic carbon (DOC) fraction that is unimportant to complexation such that no detrimental impact on complexation or metal bioavailability is likely to occur from this treatment type. High concentrations of ozone (>1 mg O3/mg DOC) are, however, likely to impact the complexation capacity for copper although this is unlikely to be important at the concentrations of copper typically found in effluent discharges or in rivers. Ozone treatment did not affect zinc complexation capacity. The complexation profiles of the sewage effluents show these to contain a category of non-humic ligand that appears unaffected by tertiary treatment and which displays a high affinity for zinc, suggesting these may substantially reduce the bioavailability of zinc in effluent discharges. The implication is that traditional metal bioavailability assessment approaches such as the biotic ligand model may overestimate zinc bioavailability in sewage effluents and effluent-impacted waters.

Time trends in Staphylococcus aureus bacteremia, 1988-2010, in a tertiary center with high methicillin resistance rates.

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Yahav, Dafna; Shaked, Hila; Goldberg, Elad; Yassin, Sharief; Eliakim-Raz, Noa; Paul, Mical; Bishara, Jihad; Leibovici, Leonard

2017-02-01

Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates. We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients). In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010. In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.

Qualitative study of the communication expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer.

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Stoewen, Debbie L; Coe, Jason B; MacMartin, Clare; Stone, Elizabeth A; E Dewey, Catherine

2014-10-01

To describe the process aspects (communication) of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer. Qualitative analysis of data acquired during in-person single and dyadic interviews. 43 dog owners participating in 30 interviews. Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions. The participants expected information to be communicated in a forthright manner; in multiple formats; with understandable language; in an unrushed environment wherein staff took the time to listen, answer all questions, and repeat information when necessary; on a continuous basis, with 24-hour access to address questions or concerns; in a timely manner; with positivity; with compassion and empathy; with a nonjudgmental attitude; and through staff with whom they had established relationships. Results indicated that the manner in which information is communicated is vitally important to clients of dogs with life-limiting cancer in that it not only facilitates comprehension but also creates a humanistic environment from which clients derive the psychosocial support needed to successfully cope with their pet's condition.

Auditing surgical service provision at a South African tertiary institution: Implications for the development of district services.

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Laing, G L; Skinner, D L; Bruce, J L; Aldous, C; Govindasamy, V; Thomson, S R; Clarke, D L

2017-11-01

The optimal management of resources within South African state hospitals has been hampered by a paucity of data due to a lack of robust auditing information systems. This study reviews the use of a Hybrid Electronic Medical Record (HEMR) system to capture and aggregate data pertaining to the inpatient service demands on a South African tertiary surgical service. This dataset was used to analyse the appropriateness of tertiary surgical resource utilisation. The HEMR system was implemented at Greys Hospital, in the city of Pietermaritzburg, Kwa-Zulu Natal, South Africa on 1 January 2013. Inpatient data pertaining to surgical admissions and operative interventions were captured prospectively. Following an 18-month study period, the data were extracted, aggregated and analysed. The district referral hospitals were mapped, and district surgical procedures performed within the tertiary center were identified and quantified. Results: 7314 patients were admitted and managed by the tertiary surgical service during the study period. The median patient age was 33 years (IQR 6.5-42.4 years). 59.7% were male and 40.3% were female. General, trauma and paediatric surgical admissions constituted 54.8%, 28.6% and 16.6% respectively. Emergency admissions constituted 62.4% and elective admissions 37.6%. Referral sources were captured for 6653 (91%) of the cohort. 4338 (65.2%) patients were referred from district hospitals. The district hospital (Northdale) closest to Greys Hospital was responsible for 1675 (25.2%) of surgical referrals. 4174 operative procedures were performed during the study period, 54.7% performed as an emergency, 34.1% electively and 11.2% semi-electively. The median waiting time for emergency operative intervention was 535 minutes (IQR 130-663). A total of 1272 (30.5%) operative procedures performed were assessed as district-level operations. The time intervals of 07:00-07:59 and 17:00-17:59 were identified as the time periods during which the least number of

Health status in 1040 adults with disorders of sex development (DSD: a European multicenter study

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Henrik Falhammar

2018-03-01

Full Text Available Objective: The knowledge about health status in adults with disorder of sex development (DSD is scarce. Design and methods: A cross-sectional observational study in 14 European tertiary centers recruited 1040 participants (717 females, 311 males, 12 others with DSD. Mean age was 32.4 ± 13.6 year (range 16–75. The cohort was divided into: Turner (n = 301, Klinefelter (n = 224, XY-DSD (n = 222, XX-DSD (excluding congenital adrenal hyperplasia (CAH and 46,XX males (n = 21, 46,XX-CAH (n = 226 and 45,X/46,XY (n = 45. Perceived and objective health statuses were measured and compared to European control data. Results: In DSD, fair to very good general health was reported by 91.4% and only 8.6% reported (very bad general health (controls 94.0% and 6.0%, P < 0.0001. Longstanding health issues other than DSD and feeling limited in daily life were reported in 51.0% and 38.6%, respectively (controls 24.5% and 13.8%, P < 0.0001 both. Any disorder except DSD was present in 84.3% (controls 24.6%, P < 0.0001. Males reported worse health than females. In the subgroup analysis, Klinefelter and 46, XX-DSD patients reported bad general health in 15.7% and 16.7%, respectively (Turner 3.2% and CAH 7.4%. Comorbidities were prevalent in all DSD subgroups but Klinefelter and Turner were most affected. Early diagnosis of DSD and a healthy lifestyle were associated with less comorbidities. Conclusions: Overall, general health appeared to be good but a number of medical problems were reported, especially in Klinefelter and Turner. Early diagnosis of DSD and a healthy lifestyle seemed to be important. Lifelong follow-up at specialized centers is necessary.

Patient satisfaction with care in an urban tertiary referral academic glaucoma clinic in the US

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Peterson KM

2018-05-01

Full Text Available Kristen M Peterson, Carrie E Huisingh, Christopher Girkin, Cynthia Owsley, Lindsay A Rhodes Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA Background: The purpose of this study was to determine the factors associated with glaucoma patients’ satisfaction with their medical care by fellowship-trained glaucoma specialists in an urban tertiary referral clinic in the US.Methods: A total of 110 established patients aged ≥60 years with a diagnosis of either primary open angle glaucoma, glaucoma suspect, or ocular hypertension monitored by an ophthalmologist with fellowship training in glaucoma were enrolled at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a general demographics questionnaire along with a Patient Satisfaction Questionnaire-18 (PSQ-18, a Likert scale validated tool. The seven dimensions of patient satisfaction from the PSQ-18 were summarized for the sample overall and by the patients’ age, race, employment status, education level, distance travelled from home address to clinic, and glaucoma therapy type. Two-sample t-tests were used to compare group means. Spearman correlation coefficients were used to correlate satisfaction scores with peripheral vision and visual acuity function.Results: Overall, the general satisfaction scores were high (mean 4.62. Patients ≥70 years of age had lower general satisfaction with their care (mean 4.5 vs 4.8, p=0.03, the interpersonal manner of their appointment (mean 4.7 vs 4.9, p=0.009, and with their time spent with their doctor (mean 4.4 vs 4.7, p=0.03 than patients aged 60–69 years. Non-European descent patients (47% African descent and 1% other of sample were more satisfied with the time they spent with the doctor (mean 4.7 vs 4.4, p=0.04 and with the communication during the appointment (mean 4.8 vs 4.6, p=0.04 than European descent patients (52% of sample. Patients with a higher level of

Looking for a Person-Centered Medicine: Non Conventional Medicine in the Conventional European and Italian Setting

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Paolo Roberti di Sarsina

2011-01-01

Full Text Available In Italy, the use of non conventional medicines (NCMs is spreading among people as in the rest of Europe. Sales of alternative remedies are growing, and likewise the number of medical doctors (MDs who practise NCM/complementary and alternative medicine (CAM. However, in Italy as in other countries of the European Union, at the present time the juridical/legal status of NCM/CAM is not well established, mainly due to the lack of any national law regulating NCM/CAM professional training, practice and public supply and the absence of government-promoted scientific research in this field. This is an obstacle to safeguarding the patient's interests and freedom of choice, especially now that dissatisfaction with biomedicine is inclining more and more people to look for a holistic and patient-centered form of medicine.

Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

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Bo Kyung Jin

2013-03-01

Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

Neuro-Ophthalmology at a Tertiary Eye Care Centre in India.

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Dhiman, Rebika; Singh, Digvijay; Gantayala, Shiva P; Ganesan, Vaitheeswaran L; Sharma, Pradeep; Saxena, Rohit

2017-11-09

Neuro-ophthalmology as a specialty is underdeveloped in India. The aim of our study was to determine the spectrum and profile of patients presenting to a tertiary eye care center with neuro-ophthalmic disorders. A retrospective hospital-based study was conducted, and records of all patients seen at the neuro-ophthalmology clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, over a 1-year period were retrieved and evaluated. Of a total of 30,111 patients referred to various specialty clinics in a span of 1 year, 1597 (5%) were referred for neuro-ophthalmology evaluation. The mean patient age was 30.8 ± 19.5 years, with a male dominance (M:F = 2.02:1). Among these patients, optic nerve disorders were noted in 63.8% (n = 1,020), cranial nerve palsy in 7% (n = 114), cortical visual impairment in 6.5% (n = 105), and others (eye/optic nerve hypophasia, blepharospasm, and optic disc drusen) in 6% (n = 95). Among the patients with optic nerve disorders, optic neuropathy without disc edema/(traumatic optic neuropathy, hereditary, tumor-related, retrobulbar neuritis, toxic, and idiopathic) was noted in 42.8% (n = 685) and optic neuropathy with disc edema (ischemic optic neuropathy, papilledema, post-papilledema optic atrophy, papillitis, neuroretinitis, and inflammatory optic neuropathy) in 20.9% (n = 335). Sixteen percent of patients (n = 263) were incorrect referrals. The neuro-ophthalmic clinic constitutes a significant referral unit in a tertiary eye care center in India. Traumatic and ischemic optic neuropathies are the most common diagnoses. Neuro-ophthalmology requires further development as a subspecialty in India to better serve the nation's population.

Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India

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Muthappan Sendhilkumar

2017-01-01

Full Text Available Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design study with quantitative methodology (survey and qualitative methodology (interviews was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. Results: The prevalence of high/very high stress was 35% among DM patients. Age 30–40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. Conclusions: This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity.

Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India.

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Sendhilkumar, Muthappan; Tripathy, Jaya Prasad; Harries, Anthony D; Dongre, Amol R; Deepa, Mohan; Vidyulatha, Ashok; Poongothai, Subramanian; Venkatesan, Ulaganathan; Anjana, Ranjit Mohan; Mohan, Viswanathan

2017-01-01

We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. The prevalence of high/very high stress was 35% among DM patients. Age 30-40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity.

Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India

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Sendhilkumar, Muthappan; Tripathy, Jaya Prasad; Harries, Anthony D.; Dongre, Amol R.; Deepa, Mohan; Vidyulatha, Ashok; Poongothai, Subramanian; Venkatesan, Ulaganathan; Anjana, Ranjit Mohan; Mohan, Viswanathan

2017-01-01

Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. Results: The prevalence of high/very high stress was 35% among DM patients. Age 30–40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. Conclusions: This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity. PMID:28217499

Seepage characteristics of the second tertiary combined model

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Huan ZHAO

2015-08-01

Full Text Available The second tertiary combined model experiment zone has been developed in Block B, Field L. The percolation feature of the second tertiary combined develop model shows great importance to rational and efficient development of the reservoir. In order to clearly illuminate its percolation feature, the typical reservoir numerical model is built by Eclipse, which is a reservoir numerical simulation software. The percolation features of original and added perforation interval under the second tertiary combined model are studied, and the variation features of general water-cut, recovery percentage, wellbore pressure, reservoir pressure and water saturation on condition of higher injection rate under the second tertiary combined model are analyzed. The research indicates that the second tertiary combined enhances the recovery of remaining oil on top of thick reservoir by developing and enhancing original perforation interval under water drive, then improves development results by polymer flooding, and gains higher recovery rate by synthetic action of water driver and polymer flooding.

Tertiary lymphoid structures in cancer and beyond.

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Dieu-Nosjean, Marie-Caroline; Goc, Jérémy; Giraldo, Nicolas A; Sautès-Fridman, Catherine; Fridman, Wolf Herman

2014-11-01

Tertiary lymphoid structures (TLS) are ectopic lymphoid formations found in inflamed, infected, or tumoral tissues. They exhibit all the characteristics of structures in the lymph nodes (LN) associated with the generation of an adaptive immune response, including a T cell zone with mature dendritic cells (DC), a germinal center with follicular dendritic cells (FDC) and proliferating B cells, and high endothelial venules (HEV). In this review, we discuss evidence for the roles of TLS in chronic infection, autoimmunity, and cancer, and address the question of whether TLS present beneficial or deleterious effects in these contexts. We examine the relationship between TLS in tumors and patient prognosis, and discuss the potential role of TLS in building and/or maintaining local immune responses and how this understanding may guide therapeutic interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mortality pattern in otorhinolaryngology ward: A 5 years retrospective study at an urban tertiary health care center in India.

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Kumar, Vivek; Kumar, Satish; Chandra Sharma, Naresh; Kumar, Badal

2017-10-01

To recognize deaths in the otorhinolaryngology indoor wards, determine the reason behind the mortalities and recommend modifications for betterment of patient care and surgical outcomes. Data was collected from the mortality register, operation theatre registers, ward registers and case notes of patients declared dead at an urban tertiary health care center in India for a period of 5 years; from January 2012 to December 2016. The data included date of admission, age, sex, educational status, residence, and clinical diagnosis, course of hospital stay and medical cause of death. Data acquired was reviewed and statistically interpreted and presented in graphical and descriptive formats. 6157 admissions were made in otorhinolaryngology (ENT) ward in the 5 year period which included 3969 males and 2188 female patients. 58 deaths were recorded during this period which gives overall death per admission crude mortality rate of 9.42% at an average of about 12 (11.60) deaths per year. The major causes of death were malignancy and septicemia. The significance of health education, aggressive healthcare campaigns, enhancement of healthcare services and wide accessibility of healthcare services to remote areas has been emphasized. Role of structured study and protocols in the management of serious cases is highlighted along with the need for prompt referral and better interdepartmental cooperation. Copyright © 2017 Chang Gung University. Published by Elsevier B.V. All rights reserved.

Secular trends of blood isolates in patients from a rural area population hospitalized in a tertiary center in a small city in Greece

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Holevas Pierros V

2006-05-01

Full Text Available Abstract Background Most of the studies evaluating the secular trends of blood isolates come from tertiary hospitals in urban areas. We sought to study the trends of the antimicrobial resistance of blood isolates in patients from a rural population hospitalized in a tertiary hospital in a small city in Greece. Methods We retrospectively collected and analysed data for the first positive blood culture obtained for each admission for each patient hospitalized in General Hospital of Tripolis, Tripolis, Peloponnesus, Greece during a 5 year period (16/05/2000 – 15/05/2005. Results Sixty-seven thousand and seventy patients were hospitalized during the study period from whom 3,206 blood cultures were obtained. A higher increase of the number of obtained blood cultures than the number of admissions was noted during the study period (p Escherichia coli (29%, and Staphylococcus aureus (18.2% were the most commonly isolated pathogens. Among the Staphylococcus aureus isolates, the proportion of methicillin-resistant Staphylococcus aureus (MRSA was 17.2% (5/29. The proportion of Escherichia coli resistant to trimethoprim and sulfamethoxazole, ampicillin and cefuroxime was 29.6% (32/108, 25.0% (27/108, and 8.3% (9/108 respectively. Imipenem-resistance was noted in 3.4% (1/29 of Pseudomonas aeruginosa isolates. There were only 6 (1.6% Acinetobacter baummanii blood isolates during the study period. Conclusion The antimicrobial resistance of isolates from patients receiving care at the studied tertiary hospital in a small city in Greece is considerably less compared to that noted in tertiary hospitals in larger cities of the country.

Pd(II)-Catalyzed Alkylation of Tertiary Carbon via Directing-Group-Mediated C(sp(3))-H Activation: Synthesis of Chiral 1,1,2-Trialkyl Substituted Cyclopropanes.

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Hoshiya, Naoyuki; Takenaka, Kei; Shuto, Satoshi; Uenishi, Jun'ichi

2016-01-04

A Pd(OAc)2-catalyzed alkylation reaction of the tertiary carbon of chiral cyclopropane substrates with alkyl iodides and bromides via C(sp(3))-H activation has been developed. This is an elusive example of a C-H activation-mediated alkylation of tertiary carbon to effectively construct a quaternary carbon center. The alkylation proceeded with various alkyl halides, including those of functional groups, to provide a variety of chiral cis- and trans-1,1,2,-trialkyl substituted cyclopropanes of medicinal chemical importance.

Differences in Patient Characteristics and Midterm Outcome Between Asian and European Patients Treated with Radiofrequency Ablation for Hepatocellular Carcinoma

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Burgmans, Mark Christiaan; Too, Chow Wei; Fiocco, Marta; Kerbert, Annarein J. C.; Lo, Richard Hoau Gong; Schaapman, Jelte J.; Erkel, Arian R. van; Coenraad, Minneke J.; Tan, Bien Soo

2016-01-01

PurposeThe aim of this study was to compare patient characteristics and midterm outcomes after RFA for unresectable Hepatocellular carcinoma (HCC) in Asian and European cohorts.Materials and MethodsThe study was based on retrospective analysis of 279 patients (mean 64.8 ± 12.1 years; 208 males) treated with RFA for de novo HCC in tertiary referral centers in Singapore and the Netherlands, with median follow-up of 28.2 months (quartiles: 13.1–40.5 months). Cumulative incidence of recurrence and death were analyzed using a competing risk model.ResultsAge was higher in the Asian group: 66.5 versus 60.1 years (p < 0.0001). The most common etiology was hepatitis B in the Asian group (48.0 %) and alcohol-induced cirrhosis in Europeans (54.4 %); p < 0.001. Asian patients had less advanced disease: 35.5, 55.0, and 3.0 %, respectively, had BCLC 0, A, and B versus 21.5, 58.2, and 15.2 % in the European group (p = 0.01). The cumulative incidences of recurrence in the Asian group at 1, 2, 3, and 5 years were 37.0, 56.4, 62.3, and 67.7 %, respectively, compared to 32.6, 47.2, 49.7, and 53.4 % in the European group (p = 0.474). At 1, 2, 3, and 5 years, the cumulative incidence rates of death in the Asian group were 2.0, 3.9, 4.9, and 4.9 %, respectively, corresponding to 7.7, 9.2, 14.1, and 21.0 % in the European group (p = 0.155).ConclusionSimilar short-term treatment outcomes are achieved with RFA in HCC patients in the South-East Asian and Northern-European populations. Midterm recurrence and death rates differ between the groups as a result of differences in baseline patient characteristics and patient selection. Our study provides insight relevant to the design of future international studies.

Differences in Patient Characteristics and Midterm Outcome Between Asian and European Patients Treated with Radiofrequency Ablation for Hepatocellular Carcinoma

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Burgmans, Mark Christiaan, E-mail: m.c.burgmans@lumc.nl [Leiden University Medical Centre, Department of Radiology (Netherlands); Too, Chow Wei, E-mail: too.chow.wei@singhealth.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore); Fiocco, Marta, E-mail: m.fiocco@lumc.nl [Leiden University Medical Centre, Department of Medical Statistics and Bioinformatics (Netherlands); Kerbert, Annarein J. C., E-mail: a.kerbert@lumc.nl [Leiden University Medical Centre, Department of Hepatology and Gastroenterology (Netherlands); Lo, Richard Hoau Gong, E-mail: richard.lo.h.g@sgh.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore); Schaapman, Jelte J., E-mail: j.j.schaapman@lumc.nl [Leiden University Medical Centre, Department of Radiology (Netherlands); Erkel, Arian R. van, E-mail: a.r.van-erkel@lumc.nl [Leiden University Medical Centre, Department of Hepatology and Gastroenterology (Netherlands); Coenraad, Minneke J., E-mail: m.j.coenraad@lumc.nl [Leiden University Medical Centre, Department of Radiology (Netherlands); Tan, Bien Soo, E-mail: tan.bien.soo@singhealth.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore)

2016-12-15

PurposeThe aim of this study was to compare patient characteristics and midterm outcomes after RFA for unresectable Hepatocellular carcinoma (HCC) in Asian and European cohorts.Materials and MethodsThe study was based on retrospective analysis of 279 patients (mean 64.8 ± 12.1 years; 208 males) treated with RFA for de novo HCC in tertiary referral centers in Singapore and the Netherlands, with median follow-up of 28.2 months (quartiles: 13.1–40.5 months). Cumulative incidence of recurrence and death were analyzed using a competing risk model.ResultsAge was higher in the Asian group: 66.5 versus 60.1 years (p < 0.0001). The most common etiology was hepatitis B in the Asian group (48.0 %) and alcohol-induced cirrhosis in Europeans (54.4 %); p < 0.001. Asian patients had less advanced disease: 35.5, 55.0, and 3.0 %, respectively, had BCLC 0, A, and B versus 21.5, 58.2, and 15.2 % in the European group (p = 0.01). The cumulative incidences of recurrence in the Asian group at 1, 2, 3, and 5 years were 37.0, 56.4, 62.3, and 67.7 %, respectively, compared to 32.6, 47.2, 49.7, and 53.4 % in the European group (p = 0.474). At 1, 2, 3, and 5 years, the cumulative incidence rates of death in the Asian group were 2.0, 3.9, 4.9, and 4.9 %, respectively, corresponding to 7.7, 9.2, 14.1, and 21.0 % in the European group (p = 0.155).ConclusionSimilar short-term treatment outcomes are achieved with RFA in HCC patients in the South-East Asian and Northern-European populations. Midterm recurrence and death rates differ between the groups as a result of differences in baseline patient characteristics and patient selection. Our study provides insight relevant to the design of future international studies.

Mobile Extracorporeal Membrane Oxygenation Teams: The North American Versus the European Experience.

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Nwozuzu, Adambeke; Fontes, Manuel L; Schonberger, Robert B

2016-12-01

To evaluate differences in the inclusion of anesthesiologists in mobile extracorporeal membrane oxygenation (ECMO) teams between North American and European centers. A retrospective review of North American versus European mobile ECMO teams. The search terms used to identify relevant articles were the following: "extracorporeal membrane transport," "mobile ECMO," and "interhospital transport." MEDLINE review of articles. None. None. Between 1986 and 2015, 25 articles were published that reported the personnel makeup of mobile ECMO teams in North America and Europe: 6 from North American centers and 19 from European centers. The included articles reported a total of 1,329 cases: 389 (29%) adult-only cohorts and 940 (71%) mixed-age cohorts. Among North American studies, 0 of 6 (0%) reported the presence of an anesthesiologist on the mobile ECMO team in contrast to European studies, in which 10 of 19 (53%) reported the inclusion of an anesthesiologist (Fisher exact p for difference = 0.05). In terms of number of cases, this discrepancy translated to 543 total cases in North America (all without an anesthesiologist) and 499 cases in Europe (37%) including an anesthesiologist on the team (Fisher exact p for difference<0.001). This study demonstrated significant geographic discrepancies in the inclusion of anesthesiologists on mobile ECMO teams, with European centers more likely to incorporate an anesthesiologist into the mobile ECMO process compared with North American centers. Copyright © 2016. Published by Elsevier Inc.

SECTORAL ANALYSIS: GROWTH ACCOUNTING OF TERTIARY INDUSTRIES

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Yahya Z. ALSHEHHI

2017-08-01

Full Text Available The tertiary sector is one of the modern styles of economic systems in view of the share it occupies in the field of production as well as employment occupied share. Hence, just like other lands, the UAE, witnessed an economic structural change similar to developed and developing nations, where the tertiary industries contributed 55.4% in 2015 to total country’s income. The empirical study aimed to analyze the contribution portion of growth in the tertiary industries through using the growth accounting framework in time-series from 1990 to 2015. The empirical study found that most of the industries contributed significantly to the growth of the tertiary sector. The contribution shares of growth due to labor and capital varied among industries. The main observed results show that there was a vice versa relationship between TFP performance and the size of labor, where the TFP positively corresponded with the decline in the size of labor specifically from 2010-2015.

Radiological imaging features and clinicopathological correlation of hemosiderotic fibrolipomatous tumor: experience in a single tertiary cancer center

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O' Driscoll, Dearbhail; Athanasian, Edward; Hameed, Meera; Hwang, Sinchun [Memorial Sloan Kettering Cancer Center, New York, NY (United States)

2015-05-01

To determine the imaging features of hemosiderotic fibrolipomatous tumor (HFLT), which has a propensity towards local recurrence and the potential to transform into myxoinflammatory fibroblastic sarcoma (MIFS). The study included 8 patients with a diagnosis of HFLT and imaging at a tertiary cancer center. Imaging studies included radiographs (n = 2), ultrasound (n = 3), and MRI (n = 16). Imaging features were evaluated including location, calcification, sonographic echogenicity, vascular flow, size, border, signal characteristics, contrast enhancement, and blooming on MRI. The HFLT was located in the ankle/foot in 4 out of 8 and was subcutaneous in 8 out of 8, ranging in size from 2 to 18 cm. Histology at initial diagnosis was HFLT in 5 out of 8 and HFLT with MIFS in 3 out of 8. None was calcified on radiography. On ultrasound 2 out of 3 were heterogeneously echogenic with ≥10 foci of vascular flow. Two out of 8 patients had MRI only at local recurrence. The tumor border was infiltrative in 4 out of 6 at initial diagnosis and in 2 patients with MRI at recurrence only. Fat and septae were present in 7 out of 8 at initial diagnosis and at recurrence. Signal intensity was iso-/hypointense to muscle on T1-weighted sequences in more than two thirds of the tumor in 4 out of 7 and hyperintense to muscle in at least one third of the tumor on fluid-sensitive sequences in 6 out of 8. Contrast enhancement was heterogeneous in 7 out of 7; blooming in two thirds of the tumor on gradient-echo sequence MRI indicated hemorrhage. The HFLT commonly presents as a mass with an infiltrative border, interspersed fat and septations at initial diagnosis and local recurrence on MRI regardless of histology of HFLT alone or with MIFS. Hemosiderin deposits may be detected as blooming on gradient-echo sequences. (orig.)

Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas' disease.

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Rassi, A; Dias, J C P; Marin-Neto, J A; Rassi, A

2009-04-01

A century after its discovery, Chagas' disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas' disease have now been detected in non-endemic areas, such as North America and some European countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas' disease have been attempted. While control of both vectorial and blood transfusion transmission of T cruzi (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas' disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.

Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital.

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Ryu, Borim; Kim, Seok; Lee, Kee-Hyuck; Hwang, Hee; Yoo, Sooyoung

2016-11-01

Bedside stations, also known as bedside terminals, are in place to enhance the quality and experience of a hospital's healthcare service delivery. The purpose of this study was to identify information needs and overall satisfaction with the personalized patient bedside system, called Smart Bedside Station (SBS) system, embedded in a tertiary general university hospital. End-user responses on the satisfaction survey and system usage logs of the SBS system were collected and analyzed. For the user opinion survey, 156 nurses and 1914 patients, their family members, or caregivers participated during the evaluation period of 2013 to 2014 in this study. All working nurses in the SBS-installed ward were answered the paper-based evaluation, for complete enumeration survey. Inpatients were voluntary participated to deliver the online questionnaire on the SBS menu. We also explored system log data including page calls and usage time from December 2013 to 2015. Regarding the relationship of overall satisfaction of the SBS with patient's characteristics, patient's education status and degree of familiarity with the smart device were statistically significant. From the analysis of system logs, Personalized My Menu(28.0%) was the most frequently used menu item (except for TV and Internet entertainment service use of 62.7%),it provides individual health information, such as laboratory test results, hospital fee check, message logs, daily medication information, and meal information. Next frequently used menus were information support(4.9%) which deliver hospital guide and health information and convenience service ordering(4.4%) such as meal order, bed sheet change. Satisfaction survey results and log data results show that the personalized service enhances the user satisfaction during hospital admission. Our post-implementation experience and subsequent assessment of SBS system is capable of providing insights into improving the hospital information system and service contents

Changing indications and techniques for corneal transplantations at a tertiary referral center in Turkey, from 1995 to 2014

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Altay Y

2016-06-01

Full Text Available Yesim Altay, Ayse Burcu, Gozde Aksoy, Evin Singar Ozdemir, Firdevs Ornek Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey Background: Indications for corneal transplantation in developed and developing nations differ according to the different spectrum of corneal disease in each country. Objective: The purpose of this study is to analyze the changing indications and surgical techniques for corneal transplantation over the past 20 years at a tertiary referral center in Turkey. Methods: We retrospectively reviewed the records of patients who underwent keratoplasty from January 1995 to December 2014 (between 1995 and 2004, period 1, and between 2005 and 2014, period 2. Patients’ demographic data, indications for corneal transplantation, and the type of surgery were recorded. Results: The number of keratoplasties performed ranged from 548 in period 1 to 782 in period 2. Between 1995 and 2004, the leading indications were keratoconus (34.1%, bullous keratopathy (17%, and non-herpetic corneal scar (13.3%, and between 2005 and 2014, they were keratoconus (33.8%, corneal stromal dystrophy (14.2%, and bullous keratopathy (12.7%. All the keratoplasties performed in the 1995–2004 period were penetrating keratoplasty (PKP. During the period 2005–2014, PKP accounted for 93%, automated lamellar keratoplasty 5.8%, and deep anterior lamellar keratoplasty 1.2% of all corneal transplantations. Conclusion: Keratoconus was the leading indication for keratoplasty in both periods. In the 2005–2014 period, corneal stromal dystrophy increased significantly. All the keratoplasties performed in period 1 and 93% of all keratoplasties performed in period 2 were PKP. Keywords: corneal transplantation, indication, keratoconus, keratoplasty technique, pene­trating keratoplasty

Characteristics of Travel-Related Severe Plasmodium vivax and Plasmodium falciparum Malaria in Individuals Hospitalized at a Tertiary Referral Center in Lima, Peru.

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Llanos-Chea, Fiorella; Martínez, Dalila; Rosas, Angel; Samalvides, Frine; Vinetz, Joseph M; Llanos-Cuentas, Alejandro

2015-12-01

Severe Plasmodium falciparum malaria is uncommon in South America. Lima, Peru, while not endemic for malaria, is home to specialized centers for infectious diseases that admit and manage patients with severe malaria (SM), all of whom contracted infection during travel. This retrospective study describes severe travel-related malaria in individuals admitted to one tertiary care referral hospital in Lima, Peru; severity was classified based on criteria published by the World Health Organization in 2000. Data were abstracted from medical records of patients with SM admitted to Hospital Nacional Cayetano Heredia from 2006 to 2011. Of 33 SM cases with complete clinical data, the mean age was 39 years and the male/female ratio was 2.8. Most cases were contracted in known endemic regions within Peru: Amazonia (47%), the central jungle (18%), and the northern coast (12%); cases were also found in five (15%) travelers returning from Africa. Plasmodium vivax was most commonly identified (71%) among the severe infections, followed by P. falciparum (18%); mixed infections composed 11% of the group. Among the criteria of severity, jaundice was most common (58%), followed by severe thrombocytopenia (47%), hyperpyrexia (32%), and shock (15%). Plasmodium vivax mono-infection predominated as the etiology of SM in cases acquired in Peru. © The American Society of Tropical Medicine and Hygiene.

German Quality in the Service of a European Public Sphere? An Analysis of the Deutsche Welle’s European Journal program

Directory of Open Access Journals (Sweden)

Oana Ludmila Popescu

2015-04-01

Full Text Available The economic crisis of the European Union has rendered the European public sphere as a forever emerging concept marked by uncertainties regarding its structure. In this context, eyes of both European officials and citizens turn towards the media, the main communication link between the EU and its citizens. The present paper looks at a media product that is designed to permeate multiple national public spheres, the weekly news show European Journal, a half-hour TV program produced by Deutsche Welle and rebroadcast by partner TV channels throughout Europe. Considering the main characteristics of the European public sphere as identified in the literature, with a focus on horizontal Europeanization, and using the method of content analysis, this paper looks at the means employed by the European Journal to support the integration process and to add a European dimension to national public sphere. Findings suggest that the type of public sphere promoted by the European Journal is not centered around the EU as a distinct entity, but around the member states, approach which supports the idea of a horizontal Europeanization.

Evaluation of recombinant activated protein C for severe sepsis at a tertiary academic medical center

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Anger KE

2013-06-01

Full Text Available Kevin E Anger,1 Jeremy R DeGrado,1 Bonnie C Greenwood,1 Steven A Cohen,2 Paul M Szumita1 1Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA; 2Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA Purpose: Early clinical trials of recombinant human activated protein C (rhAPC for severe sepsis excluded patients at high risk of bleeding. Recent literature suggests bleeding rates are higher in clinical practice and may be associated with worsened outcomes. Our objective was to evaluate baseline demographics; incidence, and risk factors for major bleeding; and mortality of patients receiving rhAPC for severe sepsis at our institution. Methods: A retrospective study was performed for all patients receiving rhAPC for treatment of severe sepsis at a tertiary academic medical center from January 2002 to June 2009. Demographic information, clinical variables, intensive care unit, and hospital outcomes were recorded. Results: Of the 156 patients that received rhAPC, 54 (34.6% did not meet institutional criteria for safe use at baseline due to bleeding precaution or contraindication. Twenty-three (14.7% patients experienced a major bleeding event. Multivariate analysis demonstrated baseline International Normalized Ratio ≥2.5 (odds ratio [OR] 3.68, 95% confidence interval [CI]: 1.28–10.56; P = 0.03 and platelet count ≤100 × 103/mm3 (OR 2.86, 95% CI: 1.07–7.67; P = 0.01 as significant predictors of a major bleed. Overall hospital mortality was 57.7%. Multivariate analysis demonstrated the presence of ≥3 organ dysfunctions (OR 2.46, 95% CI: 1.19–5.09; P < 0.05 and medical intensive care unit admission (OR 1.99, 95% CI: 1.00–3.98; P = 0.05 were independent variables associated with hospital mortality. Conclusion: Patients receiving rhAPC at our institution had higher APACHE II scores, mortality, and major bleeding events than published

A clinico-etiological study of dermatoses in pediatric age group in tertiary health care center in South Gujarat region

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Sugat A Jawade

2015-01-01

Full Text Available Background: Dermatologic conditions have different presentation and management in pediatric age group from that in adult; this to be studied separately for statistical and population based analysis. Objective: To study the pattern of various dermatoses in infants and children in tertiary health care center in South Gujarat region. Materials and Methods: This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age attending the Dermatology OPD of New Civil Hospital, Surat, Gujarat over a period of 12 months from June 2009 to June 2010. All patients were divided into four different study groups: 1 to 6 years and 7 to 14 years. Results: There were 596 boys and 425 girls in total 1021 study populations. Majority of the skin conditions in neonates were erythema toxicum neonatorum (12.97%, scabies (9.92%, mongolian spot (9.16%, and seborrheic dermatitis (7.63%. In > 1 month to 14 years age group of children among infectious disorder, children were found to be affected most by scabies (24.49%, impetigo (5.96%, pyoderma (5.62%, molluscum contagiosum (5.39%, tinea capitis (4.49%, leprosy (2.02%, and viral warts (1.35% while among non-infectious disorders, they were affected by atopic dermatitis (4.27%, pityriasis alba (4.16%, seborrheic dermatitis (3.60%, pityriasis rosea (3.15%, others (3.01%, phrynoderma (2.70%, lichen planus (2.58%, contact dermatitis (1.57% and ichthyosis (1.45%. Conclusion: There is a need to emphasize on training the management of common pediatric dermatoses to dermatologists, general practitioners and pediatricians for early treatment.

Metastasis in central nervous system: Clinicopathological study with review of literature in a tertiary care center in South India

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Rashmi Patnayak

2013-01-01

Full Text Available Background: Secondary central nervous system (CNS tumors are common in Western countries, but in Indian literature, scant data are available. With the advent of newer imaging techniques, the confirmatory histopathological diagnosis has become comparatively easier. Hereby, we have analyzed our data from a single tertiary care center in south India. Materials and Methods: In this retrospective study from January 2000 to December 2010, histopathologically diagnosed secondary CNS tumors were reviewed along with clinical, imaging, and relevant immunohistochemical findings. Meningeal, lymphoproliferative, and myeloproliferative tumors and autopsy data were not included in the study group. Results: There were 40 secondary CNS tumors. Male to female ratio was 2.3:1. Age range was wide (28-75 years. Majority of cases were seen in the fourth and fifth decade. Imaging-wise, (computed tomography and magnetic resonance imaging majority were single lesions ( n = 34, 85%. Most commonly, these single lesions were present in the cerebral hemisphere ( n = 20, 50% followed by cerebellum ( n = 10, 25%. Adenocarcinoma accounted for maximum number of cases ( n = 25, 62.5% with lungs being the most common primary. Conclusion: We have noted 25% metastatic adenocarcinomas in cerebellar location, which is higher when compared with available world literature. However, we also encountered a good number of cases (30% due to unknown primary. Though histopathological examination with use of immunohistochemical markers can reliably distinguish primary from secondary CNS tumors in addition to available clinical and imaging data, particularly in developing countries, still a better work-up with an array of immunohistochemical markers and newer imaging modalities is desirable.

Assessment of Physical Environment of Iran’s Neonatal Tertiary Care Centers from the Perspective of the Neonatal Individualized Developmental Care

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Mostajab Razavi Nejad

2017-12-01

Full Text Available Background: Globally,it is estimated that approximately 13 million neonates are born prematurely each year. The development of the central nervous system in premature neonates continues outside of the uterus and in the environment of neonatal intensive care unit (NICU. This study aimed to evaluate the physical environment of hospital and nursery in Iran’s tertiary care centers. Methods: This cross-sectional study was conducted on a total of 23 NICUs of nine Universities of Medical Sciences, where students are trained in the neonatal fellowship course, from seven provinces of Iran, 20th July to 21th September 2015. Data analysis was performed using SPSS software, version 16, and descriptive statistics. Results: In this study, four dimensions of physical environment of hospitals and NICUs including the accessibility of NICU, the physical environment of NICU, infants’ bed space, and the sensory elements of bed spaces were evaluated. The obtained scores for each item was 41.17, 39.95, 38.83, and 39.28 out of 100, respectively. The highest mean score was 71.30 that was related to NICU temperature and ventilation considerations. The lowest mean score was 20, which was related to controlling over the movements around the infants’ beds. The total mean score of the physical environment of hospital and NICU was 39.77. Conclusion: According to the results, it is recommended to take appropriate action to develop physical space and infrastructures for neonatal care regarding developmental care along with other dimensions.

Tertiary Education in the Czech Republic: The Pathway to Change

Science.gov (United States)

Pesik, Richard; Gounko, Tatiana

2011-01-01

This article analyzes recent policy proposals to reform Czech tertiary education. A brief overview of the evolution of Czech tertiary education presents the background against which emerging policy trends in education are examined. We relate the changes in tertiary education to the policy framework and recommendations of the OECD, underpinned by…

What is the role of general internists in the tertiary or academic setting?

Science.gov (United States)

Tanriover, Mine Durusu; Rigby, Shirley; van Hulsteijn, L Harry; Ferreira, Faustino; Oliveira, Narcisso; Schumm-Draeger, Petra-Maria; Weidanz, Frauke; Kramer, Mark H H

2015-01-01

The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research. In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As 'internal medicine is the cornerstone of every national healthcare system', academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

[Experience in molecular diagnostic in hereditary neuropathies in a pediatric tertiary hospital].

Science.gov (United States)

Fernández-Ramos, Joaquín A; López-Laso, Eduardo; Camino-León, Rafael; Gascón-Jiménez, Francisco J; Jiménez-González, M Dolores

2015-12-01

Charcot-Marie-Tooth (CMT) is the most common hereditary sensory motor neuropathy. Advances in molecular diagnosis have increased the diagnostic possibilities of these patients. Retrospective study of 36 pediatric patients diagnosed with CMT in a tertiary center in 2003-2015. We found 16 patients were diagnosed by a duplication in PMP22; two cases were diagnosed of hereditary neuropathy with liability to pressure palsies, one with a point mutation in PMP22; a male with a mild demyelinating phenotype, without family history, was diagnosed with GJB1 mutation; in a patient with a peripheral hypotonia at birth and axonal pattern in EMG by mutation in MFN2; a gypsy patient, with consanguineous family, CMT4D, was identified by a mutation in the gene NDRG1; a patient with multiplex congenital arthrogryposis and vocal cord paralysis, whose mother had a scapular-peroneal syndrome, had a congenital spinal muscular atrophy with mild distal axonal neuropathy by mutation in gene TRPV4; three girls, from a gypsy consanguineous family, with axonal CMT with neuromyotonic discharges were diagnosed by a mutation in the gene HINT1; twelve patients haven't molecular diagnosis currently. CMT1A predominated in our series (44%), as previous studies. We emphasize the description of a patient with a mutation in TRPV4 recently described as a cause of CMT2C and three cases, of gypsy consanguineous family, with the same mutation in HINT1 gene, recently described as a cause of axonal neuropathy with neuromyotonia, autosomal recessive (AR-CMT2). The proportion of patients without molecular diagnosis is similar to main European series.

2. Tertiary Foraminifera

NARCIS (Netherlands)

Umbgrove, J.H.F.

1931-01-01

In his review of the palaeozoology of Java, K. Martin could in 1919, record 49 foraminifera from tertiary strata of Java, on the strength of a critical study of the existant literature, and especially on the strength of his own studies and knowledge of the above mentioned fossils (Bibl. 49). In

Limits and opportunities of marketeering tertiary education in post-colonial Zimbabwe

OpenAIRE

Patrick Sibanda

2016-01-01

This paper intended to assess the impact of marketeering tertiary education in Zimbabwe. The paper revealed that marketeering of tertiary education in Zimbabwe has drastically impacted on access to higher education and training. Poor and vulnerable students have found it difficult to access tertiary education due to escalating commercialized fees. Literature indicates that, even in developed countries like UK, marketeering tertiary education has led to decreased enrolments, diminishing prospe...

Liquid nitrogen or phenolization for giant cell tumor of bone?: a comparative cohort study of various standard treatments at two tertiary referral centers.

Science.gov (United States)

van der Heijden, Lizz; van der Geest, Ingrid C M; Schreuder, H W Bart; van de Sande, Michiel A J; Dijkstra, P D Sander

2014-03-05

The rate of recurrence of giant cell tumor of bone is decreased by use of adjuvant treatments such as phenol, liquid nitrogen, or polymethylmethacrylate (PMMA) during curettage. We assessed recurrence and complication rates and functional outcome after curettage with use of phenol and PMMA, liquid nitrogen and PMMA, and liquid nitrogen and bone grafts. We retrospectively compared the relative effectiveness of treatment of giant cell tumors of bone at two tertiary centers with a regional function from 1990 to 2010. The 132 (of 201) patients who met the inclusion criteria had a mean age of thirty-three years (range, eleven to sixty-nine years). Treatment assignment depended purely on the center, with primary treatment consisting of curettage with use of phenol and PMMA (n = 82) at one center and with use of either liquid nitrogen and PMMA (n = 26) or liquid nitrogen and bone grafts (n = 24) at the other center. Recurrence and complication rates were determined, and functional outcome was assessed on the basis of the Musculoskeletal Tumor Society (MSTS) score. The mean duration of follow-up was eight years (range, two to twenty-two years). Recurrence rates were comparable among the groups (28% for phenol and PMMA, 31% for liquid nitrogen and PMMA, and 38% for liquid nitrogen and bone grafts; p = 0.52). Soft-tissue extension increased the recurrence risk (hazard ratio [HR] = 2.1, 95% confidence interval [CI] = 1.1 to 4.0, p = 0.024). The complication rate was 33% after use of liquid nitrogen and bone grafts, 27% after liquid nitrogen and PMMA, and 11% after phenol and PMMA (p = 0.019); complications included osteoarthritis, infection, postoperative fracture, nonunion, transient nerve palsy, and PMMA leakage. The complication risk was increased by the presence of a pathologic fracture (HR = 4.1, 95% CI = 1.7 to 9.5, p = 0.001) and use of liquid nitrogen (HR = 3.9, 95% CI = 1.5 to 10, p = 0.006 for liquid nitrogen and bone grafts; HR = 3.1, 95% CI = 1.1 to 8.6, p = 0

Mixed La-Li heterobimetallic complexes for tertiary nitroaldol resolution.

Science.gov (United States)

Tosaki, Shin-ya; Hara, Keiichi; Gnanadesikan, Vijay; Morimoto, Hiroyuki; Harada, Shinji; Sugita, Mari; Yamagiwa, Noriyuki; Matsunaga, Shigeki; Shibasaki, Masakatsu

2006-09-13

A kinetic resolution of tertiary nitroaldols derived from simple ketones is described. Mixed BINOL/biphenol La-Li heterobimetallic complexes gave the best selectivity in retro-nitroaldol reactions of racemic tertiary nitroaldols. By using a mixture of La-Li3-(1a)3 complex (LLB 2a) and La-Li3-(1b)3 (LLB* 2b) complex in a ratio of 2/1, chiral tertiary nitroaldols were obtained in 80-97% ee and 30-47% recovery yield.

Massification and Quality Assurance in Tertiary Education: The ...

African Journals Online (AJOL)

The study sets out to examine massification and its impact on quality assurance in tertiary education and the extent to which lecturer–student ratio, adequacy of infrastructure and pedagogical resources affect quality in tertiary institutions. Two research questions and one hypothesis were posed to guide the investigation.

The European Central Bank and the Eurosystem

OpenAIRE

Carol C. Bertaut

2002-01-01

The Eurosystem comprises the European Central Bank at its center as well as the national central banks of the twelve countries currently participating in monetary union. The European Central Bank was established in July 1998, six months before the beginning of Stage Three of economic and monetary union. Although decisions regarding monetary policy are made centrally by the Governing Council of the Eurosystem, the operational aspects of monetary policy-including open market operations, adminis...

Challenges with Tertiary-Level Mechatronic Fluid Power

DEFF Research Database (Denmark)

Dransfield, Peter; Conrad, Finn

1996-01-01

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

Characteristics of dysphagia in older patients evaluated at a tertiary center.

Science.gov (United States)

Kocdor, Pelin; Siegel, Eric R; Giese, Rachel; Tulunay-Ugur, Ozlem E

2015-02-01

To determine laryngoscopic and videofluoroscopic swallowing study (VFSS) findings in geriatric patients with dysphagia; to evaluate management. Retrospective chart review. Patients over 65 years old complaining of dysphagia, seen at a tertiary laryngology clinic, were included. Head and neck cancer and stroke patients were excluded. Demographics, laryngoscopic findings, swallowing studies, and treatment modalities were reviewed. Sixty-five patients were included. Mean age was 75 years old (range = 66-97) with female predominance of 67.6%. Weight loss was seen in 9.2% of the patients. Whereas 52.3% of the patients complained of solid food dysphagia, 53.8% were choking on food. On laryngoscopy, 15.3% of the patients had pooling in the pyriform sinuses, 30.7% had glottic gap, 18.4% had vocal fold immobility, and 3% had hypomobility. VFSS showed that 38.4% of the patients had pharyngoesophageal dysphagia, 20% had oropharyngeal dysphagia, 20% had pharyngeal dysphagia, and 20% had a normal study. In addition, 41.5% of the patients showed laryngeal penetration and 18.4% showed aspiration. Surgical intervention was employed in 29.2% of the patients in the form of botulinum toxin injection, esophageal dilatation, cricopharyngeal myotomy, vocal fold injection, diverticulectomy, and percutaneous endoscopic gastrostomy. Whereas 21.5% of the patients received swallowing therapy, 61.5% underwent diet modification. As a result, 80% of the patients needed some type of treatment. Swallowing problems in older patients are not uncommon. The clinician needs to be diligent to inquire about dysphagia because a large number of these patients will require treatment. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Food Waste Generation at Household Level: Results of a Survey among Employees of Two European Research Centers in Italy and Germany

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Juliane Jörissen

2015-03-01

Full Text Available There is a broad consensus in literature that private households are significant contributors to the total amount of food waste in the EU. Thus, any strategy to meaningfully combat food wastage must put the end consumer in the center of prevention activities. This requires deeper insights into people’s motivations to discard still edible food and knowledge about potential barriers to reduce wasting. This paper reports on results of an online survey among two European research centers in Italy (JRC/Ispra and Germany (KIT/Karlsruhe. The focus of the survey was on households’ behaviors (shopping, eating, and food preparation habits and its influence on the generation of food waste. Furthermore, reasons for the disposal of food as well as measures and technologies most needed to prevent wastage were discussed. The results of the survey are analyzed, especially with regard to two questions: (1 Are there considerable differences between Ispra and Karlsruhe? (2 Are there considerable similarities or inconsistencies with the results of previous studies?

PREGO (presentation of Graves' orbitopathy) study: changes in referral patterns to European Group On Graves' Orbitopathy (EUGOGO) centres over the period from 2000 to 2012

NARCIS (Netherlands)

Perros, Petros; Žarković, Miloš; Azzolini, Claudio; Ayvaz, Göksun; Baldeschi, Lelio; Bartalena, Luigi; Boschi, Antonella; Bournaud, Claire; Brix, Thomas Heiberg; Covelli, Danila; Ćirić, Slavica; Daumerie, Chantal; Eckstein, Anja; Fichter, Nicole; Führer, Dagmar; Hegedüs, Laszlo; Kahaly, George J.; Konuk, Onur; Lareida, Jürg; Lazarus, John; Leo, Marenza; Mathiopoulou, Lemonia; Menconi, Francesca; Morris, Daniel; Okosieme, Onyebuchi; Orgiazzi, Jaques; Pitz, Susanne; Salvi, Mario; Vardanian-Vartin, Cristina; Wiersinga, Wilmar; Bernard, Martine; Clarke, Lucy; Currò, Nicola; Dayan, Colin; Dickinson, Jane; Knežević, Miroslav; Lane, Carol; Marcocci, Claudio; Marinò, Michele; Möller, Lars; Nardi, Marco; Neoh, Christopher; Pearce, Simon; von Arx, George; Törüner, Fosun Baloş

2015-01-01

The epidemiology of Graves' orbitopathy (GO) may be changing. The aim of the study was to identify trends in presentation of GO to tertiary centres and initial management over time. Prospective observational study of European Group On Graves' Orbitopathy (EUGOGO) centres. All new referrals with a

European Unity – Between Philosophy and Ideology

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Lorena Stuparu

2011-09-01

Full Text Available Parallel or tacit agreement with the European cultural model, union political projects have evolved over time from imperial ambitions in the global democratic principles. The current project of European integration, initiated by Pan Europe manifesto as an philosophical-political alternative centered on the individual, personality and freedom ideas has a striking table normative component, for both theoretical and ideological initiatives are under the sign of moral imperative, i.e. the soteriological peaceful shade.

European Competence Network on Mastocytosis (ECNM)

DEFF Research Database (Denmark)

Valent, Peter; Arock, Michel; Bonadonna, Patrizia

2012-01-01

The European Competence Network on Mastocytosis (ECNM) was initiated in 2002 as a multidisciplinary and multinational cooperative approach to increase awareness and to improve diagnosis and therapy of mastocytosis. The network is composed of local centers, physicians, and scientists who have dedi...

Crime and Crime Management in Nigeria Tertiary Institutions

Science.gov (United States)

Adebanjo, Margaret Adewunmi

2014-01-01

This paper examines crime and its management in Nigerian tertiary institutions. Tertiary institutions today have become arenas for crime activities such as rape, cultism, murder, theft, internet fraud, drug abuse, and examination malpractices. This paper delves into what crime is, and its causes; and the positions of the law on crime management.…

10 CFR 212.78 - Tertiary incentive crude oil.

Science.gov (United States)

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Tertiary incentive crude oil. 212.78 Section 212.78 Energy DEPARTMENT OF ENERGY OIL MANDATORY PETROLEUM PRICE REGULATIONS Producers of Crude Oil § 212.78 Tertiary incentive crude oil. Annual prepaid expenses report. By January 31 of each year after 1980, the project...

Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

Science.gov (United States)

Neill, Sara; Haithcock, Sarah; Smith, P. Brian; Goldberg, Ronald; Bidegain, Margarita; Tanaka, David; Carriker, Charlene; Ericson, Jessica E.

2015-01-01

Purpose Reduction of bloodstream infections (BSI) has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in neonatal intensive care units (NICUs) around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. Subjects 6,790 infants admitted to a large, tertiary care NICU between 2005 and 2013. Design Retrospective intervention study. Methods A staged, multifaceted infection prevention plan was implemented beginning in October 2007 under nursing leadership. The incidence of BSI was determined annually for 2005-2013. Results Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1,000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1,000 infant-days and 2.44/1,000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20-0.45 infections/1,000 infant days. This represents a 92% decrease in BSI over a period of >5 years. Conclusions Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. What this study adds Long term reductions in neonatal BSI are possible with implementation of a multidisciplinary team approach and strong nursing leadership. PMID:25915573

Trauma pattern in a level I east-European trauma center

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Bogdan Stoica

2015-10-01

Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

Evolving the Design of a Mobile Application to Support Transition to Tertiary Education

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Yu Zhao

2017-11-01

Full Text Available Students’ transition to tertiary education plays a critical role in their overall post-secondary experience. Even though educational institutions have designed and implemented various transition support programs, most of them still struggle to collect detailed information and provide tailored and timely support to students. With the high adoption rate of smart phones among university students, mobile applications can be used as a platform to provide personalized support throughout the transition, which has the potential to address the shortcomings of existing programs. Moreover, the use of mobile applications to support the transition to tertiary education can benefit from emerging techniques to design applications to support individuals through transition processes. In this paper, we present the design and development process of myUniMate, a mobile application that allows students to track and reflect on information from multiple aspects of their university lives. The paper describes the user-centered design approach used in the design, the implementation process, and how the initial version evolved based on our previous study. We conducted a 4-week field trial with first year university students to validate our design.

A hard lesson for Europeans: the ASEAN CDC.

Science.gov (United States)

Tibayrenc, Michel

2005-06-01

Despite the growing threat of major pandemics, the European Union is planning no more than a meager surveillance agency staffed with 70 people on the 2007 horizon: the new European Centre for Disease Control. I argue that an effective structure should be much larger and include a strong research activity. Asian countries, inspired by the US CDC, are now taking this concept in hand and creating an ASEAN Center For Disease Control, with sophisticated laboratory facilities to be included. This is a tough lesson for us Europeans, and our avarice in this domain could have tragic consequences in the future.

Finnish Highly Skilled Migrants and the European Economic Crisis

Directory of Open Access Journals (Sweden)

Koikkalainen Saara

2017-10-01

Full Text Available Europe is home to a globally unique area where the barriers of transnational migration have been largely removed. This article focuses on Finnish highly skilled, intra-European migrants and their labour market situation immediately following the economic crisis of 2008. Based on two consecutive online surveys (carried out in spring 2008 and summer 2010 of tertiary educated Finns living in other EU countries, the article examines the effects of the global economic downturn on the careers of these highly skilled migrants. Only 16 per cent of the respondents report that their labour market situation had worsened. A higher percentage (24% felt that their situation had improved and the majority (54% had either experienced no change in their situation or stated that their reasons for changing jobs or moving had nothing to do with the crisis. The article concludes that these migrants were protected from the full force of the crisis by their high human capital, flexibility of alternating between studying and work, employment in international workplaces and their intra-European migrant status.

Tertiary Technical Education and Youth Integration in Brazil, Colombia and Mexico

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Claudia Jacinto

2014-11-01

Full Text Available Vocational training versus a traditional university education. This chapter seeks to answer the question of whether ‘tertiary technical education’ has contributed to increasing economic and social opportunity for young people in Latin America, using three case studies from Brazil, Colombia and Mexico. It examines the extent to which tertiary technical education has contributed towards democratising access to education through institutional diversification, expanded enrolment and, at least theoretically, improved access to quality employment. The analysis shows that tertiary technical education has contributed to widening of opportunities by offering an alternative form of education to new generations of young people. Tertiary technical education is more accessible, shorter in duration, has a vocational orientation, and tends to be cheaper than a university education. However, the case studies also reveal that while a tertiary technical education diploma is an asset for young people seeking employment, it nonetheless does not have the same perceived value as a traditional university education. Available data appear to indicate that graduates of tertiary technical education earn less on average than university graduates and face several challenges in the labour market. Furthermore, the studies reveal that despite the presence of highly regarded tertiary technical education institutions in all three countries, these carry less prestige and status than universities.

DEISA2: supporting and developing a European high-performance computing ecosystem

International Nuclear Information System (INIS)

Lederer, H

2008-01-01

The DEISA Consortium has deployed and operated the Distributed European Infrastructure for Supercomputing Applications. Through the EU FP7 DEISA2 project (funded for three years as of May 2008), the consortium is continuing to support and enhance the distributed high-performance computing infrastructure and its activities and services relevant for applications enabling, operation, and technologies, as these are indispensable for the effective support of computational sciences for high-performance computing (HPC). The service-provisioning model will be extended from one that supports single projects to one supporting virtual European communities. Collaborative activities will also be carried out with new European and other international initiatives. Of strategic importance is cooperation with the PRACE project, which is preparing for the installation of a limited number of leadership-class Tier-0 supercomputers in Europe. The key role and aim of DEISA will be to deliver a turnkey operational solution for a persistent European HPC ecosystem that will integrate national Tier-1 centers and the new Tier-0 centers

Tertiary recovery and tritide injection equipment

International Nuclear Information System (INIS)

Li Lin

1989-01-01

The exploitation of an oil field is a continously developing process, undergoing seveal stages, such as the low production, the high production, the stable production and the decline. The tertiary recovery is an important means of the enhanced oil recovery. Since the object of the tertiary recovery is to treat the oil in micropores which is difficult to be produced, it is more necessary to know further the reservoir. Tritide can be used as a tracer and is an ideal marker of knowing the reservoir and the state of the fluid movement. The paper presents the tritide injection equipment

Correlation between asthma and climate in the European Community Respiratory Health Survey.

Science.gov (United States)

Verlato, Giuseppe; Calabrese, Rolando; De Marco, Roberto

2002-01-01

The European Community Respiratory Health Survey, performed during 1991-1993, found a remarkable geographical variability in the prevalence of asthma and asthma-like symptoms in individuals aged 20-44 yr. The highest values occurred in the English-speaking centers. In the present investigation, the ecological relationship between climate and symptom prevalence was evaluated in the 48 centers of the European Community Respiratory Health Survey. Meteorological variables were derived from the Global Historical Climatology Network and were averaged over an 11-yr period (i.e., 1980-1990). Respiratory symptom prevalence was directly related to temperature in the coldest month and was related inversely to the temperature in the hottest month. Warm winters and cool summers are features of oceanic climate found in most English-speaking centers of the European Community Respiratory Health Survey (i.e., England, New Zealand, and Oregon). In conclusion, climate can account for significant geographic variability in respiratory symptom prevalence.

Constructivism in Teaching English for Special Purposes at Tertiary School

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Anna Y. Polenova

2017-09-01

Full Text Available The article looks at some principles of constructivism philosophy and the ways they are realized in ESP teaching at tertiary school. The purpose of this article is to describe constructivist teaching approach in enhancing students’ use of appropriate ESP learning strategies. Constructivism is a theory that emphasizes the active role of students in building understanding and making sense of the information. The constructivist teaching is learner-centered where students are actively involved in knowledge construction rather than passive listeners. Students construct knowledge by transforming, organizing, reorganizing previous knowledge through social interaction in construction of knowledge and understanding. The paper is an attempt to examine the principles of constructivist teaching and learning by providing analysis of features of constructivist theory and the organization of a constructivist classroom.

[European Community Respiratory Health Survey in Adults (ECRHS)].

Science.gov (United States)

Heinrich, J; Richter, K; Frye, C; Meyer, I; Wölke, G; Wjst, M; Nowak, D; Magnussen, H; Wichmann, H E

2002-05-01

The European Community Respiratory Health Survey (ECRHS) was the first study to assess the geographical variation in asthma, allergy, and allergic sensitization in adults using the same instruments and definitions. The database of the ECRHS includes information from approximately 140 000 individuals aged 20 - 44 years from 22 countries. The aim of this review is to summarize the results of the ECRHS and to present the specific contribution of the German centers in Hamburg and Erfurt. The prevalence ranged from 2.0 - 11.9 % for asthma, 9.5 - 40.9 % for allergic rhinitis, 4.0 - 32.0 % for wheeze, 3.4 - 27.9 % for bronchial hyperreactivity, and 16.2 - 44.5 % for allergic sensitisation against common aeroallergens. Although the prevalence of these atopic disorders were found to be consistently higher for the Hamburg center compared to the Erfurt center, strong regional differences in the prevalences were also found within several other European countries. Overall Europe, the lowest prevalences were seen in the Eastern and Middle European countries with the center Erfurt, followed by the Mediterranean region. The highest prevalences were reported for all English speaking centers. Strong geographic variation was reported for medication for asthma. Asthma seems to be undertreated in several countries. Environmental exposures and in particular indoor factors, and exposures at the workplace are playing a major role for asthma in adulthood. Furthermore, protective effects on atopy were found for exposures to pets (dogs) and a large number of siblings in early childhood. In conclusion, the ECRHS has shown that the prevalence of asthma varies widely. The fact that the geographical pattern is consistent with the distribution of atopy and bronchial responsiveness supports the conclusion that the geographical variations in the prevalence of asthma are true and likely due to environmental factors.

Launch Vehicle Control Center Architectures

Science.gov (United States)

Watson, Michael D.; Epps, Amy; Woodruff, Van; Vachon, Michael Jacob; Monreal, Julio; Williams, Randall; McLaughlin, Tom

2014-01-01

This analysis is a survey of control center architectures of the NASA Space Launch System (SLS), United Launch Alliance (ULA) Atlas V and Delta IV, and the European Space Agency (ESA) Ariane 5. Each of these control center architectures have similarities in basic structure, and differences in functional distribution of responsibilities for the phases of operations: (a) Launch vehicles in the international community vary greatly in configuration and process; (b) Each launch site has a unique processing flow based on the specific configurations; (c) Launch and flight operations are managed through a set of control centers associated with each launch site, however the flight operations may be a different control center than the launch center; and (d) The engineering support centers are primarily located at the design center with a small engineering support team at the launch site.

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

Science.gov (United States)

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

2016-01-01

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

PREVALENCE OF PAEDIATRIC DERMATOSES IN THE AGE GROUP OF 5-14 YEARS AT A TERTIARY CARE CENTER IN SALEM

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Prasanna Kanniah Baskara

2017-01-01

Full Text Available BACKGROUND Skin diseases in pediatric age group are common all over the world. Pediatric dermatoses require separate view from adult dermatoses as there are differences in their clinical presentation and treatment. OBJECTIVE The aim of our study was to determine the prevalence of pediatric dermatoses attending our tertiary care center. MATERIALS AND METHODS This was a cross-sectional study conducted in 100 consecutive children with dermatoses between 5-14 years of age attending dermatology outpatient department at Vinayaka Missions Kirupananda Variyar medical college, Salem. The study was conducted over a period of 6 months from February 2016 to August 2016. Demographic parameters, detailed history, clinical features and diagnosis were recorded and analyzed. RESULTS In our short term study, we examined 100 pediatric cases with 106 dermatoses. The incidence of infections and infestations (43.39% was more prevalent in our study. The most common non-infectious dermatoses in our study was insect bite reactions (17.9%. Dermatitis and eczema (9.39%, disorders of sweat and sebaceous glands (6.6%, pigmentary disorders (5.66%, disorders of hair and nails (3.77%, genetic disorders (2.88%, immune and allergic disorders (2.8%, psoriasis (2.8%, nutritional disorders (0.9%, Polymorphic light eruption (0.9%, pearly penile papule (0.9%, aphthous ulcer (0.9% and pityriasis rosea (0.9% were the other dermatoses seen in the study.CONCLUSION Fungal infections (tinea versicolor and tinea corporis, scabies and insect bite reactions were the common dermatoses observed in our study. Most of the pediatric patients attending our hospital came from rural areas belonging to low socioeconomic strata. Health education, proper sanitation and improved nutrition will help to reduce the incidence of pediatric dermatoses.

Solvent effects on the magnetic shielding of tertiary butyl alcohol

African Journals Online (AJOL)

)4 and tetramethyl ammonium cation N(CH3)4(+) have also been presented. KEY WORDS: Solvent effects, Magnetic shielding, Tertiary butyl alcohol, Tertiary butyl amine, Continuum solvation calculations, Chemical shift estimation methods

Ensuring Effective Mentoring in Tertiary Institutions in Anambra State ...

African Journals Online (AJOL)

This paper concerns itself only with ascertaining the strategies that could ensure effective mentoring in tertiary institutions. The survey method was employed. The study population comprised 78 teacher educators in tertiary institutions in Anambra State. One research question guided the study while one null hypothesis was ...

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

Science.gov (United States)

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

2017-12-01

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

Stroke in the young: access to care and outcome; a Western versus eastern European perspective.

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Bhalla, Ajay; Grieve, Richard; Rudd, Anthony G; Wolfe, Charles D A

2008-01-01

To develop effective strategies to address the needs of young patients with stroke, it is important to recognize what components of stroke care they receive. The aims of this study were to describe the provision of stroke care and the factors associated with 3-month mortality and disability (Barthel Index 0-14) in patients younger than 55 years across Western and Eastern Europe. Data from hospital-based stroke registers in Western Europe (7 centers, 6 countries) and Eastern Europe (4 centers, 3 countries) were analyzed. Of 1735 patients admitted to hospital, 201 (11.5%) patients were younger than 55 years (Western European centers 51%, and Eastern European centers 49%). Stroke department care was higher in Western centers (67%) than in Eastern centers (24%) (P Western centers. At 3 months, case fatalities between Western and Eastern centers were 8% versus 23% (P = .003). Patients in Eastern European centers were more likely to have disability at 3 months (odds ratio = 24.3, confidence interval = 1.2-494, P = .04). Young patients with stroke in Western Europe are more likely to gain access to a number of components of stroke care compared with those in Eastern Europe. The future challenge is to ensure that recommendations are adopted to ensure all young patients receive evidence-based stroke care across Europe.

Parathyroid carcinoma in tertiary hyperparathyroidism.

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Kim, Byung Seup; Ryu, Han Suk; Kang, Kyung Ho; Park, Sung Jun

2016-10-01

Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a successful kidney transplantation, the intact parathyroid hormone (iPTH) level of the patient was elevated consistently and could not be controlled by medical therapy. Due to the development of tertiary hyperparathyroidism with bone pain and osteoporosis, subtotal parathyroidectomy was performed 4 months after the kidney transplantation. Histological evaluation revealed that one of four parathyroid lesions was a parathyroid carcinoma, while the others were diffuse hyperplasia. Postoperative laboratory studies indicated a decreased level of iPTH. A positron emission tomography-computed tomography performed 6 months after the operation revealed no evidence of local recurrence or distant metastasis. Copyright © 2013. Published by Elsevier Taiwan.

Spatio-temporal observations of the tertiary ozone maximum

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V. F. Sofieva

2009-07-01

Full Text Available We present spatio-temporal distributions of the tertiary ozone maximum (TOM, based on GOMOS (Global Ozone Monitoring by Occultation of Stars ozone measurements in 2002–2006. The tertiary ozone maximum is typically observed in the high-latitude winter mesosphere at an altitude of ~72 km. Although the explanation for this phenomenon has been found recently – low concentrations of odd-hydrogen cause the subsequent decrease in odd-oxygen losses – models have had significant deviations from existing observations until recently. Good coverage of polar night regions by GOMOS data has allowed for the first time to obtain spatial and temporal observational distributions of night-time ozone mixing ratio in the mesosphere.

The distributions obtained from GOMOS data have specific features, which are variable from year to year. In particular, due to a long lifetime of ozone in polar night conditions, the downward transport of polar air by the meridional circulation is clearly observed in the tertiary ozone maximum time series. Although the maximum tertiary ozone mixing ratio is achieved close to the polar night terminator (as predicted by the theory, TOM can be observed also at very high latitudes, not only in the beginning and at the end, but also in the middle of winter. We have compared the observational spatio-temporal distributions of the tertiary ozone maximum with that obtained using WACCM (Whole Atmosphere Community Climate Model and found that the specific features are reproduced satisfactorily by the model.

Since ozone in the mesosphere is very sensitive to HO_x concentrations, energetic particle precipitation can significantly modify the shape of the ozone profiles. In particular, GOMOS observations have shown that the tertiary ozone maximum was temporarily destroyed during the January 2005 and December 2006 solar proton events as a result of the HO_x enhancement from the increased ionization.

Prevalence of Human Papilloma Virus Infection in Young Primiparous Women During Postpartum Period: Study from a Tertiary Care Center in Northern India.

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Garg, Alpana; Suri, Vanita; Nijhawan, Raje; Aggarwal, Neelam; Aggarwal, Ritu; Guleria, Charu; Thakur, Mili

2016-10-01

Assessment of high-risk Human Papilloma Virus (HPV) prevalence is important for monitoring long-term decrease in cervical cancer after implementation of the prophylactic HPV vaccination. To determine the prevalence of high-risk HPV infection and cytological abnormalities in young primiparous women in the age group of 16-26years. In this cross-sectional study, 214 primiparous women aged 16-26years were recruited from a public tertiary health care center postpartum clinic between June 2013 and May 2014. Cytological analysis was performed by Pap smear test and patients underwent sampling with cervical brushes for HPV-DNA detection and typing by a PCR-based assay for HPV types 16, 18, 33 and 45. High-risk HPV was detected in 41 (19.2%) women. HPV 16 was found to be most prevalent with 17 (7.9%) samples testing positive, followed by HPV 18 in nine (4.2%), HPV 45 in six (2.8%) and HPV 31 in four (1.8%) women. Five women tested positive for more than one HPV types. There were no cases of intraepithelial lesions or cervical cancer. One patient who had Atypical Cells of Undetermined Significance (ASCUS) on cytology tested negative for all four HPV genotypes. This study provides a geographic baseline data of high-risk HPV prevalence in young Indian women before implementation of a vaccination program. The results are important for comparison with other global regions and monitoring the effect of HPV vaccination.

EMERALD: Emergency visit audit of patients treated under medical oncology in a tertiary cancer center: Logical steps to decrease the burden.

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Joshi, Amit; Patil, Vijay M; Noronha, Vanita; Ramaswamy, Anant; Gupta, Sudeep; Bhattacharjee, Atanu; Bonda, Avinash; Chandrakanth, M V; Ostwal, Vikas; Khattry, Navin; Banavali, Shripad; Prabhash, Kumar

2017-01-01

We are a tertiary care cancer center and have approximately 1000-1500 emergency visits by cancer patients undergoing treatment under the adult medical oncology unit each month. However, due to the lack of a systematic audit, we are unable to plan steps toward the improvement in quality of emergency services, and hence the audit was planned. All emergency visits under the adult medical oncology department in the month of July 2015 were audited. The cause of visit, the demographic details, cancer details, and chemotherapy status were obtained from the electronic medical records. The emergency visits were classified as avoidable or unavoidable. Descriptive statistics were performed. Reasons for avoidable emergency visits were sought. Out of 1199 visits, 1168 visits were classifiable. Six hundred and ninety-six visits were classified as unavoidable (59.6%, 95% CI: 56.7-62.4), 386 visits were classified as probably avoidable visit (33.0%, 95% CI: 30.4-35.8) whereas the remaining 86 (7.4%, 95% CI: 6.0-9.01) were classified as absolutely avoidable. Two hundred and ninety-seven visits happened on weekends (25.6%) and 138 visits converted into an inpatient admission (11.9%). The factors associated with avoidable visits were curative intention of treatment (odds ratio - 2.49), discontinued chemotherapy status (risk ratio [RR] - 8.28), and private category file status (RR - 1.89). A proportion of visits to emergency services can be curtailed. Approximately one-fourth of patients are seen on weekends, and only about one-tenth of patients get admitted.

Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center.

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Kreuter, Alexander; Wischnewski, Jana; Terras, Sarah; Altmeyer, Peter; Stücker, Markus; Gambichler, Thilo

2012-12-01

The coexistence of lichen sclerosus (LiS) and localized scleroderma (LoS) has sporadically been reported in the literature. Recently, a prospective multicenter study demonstrated a surprisingly high percentage of genital LiS in patients with morphea. The aim of this study was to determine the prevalence of LiS in a cohort of patients with LoS who presented at a tertiary referral medical center for connective tissue diseases in Germany. We retrospectively evaluated the prevalence of genital and extragenital LiS in adult and pediatric patients with different subtypes of LoS. Secondary outcome measures included demographic characteristics and prevalence of other concomitant autoimmune diseases. Of the 472 patients (381 adults, 91 children; mean age: 46 years; range, 4-88 years; female to male ratio: 3.5:1 in adults and 8:1 in children) with LoS, 27 (5.7%) also presented with LiS (19 extragenital and 8 genital lesions). LiS exclusively occurred in patients with plaque-type (morphea) and generalized LoS. Twenty-six of the 27 (96.2%) patients with concomitant LoS and LiS were adults. Compared with LiS in the general population, LiS was significantly more frequent in LoS as indicated by an odds ratio of 18.1 (95% confidence interval 2.6-134.2; P morphea, should be carefully screened for concomitant LiS, including inspection of the anogenital region. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

First clinical evaluation of a new single-use flexible ureteroscope (LithoVue™): a European prospective multicentric feasibility study

NARCIS (Netherlands)

Doizi, Steeve; Kamphuis, Guido; Giusti, Guido; Andreassen, Kim Hovgaard; Knoll, Thomas; Osther, Palle Jörn; Scoffone, Cesare; Pérez-Fentes, Daniel; Proietti, Silvia; Wiseman, Oliver; de la Rosette, Jean; Traxer, Olivier

2017-01-01

We evaluated a new digital single-use flexible ureteroscope, LithoVue™ with respect to deflection, image quality and maneuverability. A prospective cohort study was conducted in eight tertiary reference centers in Europe in December 2015 and January 2016. All consecutive patients included underwent

Referral bias in ALS epidemiological studies.

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Logroscino, Giancarlo; Marin, Benoit; Piccininni, Marco; Arcuti, Simona; Chiò, Adriano; Hardiman, Orla; Rooney, James; Zoccolella, Stefano; Couratier, Philippe; Preux, Pierre-Marie; Beghi, Ettore

2018-01-01

Despite concerns about the representativeness of patients from ALS tertiary centers as compared to the ALS general population, the extent of referral bias in clinical studies remains largely unknown. Using data from EURALS consortium we aimed to assess nature, extent and impact of referral bias. Four European ALS population-based registries located in Ireland, Piedmont, Puglia, Italy, and Limousin, France, covering 50 million person-years, participated. Demographic and clinic characteristics of ALS patients diagnosed in tertiary referral centers were contrasted with the whole ALS populations enrolled in registries in the same geographical areas. Patients referred to ALS centers were younger (with difference ranging from 1.1 years to 2.4 years), less likely to present a bulbar onset, with a higher proportion of familial antecedents and a longer survival (ranging from 11% to 15%) when compared to the entire ALS population in the same geographic area. A trend for referral bias is present in cohorts drawn from ALS referral centers. The magnitude of the possible referral bias in a particular tertiary center can be estimated through a comparison with ALS patients drawn from registry in the same geographic area. Studies based on clinical cohorts should be cautiously interpreted. The presence of a registry in the same area may improve the complete ascertainment in the referral center.

Determinants of propensity of tertiary agricultural students in Ghana ...

African Journals Online (AJOL)

The study aimed to identify factors that affect the decision of tertiary agricultural students in Ghana to enter agribusiness as a self-employment venture after graduation. The results showed that tertiary agricultural students in Ghana were predominantly males with little or no farming background. They had a rather moderate ...

Initiation of a medical toxicology consult service at a tertiary care children's hospital.

Science.gov (United States)

Wang, George Sam; Monte, Andrew; Hatten, Benjamin; Brent, Jeffrey; Buchanan, Jennie; Heard, Kennon J

2015-05-01

Currently, only 10% of board-certified medical toxicologists are pediatricians. Yet over half of poison center calls involve children toxicology consultation is not common at children's hospitals. In collaboration with executive staff from Department of Pediatrics and Emergency Medicine, regional poison center, and our toxicology fellowship, we established a toxicology consulting service at our tertiary-care children's hospital. There were 139 consultations, and the service generated 13 consultations in the first month; median of 11 consultations per month thereafter (range 8-16). The service increased pediatric cases seen by the fellowship program from 30 to 94. The transition to a consult service required a culture change. Historically, call center advice was the mainstay of consulting practice and the medical staff was not accustomed to the availability of bedside medical toxicology consultations. However, after promotion of the service and full attending and fellowship coverage, consultations increased. In collaboration with toxicologists from different departments, a consultation service can be rapidly established. The service filled a clinical need that was disproportionately utilized for high acuity patients, immediately utilized by the medical staff and provided a robust pediatric population for the toxicology fellowship.

Predictors of caregivers’ burden of Parkinson’s disease in India: experience of a tertiary care center in India

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Agrawal V

2012-11-01

Full Text Available Vikas Agrawal,1 Vinay Goyal,2 Garima Shukla,2 Madhuri Behari21Department of Neurology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India; 2Department of Neurology, All India Institute of Medical Sciences, New Delhi, IndiaIntroduction: Parkinson’s disease (PD is a progressive neurodegenerative disorder characterized by increasing dependence on caregivers for activities of daily living that imposes a major burden upon the patients’ caregiver. Caregiver burden (CB refers to the physical, mental, and socioeconomic problems experienced by the caregivers of chronic patients.Patients and methods: This is a onetime cross-sectional observational study carried out in the movement disorder clinic of a tertiary referral center in India. Persons with PD were interviewed and information was collected regarding demographic and clinical details, treatment taken, and presence of non-motor features such as dementia, psychosis, depression, etc, on a pre-tested format and their caregivers were interviewed for self-perceived burden using Zerit’s caregivers’ burden inventory.Results: We interviewed 91 persons with PD (71 [78%] men, 20 [22%] women with their primary caregivers. The age of the patients ranged from 25 to 75 years (mean 56.66 ± 11.83 years. After regression analysis, depression in patients (beta = 0.352, 95% confidence interval [CI]: 0.275 to 0.790, high UPDRS-motor scores (beta = 0.255, 95% CI: 0.108 to 0.532, and presence of sleep disturbances in the atient (beta = 0.206, 95% CI: 0.817 to 11.823 were associated with increased caregiver burden and the presence of multiple caregivers was associated with lower caregiver burden (beta = −0.311, 95% CI: −10.155 to −3.436.Conclusion: The total number of caregivers was found to be an important predictor for reducing CB. Multiple caregivers is a phenomenon which has not been studied till now. Other factors which were found to have adverse predictive effect on caregiver burden are presence of

American Tertiary mollusks of the genus Clementia

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Woodring, W.P.

1927-01-01

Aside from its value as an aid in determining the age of Tertiary beds, the chief interest of the genus Clementia lies in the anomalous features of its present and former distribution. An attempt is made in this paper to trace its geologic history, to point out its paleobiologic significance, and to describe all the known American Tertiary species. The fossils from Colombia used in preparing this report were collected during explorations made under the direction of Dr. 0. B. Hopkins, chief geologist of the Imperial Oil Co. (Ltd.), who kindly donated them to the United States National Museum. Dr. T. Wayland Vaughan, of the Scripps Institution of Oceanography, furnished information relating to specimens collected by him in Mexico. Dr. Bruce L. Clark, of the University of California; Dr. G. Dallas Hanna, of the California Academy of Sciences; Dr. H. A. Pilsbry, of the Philadelphia Academy of Natural Sciences; and Dr. W. D. Matthew, of the American Museum of Natural History, generously loaned type specimens and other material. Doctor Clark and Doctor Hanna also gave information concerning the Tertiary species from California. Mr. Ralph B. Stewart, of the University of California, read the manuscript, and I have taken advantage of his suggestions. I am also indebted to Mr. L. R. Cox, of the British Museum, for information relating to the fossil species from Persia, Zanzibar, and Burma, and to Dr. Axel A. Olsson, of the International Petroleum Co., for data concerning undescribed Tertiary species from Peru.

ECTOPIC CUSHING SYNDROME: A 10-YEAR EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTHERN INDIA.

Science.gov (United States)

Sathyakumar, Samantha; Paul, Thomas Vizhalil; Asha, Hesargatta Shyamsunder; Gnanamuthu, Birla Roy; Paul, M J; Abraham, Deepak Thomas; Rajaratnam, Simon; Thomas, Nihal

2017-08-01

Ectopic adrenocorticotropic hormone (ACTH) secretion is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. We hereby describe our experience of patients with ectopic ACTH syndrome, who have been managed over the past 10 years at a tertiary care center in Southern India. The inpatient and outpatient records of patients from 2006 to 2015 were retrospectively reviewed. The clinical features, clinical history, biochemical values, imaging features, including radiologic findings and positron emission tomography scans, management, details of follow-up, and outcomes, were documented. We compared the biochemical findings in these patients with 20 consecutive patients with Cushing disease (Cushing syndrome of pituitary origin). A total of 21 patients were studied. The median age at presentation was 34 years (range, 19 to 55 years). Seven patients had thymic carcinoid, 7 had bronchial carcinoid, 3 had lung malignancies, 2 had medullary carcinoma thyroid, 1 patient had a pancreatic neuroendocrine tumor, and 1 patient had an occult source of ACTH. The most common clinical features at presentation were muscle weakness (95%), hyperpigmentation (90%), facial puffiness (76%), easy bruising (61%), edema (57%), and striae (52%). Extensive acne was seen in a large number of patients (43%). Only 3 patients (14%) had central obesity. The median 8 am cortisol was 55.5 μg/dL (range, 3.8 to 131 μg/dL), median 8 am ACTH was 207 pg/mL (range, 31.1 to 703 pg/mL), and the median 24-hour urinary free cortisol was 2,484 μg (range, 248 to 25,438 μg). Basal cortisol and ACTH, as well as midnight cortisol and ACTH level, were markedly higher in patients with ectopic Cushing syndrome as compared to patients with Cushing disease. Twelve of 21 patients had developed life-threatening infections by follow-up. Nine patients had undergone surgical intervention to address the primary tumor. However, only 1 patient exhibited a complete cure on

European astronaut training in Houston.

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Chiarenza, O

1993-11-01

Three European astronauts are currently training as Space Shuttle Mission Specialists at NASA's Johnson Space Center in Houston. Two of the astronauts, Maurizio Cheli and Jean-Francois Clervoy, recently became members of NASA's 'astronaut pool' and have entered the Advanced Training phase. The third one, Claude Nicollier, is now preparing for the mission to service the Hubble Space Telescope in December.

Yb(OTf){sub 3}-catalyzed one-pot three component synthesis for tertiary amines

Energy Technology Data Exchange (ETDEWEB)

Lee, Bum Seok; Kim, Ji Hye; Nam, Tae Kyu; Jang, Doo Ok [Dept. of Chemistry, Yonsei University, Wonju (Korea, Republic of)

2015-07-15

Tertiary amine functionality is found in many natural bioactive products such as alkaloids, amino acids, nucleic acids, pharmaceuticals, and agrochemicals. Tertiary amines have also been used as building blocks for nitrogen-containing organic compounds and synthetic polymers. A one-pot method for direct reductive amination of aldehydes has been developed to synthesize tertiary amines using HMDS as a nitrogen source in the presence of Yb(OTf ){sub 3}. With a stoichiometric amount of HMDS, the reaction afforded the desired tertiary amines without competitive reduction of the parent carbonyl compounds. This reaction offers a convenient and efficient protocol for synthesizing aromatic and aliphatic tertiary amines under mild reaction conditions.

TERRITORIAL DISPARITIES REGARDING THE DISTRIBUTION OF HEALTH SERVICE PROVIDERS IN ROMANIA AFTER JOINING THE EUROPEAN UNION STUDY CASE: MEDICAL STAFF WITH TERTIARY LEVEL OF EDUCATION

Directory of Open Access Journals (Sweden)

Babucea Ana-Gabriela

2017-02-01

Full Text Available In Romania 90ˈs, there was a relatively low level of regional disparities compared with western economies in all fields, but inequalities have emerged and widened rapidly because only certain areas, especially urban areas have benefited from inflows of capital and specialized human resources. Currently, Romania has a low level of development between EU countries, five of the eight NUTS 2 regions being the most underdeveloped in Europe. The aim of this research is a comparative analysis of developments and trends manifested in the public health system in terms of distribution of health services providers at the regional level in Romania. For the analysis of regional disparities, the research seeks to highlight a comprehensive image of the level and dynamics of the Romania territorial inequalities regarding the personnel with tertiary education, which includes physicians, dentists, and pharmaceutical chemists, as professional providers of the health services. Were took into account statistical indicators that describe the distribution of such as healthcare providers, at level of the eight Romanian NUTS2 regions, highlighting inequalities in access to health services for the population. We used available data, accessed from National Institute of Statistics of Romania, regarding Romania, and itˊs eight regions. We appeal also to statistical publications at the national and European level, other data analysis, and experts' opinions expressed in recent articles in the field. In order to identify the factors that can reduce the disparities, and ensure the equity for disadvantaged population, in terms of ensuring the health system of medical services in parallel with a homogeneous distribution of resources and services in this area, we apply specific statistics for territorial analysis and comparisons.

Antibiotic-Related Adverse Drug Reactions at a Tertiary Care Hospital in South Korea

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In Young Jung

2017-01-01

Full Text Available Background. Adverse drug reactions (ADRs are any unwanted/uncomfortable effects from medication resulting in physical, mental, and functional injuries. Antibiotics account for up to 40.9% of ADRs and are associated with several serious outcomes. However, few reports on ADRs have evaluated only antimicrobial agents. In this study, we investigated antibiotic-related ADRs at a tertiary care hospital in South Korea. Methods. This is a retrospective cohort study that evaluated ADRs to antibiotics that were reported at a 2400-bed tertiary care hospital in 2015. ADRs reported by physicians, pharmacists, and nurses were reviewed. Clinical information reported ADRs, type of antibiotic, causality assessment, and complications were evaluated. Results. 1,277 (62.8% patients were considered antibiotic-related ADRs based on the World Health Organization-Uppsala Monitoring Center criteria (certain, 2.2%; probable, 35.7%; and possible, 62.1%. Totally, 44 (3.4% patients experienced serious ADRs. Penicillin and quinolones were the most common drugs reported to induce ADRs (both 16.0%, followed by third-generation cephalosporins (14.9%. The most frequently experienced side effects were skin manifestations (45.1% followed by gastrointestinal disorders (32.6%. Conclusion. Penicillin and quinolones are the most common causative antibiotics for ADRs and skin manifestations were the most frequently experienced symptom.

Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern india

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Rautaraya Bibhudutta

2011-12-01

Full Text Available Abstract Background Mycotic keratitis is an important cause of corneal blindness world over including India. Geographical location and climate are known to influence the profile of fungal diseases. While there are several reports on mycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The reported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and northern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. Methods A retrospective review of medical and microbiology records was done for all patients with laboratory proven fungal keratitis. Results Between July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While no organisms were found in 25.4% (253/997 corneal samples, 23.4% (233/997 were bacterial, 26.4% (264/997 were fungal (45 cases mixed with bacteria, 1.4% (14/997 were Acanthamoeba with or without bacteria and 23.4% (233/997 were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264 samples grew fungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical diagnosis of fungal keratitis was made in 186 of 264 (70.5% cases. The microscopic detection of fungal elements was achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251 cases. Aspergillus species (27.9%, 60/215 and Fusarium species (23.2%, 50/215 were the major fungal isolates. Concomitant bacterial infection was seen in 45 (17.1%, 45/264 cases of mycotic keratitis. Clinical outcome of healed scar was achieved in 94 (35.6%, 94/264 cases. Fifty two patients (19.7%, 52/264 required therapeutic PK, 9 (3.4%, 9/264 went for evisceration, 18.9% (50/264 received glue application with bandage

High burden of hepatocellular carcinoma and viral hepatitis in Southern and Central Vietnam: Experience of a large tertiary referral center, 2010 to 2016.

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Nguyen-Dinh, Song-Huy; Do, Albert; Pham, Trang Ngoc Doan; Dao, Doan Y; Nguy, Trinh Nhu; Chen, Moon S

2018-01-27

To examine the largest tertiary referral center in southern and central Vietnam from 2010 to 2016, evaluating epidemiological trends of hepatocellular carcinoma (HCC) and viral hepatitis B-C in this resource-limited setting. We extracted data of patients receiving care from Cho Ray Hospital (Ho Chi Minh City), the largest oncology referral center in southern and central Vietnam, from 2010 to 2016. We collected information on patient age, gender, geographic distribution, and disease characteristics including disease stage, tumor biomarker levels [serum alpha-fetoprotein (AFP), AFP-L3 isoform percentage, and prothrombin induced by induced by vitamin K absence-II], and serological testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Data from 24091 HCC patients were extracted, with sample demographics comprising mostly male (81.8%) and older age (however with 8.5% younger than 40 years old). This patient sample included a geographic catchment population of 56 million people (60% of the country's total population of 92.7 million), derived from 38 provinces and municipalities in Vietnam. Chronic HBV infection was found in 62.3% of cases, and chronic HCV infection in 26.0%. HBV and HCV co-infection was seen in 2.7%. Cirrhosis was found in an estimated 30% to 40% of cases. Nine percent of patients were not found to have chronic viral hepatitis. Twenty three point two percent of the patients had a normal AFP level. A total of 2199 patients were tested with AFP-L3 and PIVKA II over two years, with 57.7% having elevated AFP-L3%, and 88.5% with elevated PIVKA II levels. Over this 7-year period, the incidence of HCC increased, with a large proportion of cases (overall 40.8%) presenting initially an advanced stage, not amendable to surgical or locoregional therapy. HCC contributes significant health care burden in southern and central Vietnam, with increasing case volume over this seven-year period. Viral hepatitis likely explains this high HCC prevalence.

Large Scale Cooling in Tertiary Central Europe as inferred by the MBT/CBT Paleothermometer

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Bauersachs, T.; Schouten, S.; Schwark, L.

2011-12-01

Earth's climate experienced dramatic changes throughout the last 65 Ma. Starting at the Paleocene/Eocene thermal maximum, the global climate underwent a gradual cooling that eventually resulted in the glaciations in the Neogene. Most reconstructions of climate variability are derived from the marine realm using global deep sea oxygen isotope curves or molecular paleotemperature proxies. In contrast, only little information on the changes of the continental climate is available, which is mainly due to a lack of continuous high resolution records and suitable quantitative temperature proxies. The MBT/CBT paleothermometer is a novel temperature proxy based on temperature-driven changes in the branched glycerol dialkyl glycerol tetraether (GDGT) content of soil-living bacteria. These changes have been demonstrated to correlate well with ambient air temperature and the MBT/CBT proxy has thus been used to reconstruct paleotemperature records of terrestrial as well as coastal marine sediments (1). In this study, we employed the MBT/CBT paleothermometer on a number of maar lake deposits that - due to their exceptional well preserved organic matter content and finely-laminated sediments - comprise excellent archives of a continental climate. The analysed lacustrine deposits were all situated in the middle European Tertiary volcanic belt and ranged in age from the Early Eocene to the Late Oligocene, allowing for the detailed reconstruction of climate evolution of the Central European continent. Calculated mean annual air temperatures (MAAT) of the Messel oil shale, deposited during the Eocene climate optimum, averaged at 25 °C. This agrees well with previous temperature estimates based on paleontological observations, suggesting a paratropical climate in Eocene Central Europe with an average air temperature of ca. 25-30 °C (2). In contrast, to the green house period of the Early Eocene, the climate of the Oligocene was significantly cooler reflected by low MAAT of 8-15 �

A Single Center Experience on the Management of Placental Invasion Abnormalities

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Alper Biler

2016-03-01

Full Text Available Objective: The aim of this study is to investigate our management of placental invasion abnormalities. Methods: A retrospective study was conducted on pa­tients admitted to a tertiary referral center with a diagno­sis of placental invasion abnormalities between 2011 and 2015. Risk factors and perinatal outcomes associated with placental invasion abnormalities were identified. Results: The overall incidence of placental invasion ab­normalities during the 5-year period was 8.3/10000 de­liveries, which showed an increasing trend. Ultrasonog­raphy and magnetic resonance imaging correctly identi­fied placental invasion abnormality in 36.7% and 68.7% cases, respectively. Majority of patients (55.1% with ad­herent placenta were diagnosed at the time of delivery. Of these patients, 22.4% underwent hysterectomy, 83.8% required at least one of the additional surgical procedures and 55% were transfused at least four units of packed red blood cell. Conclusion: Since placental invasion abnormalities are associated with significant morbidity, delivery should be scheduled in a tertiary center with appropriate expertise and facilities. J Clin Exp Invest 2016; 7 (1: 14-18

Disruptive innovation in academic medical centers: balancing accountable and academic care.

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Stein, Daniel; Chen, Christopher; Ackerly, D Clay

2015-05-01

Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care.

INSPIRE - gate of the European Union to spatial information about the environment

International Nuclear Information System (INIS)

Tuchyna, M.

2005-01-01

In this presentation the initiative INSPIRE (Infrastructure for Spatial Information in Europe) initiated in 2001 year on the stimulus of the European Commission in co-operation with the European Statistic Authority ESTAT and with the Joint Research Center. Implementation principles of ESTAT in the Slovak Republic on the Enviroportal are discussed

Spectrum of goitrous lesions in patients at a tertiary care center of Sikkim

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Subhabrata Sengupta

2014-01-01

Full Text Available Background: Sikkim is declared as a goitre endemic state with an estimated prevalence of 54%. The spectrums of diseases include simple goitre, thyroiditis, adenoma, carcinoma, multinodular goitre and Graves′ disease. The present study aims to determine the pattern of thyroid swelling in a hospital setup at Sikkim. Materials and Methods: This study is a retrospective analysis of records of all patients presenting with thyroid swelling in a tertiary care hospital at Gangtok, Sikkim during the period of 4 years between 1 st January 2008 and 31 st December 2011. Patients were diagnosed by clinical examination, FNAC, USG, CT scan and hormone estimation. Histopatholgical confirmation was done in surgical cases. Clinic opathological and demographic data of 166 such patients were obtained and analyzed for the present study. Results: The most common goitrous disease was simple goitre (69.27% followed by thyroiditis (10.24%, toxic goitre (7.83% and malignancy (12.65%. Papillary variant was the commonest carcinoma. Overall female:male ratio was 4.9:1. The prevalence goitrous lesion was highest in the middle age group between 30-39 years, while the extremes of age (below 10 years and above 70 years were rarely involved. Conclusions: The prevalence of goitre in Sikkim is still very high despite iodisation programs by the Government. There is urgent need for more data on autoimmunity and goitrogens status to explain the high prevalence of goitre in this population.

Neuromodulation of chronic headaches: position statement from the European Headache Federation

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2013-01-01

The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile. PMID:24144382

Removal of the eye in a tertiary care center of China:a retrospective study on 573 cases in 20 years

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Ying Zhang

2015-10-01

Full Text Available AIM:To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration.METHODS: A retrospective study of 573 eyes removed (573 inpatients at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed.RESULTS:Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14% being enucleated and 406 (70.86% eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62% in original protopathies followed by neoplasm (13.44% and ocular infections (5.76%. Phthisis bulbi (45.20% was the most common direct indication, succeeded by malignant tumor (12.57%, loss/unreconstructed of intraocular tissues due to trauma (11.00%, untreatable inflammation (9.60%, intractable glaucoma (8.55% and sclerocorneal staphyloma (5.24%. Exenteration was underwent in 20 (25.97% cases (40% for recurrent carcinoma. Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%.CONCLUSION:Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be

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

LENUS (Irish Health Repository)

Saeed, Ayman

2012-02-01

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

Utility of Amyloid and FDG-PET in Clinical Practice: Differences Between Secondary and Tertiary Care Memory Units.

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Lage, Carmen; Suarez, Andrea Gonzalez; Pozueta, Ana; Riancho, Javier; Kazimierczak, Martha; Bravo, Maria; Jimenez Bonilla, Julio; de Arcocha Torres, Marıa; Quirce, Remedios; Banzo, Ignacio; Vazquez-Higuera, Jose Luis; Rabinovici, Gil D; Rodriguez-Rodriguez, Eloy; Sánchez-Juan, Pascual

2018-04-27

The clinical utility of amyloid positron emission tomography (PET) has not been fully established. Our aim was to evaluate the effect of amyloid imaging on clinical decision making in a secondary care unit and compare our results with a previous study in a tertiary center following the same methods. We reviewed retrospectively 151 cognitively impaired patients who underwent amyloid (Pittsburgh compound B [PiB]) PET and were evaluated clinically before and after the scan in a secondary care unit. One hundred and fifty concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed changes between the pre- and post-PET clinical diagnosis and Alzheimer's disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ2 and multivariate logistic regression. Concordance between classification based on scan readings and baseline diagnosis was 66% for PiB and 47% for FDG. The primary diagnosis changed after PET in 17.2% of cases. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (p PET due to a higher likelihood of diagnostic change. We found that changes in diagnosis after PET in our secondary center almost doubled those of our previous analysis of a tertiary unit (9% versus 17.2%). Our results offer some clues about the rational use of amyloid PET in a secondary care memory unit stressing its utility in mild cognitive impairment patients.

Literacy Skills Development for Tertiary Institutions: A Case Study of ...

African Journals Online (AJOL)

Literacy Skills Development for Tertiary Institutions: A Case Study of the University of Calabar. ... These were drawn from five faculties, namely Education, Social Sciences, Law, Arts and Agriculture. The study observed that there is a ... more literacy skills. Key Words: Literacy skills, university, Nigeria, tertiary institution ...

Defensive medicine among obstetricians and gynecologists in tertiary hospitals.

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Elad Asher

Full Text Available OBJECTIVE: To describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists. STUDY DESIGN: A prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel. RESULTS: Among the 117 obstetricians and gynecologists who participated in the survey, representing 10% of the obstetricians and gynecologists registered by the Israel Medical Association, 113 (97% felt that their daily work practice is influenced by concern about being sued for medical negligence and not only by genuine medical considerations. As a result, 102 (87% physicians are more likely to offer the cesarean section option, even in the absence of a clear medical indication, 70 (60% follow court rulings concerning medical practices, and 85 (73% physicians mentioned that discussions about medical negligence court rulings are included in their departments' meetings. CONCLUSIONS: Defensive medicine is a well-embedded phenomenon affecting the medical decision process of obstetricians and gynecologists.

Predicting long-term renal damage in children with vesicoureteral reflux under conservative initial management: 205 cases in a tertiary referral center.

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Alvarez, Natalia; Alvira, Reyes Delgado; Ruiz, Yurema Gonzalez; Atuan, Rafael Fernandez; Hinojosa, Alexander Siles; Heras, Miguel Angel Rihuete; Roldan, Marisa Justa; Romero, Jesus Gracia

2018-01-01

Vesicoureteral reflux (VUR) is one of the most common ailments in children. Evidence-based guidelines recommend conservative treatment in children with VUR, followed by endoscopic surgery in those with breakthrough febrile urinary tract infections (UTIs). Despite this fact, the management of VUR is still controversial. Our objective is to evaluate the conservative strategy in children with primary VUR in terms of renal function and scarring, and identify factors associated with poor prognosis in those children. A retrospective study was carried out in a tertiary center in children with primary VUR under conservative strategy treatment from 1989 to 2015. Data extracted included age of presentation, family and prenatal backgrounds, radiographic evaluation including ultrasound (US), dimercaptosuccinic acid (DMSA) scans and voiding cystourethrogram (VCUG). The SPSS program was used for statistical analysis. Two-hundred and five patients were diagnosed and followed a conservative therapy scheme (49.8% males, 50.2% females) after febrile UTI (73.17%) or prenatal diagnosis (26.83%). VCUG showed 53.20% of low-moderate VUR grade, 46.80% high VUR grade. Renal damage was present at diagnosis in 40.89%. Mean follow-up reakthrough recurrent febrile UTIs and underwent surgery. Conservative therapy was followed in 189 patients. Renal scarring or decreased kidney function were shown in 15.12% respectively. Renal damage was identified as a risk factor for poor prognosis (p-value Conservative strategy is a feasible treatment for primary VUR in children. The majority of cases could be managed conservatively with good outcomes after long-term follow-up. Decreased renal function is more frequent in patients with high-grade VUR. Renal damage at diagnosis increases the risk for surgical treatment.

Corot 310266512: A Light Curve With Primary, Secondary And Tertiary Eclipses

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Fernández Fernández Javier

2015-01-01

Full Text Available We present the photometric study of an interesting target in the CoRoT exoplanet database: CoRoT 310266512. Its light curve shows primary, secondary and tertiary eclipses that suggests the presence of at least three celestial bodies. The primary and secondary eclipses have the same orbital period, 7.42 days, and the tertiary eclipse has an orbital period of 3.27 days. Two of the tertiary eclipses fall within a primary eclipse and a secondary eclipse. The properties of the light curve indicate the presence of two physically separated systems. The primary and secondary eclipses corresponds to a binary system (System I. The tertiary eclipses correspond to a star-planet system or a star-dwarf system (System II. Some parameters of these two systems are obtained from JKTEBOP [1] program.

Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center.

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Carmichael, John D; Broder, Michael S; Cherepanov, Dasha; Chang, Eunice; Mamelak, Adam; Said, Qayyim; Neary, Maureen P; Bonert, Vivien

2017-08-04

Acromegaly is a rare, slowly progressive disorder resulting from excessive growth hormone (GH) production by a pituitary somatotroph tumor. The objective of this study was to examine acromegaly treatment outcomes during long-term care at a specialized pituitary center in patients presenting with lack of biochemical control. Data came from an acromegaly registry at the Cedars-Sinai Medical Center Pituitary Center (center). Acromegaly patients included in this study were those who presented biochemically-uncontrolled for care at the center. Biochemical control status, based on serum insulin-like growth factor-1 values, was determined at presentation and at study end. Patient characteristics and acromegaly treatments were reported before and after presentation by presenting treatment status and final biochemical control status. Data on long-term follow-up were recorded from 1985 through June 2013. Seventy-four patients presented uncontrolled: 40 untreated (54.1%) and 34 (45.9%) previously-treated. Mean (SD) age at diagnosis was 43.2 (14.7); 32 (43.2%) were female patients. Of 65 patients with tumor size information, 59 (90.8%) had macroadenomas. Prior treatments among the 34 previously-treated patients were pituitary surgery alone (47.1%), surgery and medication (41.2%), and medication alone (11.8%). Of the 40 patients without prior treatment, 82.5% achieved control by study end. Of the 34 with prior treatment, 50% achieved control by study end. This observational study shows that treatment outcomes of biochemically-uncontrolled acromegaly patients improve with directed care, particularly for those that initially present untreated. Patients often require multiple modalities of treatment, many of which are offered with the highest quality at specialized pituitary centers. Despite specialized care, some patients were not able to achieve biochemical control with methods of treatment that were available at the time of their treatment, showing the need for additional

Effects of Primary, Secondary and Tertiary Education on Conflict Intensity in Africa

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Julius A. Agbor

2015-10-01

Full Text Available This study investigates the impact of different schooling dimensions (primary, secondary and tertiary on the intensity of intra-state conflicts in 25 African states during the period 1989–2008. It uses fixed-effects and Generalized Methods of Moments (GMM estimators in an annualized panel data framework. Parameter estimates suggest the following (1 primary schooling broadly mitigates conflicts in Africa. However, in environments with high natural resource rents, it could ignite conflicts; (2 there is evidence, although not overwhelming, that secondary schooling potentially drives conflicts in Africa. There is also evidence that urbanization potentially drives conflicts in Africa. However, although secondary schooling and urbanization potentially drives conflicts, in environments where secondary schooling (urbanization is high, urbanization (secondary schooling mitigates conflicts; (3 there is no evidence of a strong direct positive impact of tertiary education on conflicts and conditioning on tertiary schooling, income inequality potentially drives conflicts in African states. However, in contexts where income inequality (tertiary schooling is high, tertiary schooling (inequality mitigates conflict. Two important policy implications follow from this study. First, in contexts where income inequality is high (for instance, in South Africa, governments should strive to foster tertiary education in order to reduce conflict. Second, where urbanization rates are high, they should foster both secondary and tertiary education. This study contributes to existing knowledge by clearly demonstrating the utility of distinguishing between different educational dimensions and the contexts wherein they matter for conflict mitigation in Africa.

Academic mentoring and the future of tertiary education in Nigeria ...

African Journals Online (AJOL)

Tertiary education is a major outlet for the provision of high manpower for national development. This paper therefore highlighted the challenges of tertiary education in Nigeria, early perspectives of mentoring undergraduates, the rationale for academic mentoring, the role of a mentor, and the role of library as catalyst in the ...

West Hackberry Tertiary Project. Annual report, September 3, 1997--September 2, 1998

Energy Technology Data Exchange (ETDEWEB)

Gillham, T.H.

1997-09-10

The following report is the Project Management Plan for the fifth year of the West Hackberry Tertiary Project. The West Hackberry Tertiary Project is one of four mid-term projects selected by the United States Department of Energy (DOE) as part of the DOE`s Class 1 Program for the development of advance recovery technologies in fluvial dominated deltaic reservoirs. The West Hackberry Tertiary Project is a field test of the idea that air injection can be combined with the Double Displacement Process to produce a low cost tertiary recovery process which is economic at current oil prices. The Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil by gravity drainage. The Double Displacement Process is based upon the concept that in fields such as West Hackberry waterdrive recoveries are typically 50%-60% of the original oil in place while gravity drainage recoveries average 80%-90% of the original oil in place. Therefore, by injecting a gas into a watered out reservoir, a gas cap will form an additional oil can be recovered due to gravity drainage. Although the Double Displacement Process has been shown to be successful in recovering tertiary oil in other fields, this project will be the first to utilize air injection in the Double Displacement Process. The use of air injection in this process combines the benefits of air`s low cost and universal accessibility with the potential for accelerated oil recovery due to the combustion process. If successful, this project will demonstrate that the use of air injection in the Double Displacement Process will result in an economically viable tertiary process in reservoirs where tertiary oil recovery is presently uneconomical.

European Facility for Antiproton and Ion Research (FAIR): the new international center for fundamental physics and its research program

International Nuclear Information System (INIS)

Fortov, Vladimir E; Sharkov, Boris Yu; Stöker, H

2012-01-01

The Facility for Antiproton and Ion Research (FAIR) accelerator center at Darmstadt, Germany, will provide the international scientific community with unique experimental opportunities of a scope and scale out of reach for any other large-scale facility in the world. With its staff of over 2500, it is expected to fundamentally expand our knowledge of hadron, nuclear, and atomic physics and their application to cosmology, astrophysics, and technology. In this review, the design details of the accelerator complex are discussed and the experimental research program for FAIR is presented. Particular attention is paid to experiments on the extreme state of matter arising from the isochoric heating of a material by heavy-ion beams. One of the largest facilities of its kind in Europe, FAIR is a part of the strategic development roadmap for the European Strategic Forum on Research Infrastructures (ESFRI). (physics of our days)

Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI)

DEFF Research Database (Denmark)

Maas, Andrew I R; Menon, David K; Steyerberg, Ewout W

2015-01-01

in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research...

Tertiary-amine-containing thermo- and pH-sensitive hydrophilic ABA triblock copolymers: effect of different tertiary amines on thermally induced sol-gel transitions.

Science.gov (United States)

Henn, Daniel M; Wright, Roger A E; Woodcock, Jeremiah W; Hu, Bin; Zhao, Bin

2014-03-11

This Article reports on the synthesis of a series of well-defined, tertiary-amine-containing ABA triblock copolymers, composed of a poly(ethylene oxide) (PEO) central block and thermo- and pH-sensitive outer blocks, and the study of the effect of different tertiary amines on thermally induced sol-gel transition temperatures (T(sol-gel)) of their 10 wt % aqueous solutions. The doubly responsive ABA triblock copolymers were prepared from a difunctional PEO macroinitiator by atom transfer radical polymerization of methoxydi(ethylene glycol) methacrylate and ethoxydi(ethylene glycol) methacrylate at a feed molar ratio of 30:70 with ∼5 mol % of either N,N-diethylaminoethyl methacrylate (DEAEMA), N,N-diisopropylaminoethyl methacrylate, or N,N-di(n-butyl)aminoethyl methacrylate. The chain lengths of thermosensitive outer blocks and the molar contents of tertiary amines were very similar for all copolymers. Using rheological measurements, we determined the pH dependences of T(sol-gel) of 10 wt % aqueous solutions of these copolymers in a phosphate buffer. The T(sol-gel) versus pH curves of all polymers exhibited a sigmoidal shape. The T(sol-gel) increased with decreasing pH; the changes were small on both high and low pH sides. At a specific pH, the T(sol-gel) decreased with increasing the hydrophobicity of the tertiary amine, and upon decreasing pH the onset pH value for the T(sol-gel) to begin to increase noticeably was lower for the more hydrophobic tertiary amine-containing copolymer. In addition, we studied the effect of different tertiary amines on the release behavior of FITC-dextran from 10 wt % micellar gels in an acidic medium at 37 and 27 °C. The release profiles for three studied hydrogels at 37 °C were essentially the same, suggesting that the release was dominated by the diffusion of FITC-dextran. At 27 °C, the release was significantly faster for the DEAEMA-containing copolymer, indicating that both diffusion and gel dissolution contributed to the

Hospital-acquired infections in a Nigerian tertiary health facility: An ...

African Journals Online (AJOL)

Hospital-acquired infections in a Nigerian tertiary health facility: An audit of surveillance reports. ... This study evaluated the occurrence of HAI in a foremost tertiary health facility over a 5-year period for the purpose of reinforcing control efforts. Materials and Methods: A retrospective survey of records from the infection control ...

A two-center comparative study of gastric pull-up and jejunal interposition for long gap esophageal atresia

NARCIS (Netherlands)

Gallo, Gabriele; Zwaveling, S; Van Der Zee, David C.; Bax, Klaas N.; De Langen, Zacharias J.; Hulscher, Jan B F

2015-01-01

Purpose When restoration of the anatomical continuity in case of long gap esophageal atresia (LGEA) is not feasible, esophageal replacement surgery becomes mandatory. The aim of this paper is to critically compare the experience of two tertiary referral centers in The Netherlands performing either

Interactive Intranet Portal for effective Management in Tertiary Institution

OpenAIRE

Idogho O. Philipa; Akpado Kenneth; James Agajo

2011-01-01

Interactive Intranet Portal for effective management in Tertiary Institution is an enhanced and interactive method of managing and processing key issues in Tertiary Institution, Problems of result processing, tuition fee payment, library resources management are analyzed in this work. An interface was generated to handle this problem; the software is an interactive one. Several modules are involved in the paper, like: LIBRARY CONSOLE, ADMIN, STAFF, COURSE REGISTRATION, CHECKING OF RESULTS and...

Assessment Quality in Tertiary Education: An Integrative Literature Review

OpenAIRE

Gerritsen-van Leeuwenkamp, Karin; Joosten-ten Brinke, Desirée; Kester, Liesbeth

2018-01-01

In tertiary education, inferior assessment quality is a problem that has serious consequences for students, teachers, government, and society. A lack of a clear and overarching conceptualization of assessment quality can cause difficulties in guaranteeing assessment quality in practice. Thus, the aim of this study is to conceptualize assessment quality in tertiary education by providing an overview of the assessment quality criteria, their influences, the evaluation of the assessment quality ...

Fusion research in the European Community

International Nuclear Information System (INIS)

Wolf, G.H.

1988-01-01

Centering around the European joint project Joint European Torus (JET), in the framework of which hot fusion plasmas are already brought close to thermonuclear ignition, the individual research centres in Europe have taken over different special tasks. In Germany research concentrates above all on the development of super-conductive magnets, the stage of plasma-physical fundamentals or the investigation of the interaction between the plasma boundary layer and the material of the vessel wall. On this basis the development stage following JET, the Next European Torus (NET), is planned, with its main aim being the production and maintenance of a thermonuclear burning plasma, i.e. a plasma which maintains its active state from the gain of energy of its own fusion reactions. In the framework of a contractually agreed cooperation between the European Community, Japan, the USSR and the USA, the establishment of an international study group (with seat in Garching) was decided upon, which is to develop the concept of an 'International Thermonuclear Experimental Reactor (ITER)' jointly supported by these countries. The results of the studies presented show that the differences in the design data of ITER and NET are negligible. (orig./DG) [de

Tertiary Treatment Process of Preserved Wastewater

Directory of Open Access Journals (Sweden)

Wang Qingyu

2016-01-01

Full Text Available The effects of the composite coagulants on coagulation sedimentation for the preserved wastewater was investigated by changing the composite coagulant dosages, and the coagulant was composed of polymeric ferric sulfate (PFS, polyaluminium chloride (PAC, and polyaluminum ferric silicate (PAFSC, while the effect of the tertiary treatment process on the preserved wastewater was tested, which was exceeded the standard seriously. The results showed that 400 mg/L was the optimum composite coagulant dosage. The removal rates of salt and sugar were as high as 99.1% and 99.5% respectively, and the removal rates of CODCr and SS were 99.3% and 96.0%, respectively after the preserved wastewater was treated by the tertiary treatment technology, which both reached the primary standard of “The Integrated Wastewater Discharge Standard” (GB8978-1996.

Clinical spectrum of hypopituitarism in India: A single center experience

Science.gov (United States)

Gundgurthi, Abhay; Garg, M. K.; Bhardwaj, Reena; Brar, Karninder S.; Kharb, Sandeep; Pandit, Aditi

2012-01-01

Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 – 76 years). There were 78 (69%) males and 35 females (31%). There were 22 subjects aged ≤18 years (childhood and adolescence) and 91 adults (>18 years). Visual disturbances were the most common presenting complaint (33%), though headache was the most common symptom (81%). Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97%) was the most common abnormality seen followed by hypothyroidism (83.2%), hypoadrenalism (79.6%), growth hormone deficiency (88.1% of the 42 patients tested), and diabetes insipidus (13.3%). Panhypopituitarism was seen in 104 (92%) patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases. PMID:23087868

Clinical spectrum of hypopituitarism in India: A single center experience

Directory of Open Access Journals (Sweden)

Abhay Gundgurthi

2012-01-01

Full Text Available Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 - 76 years. There were 78 (69% males and 35 females (31%. There were 22 subjects aged ≤18 years (childhood and adolescence and 91 adults (>18 years. Visual disturbances were the most common presenting complaint (33%, though headache was the most common symptom (81%. Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97% was the most common abnormality seen followed by hypothyroidism (83.2%, hypoadrenalism (79.6%, growth hormone deficiency (88.1% of the 42 patients tested, and diabetes insipidus (13.3%. Panhypopituitarism was seen in 104 (92% patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases.

A roadmap for evolving towards optical intra-data-center networks

DEFF Research Database (Denmark)

Dittmann, Lars; Fagertun, Anna Manolova; Kamchevska, Valerija

2016-01-01

The first part of this paper focuses on presenting an updated view on the state of the art in data center networks. The European project COSIGN has provided industrial optical data center network roadmaps, strategies and a techno-economic analysis of the involved industrial partners’ value propos...

Favorability for uranium in tertiary sedimentary rocks, southwestern Montana

International Nuclear Information System (INIS)

Wopat, M.A.; Curry, W.E.; Robins, J.W.; Marjaniemi, D.K.

1977-10-01

Tertiary sedimentary rocks in the basins of southwestern Montana were studied to determine their favorability for potential uranium resources. Uranium in the Tertiary sedimentary rocks was probably derived from the Boulder batholith and from silicic volcanic material. The batholith contains numerous uranium occurrences and is the most favorable plutonic source for uranium in the study area. Subjective favorability categories of good, moderate, and poor, based on the number and type of favorable criteria present, were used to classify the rock sequences studied. Rocks judged to have good favorability for uranium deposits are (1) Eocene and Oligocene strata and undifferentiated Tertiary rocks in the western Three Forks basin and (2) Oligocene rocks in the Helena basin. Rocks having moderate favorability consist of (1) Eocene and Oligocene strata in the Jefferson River, Beaverhead River, and lower Ruby River basins, (2) Oligocene rocks in the Townsend and Clarkston basins, (3) Miocene and Pliocene rocks in the Upper Ruby River basin, and (4) all Tertiary sedimentary formations in the eastern Three Forks basin, and in the Grasshopper Creek, Horse Prairie, Medicine Lodge Creek, Big Sheep Creek, Deer Lodge, Big Hole River, and Bull Creek basins. The following have poor favorability: (1) the Beaverhead Conglomerate in the Red Rock and Centennial basins, (2) Eocene and Oligocene rocks in the Upper Ruby River basin, (3) Miocene and Pliocene rocks in the Townsend, Clarkston, Smith River, and Divide Creek basins, (4) Miocene through Pleistocene rocks in the Jefferson River, Beaverhead River, and Lower Ruby River basins, and (5) all Tertiary sedimentary rocks in the Boulder River, Sage Creek, Muddy Creek, Madison River, Flint Creek, Gold Creek, and Bitterroot basins

Tertiary syphilis in the lumbar spine: a case report.

Science.gov (United States)

Bai, Yang; Niu, Feng; Liu, Lidi; Sha, Hui; Wang, Yimei; Zhao, Song

2017-07-24

The incidence of tertiary syphilis involvement in the spinal column with destructive bone lesions is very rare. It is difficult to establish the correct diagnosis from radiographs and histological examination alone. Limited data are available on surgical treatment to tertiary syphilitic spinal lesions. In this article, we report a case of tertiary syphilis in the lumbar spine with osteolytic lesions causing cauda equina compression. A 44-year-old man who suffered with low back pain for 6 months and progressive radiating pain at lower extremity for 1 week. Radiologic findings showed osteolytic lesion and new bone formation in the parts of the bodies of L4 and L5. Serum treponema pallidum hemagglutination (TPHA) test was positive. A surgery of posterior debridement, interbody and posterolateral allograft bone fusion with instrumentation from L3 to S1 was performed. The low back pain and numbness abated after operation. But the follow-up radiographs showed absorption of the bone grafts and failure of instrumentation. A Charcot's arthropathy was formed between L4 and L5. It is challenging to diagnose the tertiary syphilis in the spine. Surgery is a reasonable auxiliary method to antibiotic therapy for patients who suffered with neuropathy. Charcot's arthropathy should be considered as an operative complication.

Analysis of colonoscopic perforations at a local clinic and a tertiary hospital.

Science.gov (United States)

Sagawa, Toshihiko; Kakizaki, Satoru; Iizuka, Haruhisa; Onozato, Yasuhiro; Sohara, Naondo; Okamura, Shinichi; Mori, Masatomo

2012-09-21

To define the clinical characteristics, and to assess the management of colonoscopic complications at a local clinic. A retrospective review of the medical records was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic between April 2006 and December 2010. Data obtained from a tertiary hospital in the same region were also analyzed. The underlying conditions, clinical presentations, perforation locations, treatment types (operative or conservative) and outcome data for patients at the local clinic and the tertiary hospital were compared. A total of 10  826 colonoscopies, and 2625 therapeutic procedures were performed at a local clinic and 32  148 colonoscopies, and 7787 therapeutic procedures were performed at the tertiary hospital. The clinic had no perforations during diagnostic colonoscopy and 8 (0.3%) perforations were determined to be related to therapeutic procedures. The perforation rates in each therapeutic procedure were 0.06% (1/1609) in polypectomy, 0.2% (2/885) in endoscopic mucosal resection (EMR), and 3.8% (5/131) in endoscopic submucosal dissection (ESD). Perforation rates for ESD were significantly higher than those for polypectomy or EMR (P hospital. Six perforations occurred with therapeutic endoscopy (perforation rate, 0.08%; 1 per 1298 procedures). Perforation rates for specific procedure types were 0.02% (1 per 5500) for polypectomy, 0.17% (1 per 561) for EMR, 2.3% (1 per 43) for ESD in the tertiary hospital. There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital. The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital. No procedure-related mortalities occurred. Performing closure with endoscopic clipping reduced the C-reactive protein (CRP) titers. The mean maximum CRP titer was 2.9 ± 1.6 mg/dL with clipping and 9.7 ± 6.2 mg/dL without clipping

Pushing the frontiers of atomic models for protein tertiary structure ...

Indian Academy of Sciences (India)

as an NP complete or NP hard problem.4,5 This notwith- standing, the dire need for tertiary structures of proteins in drug discovery and other areas6–8 has propelled the development of a multitude of computational recipes. In this article, we focus on ab initio/de novo strategies,. Bhageerath in particular, for protein tertiary ...

Tertiary colleges: a study of perspectives on organizational innovation

OpenAIRE

Preedy, Margaret

1998-01-01

The purpose of this research study was to explore organisational innovation in education with reference to one particular type of organisation - the tertiary college. The research sought to examine the extent to which the intended objectives for new educational organisations are realised in practice, and how far the goals and ethos which organisational leaders seek to promote are shared by organisational members. The study focused on eleven tertiary colleges, comparing the 'official' view of ...

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

Science.gov (United States)

Hoffmann, T. L.; Lauterjung, J.

2017-12-01

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

Rethinking the Tertiary Mathematics Curriculum

Science.gov (United States)

Petocz, Peter; Reid, Anna

2005-01-01

Mathematics curriculum at the tertiary level is located within a range of social and cultural theories, and is often constructed by academics seeking to promulgate a particular view of mathematics. We argue that such a curriculum should incorporate a real acknowledgement of the different ways in which students understand the nature of mathematics…

General Allylic C–H Alkylation with Tertiary Nucleophiles

Science.gov (United States)

2015-01-01

A general method for intermolecular allylic C–H alkylation of terminal olefins with tertiary nucleophiles has been accomplished employing palladium(II)/bis(sulfoxide) catalysis. Allylic C–H alkylation furnishes products in good yields (avg. 64%) with excellent regio- and stereoselectivity (>20:1 linear:branched, >20:1 E:Z). For the first time, the olefin scope encompasses unactivated aliphatic olefins as well as activated aromatic/heteroaromatic olefins and 1,4-dienes. The ease of appending allyl moieties onto complex scaffolds is leveraged to enable this mild and selective allylic C–H alkylation to rapidly diversify phenolic natural products. The tertiary nucleophile scope is broad and includes latent functionality for further elaboration (e.g., aliphatic alcohols, α,β-unsaturated esters). The opportunities to effect synthetic streamlining with such general C–H reactivity are illustrated in an allylic C–H alkylation/Diels–Alder reaction cascade: a reactive diene is generated via intermolecular allylic C–H alkylation and approximated to a dienophile contained within the tertiary nucleophile to furnish a common tricyclic core found in the class I galbulimima alkaloids. PMID:24641574

General allylic C-H alkylation with tertiary nucleophiles.

Science.gov (United States)

Howell, Jennifer M; Liu, Wei; Young, Andrew J; White, M Christina

2014-04-16

A general method for intermolecular allylic C-H alkylation of terminal olefins with tertiary nucleophiles has been accomplished employing palladium(II)/bis(sulfoxide) catalysis. Allylic C-H alkylation furnishes products in good yields (avg. 64%) with excellent regio- and stereoselectivity (>20:1 linear:branched, >20:1 E:Z). For the first time, the olefin scope encompasses unactivated aliphatic olefins as well as activated aromatic/heteroaromatic olefins and 1,4-dienes. The ease of appending allyl moieties onto complex scaffolds is leveraged to enable this mild and selective allylic C-H alkylation to rapidly diversify phenolic natural products. The tertiary nucleophile scope is broad and includes latent functionality for further elaboration (e.g., aliphatic alcohols, α,β-unsaturated esters). The opportunities to effect synthetic streamlining with such general C-H reactivity are illustrated in an allylic C-H alkylation/Diels-Alder reaction cascade: a reactive diene is generated via intermolecular allylic C-H alkylation and approximated to a dienophile contained within the tertiary nucleophile to furnish a common tricyclic core found in the class I galbulimima alkaloids.

Clinicopathologic features of adult T-cell leukemias/lymphomas at a North American tertiary care medical center: infrequent involvement of the central nervous system.

Science.gov (United States)

Hsi, Andy C; Kreisel, Friederike H; Frater, John L; Nguyen, TuDung T

2014-02-01

Human T-cell lymphotropic virus type 1 is associated with adult T-cell leukemia/lymphoma (ATLL). Published series of ATLLs seen at a United States medical institution are rare. We present the features of 4 ATLLs diagnosed at our North American tertiary care medical center from 1990 to 2012. Despite the absence of a history of origin from an endemic region, all our ATLLs demonstrated evidence of human T-cell lymphotropic virus type 1 infection. Central nervous system (CNS) involvement by ATLL was uncommon in our series, and represented only 1.6% (1/64) of all CNS B-cell or T-cell lymphomas diagnosed over a 20+ year period at our institution. Review of the medical literature reveals that the majority of CNS-involved ATLLs present with the lymphoma or acute subtype, and complete remission is difficult to achieve in these cases. CNS involvement frequently occurs with a systemic disease, which carries an aggressive clinical course with poor prognosis. In addition, CNS involvement by ATLL can be the initial presentation or seen with relapsed disease, can be the only site or be associated with other tissue sites of involvement, and may manifest with variable clinical signs/symptoms. Our retrospective study reveals that ATLLs are rare mature T-cell lymphomas in a native North American population, but the clinical and histopathologic features of ATLLs from this nonendemic region are similar to those seen from other endemic regions. Early recognition of these rare ATLLs involving uncommon sites, such as the CNS, will help optimize treatment for these infrequent mature T-cell lymphomas.

[Decomposition model of energy-related carbon emissions in tertiary industry for China].

Science.gov (United States)

Lu, Yuan-Qing; Shi, Jun

2012-07-01

Tertiary industry has been developed in recent years. And it is very important to find the factors influenced the energy-related carbon emissions in tertiary industry. A decomposition model of energy-related carbon emissions for China is set up by adopting logarithmic mean weight Divisia method based on the identity of carbon emissions. The model is adopted to analyze the influence of energy structure, energy efficiency, tertiary industry structure and economic output to energy-related carbon emissions in China from 2000 to 2009. Results show that the contribution rate of economic output and energy structure to energy-related carbon emissions increases year by year. Either is the contribution rate of energy efficiency or the tertiary industry restraining to energy-related carbon emissions. However, the restrain effect is weakening.

International Center for Gas Technology Information

International Nuclear Information System (INIS)

Gad, L.H.

1993-01-01

Based on an acknowledgement of the growing importance of natural gas, a number of European countries, USA, Japan and the Russian Federation have worked together in order to establish a common center of information on natural gas technology under the auspices of the International Energy Agency. Centers were to be established in Washington and in Denmark. The centers will concern themselves with establishing an international information center for gas technology, effecting natural gas technology transfer between global regions, carrying out analytical studies on the energy market and the development of technology within the field of natural gas. The structure of the decision-making processes that will be employed is explained in addition to the organization and economy. The centers should build up a global information network between the relevant countries, their gas companies, institutions etc. (AB)

Increasing Recovery of Nontuberculous Mycobacteria from Respiratory Specimens over a 10-Year Period in a Tertiary Referral Hospital in South Korea

OpenAIRE

Koh, Won-Jung; Chang, Boksoon; Jeong, Byeong-Ho; Jeon, Kyeongman; Kim, Su-Young; Lee, Nam Yong; Ki, Chang-Seok; Kwon, O Jung

2013-01-01

Background The number of patients with pulmonary disease caused by nontuberculous mycobacteria (NTM) has been increasing worldwide. The aim of this study was to evaluate long-term trends in the NTM recovery rate from respiratory specimens over a 10-year period in a tertiary referral hospital in South Korea. Methods We retrospectively reviewed the records of mycobacterial cultures of respiratory specimens at Samsung Medical Center from January 2001 to December 2011. Results During the study pe...

bilingualism in the english of tertiary students: a sine-qua-non

African Journals Online (AJOL)

REV YOUNG EZENWA OBIOHA

questions were used to investigate the effects of Bilingualism on the English of tertiary students. A total of three hundred students from two tertiary institutions were used. ... thoughts, inner feelings, personal psychological ... Chinese migration to the U.S.A (Akindele & ... child is taught Mathematical multiplication and division ...

Validation of the 2014 European Society of Cardiology guidelines risk prediction model for the primary prevention of sudden cardiac death in hypertrophic cardiomyopathy.

Science.gov (United States)

Vriesendorp, Pieter A; Schinkel, Arend F L; Liebregts, Max; Theuns, Dominic A M J; van Cleemput, Johan; Ten Cate, Folkert J; Willems, Rik; Michels, Michelle

2015-08-01

The recently released 2014 European Society of Cardiology guidelines of hypertrophic cardiomyopathy (HCM) use a new clinical risk prediction model for sudden cardiac death (SCD), based on the HCM Risk-SCD study. Our study is the first external and independent validation of this new risk prediction model. The study population consisted of a consecutive cohort of 706 patients with HCM without prior SCD event, from 2 tertiary referral centers. The primary end point was a composite of SCD and appropriate implantable cardioverter-defibrillator therapy, identical to the HCM Risk-SCD end point. The 5-year SCD risk was calculated using the HCM Risk-SCD formula. Receiver operating characteristic curves and C-statistics were calculated for the 2014 European Society of Cardiology guidelines, and risk stratification methods of the 2003 American College of Cardiology/European Society of Cardiology guidelines and 2011 American College of Cardiology Foundation/American Heart Association guidelines. During follow-up of 7.7±5.3 years, SCD occurred in 42 (5.9%) of 706 patients (ages 49±16 years; 34% women). The C-statistic of the new model was 0.69 (95% CI, 0.57-0.82; P=0.008), which performed significantly better than the conventional risk factor models based on the 2003 guidelines (C-statistic of 0.55: 95% CI, 0.47-0.63; P=0.3), and 2011 guidelines (C-statistic of 0.60: 95% CI, 0.50-0.70; P=0.07). The HCM Risk-SCD model improves the risk stratification of patients with HCM for primary prevention of SCD, and calculating an individual risk estimate contributes to the clinical decision-making process. Improved risk stratification is important for the decision making before implantable cardioverter-defibrillator implantation for the primary prevention of SCD. © 2015 American Heart Association, Inc.

Comparing Chinese and European American mental health decision making.

Science.gov (United States)

Gao, Shanshan; Corrigan, Patrick W; Qin, Sang; Nieweglowski, Katherine

2017-12-20

Shared decision making (SDM) tends to reflect more Western values of individualism and empowerment, values that may be foreign to East Asian healthcare preferences for collectivism and family involvement: family centered decision making (FCDM). To show that Chinese will be more likely to believe FCDM would be more pleasing for them if they were the patient. Conversely, European Americans will respond more favorably to SDM. To examine effects of Western acculturation on FCDM compared to SDM. In this study, preferences for FCDM versus SDM and doctor-led decision making (DrDM) were examined in a vignette study completed online by European Americans (n = 298) and Chinese (n = 327). Research participants read a vignette about Lily (a depression patient) presenting with symptoms of depression. After reading the vignette, participants completed items representing two sets of outcomes: three perceptions of impact on Lily and how participants might respond for themselves in a similar decision making situation. Chinese rated FCDM greater than European and Chinese Americans. Chinese Americans mostly responded similar to European Americans and not Chinese. European Americans prefer SDM more for mental health services. Chinese value FCDM more than European Americans. Preferences of Chinese living in America seem to parallel European Americans.

Epilepsy in Ireland: towards the primary-tertiary care continuum.

Science.gov (United States)

Varley, Jarlath; Delanty, Norman; Normand, Charles; Coyne, Imelda; McQuaid, Louise; Collins, Claire; Boland, Michael; Grimson, Jane; Fitzsimons, Mary

2010-01-01

Epilepsy is a chronic neurological disease affecting people of every age, gender, race and socio-economic background. The diagnosis and optimal management relies on contribution from a number of healthcare disciplines in a variety of healthcare settings. To explore the interface between primary care and specialist epilepsy services in Ireland. Using appreciative inquiry, focus groups were held with healthcare professionals (n=33) from both primary and tertiary epilepsy specialist services in Ireland. There are significant challenges to delivering a consistent high standard of epilepsy care in Ireland. The barriers that were identified are: the stigma of epilepsy, unequal access to care services, insufficient human resources, unclear communication between primary-tertiary services and lack of knowledge. Improving the management of people with epilepsy requires reconfiguration of the primary-tertiary interface and establishing clearly defined roles and formalised clinical pathways. Such initiatives require resources in the form of further education and training and increased usage of information communication technology (ICT). Epilepsy services across the primary-tertiary interface can be significantly enhanced through the implementation of a shared model of care underpinned by an electronic patient record (EPR) system and information communication technology (ICT). Better chronic disease management has the potential to halt the progression of epilepsy with ensuing benefits for patients and the healthcare system. Copyright 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

CLINICOPATHOLOGICAL CHARACTERISTICS OF SOLITARY NODULE OF THYROID- A CROSS-SECTIONAL STUDY IN A TERTIARY CENTER

Directory of Open Access Journals (Sweden)

T. V. Haridas

2017-04-01

Full Text Available BACKGROUND Solitary Thyroid Nodules (STN occur in 4-7% of the adult population. Owing to increasing incidence of malignancy, it is necessary to differentiate patients with benign STN from malignant ones for early intervention and better patient management. The aim of the study is to study the clinicopathological characteristics of STN for better diagnosis, evaluation and management; evaluate the efficacy of FNAC in preoperative diagnostics of solitary thyroid nodules. MATERIALS AND METHODS The study was conducted over a period of one year at a tertiary healthcare institution in South India. One hundred patients with solitary nodule of thyroid were studied by taking detailed history and conducting clinical examination, thyroid hormone assay, ultrasonogram, FNAC and histopathological examination. The chances of malignancy and age, sex and site distribution were also analysed. RESULTS Solitary thyroid nodule cases showed female preponderance (81%, presented mostly as neck swelling followed by dysphagia (11%. Most common FNAC report was of colloid nodule (61%, followed by follicular neoplasm (20% and papillary carcinoma (9%. Final HPR showed 53% as colloid nodule and 27% as papillary carcinoma. CONCLUSION Differentiating between benign and malignant lesions and their comprehensive management are the challenges presented by STN. Fine Needle Aspiration Cytology (FNAC is the diagnostic tool of choice for the initial evaluation of STN.

Impact of generic antiretroviral therapy (ART) and free ART programs on time to initiation of ART at a tertiary HIV care center in Chennai, India.

Science.gov (United States)

Solomon, Sunil S; Lucas, Gregory M; Kumarasamy, Nagalingeswaran; Yepthomi, Tokugha; Balakrishnan, Pachamuthu; Ganesh, Aylur K; Anand, Santhanam; Moore, Richard D; Solomon, Suniti; Mehta, Shruti H

2013-08-01

Antiretroviral therapy (ART) access in the developing world has improved, but whether increased access has translated to more rapid treatment initiation among those who need it is unknown. We characterize time to ART initiation across three eras of ART availability in Chennai, India (1996-1999: pregeneric; 2000-2003: generic; 2004-2007: free rollout). Between 1996 and 2007, 11,171 patients registered for care at the YR Gaitonde Centre for AIDS Research and Education (YRGCARE), a tertiary HIV referral center in southern India. Of these, 5726 patients became eligible for ART during this period as per Indian guidelines for initiation of ART. Generalized gamma survival models were used to estimate relative times (RT) to ART initiation by calendar periods of eligibility. Time to initiation of ART among patients in Chennai, India was also compared to an HIV clinical cohort in Baltimore, USA. Median age of the YRGCARE patients was 34 years; 77% were male. The median CD4 at presentation was 140 cells/µl. After adjustment for demographics, CD4 and WHO stage, persons in the pregeneric era took 3.25 times longer (95% confidence interval [CI]: 2.53-4.17) to initiate ART versus the generic era and persons in the free rollout era initiated ART more rapidly than the generic era (RT: 0.73; 95% CI: 0.63-0.83). Adjusting for differences across centers, patients at YRGCARE took longer than patients in the Johns Hopkins Clinical Cohort (JHCC) to initiate ART in the pregeneric era (RT: 4.90; 95% CI: 3.37-7.13) but in the free rollout era, YRGCARE patients took only about a quarter of the time (RT: 0.31; 95% CI: 0.22-0.44). These data demonstrate the benefits of generic ART and government rollouts on time to initiation of ART in one developing country setting and suggests that access to ART may be comparable to developed country settings.

Recruitment Of International Students Into Cameroon Tertiary ...

African Journals Online (AJOL)

Recruitment Of International Students Into Cameroon Tertiary Institutions In The Absence Of International Offices. ... The present system of recruiting international students is haphazardly been handled by ... AJOL African Journals Online.

Inpatient dermatology: Characteristics of patients and admissions in a tertiary level hospital in Eastern India

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Arpita Sen

2016-01-01

Full Text Available Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27% were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33% and infective disorders (73 patients, 19.47%. Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2% improved after hospitalization; while 29 (7.73% patients died from their illness. About 133 patients (35.64% required referral services during their stay, while 8 patients (2.13% were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.

Open-Access Single Balloon Enteroscopy: A Tertiary Care Experience.

Science.gov (United States)

Holman, Nathan; Wallace, Kristin; Moore, J Matthew; Brock, Andrew S

2015-12-01

To compare single balloon enteroscopy (SBE) between patients seen in consultation by a member of our gastroenterology team with those performed as open-access cases. Retrospective study of all patients who underwent SBE at a single tertiary care center from April 2008 to January 2012. Open- and closed-access procedures were compared in terms of diagnostic and therapeutic yield, adverse events, and procedural success. A total of 125 SBEs were performed on 125 patients. The mean age was 63.1 (53% men) years. In all, 43 procedures were performed open access and 82 after face-to-face consultation. Indications included anemia/gastrointestinal bleeding (110), abdominal pain (8), and other (7). Diagnostic yield for open- and closed-access procedures was 53% and 60%, respectively (P = 0.501) and therapeutic yield was 37% and 52%, respectively (P = 0.11). Overall technical success was 91% with no difference between the groups (P = 0.27). There were no major adverse events in either group. SBE can be performed as an open-access procedure without compromise to safety or diagnostic yield.

Study of clinical spectrum of pediatric dermatoses in patients attending a Tertiary Care Center in North Kerala

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Venkata Subba Reddy

2016-01-01

Full Text Available Introduction: Skin diseases are a major health problem in the pediatric age group. Aim: To determine the prevalence and clinical characteristics of different pediatric dermatoses in a tertiary care centre in Kerala. Materials and Methods: Children with age 18 years and below with clinical evidence of cutaneous disorders were studied. Results: 500 cases were studied which showed a female preponderance of 51.4%. The most common dermatoses was infections and infestations (33.8% followed by eczemas (32.6%, disorders of sweat and sebaceous glands (7.4%, keratinisation and paulosquamous disorders (4%. Nutritional disorders were seen in 1% of children. 3.6% had photodermatoses, 2.6% had hair and nail disorders and 0.4 % had adverse cutaneous drug reactions. Conclusions: Fungal infection was the most common infection noted in the study, followed by viral and bacterial infection. Allergic contact dermatitis was the commonest exogenous eczema and juvenile plantar dermatosis was the commonest endogenous eczemas. Acne, insect bite reaction and miliaria were the other common dermatoses.

Regional Tectonic Control of Tertiary Mineralization and Recent Faulting in the Southern Basin-Range Province, an Application of ERTS-1 Data

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Bechtold, I. C.; Liggett, M. A.; Childs, J. F.

1973-01-01

Research based on ERTS-1 MSS imagery and field work in the southern Basin-Range Province of California, Nevada and Arizona has shown regional tectonic control of volcanism, plutonism, mineralization and faulting. This paper covers an area centered on the Colorado River between 34 15' N and 36 45' N. During the mid-Tertiary, the area was the site of plutonism and genetically related volcanism fed by fissure systems now exposed as dike swarms. Dikes, elongate plutons, and coeval normal faults trend generally northward and are believed to have resulted from east-west crustal extension. In the extensional province, gold silver mineralization is closely related to Tertiary igneous activity. Similarities in ore, structural setting, and rock types define a metallogenic district of high potential for exploration. The ERTS imagery also provides a basis for regional inventory of small faults which cut alluvium. This capability for efficient regional surveys of Recent faulting should be considered in land use planning, geologic hazards study, civil engineering and hydrology.

Internships enhancing entrepreneurial intent and self-efficacy: Investigating tertiary-level entrepreneurship education programmes

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Melodi Botha

2016-09-01

Full Text Available Background: Entrepreneurship education interventions are deemed effective when they enhance interns’ entrepreneurial intent (EI and entrepreneurial self-efficacy (ESE. Notwithstanding the emergence of internship as an experiential learning approach in entrepreneurship education, evidence about their potential to foster EI and ESE lacks systemisation. Aim: The aim of this study was to determine whether internships enhance EI and ESE. Furthermore, to what extent South African tertiary institutions include internships in their entrepreneurship and management curricula and the obstacles to such inclusion. Setting: South Africa has made a concerted effort to insert an entrepreneurship component across tertiary curricula. The evolution of this entrepreneurship component to experiential learning approaches is, however, unclear. Methods: A qualitative research approach was followed. Firstly, it reviewed empirical evidence for the positive relationship between internships and EI and ESE. Secondly, it conducted a survey of entrepreneurship and business management programmes at all 23 South African tertiary institutions and content analysed the retrieved information to determine whether such programmes include internships. Finally, 10 experts were interviewed to unveil the constraints inhibiting the inclusion of internships in tertiary curricula. Results: The results revealed empirical support for the positive influence of internships on both EI and ESE. Significant lack of inclusion of internships in tertiary curricula in South Africa emerged, owing mainly to administrative issues, curriculum re-design challenges, and lack of mentoring capacity. Conclusion: Tertiary-level entrepreneurship education programmes should include an internship component. The paper suggested that tertiary institutions pilot-test the inclusion of internships with a small number of students and a selected cohort of small business owners.

Analysis of Management Practices in Lagos State Tertiary Institutions through Total Quality Management Structural Framework

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AbdulAzeez, Abbas Tunde

2016-01-01

This research investigated total quality management practices and quality teacher education in public tertiary institutions in Lagos State. The study was therefore designed to analyse management practices in Lagos state tertiary institutions through total quality management structural framework. The selected public tertiary institutions in Lagos…

The role of endorectal ultrasound and magnetic resonance imaging in the management of early rectal lesions in a tertiary center.

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Patel, Rikesh Kumar; Sayers, Adele Elizabeth; Kumar, Prashanth; Khulusi, Sam; Razack, Abdul; Hunter, Iain Andrew

2014-12-01

In early rectal cancer, ERUS has a vital role in determining radical or local excision based on identification of T-stage. Transanal endoscopic microsurgery (TEMs) has a reduced morbidity and mortality compared with radical surgery. Correct identification of lesions that can be managed with TEMs is therefore imperative. Our aim was to assess the accuracy of ERUS in identifying mucosal/submucosal lesions and thus their suitability for TEMs. A retrospective analysis of a prospectively maintained database of patients who underwent ERUS was carried out over an initial 25-month period at a tertiary colorectal center. Our main outcome measures were T-stage measured using ERUS or magnetic resonance imaging (MRI) (indicating suitability for local excision, ie, ≤ T1) with correlation with that of the subsequent surgical specimen and improvement in accuracy over time. After data analysis and review, the study was repeated over the subsequent 12 months to establish whether there was a learning curve with the use of ERUS. Over the initial period, 52 patients who met the inclusion criteria underwent ERUS. T-staging was accurate in 73.1% (38/52) with identification of ≤ T1 lesions having a sensitivity of 70.8% and a specificity 100%. The accuracy, sensitivity, and specificity of MRI was similar to that of ERUS (72.7%, 70.0%, and 100% respectively). Over the subsequent period, 23 patients underwent ERUS with T-staging accuracy improving to 78.3% (18/23) (P = .777). In our experience, ERUS is a useful adjunct to clinical assessment and pelvic MRI in determining suitability for local excision. Its 100% specificity in determining that a lesion is limited to the mucosa or submucosa aids in the assessment of lesions that are being considered for submucosal resection. Over the time periods assessed, improvement in T-staging accuracy was demonstrated, which might be due to the presence of a learning curve. Copyright © 2014 Elsevier Inc. All rights reserved.

Feedback from European Social Partners as Part of the Consultation on the Commission's Memorandum on Lifelong Learning. Supporting Document to the Communication from the Commission Making a European Area of Lifelong Learning a Reality.

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Commission of the European Communities, Brussels (Belgium). Directorate-General for Education and Culture.

This document provides European social partners' responses to the Commission's memorandum on lifelong learning. Part 1, Opinion of the European Center of Enterprises, makes comments and proposals related to the memorandum's six key messages, which are new basic skills for all; more investment in human resources; innovation in teaching and…

Sexually Transmitted Infections: Experience in a Multidisciplinary Clinic in a Tertiary Hospital (2010-2013).

Science.gov (United States)

Moreno-Ribera, N; Fuertes-de Vega, I; Blanco-Arévalo, J L; Bosch-Mestres, J; González-Cordón, A; Estrach-Panella, T; García-de Olalla, P; Alsina-Gibert, M

2016-04-01

The number of consultations for sexually transmitted infections (STIs) is increasing in Spain. The aim of this study was to describe and analyze the epidemiological, behavioral, clinical, and microbiological characteristics of patients registered at the STI unit of a tertiary hospital. This was a retrospective, single-center descriptive study carried out between 2010 and 2013 in a multidisciplinary unit specialized in STIs, situated in a tertiary hospital. Epidemiological, clinical, and behavioral data were gathered using a face-to-face interview and a standardized questionnaire. Samples were collected for microbiology analysis. The study included 546 patients: 96% were men, 41% had human immunodeficiency virus (HIV) infection, and 56% were men who have sex with men. The reasons for consultation were the following: urethritis; genital, anal, or perianal ulcers; proctitis; oral ulcers; sexual contact with a person with a known STI; and high-risk sexual contact. The most common microbiological diagnoses were Neisseria gonorrhoeae in urethritis, Treponema pallidum in genital and anal or perianal ulcers, and Chlamydia trachomatis lymphogranuloma venereum serovars in proctitis. The highest prevalences of the main STIs studied occurred in homosexual men with HIV infection. This study confirms the increase in the incidence of STIs in recent years and the epidemiological characteristics of the HIV/STI epidemic in Spain. Copyright © 2015 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 2017; Session "Ethics"

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--- Various Authors

2017-10-01

Full Text Available Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR, European Society for Neonatology (ESN, Union of European Neonatal & Perinatal Societies (UENPS, European Foundation for the Care of Newborn Infants (EFCNIORGANIZING COMMITTEELuc Zimmermann (President of ESPR, Morten Breindahl (President of ESN, Manuel Sánchez Luna (President of UENPS, Silke Mader (Chairwoman of the Executive Board and Co-Founder of EFCNISCIENTIFIC COMMITTEEVirgilio P. Carnielli (Congress President Chair, Pierre Gressens (Past Scientific President, Umberto Simeoni, Manon Benders, Neil Marlow, Ola D. Saugstad, Petra Hüppi, Agnes van den HoogenSession "Ethics"ABS 1. THE DELIVERY OF BAD NEWS: A ONE OR 2-STEP APPROACH? THE CASE FOR TRISOMY 21 • M.S. Schimmel, M.Y. Kassirer, H.M. TowersABS 2. NEONATAL ORGAN DONATION: A POTENTIAL NEW DONOR SOURCE FOR CELL AND ORGAN TRANSPLANTATION • C. Jorns, E. Henckel, G. Nowak, A. Karadagi, T. Kjellin, E. Bluhme, Ö. Jynge, M. Hending, A. Croon, M. Söderström, B. Fischler, A. Nemeth, R. Gramignoli, S. Strom, E. Ellis, B. HallbergABS 3. HEALTH CARE PROFESSIONALS’ AND PARENTS’ ATTITUDES TOWARD PARENTAL AUTONOMY AND THE BEST INTEREST OF THE EXTREME PRETERM INFANT: A NATIONAL STUDY IN SWITZERLAND • M. Hendriks, H. Bucher, S. Klein, R. Baumann-Holzle, J. Streuli, J. FauchèreABS 4. CHANGING PARENTAL PERCEPTIONS IN TRISOMIES – A POTENTIAL ETHICAL DILEMMA FOR NEONATOLOGISTS? • E. Simons, P. Nath, P. ParthasarathyABS 5. INGEBORG SYLLM-RAPOPORT (1912-2017 – AN EXEMPLARY LIFE FOR CHILDREN AND PAEDIATRICS • H. Sallmon, R.R. Wauer, C.C. RoehrABS 6. RETROSPECTIVE ANALYSES OF PARENTAL COUNSELING AND DECISION MAKING FOR EXTREME PRETERM BIRTH IN A TERTIARY DUTCH PERINATAL CENTER • E. de Booij, J

Chemoselective reductive nucleophilic addition to tertiary amides, secondary amides, and N-methoxyamides.

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Nakajima, Minami; Oda, Yukiko; Wada, Takamasa; Minamikawa, Ryo; Shirokane, Kenji; Sato, Takaaki; Chida, Noritaka

2014-12-22

As the complexity of targeted molecules increases in modern organic synthesis, chemoselectivity is recognized as an important factor in the development of new methodologies. Chemoselective nucleophilic addition to amide carbonyl centers is a challenge because classical methods require harsh reaction conditions to overcome the poor electrophilicity of the amide carbonyl group. We have successfully developed a reductive nucleophilic addition of mild nucleophiles to tertiary amides, secondary amides, and N-methoxyamides that uses the Schwartz reagent [Cp2 ZrHCl]. The reaction took place in a highly chemoselective fashion in the presence of a variety of sensitive functional groups, such as methyl esters, which conventionally require protection prior to nucleophilic addition. The reaction will be applicable to the concise synthesis of complex natural alkaloids from readily available amide groups. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India.

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Gandhi, K; Sahni, N; Padhy, S K; Mathew, P J

2017-10-23

The residents undergoing training at hospitals in our country face challenges in terms of infrastructure and high workload with undefined working hours. The aim of the study was to compare the stress and burnout levels in trainee doctors doing residency in surgical fields and anesthesia at a tertiary care academic center in North India. A comparative, observational study was conducted in a tertiary care teaching hospital in North India. After Ethics Committee approval, 200 residents (100 each from surgical branches and anesthesia) were required to fill a questionnaire with information about age, sex, year of residency, marital status, and the Perceived Stress Scale-10, and Burnout Clinical Subtype Questionnaire-12. Burnout and perceived stress were compared between residents of anesthesia and surgical specialties. Residents of both surgical and anesthesia branches scored high in perceived stress, namely 21 and 18, respectively. The score was significantly higher in surgical residents (P = 0.03) and increased progressively with the year of residency. The majority of residents (90% surgical, 80% anesthesia) felt that they were being overloaded with work. However, only 20%-30% of respondents felt that there was lack of development of individual skills and still fewer (<10%) reported giving up in view of difficulties. There is high level of stress and overload dimension of burnout among the residents of anesthesia and surgical branches at our tertiary care academic institution and the surgical residents score marginally higher than anesthesia residents.

Frozen Chirality of Tertiary Aromatic Amides: Access to Enantioenriched Tertiary α-Amino Acid or Amino Alcohol without Chiral Reagent.

Science.gov (United States)

Mai, Thi Thoa; Viswambharan, Baby; Gori, Didier; Guillot, Régis; Naubron, Jean-Valère; Kouklovsky, Cyrille; Alezra, Valérie

2017-04-27

One of the fundamental and intriguing aspects of life is the homochirality of the essential molecules. In this field, the absolute asymmetric synthesis of α-amino acids is a major challenge. Herein, we report access, by chemical means, to tertiary α-amino acid derivatives in up to 96 % ee without using any chiral reagent. In our strategy, the dynamic axial chirality of tertiary aromatic amides is frozen in a crystal and is responsible for the stereoselectivity of the subsequent steps. Furthermore, we could control the configuration of the final product by manually sorting and selecting the initial crystals. Based on vibrational circular dichroism studies, we could rationalize the observed stereoselectivity. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Tertiary classes–after Chern-Simons theory

Indian Academy of Sciences (India)

J.N. Iyer Institute of Mathematical Sciences Chennai, India

2013-11-08

Nov 8, 2013 ... Euler characteristic class. In early twentieth century, the notion of local product structure, i.e. fiber spaces and their generalizations appeared, in the study of topological spaces (with additional structures). J.N. Iyer. IMSc, Chennai. Tertiary classes–after Chern-Simons theory ...

Tertiary Journalism Education: Its Value in Cadet Selection at Metropolitan Media.

Science.gov (United States)

Alysen, Barbara

2001-01-01

Notes tertiary study in journalism has been a feature of the education of Australian journalists for decades, yet many industry representatives remain skeptical of its value. Finds applicants for entry-level jobs with a tertiary journalism qualification can expect to secure, on average, at least half the available positions in any cadet or trainee…

Transition and Tertiary Education: A Case Study of Mzuzu University, Malawi

Science.gov (United States)

Zozie, Paxton Andrew; Kayira, Peter Benwell

2012-01-01

This article reviews the role of guidance and counselling in Malawi in reducing dropout and easing the transition of students to tertiary education, as well as in helping them during their time in tertiary education. It begins by identifying key success factors in guidance and counselling services for learners in both developed and developing…

Sexual harassment in tertiary institutions: A comparative perspective

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Joseph Janice

2015-01-01

Full Text Available Sexual harassment is not a new phenomenon in tertiary institutions. It has been receiving considerable attention in research and the media and public awareness has increased dramatically. However, the term sexual harassment is not used uniformly across the globe because countries have defined it differently. Consequently, prevalence of sexual harassment in education varies across cultures. This paper examines sexual harassment from a comparative perspective. It specifically focuses on the definition of sexual harassment, incidence of sexual harassment of students in tertiary institutions, effects of sexual harassment on victims; and victims’ responses to sexual harassment. It also offers suggestions for curtailing sexual harassment in these institutions.

The European Commission proposes changes to the directive on nuclear safety

International Nuclear Information System (INIS)

Anon.

2013-01-01

The European Commission proposes changes in the ancient European directive on nuclear safety in order to europeanize nuclear safety. The first proposal is to submit all European nuclear facilities to a control every 6 years by a board of foreign experts. Another proposal is to impose that every new power plant should be designed so that the radiological impact of an accident should be limited to the facility itself. The same proposal would impose for every nuclear plant the presence of an emergency center resistant to radiation, earthquakes and floods. The reporting of any incident occurring in a nuclear plant would be made compulsory. The decision to extend the operating life of a nuclear plant would be suspended to the results of a compulsory safety test. (A.C.)

The equity imperative in tertiary education: Promoting fairness and efficiency

Science.gov (United States)

Salmi, Jamil; Bassett, Roberta Malee

2014-06-01

While the share of the tertiary education age cohort (19-25) which is being given the opportunity to study has increased worldwide over the past two decades, this does not in fact translate into reduced inequality. For many young people, especially in the developing world, major obstacles such as disparities in terms of gender, minority population membership or disabilities as well as academic and financial barriers are still standing in their way. The authors of this article propose a conceptual framework to analyse equity issues in tertiary education and document the scope, significance and consequences of disparities in tertiary education opportunities. They throw some light on the main determinants of these inequalities and offer suggestions about effective equity promotion policies directed towards widening participation and improving the chances of success of underprivileged youths in order to create societies which uphold humanistic values.

Total costs and benefits of biomass in selected regions of the European Union - BioCosts

Energy Technology Data Exchange (ETDEWEB)

Almeida, A de; Costa, F B [Coimbra Univ. (Portugal). Inst. de Sistemas e Robotica; Bauen, A [London Univ. (United Kingdom). Div. of Life Sciences; and others

1998-11-01

In the BioCosts project, representative biomass-to-electricity and biomass-to-transport-service fuel cycles located at different sites within the European Union have been evaluated concerning their environmental and economic performance. Each case study was compared to a fossil-fuel fired reference case. The case studies examined comprise: utilisation of forestry residues in the Naessjoe circulating fluidized bed combustion plant, Sweden, versus the use of Polish coal in the same plant; utilisation of forestry residues and short-rotation coppice for industrial combined heat and power production in Mangualde, Portugal, versus the use of fuel oil in an engine generating heat and power; production of biogas from manure slurry for municipal combined heat and power generation at Hashoej, Denmark, versus the use of Danish natural gas in the same engine; gasification of woody biomass for combined heat and power generation in Vaernamo, Sweden, and Eggborough, UK, versus the use of coal in the Naessjoe plant mentioned above and a UK power plant; production of cold-pressed rape-seed oil and its use in a cogeneration plant at Weissenburg, Germany, versus the use of diesel fuel in a similar engine; production of rape-seed oil methyl ester and its use for goods transport in Germany, versus the use of diesel fuel in the same fleet of trucks; production of ethyl tertiary butyl ether from sugar beets and sweet sorghum for transport applications in France, versus the use of methyl tertiary butyl ether from fossil sources for the same purpose 130 refs, 25 figs, 42 tabs. Research funded in part by the European Commission in the JOULE III programme

EVALUATION OF BIOMEDICAL WASTE MANAGEMENT PRACTICES IN MULTI-SPECIALITY TERTIARY HOSPITAL

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Shalini Srivastav

2010-06-01

Full Text Available Background: Biomedical Waste (BMW, collection and proper disposal has become a significant concern for both the medical and the general community The scientific “Hospital waste Management “is of vital importance as its improper management poses risks to the health care workers ,waste handlers patients, community in general and largely the environment. Objectives: (i To assess current practices of Bio-medical Waste management including generation, collection, transportation storage, treatment and disposal technologies in tertiary health care center. (ii To assess health andsafetypracticesfor the health care personnel involved in Bio-Medical waste Management. Materials and Methods: Waste management practices in tertiary care-centre was studied during May 2010 June 2010. The information/data regarding Bio-Medical Waste Management practices and safety was collected by way of semi structured interview, proforma being the one used for WASTE AUDITING QUESTIONNAIRE. The information collected was verified by personal observations of waste management practices in each ward of hospital. Results : SRMS-IMS generates 1. 25Kgs waste per bed per day and maximum waste is generated in wards. The institute has got separate color coded bins in each ward for collection of waste but segregation practices needs to be more refined. The safety measures taken by health care workers was not satisfactory it was not due to unavailability of Personal protective measures but because of un-awareness of health hazards which may occur due to improper waste management practices. Thus it is concluded that there should be strict implementation of a waste management policy set up in the institute, training and motivation must be given paramount importance to meet the current needs and standard of bio-medical waste management.

Postpartum intrauterine contraceptive device: Knowledge and factors affecting acceptance among pregnant/parturient women attending a large tertiary health center in Puducherry, India

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Abinaya Valliappan

2017-01-01

Full Text Available Context: Intrauterine contraceptive device (IUCD has been recommended for insertion within 10 min of placental delivery or within 48 h of delivery (postpartum IUCD [PPIUCD] by the WHO. However, the acceptance across our country has been low. Aims: To determine the level of knowledge and the factors affecting it and the likely adoption of PPIUCD. Settings and Design: This cross-sectional study was carried out in the antenatal clinic and postnatal ward of a large tertiary care center in South India. Subjects and Methods: A total of 339 women were studied with the help of a validated structured pro forma. Proportions were expressed in percentage. Chi-square test was applied to compare proportions and univariate analysis for the factors affecting knowledge and likely acceptance. Results: Among the 339 women, 152 (44.8% were aware of the method. Of the 152 women, 56 had a negative attitude about the method. Multiparity of the women was a significant factor affecting knowledge (χ2 = 8.068, P = 0.045. Women who were not exposed to formal health counseling were significantly associated with a lack of knowledge (χ2 = 23.332, P = 0.0001. Primiparity (χ2 = 14.683, P = 0.0001, husbands with skilled jobs (χ2 = 8.272, P = 0.0407, having shared information with their husband regarding the method (χ2 = 38.1, P < 0.001, and family support (χ2 = 58.25, P < 0.001 were the major factors associated with willingness to adopt the method. Conclusion: The level of knowledge about PPIUCD of our study population is 44.8%. Exposure to formal health counseling classes and prior discussion with husbands and family members could improve the knowledge and likelihood of acceptance of PPIUCD.

Burnout in Otolaryngology-Head and Neck Surgery: A Single Academic Center Experience.

Science.gov (United States)

Geelan-Hansen, Katie; Anne, Samantha; Benninger, Michael S

2018-05-01

Burnout in modern medicine is becoming more recognized and researched. The objective in this study is to evaluate burnout in a tertiary care academic institution and compare results among faculty, trainees, and advanced practice practitioners (APPs) in a cross-sectional survey using the Maslach Burnout Inventory. Fifty-two surveys were distributed; 44 participants completed the survey (85%): 25 staff physicians (57%), 14 resident physicians (32%), and 5 nurse practitioners (11%). Staff physicians had low emotional exhaustion, moderate depersonalization, and low result for reduced personal accomplishments; trainees reported low emotional exhaustion, high depersonalization, and moderate reduced personal accomplishment; and nurse practitioners reported moderate on all 3 dimensions. There is overall low burnout in this tertiary care academic center of otolaryngologist providers and no difference in rates among the different groups (trainees, APPs, staff). Measures addressing specific deficiencies among dimensions of burnout would be helpful to prevent disintegration of physician satisfaction into burnout.

Age of diagnosis of breast cancer in china: almost 10 years earlier than in the United States and the European union.

Science.gov (United States)

Song, Qing-Kun; Li, Jing; Huang, Rong; Fan, Jin-Hu; Zheng, Rong-Shou; Zhang, Bao-Ning; Zhang, Bin; Tang, Zhong-Hua; Xie, Xiao-Ming; Yang, Hong-Jian; He, Jian-Jun; Li, Hui; Li, Jia-Yuan; Qiao, You-Lin; Chen, Wan-Qing

2014-01-01

The study aimed to describe the age distribution of breast cancer diagnosis among Chinese females for comparison with the United States and the European Union, and provide evidence for the screening target population in China. Median age was estimated from hospital databases from 7 tertiary hospitals in China. Population-based data in China, United States and European Union was extracted from the National Central Cancer Registry, SEER program and GLOBOCAN 2008, respectively. Age-standardized distribution of breast cancer at diagnosis in the 3 areas was estimated based on the World Standard Population 2000. The median age of breast cancer at diagnosis was around 50 in China, nearly 10 years earlier than United States and European Union. The diagnosis age in China did not vary between subgroups of calendar year, region and pathological characteristics. With adjustment for population structure, median age of breast cancer at diagnosis was 50~54 in China, but 55~59 in United States and European Union. The median diagnosis age of female breast cancer is much earlier in China than in the United States and the European Union pointing to racial differences in genetics and lifestyle. Screening programs should start at an earlier age for Chinese women and age disparities between Chinese and Western women warrant further studies.

European Utility Requirements: European nuclear energy

International Nuclear Information System (INIS)

Komsi, M.; Patrakka, E.

1997-01-01

The work procedure and the content of the European Utility Requirements (EUR) concerning the future LWRs is described in the article. European Utility Requirements, produced by utilities in a number of European countries, is a document specifying the details relating to engineered safety, operating performance, reliability and economics of the reactors to be built by manufacturers for the European market

Surgical management of cesarean scar pregnancies – A single tertiary experience

Directory of Open Access Journals (Sweden)

Xiaohui Ong

2014-08-01

Full Text Available Cesarean scar pregnancies (CSPs are a rare complication of previous cesarean deliveries. As cesarean section rates continue to increase worldwide, the incidence of CSPs is likely to rise as well. The diagnosis and management of CSPs pose challenging problems to clinicians. Early accurate diagnosis is crucial, as CSP is a life-threatening emergency that can lead to potentially catastrophic consequences such as uterine rupture, hemorrhage, loss of fertility and maternal death. There is no general consensus, however, regarding the best means of management. Various case reports and case series have reported successful outcomes with medical treatment, surgical intervention, interventional radiology, as well as a combination of methods. We present a case series of CSPs managed in our center, a tertiary obstetrics and gynecology hospital. All were treated primarily by conservative and fertility-sparing surgical methods. We have also included a short review of the current literature on this rare but important condition.

Commission of the European Communities review of fast reactor activities, March 1981

Energy Technology Data Exchange (ETDEWEB)

Balz, W [Commission of the European Communities, Brussels (Belgium)

1981-05-01

The Commission of the European Communities continued its activities in the field of fast reactors development essentially in the frame of the Fast Reactor Coordinating Committee (FRCC) and by execution of a Reactor Programme at its Joint Research Center (JRC). The study was concerned with introducing fast reactors into European Community, elaboration of preliminary safety criteria and guidelines for typical fast reactor accidents; codes and standards; LMFBR safety, fuel, fuel cycle safety.

Commission of the European Communities review of fast reactor activities, March 1981

International Nuclear Information System (INIS)

Balz, W.

1981-01-01

The Commission of the European Communities continued its activities in the field of fast reactors development essentially in the frame of the Fast Reactor Coordinating Committee (FRCC) and by execution of a Reactor Programme at its Joint Research Center (JRC). The study was concerned with introducing fast reactors into European Community, elaboration of preliminary safety criteria and guidelines for typical fast reactor accidents; codes and standards; LMFBR safety, fuel, fuel cycle safety

Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades.

Science.gov (United States)

Epstein, Jonathan I; Feng, Zhaoyong; Trock, Bruce J; Pierorazio, Phillip M

2012-05-01

Prior studies assessing the correlation of Gleason score (GS) at needle biopsy and corresponding radical prostatectomy (RP) predated the use of the modified Gleason scoring system and did not factor in tertiary grade patterns. To assess the relation of biopsy and RP grade in the largest study to date. A total of 7643 totally embedded RP and corresponding needle biopsies (2004-2010) were analyzed according to the updated Gleason system. All patients underwent prostate biopsy prior to RP. The relation of upgrading or downgrading to patient and cancer characteristics was compared using the chi-square test, Student t test, and multivariable logistic regression. A total of 36.3% of cases were upgraded from a needle biopsy GS 5-6 to a higher grade at RP (11.2% with GS 6 plus tertiary). Half of the cases had matching GS 3+4=7 at biopsy and RP with an approximately equal number of cases downgraded and upgraded at RP. With biopsy GS 4+3=7, RP GS was almost equally 3+4=7 and 4+3=7. Biopsy GS 8 led to an almost equal distribution between RP GS 4+3=7, 8, and 9-10. A total of 58% of the cases had matching GS 9-10 at biopsy and RP. In multivariable analysis, increasing age (pfactoring in multiple variables including the number of positive cores and the maximum percentage of cancer per core, the concordance indexes were not sufficiently high to justify the use of nomograms for predicting upgrading and downgrading for the individual patient. Almost 20% of RP cases have tertiary patterns. A needle biopsy can sample a tertiary higher Gleason pattern in the RP, which is then not recorded in the standard GS reporting, resulting in an apparent overgrading on the needle biopsy. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Learning Enhancement in Tertiary Institutions Using Mobile ...

African Journals Online (AJOL)

2012-12-01

Dec 1, 2012 ... model that is still by far the dominant mode of education and learning in tertiary institutions. In addition to identifying ... education has there been a technology that ..... Determinant of Mobile Learning Acceptance: An Empirical.

Influence Factor of Tertiary Students’ Employability Awareness Adjust Industry 4.0

Directory of Open Access Journals (Sweden)

Chun-Mei Chou

2017-09-01

Full Text Available This study aims to analyze the correlation (N=621 among tertiary students’ career planning, erecruiting adoption acceptance, and employability awareness in Taiwan. Tertiary students’ perceived career planning includes four factors, namely, self-appraisal, job expectancy, goal selection, and problem solving. E-recruiting adoption acceptance includes four factors, namely, playfulness, ease of use, effectiveness, and usefulness. Employability awareness includes four factors, namely, personal adaptability, employability ambition, career identity, and labour market. Participants responded to a 5-point Likert-type scale for each factor. Analysis was conducted using the structural equation modeling (SEM, and a good model fit was found for both the measurement and structural models. Research findings demonstrate that tertiary students’ career planning significantly and directly influences employability awareness. Career planning significantly and indirectly influences employability awareness by e-recruiting adoption acceptance. Tertiary students’ career planning and e-recruiting adoption acceptance fit the influence model and empirical data of employability awareness. Implications of this study, including the value of student self-assessment of their skills and utility of the e-recruiting to underpin personal career development planning and inform graduate recruitment processes, are discussed and recommendations made.

A theoretical analysis of procurement auctions for tertiary control in Germany

International Nuclear Information System (INIS)

Mueller, Gernot; Rammerstorfer, Margarethe

2008-01-01

As far as energy policy is concerned, the design of the regulatory framework for energy transmission and distribution is a key issue. Consequently, also the embodiment of balancing power markets drives mainly the effectiveness of political implications for the energy sector. Initially, tertiary control in Germany was solely offered by transmission system operators of the respective power control areas and their associated power plant. The recast of the Energy Industry Act of 2005 led in last consequence to a common procurement auction for the supply of tertiary control, which starts on December 1, 2006. Admittedly, the reform has fallen short of expectations so far, first concerning the intensification of market entry of tertiary control providers as well as the desired decline of the price level. Hence, this article examines the effects of the changeover on observable demand charges. In order to identify attributes of the common procurement auction for tertiary control hampering market entry of providers, giving stimuli to collusion and strategic behavior, reducing intensity of competition and encouraging an upswing of prices, we analyze the design under an auction theoretical approach and deduce empirically whether structural components of the auction design have to be touched up again

Chemical Properties, Decomposition, and Methane Production of Tertiary Relict Plant Litters: Implications for Atmospheric Trace Gas Production in the Early Tertiary

Science.gov (United States)

Yavitt, J. B.; Bartella, T. M.; Williams, C. J.

2006-12-01

Throughout the early Tertiary (ca. 65-38 Ma) Taxodiaceae-dominated (redwood) wetland forests occupied the high latitudes and were circumpolar in their distribution. Many of these forests had high standing biomass with moderate primary productivity. The geographic extent and amount of Tertiary coals and fossil forests throughout Arctic Canada suggests large areas of wetland forests that may have cycled substantial quantities of carbon, particularly methane until they were replaced by cold tolerant Pinus, Picea, and Larix following climatic cooling associated with the Terminal Eocene Event. To test this hypothesis we compared physiochemical properties, decomposition, and trace gas production of litter from extant Metasequoia, Pinus, Picea, and Larix. Initial results from plantation-grown trees indicate Metasequoia litter is a better source of labile organic substrate than pinaceous litter. Metasequoia litter contained the least lignin and highest amounts of water-soluble compounds of the four litter types studied. Analysis of the lignin structure using cupric oxide oxidation indicates that Metasequoia lignin is enriched in 4'-hydroxyacetophenone and 4'- Hydroxy-3'-methoxyacetophenone relative to the pinaceous litter. In a 12-month decomposition study using litterbags, average litter mass loss was greater for Metasequoia litter (62%) compared to the pinaceous species (50%). Moreover, Metasequoia litter incubated under anoxic conditions produced nearly twice as much CO2 (ca. 4.2 umol/g.day) and CH4 (2.1 umol/g.day) as the pinaceous litter (2.4 umol/g.day for CO2; 1.2 umol/g.day for CH4). Our results support the idea of greater decomposability and palatability of Metasequoia litter as compared to Larix, Picea, or Pinus. Provided that the biochemical properties of Metasequoia have remained relatively stable through geologic time, it appears that early Tertiary Metasequoia-dominated wetland forests may have had higher microbial driven trace gas production than the

A Collaborative Governance Approach to Improving Tertiary Education in Papua New Guinea

Science.gov (United States)

Eldridge, Kaye; Larry, Lisa; Baird, Jeanette; Kavanamur, David

2018-01-01

Tertiary education in Papua New Guinea (PNG) is in a critical state, as the sector struggles to address increased demand for student places with severely curtailed capacity. Recent thinking about improving public services in PNG has emphasized "whole of sector" or collaborative governance. Such an approach in tertiary education has the…

Current standards of neuropsychological assessment in epilepsy surgery centers across Europe.

Science.gov (United States)

Vogt, Viola Lara; Äikiä, Marja; Del Barrio, Antonio; Boon, Paul; Borbély, Csaba; Bran, Ema; Braun, Kees; Carette, Evelien; Clark, Maria; Cross, Judith Helen; Dimova, Petia; Fabo, Daniel; Foroglou, Nikolaos; Francione, Stefano; Gersamia, Anna; Gil-Nagel, Antonio; Guekht, Alla; Harrison, Sue; Hecimovic, Hrvoje; Heminghyt, Einar; Hirsch, Edouard; Javurkova, Alena; Kälviäinen, Reetta; Kavan, Nicole; Kelemen, Anna; Kimiskidis, Vasilios K; Kirschner, Margarita; Kleitz, Catherine; Kobulashvili, Teia; Kosmidis, Mary H; Kurtish, Selin Yagci; Lesourd, Mathieu; Ljunggren, Sofia; Lossius, Morten Ingvar; Malmgren, Kristina; Mameniskiené, Ruta; Martin-Sanfilippo, Patricia; Marusic, Petr; Miatton, Marijke; Özkara, Çiğdem; Pelle, Federica; Rubboli, Guido; Rudebeck, Sarah; Ryvlin, Philippe; van Schooneveld, Monique; Schmid, Elisabeth; Schmidt, Pia-Magdalena; Seeck, Margitta; Steinhoff, Bernhard J; Shavel-Jessop, Sara; Tarta-Arsene, Oana; Trinka, Eugen; Viggedal, Gerd; Wendling, Anne-Sophie; Witt, Juri-Alexander; Helmstaedter, Christoph

2017-03-01

We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe. Wiley Periodicals, Inc. © 2017 International League

Tertiary Education and the Crisis of Public Finance

Directory of Open Access Journals (Sweden)

Milos Maryska

2012-04-01

Full Text Available Turbulent economic environment after overwhelming the last crisis period is typical for present days as well as permanent increasing dependability of all our activities on information and communication technology (ICT. Although the global economic crisis was the reason for disinvestment into ICT in 2009 there is expected that ICT will generate almost 5.8 million new jobs in Europe till year 2013 and they have to be saturated also by adequately qualified ICT specialists.This contribution presents the research in the progress focused on the tertiary education system in the Czech Republic. We are predicting trends in education and especially in ICT education in Europe and in the Czech Republic as well for next ten years. We can expect that future ten years period will be critical not only for the Czech tertiary education system, but also for the Czech Republic because number of ICT students will be decreasing and number of ICT specialist demanded by labor market will be increasing. From macroeconomic point of view we can expect that also state subventions into state governed tertiary education system will decrease in the whole Europe.Some recommendations, proposals and forecasts for further development of education system are presented at the end of this contribution.

Determination of consumption biogenic solid fuels in the commercial sector, trade, services (tertiary sector). Final report

International Nuclear Information System (INIS)

Viehmann, Cornelia; Westerkamp, Tanja; Schwenker, Andre; Schenker, Marian; Thraen, Daniela; Lenz, Volker; Ebert, Marcel

2012-01-01

The policy has both national and European level ambitious program aimed at expansion of renewable energy and related to the reduction of greenhouse gas emissions. In the national action plan for renewable energy of the Federal Republic of Germany these goals are defined by 2020. The share of renewable energy in the provision of heat and cold should therefore rise from 6.6% to 15.5% of gross final energy consumption. According to the increasing importance of solar-thermal, near-surface and geothermal heat, the relative share of biomass is decreasing. However biomass makes with those listed in the national action plan with 79% an essential amount in regenerative heat market [BMU 2010]. For the pursuit of goals and reviews, the support measures and packages of measures which are initiated in this context, a regular and timely reporting on the development of the above objectives is mandatory. The diverse and growing reporting requirements such as in the EU directive on the promotion of renewable energy, require, however well-founded knowledge of the sector-specific energy consumption from renewable sources. While the data available for use of biogenic solid fuels in the sectors household and industry has improved significantly in recent years, for the sector commercial sector, trade, services (tertiary sector) reliable figures are still lacking. Against this background, the objective is to present study, in close cooperation with the Federal Environment Agency (UBA), the determination of the final energy consumption biogenic solid fuels in the tertiary sector in Germany for the year 2008. The basis is, in addition to the development of the current knowledge of the energy and heat consumption, the delimitation and characterization of the sector and the development of an extrapolation tools. The demand for this tool is its expandability and update possibility. From the industry-nonspecific and industry-specific input data can be derived, collecting for the extrapolation

Life Cycle Assessment of urban wastewater reuse with ozonation as tertiary treatment

International Nuclear Information System (INIS)

Munoz, Ivan; Rodriguez, Antonio; Rosal, Roberto; Fernandez-Alba, Amadeo R.

2009-01-01

Life Cycle Assessment has been used to compare different scenarios involving wastewater reuse, with special focus on toxicity-related impact categories. The study is based on bench-scale experiments applying ozone and ozone in combination with hydrogen peroxide to a wastewater effluent from a Spanish sewage treatment plant. Two alternative characterisation models have been used to account for toxicity of chemical substances, namely USES-LCA and EDIP97. Four alternative scenarios have been assessed: wastewater discharge plus desalination supply, wastewater reuse without tertiary treatment, wastewater reuse after applying a tertiary treatment consisting on ozonation, and wastewater reuse after applying ozonation in combination with hydrogen peroxide. The results highlight the importance of including wastewater pollutants in LCA of wastewater systems assessing toxicity, since the contribution of wastewater pollutants to the overall toxicity scores in this case study can be above 90%. Key pollutants here are not only heavy metals and other priority pollutants, but also non-regulated pollutants such as pharmaceuticals and personal care products. Wastewater reuse after applying any of the tertiary treatments considered appears as the best choice from an ecotoxicity perspective. As for human toxicity, differences between scenarios are smaller, and taking into account the experimental and modelling uncertainty, the benefits of tertiary treatment are not so clear. From a global warming potential perspective, tertiary treatments involve a potential 85% reduction of greenhouse gas emissions when compared with desalination

Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

Science.gov (United States)

Moesinger, Robert C.; Davis, Jan W.; Hill, Britani; Johnston, W. Cory; Gray, Carl; Johnson, Harold; Ingersoll, Leslye; Whipple, Gary; Reilly, Mark; Harris, Robert; Hansen, Vincent

2011-01-01

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care. PMID:22312532

Profile of European proton and carbon ion therapy centers assessed by the EORTC facility questionnaire.

Science.gov (United States)

Weber, Damien C; Abrunhosa-Branquinho, André; Bolsi, Alessandra; Kacperek, Andrzej; Dendale, Rémi; Geismar, Dirk; Bachtiary, Barbara; Hall, Annika; Heufelder, Jens; Herfarth, Klaus; Debus, Jürgen; Amichetti, Maurizio; Krause, Mechthild; Orecchia, Roberto; Vondracek, Vladimir; Thariat, Juliette; Kajdrowicz, Tomasz; Nilsson, Kristina; Grau, Cai

2017-08-01

We performed a survey using the modified EORTC Facility questionnaire (pFQ) to evaluate the human, technical and organizational resources of particle centers in Europe. The modified pFQ consisted of 235 questions distributed in 11 sections accessible on line on an EORTC server. Fifteen centers from 8 countries completed the pFQ between May 2015 and December 2015. The average number of patients treated per year and per particle center was 221 (range, 40-557). The majority (66.7%) of centers had pencil beam or raster scanning capability. Four (27%) centers were dedicated to eye treatment only. An increase in the patients-health professional FTE ratio was observed for eye tumor only centers when compared to other centers. All centers treated routinely chordomas/chondrosarcomas, brain tumors and sarcomas but rarely breast cancer. The majority of centers treated pediatric cases with particles. Only a minority of the queried institutions treated non-static targets. As the number of particle centers coming online will increase, the experience with this treatment modality will rise in Europe. Children can currently be treated in these facilities in a majority of cases. The majority of these centers provide state of the art particle beam therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

The European Food Consumption Validation Project: conclusions and recommendations

DEFF Research Database (Denmark)

de Boer, E. J.; Slimani, N.; van 't Veer, P.

2011-01-01

Background/Objectives: To outline and discuss the main results and conclusions of the European Food Consumption Validation (EFCOVAL) Project. Subjects/Methods: The EFCOVAL Project was carried out within the EU Sixth Framework Program by researchers in 11 EU countries. The activities focused on (1...... showed that two non-consecutive EPIC-Soft 24-HDRs are suitable to estimate the usual intake distributions of protein and potassium of European adult populations. The 2-day non-consecutive 24-HDRs in combination with a food propensity questionnaire also appeared to be appropriate to rank individuals...... according to their fish and fruit and vegetable intake in a comparable way in five European centers. Dietary intake of (young) children can be assessed by the combination of EPIC-Soft 24-HDRs and food recording booklets. The EPIC-Soft-standardized method of describing foods is useful to estimate dietary...

Neutron bomb and European defense

International Nuclear Information System (INIS)

Sweet, W.

1980-01-01

France's development of the controversial neutron bomb is in line with the US goal of flexible response to a Soviet threat in Europe. US neutron bomb production is on a standby basis pending agreement among the North Atlantic Treaty Organization (NATO) members for deployment. Controversy over the bomb centers on its anti-personnel nature, which many see as immoral in comparison with weapons that primarily damage property. Opponents also see it as lowering the nuclear threshold and increasing the chance of nuclear war. Supporters view the bomb as a tactical weapon to be used on a limited scale as a last resort. If Germany's Chancellor Schmidt fails to negotiate a limit to European nuclear arms deployment with the Soviet Union, neutron-bomb production in the US and France will most likely proceed. The prospects for including European nuclear weapons in the Strategic Arms Limitation Talks (SALT) III are jeopardized by the Soviet invasion of Afghanistan and the failure of an early SALT II ratification. 17 references

ReaderBench: An Integrated Cohesion-Centered Framework

NARCIS (Netherlands)

Dascalu, Mihai; Stavarache, Lucia Larise; Dessus, Philippe; Trausan-Matu, Stefan; McNamara, Danielle S.; Bianco, Maryse

2015-01-01

Dascalu, M., Stavarache, L.L., Dessus, P., Trausan-Matu, S., McNamara, D.S., & Bianco, M. (2015). ReaderBench: An Integrated Cohesion-Centered Framework. In G. Conole, T. Klobucar, C. Rensing, J. Konert & É. Lavoué (Eds.), 10th European Conf. on Technology Enhanced Learning (pp. 505–508). Toledo,

Intermediate uveitis: pattern of etiology, complications, treatment and outcome in a tertiary academic center.

Science.gov (United States)

Ness, Thomas; Boehringer, Daniel; Heinzelmann, Sonja

2017-04-27

Patients with intermediate uveitis (IU) represent a heterogenous group characterized by a wide spectrum of etiologies and regional differences. Aim of the study was to analyze the characteristics of patients with IU examined in an academic center in Germany. We conducted a retrospective analysis of the clinical records of all patients with intermediate uveitis referred to the Eye Center, University of Freiburg from 2007 to 2014. Diagnosis followed the Standardization in Uveitis Nomenclature (SUN) criteria. Data analysis included: etiology of IU, demographics, complications, treatment and visual acuity. We identified 159 patients with intermediate uveitis during that period. Mean age at diagnosis was 35 years. Most are female (64%), and the mean duration of IU was 6.1 years (range 1 month - 35 years). Etiology of IU was idiopathic in 59%. Multiple sclerosis (MS) (20%) and sarcoidosis (10%) were frequent systemic causes of IU. Other etiologies including infectious diseases (tuberculosis, borreliosis) or immune-mediated conditions (eg, after vaccination) were present in 11%. The pattern of complications included macular edema (CME) (36%), cataract (24%), secondary glaucoma (7%), and epiretinal membrane formation (19%). Periphlebitis and optic neuritis were more frequent in conjunction with MS. Treatment comprised local and systemic steroids, immunosuppressive agents, biologics, and surgery. Best corrected visual acuity was better than 20/25 in 60% of the eyes after more than 10 years of follow-up. In our German academic center, most IU cases were idiopathic or associated with MS or sarcoidosis. In contrast to other countries, infectious cases were rare. Patients' overall visual prognosis is favorable even when the duration of IU has been long and and despite numerous complications.

Nature and origin of secondary mineral coatings on volcanic rocks of the Black Mountain, Stonewall Mountain, and Kane Springs Wash volcanic centers, southern, Nevada

Science.gov (United States)

Taranik, James V.; Hsu, Liang C.; Spatz, David M.; Chenevey, Michael J.

1989-01-01

The following subject areas are covered: (1) genetic, spectral, and LANDSAT Thematic Mapper imagery relationship between desert varnish and tertiary volcanic host rocks, southern Nevada; (2) reconnaissance geologic mapping of the Kane Springs Wash Volcanic Center, Lincoln County, Nevada, using multispectral thermal infrared imagery; (3) interregional comparisons of desert varnish; and (4) airborne scanner (GERIS) imagery of the Kane Springs Wash Volcanic Center, Lincoln County, Nevada.

Outcomes of the treatment of head and neck sarcomas in a tertiary referral center

Directory of Open Access Journals (Sweden)

Andrew eLindford

2015-05-01

Full Text Available Head and neck sarcomas are a rare and heterogeneous group of tumors that pose management challenges. We report our experience with these tumors. Forty consecutive patients treated for 44 head and neck sarcomas between 1997 and 2014 were culled from our prospectively maintained head and neck database. Five patients were excluded. The adult cohort consisted 29 (83% patients of a mean age of 57.7 years, with 33 sarcomas. The most common diagnoses were undifferentiated pleomorphic sarcoma (27% and chondroblastic osteosarcoma (21%. Clear surgical margins were achieved in 24/33 (73% lesions. Twenty-two patients received radiotherapy and/or chemotherapy. Fourteen patients developed local (n=6, regional (n=1 and distant (n=7 recurrence. The overall 5-year survival was 66% with a mean survival interval of 66.5 months. Recurrent sarcoma, close (<1mm or involved surgical margins and advanced age were associated with statistically significantly reduced survival. The pediatric cohort consisted 6 (17% patients, with a mean age of nine years. Five patients had primary embryonal rhabdomyosarcomas and one had chondroblastic osteosarcoma. Clear surgical margins were achieved in 5 (83% patients. All patients received adjuvant radiotherapy and/or chemotherapy. Mean survival interval was 102 months. Three patients developed local (n=1 or distant (n=2 recurrence. Twenty-three free and 8 pedicled flaps were performed in 25 patients. 11/39 (28% lesions in 11 patients developed a complication. In conclusion, head and neck sarcomas are best managed by a multidisciplinary team at a tertiary head and neck referral centre and resection with clear margins is vital for disease control.

Tertiary instability of zonal flows within the Wigner-Moyal formulation of drift turbulence

Science.gov (United States)

Zhu, Hongxuan; Ruiz, D. E.; Dodin, I. Y.

2017-10-01

The stability of zonal flows (ZFs) is analyzed within the generalized-Hasegawa-Mima model. The necessary and sufficient condition for a ZF instability, which is also known as the tertiary instability, is identified. The qualitative physics behind the tertiary instability is explained using the recently developed Wigner-Moyal formulation and the corresponding wave kinetic equation (WKE) in the geometrical-optics (GO) limit. By analyzing the drifton phase space trajectories, we find that the corrections proposed in Ref. to the WKE are critical for capturing the spatial scales characteristic for the tertiary instability. That said, we also find that this instability itself cannot be adequately described within a GO formulation in principle. Using the Wigner-Moyal equations, which capture diffraction, we analytically derive the tertiary-instability growth rate and compare it with numerical simulations. The research was sponsored by the U.S. Department of Energy.

Understanding Australian Aboriginal Tertiary Student Needs

Science.gov (United States)

Oliver, Rhonda; Rochecouste, Judith; Bennell, Debra; Anderson, Roz; Cooper, Inala; Forrest, Simon; Exell, Mike

2013-01-01

Drawing from a study of the experiences of Australian Aboriginal and Torres Strait Islander university students, this paper presents an overview of the specific needs of these students as they enter and progress through their tertiary education. Extracts from a set of case studies developed from both staff and student interviews and an online…

Fueling the Bio-economy: European Culture Collections and Microbiology Education and Training

KAUST Repository

Antunes, Andre; Stackebrandt, Erko; Lima, Nelson

2015-01-01

A survey of European Microbial Biological Resource Centers and their users provided an overview on microbiology education and training. The results identified future increases in demand despite several shortcomings and gaps in the current offer

Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review.

Science.gov (United States)

Tringali, Andrea; Lemmers, Arnaud; Meves, Volker; Terheggen, Grischa; Pohl, Jürgen; Manfredi, Guido; Häfner, Michael; Costamagna, Guido; Devière, Jacques; Neuhaus, Horst; Caillol, Fabrice; Giovannini, Marc; Hassan, Cesare; Dumonceau, Jean-Marc

2015-08-01

This technology review expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) on the available techniques for intraductal biliopancreatic imaging. The three cholangioscopy techniques are described: the "dual-operator" and " single-operator" mother-baby approaches using dedicated instruments, and the "direct" technique using currently available ultrathin gastroscopes. The mother-baby method is standardized and reproducible, while direct cholangioscopy is technically demanding and its safety requires further evaluation. As well as direct visualization of the bile ducts, cholangioscopy has the further advantage of allowing targeted biopsy. Image quality is still suboptimal for single-operator cholangioscopy, while the other techniques have achieved adequately detailed imaging. The costs of mother-baby cholangioscopy are high and its application in clinical practice should be restricted to selected cases (i.e. indeterminate biliary strictures/intraluminal lesions, difficult biliary stones) and to the setting of tertiary care centers. Peroral pancreatoscopy may find an indication in situations where other imaging modalities (mainly EUS) are inconclusive (i.e. delineation of main duct intraductal papillary mucinous neoplasia extension, sampling of indeterminate main pancreatic duct strictures). Intraductal ultrasonography (IDUS) has a poorer performance than EUS in the staging of pancreatic malignancies and can increase the risk of pancreatitis. A promising indication for IDUS could be the evaluation of indeterminate biliary strictures and ampullary tumors. Probe-based confocal laser endomicroscopy (pCLE) of the bile ducts is a difficult and expensive technique. Appropriate training needs to be established, since interpretation of images is challenging. pCLE can be an important diagnostic tool in the setting of indeterminate biliary strictures. © Georg Thieme Verlag KG Stuttgart · New York.

On Progress of Mass Tertiary Education: Case of Lebanon, Kenya and Oman

Science.gov (United States)

Liu, Zhimin; Mutinda, Gladys

2016-01-01

Mass higher education is a huge force to be reckoned with and its existence, already in the expansion of tertiary institutions is undeniable. This study will focus on three countries: Lebanon, Kenya and Oman. The purpose of this study is to evaluate mass tertiary education progress in these countries. It will synthesize data results of gross…

First report of tertiary syphilis presenting as lipoatrophic panniculitis in an immunocompetent patient.

Science.gov (United States)

Drago, Francesco; Ciccarese, Giulia; Tomasini, Carlo F; Calamaro, Paola; Boggio, Maurizio; Rebora, Alfredo; Parodi, Aurora

2017-03-01

We describe herein a woman who developed subcutaneous gummas in her trochanteric regions, bilaterally, although she had been treated for syphilis two decades earlier. Evidence of Treponema pallidum latent late infection was the presence of IgG antibodies against T. pallidum and the positive non-treponemal and treponemal tests. Moreover, immunohistochemical staining for T. pallidum detected some spirochetes close to the atrophic adipocytes allowing the diagnosis of lypo-atrophic panniculitis tertiary syphilis. This is the first case of tertiary syphilis presenting as panniculitis in an immunocompetent patient, demonstrating that subcutaneous fat may be another organ infected in tertiary syphilis.

Enhancing learning in tertiary institutions through multimedia based ...

African Journals Online (AJOL)

Enhancing learning in tertiary institutions through multimedia based ... convenient and cost-effective courseware reengineering methodology of our age. ... Also discussed are the reasons for converting classroom courses to e-learning format.

The institutional dimension of the European Union’s combat transnational crime, as one of the main threats to European security

Directory of Open Access Journals (Sweden)

O. S. Vonsovych

2016-06-01

Full Text Available The article investigates the role of the leading institutions of European Union in the fight with transnational crime. It was determined that the problem of transnational crime occupies one of the central places in the field of European security. This is due to the fact that the overall level of crime in Europe in recent years has increased several times compared with the beginning of the XXI century. It was found that today transnational crime is becoming a serious obstacle on the way of building stability and sustainable development. It is nothing less than terrorism, illegal immigration affects the state of European security, creating the new center of a danger in Europe. It is proved that each institution has its own specific of struggle, but the unifying factor is that all of them are working on the same thing – the elimination of the threat in order to increase the level of security in Europe in general and in EU in particular. Substantiated the thesis that it is important to further developing of close and constructive cooperation between the main European institutions, as well as mutual exchange of information and data regarding the recent changes and the manifestations of transnational crime. This will give an opportunity to strengthen the European security system, as well as implement common practical methods of counteraction. It was determined that the actualization of the practical component in the framework of EU institutional dimension in the future will contribute to strengthening European.

Anesthesia-related and perioperative mortality: An audit of 8493 cases at a tertiary pediatric teaching hospital in South Africa.

Science.gov (United States)

Meyer, Heidi M; Thomas, Jenny; Wilson, Graeme S; de Kock, Marianna

2017-10-01

This study aimed to quantify the incidence of anesthesia-related and perioperative mortality at a large tertiary pediatric hospital in South Africa. This study included all children aged anesthesia caused the death; (ii) anesthesia may have contributed to or influenced the timing of death; or (iii) anesthesia was entirely unrelated to the death. There were 47 deaths within 30 days of anesthesia prior to discharge from hospital during this 12-month period. The in-hospital mortality within 24 h of administration of anesthesia was 16.5 per 10 000 cases (95% confidence intervals [CI]=7.8-25.1) and within 30 days of administration of anesthesia was 55.3 per 10 000 cases (95% CI=39.5-71.2). Age under 1 year (OR 4.5; 95% CI=2.5-8.0, P=.012) and cardiac surgery and interventional cardiology procedures (OR 2.5; 95% CI=1.2-5.2, Prisk of perioperative mortality. The overall 24-h and 30-day anesthesia-related and in-hospital perioperative mortality rates in our study are comparable with other similar studies from tertiary pediatric centers. © 2017 John Wiley & Sons Ltd.

Severe Neutropenia at the Time of Implantable Subcutaneous Chest Port Insertion Is Not a Risk Factor for Port Removal at a Tertiary Pediatric Center.

Science.gov (United States)

Hoss, Daniel R; Bedros, Antranik A; Mesipam, Avinash; Criddle, Jared; Smith, Jason C

2017-03-01

To determine if severe neutropenia at the time of chest port insertion is a risk factor for port removal and central catheter-associated bloodstream infection (CCABSI) in pediatric patients. From May 2007 to June 2015, 183 consecutive patients (mean age, 9.9 y; range, 0.75-21 y) had a port inserted at a single tertiary pediatric center. Seventy-two had severe neutropenia at the time of port insertion (absolute neutrophil count [ANC] range, 0-500/mm 3 ; mean, 185/mm 3 ). Follow-up until port removal or death and CCABSI events were recorded. Within the first 30 days, similar incidences of CCABSI (12.5% of patients with severe neutropenia [n = 9] vs 4.5% of patients without [n = 5]), port removal for infection (2.8% [n = 2] vs 2.7% [n = 3]), and local port infection (2.8% [n = 2] vs 0.9% [n = 1]) were observed in both groups (P > .05), but the rate of CCABSI per 1,000 catheter-days was higher for patients with severe neutropenia (P = .045). Overall, similar incidences of CCABSI (18.1% [n = 13] vs 16.2% [n = 18]), port removal for infection (2.8% [n = 2] vs 7.2% [n = 8]), local port infection (2.8% [n = 2] vs 2.7% [n = 3]), and CCABSIs per 1,000 catheter-days (0.332 vs 0.400) were observed in both groups (P > .05). Port placement in patients with severe neutropenia can be performed without an increased incidence of port removal for infection. The majority of CCABSIs were successfully treated without port removal. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

Challenges Faced by Key Stakeholders Using Educational Online Technologies in Blended Tertiary Environments

Science.gov (United States)

Tuapawa, Kimberley

2016-01-01

Traditional learning spaces have evolved into dynamic blended tertiary environments (BTEs), providing a modern means through which tertiary education institutes (TEIs) can augment delivery to meet stakeholder needs. Despite the significant demand for web-enabled learning, there are obstacles concerning the use of EOTs, which challenge the…

Submarine fans and associated deposits in the Lower Tertiary of Guipuzcoa (Northern Spain)

NARCIS (Netherlands)

Vliet, van A.

1982-01-01

The Lower Tertiary outcrop along the coast of Guipuzcoa, northern Spain, consists exclusively of deep-marine sediments, deposited in a narrow elongated (ESE-WNW) basin. The early Tertiary sedimentary history of this basin can be described in terms of three main phases:

- a phase of

Indigenous Students in the Tertiary Education Sector

Science.gov (United States)

Bandias, Susan; Fuller, Don; Larkin, Steven

2014-01-01

Important recent objectives of indigenous education policy in Australia have been aimed at redressing indigenous economic and social disadvantage through increasing student retention, progression and completion rates in both compulsory and post-compulsory education. The two sectors of the tertiary education system, vocational education and…

Management and performance features of cancer centers in Europe: A fuzzy-set analysis

NARCIS (Netherlands)

Wind, Anke; Lobo, Mariana Fernandes; van Dijk, Joris; Lepage-Nefkens, Isabelle; Laranja-Pontes, Jose; da Conceicao Goncalves, Vitor; van Harten, Willem H.; Rocha-Goncalves, Francisco Nuno

2016-01-01

The specific aim of this study is to identify the performance features of cancer centers in the European Union by using a fuzzy-set qualitative comparative analysis (fsQCA). The fsQCA method represents cases (cancer centers) as a combination of explanatory and outcome conditions. This study uses

European nuclear education initiatives

International Nuclear Information System (INIS)

Glatz, Jean-Paul

2011-01-01

Whatever option regarding their future nuclear energy development is chosen by European Union Member States, the availability of a sufficient number of well trained and experienced staff is key for the responsible use of nuclear energy. This is true in all areas including design, construction, operation, decommissioning, fuel cycle and waste management as well as radiation protection. Given the high average age of existing experts leading to a significant retirement induce a real risk of the loss of nuclear competencies in the coming years. Therefore the demand of hiring skilled employees is rising. The challenge of ensuring a sufficient number of qualified staff in the nuclear sector has been acknowledged widely among the different stakeholders, in particular the nuclear industry, national regulatory authorities and Technical Support Organisations (TSOs). Already the EURATOM Treaty refers explicitly to the obligation for the Commission to carry out training actions. Recently initiatives have been launched at EU level to facilitate and strengthen the efforts of national stakeholders. The European Nuclear Education Network (ENEN) Association aims at preservation and further development of expertise in the nuclear field by higher education and training. The goal of the European Nuclear Energy Leadership Academy (ENELA) is to educate future leaders in the nuclear field to ensure the further development of sustainable European nuclear energy solutions The European Nuclear Energy Forum (ENEF) is a platform operated by the European Commission for a broad discussion on the opportunities and risks of nuclear energy. The nuclear programs under investigation in the Joint Research Center (JRC) are increasingly contributing to Education and Training (E and T) initiatives, promoting a better cooperation between key players and universities as well as operators and regulatory bodies in order to mutually optimise their training programmes. Another objective is to increase

Comparison of two public sector tertiary care hospitals' management in reducing direct medical cost burden on breast carcinoma patients in Lahore, Pakistan.

Science.gov (United States)

Hameed Khaliq, Imran; Zahid Mahmood, Hafiz; Akhter, Naveed; Danish Sarfraz, Muhammad; Asim, Khadija; Masood Gondal, Khalid

2018-01-01

Breast cancer is one of the major causes of death incurring highest morbidity and mortality amongst women of Pakistan. The purpose of this study was to assess and compare the role of two public sector tertiary care hospitals' management in reducing out of pocket (OOP) expenses on direct medical costs borne by breast carcinoma patients' household from diagnosis through treatment. Moreover, the study intended to explore the reasons of opting private diagnostic facilities by the said patients during the services taken from the foresaid tertiary care centers. A purposive sample of 164 primary breast carcinoma patients was recruited for data collection of this cross-sectional study. Face to face interviews and semistructured questionnaires were adopted as method of data gathering tools. Major cost components of direct medical costs were used to compare the financial strain on the patients' households of both targeted hospitals. In addition, information was collected regarding the reasons of opting private diagnostic centers for investigations. Frequency, percentages, median and inter quartile range (IQR) were calculated for the data. Non-parametric variables were compared using the Mann-Whitney U test. It was observed that overall direct medical cost borne by the breast carcinoma patients' households in Jinnah hospital (median US$1153.93 / Rs. 118,589) was significantly higher than Mayo hospital (median US$427.93 /Rs. 43,978), pprivately opted investigations procedures was the common issue of the patients under treatment in both hospitals.

Integrated Identity and Access Management System for Tertiary ...

African Journals Online (AJOL)

Nigerian Journal of Technology ... identity management and access control and the unavailability of actionable information on pattern of ... This Tertiary Identity and Access Management System (T-IAMS) is a fingerprint biometric database that ...

Sexism and Sexual Harassment in Tertiary Institutions | Akpotor ...

African Journals Online (AJOL)

Gender and Behaviour ... Sexual harassment is a recurring decimal in tertiary institutions. The paper therefore investigates the effects of sexual harassment on the academic performance of female students, using Delta State University, Abraka, ...

Highly Enantioselective Construction of Tertiary Thioethers and Alcohols via Phosphine-Catalyzed Asymmetric γ-Addition reactions of 5H-Thiazol-4-ones and 5H-Oxazol-4-ones: Scope and Mechanistic Understandings

KAUST Repository

Wang, Tianli

2015-06-02

Phosphine-catalyzed highly enantioselective γ-additions of 5H-thiazol-4-ones and 5H-oxazol-4-ones to allenoates have been developed for the first time. With the employment of amino-acid derived bifunctional phosphines, a wide range of substituted 5H-thiazol-4-one and 5H-oxazol-4-one derivatives bearing heteroarom (S or O)-containing tertiary chiral centers were constructed in high yields and excellent enantioselectivities. The reported method provides a facile access to enantioenriched tertiary thioether/alcohols. The mechanism of γ-addition reaction was investigated by performing DFT calculations, and the hydrogen bonding interactions between the Brønsted acid moiety of the phosphine catalysts and the “C=O” unit of donor molecules were shown to be crucial in asymmetric induction.

Highly Enantioselective Construction of Tertiary Thioethers and Alcohols via Phosphine-Catalyzed Asymmetric γ-Addition reactions of 5H-Thiazol-4-ones and 5H-Oxazol-4-ones: Scope and Mechanistic Understandings

KAUST Repository

Wang, Tianli; Yu, Zhaoyuan; Hoon, Ding Long; Huang, Kuo-Wei; Lan, Yu; Lu, Yixin

2015-01-01

Phosphine-catalyzed highly enantioselective γ-additions of 5H-thiazol-4-ones and 5H-oxazol-4-ones to allenoates have been developed for the first time. With the employment of amino-acid derived bifunctional phosphines, a wide range of substituted 5H-thiazol-4-one and 5H-oxazol-4-one derivatives bearing heteroarom (S or O)-containing tertiary chiral centers were constructed in high yields and excellent enantioselectivities. The reported method provides a facile access to enantioenriched tertiary thioether/alcohols. The mechanism of γ-addition reaction was investigated by performing DFT calculations, and the hydrogen bonding interactions between the Brønsted acid moiety of the phosphine catalysts and the “C=O” unit of donor molecules were shown to be crucial in asymmetric induction.

Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence

DEFF Research Database (Denmark)

Maurer, M; Metz, M; Bindslev-Jensen, C

2016-01-01

BACKGROUND: GA²LEN, the Global Allergy and Asthma European Network, has recently launched a program for the development, interaction, and accreditation of centers of reference and excellence in special areas of allergy embedded in its overall quality management of allergy centers of excellence. T...

The European Stroke Organisation Guidelines: a standard operating procedure.

Science.gov (United States)

Ntaios, George; Bornstein, Natan M; Caso, Valeria; Christensen, Hanne; De Keyser, Jacques; Diener, Hans-Christoph; Diez-Tejedor, Exuperio; Ferro, Jose M; Ford, Gary A; Grau, Armin; Keller, Emanuella; Leys, Didier; Russell, David; Toni, Danilo; Turc, Guillaume; Van der Worp, Bart; Wahlgren, Nils; Steiner, Thorsten

2015-10-01

In 2008, the recently founded European Stroke Organisation published its guidelines for the management of ischemic stroke and transient ischemic attack. This highly cited document was translated in several languages and was updated in 2009. Since then, the European Stroke Organisation has published guidelines for the management of intracranial aneurysms and subarachnoidal hemorrhage, for the establishment of stroke units and stroke centers, and recently for the management of intracerebral hemorrhage. In recent years, the methodology for the development of guidelines has evolved significantly. To keep pace with this progress and driven by the strong determination of the European Stroke Organisation to further promote stroke management, education, and research, the European Stroke Organisation decided to delineate a detailed standard operating procedure for its guidelines. There are two important cornerstones in this standard operating procedure: The first is the implementation of the Grading of Recommendations Assessment, Development, and Evaluation methodology for the development of its Guideline Documents. The second one is the decision of the European Stroke Organisation to move from the classical model of a single Guideline Document about a major topic (e.g. management of ischemic stroke) to focused modules (i.e. subdivisions of a major topic). This will enable the European Stroke Organisation to react faster when new developments in a specific stroke field occur and update its recommendations on the related module rather swiftly; with the previous approach of a single large Guideline Document, its entire revision had to be completed before an updated publication, delaying the production of up-to-date guidelines. After discussion within the European Stroke Organisation Guidelines Committee and significant input from European Stroke Organisation members as well as methodologists and analysts, this document presents the official standard operating procedure for

Formation mechanism of NDMA from ranitidine, trimethylamine, and other tertiary amines during chloramination: a computational study.

Science.gov (United States)

Liu, Yong Dong; Selbes, Meric; Zeng, Chengchu; Zhong, Rugang; Karanfil, Tanju

2014-01-01

Chloramination of drinking waters has been associated with N-nitrosodimethylamine (NDMA) formation as a disinfection byproduct. NDMA is classified as a probable carcinogen and thus its formation during chloramination has recently become the focus of considerable research interest. In this study, the formation mechanisms of NDMA from ranitidine and trimethylamine (TMA), as models of tertiary amines, during chloramination were investigated by using density functional theory (DFT). A new four-step formation pathway of NDMA was proposed involving nucleophilic substitution by chloramine, oxidation, and dehydration followed by nitrosation. The results suggested that nitrosation reaction is the rate-limiting step and determines the NDMA yield for tertiary amines. When 45 other tertiary amines were examined, the proposed mechanism was found to be more applicable to aromatic tertiary amines, and there may be still some additional factors or pathways that need to be considered for aliphatic tertiary amines. The heterolytic ONN(Me)2-R(+) bond dissociation energy to release NDMA and carbocation R(+) was found to be a criterion for evaluating the reactivity of aromatic tertiary amines. A structure-activity study indicates that tertiary amines with benzyl, aromatic heterocyclic ring, and diene-substituted methenyl adjacent to the DMA moiety are potentially significant NDMA precursors. The findings of this study are helpful for understanding NDMA formation mechanism and predicting NDMA yield of a precursor.

Medical tourism in India: perceptions of physicians in tertiary care hospitals.

Science.gov (United States)

Qadeer, Imrana; Reddy, Sunita

2013-12-17

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

Medical tourism in india: perceptions of physicians in tertiary care hospitals

Science.gov (United States)

2013-01-01

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

Misconception of emergency contraception among tertiary school ...

African Journals Online (AJOL)

Objective: To assess the degree of awareness and use of emergency contraception among tertiary school students in Akwa Ibom State, Nigeria. Design: A self-administered questionnaire survey. Setting: The Akwa Ibom State Polytechnic, Ikot Osurua, located on the outskirts of Ikot Ekpene local government area between ...

"Community of Practice" as a Framework for Supporting Tertiary Teachers' Informal Workplace Learning

Science.gov (United States)

Viskovic, Alison R.

2005-01-01

This article discusses aspects of the informal learning of tertiary teachers in a polytechnic, a wananga (Maori tertiary institution) and a university in New Zealand. Case studies showed that they gained their teaching knowledge and skills mainly on the job, through informal, experiential learning, and much less through formal courses,…

Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India.

Science.gov (United States)

Thakur, N A; Humne, A Y; Godale, L B

2015-01-01

Despite lower incidence of breast cancer in India, the total number of cases and the net mortality is high. To reduce this increasing load of mortality due to breast cancer we need to lay emphasis on early detection and increased use of systemic therapy. Early detection itself depends on early presentation to a health facility; thus, it is important to identify factors affecting delay in a presentation to hospital. To study the clinico-social profile of breast carcinoma patients attending a tertiary care hospital and to study the time lag since detection of lump by women and presentation to the hospital and factors affecting them. A total of 120 primary breast cancer patients visiting a tertiary care hospital over a period of 7 months (August 2010 to February 2011) were taken up for study. A detailed retrospective analysis of patients was done according to planned proforma. Maximum study subjects were in the age group of 41-50 years. Right and left breasts were equally affected. The most common histo-pathological type of breast carcinoma observed was invasive ductal carcinoma (NOS) in 105 (87.50%) cases. Majority of the cases were in stage III or stage II. The median time lag self-detection of lump in the breast by women and presentation to the hospital was 6 months. Women living in a rural area, those with lower socio-economic status and those with older age tend to assess health-care late. Carcinoma of the breast is a common cancer affecting young to middle age group with invasive ductal carcinoma being the most common histological type. Delay in presentation and late stage presentation is a major concern. Hence, proper awareness and screening programmers are needed to identify, inform and educate these categories of women.

Study of tertiary creep instability in several elevated-temperature structural materials

International Nuclear Information System (INIS)

Booker, M.K.; Sikka, V.K.

1978-01-01

Data for a number of common elevated temperature structural materials have been analyzed to yield mathematical predictions for the time and strain to tertiary creep at various rupture lives and temperatures. Materials examined include types 304 and 316 stainless steel, 2 1/4 Cr-1 Mo steel, alloy 800H, alloy 718, Hastelloy alloy X, and ERNiCr--3 weld metal. Data were typically examined over a range of creep temperatures for rupture lives ranging from less than 100 to greater than 10,000 hours. Within a given material, trends in these quantities can be consistently described, but it is difficult to directly relate the onset of tertiary creep to failure-inducing instabilities. A series of discontinued tests for alloy 718 at 649 and 620 0 C showed that the material fails by intergranular cracking but that no significant intergranular cracking occurs until well after the onset of tertiary creep

System for radiation emergency medicine. Activities of tertiary radiation emergency hospitals

International Nuclear Information System (INIS)

Kamiya, Kenji; Tanigawa, Koichi; Hosoi, Yoshio

2011-01-01

Japanese system for radiation emergency medicine is primarily built up by Cabinet Nuclear Safety Commission in 2001 based on previous Tokai JCO Accident (1999) and is composed from the primary, secondary and tertiary medical organizations. This paper describes mainly about roles and actions of the tertiary facilities at Fukushima Nuclear Power Plant Accident and tasks to be improved in future. The primary and secondary organizations in the system above are set up in the prefectures with or neighboring the nuclear facility, and tertiary ones, in two parts of western and eastern Japan. The western organization is in Hiroshima University having its cooperating 7 hospitals, and is responsible for such patients as exposed to high dose external radiation, having serious complication, and difficult to treat in the primary/secondary hospitals. The eastern is in National Institute of Radiological Sciences (NIRS) with 6 cooperating hospitals and responsible for patients with internal radiation exposure difficult to treat, with contaminated body surface with difficulty in decontamination and/or with causable of secondary contamination, and difficult to treat in the secondary hospitals. The tertiary organizations have made efforts for the education and training of medical staff, for network construction among the primary, secondary and other medicare facilities, for establishment of transferring system of patients, and for participation to the international network by global organizations like Response Assistance Network (RANET) in International Atomic Energy Agency (IAEA), and Radiation Emergency Preparedness and Network (REMPAN) in World Health Organization (WHO). At the Fukushima Accident, staffs of the two tertiary hospitals began to conduct medicare on site (Mar. 12-) and learned following tasks to be improved in future: the early definition of medicare and its network system, and Emergency Planning Zone (EPZ); urgent evacuation of residents weak to disaster like elderly

Evaluation of a tertiary teledermatology service between peripheral and academic dermatologists in the Netherlands

NARCIS (Netherlands)

van der Heijden, Job P.; de Keizer, Nicolette F.; Witkamp, Leonard; Spuls, Phyllis I.

2014-01-01

Tertiary teledermatology (TTD)-secondary-care to tertiary-care teleconsultation-is applied rarely compared with the frequently applied secondary teledermatology (primary to secondary care). The objective of this study was to determine the effect of TTD on referrals from peripheral dermatologists to

Distinguishing between tertiary and secondary facilities: a case study of cardiac diagnostic-related groups (DRGs).

Science.gov (United States)

Rouse, Paul; Arulambalam, Ajit; Correa, Ralph; Ullman, Cornelia

2010-05-14

To develop a classification of tertiary cardiac DRGs in order to investigate differences in tertiary/secondary product mix across New Zealand district health boards (DHBs). 67 DRGs from 85,442 cardiac cases were analysed using cost weights and patient comorbidity complexity levels, which were used as a proxy for complexity. The research found high variability of severity within some DRGs. 5 DHBs are the main providers of 27 DRGs which are high cost and identified as tertiary by several ADHB clinicians; the same 5 DHBs have on average higher severity by DRG than the other DHBs. NZ tertiary hospitals have a product mix of DRGs with higher complexity than secondary hospitals. Funding based on case weights needs to recognise the additional resource requirements for this higher complexity.

Oxidation of tertiary homoallylic alcohols by thallium trinitrate: fragmentation versus ring contraction

International Nuclear Information System (INIS)

Silva Junior, Luiz F.; Quintiliano, Samir A.P.; Ferraz, Helena M.C.; Santos, Leonardo S.; Eberlin, Marcos N.

2006-01-01

The oxidation of tertiary homoallylic alcohols with thallium trinitrate (TTN) was investigated. The alcohols bearing an allylic methyl group lose a molecule of acetone via a fragmentation reaction that leads to isomeric secondary allylic alcohols as major products, together with their corresponding acetylated derivatives. On the other hand, treating analogous tertiary alcohols without the allylic methyl group with TTN gives indans, through a ring contraction reaction. (author)

Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities.

Science.gov (United States)

Chiò, A; Bottacchi, E; Buffa, C; Mutani, R; Mora, G

2006-08-01

To evaluate the effects of tertiary centres for amyotrophic lateral sclerosis (ALS) on ALS outcome and the use of hospital facilities. The study was based on the data of an epidemiological, prospective, population-based register on ALS (Piemonte and Valle d'Aosta Register for amyotrophic lateral sclerosis, PARALS). The 221 patients recruited between 1995 and 1996 were prospectively followed up for outcome and use of hospital-based services. In all, 97 patients were followed up by tertiary ALS centres and 124 by general neurological clinics. Patients followed up by tertiary ALS centres were found to be 4 years younger and underwent percutaneous endoscopic gastronomy and non-invasive positive-pressure ventilation more often. Patients followed up by tertiary ALS centres were found to have a considerably longer median survival time (1080 v 775 days), even when stratifying by age, site of onset and respiratory function at diagnosis. In Cox multivariate analysis, attending a tertiary ALS centre was observed to be an independent positive prognostic factor. Moreover, patients attending a tertiary ALS centre were admitted to hospital less often (1.2 v 3.3) and were more frequently admitted for planned interventions. Conversely, patients followed up by general neurological clinics were more frequently admitted for acute events. Also, the hospital stay was considerably shorter for patients attending tertiary ALS centres (5.8 v 12.4 days). Improved survival was seen in patients with ALS attending tertiary ALS centres, independently from all other known prognostic factors, possibly through a better implementation of supportive treatments. Moreover, because of these centres, the hospitalisation rate was markedly reduced, thus offering a cost-effective service to patients with ALS and to the community as a whole.

The Columbus-CC—Operating the European laboratory at ISS

Science.gov (United States)

Kuch, T.; Sabath, D.

2008-07-01

The European ISS Columbus Control Center (Col-CC) joined the club of ISS mission control centers in Moscow, Houston and Huntsville. It took some time to reach that goal. In 1998 the European Space Agency (ESA) awarded the German Aerospace Center DLR to design, develop and implement the Col-CC at its premises in Oberpfaffenhofen, near Munich, Germany. In 2002 a core mission operations team was built up. An integrated team of ESA, industry and control center started to define processes and implemented first operations products and tools. This was accompanied by regular meetings with the international partners in the US and Russia. With intensive training and numerous simulations the team was able to gain experience and is now eagerly waiting for the launch of Columbus. However, thanks to the involvement in some operational activities the Col-CC staff has already been able to gain operational ISS experience. After the inauguration in October 2004 Col-CC supported the Eneide mission in April 2005 when the Italian ESA-Astronaut Roberto Vittori flew onboard a Soyuz to the ISS where he spent 10 days. Another very important milestone was the operations support for ESA's Astrolab mission. The Astrolab mission was of major importance for Europe and particularly for Germany because it implied the first long duration flight of ESA astronaut Thomas Reiter, an astronaut of German nationality. The tasks of Col-CC are described and also the experiences made with the first operational long-term mission which took place from July to December 2006. Meanwhile the Col-CC was able to reach the operational readiness status for the Columbus mission which is set for a launch date later in 2007. Despite the concentration on the challenging Columbus Assembly and Checkout phase emphasis is already laid on the following increments for the European ISS operations. Early 2006 ESA transferred the operational tasks and responsibilities to the hands of the industrial operator. This approach creates

Modelling the harmonized tertiary Institutions Salary Structure ...

African Journals Online (AJOL)

This paper analyses the Harmonized Tertiary Institution Salary Structure (HATISS IV) used in Nigeria. The irregularities in the structure are highlighted. A model that assumes a polynomial trend for the zero step salary, and exponential trend for the incremental rates, is suggested for the regularization of the structure.

Ten years of energy consumption in the tertiary sector

International Nuclear Information System (INIS)

Rabai, Yacine

2012-11-01

This document presents and comments data regarding electricity consumption by the tertiary sector over the last ten years in France. It notably outlines its strong increase compared to the other sectors (housing, industry, transport, agriculture). It comments the evolution of the energy mix of the tertiary sector (electricity with 47%, gas with 25% and oil with 19% are prevailing). It briefly comments the evolution of energy efficiency within this sector. It indicates and comments the shares of energy consumption, of high voltage electricity and gas consumption by the different sub-sectors (retail, automobile and motorcycle repair, public administration, health and social activity, real estate, specialised, scientific and technical activities, education, and so on)

The European Social Survey and European research policy

DEFF Research Database (Denmark)

Kropp, Kristoffer

2017-01-01

This article analyses the history of the European Social Survey (ESS) and its relationship to changes in European research policy, using Bourdieu’s field-analytical approach. It argues that the success of the ESS relied on three interwoven processes that we can understand theoretically in terms...... of the establishment of homological structures and the formation of conjunctural alliances between the field of European social-scientific research and the field of European policy. The three interwoven processes that I depict are: first, the production of a European field of social research, connected to both...... European and national scientific institutions; second, the establishment of European Union (EU) institutions and organisations that were able to identify and link up with social researchers; and third, the formation of conjunctural alliances between the two fields (social science and EU research policy...

managing tertiary institutions for the promotion of lifelong learning

African Journals Online (AJOL)

Global Journal

KEYWORDS: Managing, tertiary institutions, promotion, lifelong learning. INTRODUCTION ... science, medicine and technology towards the ... different environments, whether formal, informal ... schools considering that each day gives birth to.

Tertiary paediatric emergency department use in children and young people with cerebral palsy.

Science.gov (United States)

Meehan, Elaine; Reid, Susan M; Williams, Katrina; Freed, Gary L; Babl, Franz E; Sewell, Jillian R; Rawicki, Barry; Reddihough, Dinah S

2015-10-01

The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Usability of cerebrospinal fluid biomarkers in a tertiary memory clinic

DEFF Research Database (Denmark)

Brandt, C.; Bahl, J.C.; Heegaard, N.H.

2008-01-01

AIM: Assays for cerebrospinal fluid (CSF) levels of total tau, phospho-tau protein and beta-amyloid 1-42 have been available for some years. The aim of the study was to assess the usability of these biomarkers in a mixed population of tertiary dementia referral patients in a university-based memory......, the sensitivity of a single abnormal value was between 33 and 66%. The specificity was high except when discriminating AD from amnestic mild cognitive impairment. Two or more abnormal markers further increased the specificity and decreased the sensitivity. CONCLUSION: In a tertiary setting, abnormal CSF biomarker...

Discovery of tertiary sulfonamides as potent liver X receptor antagonists.

Science.gov (United States)

Zuercher, William J; Buckholz, Richard G; Campobasso, Nino; Collins, Jon L; Galardi, Cristin M; Gampe, Robert T; Hyatt, Stephen M; Merrihew, Susan L; Moore, John T; Oplinger, Jeffrey A; Reid, Paul R; Spearing, Paul K; Stanley, Thomas B; Stewart, Eugene L; Willson, Timothy M

2010-04-22

Tertiary sulfonamides were identified in a HTS as dual liver X receptor (LXR, NR1H2, and NR1H3) ligands, and the binding affinity of the series was increased through iterative analogue synthesis. A ligand-bound cocrystal structure was determined which elucidated key interactions for high binding affinity. Further characterization of the tertiary sulfonamide series led to the identification of high affinity LXR antagonists. GSK2033 (17) is the first potent cell-active LXR antagonist described to date. 17 may be a useful chemical probe to explore the cell biology of this orphan nuclear receptor.

Analysis of Sociodemographic parameters of patients admitted in a newly established palliative care center in a regional cancer institute of north-west India

Directory of Open Access Journals (Sweden)

Mukesh Kumar Singhal

2014-01-01

Conclusions: Palliative care services are an indispensable part of a tertiary regional cancer care center. The oncologists should be made aware of the requirement of better relief of pain and other distressing symptoms to provide better quality of life to the patients suffering from advanced cancer.

Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.

Science.gov (United States)

Grantham, W Jeffrey; To, Philip; Watson, Jeffry T; Brywczynski, Jeremy; Lee, Donald H

2016-08-01

Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation. Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482. Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling. III.

Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania.

Science.gov (United States)

Sawe, Hendry R; Mfinanga, Juma A; Lidenge, Salum J; Mpondo, Boniventura C T; Msangi, Silas; Lugazia, Edwin; Mwafongo, Victor; Runyon, Michael S; Reynolds, Teri A

2014-09-23

In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania. This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC). MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009-2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (<18 years). Patients with tetanus (2.4%) had the longest median length ICU stay: 8 (5,13) days. The overall in-ICU mortality rate was 41.4%. The ICUs in tertiary referral hospitals of Tanzania are severely limited in infrastructure, personnel, and resources, making it difficult or impossible to provide optimum care

Tertiary work-up of apparent treatment-resistant hypertension.

Science.gov (United States)

Heimark, Sondre; Eskås, Per Anders; Mariampillai, Julian Eek; Larstorp, Anne Cecilie K; Høieggen, Aud; Fadl Elmula, Fadl Elmula M

2016-10-01

Treatment-resistant hypertension (TRH) has regained attention with development of new methods for treatment. However, the prevalence of TRH varies considerably from primary to secondary and tertiary care. We aimed to assess the prevalence of true TRH in a population of patients with apparent TRH in a university hospital setting of tertiary work-up and also investigate reasons for poor BP control and evaluate how work-up can be performed in general practice and secondary care. In this cohort study, we characterize a study population from Oslo Renal Denervation (RDN) Study. Patients (n = 83) were referred for RDN from secondary care. All patients underwent thorough medical investigation and 24-h ambulatory blood pressure measurements (24ABPM) after directly observed therapy (DOT). We then assessed reasons for lack of BP control. Fifty-three of 83 patients did not have true TRH. Main reasons for non-TRH were poor drug adherence (32%), secondary hypertension (30%) and white coat hypertension (15%). Forty-seven percent achieved blood pressure control after DOT with subsequent 24ABPM. There were otherwise no statistically significant differences in patient characteristics between the true TRH and the non-TRH group. Despite being a highly selected cohort referred for tertiary work-up of apparent TRH, BP control was achieved or secondary causes were identified in almost two thirds of the patients. Thorough investigation according to guidelines and DOT with subsequent 24ABPM is needed in work-up of apparent TRH.

Bahrain’s tertiary education reform : a step towards sustainable economic development

Directory of Open Access Journals (Sweden)

Magdalena Karolak

2012-07-01

Full Text Available Bahrain has been experiencing along with other Gulf Council Cooperation countries a rapid development of its tertiary sector of education. The 2000's were marked by a boom in education with the opening of twelve private universities in this country of roughly 1 million inhabitants. Some institutions were locally based, while others worked in affiliation with foreign based universities. It is in sharp contrast with the 1990's, when only three public universities served as centers of higher education. The reasons behind this large-scale expansion of higher education include the growth of local and expatriate population, the planned transition from oil industry to a knowledge-based economy as well as the growing role of women in the workforce. All of these factors need to be addressed in order to assure a stable social and economic development, and education is the backbone of both. This paper examines the recent initiatives undertaken in Bahrain to monitor and ensure the quality of education of cross-border educational institutions as well as that of local education providers.

Examination of factors predicting secondary students' interest in tertiary STEM education

Science.gov (United States)

Chachashvili-Bolotin, Svetlana; Milner-Bolotin, Marina; Lissitsa, Sabina

2016-02-01

Based on the Social Cognitive Career Theory (SCCT), the study aims to investigate factors that predict students' interest in pursuing science, technology, engineering, and mathematics (STEM) fields in tertiary education both in general and in relation to their gender and socio-economic background. The results of the analysis of survey responses of 2458 secondary public school students in the fifth-largest Israeli city indicate that STEM learning experience positively associates with students' interest in pursuing STEM fields in tertiary education as opposed to non-STEM fields. Moreover, studying advanced science courses at the secondary school level decreases (but does not eliminate) the gender gap and eliminates the effect of family background on students' interest in pursuing STEM fields in the future. Findings regarding outcome expectations and self-efficacy beliefs only partially support the SCCT model. Outcome expectations and self-efficacy beliefs positively correlate with students' entering tertiary education but did not differentiate between their interests in the fields of study.

Neutron bomb and European defense

Energy Technology Data Exchange (ETDEWEB)

Sweet, W.

1980-08-15

France's development of the controversial neutron bomb is in line with the US goal of flexible response to a Soviet threat in Europe. US neutron bomb production is on a standby basis pending agreement among the North Atlantic Treaty Organization (NATO) members for deployment. Controversy over the bomb centers on its anti-personnel nature, which many see as immoral in comparison with weapons that primarily damage property. Opponents also see it as lowering the nuclear threshold and increasing the chance of nuclear war. Supporters view the bomb as a tactical weapon to be used on a limited scale as a last resort. If Germany's Chancellor Schmidt fails to negotiate a limit to European nuclear arms deployment with the Soviet Union, neutron-bomb production in the US and France will most likely proceed. The prospects for including European nuclear weapons in the Strategic Arms Limitation Talks (SALT) III are jeopardized by the Soviet invasion of Afghanistan and the failure of an early SALT II ratification. 17 references. (DCK)

A personalized mobile patient guide system for a patient-centered smart hospital: Lessons learned from a usability test and satisfaction survey in a tertiary university hospital.

Science.gov (United States)

Yoo, Sooyoung; Jung, Se Young; Kim, Seok; Kim, Eunhye; Lee, Kee-Hyuck; Chung, Eunja; Hwang, Hee

2016-07-01

The present study focused on the design, implementation, and evaluation of a personalized mobile patient guide system that utilizes smart phones, indoor navigation technology and a hospital information system (HIS) to address the difficulties that outpatients face in finding hospital facilities, recognizing their daily treatment schedule, and accessing personalized medical and administrative information. The present study was conducted in a fully digitized tertiary university hospital in South Korea. We developed a real-time location-based outpatient guide system that consists of Bluetooth access points (APs) for indoor navigation, an Android-based guide application, a guide server, and interfaces with the HIS. A total of 33 subjects and 43 outpatients participated in the usability test (UT) and the satisfaction survey, respectively. We confirmed that the indoor navigation feature can be applied to outpatient departments with precision using a position error test. The participants in the UT completed each scenario with an average success rate of 67.4%. According to the results, we addressed the problems and made improvements to the user interface by providing users with context-based guidance information. The satisfaction rating of the system was high, with an average score of 4.0 out of 5.0, showing its utility as a patient-centered hospital service. The innovative mobile patient guide system for outpatients is feasible and can be successfully implemented to provide personalized information with high satisfaction. Additionally, the issues identified and lessons learned from our experiences regarding task scheduling, indoor navigation, and usability should be considered when developing the system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Framework of Assessment for the Evaluation of Thinking Skills of Tertiary Level Students

Science.gov (United States)

Heng, Chan Swee; Ziguang, Yan

2015-01-01

In the 21st century, students are required to master thinking skills in order to deal with many situations that arise in the tertiary environment which later would translate into the workplace. Nowadays, thinking skills play a vital role in tertiary education. To provide an approach for teachers, this paper identifies a 4-step model that can be…

Knowledge and perception of plastic surgery among tertiary ...

African Journals Online (AJOL)

2015-10-16

Oct 16, 2015 ... tertiary education students in Enugu, South‑East. Nigeria. CM Isiguzo ..... This finding should be a motivation for plastic surgeons who have private ... population of this country some of whom travel abroad to source for these ...

European Registry of Carotid Artery Stenting: results from a prospective registry of eight high volume EUROPEAN institutions.

Science.gov (United States)

Stabile, Eugenio; Garg, Pallav; Cremonesi, Alberto; Bosiers, Marc; Reimers, Bernhard; Setacci, Carlo; Cao, Piergiorgio; Schmidt, Andrej; Sievert, Horst; Peeters, Patrick; Nikas, Dimitry; Werner, Martin; de Donato, Gianmarco; Parlani, Giambattista; Castriota, Fausto; Hornung, Marius; Mauri, Laura; Rubino, Paolo

2012-08-01

Carotid endarterectomy (CEA) is the standard revascularization therapy to prevent stroke in patients with carotid artery disease. Carotid artery stenting (CAS) could be considered a potential alternative in patients at high surgical risk. Recent clinical trials have challenged this concept due a relatively high incidence of post-CAS adverse events, which occurred in low volume centers. The aim of this study was to evaluate the outcomes associated with neuroprotected CAS in selected high volume centers. From January 2007 to December 2007, 1,611 patients underwent neuroprotected CAS in eight European Centers. For each patients, clinical, procedural, and one month follow-up data from all patients have been collected. An independent clinical events committee adjudicated the events. Overall in hospital death was 0.06% (one patient), whereas in-hospital stroke was 0.49% (eight patients). Between hospital discharge and 30 days three additional patients died (0.18%) and 10 patients experienced a stroke (0.67%). Overall 30 days mortality was 0.24% (four patients) and stroke incidence 1.12% (18 patients). The 30 day stroke/death rate was 1.36%. CAS is a reasonable alternative to CEA to treat carotid artery atherosclerosis in well-experienced high volume centers. These data suggest that future prospective trials comparing CAS and CEA outcomes should include only centers highly experienced in both treatment modalities. Copyright © 2012 Wiley Periodicals, Inc.

[2. European] TRIGA owners' conference. Papers and abstracts

International Nuclear Information System (INIS)

1972-01-01

The Second European TRIGA Owners' Conference was held in Pavia, Italy, September 1972. The meeting was organized by the University of Pavia Applied Nuclear Energy Laboratory (L.E.N.A.). Sixty-two attendees representing 12 TRIGA reactor centers in Europe, South America, and the United States were present at the Conference. The main areas of discussions were: Reactor operation and maintenance experience; Research programs and TRIGA technology development

[2. European] TRIGA owners' conference. Papers and abstracts

Energy Technology Data Exchange (ETDEWEB)

NONE

1972-07-01

The Second European TRIGA Owners' Conference was held in Pavia, Italy, September 1972. The meeting was organized by the University of Pavia Applied Nuclear Energy Laboratory (L.E.N.A.). Sixty-two attendees representing 12 TRIGA reactor centers in Europe, South America, and the United States were present at the Conference. The main areas of discussions were: Reactor operation and maintenance experience; Research programs and TRIGA technology development.

Association Between Sedentary Lifestyle and Diastolic Dysfunction Among Outpatients With Normal Left Ventricular Systolic Function Presenting to a Tertiary Referral Center in the Middle East.

Science.gov (United States)

Matta, Stephanie; Chammas, Elie; Alraies, Chadi; Abchee, Antoine; AlJaroudi, Wael

2016-05-01

Sedentary lifestyle has become prevalent in our community. Recent data showed controversy on the effect of regular exercise on left ventricular compliance and myocardial relaxation. We sought to assess whether physical inactivity is an independent predictor of diastolic dysfunction in or community, after adjustment for several covariates. Consecutive outpatients presenting to the echocardiography laboratory between July 2013 and June 2014 were prospectively enrolled. Clinical variables were collected prospectively at enrollment. Patients were considered physically active if they exercised regularly ≥3× a week, ≥30 minutes each time. The primary endpoint was presence of diastolic dysfunction. The final cohort included 1356 patients (mean age [SD] 52.9 [17.4] years, 51.3% female). Compared with physically active patients, the 1009 (74.4%) physically inactive patients were older, more often female, and had more comorbidities and worse diastolic function (51.3% vs 38.3%; P < 0.001). On univariate analysis, physical inactivity was associated with 70% increased odds of having diastolic dysfunction (odds ratio: 1.70, 95% confidence interval: 1.32-2.18, P < 0.001). There was significant interaction between physical activity and left ventricular mass index (LVMI; P = 0.026). On multivariate analysis, patients who were physically inactive and had LVMI ≥ median had significantly higher odds of having diastolic dysfunction (odds ratio: 2.82, 95% confidence interval: 1.58-5.05, P < 0.001). In a large, prospectively enrolled cohort from a single tertiary center in the Middle East, physically inactive patients with increased LVMI had 2- to 3-fold increased odds of having diastolic dysfunction after multivariate adjustment. © 2016 Wiley Periodicals, Inc.

MEASURES TO IMPROVE THE OUTCOME OF ABRUPTIO PLACENTA IN A TERTIARY REFERRAL CENTRE

Directory of Open Access Journals (Sweden)

Vijaya

2015-12-01

Full Text Available AIM To analyze the outcome of 135 patients admitted with Abruptio Placenta during a period of 9 months managed at Tertiary Referral Centre, Modern Govt. Maternity Hospital, Petalburz, Hyderabad, Telangana State. MATERIALS AND METHODS A study of 135 cases of Abruptio Placenta over a period of 9 months at a tertiary level referral centre. They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, management of Abruption and maternal and fetal outcome, and the measures to improve the condition were analyzed. RESULTS Abruptio placenta is a dreadful threat to maternal and fetal life. In our study unbooked cases were 110(81.48%, Hypertension is the main risk factor almost in 90(66.66% cases, 65% of them were between 28-36 weeks of GA, and 6 were grandmultis, 6 cases ended up with HELLP syndrome with DIC. All these 6 cases were near misses, 5 unbooked cases had eclampsia. One case of unbooked eclampsia had abruption DIC and could not be saved as it was the late referral. Total number of vaginal deliveries were 66(48.88% and total no. of abdominal deliveries were 67(49.62% in this LSCS 66 and one hysterotomy. IUD at the time of admission total were 100(74%. CONCLUSION To improve the outcome in Abruptio Placentae Good antenatal care, Educating the patient, Strengthening the Primary Health Centers in identifying the risk factors like Pre-eclampsia thereby avoiding eclampsia. Regular antenatal checkups timely delivery and availability of blood and blood products with good Neonatal care unit will help in improving the outcome of Abruptio.

A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

Science.gov (United States)

Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

2008-09-15

Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World

Peracetic acid (PAA) disinfection of primary, secondary and tertiary treated municipal wastewaters.

Science.gov (United States)

Koivunen, J; Heinonen-Tanski, H

2005-11-01

The efficiency of peracetic acid (PAA) disinfection against enteric bacteria and viruses in municipal wastewaters was studied in pilot-scale. Disinfection pilot-plant was fed with the primary or secondary effluent of Kuopio municipal wastewater treatment plant or tertiary effluent from the pilot-scale dissolved air flotation (DAF) unit. Disinfectant doses ranged from 2 to 7 mg/l PAA in the secondary and tertiary effluents, and from 5 to 15 mg/l PAA in the primary effluents. Disinfection contact times were 4-27 min. Disinfection of secondary and tertiary effluents with 2-7 mg/l PAA and 27 min contact time achieved around 3 log reductions of total coliforms (TC) and enterococci (EC). PAA disinfection also significantly improved the hygienic quality of the primary effluents: 10-15 mg/l PAA achieved 3-4 log reductions of TC and EC, 5 mg/l PAA resulting in below 2 log reductions. F-RNA coliphages were more resistant against the PAA disinfection and around 1 log reductions of these enteric viruses were typically achieved in the disinfection treatments of the primary, secondary and tertiary effluents. Most of the microbial reductions occurred during the first 4-18 min of contact time, depending on the PAA dose and microorganism. The PAA disinfection efficiency remained relatively constant in the secondary and tertiary effluents, despite of small changes of wastewater quality (COD, SS, turbidity, 253.7 nm transmittance) or temperature. The disinfection efficiency clearly decreased in the primary effluents with substantially higher microbial, organic matter and suspended solids concentrations. The results demonstrated that PAA could be a good alternative disinfection method for elimination of enteric microbes from different wastewaters.

Practical experience in post-mortem tissue donation in consideration of the European tissue law.

Science.gov (United States)

Karbe, Thomas; Braun, Christian; Wulff, Birgit; Schröder, Ann Sophie; Püschel, Klaus; Bratzke, Hansjürgen; Parzeller, Markus

2010-03-01

In consequence of the European guidelines of safety and quality standards for the donation, retrieval, storing and distribution of human tissues and cells the purpose of tissue transplantation was implemented into German legislation in May 2007. The law came into effect on August 1st 2007 considering of the European rules. The Institutes for Legal Medicine of the University of Frankfurt/Main and the University Medical Center Hamburg-Eppendorf developed a model for tissue retrieval. The Institute of Legal Medicine (I.f.R.) at the University Medical Center Hamburg cooperates with the German Institute of Cell and Tissue Replacement (Deutsches Institut für Zell--und Gewebeersatz DIZG). Potential post-mortem tissue donors (PMTD) among the deceased are selected by standardized sets of defined criteria. The procedure is guided by the intended exclusion criteria of the tissue regulation draft (German Transplant Law TPG GewV) in accordance with the European Guideline (2006/17/EC). Following the identification of the donor and subsequent removal of tissue, the retrieved samples were sent to the DIZG, a non-profit tissue bank according to the tissue regulation. Here the final processing into transplantable tissue grafts takes place, which then results in the allocation of tissue to hospitals in Germany and other European countries. The Center of Legal Medicine at the Johann Wolfgang Goethe-University Medical Center Frankfurt/Main cooperates since 2000 with Tutogen, a pharmaceutical company. Harvesting of musculoskeletal tissues follows corresponding regulations. To verify the outcome of PMTD at the I.f.R. Hamburg, two-statistic analysis over 12 and 4 months have been implemented. Our results have shown an increasing number of potential appropriate PMTD within the second inquiry interval but a relatively small and unvaryingly rate of successful post-mortem tissue retrievals similar to the first examination period. Thus, the aim of the model developed by the I.f.R. is to

Pediatric urinary tract infections in a tertiary care center from north India.

Science.gov (United States)

Taneja, Neelam; Chatterjee, Shiv Sekhar; Singh, Meenakshi; Singh, Surjit; Sharma, Meera

2010-01-01

Paediatric urinary tract infections (UTI) are associated with high morbidity and long term complications like renal scarring, hypertension, and chronic renal failure. A cause of occult febrile illness, they often remain undiagnosed. We studied the clinical and microbiologic profile and antibiotic resistance profile of such infections in paediatric UTI patients at our center. Clean catch mid-stream urine samples for culture were received from 1974 children agedinfections. Common uropathogens isolated were Escherichia coli (47.1%), Klebsiella spp. (15.6%), Enterococcus fecalis (8.7%), members of tribe Proteae (5.9%), Pseudomonas aeruginosa (5.9%) and Candida spp. (5.5%). Against lactose fermenting Enterobacteriaceae, in-vitro resistance was least against amikacin (32.5%), nitrofurantoin (26.7%) and imipenem (3.7%). Among enterococci, vancomycin resistant enterococci constituted 12 per cent of the strains. 93.4 per cent of the UTI detected was nosocomial. Paediatric UTI was common in children with male gender, ageresistant pathogens.

Factors influencing teamwork and collaboration within a tertiary medical center.

Science.gov (United States)

Chien, Shu Feng; Wan, Thomas Th; Chen, Yu-Chih

2012-04-26

To understand how work climate and related factors influence teamwork and collaboration in a large medical center. A survey of 3462 employees was conducted to generate responses to Sexton's Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R(2) = 0.59) and in collaboration (R(2) = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are operating in a setting conducive

Factors influencing teamwork and collaboration within a tertiary medical center

Science.gov (United States)

Chien, Shu Feng; Wan, Thomas TH; Chen, Yu-Chih

2012-01-01

AIM: To understand how work climate and related factors influence teamwork and collaboration in a large medical center. METHODS: A survey of 3462 employees was conducted to generate responses to Sexton’s Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. RESULTS: Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R2 = 0.59) and in collaboration (R2 = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. CONCLUSION: Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are

European Nuclear Education Network (ENEN) Association Initiative

International Nuclear Information System (INIS)

Comsa, Olivia; Meglea, Claudia; Banutoiu, Marina; Paraschiva, M. V.; Meglea, S.

2003-01-01

The main objective of the ENEN Association is the preservation and further development of a higher nuclear education and expertise. This objective should be achieved through the co-operation between European universities involved in education and research in the nuclear engineering field, research centers and the nuclear industry. To reach this objective, the ENEN Association has to: Promote and develop the collaboration in nuclear engineering education of engineers and researchers required by the nuclear industry and the regulatory bodies; Ensure the quality of nuclear academic engineering education and training; Increase the attractiveness for engagement in the nuclear field for students and young academics. The basic objectives of the ENEN Association shall be to: Deliver an European Master of Science Degree in Nuclear Engineering and promote PhD studies; Promote exchange of students and teachers participating in the frame of this network; Increase the number of students by providing incentives; Establish a framework for mutual recognition; Foster and strengthen the relationship with research laboratories and networks, industry and regulatory bodies, by involving them in (or association them with) nuclear academic education and by offering continuous training. The aims of the ENEN Association shall be achieved by: Discussion on educational objectives, methods and course contents among the members and with external partners, particularly national European industries; Organization of internal audits on the quality of nuclear engineering curricula; Awarding the label of 'European Master degree of Science in Nuclear Engineering' to the curricula satisfying the criteria set up by the ENEN Association; Cooperation between the members, and with the research centers and the nuclear industry for enhancement of mobility of teachers and students, organization of training and advanced courses, use of large research and teaching facilities or infrastructures; Cooperation

Congenital Factor VII Deficiency in Children at Tertiary Health Care Facility in Pakistan.

Science.gov (United States)

Alam, Muhammad Matloob; Moiz, Bushra; Rehman, Karim Abdur; Jethwani, Priyanka; Fadoo, Zehra

2015-10-01

This study presents the demographics, clinical spectrum, and outcome of patients with congenital factor VII (FVII) deficiency at a tertiary care center over a period of 12 years. Of the 49 patients, 27 (55%) patients were males. Consanguinity was found in 92% of the patients. The median age of symptom onset was 2.4 (interquartile range [IQR]: 1.1-6.5) years with a median age of 5.8 (IQR: 3.1-10) years at diagnosis. Life-threatening complications like intracranial bleeding (ICB) and intra-abdominal bleeding (IAB) were observed in 8 (16.4%) patients. We found that 11 (55%) of the 20 patients with FVII coagulant activity (FVIIc) 5% were affected by severe symptoms. Age factor associated with development of life-threatening bleeding episodes (P = .042; odds ratio 6.46). Overall, 4 (8.2%) died as a consequence of ICB (3 patients) and IAB (1 patient). © The Author(s) 2013.

Precipitable water and surface humidity over global oceans from special sensor microwave imager and European Center for Medium Range Weather Forecasts

Science.gov (United States)

Liu, W. T.; Tang, Wenqing; Wentz, Frank J.

1992-01-01

Global fields of precipitable water W from the special sensor microwave imager were compared with those from the European Center for Medium Range Weather Forecasts (ECMWF) model. They agree over most ocean areas; both data sets capture the two annual cycles examined and the interannual anomalies during an ENSO episode. They show significant differences in the dry air masses over the eastern tropical-subtropical oceans, particularly in the Southern Hemisphere. In these regions, comparisons with radiosonde data indicate that overestimation by the ECMWF model accounts for a large part of the differences. As a check on the W differences, surface-level specific humidity Q derived from W, using a statistical relation, was compared with Q from the ECMWF model. The differences in Q were found to be consistent with the differences in W, indirectly validating the Q-W relation. In both W and Q, SSMI was able to discern clearly the equatorial extension of the tongues of dry air in the eastern tropical ocean, while both ECMWF and climatological fields have reduced spatial gradients and weaker intensity.

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review.

Science.gov (United States)

Bonanni, L; Bontempo, G; Borrelli, I; Bifolchetti, S; Buongarzone, M P; Carlesi, N; Carolei, A; Ciccocioppo, F; Colangelo, U; Colonna, G; Desiderio, M; Ferretti, S; Fiorelli, L; D'Alessio, O; D'Amico, A; D'Amico, M C; De Lucia, R; Del Re, L; Di Blasio, F; Di Giacomo, R; Di Iorio, A; Di Santo, E; Di Giuseppe, M; Felice, N; Litterio, P; Gabriele, A; Mancino, E; Manzoli, L; Maruotti, V; Mearelli, S; Molino, G; Monaco, D; Nuccetelli, F; Onofrj, M; Perfetti, B; Sacchet, C; Sensi, F; Sensi, S; Sucapane, P; Taylor, J P; Thomas, A; Viola, P; Viola, S; Zito, M; Zhuzhuni, H

2013-06-01

Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. The results

Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital.

Science.gov (United States)

Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

2014-10-01

Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.

Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

International Nuclear Information System (INIS)

Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

2014-01-01

Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments

Tertiary Students' ICT Self-Efficacy Beliefs and the Factors Affecting Their ICT-Use

Science.gov (United States)

Turel, Vehbi; Calik, Sinan; Doganer, Adem

2015-01-01

This study looked at tertiary (i.e. undergraduate /a four-year degree) students' information and communication technology (ICT) self-efficacy beliefs and their level in use of certain common programmes at a newly established (i.e. 2007) university in Turkey in the spring of 2012. The study examined the tertiary students' (a) demographic…

Student Expectations of Tertiary Institutions: A Case Study of the Fiji National University (FNU)

Science.gov (United States)

Khan, Shana Nigar

2012-01-01

Education is a human right and Fiji's tertiary education board recently declared that all tertiary institutions in Fiji must abide by the framework in order to meet student-customers' needs. The Fiji National University's (FNU's) destiny to be Fiji's leading higher education provider could be a reality if students and staff's expectations are…

A study of structure–activity relationships of commercial tertiary amines for post-combustion CO_2 capture

International Nuclear Information System (INIS)

Xiao, Min; Liu, Helei; Idem, Raphael; Tontiwachwuthikul, Paitoon; Liang, Zhiwu

2016-01-01

Highlights: • Ethyl group is beneficial for tertiary amines of CO_2 absorption. • The existence of side carbon chain may promote the activity of tertiary amine. • Hydroxyl group reduces the equilibrium CO_2 solubility, k_2 and pKa. • Heterocyclic structure decrease the equilibrium CO_2 solubility, k_2 and pKa. • Hydroxyl group results in higher CO_2 absorption heat. - Abstract: This work examined the relationship between the structure of various commercial tertiary amines and their activity in CO_2 absorption/desorption in terms of rate of CO_2 absorption, equilibrium CO_2 loading, pKa and heat of CO_2 absorption in order to establish possible guidelines for selection of tertiary amine components for amine blends. Results show that any electron donating group linked directly to the nitrogen atom increases their reactivity with CO_2. In addition, the presence of steric hindrance effect and good water solubility also show enhancements in activity. In contrast, the existence of a hydroxyl group leads to a decrease in all the activity of the tertiary amine. The heat of CO_2 absorption of tertiary amines, which is closely related to the regeneration energy, can be reduced by decreasing the number of hydroxyethyl groups or by positing the hydroxyl group at the proper carbon relative to the nitrogen atom.

Data Management Coordinators Monitor STS-78 Mission at the Huntsville Operations Support Center

Science.gov (United States)

1996-01-01

Launched on June 20, 1996, the STS-78 mission's primary payload was the Life and Microgravity Spacelab (LMS), which was managed by the Marshall Space Flight Center (MSFC). During the 17 day space flight, the crew conducted a diverse slate of experiments divided into a mix of life science and microgravity investigations. In a manner very similar to future International Space Station operations, LMS researchers from the United States and their European counterparts shared resources such as crew time and equipment. Five space agencies (NASA/USA, European Space Agency/Europe (ESA), French Space Agency/France, Canadian Space Agency /Canada, and Italian Space Agency/Italy) along with research scientists from 10 countries worked together on the design, development and construction of the LMS. This photo represents Data Management Coordinators monitoring the progress of the mission at the Huntsville Operations Support Center (HOSC) Spacelab Payload Operations Control Center (SL POCC) at MSFC. Pictured are assistant mission scientist Dr. Dalle Kornfeld, Rick McConnel, and Ann Bathew.

REE in some tertiary volcanic complexes in the Republic of Macedonia

International Nuclear Information System (INIS)

Tasev, Goran; Serafimovski, Todor

2009-01-01

Petrological and geochemical features of the Tertiary magmatic rocks from the Republic of Macedonia were subject of study in this paper. The latest K-Ar, 87 Sr/ 86 Sr, and REE data for samples from Kratovo- Zletovo, Sasa-Toranica and Damjan-Buchim ore districts are presented. Whole rock XRF analyses confirmed host rock composition as dacites, quartz-latites, trachyandesites, rhyolites and rhyodacites. Absolute age determinations by the K-Ar dating method have shown ages range from 31 to 14 Ma confirming Oligocene-Miocene age as previously determined by relative methods. Determinations of 87 Sr/ 86 Sr ratios (0.70504 to 0.71126) suggest material is sourced from the contact zone between the lower crust and upper mantle where contamination of primary melt occurred. New REE data including negative Eu anomalies along with previously determined La/Yb ratios ranging from 13.3 to 43.0 (Serafimovski 1990) confirm inferred material source. These new data reconfirm previous results, provide insight into the Tertiary magmatic history of the district, and suggest the exact origin of the material that produced the Tertiary magmatic rocks.

Tertiary Lymphoid Organs in Takayasu Arteritis.

Science.gov (United States)

Clement, Marc; Galy, Adrien; Bruneval, Patrick; Morvan, Marion; Hyafil, Fabien; Benali, Khadija; Pasi, Nicoletta; Deschamps, Lydia; Pellenc, Quentin; Papo, Thomas; Nicoletti, Antonino; Sacre, Karim

2016-01-01

The role of B cells in the pathogenesis of Takayasu arteritis (TA) is controversial. We aimed to study the presence of tertiary lymphoid organs (TLOs) in the aortic wall of TA patients. Hematoxylin and eosin-stained sections from aorta specimens from patients with TA were screened for TLOs. The presence of B cell aggregates (CD20), follicular dendritic cells (FDCs, CD21), and high endothelial venules (HEVs, PNAd) was investigated by immunohistochemistry. Immune cells from the adventitial layer of one patient were characterized by flow cytometry. Demographic, medical history, laboratory, imaging, treatment, and follow-up data were extracted from medical records. Aorta specimens from Bentall procedures were available from seven patients (5 females, aged 22-57 years) with TA. Surgical treatment was performed at TA diagnosis (n = 4) or at a median of 108 months (84-156) after TA diagnosis. Disease was active at surgery in four patients according to NIH score. B cell aggregates-TLOs containing HEVs were observed in the adventitia of all but one patient. Of note, ectopic follicles containing CD21(+) FDCs were found in all patients (4/4) with increased aortic (18)F-fluoro-deoxyglucose (FDG) uptake before surgery but were absent in all but one patients (2/3) with no FDG uptake. In addition, flow cytometry analysis confirmed the accumulation of memory/germinal center-like B cells in the adventitial layer and showed the presence of antigen-experienced T follicular helper cells. Ectopic lymphoid neogenesis displaying functional features can be found in the aortic wall of a subset of patients with active TA. The function of these local B cell clusters on the pathogenesis of TA remains to be elucidated.

The consumption of electric power on the tertiary sector - an instrument for economical and social analysis and market studies

International Nuclear Information System (INIS)

Villela, L.E.

1991-04-01

The main subjective of this thesis is to analyse the effects of the growth of the tertiary sector on the electric power demand. In order to accomplish this goal an economical and social, analysis of the tertiary sector is made to identify its dynamic, its relations with the other sectors of the economy and to describe the methodologies for measuring the overall tertiary production. Afterwards it is made an analysis of the electric power consumption evolution in the tertiary sector, in order to identify the consumption per region of the country, per consumers and tertiary subsectors. It is also analysed the product power intensify and, finally its described the present tariff system. (author)

FINANCING CULTURE INSTITUTIONS IN EUROPEAN CONTEXT

Directory of Open Access Journals (Sweden)

Cezar Corneliu MANDA

2017-05-01

Full Text Available The paper, on the coordinates of the analysis of the problematic of financing culture institutions within the European Union member states, performs a comparative analysis focused on the financing mechanism available to the cultural sector, created both at the level of the public, and of the private sector. For the comparative analysis, the paper selected several EU member states, grouped on four geographical areas (North, South, East and Center. The analysis performed in the paper emphasized that most EU member states make significant efforts to finance the cultural sector, but the effects of the economic crisis have had a negative impact on this financing, causing, from this perspective, a gap between the states in the north and center of the EU, on the one hand, and the states in the south and east of the EU, on the other hand and outlining a cultural Europe with two peripheries.

Early Tertiary magmatism and probable Mesozoic fabrics in the Black Mountains, Death Valley, California

Science.gov (United States)

Miller, Martin G.; Friedman, Richard M.

1999-01-01

We report two early Tertiary U-Pb zircon ages for pegmatite from the Black Mountains of Death Valley, California. These ages, 54.7 ± 0.6 Ma and 56 ± 3 Ma, are unique for much of southeastern California. The samples belong to a pegmatite suite that occupies part of the footwall of the Badwater turtleback, a late Tertiary extensional feature; similar but undated pegmatite intrudes the footwalls of the Copper Canyon and Mormon Point turtlebacks farther south. The pegmatite suite demonstrates that fabric development on the turtlebacks was at least a two-stage process. Fabrics cut by these pegmatites likely formed during the Mesozoic, whereas those that involve them formed during late Tertiary extension.

Measuring the Effectiveness of Writing Center Consultations on L2 Writers’ Essay Writing Skills

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Shanthi Tiruchittampalam

2018-02-01

Full Text Available With the international growth of English-medium education, tertiary institutions are increasingly providing academic support services to L2 students, and thus, the number of writing centers working with L2 student writers has also increased. Writing center practices originated in L1 English educational contexts and their appropriateness for L2 English writers requires examination. This study investigated the effect of writing center consultations on the essay writing skills of L1 Arabic foundation level students at an English-medium university in the Gulf region. Analysis was based on quantitative measures of writing ability of two distinct groups of students: an experimental group who participated in tutoring sessions at the university’s writing center and a control group who did not. Findings indicated that students who participated in writing center consultations scored significantly higher in overall essay writing scores, as well as in two aspects of writing: task fulfilment (that is ideas and text organization/coherence. These findings contribute to a limited bank of similar empirical studies on effectiveness of writing center sessions on students’ essay writing ability. They also support the case for the expansion of writing center work beyond the domains of predominantly L1 English academic communities.

Montane pollen from the Tertiary of NW. Borneo

NARCIS (Netherlands)

Muller, J.

1966-01-01

In NW. Borneo thick series of Tertiary sediments occur which are rich in fossil pollen and spores. The majority of these plant microfossils were derived from the various types of tropical lowland vegetation such as mangrove (Muller, 1964), mixed peat swamp forest and mixed Dipterocarp forest. Some

Knowledge, attitude and practice of cervical cancer screening among women attending gynecology clinics in a tertiary level medical care center in southeastern Nigeria.

Science.gov (United States)

Mbamara, Sunday U; Ikpeze, Okechukwu C; Okonkwo, John E N; Onyiaorah, Igwebuike V; Ukah, Cornelius O

2011-01-01

To describe the knowledge, attitudes and practices of gynecology clinic attendees in a tertiary level healthcare center in Nigeria. This is a descriptive, cross-sectional, questionnaire-based study conducted at Nnamdi Azikwe University Teaching Hospital in Nigeria in December 2007. A total of 200 questionnaires were distributed, and 198 were properly completed. The 198 completely and properly filled questionnaires formed the basis of the analysis. Twenty-five (12.6%) of the women were aware of the cervical cancer screening test, while 173 (87.4%) had never heard of the test before. Only 8% of the respondents had knowledge of the prevention of cervical cancer, but none of them were aware of the introduction of the human papillomavirus vaccine. Twenty-one (84.0%) of those women who were aware of the cervical cancer screening test got their information from healthcare providers, 3 (12.0%) from television and 2 (8.0%) from radio. Of the 25 respondents who were aware of the cervical cancer screening test, 15 (60.0%) had received at least a Pap smear test. All of the screening was done as an opportunistic screening exercise. A total of 119 (85.0%) of the women were not able to be screened because they were not aware of the cervical cancer smear screening, while 4 (3.2%) felt that it was unnecessary. There is a significant association between the educational status and the knowledge of the cervical smear Pap test (chi2 = 10.14, p value = 0.001). Eighty (57.1%) of the women agreed that they would like to undertake cervical cancer screening, while 60 (42.9%) would decline the cervical cancer screening test. The knowledge about cervical cancer in this study was very low. This poor knowledge may limit the utilization of cervical cancer prevention programs. This study underscores the need to establish an intensive and sustainable awareness campaign on the prevention of cancer of the cervix.

Secondary and tertiary hyperparathyroidism in chronic kidney disease

Directory of Open Access Journals (Sweden)

Lilit V. Egshatyan

2017-12-01

Full Text Available In the treatment of secondary hyperparathyroidism of end-stage chronic kidney disease, vitamin D receptor activation and allosteric modulators of the calcium-sensing receptor – inhibit glandular hyperplasia, reduce parathyroid hormone levels, impact on bone turnover and mineral density. But the use of calcimimetic and vitamin D analogs or mimetics did not reduce the need for parathyroidectomy for refractory hyperparathyroidism. The enlarged parathyroid gland and gland nodular transformation became refractory to medical therapy and patient need for parathyroidectomy. Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone after a long period of secondary hyperparathyroidism and renal transplantation. In this article, we present the case of a Caucasian male with chronic kidney disease (end-stage on chronic hemodialysis and after kidney transplantation and different forms of hyperparathyroidism (secondary and tertiary. Our case study shows that only a multi-interventional strategy is likely to be more effective treatment in cases of severe and refractory to medical therapy hyperparathyroidism.

Medical treatment of primary, secondary, and tertiary hyperparathyroidism.

Science.gov (United States)

Vestergaard, Peter; Thomsen, Susanna vid Strym

2011-04-01

Hyperparathyroidism is a condition with elevated parathyroid hormone (PTH). The increase may be due to a) primary hyperparathyroidism which is caused by adenoma of one or more parathyroid glands or hyperplasia of all four glands, b) secondary hyperparathyroidism, which may be caused by deficiency in vitamin D or uremia, and 3) tertiary hyperparathyroidism, which most often is the result of a long-standing, severe secondary hyperparathyroidism, which has turned autonomous once the cause of the secondary hyperparathyroidism has been removed. Many new treatment options have been introduced in recent years. Cinacalcet is calcium sensing receptor agonist, which by stimulating the receptor decreases PTH and calcium levels. It may be used in primary hyperparathyroidism, secondary hyperparathyroidism caused by uremia, which may not be controlled with calcium and activated vitamin D. It may also be used in tertiary hyperparathyroidism. Newer analogues of vitamin D such as paricalcitol have also been introduced, which may have an advantage over traditional compounds such as alphacalcidol and calcitriol.

The use of tribromoisocyanuric acid to distinguish among primary, secondary and tertiary alcohols

Energy Technology Data Exchange (ETDEWEB)

Crespo, Livia T.C., E-mail: livia.vilela@ifrj.edu.br [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Instituto de Quimica. Departamento de Quimica Organica; Instituto Federal de Educacao, Ciencia e Tecnologia do Rio de Janeiro (IF-RJ), Duque de Caxias, RJ (Brazil); Mattos, Marcio C.S. de; Esteves, Pierre M. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Instituto de Quimica. Departamento de Quimica Organica

2013-09-01

Primary, secondary and tertiary alcohols can be easily distinguished due to their reactivity towards tribromoisocyanuric acid (TBCA). The test is performed by adding TBCA to the alcohol in a test tube heated in a boiling water bath. Orange color develops in the tube containing the primary alcohol, light yellow is observed in the tube containing the secondary alcohol while the tertiary alcohol results in a colorless mixture. (author)

The use of tribromoisocyanuric acid to distinguish among primary, secondary and tertiary alcohols

International Nuclear Information System (INIS)

Crespo, Livia T.C.; Mattos, Marcio C.S. de; Esteves, Pierre M.

2013-01-01

Primary, secondary and tertiary alcohols can be easily distinguished due to their reactivity towards tribromoisocyanuric acid (TBCA). The test is performed by adding TBCA to the alcohol in a test tube heated in a boiling water bath. Orange color develops in the tube containing the primary alcohol, light yellow is observed in the tube containing the secondary alcohol while the tertiary alcohol results in a colorless mixture. (author)

The use of tribromoisocyanuric acid to distinguish among primary, secondary and tertiary alcohols

Directory of Open Access Journals (Sweden)

Lívia T. C. Crespo

2013-01-01

Full Text Available Primary, secondary and tertiary alcohols can be easily distinguished due to their reactivity towards tribromoisocyanuric acid (TBCA. The test is performed by adding TBCA to the alcohol in a test tube heated in a boiling water bath. Orange color develops in the tube containing the primary alcohol, light yellow is observed in the tube containing the secondary alcohol while the tertiary alcohol results in a colorless mixture.

EARLY PROGNOSTIC FACTORS FOR DISABILITY IN MULTIPLE-SCLEROSIS, A EUROPEAN MULTICENTER STUDY

NARCIS (Netherlands)

RIISE, T; GRONNING, M; FERNANDEZ, O; LAUER, K; MIDGARD, R; MINDERHOUD, JM; NYLAND, H; PALFFY, G; POSER, S; AARLI, JA

The effects of initial clinical variables on short-term prognosis are analyzed in a cross-sectional study of 574 multiple sclerosis patients from 7 centers in 5 European countries. Patients with a primary progressive course had a 2.3 higher mean disability score (EDSS) than the primary remittent

Palynological and iridium anomalies at Cretaceous-Tertiary boundary, south-central Saskatchewan

Science.gov (United States)

Nichols, D.J.; Jarzen, D.M.; Orth, C.J.; Oliver, P.Q.

1986-01-01

The Cretaceous-Tertiary boundary in south-central Saskatchewan is marked by coincident anomalies in abundance of iridium and fern spores at the extinction level of a suite of Cretaceous pollen taxa. Evidence of disruption of the terrestrial flora includes the fern-spore abundance anomaly and local extinction of as much as 30 percent of angiosperm species. The reorganized earliest Tertiary flora is made up largely of surviving species that assumed new roles of dominance. Persistence of climatically sensitive taxa across the boundary indicates that if paleoclimate was altered by the terminal Cretaceous event, it returned quickly to the pre-event condition.

Innovating in the Real World: Exploring Institutional Effects on Tertiary Teacher Innovations in New Zealand

Science.gov (United States)

Lawrence, Belinda

2018-01-01

Innovation is a key goal of many tertiary education and distance learning providers. This research explores how teachers and educational designers across three New Zealand tertiary institutions worked to innovatively achieve teaching goals. A longitudinal design using the Cultural Historical Activity Theory (CHAT) framework explored the influence…

Social Activities and Manifest Anxiety among Freshmen in Tertiary ...

African Journals Online (AJOL)

) in tertiary institutions in Lagos state of Nigeria were analysed to determine the relationship between social activities and manifest anxiety. Social activities in the study were measured in terms of freshmen adjustment to religious activities and ...

An Innovation Systems Perspectives on Tertiary-Level Agricultural ...

African Journals Online (AJOL)

This paper examines how tertiary-level agricultural education in sub-Saharan Africa can contribute to agricultural development beyond its current role as a source of technical training. The paper draws on data and information gathered from semistructured key informant interviews conducted in late 2006 in and around Addis ...

European communion

DEFF Research Database (Denmark)

Manners, Ian James

2013-01-01

Political theory of European union, through an engagement between political concepts and theoretical understandings, provides a means of identifying the EU as a political object. It is argued that understanding the projects, processes and products of European union, based on ‘sharing’ or ‘communion......’, provides a better means of perceiving the EU as a political object rather than terms such as ‘integration’ or ‘co-operation’. The concept of ‘European communion’ is defined as the ‘subjective sharing of relationships’, understood as the extent to which individuals or groups believe themselves to be sharing...... relations (or not), and the consequences of these beliefs for European political projects, processes and products. By exploring European communion through an engagement with contemporary political theory, using very brief illustrations from the Treaty of Lisbon, the article also suggests that European...

Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center.

Science.gov (United States)

Vosler, Peter S; Kass, Jason I; Wang, Eric W; Snyderman, Carl H

2016-11-01

We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost. Single prospective analysis with historical control. Tertiary academic hospital. Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing. Severe epistaxis was similar in the pre- and post-CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 ± 1.6 to 1.4 ± 1.6; P = .001), decreased hospital stay (5.2 ± 3.9 to 2.1 ± 1.3 days; P vs 54.5%; P = .035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; P = .007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented. Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Tertiary lymphoid organs in Takayasu Arteritis

OpenAIRE

Marc eClement; Marc eClement; Adrien eGaly; Patrick eBruneval; Marion eMorvan; Fabien eHyafil; Fabien eHyafil; Khadija eBenali; Nicoletta ePasi; Lydia eDeschamps; Quentin ePellenc; Quentin ePellenc; Thomas ePapo; Antonino eNicoletti; Antonino eNicoletti

2016-01-01

Objective: The role of B cells in the pathogenesis of Takayasu arteritis (TA) is controversial. We aimed to study the presence of tertiary lymphoid organs (TLOs) in the aortic wall of TA patients.Methods: Hematoxylin and eosin–stained sections from aorta specimens from patients with TA were screened for TLOs. The presence of B cell aggregates (CD20), follicular dendritic cells (FDCs, CD21), and high endothelial venules (HEVs, PNAd) was investigated by immunohistochemistry. Immune cells from t...

Tertiary Lymphoid Organs in Takayasu Arteritis

OpenAIRE

Clement, Marc; Galy, Adrien; Bruneval, Patrick; Morvan, Marion; Hyafil, Fabien; Benali, Khadija; Pasi, Nicoletta; Deschamps, Lydia; Pellenc, Quentin; Papo, Thomas; Nicoletti, Antonino; Sacre, Karim

2016-01-01

Objective The role of B cells in the pathogenesis of Takayasu arteritis (TA) is controversial. We aimed to study the presence of tertiary lymphoid organs (TLOs) in the aortic wall of TA patients. Methods Hematoxylin and eosin-stained sections from aorta specimens from patients with TA were screened for TLOs. The presence of B cell aggregates (CD20), follicular dendritic cells (FDCs, CD21), and high endothelial venules (HEVs, PNAd) was investigated by immunohistochemistry. Immune ce...

The European Hematology Association Roadmap for European Hematology Research

DEFF Research Database (Denmark)

Engert, Andreas; Balduini, Carlo; Brand, Anneke

2016-01-01

The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology...... research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness...... of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology...

A NEW CONCEPT IN LANGUAGE LEARNING: APPLICATION OF EUROPEAN LANGUAGE DEVELOPMENT

Directory of Open Access Journals (Sweden)

Ahmet GÜNEYLI

2006-12-01

Full Text Available This study aims to adapt European Language Portfolio (ELP to teaching Turkish as a foreign languagewhose application has been planned since 2005 in all European countries. With the European Language Passport programEuropean Validity Committee aims to set a langugage learning standard and encourage multi-culturalism among EUcountries. This program targets to find out which langugages the individuals speak and to discover where, how and whenthey have learnt the language. It also provides an opportunity for them to travel, reside and work in European countries.Today, ELP is in progress of becoming a common purpose in Europe. Therefore, ELP must be utilized in teaching Turkishas a foreign language. ELP must be piloted in laboratory schools through experimental studies with an approprietlydeveloped portfolio. Pilot projects must be applied in elementary, secondary, high schools and universities with acollaboration with the Ministry of Education. This study was conducted in TOMER ( the language center of AnkaraUniversity. For this study an experimental design was used. The sample includes 20 students in the control group and 20students in the experimental group. In this study students’ proficiency level of Turkish related to four basic language skills(reading, writing, listening and speaking and their attitude towards ELP application were examined.

Accession to the European Union: Advantage or Disadvantage for Czech Companies?

Directory of Open Access Journals (Sweden)

Dušan Litva

2016-12-01

Full Text Available In this paper has been studied effects of accession to the EU on Czech companies which were selected and grouped according to 5 parameters: region, legal form, operation area, business sector and size of the company defined by number of employees. Questionnaire containing 14 questions have replied in total 146 respondents. It is possible to conclude that accession to the EU brought more advantages to big global joint- stock companies than to small regional companies which were mostly negative and claimed worsening of business results due to European integration. Most of the 146 respondents asked via questionnaire containing 14 questions did not agree with acceptance of Euro, while those who agreed had been estimated 2020 as ideal year to access Eurozone. Companies in quaternary sector were mostly positive on the opposite to the companies in tertiary sector which were negative. Companies in Prague and Central Bohemia were much more positive towards EU benefits than in rest of the Czech Republic regions.

Helpless patients' perception of bed-bath in tertiary health ...

African Journals Online (AJOL)

Helpless patients' perception of bed-bath in tertiary health institutions in Enugu, Southeast Nigeria. ... Journal Home > Vol 10, No 2 (2005) > ... patients to bed bathing by nurses is a very important aspect of quality assurance in nursing care.

Source of sulphur in the Ebro Basin (Northern Spain). Tertiary nonmarine evaporite deposits as evidenced by sulphur isotopes

International Nuclear Information System (INIS)

Birnbaum, S.J.; Coleman, D.

1979-01-01

The Ebro Basin is an intermontane basin, located in northern Spain, filled with Tertiary (largely Oligocene and Miocene) elastic and chemical deposits. Sulphur isotopes are utilized to determine the source of sulphur in the sulphate deposits (predominantly gypsum with accessory thenardite, mirabolite and epsomite). Data obtained from Tertiary gypsum rocks produce a range of delta 34 S values from +9.16% to + 14.02% with a mean of +13.61%. Data obtained from Triassic gypsum rocks (in source area) produce a range from +13.73% to +15.14%, with a mean of +14.66%. Values for Tertiary marine water range from +18% to +24%. These data indicate a nonmarine origin for sulpur within the Tertiary sulphate rocks. The contribution of Triassic sulphur to the groundwater system, plus varying degrees of dilution by isotopically lighter (atmospheric and sulphide) sulphur, best explains the isotopic ratios observed in the Tertiary Basin deposits. (Auth.)

Spatial concentration of economic activity and competitiveness of Central European regions

Directory of Open Access Journals (Sweden)

Justyna Majewska

2017-02-01

Full Text Available The paper tackles with a still somewhat underdeveloped aspect of regional competiveness which regards to spillover effects stemming from spatial proximity of highly competitive neighbors. Although spillover effects are well recognized in the literature, we focus more on inter-regional concentration of business activity when enterprises are located in a particular district which is not far from the agglomeration center but not the center itself. We check for statistical significance of spatial autocorrelation measures (local Moran’s Ii statistic in order to identify spillovers between districts in Central European countries (Germany, Poland, Czech Republic and Slovakia. We use variables indicating Knowledge Intensive Services (KIS, in particular hi-tech KIS and information and communication services (including computer science. We compare 2009 with 2015 to notice agglomeration dynamics. We observe statistically significant spillover effects in Central European countries in urbanization-type clusters as well as strengthening of the effect over time. Taking into consideration more detailed data for Poland we conclude that while hi-tech KIS mostly spill over to neighboring districts, the reverse pattern may be observed for computer science (programming and consultancy. One explanation is that this subsector relies on highly demanded workforce and a prestigious localization (in the agglomeration centers works as a bargaining chip to attract programmers. In order to measure the spillover effects more precisely it is recommended to define and measure the neighborhood of agglomeration centers using localization of firms based on GPS coordinates instead of centroids (geometric means of districts – as shown in example of Poland.

The effect of the development of an emergency transfer system on the travel time to tertiary care centres in Japan

Directory of Open Access Journals (Sweden)

Arima Hideaki

2006-06-01

Full Text Available Abstract Background In Japan, the emergency medical system is categorized into three levels: primary, secondary, and tertiary, depending on the severity of the condition of the patient. Tertiary care centres accept patients who require 24-h monitoring. In this research, the average travel times (minutes from the centroids of all municipalities in Japan to the nearest tertiary care centre were estimated, using the geographic information system. The systems affecting travel time to tertiary care centres were also examined. Regression analysis was performed to determine the factors affecting the travel time to tertiary care centres, using selected variables representing road conditions and the emergency transfer system. Linear regression analysis was performed to identify specific benchmarks that would be effective in reducing the average travel time to tertiary care centres in prefectures with travel times longer than the average 57 min. Results The mean travel time was 57 min, the range was 83 min, and the standard deviation was 20.4. As a result of multiple regression analysis, average coverage area per tertiary care centre, kilometres of highway road per square kilometre, and population were selected as variables with impact on the average travel time. Based on results from linear regression analysis, benchmarks for the emergency transfer system that would effectively reduce travel time to the mean value of 57 min were identified: 26% pavement ratio of roads (percentage of paved road to general roads, and three tertiary care centres and 108 ambulances. Conclusion Regional gaps in the travel time to tertiary care centres were identified in Japan. The systems we should focus on to reducing travel time were identified. Further reduction of travel time to tertiary care centres can be effectively achieved by improving these specific systems. Linear regression analysis showed that a 26% pavement ratio and three tertiary care centres are beneficial to

Relevance of Donation to Special Federal Tertiary Institution ...

African Journals Online (AJOL)

While structured and open-ended interview and relevant documents, including gift and donation files, acquisition records and library accession registers were used to collect data for the study. The population of the study consisted of the Special Federal Tertiary Institution Libraries under study while the subjects of the study ...

Emotional Intelligence and the Conflict Resolution Repertoire of Couples in Tertiary Institutions in Imo State

Science.gov (United States)

Nnodum, B. I.; Ugwuegbulam, C. N.; Agbaenyi, I. G.

2016-01-01

This study is a descriptive survey that investigated the relationship between emotional intelligence and conflict resolution repertoire of couples in tertiary institutions. A sample of 250 married people were drawn from the population of couples in tertiary institutions in Imo State. Two researcher made and validated instruments were used in…

The Incidence of Nosocomial Toxigenic Clostridium difficile Associated Diarrhea in Tehran Tertiary Medical Centers

Directory of Open Access Journals (Sweden)

Norakhoda Sadeghifard

2010-09-01

Full Text Available "nClostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero. Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion. Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1% were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P<0.05. Among the wards of selected hospitals, in gastroenterology of Children clinical center, Toxigenic C. difficile was isolated from patients most frequently. The sensitivity of isolates to vancomycin, Chloramphenicol and ceftriaxone were higher than other antibiotics. Toxigenic C. difficile is a common hospital-acquired infection. The organism was found in 6.1% hospitalized patients. Further studies to evaluate the rate and role of toxigenic C. difficile in nosocomial diarrheal processes, ecological and pathogenic terms are suggested.

Obesity and associated factors in young adults attending tertiary ...

African Journals Online (AJOL)

Obesity and associated factors in young adults attending tertiary institutions ... and associated factors in a group of university undergraduates in south-east Nigeria. ... being a female (X2 = 47.91), first year student (X2 = 41.82), and having high ...

Assessment Quality in Tertiary Education: An Integrative Literature Review

NARCIS (Netherlands)

Gerritsen-van Leeuwenkamp, Karin; Joosten-ten Brinke, Desirée; Kester, Liesbeth

2018-01-01

In tertiary education, inferior assessment quality is a problem that has serious consequences for students, teachers, government, and society. A lack of a clear and overarching conceptualization of assessment quality can cause difficulties in guaranteeing assessment quality in practice. Thus, the

Optimising Tertiary Student Accommodation within University Neighbourhoods

OpenAIRE

Ike, Nnenna; Baldwin, Claudia; Lathouras, Athena

2017-01-01

Tertiary students’ activities within neighbourhoods adjacent to universities engender positive and negative impacts that have consequences for neighbourhood sustainability. This might lead to studentification, a process that triggers physical, economic and socio-cultural transformation of university towns. Where non-student residents perceive negative impacts, it can lead to conflict and resentment towards the student population, mistrust between student and local resident groups and a decrea...

Evaluation of the onset of tertiary creep for types 304 and 316 stainless steels

International Nuclear Information System (INIS)

Staerk, E.; Picker, C.; Felsen, M.F.

1989-01-01

Austenitic stainless steels Types 304 and 316 are used for LMFBR components. Although at high temperature many codes base the allowable stress on the stress rupture strength, some recent codes eg ASME Code Case N47 and RCC-MR also take account of the onset of tertiary creep. In order to examine this latter aspect creep deformation data on Type 304 and Type 316 steel have been collected and analysed. The ratio time to onset of tertiary creep against the time to rupture has been analysed as a function of temperature. At temperatures below 750 0 C the ratio is found to decrease slightly with increasing temperature. Monkman Grant and Lambda relationships have also been investigated. In relation to the ASME S t allowable stress criteria it is shown that below 600 0 C the allowable stress is likely to be governed by the stress rupture strength rather than the onset of tertiary creep criterion. Recommendations are given concerning the determination of the onset of tertiary creep, the fitting of the Leyda/Rowe relationship and a method to compute the maximum allowable stress S t from equation describing the time-temperature dependency of the three constituents of S t

Tandem catalytic allylic amination and [2,3]-Stevens rearrangement of tertiary amines.

Science.gov (United States)

Soheili, Arash; Tambar, Uttam K

2011-08-24

We have developed a catalytic allylic amination involving tertiary aminoesters and allylcarbonates, which is the first example of the use of tertiary amines as intermolecular nucleophiles in metal-catalyzed allylic substitution chemistry. This process is employed in a tandem ammonium ylide generation/[2,3]-rearrangement reaction, which formally represents a palladium-catalyzed Stevens rearrangement. Low catalyst loadings and mild reaction conditions are compatible with an unprecedented substrate scope for the ammonium ylide functionality, and products are generated in high yields and diastereoselectivities. Mechanistic studies suggested the reversible formation of an ammonium intermediate.

Corifollitropin alfa followed by rFSH in a GnRH antagonist protocol for poor ovarian responder patients

DEFF Research Database (Denmark)

Polyzos, Nikolaos P; Devos, Michel; Humaidan, Peter

2013-01-01

OBJECTIVE: To identify whether women with poor ovarian response may benefit from treatment with corifollitropin alfa in a GnRH antagonist protocol. DESIGN: Retrospective pilot study. SETTING: University-based tertiary care center. PATIENT(S): Poor ovarian responders fulfilling the Bologna criteria...... developed by European Society for Human Reproduction and Embryology Consensus Group. INTERVENTION(S): Corifollitropin alfa (150 μg) followed by 300 IU rFSH in a GnRH antagonist protocol. MAIN OUTCOME MEASURE(S): Endocrinologic profile and ongoing pregnancy rates. RESULT(S): Among 43 women treated...

Morbidity and mortality of complex spine surgery

DEFF Research Database (Denmark)

Karstensen, Sven; Bari, Tanvir; Gehrchen, Martin

2016-01-01

requiring revision. METHODS: All patients undergoing spinal surgery at an academic tertiary referral center in the study period were prospectively included. The newest version of SAVES system was used, and a research coordinator collected all intraoperative and perioperative data prospectively. Once a week...... adverse events (AEs). PURPOSE: This study aimed to determine the mortality and examine the incidence of morbidity in patients undergoing complex spinal surgery, including pediatric patients, and to validate the SAVES system in a European population. STUDY DESIGN: A prospective, consecutive cohort study...

Trauma Center Based Youth Violence Prevention Programs: An Integrative Review.

Science.gov (United States)

Mikhail, Judy Nanette; Nemeth, Lynne Sheri

2016-12-01

Youth violence recidivism remains a significant public health crisis in the United States. Violence prevention is a requirement of all trauma centers, yet little is known about the effectiveness of these programs. Therefore, this systematic review summarizes the effectiveness of trauma center-based youth violence prevention programs. A systematic review of articles from MEDLINE, CINAHL, and PsychINFO databases was performed to identify eligible control trials or observational studies. Included studies were from 1970 to 2013, describing and evaluating an intervention, were trauma center based, and targeted youth injured by violence (tertiary prevention). The social ecological model provided the guiding framework, and findings are summarized qualitatively. Ten studies met eligibility requirements. Case management and brief intervention were the primary strategies, and 90% of the studies showed some improvement in one or more outcome measures. These results held across both social ecological level and setting: both emergency department and inpatient unit settings. Brief intervention and case management are frequent and potentially effective trauma center-based violence prevention interventions. Case management initiated as an inpatient and continued beyond discharge was the most frequently used intervention and was associated with reduced rearrest or reinjury rates. Further research is needed, specifically longitudinal studies using experimental designs with high program fidelity incorporating uniform direct outcome measures. However, this review provides initial evidence that trauma centers can intervene with the highest of risk patients and break the youth violence recidivism cycle. © The Author(s) 2015.

Infection Rate after Cranial Neurosurgical Procedures: A Prospective Single-Center Study.

Science.gov (United States)

Strahm, Carol; Albrich, Werner C; Zdravkovic, Vilijam; Schöbi, Barbara; Hildebrandt, Gerhard; Schlegel, Matthias

2018-03-01

To determine infection rate (IR) and to identify modifiable risk factors (RF) in cranial neurosurgery in a neurosurgical department for tertiary referral as part of an infection control surveillance to reduce surgical site infections (SSI). A prospective SSI incidence cohort study from February 2013 to January 2014 was performed in a tertiary-care neurosurgical teaching hospital and referral center. All consecutive adults undergoing any cranial neurosurgical procedure were included. Data were collected by a trained member of the infection control staff during the twice-weekly visits of the hospitalized patients. Follow-up was 30 days (procedures without implant) and 1 year (procedures involving permanent implants). SSI was diagnosed according to criteria of CDC. A total of 317 patients undergoing 333 index procedures were included. The median age was 61 years (range, 17-91 years) and 46% were female. Survival in patients with completed follow-up was 76% (196/258). Overall, IR was 7.2% (24/333 index procedures); in 96% (23/24), a neurosurgical implant was involved. The IR of extraventricular drainage (EVD) was 12.5% (13.1/1000 EVD days). The main causative pathogens were Staphylococcus aureus followed by coagulase-negative staphylococci and Propionibacterium acnes. Independent RF for neurosurgical SSI were EVD as part of the index operation and body mass index >25 kg/m 2 . IR was in accordance with recent prospective single-center studies (reported IR between 1.6% and 9%). EVD placement was identified as the strongest modifiable RF for SSI in cranial neurosurgical procedures. The need for standard infection control procedures for the insertion and maintenance of EVDs to avoid their contamination is reinforced. Copyright © 2017 Elsevier Inc. All rights reserved.

Constructing Knowledge Societies: New Challenges for Tertiary Education.

Science.gov (United States)

Salmi, Jamil

2003-01-01

The principal set of challenges facing tertiary education today is that set which links it to the construction of knowledge societies. Governments, the private sector, and the World Bank have specific tasks to perform in meeting these challenges. Countries--depending upon whether or not they are transition economies, low-income countries, or small…

Tertiary Educational Institutions for Teaching, Research and Development

Science.gov (United States)

Amoo, Sikiru A.

2014-01-01

This paper examines the quality of teaching and research in developing human resources to facilitate the development of tertiary education in the nation. It discusses the challenges and the roles of research in higher education. The author argues that the combination of content and pedagogical knowledge could help to develop human resources for…

Geochemical characteristics of Tertiary saline lacustrine oils in the Western Qaidam Basin, northwest China

International Nuclear Information System (INIS)

Zhu Yangming; Weng Huanxin; Su Aiguo; Liang Digang; Peng Dehua

2005-01-01

Based on the systematic analyses of light hydrocarbon, saturate, aromatic fractions and C isotopes of over 40 oil samples along with related Tertiary source rocks collected from the western Qaidam basin, the geochemical characteristics of the Tertiary saline lacustrine oils in this region was investigated. The oils are characterized by bimodal n-alkane distributions with odd-to-even (C 11 -C 17 ) and even-to-odd (C 18 -C 28 ) predominance, low Pr/Ph (mostly lower than 0.6), high concentration of gammacerane, C 35 hopane and methylated MTTCs, reflecting the high salinity and anoxic setting typical of a saline lacustrine depositional environment. Mango's K 1 values in the saline oils are highly variable (0.99-1.63), and could be associated with the facies-dependent parameters such as Pr/Ph and gammacerane indexes. Compared with other Tertiary oils, the studied Tertiary saline oils are marked by enhanced C 28 sterane abundance (30% or more of C 27 -C 29 homologues), possibly derived from halophilic algae. It is noted that the geochemical parameters of the oils in various oilfields exhibit regular spatial changes, which are consistent with the depositional phase variations of the source rocks. The oils have uncommon heavy C isotopic ratios (-24%o to -26%o) and a flat shape of the individual n-alkane isotope profile, and show isotopic characteristics similar to marine organic matter. The appearance of oleanane and high 24/(24 + 27)-norcholestane ratios (0.57-0.87) in the saline oils and source rocks confirm a Tertiary organic source

Trends in cigarette smoking in the German centers of the European Prospective Investigation into Cancer and Nutrition (EPIC): the influence of the educational level.

Science.gov (United States)

Rohrmann, Sabine; Becker, Nikolaus; Kroke, Anja; Boeing, Heiner

2003-04-01

Several studies in Germany and other European countries have already shown smoking prevalence to be related to education. This study was aimed to investigate time trends in smoking habits in the German cohorts Heidelberg and Potsdam of the European Prospective Investigation into Cancer and Nutrition (EPIC) according to sex, birth cohort, and level of education. Within EPIC, 25,546 and 27,548 participants were recruited in Heidelberg and Potsdam, respectively. Data on smoking were collected by means of a computer-guided interview during the baseline examination between 1994 and 1998. For each birth cohort smoking prevalence and mean number of cigarettes smoked per day at different ages were calculated. Odds ratios and 95% confidence interval for associations between smoking prevalence and educational level were computed by using logistic regression. Smoking prevalence was higher among men than among women, with a smaller difference in younger birth cohorts. Between 1950 and 1960, smoking prevalence among women in the Heidelberg cohort rose sharply (from 12.8% to 51.8% in the least educated group). This strong increase was delayed by 10 years in the Potsdam cohort. Men and women in Heidelberg smoked more cigarettes per day than their counterparts in Potsdam, but in both study centers less educated subjects smoked more than subjects with a higher education. Smoking patterns in the Potsdam and Heidelberg cohorts are quite similar with respect to prevalence and years of lifetime smoking. Since an increasing difference between smoking prevalence of less and high educated individuals is observable, programs on smoking cessation should especially concentrate on persons of lower educational level.

CH4 emissions from European Major Population Centers: Results from aircraft-borne CH4 in-situ observations during EMeRGe-Europe campaign 2017

Science.gov (United States)

Roiger, A.; Klausner, T.; Schlager, H.; Ziereis, H.; Huntrieser, H.; Baumann, R.; Eirenschmalz, L.; Joeckel, P.; Mertens, M.; Fisher, R.; Bauguitte, S.; Young, S.; Andrés Hernández, M. D.

2017-12-01

Urban environments represent large and diffuse area sources of CH4 including emissions from pipeline leaks, industrial/sewage treatment plants, and landfills. However, there is little knowledge about the exact magnitude of these emissions and their contribution to total anthropogenic CH4. Especially in the context of an urbanizing world, a better understanding of the methane footprint of urban areas is crucial, both with respect to mitigation and projection of climate impacts. Aircraft-borne in-situ measurements are particularly useful to both quantify emissions from such area sources, as well as to study their impact on the regional distribution. However, airborne CH4 observations downstream of European cities are especially sparse.Here we report from aircraft-borne CH4 in-situ measurements as conducted during the HALO aircraft campaign EMeRGe (Effect of Megacities on the Transport and Transformation of Pollutants on the Regional to Global Scales) in July 2017, which was led by the University of Bremen, Germany. During seven research flights, emissions from a variety of European (Mega)-cities were probed at different altitudes from 3km down to 500m, including measurements in the outflows of London, Rome, Po Valley, Ruhr and Benelux. We will present and compare the CH4 distribution measured downstream of the various studied urban hot-spots. With the help of other trace gas measurements (including e.g. CO2, CO, O3, SO2), observed methane enhancements will be attributed to the different potential source types. Finally, by the combination of in-situ measurements and regional model simulations using the EMAC-MECO(n) model, the contribution of emissions from urban centers to the regional methane budget over Europe will be discussed.

Management for the children with otitis media with effusion in the tertiary hospital.

Science.gov (United States)

Choung, Yun-Hoon; Shin, You Ree; Choi, Seong Jun; Park, Keehyun; Park, Hun Yi; Lee, Jong Bin; Han, Dong Hee; Kahng, Hison

2008-12-01

Recently, new evidence-based recommendations have been introduced for diagnosing and managing otitis media with effusion (OME) in children. However, there are some difficulties to follow the general guidelines in the tertiary hospitals. The purpose is to evaluate the efficiency of antibiotics or antihistamines for treatment of children with OME in the tertiary hospital with a randomized prospective clinical study. Eighty-four children with OME who had been diagnosed in the tertiary hospital were randomized to receive 5 different medications for 2 weeks. We prescribed antibiotics (amoxicillin-clavulanate syrup) in Group I (n=16), antibiotics/steroids (prednisolone) in Group II (n=18), antibiotics/antihistamines (ebastine) in Group III (n=15), antibiotics/steroids/antihistamines in Group IV (n=17), and mucolytics (ivy leaf extract) in Group V (n=17) for control. We followed-up children every 2 weeks and evaluated the state of OME at 3 months. Thirty six (42.9%) of 84 children were resolved within average 6.9 weeks after the treatments. Thirty-six (42.9%) were treated with ventilation tube insertion and 12 patients (14.3%) were observed. There was no difference in the resolution rates of OME among the five different protocols (P>0.05). There was no difference in the resolution rates among groups who used steroids, antihistamines, steroids and antihistamines, or other medications to manage 42 children with allergies (P>0.05). In the tertiary hospital, the cure rate of children with OME was not as high as well-known, and antibiotics or anti-allergic medications were not more effective than control. We may, therefore, need any other guidelines which are different from the previous evidence-based recommendations, including early operation in the tertiary hospitals.

Suggestions / contributions for the re-shaping of the European energy policy. Comparison between the ECF 'road-map 2050' scenario commissioned by Brussels and an extrapolation of the SLC-Negatep scenario at the European scale

International Nuclear Information System (INIS)

Acket, Claude; Bacher, Pierre

2011-01-01

The 'European Climate' Foundation and 'Sauvons le Climat' have proposed energy scenarios for Europe and for France, respectively, with the objectives of dividing by a factor 4 or 5 the CO 2 emissions. The objectives are similar, and so are the premises that success rests on decisive actions in all the sectors contributing to the emissions. Both scenario families call for a large improvement in energy efficiency, a massive use of renewable heat (biomass, solar etc.), and the substitution of electricity to fossil fuels in both their stationary uses (housing end tertiary sectors) and mobile uses (transport). This last requirement leads to a 50 % to 100 % increase in electricity demand by 2050. The two families diverge, however, on the means to produce this electricity: ECF calls for a massive use of renewable electricity (mainly wind an solar) and a supplement provided for by fossile energy with capture and sequestration of the CO 2 produced (CCS) and nuclear energy; a super grid connecting Southern Europe to Northern Europe has to be built to deal with the load variations, with additional combustion turbines as standby. SLC's Negatep scenarios call for a very large contribution of carbon-free (nuclear and (or) fossile with CCS) energies, and a supplement provided for by renewable electricity, the latter being limited by the existing grid capacities. The present work compares the different scenarios and their relative costs; it shows that the Negatep scenarios carry investments roughly half those of the scenarios with the largest renewable component, together with electricity costs significantly lower. In other words, a European energy policy along the lines advocated by ECF would entail particularly large capital investments and, in constant money, a two-fold increase in the cost of electricity by 2050 in Europe. And France would become a crossroad for European electricity and would have to harbour many high tension lines. The conclusion is that this situation should

European Research Reloaded : Cooperation and Integration Among Europeanized States

NARCIS (Netherlands)

Holzhacker, Ron; Haverland, Markus

2006-01-01

European integration has had an ever deepening impact on the member states. The first wave of research concerned the process of institution building and policy developments at the European Union (EU) level. The second wave, on Europeanization used the resulting integration as an explanatory factor

Outbreak of carbapenem-resistant Providencia rettgeri in a tertiary ...

African Journals Online (AJOL)

Carbapenem resistance in Enterobacteriaceae is often plasmid mediated, necessitating stringent infection control practices. We describe an outbreak of carbapenem-resistant Providencia rettgeri involving 4 patients admitted to intensive care and high-care units at a tertiary hospital. Clinical and demographic characteristics ...

Pathology findings and validation of gastric and esophageal cancer cases in a European cohort (EPIC/EUR-GAST)

DEFF Research Database (Denmark)

Carneiro, F; Moutinho, C; Pera, G

2007-01-01

OBJECTIVE: Cardia, non-cardia and intestinal and diffuse subtypes of gastric cancer may have different trends and etiological factors. However, the available information is not always collected in population cancer registries, and heterogeneous criteria have been applied for the histopathological...... classification of tumors. We describe the pathological features of incident gastric and esophageal cancers identified within the European Prospective Investigation into Cancer and Nutrition (EPIC). MATERIAL AND METHODS: In an investigation on gastric and esophageal cancer (EUR-GAST) in the EPIC project......, a validation study of diagnoses reported by EPIC centers was conducted by a European panel of pathologists. Original pathology reports, stained slides of tumors and the respective paraffin blocks were requested from the centers. RESULTS: The whole series encompassed 467 cancer cases (gastric and esophageal...

Electro-oxidation of reverse osmosis concentrates generated in tertiary water treatment.

Science.gov (United States)

Pérez, G; Fernández-Alba, A R; Urtiaga, A M; Ortiz, I

2010-05-01

This work investigates the application of the electro-oxidation technology provided with boron doped diamond (BDD), an electrode material which has shown outstanding properties in oxidation of organic and inorganic compounds, for the treatment of reverse osmosis (RO) concentrates generated in tertiary wastewater treatment plants (WWTP). Chemical oxygen demand (COD), ammonium and several anions were measured during the electro-oxidation process, and the influence of the applied current density (20-200A/m(2)) was analysed on process kinetics. Analytical assessment showed that several emerging pollutants (pharmaceuticals, personal care products, stimulants, etc.) were presented both in the effluent of the secondary WWTP as well as in the RO concentrate. For this reason, a group of 10 emerging pollutants, those found with higher concentrations, was selected in order to test whether electro-oxidation can be also applied for their mitigation. In the removal of emerging pollutants the electrical current density in the range 20-100A/m(2) did not show influence likely due to the mass transfer resistance developed in the process when the oxidized solutes are present in such low concentrations. Their removal rates were fitted to first order expressions, and the apparent kinetic constants for the anodic oxidation of each compound were calculated. Finally, the formation of trihalomethanes (THMs) has been checked; concluding that after selecting the appropriate operational conditions the attained concentration is lower than the standards for drinking water established in European and EPA regulations. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Cryptosporidium and Giardia removal by secondary and tertiary wastewater treatment.

Science.gov (United States)

Taran-Benshoshan, Marina; Ofer, Naomi; Dalit, Vaizel-Ohayon; Aharoni, Avi; Revhun, Menahem; Nitzan, Yeshayahu; Nasser, Abidelfatah M

2015-01-01

Wastewater disposal may be a source of environmental contamination by Cryptosporidium and Giardia. This study was conducted to evaluate the prevalence of Cryptosporidium oocysts and Giardia cysts in raw and treated wastewater effluents. A prevalence of 100% was demonstrated for Giardia cysts in raw wastewater, at a concentration range of 10 to 12,225 cysts L(-1), whereas the concentration of Cryptosporidium oocysts in raw wastewater was 4 to 125 oocysts L(-1). The removal of Giardia cysts by secondary and tertiary treatment processes was greater than those observed for Cryptosporidium oocysts and turbidity. Cryptosporidium and Giardia were present in 68.5% and 76% of the tertiary effluent samples, respectively, at an average concentration of 0.93 cysts L(-1) and 9.94 oocysts L(-1). A higher detection limit of Cryptosporidium oocysts in wastewater was observed for nested PCR as compared to immune fluorescent assay (IFA). C. hominis was found to be the dominant genotype in wastewater effluents followed by C. parvum and C. andersoni or C. muris. Giardia was more prevalent than Cryptosporidium in the studied community and treatment processes were more efficient for the removal of Giardia than Cryptosporidium. Zoonotic genotypes of Cryptosporidium were also present in the human community. To assess the public health significance of Cryptosporidium oocysts present in tertiary effluent, viability (infectivity) needs to be assessed.

Defining English Language Proficiency for Malaysian Tertiary Education: Past, Present and Future Efforts

Directory of Open Access Journals (Sweden)

Chan Swee Heng

2012-07-01

Full Text Available Any attempt to define English language proficiency can never be divorced from the theories that describe the nature of language, language acquisition and human cognition. By virtue of such theories being socially constructed, the descriptions are necessarily value-laden. Thus, a definition of language proficiency can only, at best, be described as developmental, following changes that are linguistic, pragmatic, cultural and political. In defining English proficiency for tertiary education, the context is naturally also linked to the focus on university education. The argument has been that an ‘acceptable’ level of language competence of a university applicant is anything but constant. Tremendous social changes have seen traditional values of elitism in university education giving way to the ‘massification’ of education. As Kaplan and Baldauf (1997:257 affirms, “The principal problem in tertiary education is not declining literacy standards but rather it is about meeting changed societal, cultural and informational requirements and circumstances”. In the light of these changes, this paper attempts to trace influencing factors that help define an ‘acceptable’ level of English proficiency for Malaysian tertiary education. The paper examines past and present efforts of establishing an English language policy and assessment practice for tertiary education, and concludes with some views on future development that could evolve from the current indicative pursuits of establishing language learning and ability.

Adults Studying Pure Mathematics in Adult Tertiary Preparation.

Science.gov (United States)

Bennison, Anne

2002-01-01

Investigated the experiences of a group of adults enrolled in the Pure Mathematics module of the Certificate IV in Adult Tertiary Preparation in 2000 at one of the Institutes of TAFE in Brisbane, Australia. Classroom learning experiences, exposure to technology, and the impact of returning to study on other facets of students' lives were…

Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications

DEFF Research Database (Denmark)

Eggebrecht, Holger; Thompson, Matt; Rousseau, Hervé

2009-01-01

BACKGROUND: Single-center reports have identified retrograde ascending aortic dissection (rAAD) as a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). METHODS AND RESULTS: Between 1995 and 2008, 28 centers participating in the European Registry on Endovascular Aortic...

Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center.

Science.gov (United States)

Nwosu, B O; Eke, N O; Obi-Nwosu, A; Osakwe, O J; Eke, C O; Obi, N P

2013-01-01

This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

Hydrochemical synthesis Northern Switzerland: tertiary- and Malm-aquifers

International Nuclear Information System (INIS)

Schmassmann, H.; Kullin, M.; Wexsteen, P.

1990-05-01

This Tertiary-Malm synthesis represents the first part of an overall hydrochemical synthesis of deep groundwaters in Northern Switzerland and adjacent areas. The investigation is mainly based on data from Nagra deep boreholes, from Nagra regional programme as well as from external sources. The first part provides a hydrogeological overview including a brief description of the aquifer rocks. A compilation of all existing hydraulic potential data is given and discussed for Northern Switzerland, Bodensee area and western Swabian Alb. In the Molasse Basin, hydrochemical and isotope analyses allowed a distinction of three main water types positioned one upon another: calcium-magnesium-bicarbonate groundwaters, sodium-bicarbonate and sodium-chloride deep groundwaters. Hydrochemical and isotopegeochemical details of these three water types comprise the major part of this report. Unlike the other two water types, the calcium-magnesium-bicarbonate groundwaters also include shallow waters with considerable tritium activities, indicating a mean residence time of less than 35 years. The spacial distribution of these three water types are demonstrated and different secular flow models in the Tertiary-Malm Aquifer group are discussed. (author) figs., tabs., 194 refs

Pedagogical Study into Tertiary Learning Styles in Vietnam

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Barry Ramsay

2016-07-01

Full Text Available Pedagogical studies for tertiary students in Vietnam are limited and no comparative benchmarking studies with other Asian tertiary students found. As a means to fill this gap and provide a better understanding the following study using Biggs (1987c Study Process Questionnaire (SPQ, a 42-item self-report survey consisting of ratings on a 5-point scale to questions relating to respondents' study motivations and their usual study patterns was conducted with 355 respondents. Findings were consistent with Hong Kong students and supports studies carried out in other countries by Kemper et al. (1989, Kemper and Gow (1991, Niles (1995, Volet and Renshaw (1996, Ramburuth (2001 and Hua, Williams and Hoi (2007. Despite learning in a “rote” manner during their formative years, students have adapted to deeper learning approaches although there is a still a slight but insignificant bias to surface learning. They desire to achieve and get good marks although strategy is limiting their progress. According to Biggs, this is commonly caused by a language problem.

English Textbooks in Parallel-Language Tertiary Education

OpenAIRE

Pecorari, D.; Shaw, P.; Irvine, Aileen; Malmstrom, H.

2011-01-01

Tertiary education in many countries is increasingly bilingual, with English used in parallel with the national language, particularly as a reading language. This article describes the results of a survey of student attitudes toward, and reading practices regarding, English language textbooks. Over 1,000 students at three Swedish universities responded to a questionnaire asking about their experiences with English textbooks. Textbooks written in English were generally unpopular, and the perce...

Fueling the Bio-economy: European Culture Collections and Microbiology Education and Training

KAUST Repository

Antunes, Andre

2015-12-23

A survey of European Microbial Biological Resource Centers and their users provided an overview on microbiology education and training. The results identified future increases in demand despite several shortcomings and gaps in the current offer. Urgent adjustments are needed to match users\\' needs, integrate innovative programs, and adopt new technologies. © 2015 Elsevier Ltd.

The development of the tertiary sector in the economy and the reduction in CO2 emissions

International Nuclear Information System (INIS)

Morvan, R.; Hubert, M.; Gregoire, P.; Lowezanin, Ch.

2004-09-01

The development of the tertiary sector appears to support sustainable development since it now accounts for almost two thirds of the national economy and is responsible for low CO 2 emission levels. Between 1980 and 1997, CO 2 emissions from the tertiary sector increased by 20 % compared with a 48 % rise in the sector value added. In terms of production, CO 2 levels in the tertiary sector are low, compared with 55 % for the secondary sector (industry). However, when trade between economic activities is taken into account, there is cause to qualify the assessment. This makes it possible to ascertain emissions from the point of view of satisfying final demand for products, and to identify direct and indirect emissions in each branch of activity. Thus, when emissions from certain industrial and agricultural activities are redistributed specifically to branches of activity in the tertiary sector, CO 2 emissions in this sector account for almost one-third of total emissions. (A.L.B.)

Comparison of Capsule Endoscopy Findings to Subsequent Double Balloon Enteroscopy: A Dual Center Experience

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Amandeep S. Kalra

2015-01-01

Full Text Available Background. There has been a growing use of both capsule endoscopy (CE and double balloon enteroscopy (DBE to diagnose and treat patients with obscure gastrointestinal blood loss and suspected small bowel pathology. Aim. To compare and correlate sequential CE and DBE findings in a large series of patients at two tertiary level hospitals in Wisconsin. Methods. An IRB approved retrospective study of patients who underwent sequential CE and DBE, at two separate tertiary care academic centers from May 2007 to December 2011, was performed. Results. 116 patients were included in the study. The mean age ± SD was 66.6 ± 13.2 years. There were 56% males and 43.9% females. Measure of agreement between prior capsule and DBE findings was performed using kappa statistics, which gave kappa value of 0.396 with P<0.001. Also contingency coefficient was calculated and was found to be 0.732 (P<0.001. Conclusions. Our study showed good overall agreement between DBE and CE. Findings of angioectasia had maximum agreement of 69%.

Assessment of job satisfaction among health workers in a tertiary ...

African Journals Online (AJOL)

Assessment of job satisfaction among health workers in a tertiary hospital in Zaria ... factors affecting job satisfaction and retention of health professionals working in ... help the hospital management to increase their employee's job satisfaction.

Oro-Dental and Maxillofacial Trauma in Epilepsy at a Tertiary ...

African Journals Online (AJOL)

Oro-Dental and Maxillofacial Trauma in Epilepsy at a Tertiary Hospital in Lagos. ... Information sought included patient's sociodemographics, type of seizure, ... bones were not so common, all such cases received surgical treatment in hospital.

Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in Tertiary Care Hospitals in Karachi, Pakistan.

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Syed Faizan Ali

Full Text Available BACKGROUND AND OBJECTIVE: Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It is imperative for at least health professionals in developing countries like Pakistan to have a sound knowledge about the disease. This study was carried out to assess the knowledge and awareness about cervical cancer and its prevention amongst health professionals in tertiary care hospitals in Karachi, Pakistan. METHODS AND DESIGN: A cross-sectional, interview based survey was conducted in June, 2009. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied as no definitive data was available regarding the number of registered interns and nurses at each center. RESULTS: Of all the interviews conducted, 1.8% did not know cervical cancer as a disease. Only 23.3% of the respondents were aware that cervical cancer is the most common cause of gynecological cancers and 26% knew it is second in rank in mortality. Seventy-eight percent were aware that infection is the most common cause of cervical cancer, of these 62% said that virus is the cause and 61% of the respondents knew that the virus is Human Papilloma Virus (HPV. Majority recognized that it is sexually transmitted but only a minority (41% knew that it can be detected by PCR. Only 26% of the study population was aware of one or more risk factors. Thirty seven percent recognized Pap smear as a screening test. In total only 37 out of 400 respondents were aware of the HPV vaccine. CONCLUSION: This study serves to highlight that the majority of working health professionals are not adequately equipped with knowledge concerning cervical cancer. Continuing Medical Education program should be started at the hospital level along with conferences to spread knowledge about this disease.

Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in Tertiary Care Hospitals in Karachi, Pakistan.

Science.gov (United States)

Ali, Syed Faizan; Ayub, Samia; Manzoor, Nauman Fazal; Azim, Sidra; Afif, Muneeza; Akhtar, Nida; Jafery, Wassi Ali; Tahir, Imran; Farid-Ul-Hasnian, Syed; Uddin, Najam

2010-06-10

Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It is imperative for at least health professionals in developing countries like Pakistan to have a sound knowledge about the disease. This study was carried out to assess the knowledge and awareness about cervical cancer and its prevention amongst health professionals in tertiary care hospitals in Karachi, Pakistan. A cross-sectional, interview based survey was conducted in June, 2009. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied as no definitive data was available regarding the number of registered interns and nurses at each center. Of all the interviews conducted, 1.8% did not know cervical cancer as a disease. Only 23.3% of the respondents were aware that cervical cancer is the most common cause of gynecological cancers and 26% knew it is second in rank in mortality. Seventy-eight percent were aware that infection is the most common cause of cervical cancer, of these 62% said that virus is the cause and 61% of the respondents knew that the virus is Human Papilloma Virus (HPV). Majority recognized that it is sexually transmitted but only a minority (41%) knew that it can be detected by PCR. Only 26% of the study population was aware of one or more risk factors. Thirty seven percent recognized Pap smear as a screening test. In total only 37 out of 400 respondents were aware of the HPV vaccine. This study serves to highlight that the majority of working health professionals are not adequately equipped with knowledge concerning cervical cancer. Continuing Medical Education program should be started at the hospital level along with conferences to spread knowledge about this disease.

Thermodynamics and kinetics of RNA tertiary structure formation in the junctionless hairpin ribozyme.

Science.gov (United States)

White, Neil A; Hoogstraten, Charles G

2017-09-01

The hairpin ribozyme consists of two RNA internal loops that interact to form the catalytically active structure. This docking transition is a rare example of intermolecular formation of RNA tertiary structure without coupling to helix annealing. We have used temperature-dependent surface plasmon resonance (SPR) to characterize the thermodynamics and kinetics of RNA tertiary structure formation for the junctionless form of the ribozyme, in which loops A and B reside on separate molecules. We find docking to be strongly enthalpy-driven and to be accompanied by substantial activation barriers for association and dissociation, consistent with the structural reorganization of both internal loops upon complex formation. Comparisons with the parallel analysis of a ribozyme variant carrying a 2'-O-methyl modification at the self-cleavage site and with published data in other systems reveal a surprising diversity of thermodynamic signatures, emphasizing the delicate balance of contributions to the free energy of formation of RNA tertiary structure. Copyright © 2017 Elsevier B.V. All rights reserved.

A joint european initiative on IASCC issues: the new Amalia nuclear network

International Nuclear Information System (INIS)

Sevini, F.; Debarberis, L.; Toerroenen, K.; Iracane, D.; Van Dijk, S.

2002-01-01

The Institute for energy of the joint research center of the European Commission has recently organized a workshop on IASCC (irradiation-assisted stress corrosion cracking) issues at Petten, with the participation of Tractebel, CEA, EDF, Ringhals, NRI from Czech Republic and of many other institutes. The conclusions showed that in-core IASCC experiments are lacking and should be developed in order to make substantial progress in the field. Beside these technical considerations, it is also important to propose an European program to set our own standards instead of relying on American propositions. The next action is therefore establishing a European network of IASCC specialists, with an integrated laboratory, formed by the complementary tools provided by the member institutions. The new network will exchange information, results and will coordinate the use of resources. AMALIA is the acronym for ''assessment of materials ageing under load and irradiation-assisted corrosion''. (A.C.)

Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre.

Science.gov (United States)

Baltatzis, Minas; Mason, J M; Chandrabalan, Vishnu; Stathakis, Panagiotis; McIntyre, Ben; Jegatheeswaran, Santhalingam; Jamdar, Saurabh; O'Reilly, Derek A; Siriwardena, Ajith K

Intravenous antibiotic prophylaxis is not recommended in acute pancreatitis. According to current international guidelines antibiotics together with further intervention should be considered in the setting of infected necrosis. Appropriate antibiotic therapy particularly avoiding over-prescription is important. This study examines antibiotic use in acute pancreatitis in a tertiary centre using the current IAP/APA guidelines for reference. Data were collected on a consecutive series of patients admitted with acute pancreatitis over a 12 month period. Data were dichotomized by patients admitted directly to the centre and tertiary transfers. Information was collected on clinical course with specific reference to antibiotic use, episode severity, intervention and outcome. 111 consecutive episodes of acute pancreatitis constitute the reported population. 31 (28%) were tertiary transfers. Overall 65 (58.5%) patients received antibiotics. Significantly more tertiary transfer patients received antibiotics. Mean person-days of antibiotic use was 23.9 (sd 29.7) days in the overall study group but there was significantly more use in the tertiary transfer group as compared to patients having their index admission to the centre (40.9 sd 37.1 vs 10.2 sd 8.9; P < 0.005). Thirty four (44%) of patients with clinically mild acute pancreatitis received antibiotics. There is substantial use of antibiotics in acute pancreatitis, in particular in patients with severe disease. Over-use is seen in mild acute pancreatitis. Better consideration must be given to identification of prophylaxis or therapy as indication. In relation to repeated courses of antibiotics in severe disease there must be clear indications for use. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Magnitude and causes of loss to follow-up among patients with viral hepatitis at a tertiary care hospital in Saudi Arabia

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Hanan H. Balkhy

2017-07-01

Full Text Available Background: Non-adherence with recommended follow-up visits is a major barrier for completing treatment of viral hepatitis and is consequently associated with unfavorable outcomes of health services. Objectives: To estimate the magnitude and identify perceived reasons and patient characteristics associated with loss to follow-up in a tertiary care setting. Methods: A two-step cross-sectional study design was used, including a chart review (2011 followed by phone survey (2012. Loss to follow-up was recorded among those who were diagnosed with hepatitis B (HBV or C (HCV during 2009–2010 but never returned for recommended/scheduled follow-up appointment(s. Results: A total of 328 patients (202 HBV and 126 HCV were included in the current analysis. The average age was 49.6 ± 17.9 years, and 57% were males. Out of 328, 131 (40% were not advised to do follow-up, and 98 (30% were not doing follow-up. Perceived reasons for loss to follow-up were as follows: unaware that a follow-up appointment was scheduled (69%, never informed of need for follow-up by healthcare provider (15%, personal belief that follow-up was not necessary (9%, logistical reasons (3% and other reasons (5%. Loss to follow-up was higher among those who had been diagnosed with HBV, referred by non-liver-related specialty, never advised to follow-up, unaware of their diagnosis, incorrectly identified their type of hepatitis, lacking hepatitis complications, having full medical coverage, pregnant, and those with low knowledge or negative attitude towards hepatitis. Conclusions: Loss to follow-up is a significant problem among patients with hepatitis in a tertiary care center, with several patient and system failures being implicated. Keywords: Viral hepatitis, Loss to follow-up, Tertiary care, Management, Saudi Arabia

Highly efficient and diastereoselective gold(I)-catalyzed synthesis of tertiary amines from secondary amines and alkynes: substrate scope and mechanistic insights.

Science.gov (United States)

Liu, Xin-Yuan; Guo, Zhen; Dong, Sijia S; Li, Xiao-Hua; Che, Chi-Ming

2011-11-11

An efficient method for the synthesis of tertiary amines through a gold(I)-catalyzed tandem reaction of alkynes with secondary amines has been developed. In the presence of ethyl Hantzsch ester and [{(tBu)(2)(o-biphenyl)P}AuCl]/AgBF(4) (2 mol %), a variety of secondary amines bearing electron-deficient and electron-rich substituents and a wide range of alkynes, including terminal and internal aryl alkynes, aliphatic alkynes, and electron-deficient alkynes, underwent a tandem reaction to afford the corresponding tertiary amines in up to 99 % yield. For indolines bearing a preexisting chiral center, their reactions with alkynes in the presence of ethyl Hantzsch ester catalyzed by [{(tBu)(2)(o-biphenyl)P}AuCl]/AgBF(4) (2 mol %) afforded tertiary amines in excellent yields and with good to excellent diastereoselectivity. All of these organic transformations can be conducted as a one-pot reaction from simple and readily available starting materials without the need of isolation of air/moisture-sensitive enamine intermediates, and under mild reaction conditions (mostly room temperature and mild reducing agents). Mechanistic studies by NMR spectroscopy, ESI-MS, isotope labeling studies, and DFT calculations on this gold(I)-catalyzed tandem reaction reveal that the first step involving a monomeric cationic gold(I)-alkyne intermediate is more likely than a gold(I)-amine intermediate, a three-coordinate gold(I) intermediate, or a dinuclear gold(I)-alkyne intermediate. These studies also support the proposed reaction pathway, which involves a gold(I)-coordinated enamine complex as a key intermediate for the subsequent transfer hydrogenation with a hydride source, and reveal the intrinsic stereospecific nature of these transformations observed in the experiments. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Primary Progressive Aphasia in the Network of French Alzheimer Plan Memory Centers.

Science.gov (United States)

Magnin, Eloi; Démonet, Jean-François; Wallon, David; Dumurgier, Julien; Troussière, Anne-Cécile; Jager, Alain; Duron, Emmanuelle; Gabelle, Audrey; de la Sayette, Vincent; Volpe-Gillot, Lisette; Tio, Gregory; Evain, Sarah; Boutoleau-Bretonnière, Claire; Enderle, Adeline; Mouton-Liger, François; Robert, Philippe; Hannequin, Didier; Pasquier, Florence; Hugon, Jacques; Paquet, Claire

2016-10-18

Few demographical data about primary progressive aphasia (PPA) are available, and most knowledge regarding PPA is based on tertiary centers' results. Our aims were to describe demographical characteristics of the PPA population in a large sample of PPA patients from the network of French Alzheimer plan memory centers (Sample 1), and to describe the stratification of cerebrospinal fluid (CSF) biomarkers in two different samples of PPA patients (Samples 2 and 3). All registered PPA patients in the French Alzheimer's disease (AD) databank (Sample 1: n = 2,035) and a subsample (Sample 2: n = 65) derived from a multicentric prospective cohort with CSF biomarker analysis were analyzed. A multicentric retrospective cohort from language expert tertiary centers (Sample 3: n = 97) with CSF biomarker analysis was added. Sample 3 was added to replicate the CSF results of the Sample 2 and to evaluate repartition of AD pathology in the three variant of PPA according to the latest classification. Non-Fluent/Agrammatic, Logopenic, and Unclassifiable PPA patients (NF/A-Logo-Unclass PPA) were older and more frequent than Semantic PPA patients (2.2 versus 0.8/100,000 inhabitants; p < 0.00001). Male predominance occurred after the age of 80 (p < 0.00001). A higher level of education was observed in the PPA population compared to a typical amnesic AD group. No demographical significant difference between PPA due to AD and not due to AD was observed. The Logopenic variant was most frequent with 85% of AD CSF biomarker profiles (35% in NF/A PPA; 20% in Semantic PPA). PPA occurs also in an elderly population, especially in male patients over 80. CSF biomarkers are useful to stratify PPA. The epidemiology of PPA should be further investigated to confirm gender and cognitive reserve role in PPA to better understand the factors and mechanisms leading to this language-predominant deficit during neurodegenerative diseases.

Fueling the Bio-economy: European Culture Collections and Microbiology Education and Training.

Science.gov (United States)

Antunes, André; Stackebrandt, Erko; Lima, Nelson

2016-02-01

A survey of European Microbial Biological Resource Centers and their users provided an overview on microbiology education and training. The results identified future increases in demand despite several shortcomings and gaps in the current offer. Urgent adjustments are needed to match users' needs, integrate innovative programs, and adopt new technologies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Drug Production in Tertiary Health Institutions – Needs, Constraints ...

African Journals Online (AJOL)

The use of questionnaires was employed in the study covering all pharmacists in the pharmaceutical services department, pharmacy technicians and quality control technologist in the drug production unit of the hospital. It was unanimously agreed by the respondents that local drug production was necessary in tertiary ...

Sexual behaviours of undergraduates of tertiary institutions in Kwara ...

African Journals Online (AJOL)

The study also examined whether or not variables of gender and school type had significant influence on the sexual behaviours of undergraduates of tertiary ... the school counsellors and teachers should provide guidance to students on developmental challenges and help youths to abstain from risky sexual behaviours.