WorldWideScience

Sample records for fr29mr10n national primary

  1. National Evaluation of the Primary Leadership Programme : Research Brief

    OpenAIRE

    Wade, Pauline; McCrone, Tami; Rudd, Peter

    2007-01-01

    This research brief presents the key findings from a national evaluation of the Primary Leadership Programme (PLP) carried out by a team at the National Foundation for Educational Research (NEFER) between 2004 and 2006. The evaluation was commissioned by the Department for Education and Skills (DfES) and included the use of case-study interviews with key personnel, surveys of school leaders and analysis of pupil examination results. KEY FINDINGS • Pupil achievement – With regard to pupil atta...

  2. The Quest for Strategic Malaysian Quality National Primary School Leaders

    Science.gov (United States)

    Ali, Hairuddin Mohd

    2012-01-01

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

  3. 40 CFR 50.8 - National primary ambient air quality standards for carbon monoxide.

    Science.gov (United States)

    2010-07-01

    ... (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.8 National primary ambient air quality standards for carbon monoxide. (a) The national primary ambient air quality standards... 40 Protection of Environment 2 2010-07-01 2010-07-01 false National primary ambient air...

  4. The Cuban National Healthcare System: Characterization of primary healthcare services.

    Directory of Open Access Journals (Sweden)

    Keli Regina DAL PRÁ

    2015-10-01

    Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

  5. Revitalizing the United Nations. Anticipation and Prevention as Primary Goals

    Directory of Open Access Journals (Sweden)

    Alexandra Novosseloff

    2000-12-01

    Full Text Available In tackling the on-going topic of UN reform, one should be honest with the analysis of the problems at stakes. It is necessary to first take into account the profound changes that have occurred since the end of the Cold War, as well as acknowledging the limits of an international organization and the shape of the UN system. It is only from that analysis that proposals can be made to rationalize and to make more efficient the functioning of the United Nations. What the Organization needs is not only a rationalization, it primarily needs a vision that gives it purpose and meaning. This article proposes that its primary goals should be anticipation and prevention – it should be the advanced guard and the conscience of the world. In this context, the United Nations is an indispensable and priceless instrument in international relations.

  6. 40 CFR 50.16 - National primary and secondary ambient air quality standards for lead.

    Science.gov (United States)

    2010-07-01

    ... air quality standards for lead. 50.16 Section 50.16 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.16 National primary and secondary ambient air quality standards for lead. (a) The national primary...

  7. 40 CFR 50.12 - National primary and secondary ambient air quality standards for lead.

    Science.gov (United States)

    2010-07-01

    ... air quality standards for lead. 50.12 Section 50.12 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.12 National primary and secondary ambient air quality standards for lead. (a) National primary and...

  8. Optimization of the National Ignition Facility primary shield design

    Energy Technology Data Exchange (ETDEWEB)

    Annese, C.E.; Watkins, E.F.; Greenspan, E.; Miller, W.F. [California Univ., Berkeley, CA (United States). Dept. of Nuclear Engineering; Latkowski, J.; Lee, J.D.; Soran, P.; Tobin, M.L. [Lawrence Livermore National Lab., CA (United States)

    1993-10-01

    Minimum cost design concepts of the primary shield for the National Ignition laser fusion experimental Facility (NIF) are searched with the help of the optimization code SWAN. The computational method developed for this search involves incorporating the time dependence of the delayed photon field within effective delayed photon production cross sections. This method enables one to address the time-dependent problem using relatively simple, time-independent transport calculations, thus significantly simplifying the design process. A novel approach was used for the identification of the optimal combination of constituents that will minimize the shield cost; it involves the generation, with SWAN, of effectiveness functions for replacing materials on an equal cost basis. The minimum cost shield design concept was found to consist of a mixture of polyethylene and low cost, low activation materials such as SiC, with boron added near the shield boundaries.

  9. Physics and national socialism an anthology of primary sources

    CERN Document Server

    1996-01-01

    This anthology of primary sources is a collection of 121 documents in English translation portraying the role of physics, both perceived and actual, in the Nazi state. These texts were written predominantly by influential German scientists, particularly physicists, both inside and outside Germany in the period from 1933 to 1945. The semipopular articles, private correspondence, and official memoranda selected for the volume reflect the contemporary developments in science as well as the change in political climate and working conditions after the National Socialists' rise to power. The extensive annotation is clearly distinguished from the original text, and the appendix provides an aid to the reader with biographical information on the more important figures and brief outlines of frequently mentioned institutions, journals and companies. The introduction surveys the latest results in the secondary literature.   ------    (…) the envisaged audience includes not only scholars and students of science, hist...

  10. Evaluation of advanced access in the national primary care collaborative.

    Science.gov (United States)

    Pickin, Mark; O'Cathain, Alicia; Sampson, Fiona C; Dixon, Simon

    2004-05-01

    An aim of the National Primary Care Collaborative is to improve quality and access for patients in primary care using principles of Advanced Access. To determine whether Advanced Access led to improved availability of appointments with general practitioners (GPs) and to examine GPs' views of the process. Observational study. Four hundred and sixty-two general practices in England participating in four waves of the collaborative during 2000 and 2001. Regression analysis of the collaborative's monthly data on the availability of GP appointments for the 352 practices in waves 1-3, and a postal survey of lead GPs in all four waves. The main outcome measures were the change in mean time to the third available appointment with GPs, and the proportion of GPs thinking it worthwhile participating in the collaborative. The time to the third available appointment improved from a mean of 3.6 to 1.9 days, difference = 1.7 days, 95% confidence interval (CI)= 1.4 to 2.0 days. It improved in two-thirds of practices (66% [219/331]), remained the same in 16% (53/331), and worsened in 18% (59/331). The majority of GPs in all four waves, 83% (308/371, 95% CI = 79 to 87), felt that it was worthwhile participating in the collaborative, although one in 12 practices would not recommend it. One-fifth of GPs cited a lack of resources as a constraint, and some expressed concerns about the trade-off between immediate access and continuity of care. Advanced Access helped practices to improve availability of GP appointments, and was well received by the majority of practices.

  11. 40 CFR 50.4 - National primary ambient air quality standards for sulfur oxides (sulfur dioxide).

    Science.gov (United States)

    2010-07-01

    ... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.4 National primary ambient air quality standards for sulfur oxides (sulfur dioxide). Link to an... applicable to all areas notwithstanding the promulgation of SO2 national ambient air quality standards...

  12. 75 FR 53267 - National Primary Drinking Water Regulations: Revisions to the Total Coliform Rule; Extension of...

    Science.gov (United States)

    2010-08-31

    ... AGENCY 40 CFR Parts 141 and 142 RIN 2040-AD94 National Primary Drinking Water Regulations: Revisions to... 30 days the public comment period for a proposed National Primary Drinking Water Regulation, the... inquiries, contact Sean Conley, Office of Ground Water and Drinking Water (MC 4607M), U.S....

  13. 75 FR 30401 - National Primary Drinking Water Regulations; Announcement of the Results of EPA's Review of...

    Science.gov (United States)

    2010-06-01

    ... AGENCY RIN 2040-AE90 National Primary Drinking Water Regulations; Announcement of the Results of EPA's Review of Existing Drinking Water Standards and Request for Public Comment and/or Information on Related... the public comment period for the National Primary Drinking Water Regulations; Announcement of...

  14. 40 CFR 50.6 - National primary and secondary ambient air quality standards for PM10.

    Science.gov (United States)

    2010-07-01

    ... air quality standards for PM10. 50.6 Section 50.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.6 National primary and secondary ambient air quality standards for PM10. (a) The level of the...

  15. 40 CFR 50.15 - National primary and secondary ambient air quality standards for ozone.

    Science.gov (United States)

    2010-07-01

    ... air quality standards for ozone. 50.15 Section 50.15 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.15 National primary and secondary ambient air quality standards for ozone. (a) The level of...

  16. Development of Quality Assurance System in Culture and Nation Character Education in Primary Education in Indonesia

    Science.gov (United States)

    Susilana, Rudi; Asra

    2013-01-01

    The purpose of national education is to develop skills and build dignified national character and civilization in educating nation life (Act No. 20, 2003). The paper describes a system of quality assurance in culture and character education in primary education. This study employs the six sigma model which consists of the formula DMAIC (Define,…

  17. Clinical findings confirm national guidelines regarding primary gastroscopy for upper gastrointestinal symptoms

    DEFF Research Database (Denmark)

    Rolff, Hans Christian; Simonsen, Louise Rolighed; Rosenberg, Jacob

    2011-01-01

    This study describes unsedated transnasal oesophagogastroduodenoscopy (UT-OGD) in the office setting. Evaluation of national guidelines regarding primary endoscopy for the investigation of upper gastrointestinal (GI) symptoms was also a focus of this study....

  18. Revitalizing the United Nations. Anticipation and Prevention as Primary Goals

    OpenAIRE

    Alexandra Novosseloff

    2000-01-01

    In tackling the on-going topic of UN reform, one should be honest with the analysis of the problems at stakes. It is necessary to first take into account the profound changes that have occurred since the end of the Cold War, as well as acknowledging the limits of an international organization and the shape of the UN system. It is only from that analysis that proposals can be made to rationalize and to make more efficient the functioning of the United Nations. What the Organization needs is no...

  19. Constructing a Successful Cross-National Virtual Learning Environment in Primary and Secondary Education

    NARCIS (Netherlands)

    Ligorio, Maria Beatrice; van Veen, Klaas

    2006-01-01

    Virtual environments are more and more used in primary schools. One of the most interesting potentialities of these environments is to foster cross-national applications. Yet, this specific feature is not fully exploited. This paper presents a successful virtual learning environment for primary educ

  20. Introducing National Curriculum Geography to Australia's Primary Schools: Lessons from England's Experience

    Science.gov (United States)

    Catling, Simon

    2013-01-01

    This article provides an insight into the development of primary geography since the inception of the national curriculum in England in the late 1980s. It is hoped this is informative as the "Australian Curriculum: Geography Foundation to Year 12" is introduced to and implemented in primary schools. It draws out various matters which…

  1. Constructing a Successful Cross-National Virtual Learning Environment in Primary and Secondary Education

    Science.gov (United States)

    Ligorio, Maria Beatrice; van Veen, Klaas

    2006-01-01

    Virtual environments are more and more used in primary schools. One of the most interesting potentialities of these environments is to foster cross-national applications. Yet, this specific feature is not fully exploited. This paper presents a successful virtual learning environment for primary education involving two European countries and…

  2. 40 CFR 142.19 - EPA review of State implementation of national primary drinking water regulations for lead and...

    Science.gov (United States)

    2010-07-01

    ... national primary drinking water regulations for lead and copper. 142.19 Section 142.19 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING... implementation of national primary drinking water regulations for lead and copper. (a) Pursuant to the...

  3. 40 CFR 50.7 - National primary and secondary ambient air quality standards for PM2.5.

    Science.gov (United States)

    2010-07-01

    ... air quality standards for PM2.5. 50.7 Section 50.7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.7 National primary and secondary ambient air quality standards for PM2.5. (a) The national primary...

  4. Expanding Global Language Education in Public Primary Schools: The National English Programme in Mexico

    Science.gov (United States)

    Sayer, Peter

    2015-01-01

    The paper examines the recent national programme of English language instruction in the Mexican public primary schools, called the "Programa Nacional de Inglés en Educación Básica" (PNIEB). The programme, initiated in 2009 by the Ministry of Education as part of the national curriculum, represents the largest expansion of English…

  5. 1 st National conference on family medicine and primary care: A journey toward stronger primary care in India

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2013-01-01

    Full Text Available Academy of Family Physicians of India organized the first National Conference on Family Medicine and Primary Care (FMPC on 20-21 April 2013 at India International Centre New Delhi. The conference was a major success towards positioning of requirement for a distinct academic discipline (family medicine within the medical and nursing education system as a means for strengthening of primary care in India. The event gained its prominence in the times when universal health coverage is being debated. A generalist approach in development of human resource prominently figured in the discussions. The deliberations and talks of the Indian as well as international experts were recorded and released as the report of national consultation on family medicine programme.

  6. Developing a Core Competency Model and Educational Framework for Primary Maternity Services: a national consensus approach.

    Science.gov (United States)

    Homer, Caroline S E; Griffiths, Marnie; Brodie, Pat M; Kildea, Sue; Curtin, Austin M; Ellwood, David A

    2012-09-01

    An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals. Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services. A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation. A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups' education and practice. The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services. Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  7. 40 CFR 50.13 - National primary and secondary ambient air quality standards for PM2.5.

    Science.gov (United States)

    2010-07-01

    ... air quality standards for PM2.5. 50.13 Section 50.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.13 National primary and secondary ambient air quality standards for PM2.5. (a) The national...

  8. The National Singing Programme for Primary Schools in England: An Initial Baseline Study

    Science.gov (United States)

    Welch, G. F.; Himonides, E.; Papageorgi, I.; Saunders, J.; Rinta, T.; Stewart, C.; Preti, C.; Lani, J.; Vraka, M.; Hill, J.

    2009-01-01

    The "Sing Up" National Singing Programme for primary schools in England was launched in November 2007 under the UK government's "Music Manifesto". "Sing Up" is a four-year programme whose overall aim is to raise the status of singing and increase opportunities for children throughout the country to enjoy singing as…

  9. Introducing National Tests in Swedish Primary Education: Implications for Test Anxiety

    Science.gov (United States)

    Nyroos, Mikaela; Wiklund-Hornqvist, Carola

    2011-01-01

    Introduction: The Swedish government has decided to introduce national tests in primary education. Swedish pupils in general have few tests and a recognised possible adverse effect of testing is test anxiety among pupils, which may have a negative impact on examination performance. However, there has been little research on effects of testing on…

  10. Characteristics of primary biliary cirrhosis in British Columbia's First Nations population

    Directory of Open Access Journals (Sweden)

    Laura Arbour

    2005-01-01

    Full Text Available Primary biliary cirrhosis (PBC is a rare, autoimmune liver disorder characterized by progressive destruction of intrahepatic bile ducts, that results in portal inflammation, scarring, cirrhosis and, eventually, liver failure. Although considered rare in Canadian populations, it is the leading indication for referral for liver transplantation in British Columbia's First Nations population. Previously, an expanded review of all cases referred to the British Columbia Transplant Society for PBC was carried out comparing the demographics of those of First Nations descent with those not of First Nations descent. The review suggested that the rate of referral for transplantation was eight times higher for those of First Nations descent compared with those of other descent (P=0.0001, and a disproportionate number of the First Nations cases lived on Vancouver Island (48% of cases versus 18% expected, P<0.05. Additionally, the age of referral was significantly younger (45.9 versus 54.3 years for those of First Nations descent and there are fewer First Nations men referred (1:34 than expected. For the purpose of the present report, 28 symptomatic cases were ascertained separately and reviewed in a clinical study to delineate the features of this population.

  11. 40 CFR Appendix P to Part 50 - Interpretation of the Primary and Secondary National Ambient Air Quality Standards for Ozone

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Interpretation of the Primary and Secondary National Ambient Air Quality Standards for Ozone P Appendix P to Part 50 Protection of Environment... STANDARDS Pt. 50, App. P Appendix P to Part 50—Interpretation of the Primary and Secondary National...

  12. 40 CFR 50.10 - National 8-hour primary and secondary ambient air quality standards for ozone.

    Science.gov (United States)

    2010-07-01

    ... ambient air quality standards for ozone. 50.10 Section 50.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.10 National 8-hour primary and secondary ambient air quality standards for ozone. (a) The level...

  13. 40 CFR 50.9 - National 1-hour primary and secondary ambient air quality standards for ozone.

    Science.gov (United States)

    2010-07-01

    ... ambient air quality standards for ozone. 50.9 Section 50.9 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.9 National 1-hour primary and secondary ambient air quality standards for ozone. (a) The level...

  14. Primary prevention of neural tube defects: data from the portuguese national registry of congenital anomalies (RENAC)

    OpenAIRE

    Braz, Paula; Machado, Ausenda; Matias Dias, Carlos

    2016-01-01

    Background: In Portugal folic acid supplementation is recommended to start at least 2-3 months before conception for primary prevention of Neural Tube Defects. The aim of this study was to evaluate, within gestations with at least one congenital anomaly, possible association between maternal socio-demographic factors and the use of folic acid. Methods: Using data from the Portuguese national registry of congenital anomalies, for the 2004-2013 period, the association between folic acid use dur...

  15. Current practice in primary total hip replacement: results from the National Hip Replacement Outcome Project

    OpenAIRE

    Best, A. J.; Fender, D.; Harper, W. M.; McCaskie, A. W.; Oliver, K; Gregg, P J

    1999-01-01

    As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. ...

  16. [Primary Spinal Tumor Registry at the National Centre for Spinal Disorders].

    Science.gov (United States)

    Szövérfi, Zsolt; Lazáry, Aron; Varga, Péter Pál

    2014-05-11

    Primary spinal tumors are rare diseases. Primary spinal tumor registry would be useful to help decision making in this complex field of spine surgery. In this article the authors present the latest findings from the Primary Spinal Tumor Registry at the National Centre for Spinal Disorders, Hungary. The registry is based on a novel database management software, the REDCap electronic data capture system. It contains data of 323 patients treated surgically during an 18-year period. Among the 126 malignant tumors, the most frequent was chordoma (61 cases). In the case of benign tumors schwannoma showed the largest prevalence (45 cases). The authors conclude that due to the rarity of the disease and the complexity of the management, multicenter, prospective registries are required to provide high level of evidence. The structure of the Primary Spinal Tumor Registry in the National Centre for Spinal Disorders in Hungary is optimal for user-friendly, fast and secure data collection providing a prospective database for scientific researches and clinical follow-up.

  17. [Legislation on primary care in Brazilian Unified National Health System: document analysis].

    Science.gov (United States)

    Domingos, Carolina Milena; Nunes, Elisabete de Fátima Polo de Almeida; Carvalho, Brígida Gimenez; Mendonça, Fernanda de Freitas

    2016-03-01

    A reflection on Brazil's legislation for primary care helps understand the way health policy is implemented in the country. This study focuses on the legal provisions aimed at strengthening primary care, drawing on an analysis of documents from the Ministry of Health's priority actions, programs, and strategies. A total of 224 provisions were identified, in two groups of documents, so-called instituting provisions and complementary provisions. The former include the principles and guidelines of the Brazilian Unified National Health System (SUS) and also involve the expansion of actions. Financing was a quantitatively central theme, especially in the complementary provisions. The analysis led to reflection on the extent to which these strategies can induce linkage between health system managers and civil society in building a political project resulting in improvements and meeting the population's health needs.

  18. The case for a national service for primary immune deficiency disorders in New Zealand.

    Science.gov (United States)

    Ameratunga, Rohan; Steele, Richard; Jordan, Anthony; Preece, Kahn; Barker, Russell; Brewerton, Maia; Lindsay, Karen; Sinclair, Jan; Storey, Peter; Woon, See-Tarn

    2016-06-10

    Primary immune deficiency disorders (PIDs) are rare conditions for which effective treatment is available. It is critical these patients are identified at an early stage to prevent unnecessary morbidity and mortality. Treatment of these disorders is expensive and expert evaluation and ongoing management by a clinical immunologist is essential. Until recently there has been a major shortage of clinical immunologists in New Zealand. While the numbers of trained immunologists have increased in recent years, most are located in Auckland. The majority of symptomatic PID patients require life-long immunoglobulin replacement. Currently there is a shortage of subcutaneous and intravenous immunoglobulin (SCIG/IVIG) in New Zealand. A recent audit by the New Zealand Blood Service (NZBS) showed that compliance with indications for SCIG/IVIG treatment was poor in District Health Boards (DHBs) without an immunology service. The NZBS audit has shown that approximately 20% of annual prescriptions for SCIG/IVIG, costing $6M, do not comply with UK or Australian guidelines. Inappropriate use may have contributed to the present shortage of SCIG/IVIG necessitating importation of the product. This is likely to have resulted in a major unnecessary financial burden to each DHB. Here we present the case for a national service responsible for the tertiary care of PID patients and oversight for immunoglobulin use for primary and non-haematological secondary immunodeficiencies. We propose that other PIDs, including hereditary angioedema, are integrated into a national PID service. Ancillary services, including the customised genetic testing service, and research are also an essential component of an integrated national PID service and are described in this review. As we show here, a hub-and-spoke model for a national service for PIDs would result in major cost savings, as well as improved patient care. It would also allow seamless transition from paediatric to adult services.

  19. 76 FR 4779 - Denial of the Petitions To Reconsider the Final Rule Promulgating the Primary National Ambient...

    Science.gov (United States)

    2011-01-26

    ... health.'' CAA section 109(b)(1). The legislative history of section 109 indicates that a primary NAAQS is... individuals, EPA must strengthen the entire national standard.''); Coalition of Battery Recyclers Ass'n v....

  20. Are primary care factors associated with hospital episodes for adverse drug reactions? A national observational study.

    Science.gov (United States)

    McKay, Ailsa J; Newson, Roger B; Soljak, Michael; Riboli, Elio; Car, Josip; Majeed, Azeem

    2015-12-29

    Identification of primary care factors associated with hospital admissions for adverse drug reactions (ADRs). Cross-sectional analysis of 2010-2012 data from all National Health Service hospitals and 7664 of 8358 general practices in England. We identified all hospital episodes with an International Classification of Diseases (ICD) 10 code indicative of an ADR, in the 2010-2012 English Hospital Episode Statistics (HES) admissions database. These episodes were linked to contemporary data describing the associated general practice, including general practitioner (GP) and patient demographics, an estimate of overall patient population morbidity, measures of primary care supply, and Quality and Outcomes Framework (QOF) quality scores. Poisson regression models were used to examine associations between primary care factors and ADR-related episode rates. 212,813 ADR-related HES episodes were identified. Rates of episodes were relatively high among the very young, older and female subgroups. In fully adjusted models, the following primary care factors were associated with increased likelihood of episode: higher deprivation scores (population attributable fraction (PAF)=0.084, 95% CI 0.067 to 0.100) and relatively poor glycated haemoglobin (HbA1c) control among patients with diabetes (PAF=0.372; 0.218 to 0.496). The following were associated with reduced episode likelihood: lower GP supply (PAF=-0.016; -0.026 to -0.005), a lower proportion of GPs with UK qualifications (PAF=-0.035; -0.058 to -0.012), lower total QOF achievement rates (PAF=-0.021; -0.042 to 0.000) and relatively poor blood pressure control among patients with diabetes (PAF=-0.144; -0.280 to -0.022). Various aspects of primary care are associated with ADR-related hospital episodes, including achievement of particular QOF indicators. Further investigation with individual level data would help develop understanding of the associations identified. Interventions in primary care could help reduce the ADR burden

  1. 40 CFR 50.11 - National primary and secondary ambient air quality standards for oxides of nitrogen (with...

    Science.gov (United States)

    2010-07-01

    ... air quality standards for oxides of nitrogen (with nitrogen dioxide as the indicator). 50.11 Section... PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.11 National primary and secondary ambient air quality standards for oxides of nitrogen (with nitrogen dioxide as the indicator). (a) The level of...

  2. A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol.

    Science.gov (United States)

    Bello, Aminu K; Ronksley, Paul E; Tangri, Navdeep; Singer, Alexander; Grill, Allan; Nitsch, Dorothea; Queenan, John A; Lindeman, Cliff; Soos, Boglarka; Freiheit, Elizabeth; Tuot, Delphine; Mangin, Dee; Drummond, Neil

    2017-08-04

    Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) as important facilitators for national QI-based studies to improve chronic disease care. The goal of our study is to improve the understanding of how patients with chronic kidney disease (CKD) are managed in primary care and the variation across practices and provinces and territories to drive improvements in care delivery. The CPCSSN database contains anonymised health information from the electronic medical records for patients of participating primary care practices (PCPs) across Canada (n=1200). The dataset includes information on patient sociodemographics, medications, laboratory results and comorbidities. Leveraging validated algorithms, case definitions and guidelines will help define CKD and the related processes of care, and these enable us to: (1) determine prevalent CKD burden; (2) ascertain the current practice pattern on risk identification and management of CKD and (3) study variation in care indicators (eg, achievement of blood pressure and proteinuria targets) and referral pattern for specialist kidney care. The process of care outcomes will be stratified across patients' demographics as well as provider and regional (provincial/territorial) characteristics. The prevalence of CKD stages 3-5 will be presented as age-sex standardised prevalence estimates stratified by province and as weighted averages for population rates with 95% CIs using census data. For each PCP, age-sex standardised prevalence will be calculated and compared with expected standardised prevalence estimates. The process-based outcomes will be defined using established methods. The CPCSSN is committed to high ethical standards when dealing with

  3. Partnership disengagement from primary community care networks (PCCNs: A qualitative study for a national demonstration project

    Directory of Open Access Journals (Sweden)

    Lin Cheng-Chieh

    2010-04-01

    Full Text Available Abstract Background The Primary Community Care Network (PCCN Demonstration Project, launched by the Bureau of National Health Insurance (BNHI in 2003, is still in progress. Partnership structures in PCCNs represent both contractual clinic-to-clinic and clinic-to-hospital member relationships of organizational aspects. The partnership structures are the formal relationships between individuals and the total network. Their organizational design aims to ensure effective communication, coordination, and integration across the total network. Previous studies have focused largely on how contractual integration among the partnerships works and on its effects. Few studies, however, have tried to understand partnership disengagement in PCCNs. This study explores why some partnerships in PCCNs disengage. Methods This study used a qualitative methodology with semi-structured questions for in-depth interviews. The semi-structured questions were pre-designed to explore the factors driving partnership disengagement. Thirty-seven clinic members who had withdrawn from their PCCNs were identified from the 2003-2005 Taiwan Primary Community Care Network Lists. Results Organization/participant factors (extra working time spend and facility competency, network factors (partner collaboration, and community factors (health policy design incompatibility, patient-physician relationship, and effectiveness are reasons for clinic physicians to withdraw or change their partnerships within the PCCNs. Conclusions To strengthen partnership relationships, several suggestions are made, including to establish clinic and hospital member relationships, and to reduce administrative work. In addition, both educating the public about the concept of family doctors and ensuring well-organized national health policies could help health care providers improve the integration processes.

  4. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

    Science.gov (United States)

    Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

    2014-06-01

    Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at α = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years.

  5. National program for family planning and primary health care Pakistan: a SWOT analysis.

    Science.gov (United States)

    Wazir, Mohammad Salim; Shaikh, Babar Tasneem; Ahmed, Ashfaq

    2013-11-22

    The National Program for Family Planning and Primary Healthcare was launched in 1994. It is one of the largest community based programs in the world, providing primary healthcare services to about 80 million people, most of which is rural poor. The program has been instrumental in improving health related indicators of maternal and child health in the last two decades. SWOT analysis was used by making recourse to the structure and dynamics of the program as well as searching the literature. Strengths of the program include: comprehensive design of planning, implementation and supervision mechanisms aided by an MIS, selection and recruitments processes and evidence created through improving health impact indicators. Weaknesses identified are slow progress, poor integration of the program with health services at local levels including MIS, and de-motivational factors such as job insecurity and non-payment of salaries in time. Opportunities include further widening the coverage of services, its potential contribution to health system research, and its use in areas other than health like women empowerment and poverty alleviation. Threats the program may face are: political interference, lack of funds, social threats and implications for professional malpractices. Strengthening of the program will necessitate a strong political commitment, sustained funding and a just remuneration to this bare foot doctor of Pakistan, the Lady Health Worker.

  6. Frequent large germline HRPT2 deletions in a French National cohort of patients with primary hyperparathyroidism.

    Science.gov (United States)

    Bricaire, Léopoldine; Odou, Marie-Françoise; Cardot-Bauters, Catherine; Delemer, Brigitte; North, Marie-Odile; Salenave, Sylvie; Vezzosi, Delphine; Kuhn, Jean-Marc; Murat, Arnaud; Caron, Philippe; Sadoul, Jean-Louis; Silve, Caroline; Chanson, Philippe; Barlier, Anne; Clauser, Eric; Porchet, Nicole; Groussin, Lionel

    2013-02-01

    Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is an autosomal dominant syndrome with incomplete penetrance that can associate in a single patient parathyroid adenoma or carcinoma, fibro-osseous jaw tumor, cystic kidney lesion, and uterine tumor. Germline mutations of the HRPT2 gene (CDC73) coding for parafibromin are identified in approximately 50%-75% of HPT-JT cases and in approximately 14% of familial isolated hyperparathyroidism. A whole deletion of this gene has recently been reported in 1 sporadic case and in a family presenting with HPT-JT. The objective of the study was to report molecular abnormalities of the HRPT2 gene in patients with primary hyperparathyroidism in a French National cohort from the Groupe d'Étude des Tumeurs Endocrines. Patients' genomic DNA was screened by PCR-based sequencing for point mutations affecting HRPT2 and real-time quantitative PCR analysis for gross deletions. We report 20 index patients with a germinal HRPT2 abnormality. Median age at diagnosis of primary hyperparathyroidism was 23 years (range 14-65 years). Median serum total calcium level at diagnosis was 3.19 mmol/L (range 2.8-4.3 mmol/L). Thirteen different mutations were identified by routine sequencing, including 7 mutations never reported. Seven patients (35%) carried a gross deletion of this gene (3 complete and 4 partial deletions). No genotype-phenotype correlation could be identified. A gross deletion of the HRPT2 gene was identified in 7% of patients for whom a routine screening by direct sequencing came up as negative. Gross deletion analysis of the HRPT2 gene is indicated for all patients negative for mutation, presenting with HPT-JT or familial isolated hyperparathyroidism, parathyroid carcinoma, or in patients with apparently sporadic parathyroid adenoma diagnosed at a young age, having a severe hypercalcemia.

  7. Partnership effectiveness in primary community care networks: A national empirical analysis of partners' coordination infrastructure designs.

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Lin, Yung-Kai; Lin, Cheng-Chieh

    2010-01-01

    Previous empirical and managerial studies have ignored the effectiveness of integrated health networks. It has been argued that the varying definitions and strategic imperatives of integrated organizations may have complicated the assessment of the outcomes/performance of varying models, particularly when their market structures and contexts differed. This study aimed to empirically verify a theoretical perspective on the coordination infrastructure designs and the effectiveness of the primary community care networks (PCCNs) formed and funded by the Bureau of National Health Insurance since March 2003. The PCCNs present a model to replace the traditional fragmented providers in Taiwan's health care. The study used a cross-sectional mailed survey designed to ascertain partnership coordination infrastructure and integration of governance, clinical care, bonding, finances, and information. The outcome indicators were PCCNs' perceived performance and willingness to remain within the network. Structural equation modeling examined the causal relationships, controlling for organizational and environmental factors. Primary data collection occurred from February through December 2005, via structured questionnaires sent to 172 PCCNs. Using the individual PCCN as the unit of analysis, the results found that a network's efforts regarding coordination infrastructures were positively related to the PCCN's perceived performance and willingness to remain within the network. In addition, PCCNs practicing in rural areas and in areas with higher density of medical resources had better perceived effectiveness and willingness to cooperate in the network.Practical Implication: The lack of both an operational definition and an information about system-wide integration may have obstructed understanding of integrated health networks' organizational dynamics. This study empirically examined individual PCCNs and offers new insights on how to improve networks' organizational design and

  8. Perspectives on the value of advanced medical imaging: a national survey of primary care physicians.

    Science.gov (United States)

    Hughes, Christine M; Kramer, Erich; Colamonico, Jennifer; Duszak, Richard

    2015-05-01

    To understand perceptions of primary care physicians (PCPs) about the value of advanced medical imaging. A national quantitative survey of 500 PCPs was conducted using an online self-administered questionnaire. Questions focused on advanced medical imaging (CT, MRI, and PET) and its perceived impact on the delivery of patient care. Responses were stratified by physician demographics. Large majorities of the PCPs indicated that advanced imaging increases their diagnostic confidence (441; 88%); provides data not otherwise available (451; 90%); permits better clinical decision making (440; 88%); increases confidence in treatment choices (438; 88%), and shortens time to definitive diagnosis (430; 86%]). Most (424; 85%) believe that patient care would be negatively affected without access to advanced imaging. PCPs whose clinical careers predated the proliferation of advanced imaging modalities (>20 years of practice) assigned higher value to advanced imaging on several dimensions compared with younger physicians whose training overlapped widespread technology availability. By a variety of metrics, large majorities of PCPs believe that advanced medical imaging provides considerable value to patient care. Those whose careers predated the widespread availability of advanced imaging tended to associate it with even higher value. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. Stress sources and manifestations in a nation-wide sample of pre-primary, primary and secondary educators in Greece

    Directory of Open Access Journals (Sweden)

    Nadia eKourmousi

    2016-04-01

    Full Text Available BackgroundTeachers experience high levels of stress as a result of their professional duties and research has shown a growing interest in this phenomenon during the recent years. Aim of this study was to explore the associations of stress sources and manifestations with individual and job-related characteristics in educators of all levels. MethodsIn a cross–sectional design, following an informative e-campaign on the study aims through the official and the main teachers’ portals in Greece, respondents completed online the Teachers Stress Inventory (TSI and the 14-item Perceived Stress Scale (PSS-14. 974 male and 2473 female pre-primary, primary and secondary educators with a mean age of 41.2 years responded. ResultsWomen and younger teachers reported significantly higher levels of stress, mainly due to lack of time and other work-related stressors, and also more emotional and gastronomic manifestations. Increased age and working experience were associated with lower levels of several stress sources. Teachers of administrative positions had increased time management stressors, but less professional distress, professional investment and discipline and motivation stressors. Additionally, working and residing far from family increased teachers’ stress levels associated to control, motivation and investment. Teachers of pre-primary education had reduced professional investment and motivation stress factors while vocational lyceum teachers of secondary education reported less work-related stressors and manifestations and more discipline and motivation related ones. Having students supported or in need of support from special educators and students with difficulties in speaking or comprehension was associated with most of the teachers' stress sources and manifestations (i.e. TSI subscales. Finally, colleagues’ and mainly supervisors' support seemed to provide a strong and consistent protection against both stress sources and manifestations

  10. Factors Influencing the Likelihood of Choice of Gaelic-Medium Primary Education in Scotland: Results from a National Public Survey

    Science.gov (United States)

    O'Hanlon, Fiona; Paterson, Lindsay

    2017-01-01

    This paper investigates the factors influencing the likelihood of choice of Gaelic-medium primary education in Scotland by means of the analysis of a national survey of public attitudes conducted in 2012. Binary logistic regression is used to investigate the association of five dimensions found in previous literature to be associated with the…

  11. Aesthetic Education of Primary School Pupils as an Integral Part of the National System of Continuous Art Education in Japan

    Science.gov (United States)

    Kuchai, Tetiana

    2014-01-01

    The article examines aesthetic education of primary school pupils as an integral part of the national system of continuous art education in Japan. One of the most important traditional means of aesthetic education in Japan, according to L. Tsaryova is considered nature. Analysis of the scientific literature by domestic and foreign scientists…

  12. Aesthetic Education of Primary School Pupils as an Integral Part of the National System of Continuous Art Education in Japan

    Science.gov (United States)

    Kuchai, Tetiana

    2014-01-01

    The article examines aesthetic education of primary school pupils as an integral part of the national system of continuous art education in Japan. One of the most important traditional means of aesthetic education in Japan, according to L. Tsaryova is considered nature. Analysis of the scientific literature by domestic and foreign scientists…

  13. 78 FR 47191 - Air Quality Designations for the 2010 Sulfur Dioxide (SO2) Primary National Ambient Air Quality...

    Science.gov (United States)

    2013-08-05

    ... AGENCY 40 CFR Part 81 RIN 2060-AR18 Air Quality Designations for the 2010 Sulfur Dioxide (SO ) Primary National Ambient Air Quality Standard AGENCY: Environmental Protection Agency (EPA). ACTION: Final rule. SUMMARY: This rule establishes air quality designations for certain areas in the United States for the...

  14. 76 FR 33756 - Notice of Approval of the Primacy Application for National Primary Drinking Water Regulations for...

    Science.gov (United States)

    2011-06-09

    ... AGENCY Notice of Approval of the Primacy Application for National Primary Drinking Water Regulations for... following offices: (1) Missouri Department of Natural Resources, Public Drinking Water Branch, 1101... Pesticides Division, Drinking Water Management Branch, 901 North 5th Street, Kansas City, Kansas 66101....

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

    Science.gov (United States)

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

    2014-01-01

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

  16. Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria.

    Science.gov (United States)

    Eboreime, Ejemai Amaize; Abimbola, Seye; Obi, Felix Abrahams; Ebirim, Obinna; Olubajo, Olalekan; Eyles, John; Nxumalo, Nonhlanhla Lynette; Mambulu, Faith Nankasa

    2017-03-21

    Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives. Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach. Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives. Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes.

  17. Final Report: Comparison of the primary (national) standards of low-pressure gas flow

    Science.gov (United States)

    Benková, Miroslava; Makovnik, Stefan; Mickan, Bodo

    2015-01-01

    The EURAMET.M.FF-K6 comparison was organized for the purpose of determination of the degree of equivalence of the primary (national) standards for low-pressure gas flow measurement over the range (2 to 100) m3/h and was performed simultaneously with CCM.FF-K6.2011 with the same transfer standard. A rotary gas meter G65 was used as a transfer standard. The measurements were provided by prescribed reference conditions. Fifteen laboratories from EURAMET participated in this key comparison - SMU, Slovakia; PTB, Germany; CEM, Spain; LNE-LADG, France; VSL, Netherlands; CMI, Czech Republic; BEV, Austria; MKEH, Hungary; GUM Poland; SP, Sweden; METAS, Switzerland; DMDM, Serbia; TUBITAK-UME, Turkey; EIM, Greece; IMBiH, Bosnia-Herzegovina. The EURAMET.M.FF-K6 is linked to the CCM.FF-K6.2011 by correcting the results of three linking laboratories (Slovakia SMU, Germany PTB and France LNE LADG). This correction provides an estimate of what would have been the result from the EURAMET.M-FF-K6 participants, if they had actually participated in CCM.FF-K6.2011. According to the evaluation 93.7 % of the results were consistent with KCRV, 3.4 % of the results were in the warning level and 2.9 % of the results were inconsistent. The results of this comparison can be used for review of the CMC tables. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

  18. Lean implementation in primary care health visiting services in National Health Service UK.

    Science.gov (United States)

    Grove, A L; Meredith, J O; Macintyre, M; Angelis, J; Neailey, K

    2010-10-01

    This paper presents the findings of a 13-month lean implementation in National Health Service (NHS) primary care health visiting services from May 2008 to June 2009. Lean was chosen for this study because of its reported success in other healthcare organisations. Value-stream mapping was utilised to map out essential tasks for the participating health visiting service. Stakeholder mapping was conducted to determine the links between all relevant stakeholders. Waste processes were then identified through discussions with these stakeholders, and a redesigned future state process map was produced. Quantitative data were provided through a 10-day time-and-motion study of a selected number of staff within the service. This was analysed to provide an indication of waste activity that could be removed from the system following planned improvements. The value-stream map demonstrated that there were 67 processes in the original health visiting service studied. Analysis revealed that 65% of these processes were waste and could be removed in the redesigned process map. The baseline time-and-motion data demonstrate that clinical staff performed on average 15% waste activities, and the administrative support staff performed 46% waste activities. Opportunities for significant waste reduction have been identified during the study using the lean tools of value-stream mapping and a time-and-motion study. These opportunities include simplification of standard tasks, reduction in paperwork and standardisation of processes. Successful implementation of these improvements will free up resources within the organisation which can be redirected towards providing better direct care to patients.

  19. The user with respiratory symptoms of tuberculosis in the primary care: assessment of actions according to national recommendations

    Directory of Open Access Journals (Sweden)

    Luize Barbosa Antunes

    2016-06-01

    Full Text Available Objective: to investigate the evaluation of the user with respiratory symptoms of tuberculosis in Primary Health Care services according to the norms of the National Program for Tuberculosis Control. Methods: cross-sectional study with application of a form to 99 people with pulmonary tuberculosis. Results: a total of 87.9% participants reported cough as the symptom that motivated the search for Primary Care; from these, 27.3% sought Primary Care units, 96.3% received care in this service, of which 46.2% reported that sputum smear was requested by professionals in the units. Conclusion: more than half of participants sought secondary or tertiary services due to the symptoms of tuberculosis, and also less than half of patients assisted in Primary Care had diagnostic tests requested by professionals of that service.

  20. Y-12 Groundwater Protection Program Extent Of The Primary Groundwater Contaminants At The Y-12 National Security Complex

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-12-01

    This report presents data summary tables and maps used to define and illustrate the approximate lateral extent of groundwater contamination at the U.S. Department of Energy (DOE) Y-12 National Security Complex (Y-12) in Oak Ridge, Tennessee. The data tables and maps address the primary (i.e., most widespread and mobile) organic, inorganic, and radiological contaminants in the groundwater. The sampling locations, calculated contaminant concentrations, plume boundary values, and paired map format used to define, quantify, delineate, and illustrate the approximate extent of the primary organic, inorganic, and radiological contaminants in groundwater at Y-12 are described.

  1. The national improvement partnership network: state-based partnerships that improve primary care quality.

    Science.gov (United States)

    Shaw, Judith S; Norlin, Chuck; Gillespie, R J; Weissman, Mark; McGrath, Jane

    2013-01-01

    Improvement partnerships (IPs) are a model for collaboration among public and private organizations that share interests in improving child health and the quality of health care delivered to children. Their partners typically include state public health and Medicaid agencies, the local chapter of the American Academy of Pediatrics, and an academic health care organization or children's hospital. Most IPs also engage other partners, including a variety of public, private, and professional organizations and individuals. IPs lead and support measurement-based, systems-focused quality improvement (QI) efforts that primarily target primary care practices that care for children. Their projects are most often conducted as learning collaboratives that involve a team from each of 8 to 15 participating practices over 9 to 12 months. The improvement teams typically include a clinician, office manager, clinical staff (nurses or medical assistants), and, for some projects, a parent; the IPs provide the staff and local infrastructure. The projects target clinical topics, chosen because of their importance to public health, local clinicians, and funding agencies, including asthma, attention-deficit/hyperactivity disorder, autism, developmental screening, obesity, mental health, medical home implementation, and several others. Over the past 13 years, 19 states have developed (and 5 are exploring developing) IPs. These organizations share similar aims and methods but differ substantially in leadership, structure, funding, and longevity. Their projects generally engage pediatric and family medicine practices ranging from solo private practices to community health centers to large corporate practices. The practices learn about the project topic and about QI, develop specific improvement strategies and aims that align with the project aims, perform iterative measures to evaluate and guide their improvements, and implement systems and processes to support and sustain those improvements

  2. Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

    Science.gov (United States)

    Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

    2014-01-01

    The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

  3. Teaching at primary healthcare services within the Brazilian national health system (SUS in Brazilian healthcare professionals' training

    Directory of Open Access Journals (Sweden)

    Ramona Fernanda Ceriotti Toassi

    2013-06-01

    Full Text Available The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.

  4. Patient safety skills in primary care: a national survey of GP educators

    OpenAIRE

    Ahmed, Maria; Arora, Sonal; McKay, John; Long, Susannah; Vincent, Charles; Kelly, Moya; Sevdalis, Nick; Bowie, Paul

    2014-01-01

    Background Clinicians have a vital role in promoting patient safety that goes beyond their technical competence. The qualities and attributes of the safe hospital doctor have been explored but similar work within primary care is lacking. Exploring the skills and attributes of a safe GP may help to inform the development of training programmes to promote patient safety within primary care. This study aimed to determine the views of General Practice Educational Supervisors (GPES) regarding the ...

  5. Primary prevention of overweight and obesity: an analysis of national survey data.

    Science.gov (United States)

    Lutfiyya, May Nawal; Nika, Bill; Ng, Lauren; Tragos, Christina; Won, Regina; Lipsky, Martin S

    2008-06-01

    Obesity is rapidly approaching tobacco as the leading cause of preventable morbidity and mortality. Health care providers have the opportunity to address this through primary prevention strategies. To assess whether health care professionals provide primary prevention for overweight and obesity by examining the percentage of healthy-weight (body mass index [BMI] = 18.5-24.9 kg/m(2)) individuals who report being advised to maintain a healthy weight. Cross-sectional analysis of the 2003 Behavioral Risk Factor Surveillance Survey data. Noninstitutionalized U.S. adults >18 years of age. Among healthy BMI respondents, only 2.6% reported receiving primary prevention. Logistic regression analyses yielded that healthy-weight adults receiving primary prevention were more likely to report: being 18-49 years of age, annual household incomes <$35,000, having at least 1 comorbidity, having a health care provider, changed eating habits to include less fat or fewer calories, and using physical activity to maintain or lose weight. Men were also more likely to receive primary prevention. Only a very small proportion of healthy-weight adults received primary prevention, which suggests that physicians are missing opportunities to help address the epidemic of adult obesity in the US.

  6. 76 FR 76259 - National Emissions Standards for Hazardous Air Pollutants: Primary Aluminum Reduction Plants

    Science.gov (United States)

    2011-12-06

    ... NTTAA National Technology Transfer and Advancement Act O&M operation and maintenance OAQPS Office of Air Quality Planning and Standards ODW Office of Drinking Water OECA Office of Enforcement and Compliance...

  7. Primary percutaneous coronary intervention as a national Danish reperfusion strategy of ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Jacob Thorsted; Steengaard, Carsten; Holmvang, Lene

    2013-01-01

    The use of primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) requires optimal systems-of-care and logistics in order to enable rapid treatment of all patients. In Denmark, this has been achieved through prehospital...... electrocardiogram diagnosis, field triage and dedicated PCI centres 24/7. Today, primary PCI is an option for all Danish patients with STEMI, regardless of the distance to a PCI centre. This has led to a decline in both mortality and morbidity....

  8. "Poetry? Of Course We Do It. It's in the National Curriculum." Primary Children's Perceptions of Poetry

    Science.gov (United States)

    Kelly, Alison

    2005-01-01

    What can listening to children's ideas about poetry teach us? This article considers ways in which exploring primary-aged students' perceptions of poetry can inform teachers' work with children. Using strategies from earlier studies in secondary schools, a small-scale project with Year 6 students revealed their complex and sometimes contradictory…

  9. 76 FR 14636 - National Emission Standards for Hazardous Air Pollutants: Primary Lead Smelting

    Science.gov (United States)

    2011-03-17

    ... Air Pollutants for Primary Lead Smelting (76 FR 9410). The EPA is extending the deadline for written...-2004-0305, by one of the following methods: http://www.regulations.gov : Follow the on-line... the use of special characters, any form of encryption, and be free of any defects or viruses....

  10. Absolute measurement of the DT primary neutron yield on the National Ignition Facility

    Directory of Open Access Journals (Sweden)

    Leeper R.J.

    2013-11-01

    Full Text Available The measurement of the absolute neutron yield produced in inertial confinement fusion target experiments conducted on the National Ignition Facility (NIF is essential in benchmarking progress towards the goal of achieving ignition on this facility. This paper describes three independent diagnostic techniques that have been developed to make accurate and precise DT neutron yield measurements on the NIF.

  11. Children's Construction and Experience of Racism and Nationalism in Greek-Cypriot Primary Schools

    Science.gov (United States)

    Zembylas, Michalinos

    2010-01-01

    This article presents findings that highlight children's construction and experience of racism and nationalism among a sample of Greek-Cypriot (the majority) and Turkish-speaking (the minority) children in Greek-Cypriot schools through the lens of intersectionality theory. The article first reviews previous work in relation to children, racism and…

  12. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Science.gov (United States)

    Uchôa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre; Fronteira, Inês Santos Estevinho; Coêlho, Ardigleusa Alves; Martiniano, Claudia Santos; Brandão, Isabel Cristina Araújo; Yamamura, Mellina; Maroto, Renata Melo

    2016-01-01

    Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil. PMID:26959332

  13. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Directory of Open Access Journals (Sweden)

    Severina Alice da Costa Uchôa

    2016-01-01

    Full Text Available Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%. Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000, availability (p=0.0000, coordination of care (p=0.0000, integration (p=0.0000 and supply (p=0.0000, verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.

  14. Prevention, early detection and team management of skin cancer in primary care: contribution to The health of the nation objectives.

    Science.gov (United States)

    Jackson, A

    1995-02-01

    The incidence of all skin cancers is increasing. If The health of the nation targets are to be addressed, incidence figures need to be more accurate. Solar damage is the major causal factor in all skin cancers. Certain individual risk factors also play an important part, especially in the development of malignant melanoma. Prevention and early detection are crucial in reducing morbidity and mortality from skin cancer. This paper considers the role of primary care skin screening clinics and cutaneous surgery facilities in the early detection and management of skin cancer. It also illustrates the value of a team approach in primary care in the prevention and early detection of skin cancer and in the more accurate recording of incidence rates.

  15. Primary healthcare reform in the United Nations Relief and Works Agency for Palestine Refugees in the Near East.

    Science.gov (United States)

    Santoro, A; Abu-Rmeileh, N; Khader, A; Seita, A; McKee, M

    2016-09-25

    Palestinian refugees served by the United Nation Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) are experiencing increasing rates of diagnosis of non-communicable diseases. In response, in 2011 UNRWA initiated an Agency-wide programme of primary healthcare reform, informed by the Chronic Care Model framework. Health services were reorganized following a family-centred approach, with delivery by multidisciplinary family health teams supported by updated technical advice. An inclusive clinical information system, termed e-Health, was implemented to collect a wide range of health information, with a focus on continuity of treatment. UNRWA was able to bring about these wide-ranging changes within its existing resources, reallocating finances, reforming its payment mechanisms, and modernizing its drug-procurement policies. While specific components of UNRWA's primary healthcare reform are showing promising results, additional efforts are needed to empower patients further and to strengthen involvement of the community.

  16. Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE guidelines being met?

    Directory of Open Access Journals (Sweden)

    Jordan Rita

    2008-10-01

    Full Text Available Abstract Background Most patients contact their general practitioner (GP following presentation to an Emergency Department (ED after a self-harm incident, and strategies to help GPs manage these patients include efficient communication between services. The aim of this study was to assess the standard of documentation and communication to primary care from secondary care as recommended by the National Institute of Clinical Excellence (NICE guidelines on the short-term management of people who self-harm. Methods An audit of medical records (ED and Psychiatric on people aged 16 years and over who had presented to the ED following self-harm, benchmarked according to government guidelines, was performed. Data were collected over a 4-week period at a general teaching hospital. Results We collected data on 93 consecutive episodes of self-harm; 62% of episodes were communicated to primary care, 58% of these communications were within 24 h and most within 3 days. Patient identifying details and follow-up arrangements were specified in most cases. Communication via psychiatric staff was most detailed. ED clinicians provided few communications and were of limited content. Communication with the patient's GP was not made in half of those cases seen by a mental health specialist. Conclusion Government guidelines are only partially being met. Reliance on communication by ED staff would leave a substantial proportion of patients discharged from the ED with no or minimal communication to primary care. Psychiatric services need to improve the rate of communication to the patient's GP following assessment A national sample of National Health Service (NHS trusts would establish if this is a problem elsewhere.

  17. Aesthetic Education of Primary School Pupils as an Integral Part of the National System of Continuous Art Education in Japan

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    Kuchai Tetiana

    2014-09-01

    Full Text Available The article examines aesthetic education of primary school pupils as an integral part of the national system of continuous art education in Japan. One of the most important traditional means of aesthetic education in Japan, according to L. Tsaryova is considered nature. Analysis of the scientific literature by domestic and foreign scientists suggests that instead of collective worship the Japanese established habits that help people develop artistic taste. Having considered the traditions of: tea ceremony, admiring nature; writing, which doesn’t differ from painting and so on, one should point out that the traditions are valuable and remain till nowadays thus promoting the aestheticization of the Japanese people.

  18. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

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    McDermott Robyn

    2010-05-01

    Full Text Available Abstract Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE project has facilitated the implementation of modern Continuous Quality Improvement (CQI approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1 explore the factors associated with variation in clinical performance; 2 examine specific strategies that have been effective in improving primary care clinical performance; and 3 work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers, the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary

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

    Science.gov (United States)

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

    2013-01-01

    Subalpine meadows are some of the most ecologically important components of mountain landscapes, and primary productivity is important to the maintenance of meadow functions. Understanding how changes in primary productivity are associated with variability in moisture and temperature will become increasingly important with current and anticipated changes in climate. Our objective was to describe patterns and variability in aboveground live vascular plant biomass in relation to climatic factors. We harvested aboveground biomass at peak growth from four 64-m2 plots each in xeric, mesic, and hydric meadows annually from 1994 to 2000. Data from nearby weather stations provided independent variables of spring snow water content, snow-free date, and thawing degree days for a cumulative index of available energy. We assembled these climatic variables into a set of mixed effects analysis of covariance models to evaluate their relationships with annual aboveground net primary productivity (ANPP), and we used an information theoretic approach to compare the quality of fit among candidate models. ANPP in the xeric meadow was negatively related to snow water content and thawing degree days and in the mesic meadow was negatively related to snow water content. Relationships between ANPP and these 2 covariates in the hydric meadow were not significant. Increasing snow water content may limit ANPP in these meadows if anaerobic conditions delay microbial activity and nutrient availability. Increased thawing degree days may limit ANPP in xeric meadows by prematurely depleting soil moisture. Large within-year variation of ANPP in the hydric meadow limited sensitivity to the climatic variables. These relationships suggest that, under projected warmer and drier conditions, ANPP will increase in mesic meadows but remain unchanged in xeric meadows because declines associated with increased temperatures would offset the increases from decreased snow water content.

  20. Nation-wide primary healthcare research network: a privacy protection assessment.

    Science.gov (United States)

    De Clercq, Etienne; Van Casteren, Viviane; Bossuyt, Nathalie; Moreels, Sarah; Goderis, Geert; Bartholomeeusen, Stefaan; Bonte, Pierre; Bangels, Marc

    2012-01-01

    Efficiency and privacy protection are essential when setting up nationwide research networks. This paper investigates the extent to which basic services developed to support the provision of care can be re-used, whilst preserving an acceptable privacy protection level, within a large Belgian primary care research network. The generic sustainable confidentiality management model used to assess the privacy protection level of the selected network architecture is described. A short analysis of the current architecture is provided. Our generic model could also be used in other countries.

  1. Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study.

    LENUS (Irish Health Repository)

    Whitford, David L

    2009-01-01

    BACKGROUND: Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. METHODS: Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. RESULTS: Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. CONCLUSION: General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.

  2. Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

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    O'Sullivan Bernadette

    2009-04-01

    Full Text Available Abstract Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response. Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.

  3. Prevalence of intimate partner violence in Spain: A national cross-sectional survey in primary care.

    Science.gov (United States)

    Ruiz-Pérez, Isabel; Escribà-Agüir, Vicenta; Montero-Piñar, Isabel; Vives-Cases, Carmen; Rodríguez-Barranco, Miguel

    2017-02-01

    (1) To analyze the prevalence of Intimate Partner Violence by types. (2) To examine the relationship between sociodemographic characteristics and Intimate Partner Violence. Cross-sectional study using a self-administered questionnaire. Primary Healthcare centers in Spain. 10,322 women (18-70 years) attending Primary Healthcare centers. A compound index was calculated based on frequency, types, and duration of Intimate Partner Violence. Multivariable adjusted logistic regression models were used to identify the sociodemographic factors, which were independently associated with each Intimate Partner Violence category. The prevalence of Intimate Partner Violence was 24.8%. For the physical only category, no differences were observed regarding education or employment status, and women with the highest income have less risk. For the psychological only category, no differences were observed according to the income level. The risk increases as the education level decreases, and the greatest frequency of only psychological Intimate Partner Violence was observed in women who were unemployed or students. For both the physical and psychological category of Intimate Partner Violence, a clear risk increase is observed as income and education levels decrease. Retired women showed the highest frequency of this violence category. The results show that Intimate Partner Violence affects women of all social strata, but the frequency and Intimate Partner Violence category will vary according to the socio-economic. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  4. The potential impact of the next influenza pandemic on a national primary care medical workforce

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    Crampton Peter

    2005-08-01

    Full Text Available Abstract Background Another influenza pandemic is all but inevitable. We estimated its potential impact on the primary care medical workforce in New Zealand, so that planning could mitigate the disruption from the pandemic and similar challenges. Methods The model in the "FluAid" software (Centers for Disease Control and Prevention, CDC, Atlanta was applied to the New Zealand primary care medical workforce (i.e., general practitioners. Results At its peak (week 4 the pandemic would lead to 1.2% to 2.7% loss of medical work time, using conservative baseline assumptions. Most workdays (88% would be lost due to illness, followed by hospitalisation (8%, and then premature death (4%. Inputs for a "more severe" scenario included greater health effects and time spent caring for sick relatives. For this scenario, 9% of medical workdays would be lost in the peak week, and 3% over a more compressed six-week period of the first pandemic wave. As with the base case, most (64% of lost workdays would be due to illness, followed by caring for others (31%, hospitalisation (4%, and then premature death (1%. Conclusion Preparedness planning for future influenza pandemics must consider the impact on this medical workforce and incorporate strategies to minimise this impact, including infection control measures, well-designed protocols, and improved health sector surge capacity.

  5. 40 CFR Appendix H to Part 50 - Interpretation of the 1-Hour Primary and Secondary National Ambient Air Quality Standards for Ozone

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Interpretation of the 1-Hour Primary and Secondary National Ambient Air Quality Standards for Ozone H Appendix H to Part 50 Protection of... AIR QUALITY STANDARDS Pt. 50, App. H Appendix H to Part 50—Interpretation of the 1-Hour Primary and...

  6. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

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    Darko Gvozdanovi_

    2007-09-01

    Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

  7. Research on cultivating martial art teachers of primary and secondary schools under the background of new national curriculum standard

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    HAN Xue

    2013-08-01

    Full Text Available Martial art instructors play an important role in martial art education,and the quality of martial art instructors determines the level of quality of martial art education. Therefore,under the background of new national curriculum standard,who is to teach martial art,or in other words,martial art teacher issues concern the development of martial art in primary and secondary schools.In this paper,by use of literature,interviews and other research methods,the history of martial art education in our country is reviewed at first,leading to a conclusion that there exist problems in primary and middle school martial art education in our country,i.e.professional martial art instructors in primary and middle schools are seriously deficient,martial art instructors are lacking in professional martial art knowledge and professional competence,the continuing education system is not perfect,and training and education are formalized.The author therefore puts forward countermeasures to improve the current situation.

  8. Patient experience of access to primary care: identification of predictors in a national patient survey

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    Kontopantelis Evangelos

    2010-08-01

    Full Text Available Abstract Background The 2007/8 GP Access Survey in England measured experience with five dimensions of access: getting through on the phone to a practice, getting an early appointment, getting an advance appointment, making an appointment with a particular doctor, and surgery opening hours. Our aim was to identify predictors of patient satisfaction and experience with access to English primary care. Methods 8,307 English general practices were included in the survey (of 8,403 identified. 4,922,080 patients were randomly selected and contacted by post and 1,999,523 usable questionnaires were returned, a response rate of 40.6%. We used multi-level logistic regressions to identify patient, practice and regional predictors of patient satisfaction and experience. Results After controlling for all other factors, younger people, and people of Asian ethnicity, working full time, or with long commuting times to work, reported the lowest levels of satisfaction and experience of access. For people in work, the ability to take time off work to visit the GP effectively eliminated the disadvantage in access. The ethnic mix of the local area had an impact on a patient's reported satisfaction and experience over and above the patient's own ethnic identity. However, area deprivation had only low associations with patient ratings. Responses from patients in small practices were more positive for all aspects of access with the exception of satisfaction with practice opening hours. Positive reports of access to care were associated with higher scores on the Quality and Outcomes Framework and with slightly lower rates of emergency admission. Respondents in London were the least satisfied and had the worst experiences on almost all dimensions of access. Conclusions This study identifies a number of patient groups with lower satisfaction, and poorer experience, of gaining access to primary care. The finding that access is better in small practices is important given

  9. The Security Education Concepts in the Textbooks of the National and Civic Education of the Primary Stage in Jordan--An Analytical Study

    Science.gov (United States)

    Al-Edwan, Zaid Suleiman

    2016-01-01

    The present study aimed at exploring the concepts of the security education in the textbooks of the national and civic education of the higher primary stage in Jordan. It adopted the descriptive analytical method. The study sample consisted of the textbooks of the national and civic education for the basic eighth, ninth and tenth grades. To…

  10. Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

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    Bordonaba-Bosque Daniel

    2011-06-01

    Full Text Available Abstract Background There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC utilisation patterns between immigrants and the native population with regard to their morbidity burden. Methods This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain. Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System®. Results The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p Conclusions Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.

  11. Social franchising primary healthcare clinics--a model for South African National Health Insurance?

    Science.gov (United States)

    Robinson, Andrew Ken Lacey

    2015-09-21

    This article describes the first government social franchise initiative in the world to deliver a 'brand' of quality primary healthcare (PHC) clinic services. Quality and standards of care are not uniformly and reliably delivered across government PHC clinics in North West Province, South Africa, despite government support, numerous policies, guidelines and in-service training sessions provided to staff. Currently the strongest predictor of good-quality service is the skill and dedication of the facility manager. A project utilising the social franchising business model, harvesting best practices, has been implemented with the aim of developing a system to ensure reliably excellent healthcare service provision in every facility in North West. The services of social franchising consultants have been procured to develop the business model to drive this initiative. Best practices have been benchmarked, and policies, guidelines and clinic support systems have been reviewed, evaluated and assessed, and incorporated into the business plan. A pilot clinic has been selected to refine and develop a working social franchise model. This will then be replicated in one clinic to confirm proof of concept before further scale-up. The social franchise business model can provide solutions to a reliable and recognisable 'brand' of quality universal coverage of healthcare services.

  12. How to use The National Gallery as a cross curricular approach to weather and climate studies at primary level.

    Science.gov (United States)

    Hansen, P. J. K.

    2009-09-01

    How to use The National Gallery as a cross curricular approach to weather and climate studies at primary level. Pål J. Kirkeby Hansen Faculty of Education and International Studies, Oslo University College (PalKirkeby.Hansen@lui.hio.no) Weather and climate are topics in natural science and geography in primary and secondary education in most countries. The pupils are often doing own weather observations and measurements and are presenting the results oral, by posters or with digital aids. They also use the Internet with all its relevant resources in their studies to develop vocabulary, practical and conceptual knowledge. Knowledge about weather and climate is parts of liberal education and could be projected to other topics in science and to topics in other subjects, for instance: history, social geography, literature and arts. This article reports from a case study in grade 3 classes (age 9 year) during their Weather Week. Their science teacher was, quite untypical, also educated in art history. She arranged a visited to The National Gallery with the double agenda: 1. To introduce the pupils to Norwegian canon paintings from the national romantic period, our so-called "golden age”. 2. To look for and discuss weather elements in this paintings. For one hour the museum curator guided the pupils around the water cycle by using the paintings. While the pupils' own observations of weather, clouds and wind and measurements of temperature and precipitation during the Weather Week only are point checks, the guided tour in The National Gallery gave literally "the whole picture” of the Norwegian weather and climate and of the water cycle. During the tour, the curator constantly invited the pupils to tell about and discuss what weather and water elements they were looking at when standing in front of a painting. The pupils were responsive and interested all the time. Back at school, they demonstrated that they had learned much about both weather elements, the water

  13. Internet Gaming Disorder Among Slovenian Primary Schoolchildren: Findings From a Nationally Representative Sample of Adolescents.

    Science.gov (United States)

    Pontes, Halley M; Macur, Mirna; Griffiths, Mark D

    2016-06-01

    Background and aims Since the inclusion of Internet Gaming Disorder (IGD) in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a tentative disorder, a few psychometric screening instruments have been developed to assess IGD, including the 9-item Internet Gaming Disorder Scale - Short-Form (IGDS9-SF) - a short, valid, and reliable instrument. Methods Due to the lack of research on IGD in Slovenia, this study aimed to examine the psychometric properties of the IGDS9-SF in addition to investigating the prevalence rates of IGD in a nationally representative sample of eighth graders from Slovenia (N = 1,071). Results The IGDS9-SF underwent rigorous psychometric scrutiny in terms of validity and reliability. Construct validation was investigated with confirmatory factor analysis to examine the factorial structure of the IGDS9-SF and a unidimensional structure appeared to fit the data well. Concurrent and criterion validation were also investigated by examining the association between IGD and relevant psychosocial and game-related measures, which warranted these forms of validity. In terms of reliability, the Slovenian version IGDS9-SF obtained excellent results regarding its internal consistency at different levels, and the test appears to be a valid and reliable instrument to assess IGD among Slovenian youth. Finally, the prevalence rates of IGD were found to be around 2.5% in the whole sample and 3.1% among gamers. Discussion and conclusion Taken together, these results illustrate the suitability of the IGDS9-SF and warrants further research on IGD in Slovenia.

  14. The retention of health human resources in primary healthcare centers in Lebanon: a national survey

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    Alameddine Mohamad

    2012-11-01

    Full Text Available Abstract Background Critical shortages of health human resources (HHR, associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. Methods A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory. A total of 755 providers completed the questionnaire (60.5% response rate. Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Results Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%, better job opportunities outside the country (35.1% and lack of professional development (33.7%. A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. Conclusions The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits

  15. The retention of health human resources in primary healthcare centers in Lebanon: a national survey

    Science.gov (United States)

    2012-01-01

    Background Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. Methods A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Results Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. Conclusions The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health

  16. EHR systems in the Spanish Public Health National System: the lack of interoperability between primary and specialty care.

    Science.gov (United States)

    de la Torre-Díez, Isabel; González, Sandra; López-Coronado, Miguel

    2013-02-01

    One of the problems of the Spanish Public Health National System is the lack of interoperability in the implemented Electronic Health Records (EHRs) systems in primary and specialty care. There is a deficiency in the electronic health systems that store the data of primary care patients, so one of the basic problems that prevent that every hospital and health center working on the same method is that deficiency. In this paper we research on this problem and to give expression to a series of solutions to it. Bibliographic material in this work has been obtained mainly from MEDLINE source. Additionally, due to the lack of information and privacy about the different EHRs systems, we have resorted to making direct contact with the organizations that have implemented those systems and technological providers. Two solutions have been propounded given several aspects for a feasibility study. The first solution is based upon in the execution of backups in different EHRs databases, which implies a huge economical and infrastructure development. The second of these solutions so that due to the creation of protocols by means of Cloud Computing Technologies. It is crucial the need to reach a homogeneity concerning to the storage of patients clinical data. On the results achieved we can emphasize that maybe the main problems are not the economical handicaps or the large technological development needed, but, as for Health each Region manages its own competences, each one governs with independent policies and decisions.

  17. Factors Influencing Academic Performance Of Standard Eight Girls In National Examinations In Public Primary Schools A Case Of Matungu Division.

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    Oparanya Wamukoya Windrick

    2015-06-01

    Full Text Available ABSTARCT This study is designed to establish the factors influencing academic of standard eight girls in public primary schools in National exams in Matungu division. The researcher aimed at finding out why there is increased low performance of girls in public schools despite the fact that they are assessed through periodic performance tests do continuous assessment tests CATS midterm carry out tuition and the provision of free primary education which is aimed at improving academic performance. This study adapted a descriptive survey design as a major method of research where data was collected by the researcher members of a population under study. The target population comprised of Head teachers teachers pupils parents and parent schools representatives. Purposive sampling and simple random technique were used. Data was collected by use of questionnaires and interview guides. Data was analyzed by use of descriptive statistics constituting frequencies and percentages.The study established that girls were exposed to harsh school environmental conditions they walked long distances to school schools lacked facilities like toilets libraries and were exposed to male pest teachers. There were also teacher factors like training teacher shortage and motivation that affected girls performance.The study came up with recommendations for improvement of girls academic performance. More public schools should be build to reduce on distance and also overpopulation. The ministry of Education should monitor and evaluate the academic performance of girls in rural areas. The government should put up strict rules on pest teachers. The ministry should hire more teachers.

  18. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data.

    Science.gov (United States)

    Atun, Rifat; Gurol-Urganci, Ipek; Hone, Thomas; Pell, Lisa; Stokes, Jonathan; Habicht, Triin; Lukka, Kaija; Raaper, Elin; Habicht, Jarno

    2016-12-01

    Following independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system. Using routinely collected health billing records for 2005-2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co-morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply-side variables, and PHC use. Over the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow-up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services. Our findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions.

  19. A comparison of primary care information content in UpToDate and the National Guideline Clearinghouse*

    Science.gov (United States)

    Fenton, Susan H.; Badgett, Robert G.

    2007-01-01

    Objectives: The study sought to determine if two major resources for primary care questions have significant differences in information content and whether the number of documents found differs by disease category, patient age, or patient gender. Methods: Seven hundred fifty-two questions were randomly selected from the Clinical Questions Collection of the National Library of Medicine. UpToDate and the National Guidelines Clearinghouse (NGC) were searched utilizing keywords from the questions. The number of documents retrieved for each question in the resources was recorded. Chi-squared analysis was used to compare differences in retrieval between the resources. Logistic regression was used to evaluate the effect of patient age, patient gender, or disease category on the ability to find content. Results: UpToDate returned 1 or more documents for 580 questions, while NGC returned at least 1 document for 493 questions (77.1% versus 65.5% of question sampled, P = 0.001). In combination, the 2 resources returned content for 91% of searches (n = 685). NGC retrieved a mean of 16.3 documents per question versus 8.7 documents from UpToDate. Disease category was the only variable having a significant impact on the presence of online resource content. Conclusions: UpToDate had greater breadth of content than NGC, while neither resource provided complete coverage. Current practice guidelines, as reflected by those in the NGC, addressed at most two-thirds of the selected clinical questions. PMID:17641755

  20. A comparison of primary care information content in UpToDate and the National Guideline Clearinghouse.

    Science.gov (United States)

    Fenton, Susan H; Badgett, Robert G

    2007-07-01

    The study sought to determine if two major resources for primary care questions have significant differences in information content and whether the number of documents found differs by disease category, patient age, or patient gender. Seven hundred fifty-two questions were randomly selected from the Clinical Questions Collection of the National Library of Medicine. UpToDate and the National Guidelines Clearinghouse (NGC) were searched utilizing keywords from the questions. The number of documents retrieved for each question in the resources was recorded. Chi-squared analysis was used to compare differences in retrieval between the resources. Logistic regression was used to evaluate the effect of patient age, patient gender, or disease category on the ability to find content. UpToDate returned 1 or more documents for 580 questions, while NGC returned at least 1 document for 493 questions (77.1% versus 65.5% of question sampled, P = 0.001). In combination, the 2 resources returned content for 91% of searches (n = 685). NGC retrieved a mean of 16.3 documents per question versus 8.7 documents from UpToDate. Disease category was the only variable having a significant impact on the presence of online resource content. UpToDate had greater breadth of content than NGC, while neither resource provided complete coverage. Current practice guidelines, as reflected by those in the NGC, addressed at most two-thirds of the selected clinical questions.

  1. The distribution of lung cancer across sectors of society in the United Kingdom: a study using national primary care data

    Directory of Open Access Journals (Sweden)

    Iyen-Omofoman Barbara

    2011-11-01

    Full Text Available Abstract Background There is pressing need to diagnose lung cancer earlier in the United Kingdom (UK and it is likely that research using computerised general practice records will help this process. Linkage of these records to area-level geo-demographic classifications may also facilitate case ascertainment for public health programmes, however, there have as yet been no extensive studies of data validity for such purposes. Methods To first address the need for validation, we assessed the completeness and representativeness of lung cancer data from The Health Improvement Network (THIN national primary care database by comparing incidence and survival between 2000 and 2009 with the UK National Cancer Registry and the National Lung Cancer Audit Database. Secondly, we explored the potential of a geo-demographic social marketing tool to facilitate disease ascertainment by using Experian's Mosaic Public Sector ™ classification, to identify detailed profiles of the sectors of society where lung cancer incidence was highest. Results Overall incidence of lung cancer (41.4/100, 000 person-years, 95% confidence interval 40.6-42.1 and median survival (232 days were similar to other national data; The incidence rate in THIN from 2003-2006 was found to be just over 93% of the national cancer registry rate. Incidence increased considerably with area-level deprivation measured by the Townsend Index and was highest in the North-West of England (65.1/100, 000 person-years. Wider variations in incidence were however identified using Mosaic classifications with the highest incidence in Mosaic Public Sector ™types 'Cared-for pensioners, ' 'Old people in flats' and 'Dignified dependency' (191.7, 174.2 and 117.1 per 100, 000 person-years respectively. Conclusions Routine electronic data in THIN are a valid source of lung cancer information. Mosaic ™ identified greater incidence differentials than standard area-level measures and as such could be used as a tool

  2. An online photographic catalog of primary types of Platygastroidea (Hymenoptera in the National Museum of Natural History, Smithsonian Institution

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    Elijah J. Talamas

    2017-06-01

    Full Text Available A photographic catalog of primary types of Platygastroidea housed in the National Insect Collection, National Museum of Natural History, is here made available online at the image database at The Ohio State University (specimage.osu.edu. Following examination of this collection we enact the following taxonomic changes: Leptacis piniella MacGown syn. n. is treated as a junior synonym of Leptacis pinicola MacGown; Sacespalus indicus Mani is transferred to Platygaster Latreille; Platygaster indica Mukerjee is given the replacement name Platygaster chaos Talamas, n. n.; Synopeas rugiceps (Ashmead, comb. n. is transferred from Leptacis Förster; Axea atriclava (Kieffer, comb. n. is transferred from Psilanteris Kieffer; Chakra pachmarhica (Sharma, comb. n. is transferred from Paridris Kieffer; Paridris dubeyi Sharma, syn. n. is treated as a junior synonym of Chakra pachmarhica; Holoteleia indica (Mani is transferred to Opisthacantha Ashmead and given a replacement name, Opisthacantha nomados Talamas, n. n.; Psilanteris nigriclavata (Ashmead, comb. n. is transferred from Anteris Förster; Probaryconus grenadensis (Ashmead, comb. n. is transferred from Monoteleia Kieffer; Monoteleia syn.n. is treated as a junior synonym of Probaryconus Kieffer; Paridris karnatakensis Sharma, syn. n is treated as a junior synonym of Probaryconus cauverycus Saraswat; Probaryconus punctatus (Ashmead, comb. n. is transferred from Oxyteleia Kieffer; Triteleia bengalensis (Saraswat, comb. n. is transferred from Alloteleia Kieffer; Trimorus varius Fouts, syn. n. and Trimorus pulchricornis Fouts, syn. n. are treated as junior synonyms of Trimorus annulicornis (Ashmead; Neotypes are designated for Gryon leptocorisae (Howard, Idris seminiger (Ashmead, Telenomus graptae Howard, Telenomus persimilis Ashmead, and Telenomus rileyi Howard; lectotypes are designated for Cremastobaeus bicolor Ashmead, Oethecoctonus insularis (Ashmead, Oethecoctonus laticinctus (Ashmead and Probaryconus

  3. The potential impact of new national guidance on primary prevention of cardiovascular disease in people living with HIV

    Directory of Open Access Journals (Sweden)

    Nadia Ahmed

    2014-11-01

    Full Text Available Introduction: Cardiovascular disease (CVD is the leading cause of death in England and Wales. As people living with HIV (PLWH age, proactive management of CVD risk factors is crucial. The long-awaited draft guidelines for CVD from the National Institute of Clinical Excellence (NICE propose lipid modification (with statins and lifestyle modification for 40–74 year olds with >10% (previously >20% 10-year risk of CVD using QRISK2. We currently use Framingham so compared 3 CVD risk calculators in our cohort and analyzed the impact of a change in CVD threshold on the proportion of our patients who would need intervention. Materials and Methods: Framingham, QRISK2 and JBS3 cardiovascular risk calculators were compared in a group of randomly selected patients. Then, to analyze the impact of a change in primary prevention threshold on our cohort, we interrogated a prospectively collected database to identify all individuals who had a documented Framingham risk assessment and applied the current/proposed thresholds accordingly. We performed the same analysis for the three calculator subgroup (recalculating Framingham risk. Finally we surveyed HIV services in England & Wales regarding their choice of calculator. Results: We compared the 3 CVD risk calculators in 100 patients, see Table 1.In terms of eligibility for primary prevention 20.9% (916/4383 had documented Framingham risk assessment as part of routine care. Using a 20% threshold, 8.8% (81/916 would require intervention, increasing to 35.2% (322/916 with a threshold for intervention of 10%. Restricting analysis to the 100 patients to whom we applied all three calculators resulted in the following proportion requiring intervention with a 20%/10% threshold, respectively: Framingham 28%/76%, QRISK2 20%/53%, JBS3 15%/42% (four patients were excluded due to incomplete data. Conclusions: Reducing the threshold for cardiovascular preventative measures to 10% vastly increases the number of patients

  4. Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes.

    Science.gov (United States)

    Smith, Samuel G; Foy, Robbie; McGowan, Jennifer A; Kobayashi, Lindsay C; DeCensi, Andrea; Brown, Karen; Side, Lucy; Cuzick, Jack

    2017-06-01

    The cancer strategy for England (2015-2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk. To investigate GPs' attitudes towards prescribing tamoxifen. In an online survey, GPs in England, Northern Ireland, and Wales (n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription. In the vignette, the hypothetical patient's breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164. Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, PGPs willing to prescribe were more likely to be aware of the NICE guideline (P = 0.039) and to have acknowledged the benefits of tamoxifen (PGPs to continue the patient's care may overcome some prescribing barriers. © British Journal of General Practice 2017.

  5. Developing primary PCI as a national reperfusion strategy for patients with ST-elevation myocardial infarction: the UK experience.

    Science.gov (United States)

    McLenachan, James M; Gray, Huon H; de Belder, Mark A; Ludman, Peter F; Cunningham, David; Birkhead, John

    2012-08-01

    In 2004 in the United Kingdom (UK), the infrastructural and organisational changes required for implementation of primary PCI for treatment of STEMI were unclear, and the cost-effectiveness and sustainability of a changed reperfusion strategy had not been tested. In addition, any proposed change was to be made against the background of a previously successful in-hospital thrombolysis strategy, with plans for greater use of pre-hospital administration. A prospective study (the "National Infarct Angioplasty Project - NIAP") was set up to collect information on all patients presenting with STEMI in selected regions in the UK over a one year period (April 2005 - March 2006). The key findings from the NIAP project included that PPCI could be delivered within acceptable treatment times in a variety of geographical settings and that the shortest treatment times were achieved with direct admission to a PPCI-capable cardiac catheter laboratory. The transformation from a dominant lytic strategy to one of PPCI across the UK was achieved both swiftly and consistently with the help of 28 cardiac networks. By the second quarter of 2011, 94% of those STEMI patients in England who received reperfusion treatment were being treated by PPCI compared with 46% during the third quarter of 2008.

  6. 40 CFR Appendix I to Part 50 - Interpretation of the 8-Hour Primary and Secondary National Ambient Air Quality Standards for Ozone

    Science.gov (United States)

    2010-07-01

    ... and Secondary National Ambient Air Quality Standards for Ozone I Appendix I to Part 50 Protection of... AIR QUALITY STANDARDS Pt. 50, App. I Appendix I to Part 50—Interpretation of the 8-Hour Primary and... valid day if valid 8-hour averages are available for at least 75% of possible hours in the day (i.e.,...

  7. 40 CFR Appendix T to Part 50 - Interpretation of the Primary National Ambient Air Quality Standards for Oxides of Sulfur (Sulfur...

    Science.gov (United States)

    2010-07-01

    ... Ambient Air Quality Standards for Oxides of Sulfur (Sulfur Dioxide) T Appendix T to Part 50 Protection of... AIR QUALITY STANDARDS Pt. 50, App. T Appendix T to Part 50—Interpretation of the Primary National Ambient Air Quality Standards for Oxides of Sulfur (Sulfur Dioxide) 1. General (a) This appendix...

  8. Nation

    DEFF Research Database (Denmark)

    Østergaard, Uffe

    2014-01-01

    Nation er et gammelt begreb, som kommer af det latinske ord for fødsel, natio. Nationalisme bygger på forestillingen om, at mennesker har én og kun én national identitet og har ret til deres egen nationalstat. Ordet og forestillingen er kun godt 200 år gammel, og i 1900-tallet har ideologien bredt...... sig over hele verden. Nationalisme er blevet global....

  9. Positive predictive values of ICD-10 codes to identify incident acute pancreatitis and incident primary malignancy in the Scandinavian national patient registries among women with postmenopausal osteoporosis.

    Science.gov (United States)

    Munch, Troels; Christensen, Lotte B; Adelborg, Kasper; Tell, Grethe S; Apalset, Ellen M; Westerlund, Anna; Lagerros, Ylva T; Kahlert, Johnny; Xue, Fei; Ehrenstein, Vera

    2017-01-01

    Validation of definitions used to identify conditions of interest is imperative to epidemiologic studies based on routinely collected data. The objective of the study was thus to estimate positive predictive values (PPVs) of International Classification of Diseases, 10th Revision (ICD-10) codes to identify cases of incident acute pancreatitis leading to hospitalization and incident primary malignancy in the Scandinavian (Denmark, Norway, and Sweden) national patient registries in women with postmenopausal osteoporosis (PMO). This validation study included postmenopausal (defined as 55 years or older) women with osteoporosis, identified between 2005-2014. Potential cases were sampled based on ICD-10 codes from the three national patient registries. Cases were adjudicated by physicians, using medical record review as gold standard. PPVs with corresponding 95% CIs were computed. Medical records of 286 of 325 (retrieval rate 88%) women with PMO were available for adjudication. Acute pancreatitis leading to hospitalization had a PPV of 87.6% (95% CI: 80.8%-90.2%). Incident primary malignancy had a PPV of 88.1% (95% CI: 81.3%-92.7%). The PPVs did not vary substantially across the three countries. ICD-10 codes to identify acute pancreatitis leading to hospitalization, and incident primary malignancy in the Scandinavian national patient registries had high PPVs among women with PMO. This allows identification of cases of acute pancreatitis and incident primary malignancy with reasonable validity and to use these as outcomes in comparative analyses.

  10. National Health Models and the Adoption of E-Health and E-Prescribing in Primary Care - New Evidence from Europe.

    Science.gov (United States)

    Brennan, James; McElligott, Annette; Power, Norah

    2015-11-25

    Recent research from the European Commission (EC) suggests that the development and adoption of eHealth in primary care is significantly influenced by the context of the national health model in operation. This research identified three national health models in Europe at this time - the National Health Service (NHS) model, the social insurance system (SIS) model and the transition country (TC) model, and found a strong correlation between the NHS model and high adoption rates for eHealth. The objective of this study is to establish if there is a similar correlation in one specific application area - electronic prescribing (ePrescribing) in primary care. A review of published literature from 2000 to 2014 was undertaken covering the relevant official publications of the European Union and national government as well as the academic literature. An analysis of the development and adoption of ePrescribing in Europe was extracted from these data. The adoption of ePrescribing in primary care has increased significantly in recent years and is now practised by approximately 32% of European general practitioners. National ePrescribing services are now firmly established in 11 countries, with pilot projects underway in most others. The highest adoption rates are in countries with the NHS model, concentrated in the Nordic area. The electronic transmission of prescriptions continues to pose a significant challenge, especially in SIS countries and TCs. There is a strong correlation between the NHS model and high adoption rates for ePrescribing similar to the EC findings on the adoption of eHealth. It may be some time before many SIS countries and TCs reach the same adoption levels for ePrescribing and eHealth in primary care as most NHS countries.

  11. National Health Models and the Adoption of E-Health and E-Prescribing in Primary Care – New Evidence from Europe

    Directory of Open Access Journals (Sweden)

    James Brennan

    2015-11-01

    Full Text Available OBJECTIVE:  Recent research from the European Commission (EC suggests that the development and adoption of eHealth in primary care is significantly influenced by the context of the national health model in operation. This research identified three national health models in Europe at this time – the National Health Service (NHS model, the social insurance system (SIS model and the transition country (TC model, and found a strong correlation between the NHS model and high adoption rates for eHealth. The objective of this study is to establish if there is a similar correlation in one specific application area – electronic prescribing (ePrescribing in primary care.METHODS: A review of published literature from 2000 to 2014 was undertaken covering the relevant official publications of the European Union and national government as well as the academic literature. An analysis of the development and adoption of ePrescribing in Europe was extracted from these data.RESULTS: The adoption of ePrescribing in primary care has increased significantly in recent years and is now practised by approximately 32% of European general practitioners. National ePrescribing services are now firmly established in 11 countries, with pilot projects underway in most others. The highest adoption rates are in countries with the NHS model, concentrated in the Nordic area. The electronic transmission of prescriptions continues to pose a significant challenge, especially in SIS countries and TCs.CONCLUSIONS: There is a strong correlation between the NHS model and high adoption rates for ePrescribing similar to the EC findings on the adoption of eHealth. It may be some time before many SIS countries and TCs reach the same adoption levels for ePrescribing and eHealth in primary care as most NHS countries.

  12. The Computer-Assisted Web Interview Method as Used in the National Study of ICT Use in Primary Healthcare in Poland – Reflections on a Case Study

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    Sowa Paweł

    2015-12-01

    Full Text Available The development and widespread use of ICT in society are reflected by the way research is designed and conducted. The Computer Assisted Web Interview method is becoming more attractive and is a frequently used method in health sciences. The National Study of ICT Use in Primary Healthcare in Poland was conducted using this method. The aim of this paper is to present the major advantages and disadvantages of web surveys. Technical aspects of methodology and important stages of the aforementioned study, as well as key elements for its procedure, are mentioned. The authors also provide reflections based on their analysis of this national study, conducted between January and April 2014.

  13. Aboveground Net Primary Production of tree cover at the post-disturbance area in the Tatra National Park, Slovakia

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    Konôpka Bohdan

    2015-09-01

    Full Text Available Large-scale disturbances under the conditions of Slovakia, caused especially by storm and bark beetle, bring dramatic decline in carbon budget of the country, besides other negative consequences. The largest disturbance in modern history of the Slovak forestry was the storm damage that occurred in November 2004. The Tatra National Park (TNP was one of the most affected regions. Thus, in this territory, two transects (T1 – the Danielov dom site and T2 – near the Horný Smokovec village were established to survey basic dendrometric properties of trees in young stands established after the disaster. The standing stock of aboveground biomass in tree cover for the spring and autumn 2014 was calculated using the recorded variables, i.e. tree height and diameter measured at the stem base, together with the region-specific allometric relations. Then, the Aboveground Net Primary Production (ANPP in tree cover was estimated with respect to its components (stem, branches and foliage. ANPP was 315 g m−2 per year (Transect T1, and 391 g m−2 per year (Transect T2. The differences in the structure of ANPP, i.e. contribution of tree components, were found between transects T1 and T2. They were caused by the contrasting tree species composition, specifically the ratios between Norway spruce and broadleaved species. Broadleaves allocated more biomass production to foliage than spruce. This phenomenon together with higher turnover (once a year of foliage caused that broadleaves manifest higher share of fast-cycling carbon in comparison to the amount of carbon sequestrated in woody parts (stem and branches. High variability of ANPP was found within the transects, i.e. among the plots (microsites. As for the representative estimation of the standing stock of aboveground part of tree cover as well as ANPP at the post-disturbance area in the TNP territory, the survey should be performed on a net of research plots. Only this approach enables reliable estimates

  14. The Evaluation of Texts In “National Culture” Theme That Placed in Secondary Part of Primary School 7th Grade Turkish Textbooks

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    Dilek CERAN

    2013-04-01

    Full Text Available The text that place in Turkish lesson books have an important place for teaching Turkish. The aim of study is evaluate the texts of “National Culture” subject in 7th grade Turkish textbooks, which are belonging to different publishers. For this purpose, by beginning from the features that are supposed to be in reading and listening texts of Turkish lesson books, which are in 2006 Primary Turkish Lesson Teaching Program, the texts of 7th grade Turkish textbooks of four different publishers, have been analyzed. The study is descriptive document analyze has been done in evaluating and studying of the texts that are in National Culture theme of Primary School 7th grade Turkish Textbooks. The texts have been evaluated under four main titles; quantity, the harmony of sub-themes with main themes. But free reading texts were not assessed.

  15. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

    Science.gov (United States)

    Cohen, Deborah J; Balasubramanian, Bijal A; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I; Crabtree, Benjamin F; Stange, Kurt C; Davis, Melinda; Miller, William L; Damschroder, Laura J; McConnell, K John; Creswell, John

    2016-06-29

    The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. ESCALATES is

  16. Flash flip book applications to measure the level of nationalism with quasi experiment on primary school students

    Science.gov (United States)

    Asri, Yessy; Fitriani, Yessy

    2017-08-01

    Great nation is a nation that respects the the sacrifice of the heroes and the history of his people. This young generation is the root of a nation who need to know and respect the values of which has been laid the founding fathers. The history continues to be written by people, in all civilizations and in all times,History in writing or documentation becomes an important tool in studying the progress and setbacks of a nation that is contained in various events in the past. Indonesia is a pluralistic nation consisting of various tribes, culture and history are scattered throughout the country. Interactive flash flip book application built to pack the local stories and history of the nation which is widespread in the thirty-three provinces to to elementary school children through teachers, especially elementary school teachers Islam Bani Saleh 5 and SDN Setiadarma 04 Bekasi in the subjects of Citizenship Education (PKn). The main problem in this research is "Whether a flash flip book can give effect to increase the spirit of nationalism elementary school students ? ". The method used is the One group pretest posttest design. Population in this research is class student V SD Islam Bani Saleh and SDN Setiadarma 04 Bekasi. Results of this study was to measure the influence of media flash flip book to foster a sense of nationalism graders V SD in the subjects of Citizenship Education (PKn) in SD Islam Bani Saleh 5 and SDN Setiadarma 04 Bekasi Bekasi.

  17. 40 CFR Appendix S to Part 50 - Interpretation of the Primary National Ambient Air Quality Standards for Oxides of Nitrogen...

    Science.gov (United States)

    2010-07-01

    ... Ambient Air Quality Standards for Oxides of Nitrogen (Nitrogen Dioxide) S Appendix S to Part 50 Protection... National Ambient Air Quality Standards for Oxides of Nitrogen (Nitrogen Dioxide) 1. General (a) This... national ambient air quality standards for oxides of nitrogen as measured by nitrogen dioxide (“NO2...

  18. Chasm in primary care provision in a universal health system: Findings from a nationally representative survey of health facilities in Malaysia

    Science.gov (United States)

    Sivasampu, Sheamini; Khoo, Ee Ming; Mohamad Noh, Kamaliah

    2017-01-01

    Background Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation. Methods We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012. Using a questionnaire developed based on the World Health Organization toolkits on monitoring health systems strengthening, we examined the availability of primary care services/resources and the associations between service/resource availability and clinic ownership, locality, and patient load. Data were weighted for all analyses to account for the complex survey design and produce unbiased national estimates. Results Private primary care clinics and doctors outnumbered their public counterparts by factors of 5.6 and 3.9, respectively, but the private clinics were significantly less well-equipped with basic facilities and provided a more limited range of services. Per capita densities of primary care clinics and workforce were higher in urban areas (2.2 clinics and 15.1 providers per 10,000 population in urban areas versus 1.1 clinics and 11.7 providers per 10,000 population in rural areas). Within the public sector, the distribution of health services and resources was unequal and strongly favored the urban clinics. Regression analysis revealed that rural clinics had lower availability of services and resources after adjusting for ownership and patient load, but the associations were not significant except for workforce availability (adjusted odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.71–0.96). Conclusions Targeted primary care expansion in rural areas could be an effective first step towards achieving universal health coverage, especially in

  19. The Primary Resistance of Helicobacter pylori in Taiwan after the National Policy to Restrict Antibiotic Consumption and Its Relation to Virulence Factors-A Nationwide Study.

    Directory of Open Access Journals (Sweden)

    Jyh-Ming Liou

    Full Text Available The Taiwan Government issued a policy to restrict antimicrobial usage since 2001. We aimed to assess the changes in the antibiotic consumption and the primary resistance of H. pylori after this policy and the impact of virulence factors on resistance.The defined daily dose (DDD of antibiotics was analyzed using the Taiwan National Health Insurance (NHI research database. H. pylori strains isolated from treatment naïve (N=1395 and failure from prior eradication therapies (N=360 from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method.The DDD per 1000 persons per day of macrolides reduced from 1.12 in 1997 to 0.19 in 2008, whereas that of fluoroquinolones increased from 0.12 in 1997 to 0.35 in 2008. The primary resistance of amoxicillin, clarithromycin, metronidazole, and tetracycline remained as low as 2.2%, 7.9%, 23.7%, and 1.9% respectively. However, the primary levofloxacin resistance rose from 4.9% in 2000-2007 to 8.3% in 2008-2010 and 13.4% in 2011-2012 (p=0.001. The primary resistance of metronidazole was higher in females than males (33.1% vs. 18.8%, p<0.001, which was probably attributed to the higher consumption of nitroimidazole. Neither CagA nor VacA was associated with antibiotic resistance.The low primary clarithromycin and metronidazole resistance of H. pylori in Taiwan might be attributed to the reduced consumption of macrolides and nitroimidazole after the national policy to restrict antimicrobial usage. Yet, further strategies are needed to restrict the consumption of fluoroquinolones in the face of rising levofloxacin resistance.

  20. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Mansfield Richard J

    2005-02-01

    Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

  1. Potential Teaching Model for Applying Novel Approaches of Renewed Estonian National Curriculum into Visual Art Classes in Primary School

    Science.gov (United States)

    Vahter, Edna

    2015-01-01

    In 2010, the renewed national curriculum was legislated in Estonia. Major changes include a new list of cross-curricular topics, increased importance of integration and specification of the components of the art learning process. In this situation, the question arises--how to fully implement the challenges of the renewed curriculum in primary…

  2. Barriers and enablers of health promotion, prevention and early intervention in primary care: evidence to inform the Australian national dementia strategy.

    Science.gov (United States)

    Travers, Catherine; Martin-Khan, Melinda; Lie, David

    2009-06-01

    A comprehensive literature review was undertaken to: (i) identify and summarise the research evidence regarding barriers and enablers of health promotion, prevention and early intervention (PPEI) in primary care to reduce the risk of chronic disease in the older population; and (ii) use this evidence to make recommendations to inform the Australian national dementia prevention strategy around the translation of evidence-based care into practice. PPEI activities in primary care have the potential to not only reduce the prevalence and impact of a number of chronic diseases, but may also prevent or slow the onset of dementia given the apparent overlap in risk factors. While sizeable gaps exist regarding the most effective ways to promote the adoption of these activities, limited evidence suggests that, to be effective, PPEI activities should be quick and easy to administer, have a sound rationale and be readily incorporated into existing work processes.

  3. [Quality of life, work management, and career planning as a primary care technology in the Unified National Health System in São Paulo State, Brazil].

    Science.gov (United States)

    Lacaz, Francisco Antonio de Castro; Vieira, Nelson Passagem; Cortizo, Carlos Tato; Junqueira, Virgínia; dos Santos, Ana Paula Lopes; Santos, Fabio Souza

    2010-02-01

    This article discusses the concept of quality of life in and at work, linked to health work management based on the evaluation of a work management instrument: the Career, Job, and Wage Plan. The aim was to analyze the plan as a work management technology in primary care in the Unified National Health System (SUS). The article discusses the plan in three municipalities in São Paulo State, Brazil: São Paulo, Guarulhos, and Campinas, in compliance with guidelines issued by the National Health Council in 2006, and using a qualitative survey conducted in 2007-2008. The study presents the findings from research in eight municipalities, based on interviews with managers, users (represented by Health Councils), and health workers and health sector trade unionists. The article concludes that this is still an incipient public management policy issue, with limited command by users, trade unionists, and health workers in the target municipalities, heavily populated 'hub cities' in the health regions.

  4. Risk factors for overweight and obesity in Swiss primary school children: results from a representative national survey.

    Science.gov (United States)

    Murer, Stefanie B; Saarsalu, Siret; Zimmermann, Jasmin; Herter-Aeberli, Isabelle

    2016-03-01

    Obesity is a global epidemic affecting around 10 % of 5- to 17-year olds. With the causes for obesity being multifactorial, a better understanding of the influencing factors is essential for effective treatment and prevention programs. The aim of this study was therefore to identify specific risk factors for overweight and obesity in children in Switzerland. A nationally representative sample of children aged 6-12 years was recruited (n = 2724). Height and weight were measured to calculate BMI (kg/m(2)). In addition, a questionnaire was distributed to all children asking about their physical activity, media consumption, and dietary habits as well as some parental factors. The prevalence of overweight and obesity in boys was 11.8 and 7.5 %, respectively, and in girls, it was 11.9 and 5.7 %. In univariate analyses, a number of parental, dietary, and activity factors were shown to be associated with BMI category. Based on a multinomial logistic regression, parent nationality and media consumption were the most important factors predicting obesity in boys, while in girls it was parental education, nationality, and physical activity. We have demonstrated that parental nationality and education play an important role in the development of childhood obesity, together with media consumption and physical activity. However, risk factors are also different according to child gender. Thus, an important target group for the treatment and prevention of childhood obesity in Switzerland are immigrant families, and the problem needs to be tackled differently in boys and girls as their risk factors are not the same.

  5. The effects of national health care reform on local businesses--part II: study methodology and primary research questions.

    Science.gov (United States)

    Liberman, Aaron; Rotarius, Timothy; Perez, Bianca

    2012-01-01

    This is the second part of a 3-part examination of what may be potentially expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that, nationally, members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (year 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be-newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

  6. Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006–7: Australian Orthopaedic Association National Joint Replacement Registry

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    Brennan Sharon L

    2012-04-01

    Full Text Available Abstract Background The utilization of total hip replacement (THR surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD of Victoria, Australia. Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years. Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

  7. Impact of a primary care national policy on HIV screening in France: a longitudinal analysis between 2006 and 2013.

    Science.gov (United States)

    Sicsic, Jonathan; Saint-Lary, Olivier; Rouveix, Elisabeth; Pelletier-Fleury, Nathalie

    2016-12-01

    Early diagnosis of HIV infection is a major public health issue worldwide. In 2009, the French National Authority for Health (Haute Autorité de Santé) developed specific guidelines and recommended mass screening of 15-70-year-olds across the general population. The guidelines were supported by communication directed at healthcare professionals, especially GPs. To assess the impact of the national mass screening policy on HIV testing. The study used data from the French National Health Insurance Fund database, from January 2006 to December 2013. Males and females aged 15-70 years, excluding HIV-positive individuals and pregnant females, were followed up throughout the 2006-2013 period. During the study period, 2 176 657 person-years and a total of 329 748 different individuals were followed up. Standardised and non-standardised rates of HIV screening were calculated for each year; the impact of the policy was assessed using adjusted segmented regression analyses. Overall, annual HIV screening rates increased over the study period, from 4.2% (95% confidence interval [CI] = 4.2 to 4.3) in 2006 to 5.8% (95% CI = 5.7 to 5.9) in 2013 with a more pronounced trend after 2010 (Ppolicy led to a 20.4% increase (95% CI = 17.0 to 23.8) in HIV screening in 2013 compared with only a 4.5% increase (95% CI = 4.4 to 4.5) for those who did not consult a GP regularly in 2013. The results show that the mass screening policy coordinated by GPs had a significant impact on HIV testing in France, which could result in positive impacts on public and individual health outcomes. © British Journal of General Practice 2016.

  8. National Use of Safety-Net Clinics for Primary Care among Adults with Non-Medicaid Insurance in the United States.

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    Oanh Kieu Nguyen

    Full Text Available To describe the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare.Cross-sectional analysis using the 2006-2010 National Ambulatory Medical Care Surveys, annual probability samples of outpatient visits in the U.S. We estimated national prevalence of safety-net visits using weighted percentages to account for the complex survey design. We conducted bivariate and multivariate logistic regression analyses to examine characteristics associated with safety-net clinic use.More than one-third (35.0% of all primary care safety-net clinic visits were among adults with non-Medicaid primary insurance, representing 6,642,000 annual visits nationally. The strongest predictors of safety-net use among non-Medicaid insured adults were: being from a high-poverty neighborhood (AOR 9.53, 95% CI 4.65-19.53, being dually eligible for Medicare and Medicaid (AOR 2.13, 95% CI 1.38-3.30, and being black (AOR 1.97, 95% CI 1.06-3.66 or Hispanic (AOR 2.28, 95% CI 1.32-3.93. Compared to non-safety-net users, non-Medicaid insured adults who used safety-net clinics had a higher prevalence of diabetes (23.5% vs. 15.0%, p<0.001, hypertension (49.4% vs. 36.0%, p<0.001, multimorbidity (≥2 chronic conditions; 53.5% vs. 40.9%, p<0.001 and polypharmacy (≥4 medications; 48.8% vs. 34.0%, p<0.001. Nearly one-third (28.9% of Medicare beneficiaries in the safety-net were dual eligibles, compared to only 6.8% of Medicare beneficiaries in non-safety-net clinics (p<0.001.Safety net clinics are important primary care delivery sites for non-Medicaid insured minority and low-income populations with a high burden of chronic illness. The critical role of safety-net clinics in care delivery is likely to persist despite expanded insurance coverage under the Affordable Care Act.

  9. What is the actual epidemiology of familial hypercholesterolemia in Italy? Evidence from a National Primary Care Database.

    Science.gov (United States)

    Guglielmi, Valeria; Bellia, Alfonso; Pecchioli, Serena; Medea, Gerardo; Parretti, Damiano; Lauro, Davide; Sbraccia, Paolo; Federici, Massimo; Cricelli, Iacopo; Cricelli, Claudio; Lapi, Francesco

    2016-11-15

    There are some inconsistencies on prevalence estimates of familial hypercholesterolemia (FH) in general population across Europe due to variable application of its diagnostic criteria. We aimed to investigate the FH epidemiology in Italy applying the Dutch Lipid Clinical Network (DLCN) score, and two alternative diagnostic algorithms to a primary care database. We performed a retrospective population-based study using the Health Search IMS Health Longitudinal Patient Database (HSD) and including active (alive and currently registered with their general practitioners (GPs)) patients on December 31, 2014. Cases of FH were identified by applying DLCN score. Two further algorithms, based on either ICD9CM coding for FH or some clinical items adopted by the DLCN, were tested towards DLCN itself as gold standard. We estimated a prevalence of 0.01% for "definite" and 0.18% for "definite" plus "probable" cases as per the DLCN. Algorithms 1 and 2 reported a FH prevalence of 0.9 and 0.13%, respectively. Both algorithms resulted in consistent specificity (1: 99.10%; 2: 99.9%) towards DLCN, but Algorithm 2 considerably better identified true positive (sensitivity=85.90%) than Algorithm 1 (sensitivity=10.10%). The application of DLCN or valid diagnostic alternatives in the Italian primary care setting provides estimates of FH prevalence consistent with those reported in other screening studies in Caucasian population. These diagnostic criteria should be therefore fostered among GPs. In the perspective of FH new therapeutic options, the epidemiological picture of FH is even more relevant to foresee the costs and to plan affordable reimbursement programs in Italy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. The association between socioeconomic status and visual impairments among primary glaucoma: the results from Nationwide Korean National Health Insurance Cohort from 2004 to 2013.

    Science.gov (United States)

    Sung, Haejune; Shin, Hyun Ho; Baek, Yunseng; Kim, Gyu Ah; Koh, Jae Sang; Park, Eun-Cheol; Shin, Jaeyong

    2017-08-23

    Glaucoma is one of the most leading causes of permanent visual impairments in Korea, and social expenses spent for the glaucoma are increasing. This study is to identify association between socioeconomic status and the visual impairments caused by primary glaucoma in Korea. This study is based on a cohort study using stratified representative samples in the National Health Insurance claim data from 2002 to 2013 with 1,025,340 representative subjects. Target subjects were patients who are newly diagnosed with primary glaucoma from 2004 to 2013. We conducted a multiple logistic regression analysis depending on the occurrence of visual impairment and its temporal order compared to the glaucoma diagnosis. Among 1728 patients with primary glaucoma, those with low and middle income shows higher odds ratio (OR) of the visual impairments than those with high income group (low income; OR = 3.42, 95% Confidential Interval (CI):2.06-5.66, middle income; OR = 2.13, 95% CI: 1.28-3.55), in case of the occurrence of the visual impairments preceded the diagnosis of glaucoma. Glaucoma patients without pre-existing glaucoma history before visual impairment have higher association between socioeconomic status and the occurrence of visual impairments by primary glaucoma. Since glaucoma had not been diagnosed and recognized yet, the differences may have been derived from the disparities of the awareness of the glaucoma. These findings call attention to the correlation between socioeconomic factors and the visual impairments by glaucoma, and raise public health needs over the importance of glaucoma awareness and eye screening for glaucoma, especially for low socioeconomic status.

  11. Implementing and managing self-management skills training within primary care organisations: a national survey of the expert patients programme within its pilot phase

    Directory of Open Access Journals (Sweden)

    Rogers Anne

    2006-02-01

    Full Text Available Abstract A key element of the United Kingdom (UK health policy reform in relation to chronic disease management is the introduction of a national programme seeking to promote self-care from within the National Health Service (NHS. The mainstay of the Expert Patients Programme (EPP is a six-week training course that provides the opportunity for anyone with a long-term condition to develop new skills to manage their condition better on a day-to-day basis. The course forms part of the NHS self-care support programme, is administered by Primary Care Trusts (PCTs and delivered by people who have personal experience of living with a long-term condition. The NHS' official Expert Patients Programme website presently states that, "Pilot EPP courses began at 26 NHS PCT sites across England in May 2002, and by May 2004 approximately 300 PCTs had either actively implemented pilot courses or had committed to joining. The majority of PCTs are now coming to the end of the pilot phase, with many implementing plans to make EPP sustainable for the long-term." The NHS website heralds the pilot "a success." A national, postal survey of PCT EPP Leads was undertaken in order to examine both the evolvement of EPP during its pilot stage and future plans for the programme. A questionnaire was sent out to the 299 PCTs known to have committed to the EPP pilot, and an excellent 100% response rate was obtained over a 3-month period (April-July 2005. One marker of success of the Expert Patients Programme implementation is the actual running of courses by the Primary Care Trusts. This paper explores the extent to which the implementation of the pilot can indeed be viewed as a "success," primarily in terms of the number of courses run, and considers the extent to which PCTs have carried out all that they were committed to do. Findings suggest that the more time an EPP Lead dedicates to the Programme, the more likely it is that EPP has run successfully in the past, and the more

  12. Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study.

    Science.gov (United States)

    Farzadfar, Farshad; Murray, Christopher J L; Gakidou, Emmanuela; Bossert, Thomas; Namdaritabar, Hengameh; Alikhani, Siamak; Moradi, Ghobad; Delavari, Alireza; Jamshidi, Hamidreza; Ezzati, Majid

    2012-01-07

    Non-communicable diseases and their risk factors are leading causes of disease burden in Iran and other middle-income countries. Little evidence exists for whether the primary health-care system can effectively manage non-communicable diseases and risk factors at the population level. Our aim was to examine the effectiveness of the Iranian rural primary health-care system (the Behvarz system) in the management of diabetes and hypertension, and to assess whether the effects depend on the number of health-care workers in the community. We used individual-level data from the 2005 Non-Communicable Disease Surveillance Survey (NCDSS) for fasting plasma glucose (FPG) and systolic blood pressure (SBP), body-mass index, medication use, and sociodemographic variables. Data for Behvarz-worker and physician densities were from the 2006 Population and Housing Census and the 2005 Outpatient Care Centre Mapping Survey. We assessed the effectiveness of treatment on FPG and SBP, and associations between FPG or SBP and Behvarz-worker density with two statistical approaches: a mixed-effects regression analysis of the full NCDSS sample adjusting for individual-level and community-level covariates and an analysis that estimated average treatment effect on data balanced with propensity score matching. NCDSS had data for 65,619 individuals aged 25 years or older (11,686 of whom in rural areas); of these, 64,694 (11,521 in rural areas) had data for SBP and 50,202 (9337 in rural areas) had data for FPG. Nationally, 39·2% (95% CI 37·7 to 40·7) of individuals with diabetes and 35·7% (34·9 to 36·5) of those with hypertension received treatment, with higher treatment coverage in women than in men and in urban areas than in rural areas. Treatment lowered mean FPG by an estimated 1·34 mmol/L (0·58 to 2·10) in rural areas and 0·21 mmol/L (-0·15 to 0·56) in urban areas. Individuals in urban areas with hypertension who received treatment had 3·8 mm Hg (3·1 to 4·5) lower SBP than

  13. Variation in promptness of presentation among 10,297 patients subsequently diagnosed with one of 18 cancers: evidence from a National Audit of Cancer Diagnosis in Primary Care.

    Science.gov (United States)

    Keeble, Stuart; Abel, Gary A; Saunders, Catherine L; McPhail, Sean; Walter, Fiona M; Neal, Richard D; Rubin, Gregory P; Lyratzopoulos, Georgios

    2014-09-01

    Cancer awareness public campaigns aim to shorten the interval between symptom onset and presentation to a doctor (the 'patient interval'). Appreciating variation in promptness of presentation can help to better target awareness campaigns. We explored variation in patient intervals recorded in consultations with general practitioners among 10,297 English patients subsequently diagnosed with one of 18 cancers (bladder, brain, breast, colorectal, endometrial, leukaemia, lung, lymphoma, melanoma, multiple myeloma, oesophageal, oro-pharyngeal, ovarian, pancreatic, prostate, renal, stomach, and unknown primary) using data from of the National Audit of Cancer Diagnosis in Primary Care (2009-2010). Proportions of patients with 'prompt'/'non-prompt' presentation (0-14 or 15+ days from symptom onset, respectively) were described and respective odds ratios were calculated by multivariable logistic regression. The overall median recorded patient interval was 10 days (IQR 0-38). Of all patients, 56% presented promptly. Prompt presentation was more frequent among older or housebound patients (p presentation was most frequent for bladder and renal cancer (74% and 70%, respectively); and least frequent for oro-pharyngeal and oesophageal cancer (34% and 39%, respectively, p presentation were 2.26 (95% confidence interval 1.57-3.25) and 0.42 (0.34-0.52) for oro-pharyngeal and bladder cancer, respectively. Sensitivity analyses produced similar findings. Routinely recorded patient interval data reveal considerable variation in the promptness of presentation. These findings can help to prioritise public awareness initiatives and research focusing on symptoms of cancers associated with greater risk of non-prompt presentation, such as oro-pharyngeal and oesophageal cancer.

  14. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

    Science.gov (United States)

    Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F

    2015-01-01

    Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, pperception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the

  15. Primary total hip replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    Science.gov (United States)

    Malik, M. H. A.; Gambhir, A. K.; Bale, L.; Pradhan, N.; Porter, M. L.

    2004-01-01

    BACKGROUND: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England to this document to ascertain adherence to this guide to best practice. METHODS: A total of 86 surgeons from 26 hospitals were included in a questionnaire study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. Of respondents, 42.2% routinely used exhaust suits, 68.1% routinely used impermeable disposable gowns, and 26.1% used impermeable re-usable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses. All surgeons used some form of anti-thromboembolic prophylaxis: 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin--70.7% used a 3-dose regimen over 24 h, 2.6% of surgeons continued antibiotic prophylaxis for 48 h after surgery, and 93.7% of surgeons routinely use antibiotic-loaded cement. All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%. CONCLUSIONS: This study has demonstrated considerable variation of practice in total hip arthroplasty across the North West Region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices

  16. The Correlation of Tree Phenology with nest number of Orang Utan Sumatera (Pongo abelii) on Primary Forest, Resort Sei Betung, Gunung Leuser National Park

    Science.gov (United States)

    Hartini, K. S.; Patana, P.; Oktaviani, M.

    2017-03-01

    Food availability affect the orangutan activities, including activities to make nests. This study was conducted to determine the correlation between the phenology of trees with the number of nests made by orangutans in primary forest Resort Sei Betung, Gunung Leuser National Park. Multi linear regression was used in this study to determine the relation and correlation between phenology and the presence of orangutan nests on a track that has been created. It took over 6 months (March - August 2015). There were 15 orangutan nests found on the track during the study. The equation model was : = 27,649 -0,011X1-0,104X2-0,056X3, and there was no significant differences (sig >0,05). The value of R2 was 70,3%. It means that all predictors simultaneously explain 70,3% of the presence of orangutan’s nest, and there is an expected predictors that may be the most affect on nest presence. The season or the intensity of rain may consider as an expected predictor.

  17. Accounting for overdispersion when determining primary care outliers for the identification of chronic kidney disease: learning from the National Chronic Kidney Disease Audit.

    Science.gov (United States)

    Kim, Lois G; Caplin, Ben; Cleary, Faye; Hull, Sally A; Griffith, Kathryn; Wheeler, David C; Nitsch, Dorothea

    2017-04-01

    Early diagnosis of chronic kidney disease (CKD) facilitates best management in primary care. Testing coverage of those at risk and translation into subsequent diagnostic coding will impact on observed CKD prevalence. Using initial data from 915 general practitioner (GP) practices taking part in a UK national audit, we seek to apply appropriate methods to identify outlying practices in terms of CKD stages 3-5 prevalence and diagnostic coding. We estimate expected numbers of CKD stages 3-5 cases in each practice, adjusted for key practice characteristics, and further inflate the control limits to account for overdispersion related to unobserved factors (including unobserved risk factors for CKD, and between-practice differences in coding and testing). GP practice prevalence of coded CKD stages 3-5 ranges from 0.04 to 7.8%. Practices differ considerably in coding of CKD in individuals where CKD is indicated following testing (ranging from 0 to 97% of those with and glomerular filtration rate  Accounting for overdispersion is crucial in providing useful information about outlying practices for CKD prevalence.

  18. The Role of National Adult Education Centre in Curriculum Development in Somalia in Selected Government Primary Adult Schools of Mogadisho. African Studies in Curriculum Development and Evaluation, No. 109.

    Science.gov (United States)

    Bahar, Ismail F. S.

    A study of curriculum development in Somalia focused on the role of the National Adult Education Centre (NAEC) and involvement of teachers and inspectors. The sample consisted of 80 Mogadisho primary adult school teachers. Information sources were related literature, teacher questionnaires, and unstructured interviews with school inspectors,…

  19. Integration in primary community care networks (PCCNs: examination of governance, clinical, marketing, financial, and information infrastructures in a national demonstration project in Taiwan

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    Lin Blossom Yen-Ju

    2007-06-01

    Full Text Available Abstract Background Taiwan's primary community care network (PCCN demonstration project, funded by the Bureau of National Health Insurance on March 2003, was established to discourage hospital shopping behavior of people and drive the traditional fragmented health care providers into cooperate care models. Between 2003 and 2005, 268 PCCNs were established. This study profiled the individual members in the PCCNs to study the nature and extent to which their network infrastructures have been integrated among the members (clinics and hospitals within individual PCCNs. Methods The thorough questionnaire items, covering the network working infrastructures – governance, clinical, marketing, financial, and information integration in PCCNs, were developed with validity and reliability confirmed. One thousand five hundred and fifty-seven clinics that had belonged to PCCNs for more than one year, based on the 2003–2005 Taiwan Primary Community Care Network List, were surveyed by mail. Nine hundred and twenty-eight clinic members responded to the surveys giving a 59.6 % response rate. Results Overall, the PCCNs' members had higher involvement in the governance infrastructure, which was usually viewed as the most important for establishment of core values in PCCNs' organization design and management at the early integration stage. In addition, it found that there existed a higher extent of integration of clinical, marketing, and information infrastructures among the hospital-clinic member relationship than those among clinic members within individual PCCNs. The financial infrastructure was shown the least integrated relative to other functional infrastructures at the early stage of PCCN formation. Conclusion There was still room for better integrated partnerships, as evidenced by the great variety of relationships and differences in extent of integration in this study. In addition to provide how the network members have done for their initial work at

  20. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

    Directory of Open Access Journals (Sweden)

    Robert Kaba Alhassan

    Full Text Available Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS in Ghana are also discussed.This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001. Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in

  1. Primary total knee replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    Science.gov (United States)

    Malik, M. H. A.; Chougle, A.; Pradhan, N.; Gambhir, A. K.; Porter, M. L.

    2005-01-01

    INTRODUCTION: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Association for Surgery of the Knee (BASK) to provide a basis for regional and national auditable standards: we have compared practice in the North West of England to this document to ascertain adherence to this guide to best practice. MATERIALS AND METHODS: A direct comparison of data held on the North West Hip Arthroplasty Register for 2001/2002 and BASK/BOA guidelines was performed. 86 surgeons from 26 hospitals were included in the study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. 42.2% of respondents routinely used exhaust suits and 68.1% of respondents routinely used impermeable disposable gowns. All surgeons use some form of anti-thromboembolic prophylaxis; 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin. 93.7% of surgeons routinely use antibiotic-loaded cement. The PFC and Kinemax prostheses were the most commonly used prostheses. Interestingly, 97.7% of all first-choice implants were cemented. Only 2 surgeons used uncemented total knee replacement. 69.8% of surgeons used a posterior cruciate retaining design. A midline longitudinal skin incision is used by 87.2% of surgeons, a medial longitudinal skin incision by 7.0% and a lateral longitudinal skin incision by 5.8% of surgeons. A medial parapatellar capsular incision is preferred by 91.9% with the remainder using mid vastus or trivector retaining capsulotomy. Closure of capsulotomies is performed in flexion by 65.1% and in extension by 34.9%. In patients with osteoarthritis, 38.4% routinely resurfaced the patella, 34.9% never resurfaced the patella and 26.7% selectively resurfaced. This was in direct contrast to

  2. Use of Fibrates Monotherapy in People with Diabetes and High Cardiovascular Risk in Primary Care: A French Nationwide Cohort Study Based on National Administrative Databases.

    Directory of Open Access Journals (Sweden)

    Ronan Roussel

    Full Text Available According to guidelines, diabetic patients with high cardiovascular risk should receive a statin. Despite this consensus, fibrate monotherapy is commonly used in this population. We assessed the frequency and clinical consequences of the use of fibrates for primary prevention in patients with diabetes and high cardiovascular risk.Retrospective cohort study based on nationwide data from the medical and administrative databases of French national health insurance systems (07/01/08-12/31/09 with a follow-up of up to 30 months.Lipid-lowering drug-naive diabetic patients initiating fibrate or statin monotherapy were identified. Patients at high cardiovascular risk were then selected: patients with a diagnosis of diabetes and hypertension, and > 50 (men or 60 (women, but with no history of cardiovascular events. The composite endpoint comprised myocardial infarction, stroke, amputation, or death.Of the 31,652 patients enrolled, 4,058 (12.8% received a fibrate. Age- and gender-adjusted annual event rates were 2.42% (fibrates and 2.21% (statins. The proportionality assumption required for the Cox model was not met for the fibrate/statin variable. A multivariate model including all predictors was therefore calculated by dividing data into two time periods, allowing Hazard Ratios to be calculated before (HR 540 of follow-up. Multivariate analyses showed that fibrates were associated with an increased risk for the endpoint after 540 days: HR 540 = 1.73 (1.28-2.32.Fibrate monotherapy is commonly prescribed in diabetic patients with high cardiovascular risk and is associated with poorer outcomes compared to statin therapy.

  3. Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management

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    Muriel Alfonso

    2006-05-01

    Full Text Available Abstract Background The Spanish National Health Service is a universal and free health care system. Non-specific low back pain (LBP is a prevalent disorder, generating large health and social costs. The objectives of this study were to describe its management in primary care, to assess patient characteristics that influence physicians' decisions, and to describe clinical outcome at 2 months. Methods A cross-sectional sample of 648 patients with non-specific low back pain was recruited by 75 physicians (out of 361 – 20.8% working in 40 primary care centers in 10 of the 17 administrative regions in Spain, covering 693,026 out of the 40,499,792 inhabitants. Patients were assessed on the day they were recruited, and prospectively followed-up 14 and 60 days later. The principal patient characteristics that were analyzed were: sex, duration of the episode, history of LBP, working status, severity of LBP, leg pain and disability, and results of straight leg raising test. Descriptors of management were: performance of the straight leg raising test, ordering of diagnostic procedures, prescription of drug treatment, referral to physical therapy, rehabilitation or surgery, and granting of sick leave. Regression analysis was used to analyze the relationship between patients' baseline characteristics and physicians' management decisions. Only workers were included in the models on sick leave. Results Mean age (SD of included patients was 46.5 (15.5 years, 367 (56.6% were workers, and 338 (52.5% were females. Median (25th–75th interquartile range duration of pain when entering the study was 4 (2–10 days and only 28 patients (4.3% had chronic low back pain. Diagnostic studies included plain radiographs in 43.1% of patients and CT or MRI scans in 18.8%. Drug medication was prescribed to 91.7% of patients, 19.1% were sent to physical therapy or rehabilitation, and 9.6% were referred to surgery. The main determinants of the clinical management were duration

  4. Experiences and Attitudes of Primary Care Providers Under the First Year of ACA Coverage Expansion: Findings from the Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers.

    Science.gov (United States)

    2015-06-01

    A new survey from The Kaiser Family Foundation and The Commonwealth Fund asked primary care providers--physicians, nurse practitioners, and physician assistants--about their views of and experiences with the Affordable Care Act (ACA) and other changes in health care delivery and payment, as well as their thoughts on the future of primary care. In this first brief based on the survey, many providers reported seeing an increased number of patients since the coverage expansions went into effect, but not an accompanying compromise in quality of care. A large majority of primary care providers are satisfied with their medical practice, but a substantial percentage of physicians expressed pessimism about the future of primary care. Similar to the population overall, providers' views of the ACA are divided along party lines. A second brief will report on providers' reactions to other changes occurring in primary care delivery and payment.

  5. Genetics Home Reference: primary myelofibrosis

    Science.gov (United States)

    ... Other Diagnosis and Management Resources (3 links) Merck Manual Professional Version: Primary Myelofibrosis Myeloproliferative Neoplasm (MPN) Research Foundation: Primary Myelofibrosis (PMF) National Organization for Rare Disorders (NORD) Physician Guide General Information ...

  6. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology

    DEFF Research Database (Denmark)

    Grau, Cai; Johansen, L V; Jakobsen, J;

    2000-01-01

    The management of patients with cervical lymph node metastases from unknown primary tumours is a major challenge in oncology. This study presents data collected from all five oncology centres in Denmark.......The management of patients with cervical lymph node metastases from unknown primary tumours is a major challenge in oncology. This study presents data collected from all five oncology centres in Denmark....

  7. The use of primary stenting or balloon percutaneous transluminal coronary angioplasty for the treatment of acutely occluded saphenous vein grafts. Results from the Brazilian National Registry - CENIC

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    Luiz Alberto Mattos

    2001-06-01

    Full Text Available OBJECTIVE: We conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (PTCA or stent implantation because of an acute myocardial infarction (AMI related to an acute vein graft occlusion. METHODS: Since 1991 the Brazilian Society of Hemodynamic and Interventional Cardiology has maintained a large database (CENIC. From these, we selected all consecutive patients, who underwent primary PTCA or stenting in the first 24 hours of AMI, with the target vessel being an occluded vein graft. Immediate results and major coronary events occurring up until hospital discharge were analyzed. RESULTS: During this period, 5,932 patients underwent primary PTCA or stenting; 158 (3% of the procedures were performed because of an acute vein graft occlusion. Stenting was performed in 74 (47% patients. Patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon PTCA. The incidence of reinfarction and death were similar for stenting and balloon PTCA. CONCLUSION: Primary percutaneous treatment of AMI related to acute vein graft occlusion is still an uncommon practice. Primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with PTCA treatment.

  8. Health Professionals' Perspectives on Exercise Referral and Physical Activity Promotion in Primary Care: Findings from a Process Evaluation of the National Exercise Referral Scheme in Wales

    Science.gov (United States)

    Din, Nafees U.; Moore, Graham F.; Murphy, Simon; Wilkinson, Clare; Williams, Nefyn H.

    2015-01-01

    Background and objectives: Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise…

  9. In-hospital organization of primary care of patients presenting a life-threatening emergency: A French national survey in 32 university hospitals.

    Science.gov (United States)

    Quintard, Hervé; Severac, Mathilde; Martin, Claude; Ichai, Carole

    2015-08-01

    The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients. A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients. Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals. This survey is the first to assess the in-hospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  10. Primary Care Providers' Views of Recent Trends in Health Care Delivery and Payment. Findings from the Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers.

    Science.gov (United States)

    2015-08-01

    A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers--physicians, nurse practitioners, and physician assistants--about their experiences with and reactions to recent changes in health care delivery and payment. Providers' views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers' experiences under the ACA's coverage expansions and their opinions about the law.

  11. Promoting high quality care for all at the end of life: review of NHS National End of Life Care Programme 2004–2007 and implications for primary care

    OpenAIRE

    Henry, Claire; Hayes, Anita

    2009-01-01

    Background Research shows most people want to die at home yet most in fact die in hospital. The underlying reason for this mismatch is that health and social care services struggle to respond satisfactorily to people's varying end of life care needs. The creation of the National End of Life Care Programme in 20041 and the launch of the End of Life Care Strategy in 20082 were designed to improve this situation.

  12. THE PRIMARY FACTORS OF THE NATIONAL STRATEGY FOR UTILISING “GREEN ENERGY†(BIOMASS) BY INCINERATION TECHNOLOGY

    OpenAIRE

    Gergely, Sandor

    2006-01-01

    On the basis of the current trends we can state that green energy production is becoming increasingly important in the utilisation of agricultural areas. In our paper we compare the characteristics of land utilisation by energy forests, energy grass, energy hemp, and china reed (Myscanthus gigantheus). The analysis is based on market position, equity requirements and profitability, the effects on the national economy and/or on a particular region, as well as the environmental and social effec...

  13. Efficacy and safety of human papillomavirus vaccine for primary prevention of cervical cancer: A review of evidence from phase III trials and national programs

    Directory of Open Access Journals (Sweden)

    Partha Basu

    2013-01-01

    Full Text Available The Human Papillomavirus (HPV vaccines have been widely introduced in the national immunization programs in most of the medium and high income countries following endorsement from national and international advisory bodies. HPV vaccine is unique and its introduction is challenging in many ways - it is the first vaccine developed to prevent any cancer, the vaccine is gender specific, it targets adolescent females who are difficult to reach by any health intervention programs. It is not unusual for such a vaccine to face scepticism and reservations not only from lay public but also from professionals in spite of the clinical trial results convincingly and consistently proving their efficacy and safety. Over the last few years millions of doses of the HPV vaccine have been administered round the world and the efficacy and safety data have started coming from the real life programs. A comprehensive cervical cancer control program involving HPV vaccination of the adolescent girls and screening of the adult women has been proved to be the most cost-effective approach to reduce the burden of cervical cancer. The present article discusses the justification of HPV vaccination in the backdrop of natural history of cervical cancer, the mechanism of action of the vaccines, efficacy and safety data from phase III randomized controlled trials as well as from the national immunization programs of various countries.

  14. 独立式大学科技园布局浅析%Primary Analysis of Distribution Patterns of Independent National University Science Park

    Institute of Scientific and Technical Information of China (English)

    卢植

    2016-01-01

    我国国家大学科技园区的建设呈现多样化的趋势,其中一种主要的类型是大学科技园区远离高校,位于城市边缘的高新区形成的独立式布局的大学科技园区。笔者分析了这一类型园区的特点,列举了这种类型大学科技园区的空间布局形式,并探索这种类型的大学科技园区的规律。%The construction of the National University Science and Technology Park in our country presents the trend of diversification, of which a major type is located in the edge of the city of the high-tech Zone to form a separate layout of National University Science Park. The author analyzes the characteristics of this type, lists the distribution paterns of this type, and explores the regular patern of this type of National University Science Park.

  15. Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study

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    Soljak Michael

    2007-06-01

    Full Text Available Abstract Background Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP Contract. Methods We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke Quality and Outcomes Framework (QOF indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. Results Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively. Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P Conclusion The volume-outcome relationship found in hospital settings is not seen between practices in the UK in management of cardiovascular disorders in primary care

  16. The management of lactose intolerance among primary care physicians and its correlation with management by gastroenterologists: the SEPD-SEMG national survey

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    Federico Argüelles-Arias

    2015-09-01

    Full Text Available Introduction and aims: The understanding of lactose intolerance (LI is limited in some professional settings. Sociedad Española de Patología Digestiva (SEPD and Sociedad Española de Medicina General (SEMG have developed a survey in order to: a Analyze primary care physicians (PCPs knowledge and clinical management; and b to compare results with those of a previous survey of Spanish gastroenterologists (GEs. Material and methods: An online questionnaire was sent to SEMG members with 27 items on various issues: Demographics, occupational characteristics, outlook on LI, diagnostic tests, treatment, and follow-up. Results were compared to those from a survey of GEs. Results: A total of 456 PCPs responded, versus 477 GEs. PCPs had an older mean age and longer professional experience. Level of understanding of LI was similar, albeit a higher proportion of PCPs lacked epidemiological awareness (p 0.001, and LI symptoms as overlapping those of irritable bowel syndrome (93.5 vs. 88.2%; p = 0.005, although symptoms perceived as suspicious of LI were similar in both groups. Dietary recommendations were recognized as the primary therapeutic approach. Conclusion: This study reveals the outlook of PCPs on LI, and allows comparison with that of GEs, as a basis for the development of strategies aimed at improving LI understanding, approach and management in our setting.

  17. Management of the clinical issue of constipation with abdominal complaints in adults: a national survey of Primary Care physicians and gastroenterologists

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    Enrique Rey

    Full Text Available Irritable bowel syndrome and functional constipation represent a relevant and common health issue. However, real-world clinical practice includes patients with constipation who may or may not have other abdominal complaints (pain, bloating, abdominal discomfort with variable frequency. The goal of the present study was to obtain information on the workload entailed by patients with constipation and associated abdominal complaints, predominant clinical behaviors, education needs, and potential daily practice aids both in Primary Care and gastroenterology settings. The clinical behavior of doctors is generally similar at both levels, despite differences in healthcare approach: use of empiric therapies and clinically guided diagnostic tests, with some differences in colonoscopy use (not always directly accessible from Primary Care. Regarding perceptions, general support and osmotic laxatives are most valued by PC doctors, whereas osmotic laxatives, combined laxatives, and linaclotide are most valued by GE specialists. Furthermore, over half of respondents considered differentiating both diagnoses as challenging. Finally, considerable education needs are self-acknowledged at both levels, as is a demand for guidelines and protocols to help in managing this issue in clinical practice. A strength of this study is its providing a joint photograph of the medical approach and the perceptions of constipation with abdominal discomfort from a medical standpoint. Weaknesses include self-declaration (no formal validation and a response rate potentially biased by professional motivation.

  18. The management of lactose intolerance among primary care physicians and its correlation with management by gastroenterologists: the SEPD-SEMG national survey.

    Science.gov (United States)

    Argüelles-Arias, Federico; Rodríguez Ledo, Pilar; Tenías, José María; Otero, Mercedes; Casellas, Francesc; Blay Cortés, Guadalupe; Lucendo, Alfredo; Domínguez-Jiménez, José Luis; Carballo, Fernando

    2015-09-01

    The understanding of lactose intolerance (LI) is limited in some professional settings. Sociedad Española de Patología Digestiva (SEPD) and Sociedad Española de Medicina General (SEMG) have developed a survey in order to: a) Analyze primary care physicians (PCPs) knowledge and clinical management; and b) to compare results with those of a previous survey of Spanish gastroenterologists (GEs). An online questionnaire was sent to SEMG members with 27 items on various issues: Demographics, occupational characteristics, outlook on LI, diagnostic tests, treatment, and follow-up. Results were compared to those from a survey of GEs. A total of 456 PCPs responded, versus 477 GEs. PCPs had an older mean age and longer professional experience. Level of understanding of LI was similar, albeit a higher proportion of PCPs lacked epidemiological awareness (p 0.001), and LI symptoms as overlapping those of irritable bowel syndrome (93.5 vs. 88.2%; p = 0.005), although symptoms perceived as suspicious of LI were similar in both groups. Dietary recommendations were recognized as the primary therapeutic approach. This study reveals the outlook of PCPs on LI, and allows comparison with that of GEs, as a basis for the development of strategies aimed at improving LI understanding, approach and management in our setting.

  19. Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study

    Directory of Open Access Journals (Sweden)

    Alexander Bischoff

    2016-05-01

    Full Text Available Background: In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO nursing school and make recommendations for other similar initiatives. Design: This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Results: Six themes emerged from the experiences that shaped the course of the project: 1 Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public–private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2 Communication was an important and often underrated factor for all types of development projects. 3 Managing the unknown and 4 managing expectations characterised the project inception. Almost all themes had to do with 5 handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6 the need to adjust to ever-changing targets. Conclusions: This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1 Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2 Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve

  20. Assessing health-care providers' readiness for reporting quality and patient safety indicators at primary health-care centres in Lebanon: a national cross-sectional survey.

    Science.gov (United States)

    Alameddine, Mohamad; Saleh, Shadi; Natafgi, Nabil

    2015-05-22

    Successful endorsement of quality indicators hinges on the readiness and acceptability of care providers for those measures. This paper aims to assess the readiness of care providers in the primary health-care sector in Lebanon for the implementation of quality and patient safety indicators. A cross-sectional survey methodology was utilized to gather information from 943 clinical care providers working at 123 primary health-care centres in Lebanon. The questionnaire included two sections: the first assessed four readiness dimensions (appropriateness, management support, efficacy, and personal valence) of clinical providers to use quality and safety indicators using the Readiness for Organization Change (ROC) scale, and the second section assessed the safety attitude at the primary care centre utilizing the Agency of Health Research and Quality (AHRQ) Safety Attitude Questionnaire (SAQ)-Ambulatory version. Although two thirds (66%) of respondents indicated readiness for implementation of quality and patient safety indicators in their centres, there appear to be differences by professional group. Physicians displayed the lowest scores on all readiness dimensions except for personal valence which was the lowest among nurses (60%). In contrast, allied health professionals displayed the highest scores across all readiness dimensions. Generally, respondents reflected a positive safety attitude climate in the centres. Yet, there remain a few areas of concern related to punitive culture (only 12.8% agree that staff should not be punished for reported errors/incidents), continuity of care (41.1% believe in the negative consequences of lack in continuity of care process), and resources (48.1% believe that the medical equipment they have are adequate). Providers with the highest SAQ score had 2.7, 1.7, 7 and 2.4 times the odds to report a higher readiness on the appropriateness, efficacy, management and personal valence ROC subscales, respectively (P value quality and patient

  1. [Conceptions and typology of conflicts between workers and managers in the context of primary healthcare in the Brazilian Unified National Health System (SUS)].

    Science.gov (United States)

    Carvalho, Brígida Gimenez; Peduzzi, Marina; Ayres, José Ricardo de Carvalho Mesquita

    2014-07-01

    This study aimed to analyze perceptions of conflict between workers and managers in primary healthcare units and to present a typology of conflicts on the job. This was a comprehensive interpretive case study with a critical hermeneutic approach. Data collection techniques included: focus group with managers, workplace observation, and worker interviews, conducted from April to November 2011. The results were triangulated and indicated the coexistence of distinct concepts of conflict, typified in six modalities: lack of collaboration at work; disrespect resulting from asymmetrical relations between workers; problematic employee behavior; personal problems; asymmetry with other management levels; and inadequate work infrastructure. The relevance of (non)mutual recognition, as proposed by Axel Honneth, stood out in the interpretation of the causes and practical implications of these conflicts.

  2. Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Jianhua Wu

    Full Text Available BACKGROUND: Guidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions. METHODS: A retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008 patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing. RESULTS: Of 365,718 patients with complete data, 13.8% (50,558 were prescribed lipid lowering drugs: 28.5% (21,101/74,137 of those eligible and 10.1% (29,457/291,581 of those ineligible. Only 41.7% (21,101/50,558 of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥ 65 years 4.21; 95% CI 4.05-4.39; diabetes (OR 4.49; 95% CI 4.35-4.64; total cholesterol level ≥ 7 mmol/L (OR 2.20; 95% CI 2.12-2.29; and ≥ 4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06-4.42. The predictors were similar in eligible and ineligible patients. CONCLUSIONS: Most lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients.

  3. Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana

    DEFF Research Database (Denmark)

    Fenny, Ama Pokuah; Enemark, Ulrika; Asante, Felix A

    2014-01-01

    Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative...... system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand...... for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics...

  4. Healthcare is primary.

    Science.gov (United States)

    Kumar, Raman

    2015-01-01

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

  5. Primary Episodic Ataxias

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-10-01

    Full Text Available The clinical and genetic diagnosis, genotype-phenotype correlations, pathophysiology and treatment of primary episodic ataxia syndromes are reviewed by researchers from Departments of Neurology, UCLA School of Medicine, Los Angeles, CA; National Hospital for Neurology, Queen Square, London, UK; Johns Hopkins University School of Medicine, Baltimore, MD; and University of Rochester School of Medicine, NY, USA.

  6. Comprehensive coronary risk determination in primary prevention: an imaging and clinical based definition combining computed tomographic coronary artery calcium score and national cholesterol education program risk score.

    Science.gov (United States)

    Nasir, Khurram; Vasamreddy, Chandra; Blumenthal, Roger S; Rumberger, John A

    2006-06-16

    Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of morbidity. Coronary heart disease (CHD) accounts for nearly half of all CVD deaths. Currently estimation of risk in primary prevention is based on the Framingham risk equations, which inputs traditional risk factors and is helpful in predicting the development of CHD in asymptomatic individuals. However many individuals suffer events in the absence of established risk factors for atherosclerosis and broad based population risk estimations may have little precision when applied to a given individual. To meet the challenge of CHD risk assessment, several tools have been developed to identify atherosclerotic disease in its preclinical stages. This paper aims to incorporate information from coronary artery calcification (CAC) scoring from a computed tomographic "heartscan" (using Electron Beam Tomography (EBT) as the validated prototype) along with current Framingham risk profiling in order to refine risk on an absolute scale by combining imaging and clinical data to affect a more comprehensive calculation of absolute risk in a given individual. For CAC scores above the 75th percentile but or =55 years, women> or =65 years) a CAC = 0 will result in an age point score corresponding to the age-group whose median CAC score is zero i.e., 40-44 years for men and 55-59 years for women. The utilization of CAC scores allows the inclusion of sub-clinical disease definition into the context of modifiable risk factors as well as identifies high-risk individuals requiring aggressive treatment.

  7. Final report on CIPM key comparison CCM.FF-K6.2011: Comparison of the primary (national) standards of low-pressure gas flow

    Science.gov (United States)

    Benková, Miroslava; Makovnik, Stefan; Mickan, Bodo; Arias, Roberto; Chahine, Khaled; Funaki, Tatsuya; Li, Chunhui; Choi, Hae Man; Seredyuk, Denys; Su, Chun-Min; Windenberg, Christophe; Wright, John

    2014-01-01

    The comparison CCM.FF-K6.2011 was organized for the purpose of determination of the degree of equivalence of the national standards for low-pressure gas flow measurement over the range (2 to 100) m3/h. A rotary gas meter was used as a transfer standard. The measurements were provided at prescribed reference conditions. Eleven laboratories from four RMOs participated in this key comparison—EURAMET: PTB, Germany; SMU, Slovakia; LNE-LADG, France; SIM: NIST, USA; CENAM, Mexico; APMP: NMIJ AIST Japan; KRISS, Korea; NMI, Australia; NIM, China; CMS, Chinese Taipei; COOMET: GP GP Ivano-Frankivs'kstandart-metrologia, Ukraine and all participants reported independent traceability chains to the SI. All results were used in the determination of the key comparison reference value (KCRV) and the uncertainty of the KCRV. The reference value was determined at each flow separately following procedure A presented by M G Cox. The degree of equivalence with the KCRV was also calculated for each flow and laboratory. All reported results were consistent with the KCRV. This KCRV can now be used in the further regional comparisons. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

  8. Optimal Management Strategies for Primary HPV Testing for Cervical Screening: Cost-Effectiveness Evaluation for the National Cervical Screening Program in Australia

    Science.gov (United States)

    Hall, Michaela; Lew, Jie-Bin; Hughes, Suzanne; Yuill, Susan; Hammond, Ian; Saville, Marion; Canfell, Karen

    2017-01-01

    Background Several countries are implementing a transition to HPV testing for cervical screening in response to the introduction of HPV vaccination and evidence indicating that HPV screening is more effective than cytology. In Australia, a 2017 transition from 2-yearly conventional cytology in 18–20 to 69 years to 5-yearly primary HPV screening in 25 to 74 years will involve partial genotyping for HPV 16/18 with direct referral to colposcopy for this higher risk group. The objective of this study was to determine the optimal management of women positive for other high-risk HPV types (not 16/18) ('OHR HPV'). Methods We used a dynamic model of HPV transmission, vaccination, natural history and cervical screening to determine the optimal management of women positive for OHR HPV. We assumed cytology triage testing was used to inform management in this group and that those with high-grade cytology would be referred to colposcopy and those with negative cytology would receive 12-month surveillance. For those with OHR HPV and low-grade cytology (considered to be a single low-grade category in Australia incorporating ASC-US and LSIL), we evaluated (1) the 20-year risk of invasive cervical cancer assuming this group are referred for 12-month follow-up vs. colposcopy, and compared this to the risk in women with low-grade cytology under the current program (i.e. an accepted benchmark risk for 12-month follow-up in Australia); (2) the population-level impact of the whole program, assuming this group are referred to 12-month surveillance vs. colposcopy; and (3) the cost-effectiveness of immediate colposcopy compared to 12-month follow-up. Evaluation was performed both for HPV-unvaccinated cohorts and cohorts offered vaccination (coverage ~72%). Findings The estimated 20-year risk of cervical cancer is ≤1.0% at all ages if this group are referred to colposcopy vs. ≤1.2% if followed-up in 12 months, both of which are lower than the ≤2.6% benchmark risk in women with low

  9. DNA methyltransferase 3B promoter polymorphism and its susceptibility to primary hepatocellular carcinoma in the Chinese Han nationality population: A case-control study

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To investigate the correlation between C/T single nucleotide polymorphism (SNP) in the promoter of the DNA methyltransferase 3B (DNMT3B) gene and risk for development and progression of primary hepatocellular carcinoma (HCC).METHODS: One hundred case subjects were selected consecutively from Tongji Hospital (Wuhan, China).from March to November 2006. They did not receive radiotherapy or chemotherapy for newly diagnosed and histopathologically confirmed HCC. One hundred and forty control subjects having no history of cancerous or genetic diseases were healthy volunteers to Wuhan Blood Center in the same period. Frequency was matched for sex, age, alcohol consumption and cigarette smoking status of the case subjects. C/T polymorphism of the DNMT3B promoter was analyzed using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) and sequencing analysis. The association between genotypes of DNMT3B and clinicopathological parameters among cases was also studied.RESULTS: The CC genotype was not detected in both HCC patients and controls. In control ubjects, the frequency of TT and CT genotypes was 99.3% and 0.7%respectively, and that of T and C alleles was 99.6%and 0.4% respectively. The frequency of CT genotype was higher in HCC (3.0%). The frequency of T and C alleles was 98.5% and 1.5% respectively. However, the genotype and allelotype distribution in HCC patients was not significantly different from that in controls.CONCLUSION: C/T polymorphism is not associated with the increased risk of HCC. DNMT3B enetic polymorphism is variable in different races, ethnic groups or geographic areas. Further study is needed to clarify the role of DNMT3B SNP in the development of HCC among other populations.

  10. Sjögren SER: National registry of the Spanish Society of Rheumatology of patients with primary Sjögren syndrome: Objectives and methodology.

    Science.gov (United States)

    Fernández Castro, Mónica; Andreu, Jose Luis; Sánchez-Piedra, Carlos; Martínez Taboada, Víctor; Olivé, Alejandro; Rosas, José; Sánchez-Alonso, Fernando

    2016-01-01

    To describe the objectives and methods of the Spanish Society of Rheumatology primary Sjögren syndrome (pSS) registry (SJOGREN-SER) METHODS: This is a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American consensus criteria collected from Rheumatology clinics all over Spain. Patients were included by randomisation from an anonymised list provided by every department. Data were collected by reviewing clinical records and an interviewing the patients. Two hundred and ninety eight variables were investigated: epidemiological, clinical, serological characteristics, treatments and complications. Informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75). A total of 3 rheumatology departments participated in the registry. A total of 437 patients were included. And 95% of them were women, with a median age of 58. Median age at pSS 's diagnosis was 50 years. Dryness symptoms (95%) were the most frequent complaint and anti-Ro/SS-A were present in 94% of the cases. Only 27% of the patients fulfilled the new 2012 SICCA-ACR classification criteria. SJOGREN-SER has been designed in order to characterize a representative pSS Spanish cohort, in clinical daily practice, to analyze the magnitude and distribution of its manifestations, activity, accumulated damage and therapeutic management of the disease. This will allow broadening the knowledge of this disease and plan strategies of action in pSS. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  11. Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana.

    Science.gov (United States)

    Fenny, Ama Pokuaa; Enemark, Ulrika; Asante, Felix A; Hansen, Kristian S

    2014-04-01

    Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients' satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients' perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies.

  12. Standing orders for influenza and pneumococcal polysaccharide vaccination: Correlates identified in a national survey of U.S. Primary care physicians

    Directory of Open Access Journals (Sweden)

    Albert Steven M

    2012-03-01

    Full Text Available Abstract Background Standing orders programs (SOPs allow non-physician medical staff to assess eligibility and administer vaccines without a specific physician's order. SOPs increase vaccination rates but are underutilized. Method In 2009, correlates of SOPs use for influenza vaccine and pneumococcal polysaccharide vaccination (PPV were assessed in a nationally representative, stratified random sample of U.S. physicians (n = 880 in family and internal medicine who provided office immunization. The response rate was 67%. Physicians reporting no SOPs, only influenza SOPs, and joint influenza and PPV SOPs were compared using multinomial and logistic regression models to examine individual and practice-level correlates. Results 23% reported using SOPs consistently for both influenza vaccine and PPV, and 20% for influenza vaccination only, with the remainder not using SOPs. Practice-level factors that distinguished practices with joint influenza-PPV SOPs included perceived practice openness to change, strong practice teamwork, access to an electronic medical record, presence of an immunization champion in the practice, and access to nurse/physician assistant staff as opposed to medical assistants alone. Discussion Physicians in practices with SOPs for both vaccines reported greater awareness of ACIP recommendations and/or Medicare regulations and were more likely to agree that SOPs are an effective way to boost vaccination coverage. However, implementation of both influenza and PPV SOPs was also associated with a variety of practice-level factors, including teamwork, the presence of an immunization champion, and greater availability of clinical assistants with advanced training. Conclusions Practice-level factors are critical for the adoption of more complex SOPs, such as joint SOPs for influenza and PPV.

  13. Primary Productivity (PP_Master)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set included primary production for each subregion in the study (Georges Bank, Gulf of Maine, Southern New England, Middle Atlantic Bight) . The data came...

  14. Linking of Primary Care Records to Census Data to Study the Association between Socioeconomic Status and Cancer Incidence in Southern Europe: A Nation-Wide Ecological Study

    Science.gov (United States)

    Garcia-Gil, Maria; Elorza, Josep-Maria; Banque, Marta; Comas-Cufí, Marc; Blanch, Jordi; Ramos, Rafel; Méndez-Boo, Leonardo; Hermosilla, Eduardo; Bolibar, Bonaventura; Prieto-Alhambra, Daniel

    2014-01-01

    Background Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. Objective To study the association between deprivation and incidence of common cancer types in a Southern European region. Methods Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009–2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. Results SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64–2.01], IRR 1.60 [1.34–1.90], IRR 1.22 [1.07–1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80–1.00], IRR 0.91 [0.78–1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08–1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84–0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11–1.45]), prostate (0.74 [0.69–0.80]), and breast (0.76 [0.71–0.81]) cancer. Conclusions Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area

  15. Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study.

    Directory of Open Access Journals (Sweden)

    Maria Garcia-Gil

    Full Text Available BACKGROUND: Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. OBJECTIVE: To study the association between deprivation and incidence of common cancer types in a Southern European region. METHODS: Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care database of longitudinal electronic medical records for a representative population of Catalonia (Spain and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009-2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. RESULTS: SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR 1.82 [1.64-2.01], IRR 1.60 [1.34-1.90], IRR 1.22 [1.07-1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80-1.00], IRR 0.91 [0.78-1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08-1.25], reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84-0.95], and did not modify the associations with cervical (IRR 1.27 [1.11-1.45], prostate (0.74 [0.69-0.80], and breast (0.76 [0.71-0.81] cancer. CONCLUSIONS: Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area

  16. Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study.

    Science.gov (United States)

    Garcia-Gil, Maria; Elorza, Josep-Maria; Banque, Marta; Comas-Cufí, Marc; Blanch, Jordi; Ramos, Rafel; Méndez-Boo, Leonardo; Hermosilla, Eduardo; Bolibar, Bonaventura; Prieto-Alhambra, Daniel

    2014-01-01

    Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. To study the association between deprivation and incidence of common cancer types in a Southern European region. Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009-2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64-2.01], IRR 1.60 [1.34-1.90], IRR 1.22 [1.07-1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80-1.00], IRR 0.91 [0.78-1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08-1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84-0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11-1.45]), prostate (0.74 [0.69-0.80]), and breast (0.76 [0.71-0.81]) cancer. Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This

  17. Ethnic variations in incidence of asthma episodes in England & Wales:national study of 502,482 patients in primary care

    Directory of Open Access Journals (Sweden)

    Sheikh Aziz

    2005-10-01

    Full Text Available Summary Background Recent studies have demonstrated marked international variations in the prevalence of asthma, but less is known about ethnic variations in asthma epidemiology within individual countries and in particular the impact of migration on risk of developing asthma. Recent within country comparisons have however revealed that despite originating from areas of the world with a low risk for developing asthma, South Asian and Afro-Caribbean people in the UK are significantly (3× and 2× respectively more likely to be admitted to hospital for asthma related problems than Whites. Methods Using data from the Fourth National Study of Morbidity Statistics in General Practice, a one-percent broadly representative prospective cohort study of consultations in general practice, we investigated ethnic variations in incident asthma consultations (defined as new or first consultations, and compared consultation rates between those born inside and outside the UK (migrant status. Logistic regression models were used to examine the combined effects of ethnicity and migration on asthma incident consultations. Results Results showed significantly lower new/first asthma consultation rates for Whites than for each of the ethnic minority groups studied (mean age-adjusted consultation rates per 1000 patient-years: Whites 26.4 (95%CI 26.4, 26.4; South Asians 30.4 (95%CI 30.3, 30.5; Afro-Caribbeans 35.1 (95%CI 34.9, 35.3; and Others 27.8 (27.7, 28.0. Within each of these ethnic groups, those born outside of the UK showed consistently lower rates of incident asthma consultations. Modelling the combined effects of ethnic and migrant status revealed that UK-born South Asians and Afro-Caribbeans experienced comparable risks for incident GP consultations for asthma to UK-born Whites. Non-UK born Whites however experienced reduced risks (adjusted OR 0.82, 95%CI 0.69, 0.97 whilst non-UK born South Asians experienced increased risks (adjusted OR 1.33, 95%CI 1.04, 1

  18. Functional outcome, revision rates and mortality after primary total hip replacement--a national comparison of nine prosthesis brands in England.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee, cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed, and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy.We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS ranging from 0 (worst to 48 (best in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001. Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7 and those with cemented prostheses the worst (37.7, 37.3 to 38.1. Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4% and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%. Differences in mortality according to prosthesis type were small and not significant (p = 0.06. Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best and cementless prostheses (p = 0.01, with Corail Pinnacle having the best. Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest.Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

  19. Primary fibromyalgia

    DEFF Research Database (Denmark)

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

    1990-01-01

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

  20. Nation/non-nation

    DEFF Research Database (Denmark)

    Sonnichsen, André; Gad, Ulrik Pram

    2008-01-01

    Is nationality the only way of organizing political community? Given the ubiquity of the national principle, one might think so. But, in practice, the national principle is constantly challenged by what can be termed non-national identities. This article looks at manners in which such deviating...

  1. Nationalism in Stateless Nations

    DEFF Research Database (Denmark)

    Thomsen, Robert Chr.

    previously independent countries, are excellent examples of this. Building on theories of national identity-formation and nationalism, it traces the development of cultural and political nationalism, and changing images of the national self. With a focus on important fomenting factors and actors...... - intellectuals, political parties and the media - the book combines historical, sociological, political and media studies analyses in an interdisciplinary investigation, providing a comprehensive account of the waxing and waning of nationalism....

  2. National Agriculture Imagery Program

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The National Agriculture Imagery Program (NAIP) acquires aerial imagery during the agricultural growing seasons in the continental U.S. A primary goal of the NAIP...

  3. Teacher of primary English

    CERN Multimedia

    2003-01-01

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

  4. Primary productivity

    Digital Repository Service at National Institute of Oceanography (India)

    Verlecar, X.N.; Parulekar, A.H.

    Photosynthetic production in the oceans in relation to light, nutrients and mixing processes is discussed. Primary productivity in the estuarine region is reported to be high in comparison to coastal and oceanic waters. Upwelling phenomenon...

  5. Primary hyperparathyroidism

    OpenAIRE

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

    2016-01-01

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

  6. Primary Myelofibrosis

    Science.gov (United States)

    ... the blood cells. Symptoms of primary myelofibrosis include pain below the ribs on the left side and feeling very tired. ... if you have any of the following: Feeling pain or fullness below the ribs on the left side. Feeling full sooner than ...

  7. [Primary hyperaldosteronism

    NARCIS (Netherlands)

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

    2003-01-01

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

  8. [Primary hyperaldosteronism

    NARCIS (Netherlands)

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

    2003-01-01

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

  9. Primary Processing

    NARCIS (Netherlands)

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

    2012-01-01

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

  10. Physical Education: Primary Matters, Secondary Importance

    Science.gov (United States)

    Griggs, Gerald

    2007-01-01

    Considerable literature has been written over the last decade which indicates that the National Curriculum for Physical Education in England and Wales is being delivered ineffectively in primary schools. This paper discusses the key issues currently faced within primary PE and identifies why within Physical Education, primary matters appear to be…

  11. Millimeter-wave Power National Primary Standard and International Key Comparison%毫米波国家功率基准及其国际关键比对

    Institute of Scientific and Technical Information of China (English)

    崔孝海; 李勇; 孙伟杰

    2013-01-01

    文章介绍了一种基于热敏电阻功率座的对称双线结构的矩形波导微量热计的设计和传递标准有效效率计算方法。给出了功率基准热电堆测量曲线及该频段毫米波功率传递标准量值结果。这种新的微量热计将作为我国毫米波功率基准,它将我国的毫米波功率测量能力提高到了75GHz。国际比对是国际多边证书互认的基础,是我国产品进入国际市场准入的质量认证基础,国际关键比对是比对活动中的核心活动。文章介绍了我国参加毫米波WR22(33GHz 50GHz)国际关键比对情况。%The design and realization technique of a rectangular waveguide microcalorimeter based on a thermistor mount is presented. The effective effciency calculation method of the transfer standard is presented too. The thermopile output curves and transfer standard’s values is provided. The microcalorimeter will be national primary standard of millimeter-wave power. It enhanced China’s RF power measurement capability up to 75 GHz. International comparison is the base of the Mu-tual Recognition Arrangement(MRA),it is also the base of the international market tentry of China’s products,and the Key Comparison is the core of the international comparison. The key comparison of China’s WR-22 power primary standard is in-troduced in this paper.

  12. An Investigation into the Mental Health of the Rural Primary School Students of the Mulao Nationality%仫佬族农村小学生心理健康状况调查

    Institute of Scientific and Technical Information of China (English)

    刘雪珍

    2011-01-01

    The research aims to find out the mental health status of the rural primary school students of the Mulao nationality.By using the "Mental Health Test(MHT)",a questionnaire investigation was launched into 431 rural primary school students of the Mulao Nationality in Luocheng Mulao Autonomous County.The result shows that the positive ratio of mental health problems of these students is 0.5%,and 59.2% of the students have problems in at least one dimension of the eight sub-scales.The mental health problems of girl students are more than those of boy students;the problems of the children in single-parent families are more than those in normal families;and the problems of home-left children are more than those of the children staying with their parents; these differences have statistical significance(p0.05);the problem prevalence of Grade Four is the lowest,Grade Five comes next,and Grade Six is the highest.All these indicate that in view of the current mental health status of these children,schools,families and society should pay special attention to the mental health problems of girl students,children in single-parent families and home-left children.%调查的主要目的是了解罗城仫佬族农村小学生心理健康状况;采用的方法是用《心理健康诊断测验》对罗城仫佬族自治县431名仫佬族农村小学生进行问卷调查。分析其结果如下:仫佬族农村小学生心理健康问题的阳性检出率为0.5%,八个分量表中至少有一项呈阳性的检出率为59.2%;心理健康问题女生高于男生,单亲儿童高于非单亲儿童,留守儿童高于非留守儿童,差异具有统计学意义(P﹤0.05);4年级问题检出率最低,5年级其次,6年级最高。这些结论表明,仫佬族农村小学生心理健康状况不容乐观,学校、家庭、社会应特别关注女生、单亲家庭儿童与留守儿童的心理健康教育。

  13. Hyperthyroidism (primary)

    DEFF Research Database (Denmark)

    Nygaard, Birte

    2010-01-01

    Hyperthyroidism is characterised by high levels of serum thyroxine and triiodothyronine, and low levels of thyroid-stimulating hormone. The main causes of hyperthyroidism are Graves' disease, toxic multinodular goitre, and toxic adenoma. About 20 times more women than men have hyperthyroidism....... METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for primary hyperthyroidism? What are the effects of surgical treatments for primary hyperthyroidism? What are the effects of treatments for subclinical...... hyperthyroidism? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US...

  14. Hyperthyroidism (primary)

    OpenAIRE

    Nygaard, Birte

    2008-01-01

    Hyperthyroidism is characterised by high levels of serum thyroxine and triiodothyronine, and low levels of thyroid-stimulating hormone. Thyrotoxicosis is the clinical effect of high levels of thyroid hormones, whether or not the thyroid gland is the primary source.The main causes of hyperthyroidism are Graves' disease, toxic multinodular goitre, and toxic adenoma.About 20 times more women than men have hyperthyroidism.

  15. Hyperthyroidism (primary)

    OpenAIRE

    Nygaard, Birte

    2010-01-01

    Hyperthyroidism is characterised by high levels of serum thyroxine and triiodothyronine, and low levels of thyroid-stimulating hormone (TSH). Thyrotoxicosis is the clinical effect of high levels of thyroid hormones, whether or not the thyroid gland is the primary source.The main causes of hyperthyroidism are Graves' disease, toxic multinodular goitre, and toxic adenoma.About 20 times more women than men have hyperthyroidism.

  16. 实施基本药物制度对基层医疗卫生机构的影响及政策建议%The impact of institutions and policy recommendations for the implementation of national basic medicine system for primary health care system

    Institute of Scientific and Technical Information of China (English)

    孟宏伟; 尹文强; 黄冬梅; 于倩倩; 郭洪伟; 李伟

    2012-01-01

    With the deepening of health system reform, as an important parts of national health system reform in China, national essential drug policy has been rapidly implemented in primary health care institutions. As of 2011 March, national essential drug policy has covered 82.6% of the primary health care institutes. By literature review, the impact of national essential drug policy in primary health care institutes has been summarized and suggestions h for improving the basic drug system has been presented.%随着医改的深入推进,在基层医疗卫生机构实施基本药物制度作为医改的一项重要内容,在全国范围内全面展开.截至2011年3月底,已覆盖全国82.6%的基层医疗机构.通过查阅相关文献,汇总分析实施基本药物制度对基层医疗机构产生的影响,提出针对性政策建议,为完善基本药物制度提供借鉴.

  17. Primary fibromyalgia

    DEFF Research Database (Denmark)

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

    1990-01-01

    type III aminoterminal peptide. Subjective symptoms, tender points and dynamic muscle strength in 45 women with primary fibromyalgia were related to serum concentrations of procollagen type III aminoterminal peptide. Patients with low serum concentrations of procollagen type III aminoterminal peptide...... had more symptoms, a higher frequency of tender points and lesser quality of sleep compared to patients with normal serum concentrations of procollagen type III aminoterminal peptide (P less than 0.05). They also had a lower dynamic muscle strength (P less than 0.0005). We conclude that the serum...

  18. PRIMARY SCHOOL TEACHER

    CERN Multimedia

    Madeleine Dittus

    2002-01-01

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

  19. The NIST Primary Radon-222 Measurement System

    OpenAIRE

    Collé, R.; Hutchinson, J. M. R.; Unterweger, M. P.

    1990-01-01

    Within the United States, the national standard for radon measurements is embodied in a primary radon measurement system that has been maintained for over 50 years to accurately measure radon (222Rn) against international and national radium (226Ra) standards. In turn, all of the radon measurements made at the National Institute of Standards and Technology (NIST) and the radon transfer calibration standards and calibration services provided by NIST are directly related to this national radon ...

  20. 海南黎族地区黎汉族小学生生长发育现况%Growth and development among primary school students in Hainan: Comparison between Li and Han nationality

    Institute of Scientific and Technical Information of China (English)

    史金端; 黄垂波; 陈丽珠; 陈智明; 黄惠宇; 冯礼明; 柳贤勤; 马静

    2011-01-01

    目的 掌握海南黎族地区黎、汉族小学生生长发育现况,为制定海南黎族地区学生营养干预方案提供依据.方法 2010年1-6月采用分层整群抽样方法抽查五指山、白沙、陵水、乐东、昌江5市县3 147名汉,黎族小学生进行身高、体重、胸围等生长发育指标测定.结果 黎、汉族小学生之间身高、体重、胸围差异均无统计学意义;城乡之间、男女之间差异均有统计学意义.在低年龄组,黎族学生生长水平普遍高于同年龄组汉族学生,而随着年龄的增长,黎族学生发育速度不如汉族学生,到高年龄组,汉族学生生长水平普遍高于同年龄组黎族学生.结论 应提高黎族地区居民的经济收入,加强黎族地区学生营养知识教育的宣传和普及,以达到提高黎族地区少年儿童整体素质的目的.%Objective To compare the growth and development status of the children between Li and Han nationality, and to provide evidence for nutritional intervention targeting Hainan Li primary school students.Methods During January to June 2010, a stratified random cluster sampling method was used to select 3 147 primary school students from Wuzhishan, Baisha, Lingshui, Ledong and Changjiang.Their height, weight,and chest circumference were measured.Results All the students showed the height, weight and chest circumference grow year by year.However,these traits were not displaying any significant differences between Li and Han children, but the children lived in the city and countries had statistical differences.Height, weight and chest circumference growth in some age of Li students was higher than Han students of the same group.Conclusion The poor level of physical development in Li children may be due to causes of poverty and low literacy levels, increase the economic income of local residents, and enhancing the students knowledge of nutrition education and publicity and popularity of the Li region in order to achieve

  1. 畲族中小学生体质测量的研究%Physical measurement of pupils and students of SHE nationality in primary and middle school of China

    Institute of Scientific and Technical Information of China (English)

    刘长节; 郭尧允; 陈吟; 高树英

    2012-01-01

    Objective To study the physical character and body condition of pupils and students of SHE nationality in primary and middle schools of China to accumulate datum for anthropology and provide scientific bases for the healthy growth of the pupils and students. Method According to somatometry, we measured their heights, weights BWH and body fat and calculated the standard index of weight and BWH. Results The increase of weight and height growed fast for 14-year-old boys and 13-year-old girls, and then slowed down after 16 years old. The growth of boys and girls'height and weight appeared two peaks at 8 and 18 years old. Conclusion The height and weight of the pupils and students are related to the growth of age, girls weight appears negative growth after 16 years old.%目的 为了解畲族中小学生身体发育状况及体质特征,积累人类学资料,为促进畲族中小学生健康成长提供科学依据.方法 按活体测量要求,对身高、体重、胸围、腰围、臀围、体脂百分率进行测量,计算出体重、胸围、腰围、臀围的标准指数.结果 畲族中小学生男生14岁、女生13岁,身高、体重生长速度较快,16岁后生长速度缓慢;男女生8-18岁期间身高、体重生长出现两个生长高峰期.结论 畲族中小学生身高、体重与年龄增长具有相关性,但女生体重16岁后反而呈现负增长.

  2. Primary hyperparathyroidism.

    Science.gov (United States)

    Muñoz-Torres, Manuel; García-Martín, Antonia

    2017-10-06

    Primary hyperparathyroidism (PHPT) is a common endocrinological process, characterized by chronic elevation of serum concentrations of calcium and parathyroid hormone (PTH). Many years ago, the most frequent forms of clinical presentation were symptomatic renal or skeletal disease with moderate or severe hypercalcemia; however, currently, most patients have few symptoms and mild hypercalcemia. A new form of presentation called normocalcemic PHPT has also been described but clinical consequences are not well established. The biochemical profile of PHPT is characterized by hypercalcemia and high or inappropriately normal PTH concentrations. Parathyroidectomy is the only definitive cure. Medical treatment with the calcimimetic cinacalcet has been shown to normalize calcemia in a high percentage of cases. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  3. Primary Hyperoxaluria

    Directory of Open Access Journals (Sweden)

    Jérôme Harambat

    2011-01-01

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

  4. OZ: An Innovative Primary Flight Display Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed SBIR project will develop OZ, an innovative primary flight display for aircraft. The OZ display, designed from "first principles" of vision science,...

  5. Primary immunodeficiency

    Directory of Open Access Journals (Sweden)

    McCusker Christine

    2011-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Ana Sollazzo

    2011-06-01

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

  7. Nationalism in Stateless Nations

    DEFF Research Database (Denmark)

    Thomsen, Robert Chr.

    democracies need not, as argued by theories of 'classic' nationalist movements, strive for full independence. In fact, nationalist movements are adapting to circumstances by becoming autonomist rather than separatist, pragmatic rather than dogmatic, and the book illustrates how Scotland and Newfoundland, both...... - intellectuals, political parties and the media - the book combines historical, sociological, political and media studies analyses in an interdisciplinary investigation, providing a comprehensive account of the waxing and waning of nationalism....

  8. [Primary lipodystrophies].

    Science.gov (United States)

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

    2007-02-01

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

  9. Primary care physicians shortage: a Korean example.

    Science.gov (United States)

    Cho, Kyung-Hwan; Roh, Yong-Kyun

    2003-01-01

    A mismatch in the demand and supply of primary care physicians could give rise to a disorganization of the health care system and public confusion about health care access. There is much evidence in Korea of the existence of a primary care physician shortage. The appropriate required ratio of primary care physicians to the total number of physicians is estimated by analyzing data for primary care insurance consumption in Korea. Sums of primary care expenditure and claims were calculated to estimate the need for primary care physicians by analyzing the nationwide health insurance claims data of the Korean National Medical Insurance Management Corporation (KNMIMC) between the years 1989-1998. The total number of physicians increased 183% from 1989 to 1998. However, the number of primary care physicians including general physicians, family physicians, general internists, and general pediatricians showed an increase of only 169% in those 10 years. The demand for primary care physicians reaches at least 58.6%, and up to 83.7%, of the total number of physicians in Korea. However, the number of primary care physicians comprises up to 22.0% of the total number of active physicians during the same research period, which showed a large gap between demand and supply of primary care physicians in Korea. To provide high quality care overall, a balanced supply of primary care physicians and specialists is required, based on the nation's demand for health services.

  10. Scotland: Nation without Nationalism?

    Directory of Open Access Journals (Sweden)

    Ya. I. Maltsev

    2015-01-01

    Full Text Available In the period before 1990s two concepts were used to describe the Scottish political development: “Nation without nationalism” and “The stateless nation”. After the devolution of 1998 and electoral achievements of SNP neither of these constructions can properly characterize the processes, undergoing in Scotland. The forming of new alignment of political powers in Scotland is not yet finished, but so far its development leads to the emergence of political configuration separated from that of All-British, with regard to extreme weakening of “big” parties in Scotland. 

  11. PRIMARY SCHOOL TEACHER

    CERN Multimedia

    Madeleine Dittus

    2002-01-01

    For the beginning of the school year 2002/2003, the A.P.E.G. has an opening for a primary school teacher in the German national language program. The position requires one afternoon of teaching (13:30 till 16:30) every Tuesday at the Collège in Prévessin. The candidate should be a native speaker of German and have some knowledge of French. If you are interested, please send your CV, a copy of your diploma, and a short letter of motivation, until March 10th, to the following address. Madeleine Dittus - Présidente A.P.E.G. 5, La vie Destraz 01630 St. Genis-Pouilly - France

  12. Primary care guidelines

    DEFF Research Database (Denmark)

    Ijäs, Jarja; Alanen, Seija; Kaila, Minna

    2009-01-01

    -sectional telephone survey. SETTING: All municipal health centres in Finland. SUBJECTS: Health centres where both the head physician and the senior nursing officer responded. MAIN OUTCOME MEASURES: Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension......OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p

  13. Development of national neglect norm for urban primary school students of China%中国城市6~11岁小学生忽视评价常模的研制

    Institute of Scientific and Technical Information of China (English)

    潘建平; 王飞; 李敏; 陈晶琦; 张慧颖; 王桂香; 古桂雄; 郭蔚蔚; 彭玉林

    2013-01-01

    目的 研制中国城市小学生忽视评价常模.方法 按照多阶段分层整群抽样原则,于2008年12月1-31日期间,从全国抽取13个省份24个城市中的小学生进行现场问卷调查.调查问卷自行设计,前期历经2年多的3轮预试验、10多次反复修改,并经专家审评后确定.两种忽视评价调查问卷(小学1~3年级、4~6年级)获得有效样本量分别为1491名和2236名,共3727名.经过项目分析、因素分析、效度分析和信度分析等处理确定常模量表,通过信度检验和效度检验评价常模的稳定性和可靠性,并采用百分位数法确定量表的评价标准,完成常模的初步研制.结果 两个量表最终分别保留6个忽视层面(身体、情感、教育、安全、医疗及社会忽视)的55个和57个题项.两个量表各题项的因素负荷量分别在0.301 ~0.687和0.321 ~0.730之间,均达到了统计学要求.1~3年级忽视量表总的Cronbach α系数为0.914,总的劈半系数为0.896,除医疗、社会外,各个层面的Cronbach α系数均大于0.737,劈半系数在0.461 ~0.757之间;4~6年级忽视量表总的Cronbach α系数为0.916,总的劈半系数为0.883,除社会层面外,其余层面的Cronbach α系数在0.457 ~ 0.856之间,劈半系数在0.500 ~0.798之间;1~3年级和4~6年级量表确定的总的忽视界值点分别为125分和155分.结论 两常模量表结构合理,具有良好的鉴别力、信度和效度,稳定性和可靠性强.%Objective To develop the national neglect norms for urban primary school students in China.Methods According to multi-stage stratified cluster sampling principle,24 cities of 13 provinces (municipalities) in China were selected during December 1 to 31,2008.A total of 1491 students in grade 1-3 and 2236 students in grade 4-6 were selected.Questionnaire was designed by authors and the final norms were determined through several statistical analysis methods,such as item analysis method

  14. Complications - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications - national data. This data set includes national-level data the hip/knee complication measure, and the Agency for Healthcare Research and Quality...

  15. HCAHPS - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The national average for the HCAHPS survey categories. HCAHPS is a national, standardized survey of hospital patients about their experiences during a recent...

  16. Payment - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment measures – national data. This data set includes national-level data for the payment measures associated with an episode of care for heart attack, heart...

  17. Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor)

    Science.gov (United States)

    YOSHIMOTO, Koji; KADA, Akiko; KUGA, Daisuke; HATAE, Ryusuke; MURATA, Hideki; AKAGI, Yojiro; NISHIMURA, Kunihiro; KUROGI, Ryota; NISHIMURA, Ataru; HATA, Nobuhiro; MIZOGUCHI, Masahiro; SAYAMA, Tetsuro; IIHARA, Koji

    2016-01-01

    We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed. Chemotherapy was the most frequent treatment (27% of cases), followed by surgery (13%) and surgery + chemo-radiotherapy (11%). Temozolomide (TMZ), the most frequently used chemotherapeutic drug, was administered to 1,236 patients. Concomitant TMZ and radiotherapy was administered to 816 patients, and was performed according to the Stupp regimen in many cases. The mean length of hospital stay (LOS) was 16 days, and the mean medical cost was 1,077,690 yen. The average medical cost of TMZ-only treatment was 1,138,620 yen whilst it was 4,424,300 yen in concomitant TMZ patients. The LOS was significantly shorter in high-volume than in low-volume hospitals, and the medical cost was higher in hospitals treating 21–50 patients compared to those treating 1–10 patients. However, the direct medical cost of TMZ treatment was the same across different volume hospitals. This is the first report of current trends and healthcare resource usage in the treatment of primary malignant brain tumor inpatients in the TMZ era in Japan. PMID:27680329

  18. Current Trends and Healthcare Resource Usage in the Hospital Treatment of Primary Malignant Brain Tumor in Japan: A National Survey Using the Diagnostic Procedure Combination Database (J-ASPECT Study-Brain Tumor).

    Science.gov (United States)

    Yoshimoto, Koji; Kada, Akiko; Kuga, Daisuke; Hatae, Ryusuke; Murata, Hideki; Akagi, Yojiro; Nishimura, Kunihiro; Kurogi, Ryota; Nishimura, Ataru; Hata, Nobuhiro; Mizoguchi, Masahiro; Sayama, Tetsuro; Iihara, Koji

    2016-11-15

    We conducted this study to clarify the current trends and healthcare resource usage in the treatment of inpatients with primary malignant brain tumors. The Diagnostic Procedure Combination (DPC) data of all inpatients treated between 2013 and 2014 in the 370 core and branch hospitals enrolled in the Japanese Neurosurgical Society training program were collected. DPC is a discharge abstract and administrative claims database of inpatients. We assessed 6,142 primary, malignant brain tumor patients. Patient information, diagnostic information, treatment procedure, and healthcare resource usage were analyzed. Chemotherapy was the most frequent treatment (27% of cases), followed by surgery (13%) and surgery + chemo-radiotherapy (11%). Temozolomide (TMZ), the most frequently used chemotherapeutic drug, was administered to 1,236 patients. Concomitant TMZ and radiotherapy was administered to 816 patients, and was performed according to the Stupp regimen in many cases. The mean length of hospital stay (LOS) was 16 days, and the mean medical cost was 1,077,690 yen. The average medical cost of TMZ-only treatment was 1,138,620 yen whilst it was 4,424,300 yen in concomitant TMZ patients. The LOS was significantly shorter in high-volume than in low-volume hospitals, and the medical cost was higher in hospitals treating 21-50 patients compared to those treating 1-10 patients. However, the direct medical cost of TMZ treatment was the same across different volume hospitals. This is the first report of current trends and healthcare resource usage in the treatment of primary malignant brain tumor inpatients in the TMZ era in Japan.

  19. "National School Leadership Training Program" Promoting the Professional Development of Primary and Secondary School Principals in Sweden%瑞典《国家学校领导者培训计划》助力中小学校长专业发展

    Institute of Scientific and Technical Information of China (English)

    曾琳

    2012-01-01

    The primary and secondary school principals play a vital role in the school development and in quality improvement of basic education. Sweden's "National School Leadership Training Program" in 2009 clarifies the role and responsibilities of school principals, specifies the content, model and evaluation of the training program, which seeks to develop school principals into school leaders bearing administrative ,pedagogic and strategic roles. In all , Sweden's "National School Leadership Training Program" of 2009 plays a significant role in promoting the professional development of primary and secondary school principals.%中小学校长对学校发展和基础教育质量的提高起着至关重要的作用。瑞典2009《国家学校领导者培训计划》明晰了中小学校长的角色,规定了培训的内容、模式以及评价方式,旨在把校长培养成为集"管理、教学、学校发展"三种角色为一体的学校领导者,对中小学校长的专业发展起到了极大的促进作用。

  20. Culinary nationalism.

    Science.gov (United States)

    Ferguson, Priscilla Parkhurst

    2010-01-01

    Culinary consciousness raisers, cooking texts often serve as vehicles of national identification. From Pampille (Marthe Allard Daudet) and her cookbook, Les Bons Plats de France, in 1913 to the international culinary competitions of today such as the Bocuse d'or, culinary distinction promotes national interests. In contrast to the strident nationalism of the early twentieth century, culinary nationalism today operates in an increasingly globalized world. National culinary distinction defines the nation and sells its products in a highly competitive international arena. A recent culinary text, the South Korean film Le Grand Chef [Sik Gaek ] (2007), illustrates the phenomenon, subsuming national culinary promotion in a mega culinary competition, all in the service of Korean culinary achievement.

  1. 中小学生民族偏见与歧视的成因及干预策略:群际接触的视角%The Influence Factors and Intervention Strategies of Primary and Secondary Students’ National Prejudice and Discrimination:The View of Intergroup Contact

    Institute of Scientific and Technical Information of China (English)

    曲映蓓; 辛自强

    2016-01-01

    民族偏见与歧视是影响社会稳定的重要问题,它在中小学阶段就有所表现。汉族中小学生形成对少数民族的偏见与歧视可能是因为他们缺乏有关少数民族的信息或拥有了错误信息,缺少在最佳条件下的群际接触。群际接触理论认为最佳条件下的群际接触是减少群际偏见与歧视的主要途径。基于该理论,我们可以从真实的接触、拓展的接触、想象的接触三个角度为学校制定改善中小学生民族偏见与歧视的策略。中小学阶段是民族偏见与歧视的形成阶段,在这一时期进行干预会更加有效。%National prejudice and discrimination are the important problems that affect social stability, which have been shown in the stage of primary and secondary school. The reasons why Han primary and secondary school students have prejudice and discrimination to the minority are the lack of information about the minority or the possession of wrong message and the short of contact to the minority in the optimal conditions. Intergroup contact theory indicates that intergroup contact under the optimal conditions is an effective way to reduce intergroup prejudice. Based on the intergroup contact theory, we proposed strategies to change the national prejudice and discrimination of Han primary and secondary school students from three aspects of direct, extended and imagined intergroup contact. Primary and secondary stages are the main stages forming national prejudice and discrimination, so intervening in this period is the most effective.

  2. National Intelligence and National Prosperity

    Science.gov (United States)

    Hunt, Earl; Wittmann, Werner

    2008-01-01

    What is the relation between the cognitive competence of a national population that nation's economic prosperity? Lynn and Vanhanen [Lynn, R. & Vanhanen, T. (2002). "IQ and the wealth of nations." Westport, CT: Praeger.] presented data pointing to an exceptionally strong relationship between IQ scores and Gross Domestic Product per capita (GDP/c).…

  3. Primary Study on “Hulusheng” Dance of Yi Nationality from the Point of Educational Anthropology%彝族葫芦笙舞文化的教育人类学初探

    Institute of Scientific and Technical Information of China (English)

    杨君

    2011-01-01

    “Hulusheng” dance is a kind of Yi nationality culture inherited generation by generation. The paper discusses how the "Hulusheng" dance culture affects man's forming and advances suggestions for effectively protecting and inheriting this culture.%彝族葫芦笙舞是彝家人世世代代传承的一种文化。文章主要从教育人类学的视角探讨葫芦笙舞文化对人的形成是如何产生影响的,并对有效保护和传承葫芦笙舞提出了自己的建议。

  4. Primary pulmonary hypertension.

    Science.gov (United States)

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

    2000-01-01

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

  5. National Parks

    Data.gov (United States)

    Department of Transportation — National Park Service unit boundaries (NTAD). These park boundaries signify legislative boundary definitions and local park names have been consolidated according to...

  6. Impacto de un programa nacional de tratamiento en mujeres adultas con exceso de peso en centros de atención primaria Impact of a national treatment program in overweight adults women in primary care centers

    Directory of Open Access Journals (Sweden)

    J. Echenique Sarah

    2011-12-01

    Full Text Available Antecedentes: Existe una alta prevalencia de sobrepeso y obesidad en Chile y es importante aplicar y evaluar estrategias de tratamiento y control que sean eficaces. Objetivos: Evaluar cambios en estado nutricional y glicemia en ayunas en mujeres con exceso de peso, pre-diabéticos y/o pre- hipertensos, intervenidos en Centros de Atención Primaria del sector público de salud. Material y métodos: Estudio de una cohorte retrospectiva intervenida del universo de mujeres ingresadas al programa en los Centros de Atención Primaria participantes durante 18 meses. La intervención incluye consultas y talleres con médicos, nutricionistas, psicólogos y kinesiólogos durante 4 meses, por profesionales de atención primaria, fomentándose una alimentación saludable y mayor actividad física, sin uso de fármacos. Análisis de causas de ingreso, abandono, participación en actividades programadas y cambios en el estado nutricional inicial y glicemia en ayunas después de 4 meses de intervención. Resultados: Se estudiaron 1.528 mujeres de 18 a 65 años, con IMC inicial entre 25 y 40; 1.222 completaron el tratamiento (71,6%. La mediana de cambio de peso fue - 3,9% (IC -4,1-3,7 del peso inicial y de glicemia -2,0 mg/dl (IC -2,0-1,0. El 36,8% de las pacientes bajo ≥ 5% del peso inicial, el 12,5% de los sobrepeso se normalizaron y aproximadamente un tercio de las obesas tuvieron una mejoría parcial. Hubo reducción significativa de la prevalencia de pre-diabetes (16,6 a 8,8%, p Background: Chile has a high prevalence of overweight and obesity and is important to implement and evaluate treatment and control strategies that are effective. Objectives: To evaluate changes in nutritional status and fasting glucose in overweight women, pre-diabetic and/or pre-hypertension in primary care centers of public health sector. Material and methods: A retrospective cohort of the universe of women admitted to the program in the participating primary care centers for

  7. 张家界国家森林公园植物旅游开发初探%Primary Exploration of Developing Botanical Tourism in Zhangjiajie National Forest Park

    Institute of Scientific and Technical Information of China (English)

    柳菲; 陈功锡

    2013-01-01

    从植物旅游的概念出发,结合张家界国家森林公园内丰富的植物资源条件,针对张家界国家森林公园植物旅游开发提出了几点意见:①“非毁坏性利用模式”植物资源持续利用;②丰富旅游内涵的同时提升公众科学文化素养;③观光型旅游向复合型旅游转型;④定期开展“国际植物旅游节”。%Based on the concept of botanical tourism ,this article discusses the development of botanical tourism in Zhangjiajie National Forest Park .Combining with its rich plant resources ,it puts forward the following suggestions :①adopting non -destructive utilization model to sustainably use the plant resources ;②improving scientific literacy of the public while enriching the connotation of tourism ;③ transforming sightseeing tourism to composite tourism ;④carrying out "international plant tourism festival"regularly .

  8. Integrated primary health care in Australia

    Directory of Open Access Journals (Sweden)

    Gawaine Powell Davies

    2009-10-01

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

  9. Primary Considerations for Primary TEFL in China

    Institute of Scientific and Technical Information of China (English)

    Yvonne Griffiths

    2007-01-01

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

  10. Brain tumor - primary - adults

    Science.gov (United States)

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

  11. 山地民族地区中小学英语教学中的民族文化融入--以武陵山区土家族为例%Melting the National Cultural to English Teaching of Middle and Primary Schools in Mountainous Minority Region---Taking Tuj ia People of Wuling Mountainous Area as an example

    Institute of Scientific and Technical Information of China (English)

    尹波

    2014-01-01

    在武陵山区土家族为主的中小学英语教学中融入土家族的非物质文化能够增强土家族中小学生对于家乡和民族的热爱,也能够培养他们正确的跨文化交际意识。%Melting the intangible culture of tuj ia minority in the English Teaching of tuj ia mi-nority’s middle and primary school can strengthen their love of hometown and nation,at the same time,it can promote their correct cross-cultural communication awareness.

  12. 初探民族中小学实施体育双语教学首先解决的最主要问题%The Most Important Issue to be First Solved of National Primary and Secondary Schools Sports Bilin~ual Education

    Institute of Scientific and Technical Information of China (English)

    阿力木江·依米提·塔尔肯

    2012-01-01

    According to the practical experience of bilingual teaching in minority primary and secondary school sports, this paper brings forward the main problem of sport bilingual teaching at elementary and middle school in the Hetian region national minority, which is a serious lack of bilingual teachers, and provide the reference for similar bilingual pilot schools sports bilingual education.%摘要:根据少数民族中小学体育双语课程教学的实践经验,提出和田地区少数民族中小学实施体育双语教学中面临的最主要问题一双语师资队伍严重缺乏的有效解决方法,并为同类双语试点学校体育双语教学开展提供一定的参考。

  13. Primary Hyperparathyroidism: An Overview

    OpenAIRE

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

    2011-01-01

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

  14. Primary Meningeal Rhabdomyosarcoma

    OpenAIRE

    2011-01-01

    Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imagin...

  15. Responsible nations

    DEFF Research Database (Denmark)

    Lippert-Rasmussen, Kasper

    2009-01-01

    In National Responsibility and Global Justice, David Miller defends the view that a member of a nation can be collectively responsible for an outcome despite the fact that: (i) she did not control it; (ii) she actively opposed those of her nation's policies that produced the outcome; and (iii......) actively opposing the relevant policy was costly for her. I argue that Miller's arguments in favor of this strong externalist view about responsibility and control are insufficient. Specifically, I show that Miller's two models of synchronic collective responsibility*the like-minded group model...

  16. Primary Care's Dim Prognosis

    Science.gov (United States)

    Alper, Philip R.

    2010-01-01

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

  17. Investigating Primary Source Literacy

    Science.gov (United States)

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

    2009-01-01

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

  18. Enhanced National Land Cover Data 1992 (NLCDe 92)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The enhanced National Land Cover Data 1992 ("NLCDe 92") served as the primary source for nationally consistent mapped land cover during the first decade of sampling...

  19. Bhutan's National ECCD Impact Evaluation: Local, National, and Global Perspectives

    Science.gov (United States)

    Pisani, Lauren; Dyenka, Karma; Sharma, Parvati; Chhetri, Nar; Dang, Sara; Gayleg, Karma; Wangdi, Chencho

    2017-01-01

    Early childhood care and development (ECCD) services have been steadily expanding with structures on the community, national, and international levels. However, many low- and middle-income countries still have very limited ECCD coverage, and there is a lack of global guidance on best practices for effectively expanding pre-primary education. In…

  20. Rural Primary School Closures in England.

    Science.gov (United States)

    Whitfield, Richard C.

    A three-phase interdisciplinary effort between educators and environmental planners is focusing on the social effects of rural primary school reorganization now occuring in England as a result of a declining birth rate and the resulting need for school closure. A questionnaire mailed nationally to rural Local Education Authorities, cross-community…

  1. Primary Hyperparathyroidism: An Overview

    Directory of Open Access Journals (Sweden)

    Jessica MacKenzie-Feder

    2011-01-01

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

  2. National database

    DEFF Research Database (Denmark)

    Kristensen, Helen Grundtvig; Stjernø, Henrik

    1995-01-01

    Artikel om national database for sygeplejeforskning oprettet på Dansk Institut for Sundheds- og Sygeplejeforskning. Det er målet med databasen at samle viden om forsknings- og udviklingsaktiviteter inden for sygeplejen.......Artikel om national database for sygeplejeforskning oprettet på Dansk Institut for Sundheds- og Sygeplejeforskning. Det er målet med databasen at samle viden om forsknings- og udviklingsaktiviteter inden for sygeplejen....

  3. Nation First

    Institute of Scientific and Technical Information of China (English)

    He Tao

    2012-01-01

    In addition to the success of onomic integration,the ultural effects of globalization have been considerable.The increasingly globalized culture creates the potential to alter the way people identify themselves,eroding geographic boundaries as well as local and national cultures.While the West was happily appreciating this gift from globalization,they found themselves involved in an unexpected wave of reemerging nationalism in many countries.

  4. Training the Internist for Primary Care: A View From Nevada

    Science.gov (United States)

    Kurtz, Kenneth J.

    1982-01-01

    The recent establishment of primary care residencies at the University of Nevada School of Medicine has raised important questions about local priorities in the training of physicians to provide primary care for adults. Because the amount of money available for health care training is decreasing, these questions also have national importance. Primary care internal medicine, not synonymous with general internal medicine, offers distinct advantages to patients over family practice adult care and primary care offered by internist subspecialists. The University of Nevada has a singular opportunity to organize a strong primary care internal medicine residency, but national problems of internal medicine emphasis exist. Nationwide changes in internal medicine residency programs (ongoing) and American Board of Internal Medicine nationalization of the fledgling primary care internal medicine fellowship movement are suggested. Specifically proposed is an extra year for primary care training with a single examination after four years, producing general internists with a primary care “minor.” Alternately, and ideally, there would be a full two-year primary care fellowship with a separate internal medicine primary care subspecialty board examination. Either of the above options would provide necessary training and academic credibility for primary care internists, and would redirect internal medicine certification and training. PMID:7072246

  5. The Danish National Health Service Register

    DEFF Research Database (Denmark)

    Andersen, John Sahl; Olivarius, Niels de Fine; Krasnik, Allan

    2011-01-01

    Abstract Introduction: To describe the Danish National Health Service Register in relation to research. Content: The register contains data collected for administrative and scientific purposes from health contractors in primary health care. It includes information about citizens, providers...

  6. Chautauqua National Wildlife Refuge : Animal Control Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The primary objectives of the Chautauqua National Wildlife Refuge complex are to provide optimum conditions for resting, migrating waterfowl and to perpetuate...

  7. 78 FR 68821 - Availability of Seats for National Marine Sanctuary Advisory Councils

    Science.gov (United States)

    2013-11-15

    ... natural and cultural resources, and through active research, management, and public engagement, sustains...); Diving (primary member); Diving (alternate); Education (primary member); Education (alternate); Tourism (primary member); Tourism (alternate); and Conservation (alternate). National Marine Sanctuary of...

  8. Ireland's Cherry Orchard National School

    Science.gov (United States)

    O Cuiv, Shan

    2007-01-01

    This recently completed primary school illustrates how architecture can contribute to creating a safe and warm environment in a difficult area and can meet the particular needs of the student community. In its first year in operation, Cherry Orchard National School is proving to be a successful project. Presented here are the architectural…

  9. Ireland's Cherry Orchard National School

    Science.gov (United States)

    O Cuiv, Shan

    2007-01-01

    This recently completed primary school illustrates how architecture can contribute to creating a safe and warm environment in a difficult area and can meet the particular needs of the student community. In its first year in operation, Cherry Orchard National School is proving to be a successful project. Presented here are the architectural…

  10. Primary care career advice: a student perspective.

    Science.gov (United States)

    Maddams, Jessica; Miller, Kathryn; Rushforth, Bruno

    2012-04-01

    In the UK, undergraduate curricula have evolved to include a greater proportion of community-based teaching. However, for most students it still remains predominantly a hospital-based training experience. With 50 per cent of all medical graduates in the UK now expected to work in the community, students need to be fully informed about career pathways and opportunities within primary care. A key driver for curriculum change in the UK has been the General Medical Council's guidance in Tomorrow's Doctors, which advocates experience in a variety of health care settings together with career advice at undergraduate level. However, the existing career guidance provision may be inadequate for the current needs of students. We explore what students are doing to combat the lack of primary care focused career guidance: from taking a year out to intercalate in primary care to setting up and running student-led primary care groups. We report on a new UK venture that we hope to launch in consultation with national primary care bodies to provide support and guidance for students considering a career in primary care. Primary care-focused career advice should be incorporated into the undergraduate curriculum. Student-led primary care groups can offer an alternative source of support and guidance. © Blackwell Publishing Ltd 2012.

  11. Environmental Education in Mexican Schools: The Primary Level.

    Science.gov (United States)

    Barraza, Laura

    2001-01-01

    Discusses schools' relevance in developing environmental awareness in young children. Explains that the primary-level national curriculum and the Mexican educational system are working toward an environmental policy. (Author/MM)

  12. Primary care teams: New Zealand's experience with community-governed non-profit primary care.

    Science.gov (United States)

    Crampton, Peter; Davis, Peter; Lay-Yee, Roy

    2005-05-01

    Community-governed non-profit primary care organisations started developing in New Zealand in the late 1980s with the aim to reduce financial, cultural and geographical barriers to access. New Zealand's new primary health care strategy aims to co-ordinate primary care and public health strategies with the overall objective of improving population health and reducing health inequalities. The purpose of this study is to carry out a detailed examination of the composition and characteristics of primary care teams in community-governed non-profit practices and compare them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. The study used data from a representative national cross-sectional survey of general practitioners in New Zealand (2001/2002). Primary care teams were largest and most heterogeneous in community-governed non-profit practices, which employed about 3% of the county's general practitioners. Next most heterogeneous in terms of their primary care teams were practices that belonged to an Independent Practitioner Association, which employed the majority of the country's general practitioners (71.7%). Even though in absolute and relative terms the community-governed non-profit primary care sector is small, by providing a much needed element of professional and organisational pluralism and by experimenting with more diverse staffing arrangements, it is likely to continue to have an influence on primary care policy development in New Zealand.

  13. Spatial Vegetation Data for Petrified Forest National Park Vegetation Mapping Project

    Data.gov (United States)

    National Park Service, Department of the Interior — The Petrified Forest National Park Vegetation Map Database was developed as a primary product in the Petrified Forest National Park Vegetation Classification,...

  14. Spatial Vegetation Data for Canyon De Chelly National Monument Vegetation Mapping Project

    Data.gov (United States)

    National Park Service, Department of the Interior — The Canyon de Chelly National Monument Vegetation Map Database was developed as a primary product in the Canyon de Chelly National Monument Vegetation...

  15. Spatial Vegetation Data for Mesa Verde National Park Vegetation Mapping Project

    Data.gov (United States)

    National Park Service, Department of the Interior — The Mesa Verde National Park Vegetation Map Database was developed as a primary product in the Mesa Verde National Park Vegetation Classification, Distribution, and...

  16. National medalist

    Science.gov (United States)

    President Clinton has chosen eight prominent American scientists to receive the 1994 National Medal of Science, the nation's highest scientific honor. Frank Press, an AGU member and geophysicist at the Carnegie Institution of Washington, numbers among the eight science medalists who will receive their medals in October, according to an announcement last week by Jack Gibbons, assistant to the president for science and technology. The president chose the other seven recipients from the fields of structural engineering, organic photochemistry, theoretical physics, biology, computer science, sociology, and biochemistry.

  17. Primary Intraosseous Meningioma.

    Science.gov (United States)

    Chen, Thomas C

    2016-04-01

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

  18. Hyperaldosteronism - primary and secondary

    Science.gov (United States)

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

  19. The Danish National Chronic Lymphocytic Leukemia Registry

    DEFF Research Database (Denmark)

    da Cunha-Bang, Caspar; Geisler, Christian Hartmann; Enggaard, Lisbeth

    2016-01-01

    AIM: In 2008, the Danish National Chronic Lymphocytic Leukemia Registry was founded within the Danish National Hematology Database. The primary aim of the registry is to assure quality of diagnosis and care of patients with chronic lymphocytic leukemia (CLL) in Denmark. Secondarily, to evaluate...

  20. Sports Nation

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    China is working to become a global sports power International Olympic Committee President Jacques Rogge watched China’s 11th National Games at Jinan’s stadium in Shandong Province on October 16, 2009. His high-profile attendance has set the

  1. Nations Within.

    Science.gov (United States)

    Sheets, Rosa Hernandez

    1998-01-01

    Karen Gayton Swisher (Sioux), chair of teacher education at Haskell Indian Nations University (Kansas), discusses the history of American Indian education, its effects on Indian families and cultures, overcoming stereotypes, how teachers can teach Indian children more effectively, the importance of Indian interpretations of Indian education and…

  2. Happy Nation

    DEFF Research Database (Denmark)

    Baron, Christian

    Happy Nation er et stykke eksperimentel teknologiformidling, der er udformet som en skønlitterær roman. Værket tager udgangspunkt i et fremtidsscenarie, hvor virtual reality er blevet en hverdagsteknologi, hvis sansedel bliver understøttet af implantater, der kan foretage dyb hjernestimulation...

  3. Nations Within.

    Science.gov (United States)

    Sheets, Rosa Hernandez

    1998-01-01

    Karen Gayton Swisher (Sioux), chair of teacher education at Haskell Indian Nations University (Kansas), discusses the history of American Indian education, its effects on Indian families and cultures, overcoming stereotypes, how teachers can teach Indian children more effectively, the importance of Indian interpretations of Indian education and…

  4. Highly Adaptive Primary Mirror Having Embedded Actuators, Sensors, and Neural Control Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Xinetics has demonstrated the technology required to fabricate a self-compensating highly adaptive silicon carbide primary mirror system having embedded actuators,...

  5. Primary osteosarcoma of breast

    Science.gov (United States)

    Gull, Sadaf; Patil, Prashant; Spence, Roy AJ

    2011-01-01

    Primary osteosarcoma of breast is rare. The authors present a case of a 51-year-old female who was admitted with a large necrotising tumour involving the right breast. CT scan confirmed chest wall invasion along with a solitary lung metastasis. She underwent a primary mastectomy with chest wall reconstruction. Unfortunately 3 months later she developed local recurrence. PMID:22688473

  6. Using Primary Source Documents.

    Science.gov (United States)

    Mintz, Steven

    2003-01-01

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

  7. Primary Spinal Meningeal Melanocytoma

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-12-15

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

  8. Using Primary Source Documents.

    Science.gov (United States)

    Mintz, Steven

    2003-01-01

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

  9. Bilateral primary writing tremor.

    Science.gov (United States)

    Jimenez-Jimenez; Cabrera-Valdivia; Orti-Pareja; Gasalla; Tallon-Barranco; Zurdo

    1998-11-01

    Primary writing tremor is a task-specific tremor that is considered to be unilateral. We report a 59-year-old man with a 5-year history of a typical primary writing tremor in the right hand who developed similar symptoms in the left hand. Copyright 1998 Lippincott Williams & Wilkins

  10. Transforming Primary Mathematics

    Science.gov (United States)

    Askew, Mike

    2011-01-01

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

  11. Primary health care.

    Science.gov (United States)

    Kitai, A

    1986-07-01

    Development of primary care in Japan in still relatively unorganized and unstructured. As mentioned above, the author describes some strengths and weaknesses of the Japanese primary care system. In addressing the weaknesses the following suggestions are offered for the Japanese primary care delivery system: Increase the number of emergency rooms for all day, especially on holidays and at night. Introduce an appointment system. Introduce an open system of hospitals. Coordinate with public hospitals and primary care clinics. Organize the referral system between private practitioners and community hospitals. Increase the number of paramedical staff. Strengthen group practice among primary care physicians. Increase the establishment of departments of primary care practice with government financial incentives to medical schools and teaching hospitals. Develop a more active and direct teaching role for primary care practice or family practice at undergraduate, graduate, and postgraduate levels. Improve and maintain present health insurance payment method, shifting from quantity of care to quality and continuity of care. Introduce formal continuing education. Introduce formal training programs of primary care and strengthen ambulatory care teaching programs.

  12. Application of the Quartz-flexure Accelerometer to the Development of Ultra-low Frequency Vibration National Primary Standard Device%石英挠性加速度计在超低频振动国家基准研制中的应用研究

    Institute of Scientific and Technical Information of China (English)

    于梅; 刘爱东; 何闻; 杨丽峰; 胡红波; 左爱斌; 马明德

    2011-01-01

    The improved quartz-flexure accelerometer with independent developed condition-amplifier is adopted as the vibration pickup sensor in ultra-low frequency vibration feedback control, and as the standard implement for performance measuring of ultra-low frequency vibration primary standard device.The distortion of vibrator output acceleration waveform is decreased effectively, and the effect of environmental vibration is suppressed to some extent.The acceleration distortion is less than 1% above 0.002 Hz.It solves the measurement means problem caused by without measuring sensor below 1Hz.The stability and repeatability meet requirements of standard devices.It is considered that it can be used as the standard implement of calibration and the check standard for low frequency or ultra-low frequency vibration national primary standard and standard devices.%介绍了超低频振动国家基准装置.采用改进型石英挠性加速度计SA704和研发的适配器MSA-I组成的振动套组,作为超低频振动台负反馈控制的拾振器和装置性能测试的标准器,有效地降低了振动台台面输出加速度波形的失真度,抑制了环境振动的影响,实现了0.002 Hz以上加速度失真度小于1%;解决了1 Hz以下超低频段无测量传感器的问题.该套组可作为低频和超低频振动基标准装置量值传递的标准器和核查标准.

  13. Pedagogy and Primary Sources: Outcomes of the Library of Congress' Professional Development Program, Teaching with Primary Sources at Loyola

    Science.gov (United States)

    Fry, Michelle L.

    2010-01-01

    Until recently, few K-12 teachers outside of social studies have integrated primary sources in classroom instruction. Integrating primary sources in educational practice does require an uncommon pedagogical understanding. Addressing this K-12 educator need is the Library of Congress. Recently, the Library implemented a national educator…

  14. 77 FR 9852 - Special Regulations; Areas of the National Park System, Cape Cod National Seashore

    Science.gov (United States)

    2012-02-21

    .... DATES: This rule is effective March 22, 2012. FOR FURTHER INFORMATION CONTACT: Craig Thatcher, Acting... primary authors of this regulation were Craig Thatcher, Acting Chief Ranger, Cape Cod National...

  15. US Army primary radiation standards complex

    Energy Technology Data Exchange (ETDEWEB)

    Rogers, S.C. [Radiation Standards and Dosimetry Laboratory, Redstone Arsenal, AL (United States)

    1993-12-31

    This paper describes the U.S. Army Primary Radiation Standards Complex (PRSC) to be constructed at Redstone Arsenal, Alabama. The missions of the organizations to be located in the PRSC are described. The health physics review of the facility design is discussed. The radiation sources to be available in the PRSC and the resulting measurement capabilities of the Army Primary Standards Laboratory Nucleonics section are specified. Influence of the National Voluntary Laboratory Accrediation Program (NVLAP) accreditation criteria on facility design and source selection is illustrated.

  16. 重庆市基层医疗卫生机构实施国家基本药物制度的实践与思考%Practice and Thinking about National Essential Drug System of Primary Medical Institution in Chongqing

    Institute of Scientific and Technical Information of China (English)

    路鱼涓; 刘志远

    2012-01-01

    OBJECTIVE: To study the effects of the implementation of national essential drug system in primary medical institutions in Chongqing. METHODS: Literature study and qualitative research were conducted. RESULTS: There were among problems in the implementation of essential drug system in primary medical institutions in Chongqing, such as species composition of essential drugs was unreasonable; the principle for the selection of experts was not clear; distribution efficiency was affected by purchase click-trough ratio; uniform bidding and distribution was more expensive than independent purchase; service population estimation method was unreasonable, and the motivation of staff was not high at primary level; the connection of essential drug system with basic medical insurance system should be strengthened. CONCLUSIONS: It is suggested to management essential drug list dynamically and establish the selection principle of scientific experts; centralized bidding and purchasing to follow market principles; estimate service population reasonably and give full play to incentives; strengthen supervision and speed up synchronous connection of medical care, medicine and insurance.%目的:研究基层医疗卫生机构实施国家基本药物制度的实践成效.方法:采用文献资料研究和专家访谈法.结果:重庆市实施国家基本药物制度的实践中存在不少问题,例如基本药物品种构成不合理,遴选专家选拔原则不清晰;配送效率受采购点击率影响;服务人口测算方法不合理、基层人员工作积极性不高;国家基本药物制度与基本医疗保险制度衔接有待加强.结论:应动态管理基本药物目录、建立科学原则选拔专家;集中招标采购遵循市场原则;合理测算服务人口、充分发挥激励机制;加强监督,加快医疗、医药、“医保”同步衔接.

  17. Nation branding and sustainable competitiveness of nations

    OpenAIRE

    2009-01-01

    Considering the importance of explaining how a nation brand is effectively managed and how nation branding aligns the nation's brand with country management so as to gain competitiveness, this research aims to assess the role of nation branding and to create a strategic management tool for nation branding to achieve sustainable competitiveness of nations. Focusing on performance in nation branding, the dissertation develops a brand management model towards a systematic and strategic applicati...

  18. National Development Generates National Identities

    Science.gov (United States)

    2016-01-01

    The purpose of the article is to test the relationship between national identities and modernisation. We test the hypotheses that not all forms of identity are equally compatible with modernisation as measured by Human Development Index. The less developed societies are characterised by strong ascribed national identities based on birth, territory and religion, but also by strong voluntarist identities based on civic features selected and/or achieved by an individual. While the former decreases with further modernisation, the latter may either decrease or remain at high levels and coexist with instrumental supranational identifications, typical for the most developed countries. The results, which are also confirmed by multilevel regression models, thus demonstrate that increasing modernisation in terms of development contributes to the shifts from classical, especially ascribed, identities towards instrumental identifications. These findings are particularly relevant in the turbulent times increasingly dominated by the hardly predictable effects of the recent mass migrations. PMID:26841050

  19. Primary myelofibrosis L.

    Directory of Open Access Journals (Sweden)

    L. M. Meshcheryakova

    2014-07-01

    Full Text Available Literature data of idiopathic myelofibrosis are presented: classification, diagnostic criteria, morphological and molecular features. Particular attention is given to therapy of various clinical forms of primary myelofibrosis.

  20. Primary meningeal rhabdomyosarcoma.

    Science.gov (United States)

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

    2011-01-01

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

  1. Primary infertility (image)

    Science.gov (United States)

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

  2. Histoplasmosis - acute (primary) pulmonary

    Science.gov (United States)

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

  3. Primary Amoebic Meningoencephalitis

    National Research Council Canada - National Science Library

    Gupta, Ritu; Parashar, M K; Kale, Aditya

    2015-01-01

    Primary amoebic meningoencephalitis due to free living amoeba, also called 'brain eating amoeba', Naegleria fowleri, was detected in retroviral disease patient of 40 years who has history of using well water...

  4. Primary Meningeal Rhabdomyosarcoma

    Directory of Open Access Journals (Sweden)

    Manisha Palta

    2011-01-01

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

  5. ESTHETICS IN PRIMARY TEETH

    National Research Council Canada - National Science Library

    Mathew Renu Ann

    2013-01-01

    .... Esthetic restoration of primary anterior teeth can be especially challenging due to the small size of the teeth, close proximity of pulp to tooth surface, relatively thin enamel and surface area...

  6. Primary headache disorders.

    Science.gov (United States)

    Benoliel, Rafael; Eliav, Eli

    2013-07-01

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

  7. Teaching primary care obstetrics

    Science.gov (United States)

    Koppula, Sudha; Brown, Judith B.; Jordan, John M.

    2014-01-01

    Abstract Objective To explore the experiences and recommendations for recruitment of family physicians who practise and teach primary care obstetrics. Design Qualitative study using in-depth interviews. Setting Six primary care obstetrics groups in Edmonton, Alta, that were involved in teaching family medicine residents in the Department of Family Medicine at the University of Alberta. Participants Twelve family physicians who practised obstetrics in groups. All participants were women, which was reasonably representative of primary care obstetrics providers in Edmonton. Methods Each participant underwent an in-depth interview. The interviews were audiotaped and transcribed verbatim. The investigators independently reviewed the transcripts and then analyzed the transcripts together in an iterative and interpretive manner. Main findings Themes identified in this study include lack of confidence in teaching, challenges of having learners, benefits of having learners, and recommendations for recruiting learners to primary care obstetrics. While participants described insecurity and challenges related to teaching, they also identified positive aspects, and offered suggestions for recruiting learners to primary care obstetrics. Conclusion Despite describing poor confidence as teachers and having challenges with learners, the participants identified positive experiences that sustained their interest in teaching. Supporting these teachers and recruiting more such role models is important to encourage family medicine learners to enter careers such as primary care obstetrics. PMID:24627402

  8. Primary biliary cirrhosis: Report

    Directory of Open Access Journals (Sweden)

    Filipović Branka

    2002-01-01

    Full Text Available Chronic non-suppurative destructive cholangitis, the so-called primary biliary cirrhosis, is characterised by changes, which occur in intrahepatic bile ducts in early stages and in hepatic parenchyma as the disease progresses. The disease gradually evolves into the full-blown picture of biliary cirrhosis. Primary biliary cirrhosis predominantly affects women between 35 and 60 years of age in all social classes and in all races. Our patient was a woman, old 78 years old who admitted for treatment of hypertrophie cardiomyopathy. During the routine laboratory exploration signs of cholestasis were noted: higher values of alkaline phosphatase and gamma glutamyl transferase, combined with low level of platelets, probably of autoimmune origin. Hypercholesterolaemia (7.8 mmol/L associated with normal values of triglycerides was observed. The main criterion for establishing the diagnosis of primary biliary cirrhosis was the titer of antimito-chondrial antibodies in the serum, which was 1:640. At the same time, she had a urinary infection, caused by Escherichia coli, which confirmed possible relationship between primary biliary cirrhosis and occurence of some Gramm negative bacteria, reported elsewhere. On the other hand, biopsy of the liver was just an auxiliary method, serving for the confirmation of diagnosis. Ursodeoxycholic acid was used as the main drug in the therapy of primary biliary cirrhosis. This case of primary biliary cirrhosis is a worth report because of the comorbidity with cardiac symptoms, which were covering symptoms of hepatic disorder.

  9. Primary Aldosteronism and ARMC5 Variants

    Science.gov (United States)

    Zilbermint, Mihail; Xekouki, Paraskevi; Faucz, Fabio R.; Berthon, Annabel; Gkourogianni, Alexandra; Schernthaner-Reiter, Marie Helene; Batsis, Maria; Sinaii, Ninet; Quezado, Martha M.; Merino, Maria; Hodes, Aaron; Abraham, Smita B.; Libé, Rossella; Assié, Guillaume; Espiard, Stéphanie; Drougat, Ludivine; Ragazzon, Bruno; Davis, Adam; Gebreab, Samson Y.; Neff, Ryan; Kebebew, Electron; Bertherat, Jérôme; Lodish, Maya B.

    2015-01-01

    Context: Primary aldosteronism is one of the leading causes of secondary hypertension, causing significant morbidity and mortality. A number of genetic defects have recently been identified in primary aldosteronism, whereas we identified mutations in ARMC5, a tumor-suppressor gene, in cortisol-producing primary macronodular adrenal hyperplasia. Objective: We investigated a cohort of 56 patients who were referred to the National Institutes of Health for evaluation of primary aldosteronism for ARMC5 defects. Methods: Patients underwent step-wise diagnosis, with measurement of serum aldosterone and plasma renin activity followed by imaging, saline suppression and/or oral salt loading tests, plus adrenal venous sampling. Cortisol secretion was also evaluated; unilateral or bilateral adrenalectomy was performed, if indicated. DNA, protein, and transfection studies in H295R cells were conducted by standard methods. Results: We identified 12 germline ARMC5 genetic alterations in 20 unrelated and two related individuals in our cohort (39.3%). ARMC5 sequence changes in 6 patients (10.7%) were predicted to be damaging by in silico analysis. All affected patients carrying a variant predicted to be damaging were African Americans (P = .0023). Conclusions: Germline ARMC5 variants may be associated with primary aldosteronism. Additional cohorts of patients with primary aldosteronism and metabolic syndrome, particularly African Americans, should be screened for ARMC5 sequence variants because these may underlie part of the known increased predisposition of African Americans to low renin hypertension. PMID:25822102

  10. Nation branding and sustainable competitiveness of nations

    NARCIS (Netherlands)

    Lee, Kyung Mi

    2009-01-01

    Considering the importance of explaining how a nation brand is effectively managed and how nation branding aligns the nation's brand with country management so as to gain competitiveness, this research aims to assess the role of nation branding and to create a strategic management tool for nation

  11. Nation branding and sustainable competitiveness of nations

    NARCIS (Netherlands)

    Lee, Kyung Mi

    2009-01-01

    Considering the importance of explaining how a nation brand is effectively managed and how nation branding aligns the nation's brand with country management so as to gain competitiveness, this research aims to assess the role of nation branding and to create a strategic management tool for nation br

  12. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's.

  13. Other primary headaches

    Directory of Open Access Journals (Sweden)

    Anish Bahra

    2012-01-01

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

  14. Modern Languages in the Primary Curriculum: Are We Creating Conditions for Success?

    Science.gov (United States)

    McLachlan, Angela

    2009-01-01

    As the 2010 deadline for implementation of the National Languages Strategy in primary schools approaches, how effective is the current national strategy likely to be in embedding modern languages successfully into the primary curriculum? Have lessons been learnt from the last--and ultimately failed--attempt to introduce languages into the…

  15. Danish National Lymphoma Registry

    DEFF Research Database (Denmark)

    Arboe, Bente; Josefsson, Pär; Jørgensen, Judit;

    2016-01-01

    AIM OF DATABASE: The Danish National Lymphoma Registry (LYFO) was established in order to monitor and improve the diagnostic evaluation and the quality of treatment of all lymphoma patients in Denmark. STUDY POPULATION: The LYFO database was established in 1982 as a seminational database including...... all lymphoma patients referred to the departments of hematology. The database became nationwide on January 1, 2000. MAIN VARIABLES: The main variables include both clinical and paraclinical variables as well as details of treatment and treatment evaluation. Up to four forms are completed for each...... patient: a primary registration form, a treatment form, a relapse form, and a follow-up form. Variables are used to calculate six result quality indicators (mortality 30 and 180 days after diagnosis, response to first-line treatment, and survival estimates 1, 3, and 5 years after the time of diagnosis...

  16. Primary hepatic carcinoid tumor

    Directory of Open Access Journals (Sweden)

    Gao Jinbo

    2011-11-01

    Full Text Available Abstract Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.

  17. Primary renal synovial sarcoma

    Directory of Open Access Journals (Sweden)

    Girish D. Bakhshi

    2012-03-01

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

  18. Normocalcemic primary hyperparathyroidism

    Science.gov (United States)

    Bilezikian, John P.; Silverberg, Shonni J.

    2011-01-01

    SUMMARY Primary hyperparathyroidism is a common disorder of mineral metabolism characterized by incompletely regulated, excessive secretion of parathyroid hormone from one or more of the parathyroid glands. The historical view of this disease describes two distinct entities marked by two eras. When primary hyperparathyroidism was first discovered about 80 years ago, it was always symptomatic with kidney stones, bone disease and marked hypercalcemia. With the advent of the multichannel autoanalyzer about 40 years ago, the clinical phenotype changed to a disorder characterized by mild hypercalcemia and the absence of classical other features of the disease. We may now be entering a 3rd era in the history of this disease in which patients are being discovered with normal total and ionized serum calcium concentrations but with parathyroid hormone levels that are consistently elevated. In this article, we describe this new entity, normocalcemic primary hyperparathyroidism, a forme fruste of the disease. PMID:20485897

  19. Primary lymphoma of the brain

    Science.gov (United States)

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

  20. Prevenção quaternária na atenção primária à saúde: uma necessidade do Sistema Único de Saúde Quaternary prevention in primary care: a necessity for the Brazilian Unified National Health System

    Directory of Open Access Journals (Sweden)

    Armando Henrique Norman

    2009-09-01

    Full Text Available Em 2003, a Organização Mundial de Colégios Nacionais, Academias e Associações Acadêmicas de Médicos gerais/Médicos de Família (WONCA propôs um conceito relativamente pouco discutido que visa proteger os pacientes da intervenção médica desnecessária e prevenir iatrogenias: a prevenção quaternária. Tal conceito tem evidente relevância para a saúde pública e para o Sistema Único de Saúde (SUS, em tempos de intensa medicalização social e expansão da atenção à saúde via Estratégia Saúde da Família. Neste artigo, o conceito de prevenção quaternária é apresentado e contextualizado, e sua relevância é discutida, ressaltando três situações comuns do cuidado médico geradoras de grande iatrogenia: excesso de rastreamento, de solicitação de exames complementares e de medicalização de fatores de risco. Defende-se a necessidade da adoção e discussão deste conceito no SUS e especialmente na atenção primária à saúde.In 2003, the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA proposed a concept (that had previously received relatively little discussion aiming to protect patients from unnecessary medical interventions and to prevent iatrogenicity: quaternary prevention. In times of intense social medicalization, particularly in Brazil due to the expansion of health care through the Family Health Strategy, iatrogenicity has become a highly relevant issue for both public health and the Unified National Health System (SUS. This article presents the concept of quaternary prevention and discusses and frames its relevance in light of three common situations in medical care with potentially iatrogenic results: excessive screening, complementary tests, and medicalization of risk factors. We propose the inclusion and discussion of this concept in the SUS, especially in primary care.

  1. Primary leptomeningeal lymphoma

    Science.gov (United States)

    Taylor, Jennie W.; Flanagan, Eoin P.; O'Neill, Brian P.; Siegal, Tali; Omuro, Antonio; DeAngelis, Lisa; Baehring, Joachim; Nishikawa, Ryo; Pinto, Fernando; Chamberlain, Marc; Hoang-Xuan, Khe; Gonzalez-Aguilar, Alberto; Batchelor, Tracy; Blay, Jean-Yves; Korfel, Agnieszka; Betensky, Rebecca A.; Lopes, Maria-Beatriz S.

    2013-01-01

    Objective: To evaluate clinical presentation, optimal diagnostic evaluation and treatment, and outcome in primary leptomeningeal lymphoma, a rare form of primary CNS lymphoma without parenchymal or systemic involvement. Methods: The International Primary CNS Lymphoma Collaborative Group, a multidisciplinary group of physicians with a particular interest in primary CNS lymphoma, retrospectively identified cases of lymphoma isolated to the leptomeninges as diagnosed by CSF cytology, flow cytometry, or biopsy, without systemic or parenchymal brain/spinal cord lymphoma or immunodeficiency. Results: Forty-eight patients were identified, with median age at diagnosis of 51 years and median Eastern Cooperative Oncology Group performance status of 2. Presenting symptoms were multifocal in 68%. Leptomeningeal enhancement was seen in 74% and CSF profile was abnormal in all cases. CSF cytology detected malignant lymphocytes in 67%. Flow cytometry identified monoclonal population in 80%, as did receptor gene rearrangement studies in 71%. Sixty-two percent had B-cell lymphoma, 19% T-cell, and 19% unclassified. Treatment varied and included fractionated radiotherapy (36%), systemic chemotherapy (78%), and intra-CSF chemotherapy (66%), with 66% receiving ≥2 modalities. Seventy-one percent had a favorable clinical response; ultimately, 44% received salvage treatment. Median overall survival was 24 months, with 11 patients still alive at 50 months follow-up. Conclusion: Primary leptomeningeal lymphoma is a rare form of primary CNS lymphoma. Patients usually present with multifocal symptoms, with evidence of leptomeningeal enhancement and diagnostic CSF analysis. Although treatment is highly variable, patients have a better prognosis than previously reported and a subset may be cured. PMID:24107866

  2. Primary cutaneous leiomysarcoma

    Directory of Open Access Journals (Sweden)

    Shubhangi Vinayak Agale

    2011-01-01

    Full Text Available Primary cutaneous leiomyosarcoma of the skin is a rare soft tissue neoplasm, accounting for about 2-3% of all superficial soft tissue sarcomas. It arises between the ages of 50 and 70 years, and shows a greater predilection for the lower extremities. Clinically, it presents with solitary, well-circumscribed nodule and, microscopically, consists of fascicles of spindle-shaped cells with "cigar-shaped" nuclei. Local recurrence is known in this tumor. We document a case of primary cutaneous leiomyosarcoma in a 77-year-old man and discuss the histological features and immunohistochemical profile of this uncommon neoplasm.

  3. Bilateral Primary Intraocular Lymphoma

    Directory of Open Access Journals (Sweden)

    Mehrdad Karimi

    2011-01-01

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

  4. Melatonin for primary insomnia?

    Science.gov (United States)

    2009-07-01

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

  5. Neurobiology in primary headaches

    DEFF Research Database (Denmark)

    Edvinsson, Lars; Uddman, Rolf

    2005-01-01

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

  6. Primary Pulmonary Hodgkin Lymphoma

    OpenAIRE

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

    2015-01-01

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

  7. Assembly of primary cilia

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  8. Philosophy in Primary Schools?

    Science.gov (United States)

    White, John

    2012-01-01

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

  9. Primary and Presidential Candidates

    DEFF Research Database (Denmark)

    Goddard, Joseph

    2012-01-01

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

  10. Philosophy in Primary Schools?

    Science.gov (United States)

    White, John

    2012-01-01

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

  11. Primary cutaneous myoepithelial carcinoma

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  12. Multiple Primary Cancer Monograph

    Science.gov (United States)

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

  13. Surgery of Primary Melanomas

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-05-11

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

  14. Primary diffuse leptomeningeal gliosarcomatosis.

    Science.gov (United States)

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

    2015-04-01

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

  15. Primary ectopic frontotemporal craniopharyngioma

    Science.gov (United States)

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

    2015-01-01

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

  16. Primary cultures of astrocytes

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  17. National Security and National Development: A Critique

    African Journals Online (AJOL)

    DR Nneka

    services, decayed and collapsed infrastructure, environmental degradation and socio ... Nigeria as a nation is reported to be blessed by enormous human and natural ... There has been the tendency right from independence to view national .... security is the protection of national survival, while Ray (1987) says that national.

  18. Restoring primary anterior teeth.

    Science.gov (United States)

    Waggoner, William F

    2002-01-01

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

  19. National population policy.

    Science.gov (United States)

    1983-01-26

    India evolved a comprehensive national population policy in April 1967. The primary assumption behind this policy was that the population explosion was an offshoot of poverty and must be dealt with as a part of an overall design for a better life. Clear demographic goals were defined, and several programs were initiated as part of the policy in an effort to integrate family planning with the overall strategy of socioeconomic development. The following are among the more important features of the 1976 national population policy: 1) increase the marriage age from 15-18 years for girls and from 18 to 21 years for boys; 2) freeze the population figures at the 1971 level until the year 2001 for purposes of representation in the national parliament as well as for allocation of central assistance, devolution of taxes, and so forth to the States; 3) more attention to the education of girls; 4) a proper place for population education in the total system of education; 5) involvement of all ministries/departments of government in the family planning program; 6) increase in monetary compensation for sterilization; 7) institution of group awards as incentives for various organizations and bodies representing the people at local levels; 8) the intimate association of voluntary organizations with the implementation of the program; 9) more attention to research; and 10) greater use of motivational media, particularly in rural areas, for increasing acceptance of family planning. According to Indira Gandhi, the objective is not simply to curb population growth but to have happier and healthier families, which, in India's circumstances, means smaller families. In the 1st 5-year plan (1951-56) India's outlay on family planning (Rs. in crores) was 0.65. It had increased to 1010.00 by the 6th 5-year plan (1980-85).

  20. Acupuncture in primary care.

    Science.gov (United States)

    Mao, Jun J; Kapur, Rahul

    2010-03-01

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

  1. Cancer of unknown primary

    DEFF Research Database (Denmark)

    Dyrvig, Anne-Kirstine; Yderstræde, Knud Bonnet; Gerke, Oke

    2017-01-01

    Cancer of unknown primary (CUP) ranges within top 10 cancers in both incidence and mortality. As primary identification is crucial to choosing treatment, guidelines on CUP emphasize the diagnostic strategy. Whether guidelines are complied with, or if they are indeed helpful, is however unclear. We...... to procedures and patient survival. The cohort was investigated in terms of validity of diagnosis through cross-referencing with the Cancer Registry (CR), which served as gold standard for cancer diagnoses and patients' cancer histories.The NPR cohort consisted of 542 patients (275 males, 264 females) of whom...... after 4 years.The validity of a CUP diagnosis in NPR was low when using data from CR as reference. More than half the suspected CUP patients had a previous cancer diagnosis with CUP being the most frequent. Patients were diagnosed in compliance with guidelines indicating high external validity, but less...

  2. [Basics of primary immunodeficiencies].

    Science.gov (United States)

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

    2016-01-01

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

  3. Primary hyperparathyroidism and nephrolithiasis.

    Science.gov (United States)

    Vestergaard, Peter

    2015-05-01

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

  4. Primary renal hydatidosis

    Directory of Open Access Journals (Sweden)

    Johnsy Merla Joel

    2016-01-01

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

  5. Thematically Organized Social Studies: A Solution to the Primary Education Dilemma. Pull-Out Feature.

    Science.gov (United States)

    Nickell, Pat

    1995-01-01

    Maintains that the multiage primary school approach is rapidly gaining advocates across the nation. Asserts that the thematic approach used in the National Council for the Social Studies national standards provides a structure for this curriculum schema. Discusses teachers' concerns about curriculum change and strengths of the nongraded primary…

  6. [Primary care in France].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. TIGER/Line Shapefile, 2015, nation, U.S., Primary Roads National Shapefile

    Data.gov (United States)

    US Census Bureau, Department of Commerce — The TIGER/Line shapefiles and related database files (.dbf) are an extract of selected geographic and cartographic information from the U.S. Census Bureau's Master...

  8. TIGER/Line Shapefile, 2016, nation, U.S., Primary Roads National Shapefile

    Data.gov (United States)

    US Census Bureau, Department of Commerce — The TIGER/Line shapefiles and related database files (.dbf) are an extract of selected geographic and cartographic information from the U.S. Census Bureau's Master...

  9. Primary care for refugees.

    Science.gov (United States)

    Eckstein, Barbara

    2011-02-15

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

  10. Primary stabbing headache.

    Science.gov (United States)

    Pareja, Juan A; Sjaastad, Ottar

    2010-01-01

    Primary stabbing headache is characterized by transient, cephalic ultrashort stabs of pain. It is a frequent complaint with a prevalence of 35.2%, a female preponderance, and a mean age of onset of 28 years (Vågå study). Attacks are generally characterized by moderate to severe, jabbing or stabbing pain, lasting from a fraction of a second to 3s. Attack frequency is generally low, with one or a few attacks per day. The paroxysms generally occur spontaneously, during daytime. Most patients exhibit a sporadic pattern, with an erratic, unpredictable alternation between symptomatic and non-symptomatic periods. Paroxysms are almost invariably unilateral. Temporal and fronto-ocular areas are most frequently affected. Attacks tend to move from one area to another, in either the same or the opposite hemicranium. Jabs may be accompanied by a shock-like feeling and even by head movement - "jolts" -or vocalization. On rare occasions, conjunctival hemorrhage and monocular vision loss have been described as associated features. Primary stabbing headache may concur, synchronously or independently, with other primary headaches. In contrast to what is the case in adults, in childhood it is not usually associated with other headaches. Treatment is rarely necessary. Indomethacin, 75-150 mg daily, may seem to be of some avail. Celecoxib, nifedipine, melatonin, and gabapentin have been reported to be effective in isolated cases and small series of patients. The drug studies need corroboration. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. 78 FR 49728 - Availability of Seats for National Marine Sanctuary Advisory Councils

    Science.gov (United States)

    2013-08-15

    ... they are applying; community and professional affiliations; philosophy regarding the protection and... Advisory Council: Fishing (primary member); Fishing (alternate); and Education (alternate). Florida Keys... Council: Education (primary member); and Education (alternate). Hawaiian Islands Humpback Whale National...

  12. Saberes escolares de uma escola primária paulista: regras de civilidade e noções de moral, civismo e nacionalismo (1930-1980 - Schooling knowledgesfrom paulista primary school: civilizing rules and moral notions, civism and nationalism (1930-1980

    Directory of Open Access Journals (Sweden)

    Laurizete Ferragut Passos, Diva Otero Pavan

    2011-03-01

    Full Text Available Resumo O presente texto objetiva expor resultados da  pesquisa  sobre os saberes escolares, realizada em uma da escola considerada exemplar: o Grupo   Escolar   Conde   do   Parnaíba. Foram utilizadas  fontes privilegiadas: entrevistas com professoras que trabalharam no período de   1930-1980,  anos  que  assinalam  o  processo  de   fixação  das diretrizes da educação nacional, o jornal do Grupo Escolar e diário de aula de uma das professoras. Os autores que serviram de apoio para análise foram Bourdieu,  Hebrard  e  Souza. Os comportamentos desejados pela ordem pública, expressados nas composições, fábulas e jornal escolar, eram introjetados  por meio da cópia e repetição e a mudança de  consciência e atitudes pelo canto  orfeônico, o ensino religioso e o escotismo. Palavras-chave: instituição; escola; civismo; nacionalismo; ensino primário.   SCHOOLING KNOWLEDGES  FROM PAULISTA PRIMARY SCHOOL: CIVILIZING RULES AND MORAL NOTIONS, CIVISM AND NATIONALISM (1930  –1980 Abstract The   text   aims   at   showing  research   results   about   schooling knowledges, made in  a  school considered an  example: Conde  do Parnaíba  schooling group. Privileged  sources were  used: interviews with teachers who worked from 1930 to 1980,  years that focus the national education process, the schooling group news and lesson plan from one of the teachers. The helpful authors for this analysis were Bourdieu, Hebrard and Souza. The disired behaviors by public order, expressed in  compositions, fables and school news were inserted by copying and  repetition  and  conscious  change  and   aptitudes  for orphonic melody, the religious teaching and the escotism. Keywords: institution;  school;  civism; nationalism; primary teaching.   SABERES  ESCOLARES  DE UNA ESCUELA PRIMARIA PAULISTA: REGLAS DE CIVILIDAD Y NOCIONES DE MORAL, CIVISMO Y NACIONALISMO (1930-1980 Resumen El

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

    Science.gov (United States)

    Rollow, William; Cucchiara, Peter

    2016-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Wilson Andrew

    2010-10-01

    reflect the quality, and efficiency of primary care. Conclusions A standardized instrument for describing and comparing primary care systems has been developed based on scientific evidence and consensus among an international panel of experts, which will be tested to all configurations of primary care in Europe, intended for producing comparable information. Widespread use of the instrument has the potential to improve the understanding of primary care delivery in different national contexts and thus to create opportunities for better decision making.

  15. Educating primary care providers about HIV disease: multidisciplinary interactive mechanisms.

    OpenAIRE

    Macher, A; Goosby, E; Barker, L; Volberding, P; Goldschmidt, R.; Balano, K B; Williams, A; Hoenig, L; Gould, B; Daniels, E.

    1994-01-01

    As HIV-related prophylactic and therapeutic research findings continue to evolve, the Health Resources and Services Administration (HRSA) of the Public Health Service has created multidisciplinary mechanisms to disseminate new treatment options and educate primary care providers at rural and urban sites throughout our nation's health care system. HRSA has implemented (a) the International State-of-the-Art HIV Clinical Conference Call Series, (b) the national network of AIDS Education and Trai...

  16. National Pregnancy and Health Survey: Drug Use Among Women Delivering Live Births (NPHS-1992)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The primary objective of the National Pregnancy and Health Survey (NPHS) was to produce national annual estimates of the percentages and numbers of mothers of live...

  17. 75 FR 77615 - Availability of Seats for the Hawaiian Islands Humpback Whale National Marine Sanctuary Advisory...

    Science.gov (United States)

    2010-12-13

    ... Whale National Marine Sanctuary Advisory Council and Extension of Application Deadline AGENCY: Office of... Humpback Whale National Marine Sanctuary Advisory Council: Honolulu County (primary only), Research (alternate only), Commercial Shipping, Whale Watching, Ocean Recreation, Business/ Commerce, Citizen-at-Large...

  18. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2001-03-01

    Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  19. National Emergency Communications Plan

    Science.gov (United States)

    2008-07-01

    Integration Center’s ( NIC ) Incident Management Systems Integration Division (IMSID) promotes plain- language standards and associated guidance. o Within...and Command and Control Centers Coordination Centers Lead Agency Supporting/Participating Departments and Agencies National Operations Center ( NOC ...National Guard Bureau NGO Nongovernmental Organization NIC National Integration Center NIEM National Information Exchange Model National Emergency

  20. Primary hypertriglyceridemia in children and adolescents.

    Science.gov (United States)

    Shah, Amy S; Wilson, Don P

    2015-01-01

    Primary disorders of lipid metabolism causing hypertriglyceridemia (HyperTG) result from genetic defects in triglyceride synthesis and metabolism. With the exception of lipoprotein lipase deficiency, these primary HyperTG disorders usually present in adulthood. However, some are unmasked earlier by precipitating factors, such as obesity and insulin resistance, and can be diagnosed in adolescence. Physical findings may be present and can include eruptive, palmer, or tuberoeruptive xanthomas. Triglyceride levels are very high to severe and can occur in the absence or the presence of other lipid abnormalities. Each of the causes of HyperTG is associated with an increased risk to develop recurrent pancreatitis and some may increase the risk of premature cardiovascular disease. Adoption of a healthy lifestyle that includes a low-fat diet, optimizing body weight, smoking avoidance/cessation, and daily physical activity is the first line of therapy. Pharmacologic therapies are available and can be beneficial in select disorders. Here, we review the causes of primary HyperTG in children and adolescents, discuss their clinical presentation and associated complications including the risk of pancreatitis and premature cardiovascular disease, and conclude with management and novel therapies currently in development. The goal of this article is to provide a useful resource for clinicians who may encounter primary HyperTG in the pediatric population. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  1. Localization of primary aldosteronism

    Energy Technology Data Exchange (ETDEWEB)

    Pagny, J.Y.; Chatellier, G.; Raynaud, A.; Plouin, P.F.; Corvol, P.

    1988-01-01

    After diagnosis of primary aldosteronism on the basis of biochemical evidence, the detection of the tumour is of crucial importance in the management of the disease. The efficacy of CT-Scan, Iodo-Cholesterol Scintigraphy, digitalized phlebography, adrenal vein sampling for steroid measurements (AVS), and Nuclear Magnetic Resonance (NMR) in 160 hypertensive patients with primary aldosteronism was reviewed. Diagnosis of Conn's adenoma (n=96) or Adrenal Hyperplasia (n=40) was confirmed by surgery or at least two concordant tumour localization tests. Scintigraphy gave a correct diagnosis in 53% of the 51 exams, CT-Scan in 82% of the 85 exams, and phlebography in 79% of 61 exams. Plasma Aldosterone/Cortisol ratio was 5 times higher on the side of adenoma in 55% of the 47 cases but this ratio was also present in 23% of 22 patients with adrenal hyperplasia. Each procedure exhibited few false positive and false negative cases. NMR performed in 15 patients with Conn's adenoma identified all the cases. But tumours displayed a signal close to the liver signal and identical to the normal adrenal. These results and the risk of invasive procedure failure of catheterization of the right adrenal vein (n=6) and adrenal haematoma (n=2) lead to propose a schema of exploration of patients with primary aldosteronism. The CT-Scan could be performed at the first step once the biological diagnosis confirmed. Phlebography and AVS will be performed only if tumour was less than 1 cm at the CT-Scan despite important biological abnormalities. This schema requires to be validated by a prospective evaluation.

  2. Bilateral primary breast lymphoma

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

  3. Primary Prevention With Statins

    DEFF Research Database (Denmark)

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

    2015-01-01

    BACKGROUND: Guidelines recommend initiating primary prevention for atherosclerotic cardiovascular disease (ASCVD) with statins based on absolute ASCVD risk assessment. Recently, alternative trial-based and hybrid approaches were suggested for statin treatment eligibility. OBJECTIVES: This study...... prevention of ASCVD with statins was superior to the trial-based and hybrid approaches. Our results indicate that the ACC/AHA guidelines will prevent more ASCVD events than the trial-based and hybrid approaches, while treating fewer people compared with the trial-based approach....

  4. Primary Pancreatic Lymphomas

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2006-05-01

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

  5. PRIMARY CARIES: AN OVERVIEW

    Directory of Open Access Journals (Sweden)

    Gaurav Solanki

    2012-01-01

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

  6. Primary leptomeningeal melanoma.

    Science.gov (United States)

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

    2014-06-01

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

  7. Epigenetics and primary care.

    Science.gov (United States)

    Wright, Robert; Saul, Robert A

    2013-12-01

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

  8. Cardiovascular Risk According to Plasma Apolipoprotein and Lipid Profiles in a Canadian First Nation* * This article is part of a joint publication initiative between Preventing Chronic Disease and Chronic Diseases in Canada. Preventing Chronic Disease is the primary publisher, while Chronic Diseases in Canada is the secondary publisher.

    OpenAIRE

    Riediger, Natalie D; Bruce, Sharon G; T. Kue Young

    2010-01-01

    Introduction Despite high diabetes rates among Canadian First Nations people, little is known about their cardiovascular disease risk. Our aim was to describe the apolipoprotein profile with respect to cardiovascular risk in a Canadian First Nation community. Methods In 2003, a representative sample of adult members of a Manitoba First Nation (N = 483) participated in a screening study for diabetes and diabetes complications. We assessed their cardiovascular risk factors. Results Sixty percen...

  9. Public Waterfowl Hunting Environmental Assessment for Anahuac National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The primary objective of this environmental assessment is to add Anahuac National Wildlife Refuge to the Code of Federal Regulations list of refuges open to...

  10. Nuisance Animal Control Plan for Loess Bluffs National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This Control Plan will cover control of invasive animal species on Squaw Creek National Wildlife Refuge. The primary nuisance species on Squaw Creek NWR is the...

  11. Nuisance Animal Control Plan for Mingo National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This Control Plan will cover control of invasive animal species on Mingo National Wildlife Refuge. The two primary nuisance species on Mingo NWR are beavers and...

  12. Annual Trapping Program at Missisquoi National Wildlife Refuge 2003

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The primary objective of the Missisquoi National Wildlife Refuge is to provide migratory feeding and resting habitat to waterfowl and other migratory birds using the...

  13. Migratory Bird Disease Contingency Plan : Parker River National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Canada geese, black ducks, mallards, and blue-winged teal are the primary waterfowl species that nest on Parker River National Wildlife Refuge. Black ducks and...

  14. Assessment of potential contaminant threats to Iroquois National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The primary purpose of the NBS Manual is to provide a standardized and systematic approach for identifying existing or potential contaminant problems on National...

  15. Timber Management Plan Montezuma National Wildlife Refuge 1959

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The primary objective of Montezuma National Wildlife Refuge is to produce maximum habitat for waterfowl. This will ultimately mean the elimination of all large...

  16. Tewaukon national Wildlife Refuge - Public Hunting and Fishing Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This public hunting and fishing plan for Tewaukon National Wildlife Refuge explains the primary wildlife management objectives for: waterfowl, migratory birds other...

  17. Cokeville Meadows National Wildlife Refuge Proposal : Final Environmental Impact Statement

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This environmental document assesses the potential environmental effects of establishment of a national wildlife refuge for the primary purpose of preserving and...

  18. Orthorectified Photomosaic for Walnut Canyon National Monument Vegetation Mapping Project

    Data.gov (United States)

    National Park Service, Department of the Interior — Orthophotos combine the image characteristics of a photograph with the geometric qualities of a map. The primary digital orthophotoquad (DOQ) is a 1-meter ground...

  19. Search and Rescue Plan: Big Stone National Wildlife Refuge

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This plan outlines search and rescue protocols for staff at Big Stone National Wildlife Refuge. The primary concern of a search and rescue policy is the protection...

  20. NAIP = USDA FSA National Agricultural Imagery Program: 2003 - Present

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The National Agriculture Imagery Program (NAIP) acquires aerial imagery during the agricultural growing seasons in the continental U.S. A primary goal of the NAIP...

  1. Forest Management Plan Area 1 Erie National Wildlife Refuge 1985

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The management objective on Area l at Erie National Wildlife Refuge is to increase forest diversity in order to benefit all indigenous species with primary...

  2. Mount Rainier National Park

    Science.gov (United States)

    Hoffman, Robert; Woodward, Andrea; Haggerty, Patricia K.; Jenkins, Kurt J.; Griffin, Paul C.; Adams, Michael J.; Hagar, Joan; Cummings, Tonnie; Duriscoe, Dan; Kopper, Karen; Riedel, Jon; Samora, Barbara; Marin, Lelaina; Mauger, Guillaume S.; Bumbaco, Karen; Littell, Jeremy S.

    2014-01-01

    Natural Resource Condition Assessments (NRCAs) evaluate current conditions for a subset of natural resources and resource indicators in national parks. NRCAs also report on trends in resource condition (when possible), identify critical data gaps, and characterize a general level of confidence for study findings. The resources and indicators emphasized in a given project depend on the park’s resource setting, status of resource stewardship planning and science in identifying high-priority indicators, and availability of data and expertise to assess current conditions for a variety of potential study resources and indicators. Although the primary objective of NRCAs is to report on current conditions relative to logical forms of reference conditions and values, NRCAs also report on trends, when appropriate (i.e., when the underlying data and methods support such reporting), as well as influences on resource conditions. These influences may include past activities or conditions that provide a helpful context for understanding current conditions and present-day threats and stressors that are best interpreted at park, watershed, or landscape scales (though NRCAs do not report on condition status for land areas and natural resources beyond park boundaries). Intensive cause-andeffect analyses of threats and stressors, and development of detailed treatment options, are outside the scope of NRCAs. It is also important to note that NRCAs do not address resources that lack sufficient data for assessment. For Mount Rainier National Park, this includes most invertebrate species and many other animal species that are subject to significant stressors from climate change and other anthropogenic sources such as air pollutants and recreational use. In addition, we did not include an analysis of the physical hydrology associated with streams (such as riverine landforms, erosion and aggradation which is significant in MORA streams), due to a loss of staff expertise from the USGS

  3. Primary Sclerosing Cholangitis

    Directory of Open Access Journals (Sweden)

    A Stiehl

    2000-01-01

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

  4. Primary pediatric gastrointestinal lymphoma

    Directory of Open Access Journals (Sweden)

    Ranjana Bandyopadhyay

    2011-01-01

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

  5. Primary pulmonary choriocarcinoma

    Science.gov (United States)

    Snoj, Ziga; Kocijancic, Igor

    2017-01-01

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

  6. Grammar and the English National Curriculum

    Science.gov (United States)

    Paterson, Laura Louise

    2010-01-01

    In 1998 the regulatory body for the National Curriculum, the Qualifications and Curriculum Authority, acknowledged that there was "widespread uncertainty" over the grammar requirements of the English Curriculum. In this paper I argue that the QCA still has not addressed this uncertainty. I analyse the 1999 and 2011 Primary English Curricula,…

  7. The National Archives UFO Project homepage

    OpenAIRE

    Clarke, David

    2012-01-01

    A permanent internet resource (http://www.nationalarchives.gov.uk/ufos) created by The National Archives in 2008 and curated by David Clarke. Includes background and contextual material, highlights guides, podcasts etc that supplement primary documents released to the public under the Freedom of Information Act.

  8. Chinese National Income, ca. 1661–1933

    NARCIS (Netherlands)

    van Leeuwen, Bas

    2015-01-01

    In recent decades, national income has become increasingly important as a measure of a nation’s economic health. In this study, we used a wide array of primary and secondary sources to arrive at values of the Chinese per capita gross domestic product (GDP) during the period of 1661–1933. We found a

  9. National Wildlife Refuges of Louisiana, UTM Zone 15 NAD83, USFWS (2001) [National_Wildlife_Refuges_LA_USFWS_2001

    Data.gov (United States)

    Louisiana Geographic Information Center — National Wildlife Refuges are federal lands managed by the U.S. Fish and Wildlife Service (USFWS). The primary source for boundary information is the USFWS Realty...

  10. National Environmental Policy Act

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Environmental Policy Act (NEPA) was the first major environmental law in the United States and established national environmental policies for the...

  11. National Wetlands Inventory Polygons

    Data.gov (United States)

    Minnesota Department of Natural Resources — Wetland area features mapped as part of the National Wetlands Inventory (NWI). The National Wetlands Inventory is a national program sponsored by the US Fish and...

  12. National Convective Weather Diagnostic

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Current convective hazards identified by the National Convective Weather Detection algorithm. The National Convective Weather Diagnostic (NCWD) is an automatically...

  13. The Danish National Chronic Lymphocytic Leukemia Registry

    DEFF Research Database (Denmark)

    da Cunha-Bang, Caspar; Geisler, Christian Hartmann; Enggaard, Lisbeth;

    2016-01-01

    , and for decision on treatment initiation as well as characteristics included in the CLL International Prognostic Index are collected. DESCRIPTIVE DATA: To ensure full coverage of Danish CLL patients in the registry, both continuous queries in case of missing data, and cross-referencing with the Danish National......, 3,082 patients have been registered. CONCLUSION: The Danish National CLL Registry is based within the Danish National Hematology Database. The registry covers a cohort of all patients diagnosed with CLL in Denmark since 2008. It forms the basis for quality assessment of CLL treatment in Denmark......AIM: In 2008, the Danish National Chronic Lymphocytic Leukemia Registry was founded within the Danish National Hematology Database. The primary aim of the registry is to assure quality of diagnosis and care of patients with chronic lymphocytic leukemia (CLL) in Denmark. Secondarily, to evaluate...

  14. Methotrexate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  15. Bezafibrate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  16. National Wetlands Inventory Lines

    Data.gov (United States)

    Minnesota Department of Natural Resources — Linear wetland features (including selected streams, ditches, and narrow wetland bodies) mapped as part of the National Wetlands Inventory (NWI). The National...

  17. Sandia National Laboratories

    Data.gov (United States)

    Federal Laboratory Consortium — For more than 60 years, Sandia has delivered essential science and technology to resolve the nation's most challenging security issues.Sandia National Laboratories...

  18. National Airspace System Resources

    Data.gov (United States)

    Department of Transportation — National Airspace System Resources (NASR) maintains the national aeronautical information database, containing static data related to NAS facilities and operations....

  19. National Health Expenditure Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — National Health Expenditure Accounts are comprised of the following, National Health Expenditures - Historical and Projected, Age Estimates, State Health...

  20. Primary Teacher Education in Malaysia

    Science.gov (United States)

    Ching, Chin Phoi; Yee, Chin Peng

    2012-01-01

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

  1. Primary and secondary stabbing headache.

    Science.gov (United States)

    Robbins, Matthew S; Evans, Randolph W

    2015-04-01

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

  2. Primary osteoporosis in children.

    Science.gov (United States)

    Tan, Lay Ong; Lim, Soo Yen; Vasanwala, Rashida Farhad

    2017-09-01

    Osteoporosis in childhood is uncommon, and it may be secondary to a spectrum of diverse conditions. Idiopathic juvenile osteoporosis is a primary osteoporosis of unknown aetiology present in previously well children and is a diagnosis of exclusion. We describe a 10-year-old prepubertal boy who presented with back pain of 1-week duration. His spinal X-ray showed generalised loss of vertebral body heights in keeping with osteoporosis. Endocrine and haematological work-up were normal. He was treated with vitamin D supplement and intravenous pamidronate. This case illustrates the general work-up and causes for paediatric osteoporosis, and the management for idiopathic juvenile osteoporosis. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Primary conjunctival amyloidosis

    Directory of Open Access Journals (Sweden)

    Chandana Chakraborti

    2014-01-01

    Full Text Available A 19-year-old previously healthy male presented with a 4 year history of painless drooping of right upper eyelid.On eversion of the right upper eyelid, a yellowish pink mass was seen in the tarsal region. Rest of the ocular examination was normal in both the eyes. Initial biopsy showed chronic inflammation. Subsequently, the entire mass was excised and histopathological examination showed the presence of amyloid in the subconjunctival stroma. At 3 months follow-up, similar lesion was detected in the right lower, left upper, and lower lid, which were treated with cryotherapy, with partial resolution. Patient has been followed up for more than 2 years without any complaints. To our knowledge, this is the first case report of an isolated primary conjunctival amyloidosis with involvement of both the upper and lower palpebral conjunctiva of either eye. It was treated successfully by excision and cryotherapy.

  4. Apoptosis in Primary Hyperparathyroidism.

    Science.gov (United States)

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

    2017-03-31

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

  5. [Primary spontaneous pneumomediastinum].

    Science.gov (United States)

    Togashi, K; Hosaka, Y

    2007-12-01

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

  6. Primary hyperparathyroidism in pregnancy.

    Science.gov (United States)

    Kamenický, Peter; Lecoq, Anne-Lise; Chanson, Philippe

    2016-06-01

    Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders in the general population but is rarely diagnosed during pregnancy. Symptoms of gestational PHPT may be unrecognized, or masked by physiological changes in calcium homeostasis associated with pregnancy. Gestational PHPT may have severe consequences for both mother and fetus. However, nowadays, gestational PHPT is usually diagnosed in earlier stages and milder forms, with low complication rates. Treatment should be individually tailored according to gestational age, the severity of hypercalcemia, and the risk-benefit balance. The conservative approach is preferred in mild forms, whereas surgery, usually performed during the second trimester, is reserved for symptomatic hypercalcemic PHPT. Given the young age of the patients, genetic causes should be considered.

  7. Primary aldosteronism. Clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Grant, C.S.; Carpenter, P.; van Heerden, J.A.; Hamberger, B.

    1984-05-01

    We retrospectively reviewed the clinical features, methods of diagnosis and localization, and results of treatment in 105 patients with primary aldosteronism seen between 1969 and 1981. Coincident with the use of computed tomography (CT), /sup 131/I-6-beta-iodomethyl norcholesterol scans (NP-59), and postural response studies, the study group was temporally divided into pre-1976 and post-1976 groups, and subdivided into groups with aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) due to bilateral adrenal hyperplasia. Our results indicate that aldosterone postural response studies and CT differentiate and localize APA and IHA reliably. Adrenalectomy is a safe and effective treatment for APA, whereas medical treatment alone is preferable for IHA.

  8. Primary ciliary dyskinesia

    Directory of Open Access Journals (Sweden)

    Plavec Goran

    2004-01-01

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

  9. Primary Fallopian Tube Carcinoma

    Directory of Open Access Journals (Sweden)

    Prasad K Shetty

    2011-01-01

    Full Text Available Primary Fallopian Tube Carcinoma (PFTC is rare and accounts for about 0.3% of all gynecologic cancers. Less than 1500 cases have been reported in the literature. It arises in postmenopausal women and typically presents with abdominal pelvic pain, vaginal bleeding and watery discharge. However, a correct diagnosis is rarely achieved preoperative, and in many cases, the diagnosis is made after incidental surgery for unrelated conditions commonly being ovarian carcinoma . Compared with ovarian carcinoma, PFTC more often presents at early stages, but it has a worse prognosis. PFTC is usually managed in the same manner as ovarian cancer. We report a case of Left PFTC that presented as Left ovarian mass, and we briefly review the literature.

  10. Primary thrombocytosis in children

    Science.gov (United States)

    Kucine, Nicole; Chastain, Katherine M.; Mahler, Michelle B.; Bussel, James B.

    2014-01-01

    Myeloproliferative neoplasms are uncommon disorders in children, for which we have limited understanding of the pathogenesis and optimal management. JAK2 and MPL mutations, while common drivers of myeloproliferative neoplasms in adult patients, are not clearly linked to pediatric disease. Management and clinical outcomes in adults have been well delineated with defined recommendations for risk stratification and treatment. This is not the case for pediatric patients, for whom there is neither a standard approach to workup nor any consensus regarding management. This review will discuss thrombocytosis in children, including causes of thrombocytosis in children, the limited knowledge we have regarding pediatric primary thrombocytosis, and our thoughts on potential risk stratification and management, and future questions to be answered by laboratory research and collaborative clinical study. PMID:24688110

  11. Primary mediastinal hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    Efstathiou A

    2006-04-01

    Full Text Available Abstract Background Hemangiopericytoma is a rare mesenchymal neoplasm, accounting for about 1% of vascular tumors The tumor occurs most commonly in the skin, subcutaneous soft tissues, muscles of the extremities, retroperitoneum but rarely in the lung, trachea or mediastinum. Case presentation A rare case of primary mediastinal hemangiopericytoma is presented. A 72-year-old woman was treated by complete surgical resection of the tumor. Details of the clinical and radiographic feature are presented. The patient's postoperative course was uneventful with no evidence of recurrence 9 months after the operation. Conclusion Hemangiopericytoma is an uncommon, potentially malignant tumor originating from pericytes in the small vessels and surgical radical excision is the treatment of choice, although the criteria for determining the area of resection have not been established. International literature has demonstrated that recurrent disease usually occurs within 2 years and therefore a long-term careful follow-up is required.

  12. The National Ecological Observatory Network

    Science.gov (United States)

    Michener, W. K.

    2006-05-01

    The National Ecological Observatory Network (NEON) is a research platform designed to advance understanding of how ecosystems and organisms respond to variations in climate and changes in land use. NEON is the first long-term ecological observatory conceived as a continental-scale network; equipped with standardized sensors, cyberinfrastructure, and data-collection protocols across the network; and designed to simultaneously address a common set of research questions and support investigator-driven ecological research in all regions of the United States. The Observatory focuses on variations in climate and land use because they are primary drivers of the Nation's environmental challenges, as identified by the National Research Council--i.e., biodiversity, biogeochemical cycles, climate change, hydroecology, infectious disease, invasive species, and land use. At the broadest scale, NEON links the complexity of climate variation to the behavior of ecological systems, a core aspect of ecological complexity. At the same time, because of the complexity of the interactions among humans and ecosystems, the network design includes NEON sites in wild, managed and urban systems within climate domains. Observatory data will also be part of a national education program designed to advance ecological science literacy through new programs and activities that develop and promote scientific ways of thinking.

  13. Primary fallopian tube carcinoma

    Directory of Open Access Journals (Sweden)

    Mladenović-Segedi Ljiljana

    2009-01-01

    Full Text Available Introduction. Primary fallopian tube carcinoma is extremely rare, making 0.3-1.6% of all female genital tract malignancies. Although the etymology of this tumor is unknown, it is suggested to be associated with chronic tubal inflammation, infertility, tuberculous salpingitis and tubal endometriosis. High parity is considered to be protective. Cytogenetic studies show the disease to be associated with over expression of p53, HER2/neu and c-myb. There is also some evidence that BRCA1 and BRCA2 mutations have a role in umorogeneis. Clinical features. The most prevailing symptoms with fallopian tube carcinoma are abdominal pain, abnormal vaginal discharge/bleeding and the most common finding is an adnexal mass. In many patients, fallopian tube carcinoma is asymptomatic. Diagnosis. Due to its rarity, preoperative diagnosis of primary fallopian tube carcinoma is rarely made. It is usually misdiagnosed as ovarian carcinoma, tuboovarian abscess or ectopic pregnancy. Sonographic features of the tumor are non-specific and include the presence of a fluid-filled adnexal structure with a significant solid component, a sausage-shaped mass, a cystic mass with papillary projections within, a cystic mass with cog wheel appearance and an ovoid-shaped structure containing an incomplete separation and a highly vascular solid nodule. More than 80% of patients have elevated pretreatment serum CA-125 levels, which is useful in follow-up after the definite treatment. Treatment. The treatment approach is similar to that of ovarian carcinoma, and includes total abdominal hysterectomy and bilateral salpingo-oophorectomy. Staging is followed with chemotherapy.

  14. Secondary Analysis of National Longitudinal Transition Study 2 Data

    Science.gov (United States)

    Hicks, Tyler A.; Knollman, Greg A.

    2015-01-01

    This review examines published secondary analyses of National Longitudinal Transition Study 2 (NLTS2) data, with a primary focus upon statistical objectives, paradigms, inferences, and methods. Its primary purpose was to determine which statistical techniques have been common in secondary analyses of NLTS2 data. The review begins with an…

  15. Primary Standards Laboratory report 1st half 1993

    Energy Technology Data Exchange (ETDEWEB)

    Levy, W.G.T. [comp.

    1993-11-01

    Sandia National Laboratories operates the Primary Standards Laboratory for the Department of Energy, Albuquerque Operations Office (DOE/AL). This report summarizes metrology activities that received emphasis in the first half of 1993 and provides information pertinent to the operation of the DOE/AL system-wide Standards and Calibration Program.

  16. 3-D Nanofilm Primary Li Air Battery Project

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA requires a new primary battery capable of providing specific energy exceeding 2000Wh/kg over an operating temperature range of 0oC to 35oC with a shelf life...

  17. Primary hyperoxaluria type 1 in The Netherlands : prevalence and outcome

    NARCIS (Netherlands)

    van Woerden, CS; Groothoff, JW; Davin, JC; Wijburg, FA

    2003-01-01

    Background. Primary hyperoxaluria type 1 (PH1) is a phenotypically heterogeneous disease. To date the relationship between biochemical parameters and outcome is unclear. We therefore undertook a national cohort study on biochemical and clinical parameters and outcome in PH1. Methods. Review of medic

  18. Equality of Educational Opportunities at Public Primary Schools in Argentina

    Science.gov (United States)

    Adrogue, Cecilia

    2013-01-01

    This paper assesses the degree of equality of educational opportunities across Argentina's public primary schools. The main finding is that there are inequalities between jurisdictions, but even greater inequalities within them, suggesting the existence of serious problems in the distribution of resources at the sub-national level. Following the…

  19. Aerial Photography and Imagery, Ortho-Corrected, This dataset contains imagery of Prince George's County in RGB format. The primary goal was to acquire Countywide Digital Orthoimagery at 6" ground pixel resolution., Published in 2009, 1:1200 (1in=100ft) scale, Maryland National Capital Park and Planning Commission.

    Data.gov (United States)

    NSGIC Non-Profit | GIS Inventory — Aerial Photography and Imagery, Ortho-Corrected dataset current as of 2009. This dataset contains imagery of Prince George's County in RGB format. The primary goal...

  20. Management of Primary Hyperparathyroidism: Can We Do Better?

    Science.gov (United States)

    Sharata, Ahmed; Kelly, Tracy L; Rozenfeld, Yelena; Hammill, Chet W; Schuman, Earl; Carlisle, James R; Aliabadi-Wahle, Shaghayegh

    2017-01-01

    The failure to follow national guidelines in management of various diseases has been previously established. We sought to quantify primary care providers' familiarity with primary hyperparathyroidism as it affects adherence to the 2009 National Institute of Health (NIH) consensus recommendations in treatment of primary hyperparathyroidism. A large primary care group was surveyed to determine their familiarity with the 2009 NIH consensus recommendations for management of primary hyperparathyroidism (PHPT). Retrospective review of the group's records (2009-2011) was performed to verify compliance. Survey responders included 109 clinicians, 31 per cent were familiar with all criteria for surgical intervention in asymptomatic patients and 34 per cent correctly identified appropriate surveillance testing for patients undergoing observation. Chart review identified 124 patients with PHPT. Of the patients who met NIH criteria, 34 per cent had a parathyroidectomy. Younger age, higher intact parathyroid hormone, hypercalciuria, and history of nephrolithiasis were associated with surgery in multivariable analysis. Of the observed patients, 16 per cent had appropriate surveillance studies. In conclusion, this study confirms suboptimal adherence with consensus recommendations in management of PHPT. A minority of clinicians demonstrated solid familiarity with management strategies, paralleling their treatment approach. Educational efforts may improve adherence with upcoming national recommendations.

  1. Raising the Achievement of Bilingual Learners in Primary Schools: Evaluation of the Pilot/Programme. Research Report RR758

    Science.gov (United States)

    White, Kerensa; Lewis, Karen; Fletcher-Campbell, Felicity

    2006-01-01

    The National Foundation for Educational Research (NFER) carried out an evaluation of a pilot/programme that was introduced in 2004 to help raise the achievement of bilingual learners in primary schools. Within participating authorities, pilot consultants were appointed and were managed by the Primary National Strategy managers and the Ethnic…

  2. 148 decentralization for national development in nigeria from a ...

    African Journals Online (AJOL)

    Ike Odimegwu

    Nigeria worsened the problematic state of the nation with varied practices of absolute .... earned wages below Nigerian national income per capital. More so, ... their full remunerations as the real land owners, and producers and .... 24:2-3, 14-15). .... private firms, local farmers and manufacturers of primary products at LGs; to ...

  3. National identitet og kultursyn

    DEFF Research Database (Denmark)

    Lindhardt, Eva

    2013-01-01

    I kapitel bliver forholdet mellem nation, national identitet og nationalisme undersøgt med inddragelse af G. F. Herder og N.F.S. Grundtvigs syn på forholdet mellem kultur og nation samt en modstilling af det kulturelle og politiske medborgerskab. Herefter problematiseres begrebet nation med...

  4. Primary total elbow arthroplasty

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2013-01-01

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

  5. Why health improves: defining the issues concerning 'comprehensive primary health care' and 'selective primary health care'.

    Science.gov (United States)

    Rifkin, S B; Walt, G

    1986-01-01

    What is the impact of technology on improving the life situations of people, especially the poor? How is this impact analyzed in terms of health improvements? These questions are paramount in the minds of health planners as they pursue national policies of primary health care, a policy popularized by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) and accepted by over 150 governments at Alma Ata in 1978. The purpose of this paper is to explore these questions in depth. It begins by giving the background to the debate, then examines the origins of two concepts which have dominated the field, those of 'primary health care' and 'selective primary health care.' On this basis it suggests areas of differences in the two concepts and discusses the policy and practical implications of confusing the two approaches. The paper suggests that the differences are firstly who controls the outcome of technological interventions and the perceived time frame in which plans can be carried out.

  6. Liquid cathode primary batteries

    Science.gov (United States)

    Schlaikjer, Carl R.

    1985-03-01

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

  7. Management of primary hypothyroidism.

    Science.gov (United States)

    Nordyke, R A; Gilbert, F I

    1990-07-01

    Primary hypothyroidism is a common condition requiring lifelong treatment and monitoring. The type and amount of thyroid hormone replacement, selection of laboratory tests, and timing of office visits are all important for optimizing patient well-being and reducing the costs of medical care. The aim of treatment is to bring the patient to the euthyroid state. Currently this is defined as a normal serum concentration of TSH by recently developed sensitive and specific immunometric assays, and is accomplished by titrating the dose of levothyroxine and changing it not more often than at 4- to 6-week intervals. As an indicator of euthyroidism, the sensitive TSH assay has advantages over tests of serum T4, FT4I, T3, FT4, and TSH by RIA because it is independent of TBG changes that result from pregnancy, birth-control pills, and estrogen replacement, is not spuriously elevated by the levothyroxine treatment itself, and is the only test that detects both subclinical hypothyroidism and subclinical hyperthyroidism. Additional serum tests are not usually necessary but have advantages under special circumstances. Once the optimal replacement dose is determined, monitoring can be done yearly or even bi-yearly, depending on the adequacy of patient education and patient compliance.

  8. Primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Marina G Silveira

    2008-01-01

    Full Text Available Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts, resulting in end-stage liver disease and reduced life expectancy. PSC primarily affects young and middle-aged men, often in association with underlying inflammatory bowel disease. The etiology of PSC includes immune-mediated components and elements of undefined nature. A cholestatic picture of liver biochemistries with elevations in serum alkaline phosphatase, nonspecific autoantibodies such as perinuclear antineutrophilic antibody, antinuclear antibodies and smooth muscle antibodies, and diffuse multifocal biliary strictures, resulting in a ‘beaded’ appearance on radiographic studies, are the hallmarks of the disease. No effective medical therapy is currently available, although clinical studies are in progress. Ursodeoxycholic acid at high doses (28 mg/kg/day to 30 mg/kg/day is the most promising agent but is unproven so far. Liver transplantation is currently the only life-extending therapy for patients with end-stage disease, although recurrent disease can be observed in the transplanted liver. The multiple complications of PSC include pruritus, fatigue, vitamin deficiencies, metabolic bone disease, peristomal varices, bacterial cholangitis, dominant biliary strictures, gallbladder stones and polyps, and malignancy, particularly cholangiocarcinoma, which is the most lethal complication of PSC.

  9. Primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Chapman Roger

    2006-10-01

    Full Text Available Abstract Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease of unknown aetiology characterised by inflammation and fibrosis of the biliary tree. The mean age at diagnosis is 40 years and men are affected twice as often as women. There is a reported annual incidence of PSC of 0.9–1.31/100,000 and point prevalence of 8.5–13.6/100,000. The onset of PSC is usually insidious and many patients are asymptomatic at diagnosis or have mild symptoms only such as fatigue, abdominal discomfort and pruritus In late stages, splenomegaly and jaundice may be a feature. In most, the disease progresses to cirrhosis and liver failure. Cholangiocarcinoma develops in 8–30% of patients. PSC is thought to be immune mediated and is often associated with inflammatory bowel disease, especially ulcerative colitis. The disease is diagnosed on typical cholangiographic and histological findings and after exclusion of secondary sclerosing cholangitis. Median survival has been estimated to be 12 years from diagnosis in symptomatic patients. Patients who are asymptomatic at diagnosis, the majority of whom will develop progressive disease, have a survival rate greater than 70% at 16 years after diagnosis. Liver transplantation remains the only effective therapeutic option for patients with end-stage liver disease from PSC, although high dose ursodeoxycholic acid may have a beneficial effect.

  10. Primary multidrug resistant tuberculosis

    Directory of Open Access Journals (Sweden)

    Sarkar Supriya

    2007-01-01

    Full Text Available A 37-year old man presented at our institution with back pain, low-grade fever and weight-loss. X-ray of chest (postero-anterior view showed multiple opacities with erosion of right 2nd and left 6th ribs. CT-scan of thorax and CT-guided FNAC con-firmed the diagnosis of tuberculosis of ribs. Even after 5-months of treatment with four first line drugs, the patient developed a cold abscess at the back. Mycobacterial culture and drug sensitivity of material aspirated by Radiometric method from the cold abscess showed growth of Mycobacterium tuberculosis, and those bacilli were resistant to both isoniazide and rifampicin. The patient did not have anti-tubercu-lar medication in the past, and that established the diagnosis of primary multidrug resistant tuberculosis of ribs. Patient was treated successfully with 2nd line drugs at the cost of moderate degree of hearing loss. After one and half years of treatment X-ray of chest (PA view showed complete healing of rib erosions with new bone formation.

  11. Liquid cathode primary batteries

    Energy Technology Data Exchange (ETDEWEB)

    Schlaikjer, C.R.

    1985-01-15

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

  12. Primary gastrointestinal lymphoma

    Institute of Scientific and Technical Information of China (English)

    Prasanna Ghimire; Guang-Yao Wu; Ling Zhu

    2011-01-01

    Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific,thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.

  13. Primary hyperoxaluria in infants

    Directory of Open Access Journals (Sweden)

    Manel Jellouli

    2016-01-01

    Full Text Available The infantile form of primary hyperoxaluria type-1 (PH-1 is characterized by a rapid progression to the end-stage renal disease (ESRD due to both increased oxalate load and reduced glomerular filtration rate. In the literature, data on this form are limited. The purpose of this study is to analyze retrospectively the clinical, biological, and radiological features of children who were diagnosed with PH-1 during the 1styear of life. We reviewed the records of all children with PH-1 diagnosed and followed-up at our department between January 1995 and December 2013. Among them, only infants younger than 12 months of age were retrospectively enrolled in the study. Fourteen infants with the median age of two months were enrolled in the study. At diagnosis, 11 patients had ESRD. All patients had nephrocalcinosis and two of them had calculi. The diagnosis was established in nine patients on the basis of the positive family history of PH-1, bilateral nephrocalcinosis, and quantitative crystalluria. In four patients, the diagnosis was made with molecular analysis of DNA. Kidney biopsy contributed to the diagnosis in one patient. During follow-up, two patients were pyridoxine sensitive and preserved renal function. Seven among 11 patients who had ESRD died, four patients are currently undergoing peritoneal dialysis. Children with infantile PH and ESRD are at high risk of early death. Peritoneal dialysis is not a treatment of choice. Combined liver-kidney transplantation is mandatory.

  14. The primary hyperoxalurias.

    Science.gov (United States)

    Bobrowski, Amy E; Langman, Craig B

    2008-03-01

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

  15. Parapharyngeal space primary tumours.

    Science.gov (United States)

    Grilli, Gianluigi; Suarez, Vanessa; Muñoz, María Gabriela; Costales, María; Llorente, José Luis

    The aim of this study is to present our experience with the diagnostic and therapeutic approaches for parapharyngeal space tumours. This study is a retrospective review of 90 patients diagnosed with tumours of the parapharyngeal space and treated surgically between 1984 and 2015. Patients whose tumours were not primary but invaded the parapharyngeal space expanding from another region, tumours originating in the deep lobe of the parotid gland and head and neck metastasis were excluded from this study. 74% percent of the parapharyngeal space neoplasms were benign and 26% were malignant. Pleomorphic adenoma was the most common neoplasm (27%), followed by paragangliomas (25%), miscellaneous malignant tumours (16%), neurogenic tumours (12%), miscellaneous benign tumours (10%), and malignant salivary gland tumours (10%). The transcervical approach was used in 56 cases, cervical-transparotid approach in 15 cases, type A infratemporal fossa approach in 13 cases, transmandibular approach in 4 cases and transoral approach in 2 cases. The most common complications were those deriving from nervous injuries. Most parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  16. Primary hyperparathyroidism in pregnancy.

    Science.gov (United States)

    Rchachi, Meryem; El Ouahabi, Hanan; Boujraf, Saïd; Ajdi, Farida

    2017-01-01

    Primary hyperparathyroidism (PHT) is a frequent and asymptomatic pathology in 80% of patients, and a parathyroidal adenoma is found in the most case. However, rare cases might occur during pregnancy; and the literature reported up to 200 cases. We report three cases of PHT that occurred during the second and last third trimesters of pregnancy stage in patients aged 26, 42 and 32-year-old. Despite diagnosis limitations, since scintigraphy is prohibited in pregnancy, the patients were managed conservatively with good prognosis for both mothers and babies. L'hyperparathyroïdie primaire (HTP) est une maladie fréquente et asymptomatique chez 80% des patients. Un adénome parathyroïdien est retrouvé chez une grande majorité des cas. Cependant, l'apparition au cours de la grossesse est particulièrement rare et la littérature ne rapporte que 200 cas. Nous en rapportons 3 cas d'hyperparathyroïdie âgés de 26, 42 et 32 ans, survenue au cours du deuxième et troisième trimestre de la grossesse. Malgré les limites diagnostiques dues à l'interdiction de la scintigraphie au cours de la grossesse, la gestion avait été faite de façon très conservative de sorte à avoir le meilleur pronostic pour les patientes leurs fétus.

  17. Seasonal and interannual patterns in primary production ...

    Science.gov (United States)

    Measurements of primary production and respiration provide fundamental information about the trophic status of aquatic ecosystems, yet such measurements are logistically difficult and expensive to sustain as part of long-term monitoring programs. However, ecosystem metabolism parameters can be inferred from high frequency water quality data collections using autonomous logging instruments. For this study, we analyzed such time series datasets from three Gulf of Mexico estuaries: Grand Bay, MS, Weeks Bay AL and Apalachicola Bay FL. Data were acquired from NOAA's National Estuarine Research Reserve System Wide Monitoring Program and used to calculate gross primary production (GPP), ecosystem respiration (ER) and net ecosystem metabolism (NEM) using Odum's open water method. The three systems present a diversity of estuaries typical of the Gulf of Mexico region, varying by as much as 2 orders of magnitude in key physical characteristics, such as estuarine area, watershed area, freshwater flow, and nutrient loading. In all three systems, gross primary production (GPP) and ecosystem respiration (ER) displayed strong seasonality, peaking in summer and being lowest during winter. Peak rates of GPP and ER exceeded 200 mmol O2 m-2 d-1 52 in all three estuaries. To our knowledge, this is the only study examining long term trends in rates of GPP, ER and NEM in estuaries. Variability in metabolism tended to be small among sites within each estuary. Nitrogen loading was high

  18. First National Regulation (Standard): What Will Be Ahead?

    OpenAIRE

    Konstyantyn Bezverkhiy

    2013-01-01

    The most notable innovation in regulatory accounting software in Ukraine was the adoption of the National Accounting Provision (Standard), 'General Requirements for Financial Statements' (NAP(S) 1) in 2013. The new provision was given the national status and it superseded the accounting standards which determined the order of each primary financial statement presentation. The changes were to be made to bring the national accounting and financial reporting in accordance with international acco...

  19. NODC Standard Format Primary Productivity 1 (F029) Data (1958-1983) (NCEI Accession 0014152)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This dataset contains data from measurements of primary productivity. The data are collected to provide information on nutrient levels and nutrient flow in offshore...

  20. Parent run science clubs: A case study at Nooitgedacht 88 primary school

    CSIR Research Space (South Africa)

    Butgereit, L

    2006-12-01

    Full Text Available Parent Run Science Clubs: A case study at Nooitgedacht 88 Primary School is a presentation case study presentation that will facilitate national, economic and social improvement through human capital development...

  1. Advanced Li/CFx Primary Batteries with Non-Flammable Electrolytes Project

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA seeks to develop high specific energy primary batteries that are safe and capable of performing under a wide temperature range, for manned space missions. To...

  2. Primary Productivity, NASA Aqua MODIS, 4.4 km, Global, EXPERIMENTAL

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Primary Productivity is calculated from NASA Aqua MODIS Chl a SST data. THIS IS AN EXPERIMENTAL PRODUCT: intended strictly for scientific evaluation by professional...

  3. How cheap is primary health care? Cost per script at the Heidedal ...

    African Journals Online (AJOL)

    Cost per script at the Heidedal Community Health Centre and National District Hospital in ... Log in or Register to get access to full text downloads. ... Primary health care is actually very expensive and good quality control is necessary.

  4. Academic Achievement and Psychosocial Profile of Egyptian Primary School Children in South Sinai

    Directory of Open Access Journals (Sweden)

    Zeinab M. Monir

    2016-10-01

    CONCLUSION: Comorbid academic and psychosocial dysfunction in primary school children were observed in South Sinai. A national strategy to minimise the educational gap between Bedouin and urban areas should be implemented.

  5. Primary Productivity, NASA Aqua MODIS and GOES Imager, 0.1 degrees, Global, EXPERIMENTAL

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Primary Productivity is calculated from NASA Aqua MODIS Chl a and NOAA GOES Imager SST data. THIS IS AN EXPERIMENTAL PRODUCT: intended strictly for scientific...

  6. Primary Productivity, NASA Aqua MODIS, 4.4 km, Global, EXPERIMENTAL

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Primary Productivity is calculated from NASA Aqua MODIS Chl a SST data. THIS IS AN EXPERIMENTAL PRODUCT: intended strictly for scientific evaluation by professional...

  7. Primary care in the Netherlands: current situation and trends

    Directory of Open Access Journals (Sweden)

    Dinny H. de Bakker

    2009-06-01

    Full Text Available

    Background: Primary care in the Netherlands has a strong international reputation. However, this picture may be qualified in two respects. First of all, the Dutch primary care system is less cohesive than is sometimes suggested. Secondly, there are major challenges in the Dutch system (as is the case with other European health care systems, which have to be resolved in order to maintain and improve primary care. Methods: Description of primary care in the Netherlands based on nationally and internationally published sources. Identification of challenges and trends. Narrative review of the literature.

    Results: GPs have a strong position in the Netherlands. Their numbers are relatively low; they have a gatekeeping position, and there is no cost-sharing for GP care (unlike other forms of care. The primary care system as a whole, however, is characterised by weak coherence. Individual primary care disciplines have their own separate modes of funding. Challenges include a growing and changing demand for primary care services, and changes in manpower and organisation, that affect the balance between demand and supply regarding primary care services.

    Conclusions: Among the threats to strong primary care are the risk of increasing fragmentation of care, negative side effects of a transformation process from cottage industry to service industry, and reluctance to invest in integrated primary care. An opportunity lies in the consensus among stakeholders that integrated primary care has a future. Technological developments support this, especially the development of electronic patient records.

  8. Primary erythromelalgia: a review.

    Science.gov (United States)

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

    2015-09-30

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

  9. Primary biliary cirrhosis

    Directory of Open Access Journals (Sweden)

    Heathcote E Jenny

    2008-01-01

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

  10. Data compilations for primary production, herbivory, decomposition, and export for different types of marine communities, 1962-2002 (NCEI Accession 0054500)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This dataset is a compilation of published data on primary production, herbivory, and nutrient content of primary producers in pristine communities of...

  11. Primary nucleation of lithium carbonate

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  12. Women's Political Empowerment and Investments in Primary Schooling in India.

    Science.gov (United States)

    Halim, Nafisa; Yount, Kathryn M; Cunningham, Solveig A; Pande, Rohini P

    2016-02-01

    Using a national district-level dataset of India composed of information on investments in primary schooling (data from the District Information Survey for Education [DISE, 2007/8]) and information on demographic characteristics of elected officials (data from the Election Commission of India [ECI, 2000/04]), we examined the relationship between women's representation in State Legislative Assembly (SLA) seats and district-level investments in primary schooling. We used OLS regressions adjusting for confounders and spatial autocorrelation, and estimated separate models for North and South India. Women's representation in general SLA seats typically was negatively associated with investments in primary-school amenities and teachers; women's representation in SLA seats reserved for under-represented minorities, i.e., scheduled castes and scheduled tribes, typically was positively associated with investments in primary schooling, especially in areas addressing the basic needs of poor children. Women legislators' gender and caste identities may shape their decisions about redistributive educational policies.

  13. Risk of primary biliary cirrhosis in patients with coeliac disease

    DEFF Research Database (Denmark)

    Sørensen, Henrik Toft; Thulstrup, Ane Marie; Blomqvist, P

    1999-01-01

    BACKGROUND: Several case reports, but only a few studies, have examined the coexistence of coeliac disease and primary biliary cirrhosis. AIM: To estimate the risk of primary biliary cirrhosis in two national cohorts of patients with coeliac disease in Denmark and Sweden. METHODS: Through record...... linkage all Danish patients hospitalised with coeliac disease were followed for possible occurrence of primary biliary cirrhosis from 1 January 1977 until 31 December 1992. All patients hospitalised with coeliac disease in Sweden from 1987 to 1996 were also followed in a separate analysis. RESULTS......: A total of 896 patients with coeliac disease were identified in Denmark with a median follow up period of 9.1 years for a total of 8040 person-years at risk. Two cases of primary biliary cirrhosis were observed where 0.07 were expected, giving a standardised incidence ratio of 27.6 (95% confidence...

  14. [Renewing primary health care in the Americas].

    Science.gov (United States)

    Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa

    2007-01-01

    At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.

  15. 76 FR 45428 - National Oil and Hazardous Substances Pollution Contingency Plan; National Priorities List...

    Science.gov (United States)

    2011-07-29

    ... of the shallow ground water. The State of Texas defines ground water resources based on water quality... of the primary effects screening level. Furthermore, results from the soils and ground water data do... in Port Arthur, Texas (Jefferson County), from the National Priorities List (NPL). The...

  16. Yakama Nation Renewable Energy Plan

    Energy Technology Data Exchange (ETDEWEB)

    Rigdon, Phillip [Yakama Nation, Toppenish, WA (United States)

    2016-05-10

    It is the intention of the Yakama Nation to make improvements on the Wapato Irrigation Project (WIP) for the benefit of all stakeholders. Water management, water conservation and water allocation on the Wapato Irrigation Project is equally as important as hydropower. Irrigation will always be the primary purpose of this water system, but the irrigation system can also generate energy. The purpose of this project is the purchase and installation of inflow water turbines to generate an additional one megawatt of hydro-electrical power. The project will occur in two phases, Environmental Assessment and Project Implementation. The core objective for this proposal is to meet the Yakama Nation’s goal in hydroelectric power development. This will include the installation of inflow water turbines on the Wapato Irrigation Project. The Yakama Nation will prepare an Environmental Assessment in preparation to purchase and install new water turbines for hydropower generation of 1 Megawatt. This is a valuable economic development strategy for Yakama Nation that will create new jobs, improve and increase rural electrification, and attract private investments. This water system has an untapped low head/low power potential without the need to construct a new dam. The objective of Phase 1 is to complete an environmental assessment and obtain approval to proceed with installation of the hydroelectric power system.

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

    Science.gov (United States)

    Seddon, Frederick; Biasutti, Michele

    2008-01-01

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

  18. 77 FR 38838 - Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage...

    Science.gov (United States)

    2012-06-29

    ..., Mental Health, and Dental Health Professional Shortage Areas AGENCY: Health Resources and Services... primary medical care, mental health, and dental health professional shortage areas (HPSAs) as of April 1... National Health Service Corps (NHSC) personnel to provide primary care, dental, or mental health...

  19. A Small-Scale Study of Primary School English Language Teachers' Classroom Activities and Problems

    Science.gov (United States)

    Arikan, Arda

    2011-01-01

    Turkey's search for upgrading the quality of English language teaching is still in progress. Publication of Ministry of National Education's "English Language Curriculum for Primary Education Grades 4,5,6,7 and 8" (2006) framed the content and delivery of our primary school English language teaching classes along with a list of suggested…

  20. Parental Influence on Academic Achievement among the Primary School Students in Trinidad

    Science.gov (United States)

    Johnson, Emmanuel Janagan; Descartes, Christine H.

    2017-01-01

    The present study examined the level of parental influence on academic achievement in primary school students who prepare for the National-level test at standard five (grade 6), Secondary Entrance Examinations in Trinidad. A sample of 128 students studying standard five from primary schools was randomly selected. The data were analysed using SPSS.…

  1. Guidelines on anaemia : effect on primary-care midwives in The Netherlands

    NARCIS (Netherlands)

    Offerhaus, P; Fleuren, M; Wensing, M

    2005-01-01

    Objective: to assess the adherence and perceived barriers for implementation of a clinical-practice guideline on anaemia, which was the first national guideline for primary-care midwifery in The Netherlands. Design: cross-sectional survey study. Setting: primary-care midwifery in The Netherlands. Pa

  2. Guidelines on anaemia: effect on primary-care midwives in The Netherlands.

    NARCIS (Netherlands)

    Offerhaus, P.M.; Fleuren, M.; Wensing, M.J.P.

    2005-01-01

    OBJECTIVE: To assess the adherence and perceived barriers for implementation of a clinical-practice guideline on anaemia, which was the first national guideline for primary-care midwifery in The Netherlands. DESIGN: Cross-sectional survey study. SETTING: Primary-care midwifery in The Netherlands. PA

  3. Parity of Provision? Learning Support for English and Mathematics in Irish Primary Schools

    Science.gov (United States)

    Surgenor, Paul; Shiel, Gerry

    2008-01-01

    This article examines the differences in learning support provision for English and mathematics in Irish primary schools. Questionnaires were completed by 172 learning support teachers in Irish primary schools, as part of a national assessment of English and mathematics. Few respondents (3%) provide learning support for mathematics only, over…

  4. Communication Strategies in Primary Schools in Botswana: Interventions Using Cooks, Teacher Aides and Learners

    Science.gov (United States)

    Mokibelo, Eureka B.

    2016-01-01

    This paper examines the micro planning activities that schools engage in to address learners' needs to make education work in rural primary schools of Botswana. The national language plan prescribes the use of English and Setswana only as languages of instruction at the primary school level. However, this plan is not practical in some regions…

  5. Primary Prevention of Acculturative Stress among Refugees: Application of Psychological Theory and Practice.

    Science.gov (United States)

    Williams, Carolyn L.; Berry, J. W.

    1991-01-01

    Summarizes research suggesting that refugees, being an at-risk population, are especially suited to primary mental health prevention. Describes research on stress and acculturation and its importance to prevention in refugee mental health. Examples of primary prevention programs at the local, national, and international levels are given. (CJS)

  6. 77 FR 36550 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

    Science.gov (United States)

    2012-06-19

    ... HUMAN SERVICES Health Resources and Services Administration Advisory Committee on Training in Primary... create a national faculty development initiative. The purpose of this HRSA-supported program is to train... Committee on Training in Primary Care, Medicine and Dentistry (ACTPCMD). Dates and Times: July 19, 2012, 8...

  7. Influence of national culture on the social construction of health care quality

    OpenAIRE

    Aldousari, Abdulrahman

    2015-01-01

    The purpose of this study is to examine how national culture influences the social constructions of health care quality in the Kuwaiti primary care. Kuwait has a well- developed primary care system, offering a wide range of services in practices distributed throughout the nation, throughout the day, and on a walk-in basis. Despite its extended hours, relative comprehensiveness and affordability, the primary care service in Kuwait appears to be poorly received by the public. This study employe...

  8. Integrating Primary Source Documents into the Classroom.

    Science.gov (United States)

    Logan, Linda

    1999-01-01

    Addresses the introduction of primary sources to students, discusses analyzing a primary source document, and provides two example primary accounts. Offers ideas for accessing primary source documents and includes a bibliography for further reading. (CMK)

  9. Primary leiomyosarcoma of the spine

    Energy Technology Data Exchange (ETDEWEB)

    Lo, T.H. [Dept. of Radiology, St. Elisabeth Hospital, Tilburg (Netherlands); Rooij, W.J.J. van [Dept. of Radiology, St. Elisabeth Hospital, Tilburg (Netherlands); Teepen, J.L.J.M. [Dept. of Pathology, St. Elisabeth Hospital, Tilburg (Netherlands); Verhagen, I.T.H.J. [Dept. of Neurosurgery, St. Elisabeth Hospital, Tilburg (Netherlands)

    1995-08-01

    Primary leiomyosarcoma (LMS) of bone is exceedingly rare, with few cases in the literature, most involving the femur and tibia. We found only one case in which CT was performed. We present a case of primary LMS of the eighth thoracic vertebra with emphasis on radiological findings including myelography, CT, MRI and angiography. (orig.)

  10. Civil Conversations Using Primary Documents

    Science.gov (United States)

    Singleton, Laurel; Pereira, Carolyn

    2005-01-01

    Primary source documents can be a key element in conversation and deliberation. They lend authenticity to student consideration of issues facing people's democracy and stimulate student interest. In addition, conversation about a primary document leads to a much deeper understanding of that document and can raise authentic questions for further…

  11. Educational paper: Primary antibody deficiencies

    NARCIS (Netherlands)

    G.J.A. Driessen (Gertjan); M. van der Burg (Mirjam)

    2011-01-01

    textabstractPrimary antibody deficiencies (PADs) are the most common primary immunodeficiencies and are characterized by a defect in the production of normal amounts of antigen-specific antibodies. PADs represent a heterogeneous spectrum of conditions, ranging from often asymptomatic selective IgA a

  12. Glucocorticosteroids for primary sclerosing cholangitis

    DEFF Research Database (Denmark)

    Chen, Weikeng; Gluud, C

    2004-01-01

    Glucocorticosteroids have been suggested for primary sclerosing cholangitis, which is characterised by chronic inflammation and fibrosis in the intrahepatic and extrahepatic biliary tree.......Glucocorticosteroids have been suggested for primary sclerosing cholangitis, which is characterised by chronic inflammation and fibrosis in the intrahepatic and extrahepatic biliary tree....

  13. Primary care research in Denmark

    DEFF Research Database (Denmark)

    Vedsted, Peter; Kallestrup, Per

    2016-01-01

    International Perspectives on Primary Care Research examines how the evidence base from primary care research can strengthen health care services and delivery, tackle the growing burden of disease, improve quality and safety, and increase a person-centred focus to health care. Demonstrating the i...

  14. A RARE 10 PRIMARY CANCERS

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    @@ Here we report an unusual case with ten primary cancers. The patient was a 74 years old male and died in 1999. He had had ten primary cancers from 1972 to 1999. 1) Diagnosed as adenocarcinoma in the transverse colon, Duke's B.

  15. National Farm Medicine Center

    Science.gov (United States)

    Research Areas Applied Sciences Biomedical Informatics Clinical Research Epidemiology Farm Medicine Human Genetics Oral-Systemic Health Clinical ... Consulting Agritourism Farm MAPPER Lyme Disease ROPS Rebate Zika Virus National Farm Medicine Center The National Farm ...

  16. National Toxicology Program

    Science.gov (United States)

    ... to Main Navigation Skip to Site Sidebar National Toxicology Program http://ntp.niehs.nih.gov Home Testing ... NTP Cell Phone Radiofrequency Radiation Studies The National Toxicology Program (NTP) has been conducting experiments in rats ...

  17. New Mexico National Cemeteries

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The United States Department of Veterans Affairs National Cemetery Administration maintains 2 national cemeteries in the state of New Mexico; the Fort Bayard...

  18. National Rehabilitation Information Center

    Science.gov (United States)

    ... including News and Notes) Welcome to the National Rehabilitation Information Center! We are conducting improvements to the ... experience. We apologize for any inconvenience The National Rehabilitation Information Center ( NARIC ) is the library of the ...

  19. National Vulvodynia Association

    Science.gov (United States)

    ... 20 years, the National Vulvodynia Association (NVA) , a nonprofit organization, has been dedicated to improving the health and ... of Use The National Vulvodynia Association is a nonprofit organization that strives to improve women's lives through education, ...

  20. Complications and Deaths - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications and deaths - national data. This data set includes national-level data for the hip/knee complication measure, the Agency for Healthcare Research and...

  1. National Diabetes Education Program

    Science.gov (United States)

    ... Living Tips About WIN NIDDK Information Clearinghouses National Diabetes Education Program Together with more than 200 partners ... type 2 diabetes. Learn more about NDEP . National Diabetes Month You are the center of your diabetes ...

  2. Regional National Cooperative Observer

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA publication dedicated to issues, news and recognition of observers in the National Weather Service Cooperative Observer program. Issues published regionally...

  3. Heart Attack Payment - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – national data. This data set includes national-level data for payments associated with a 30-day episode of care for heart...

  4. National Drug IQ Challenge

    Science.gov (United States)

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

  5. National Environmental Research Parks

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-01

    The National Environmental Research Parks are outdoor laboratories that provide opportunities for environmental studies on protected lands that act as buffers around Department of Energy (DOE) facilities. The research parks are used to evaluate the environmental consequences of energy use and development as well as the strategies to mitigate these effects. They are also used to demonstrate possible environmental and land-use options. The seven parks are: Fermilab National Environmental Research Park; Hanford National Environmental Research Park; Idaho National Environmental Research Park; Los Alamos National Environmental Research Park; Nevada National Environmental Research Park; Oak Ridge National Environmental Research Park; and Savannah River National Environmental Research Park. This document gives an overview of the events that led to the creation of the research parks. Its main purpose is to summarize key points about each park, including ecological research, geological characteristics, facilities, and available databases.

  6. National Register Historic Districts

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — The National Register Historic District layer is a shape file showing the boundaries of Historic Districts that are listed on the National Register of Historic Places.

  7. National Forest Boundaries

    Data.gov (United States)

    Minnesota Department of Natural Resources — This theme shows the USFS national forest boundaries in the state. This data was acquired from the GIS coordinators at both the Chippewa National Forest and the...

  8. National oceanographic information system

    Digital Repository Service at National Institute of Oceanography (India)

    Desai, B.N.; Kunte, P.D.; Bhargava, R.M.S.

    Ocean study is inherently interdisciplinary and therefore calls for a controlled and integrated approach for information generation, processing and decision making. In this context, Indian National Oceanographic Data Centre (INODC) of National...

  9. Patient survey (HCAHPS) - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The national average for the HCAHPS survey categories. HCAHPS is a national, standardized survey of hospital patients about their experiences during a recent...

  10. National Emission Inventory (NEI)

    Data.gov (United States)

    U.S. Environmental Protection Agency — This data exchange allows states to submit data to the US Environmental Protection Agency's National Emissions Inventory (NEI). NEI is a national database of air...

  11. Models for primary eye care services in India.

    Science.gov (United States)

    Misra, Vasundhra; Vashist, Praveen; Malhotra, Sumit; Gupta, Sanjeev K

    2015-01-01

    Blindness and visual impairment continues to be a major public health problem in India. Availability and easy access to primary eye care services is essential for elimination of avoidable blindness. 'Vision 2020: The Right to Sight - India' envisaged the need for establishing primary eye care units named vision centers for every 50,000 population in the country by the year 2020. The government of India has given priority to develop vision centers at the level of community health centers and primary health centers under the 'National Program for Control of Blindness'. NGOs and the private sector have also initiated some models for primary eye care services. In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

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

    OpenAIRE

    2014-01-01

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

  13. MULTIMEDIA TECHNOLOGIES IN PRIMARY SCHOOL

    Directory of Open Access Journals (Sweden)

    Vira M. Andriievska

    2010-08-01

    Full Text Available In the article it has been analysed a role of multimedia technologies in primary school. On the basis of conducted analysis of different approaches to interpretation of “multimedia technologies” concept the context of this term is summarized. It is grounded an expedience of the use of multimedia in primary school practice as well as the types of multimedia technologies are selected. The factors which must be taken into account during organization the work of primary school pupils with programmatic facilities such as features of psychophysiologic development of primary school pupils and their educational-cognitive activity; didactics potential of multimedia technologies; features of the use of multimedia in studies; requirements to introduction of multimedia in the educational process of primary school are considered.

  14. Glucocorticosteroids for primary sclerosing cholangitis

    DEFF Research Database (Denmark)

    Giljaca, Vanja; Poropat, Goran; Stimac, Davor

    2010-01-01

    Primary sclerosing cholangitis is a chronic cholestatic disease of intrahepatic and extrahepatic biliary ducts, characterised by chronic periductal inflammation and sclerosis of the ducts, which results in segmental stenoses of bile ducts, cholestasis, fibrosis, and ultimately, liver cirrhosis....... Patients with primary sclerosing cholangitis are at higher risk of cholangiocarcinoma as well as of colonic neoplasia, since primary sclerosing cholangitis is associated with inflammatory bowel disease in more than 80% of the patients. Several therapeutic modalities have been proposed for primary...... sclerosing cholangitis, like ursodeoxycholic acid, glucocorticosteroids, and immunomodulatory agents, but none has been successful in reversing the process of the disease. To date, liver transplantation is the only definite therapeutic solution for patients with advanced primary sclerosing cholangitis...

  15. FORMATION OF PEDAGOGICS OF NATIONAL ART CREATIVITY IN THE TIDEWAY OF DEVELOPMENT OF MOTHERLAND HUMANISTIC PEDAGOGICS OF A XIX-TH CENTURY. SOCIAL-PEDAGOGICAL PROBLEMS OF RUSSIAN NATIONAL SCHOOL

    Directory of Open Access Journals (Sweden)

    Lyubov Kalantaryan

    2012-01-01

    Full Text Available To the middle of XIX-th century the increased interest of a society to national education problems stimulated transition from the state pedagogics to public. Main currents in motherland humanistic pedagogics (abstract, practical and universal humanism were designated. Priority value is received by ideas of a humanisation of national education, the primary goals of Russian national school are proved. In sphere of national education find wide application and ideas of national pedagogics, national education.

  16. Prediction of National Wealth

    Science.gov (United States)

    Whetzel, Deborah L.; McDaniel, Michael A.

    2006-01-01

    In their book, IQ and the Wealth of Nations, Lynn and Vanhanen ([Lynn, R. and Vanhanen, T. (2002). IQ and the wealth of nations. Westport, CT: Praeger.]) proposed the hypothesis that "the intelligence of the populations has been a major factor responsible for the national differences in economic growth and for the gap in per capita income between…

  17. Gross National Happiness

    DEFF Research Database (Denmark)

    Giri, Krishna Prasad; Kjær-Rasmussen, Lone Krogh

    This paper investigates practices related to the ideology of infusing Gross National Happiness (GNH) into school curriculum, the effectiveness of the meditation and mind training and the implication of GNH for school environment. It also explores how GNH ambience has been managed and practiced...... of Gross National Happiness and Educating for Gross National happiness....

  18. Banal nationalism in practice

    DEFF Research Database (Denmark)

    Koefoed, Lasse Martin

    . The paper falls into four parts. First, I outline the problem in a broader European context. Second, the paper extends and elaborates on concepts such as everyday life nationalism, social poetics of the nation-state and banal nationalism. Third, the paper illustrates, on the basis of an interview analysis...

  19. National Stereotypes in Music

    NARCIS (Netherlands)

    Lajosi, K.

    2014-01-01

    Music became a marker of national identity in nineteenth-century Europe. Western art music consists of tonal systems that are universally intelligible, but certain rhythms and musical idioms have been associated with national styles. How, when, and why does a musical phrase or piece become national?

  20. 2015 National Nation-Level Geography Geodatabase

    Data.gov (United States)

    US Census Bureau, Department of Commerce — The 2015 TIGER Geodatabases are extracts of selected nation based and state based geographic and cartographic information from the U.S. Census Bureau's Master...

  1. Elites and popular nationalism.

    Science.gov (United States)

    Whitmeyer, Joseph M

    2002-09-01

    Much current theory concerning nationalism holds that elites commonly create or cause popular nationalism. In part, that thesis may be due to an overwhelming emphasis in research on nationalism on positive cases: cases where nationalism has appeared, ignoring cases where it has not. In this article, I challenge the thesis by showing numerous historical cases in which elites have promoted nationalisms that ordinary people have not adopted, or in which ordinary people have adopted a nationalism before it was taken up by elites. Even if elites do not create popular nationalism, however, they can and do shape its expression in a variety of ways, such as organizing it, providing relevant information, or providing opportunity or incentive for it. I show this through historical examples.

  2. Banal Nationalism in ESL Textbooks

    Science.gov (United States)

    Gulliver, Trevor

    2011-01-01

    Despite repeating claims that Canadians are less nationalistic than members of other nations, English as a second language (ESL) textbooks often participate in banal repetitions of nation-ness and nationalism. This banal nationalism takes the form of the marking of nation through flags, maps, routine deixis, and nationalized symbols. This study…

  3. Input, Process, and Learning in primary and lower secondary schools

    DEFF Research Database (Denmark)

    Larsen, Michael Søgaard; Nordenbo, Sven Erik; Holm, Anders

    , which consists of representatives of The Agency for the Evaluation and Quality Development of Primary and Lower Secondary Education in Denmark, the Danish Evaluation Institute, the Swedish National Agency for Education, the Norwegian Directorate for Education and Training, the Finnish National Board...... Actor (Teacher); Pupil Composition of the School; and Parental Relationship. What are the implications? For practice: The school leader should realize that a number of aspects of his or her work are important for pupil learning: the more he or she is available for teachers the better; the more...

  4. Primary amenorrhea: diagnosis and management.

    Science.gov (United States)

    Marsh, Courtney A; Grimstad, Frances W

    2014-10-01

    Puberty is a defining time of many adolescents' lives. It is a series of events that includes thelarche, pubarche, and menarche. Primary amenorrhea is the absence of menarche. There are numerous etiologies including outflow tract obstructions, gonadal dysgenesis, and anomalies of the hypothalamic axis. This review's aims are to define primary amenorrhea and describe the various causes, their workups, associated comorbidities, and treatment options. At the end, a generalist should be able to perform an assessment of an adolescent who presents with primary amenorrhea and, if warranted, begin initial treatment.

  5. Primary ciliary dyskinesiatwo cases reports

    Directory of Open Access Journals (Sweden)

    Mohammad Sadegh Rezaee1

    2009-01-01

    Full Text Available (Received 22 December, 2009 ; Accepted 10 March, 2010AbstractPrimary ciliary dyskinesia and Kartagener's syndrome are rare genetic disorders. There is a ciliary dysfunction in these disorders that cause recurrent infections in respiratory and sinus tracts associated with dextrocardia, chronic vasomotor rhinitis and dextrocardia. The aim of this paper is to report two rare cases of Primary ciliary dyskinesia, including one case of primary ciliary dyskinesia and Kartagener's syndrome for additional knowledge. J Mazand Univ Med Sci 2009; 19(73: 85-89 (Persian.

  6. Peptide primary messengers in plants

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    The peptide primary messengers regulate embryonic development,cell growth and many other activities in animal cells. But recent evidence verified that peptide primary messengers are also involved in plant defense responses, the recognition between pollen and stigma and keep the balance between cell proliferation and differentiations in shoot apical meristems. Those results suggest that plants may actually make wide use of peptide primary messengers, both in embryonic development and late life when they rally their cells to defend against pathogens and insect pests. The recent advance in those aspects is reviewed.

  7. Primary vertebral tumours in children

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, K.; Beluffi, G.; Masel, J.; Diard, F.; Ferrari-Ciboldi, F.; Le Dosseur, P.; Labatut, J.

    1984-03-01

    20 cases of primary benign and malignant bone tumours in children were reported. The most common tumours were Ewing's sarcoma, aneurismal bone cyst, benign osteoblastoma and osteoid osteoma. Some rare primary bone tumours in children (osteochondroma, chondroblastoma 6F, primary lymphoma of bone and neurofibromatosis with unusual cervical spinal changes) were also reported. The authors believe that radiographic findings together with clinical history and clinical examination may yield a high percentage of accurate diagnoses. Although microscopy is essential in the final diagnosis, the microscopic report should be also accepted with caution.

  8. Final Report National Laboratory Professional Development Workshop for Underrepresented Participants

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Valerie [Texas Engineering Experiment Station, College Station, TX (United States)

    2016-11-07

    The 2013 CMD-IT National Laboratories Professional Development Workshop for Underrepresented Participants (CMD-IT NLPDev 2013) was held at the Oak Ridge National Laboratory campus in Oak Ridge, TN. from June 13 - 14, 2013. Sponsored by the Department of Energy (DOE) Advanced Scientific Computing Research Program, the primary goal of these workshops is to provide information about career opportunities in computational science at the various national laboratories and to mentor the underrepresented participants through community building and expert presentations focused on career success. This second annual workshop offered sessions to facilitate career advancement and, in particular, the strategies and resources needed to be successful at the national laboratories.

  9. 系统论视野下新疆民族基础教育“双语”教学模式探论--基于和田地区民族中小学“双语”教学现状的调研与反思%The perspective of system theory of xinjiang national elementary education theory of"bilingual"teaching mode---based on the national primary and secondary schools in hotan area"bilingual"teaching research and reflection on the

    Institute of Scientific and Technical Information of China (English)

    陈金凤; 李儒忠; 王继青

    2013-01-01

    Research in hotan region on the basis of national primary and secondary schools "bilingual teach-ing", guided by the system theory , studied the present situation and problems of reflection , the connotation of bilingual teaching in in -depth analysis of the people , the fundamental goal , essential characteristics and the problems in the bilingual teaching system , and then from two aspects: theoretical framework and practical framework based on system theory was put forward the people of the bilingual teaching mode .In the construc-tion of a theoretical framework , the author argues that scientific definition of "bilingual""bilingual"teaching objectives , teaching and exact students establish the correct concept , establish the teaching view of overall op-timization and dynamic balance , etc.;In building a practical framework , the author argues vigorously promote the bilingual teaching ability of teachers quality , raises the student good "bilingual"learning behavior , to strengthen the construction of "bilingual"teaching material system , optimize the environment of small and me-dium-sized school "bilingual teaching", build scientific "bilingual"teaching quality evaluation index sys-tem, etc.These strategies to guide the national primary and secondary schools in xinjiang , out of the "bilin-gual"teaching reform of teaching mode , improving the quality of the bilingual teaching , is of positive theoreti-cal and realistic significance .%在调研和田地区民族中小学“双语”教学现状的基础上,以系统论为指导,对现状和问题进行了深刻反思,深入分析了民汉双语教学的内涵、根本目标、本质特征以及“双语”教学系统存在的若干问题,进而从理论框架与实践框架两个层面提出了构建基于系统论的民汉双语教学模式。在理论框架的构建中,笔者主张科学界定“双语”教学、准确定位“双语”教学目标、确立正确的学生观、确立整体优化

  10. The clinical implementation of primary HPV screening.

    Science.gov (United States)

    Mariani, Luciano; Igidbashian, Sarah; Sandri, Maria Teresa; Vici, Patrizia; Landoni, Fabio

    2017-03-01

    To evaluate, from a gynecology perspective, the transition from cytology-based HPV screening to primary HPV screening. Studies examining switching from cytology-based screening to primary HPV-DNA testing with triaging of patients with positive test results were retrieved and reviewed, with a particular focus on screening in an Italian setting. The increased complexity of patient-management decisions when implementing HPV-based screening was a critical issue discussed in the literature. The change in strategy represents a paradigm shift in moving from a medical perspective of identifying the disease in individual patients, to a public-healthcare perspective of excluding HPV from the healthy population and identifying a small sub-group of individuals at increased risk of HPV. With knowledge about HPV screening evolving rapidly, new programs and related algorithms need to be sufficiently flexible to be adjusted according to ongoing research and the validation of new assays. The establishment of a national working group (including epidemiologists, gynecologists, pathologists, and healthcare providers) will be necessary to properly implement and govern this important technical and cultural transition. © 2016 International Federation of Gynecology and Obstetrics.

  11. Competition and rural primary care programs.

    Science.gov (United States)

    Ricketts, T C

    1990-04-01

    Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

  12. On written expression of primary school pupils

    Directory of Open Access Journals (Sweden)

    Stevanović Jelena

    2009-01-01

    Full Text Available Normative rules of standard Serbian language are acquired during primary and secondary education through curriculum demands of Serbian language instruction, which takes place in three fields: grammar, orthography and culture of expression. Topic of interest in this paper is the quality of written expression of 6th and 7th grade pupils, in the context of all three fields specified to be mastered by the curriculum of Serbian language. Research comprised 148 primary school pupils from Belgrade. Linguistic analysis of spontaneously created written text was performed, in the conditions where it was not explicitly demanded form the pupil to write correctly. The results indicate that the majority of pupils make spelling and grammatical errors, meeting the condition for the basic level of mastering the knowledge in Serbian language according to the standards specified for the end of compulsory education. In addition to this, a considerable majority of pupils has a satisfactory level of culture of written expression. Pupils more often make spelling than grammatical errors. Seventh grade pupils are better than sixth grade pupils with respect to adhering to grammar rules and according to culture of written expression, while the mark in Serbian language and general school achievement of pupils correlate only with the degree of adhering to the orthographic rules. It was concluded that not only individual programs of support for pupils who make more errors are necessary, but also launching national projects for the development of linguistic competence of the young in Serbia.

  13. Fatigue in primary Sjogren's syndrome

    NARCIS (Netherlands)

    P.J. Barendregt (Pieternella); M.R. Visser (Mechteld); E.M.A. Smets (Ellen); J.H.M. Tulen (Joke); A.H. van den Meiracker (Anton); F. Boomsma (Frans); H.M. Markusse

    1998-01-01

    textabstractOBJECTIVE: To assess fatigue in relation to depression, blood pressure, and plasma catecholamines in patients with primary Sjogren's syndrome (SS), in comparison with healthy controls and patients with rheumatoid arthritis. METHODS: For the assessment of fat

  14. Primary hepatic sarcomas: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Ri-Sheng; Chen, Ying; Jiang, Biao; Wang, Liu-Hong [Zhejiang University School of Medicine, Department of Radiology, Hangzhou (China); Xu, Xiu-Fang [Zhejiang Medical College, Teaching and Research Group of Radiology, Hangzhou (China)

    2008-10-15

    Primary hepatic sarcomas are rare tumors that are difficult to diagnose clinically. Different primary hepatic sarcomas may have different clinical, morphologic, and radiological features. In this pictorial review, we summarized computed tomography (CT) findings of some relatively common types of hepatic sarcomas, including angiosarcoma, epithelioid hemangioendothelioma (EHE), liposarcoma, undifferentiated embryonal sarcoma (UES), leiomyosarcoma, malignant fibrous histiocytoma (MFH), and carcinosarcoma (including cystadenocarcinosarcoma). To our knowledge, hepatic cystadenocarcinosarcoma has not been described in the English literature. The CT findings in our case are similar to that of cystadenocarcinoma, a huge, multilocular cystic mass with a large mural nodule and solid portion. The advent of CT has allowed earlier detection of primary hepatic sarcomas as well as more accurate diagnosis and characterization. In addition, we briefly discuss the MRI findings and diagnostic value of primary hepatic sarcomas. (orig.)

  15. Molariform Mesiodens in Primary Dentition

    Directory of Open Access Journals (Sweden)

    Sachin B. Mangalekar

    2013-01-01

    Full Text Available Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch, and incidence of molariform mesiodens in the maxillary midline is rare in permanent dentition and extremely uncommon in primary dentition. A midline supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. This paper reports a rare case of the presence of a molariform mesiodens in the primary dentition. On clinical and radiographic examination, flaring of the primary central incisors was seen, with a molariform mesiodens consisting of multiple lobes or tubercles on the occlusal surface with the well-formed root. The treatment plan consisted of the extraction of the supernumerary tooth and regular observation of permanent central incisors for proper eruption and alignment.

  16. Primary sclerosing cholangitis and pregnancy

    Directory of Open Access Journals (Sweden)

    Casper Q. Kammeijer

    2011-08-01

    Full Text Available Primary sclerosing cholangitis is a progressive disease, and coincidentally in pregnancy it is rare. It is characterized by progressive inflammation and destruction of bile ducts finally resulting in liver failure. A rare case of primary sclerosing cholangitis in pregnancy is presented. The course of the pregnancy was marked by threatened preterm delivery and exacerbation of cholestasis. She was successfully treated with ursodeoxycholic acid (UDCA. Although, primary sclerosing cholangitis has both maternal and fetal effects on pregnancy, the overall outcome is favorable. Only few cases have been reported using high dose ursodeoxycholic acid for primary sclerosing cholangitis in pregnancy, it often improves pruritus but has no protection against stillbirth. Data on the safety to the fetus or neonate and long-term outcome are scarce.

  17. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Cervical cancer remains a major public health challenge in developing countries ... relation to knowledge on cervical cancer, primary level of education ... Latin America and Southeast Asia. ... practices such as level of awareness, educational.

  18. GI-IANAIAN PRIMARY SCHOOLS

    African Journals Online (AJOL)

    50 classrooms in six primary schools within the Kumasi metropolis. Blackboards, flash .... work teachers have to do. large class sizes and ... what they themselves had produced, even in. Schools ... the right kind of motivation to support instruc-.

  19. Problems of Primary Education Today

    Science.gov (United States)

    Dubova, M. V.

    2014-01-01

    Primary education in Russia has failed to adapt to the needs of post-Soviet society, and is still based on rote learning and memorization instead of learning through discovery and learning to use and apply what is learned.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi-Araba, P.M.B. ... the child's health, culturally based beliefs and ..... immunization safety as this was a rural ... Charles SW, Olalekan AU, Peter MN,.