Domagala, J.E.; Clements, D.J.; Prior, P.C.S.
A governor for limiting the speed of a rotating member relative to another member, has one member in the form of a conducting disc, and the other incorporates a plurality of magnets disposed circumferentially in an appropriate polarity pattern so that relative rotation results in the generation of a braking torque. In a modification the members are movable axially to vary the braking torque developed. The gap is preferably reduced automatically to increase the braking torque when the relative speeds attain a predetermined high value. (author)
... Farm ® , is out now. News Read News Getting Self-Driving Cars on the Road Soon Might Save Lives ... Speed and Red Light Cameras Speeding and Aggressive Driving Teen and Novice Drivers Traffic Records State Laws By Issue By State Resources ...
The physics of the fly-ball governor, introduced to regulate the speed of steam engines, is here analysed anew. The original analysis is generalized to arbitrary governor geometry. The well-known stability criterion for the linearized system breaks down for large excursions from equilibrium; we show approximately how this criterion changes.
Full Text Available Background. Recently, the percentage of older adults in developing countries has increased significantly. Objective. This study examined patterns and factors associated with primary health care services utilization in the past 1, 6, and 12 months. Method. A cross-sectional study design was used to collect data from 190 older adults in the Irbid governorate of Jordan. Results. Primary health care services were used by less than half of the participants in the past 1 month, by 68.4% in the past 6 months, and by 73.8% in the past 12 months. Primary health care (PHC services use was associated with age, education level, tobacco use, chronic illnesses, perceived general health status today, a physical component summary score, employment, and perceived general health status in the past 6 and 12 months. The primary predictor of PHC services use at 1, 6, and 12 months was chronic illnesses (OR=13.32, (OR=19.63, and (OR=17.91, respectively. Conclusion. Although many factors were associated with PHC service utilization, the strongest predictor of PHC service utilization was chronic illnesses.
The document gives information about the election of 11 Member States to the IAEA Board of Governors, the 35-member policy-making body, during the 44th regular session of the IAEA's General Conference (18 - 22 September 2000, Austria Center, Vienna). The newly elected Member States are: Argentina, Egypt, Ghana, Ireland, Libyan Arab Jamahiriya, Mexico, Pakistan, Peru, Switzerland, Thailand, Ukraine. The other 24 Member States of the Board are also given
The document gives information about the election of 11 Member States to the IAEA Board of Governors, the 35-member policy-making body, during the 45th regular session of the IAEA's General Conference (17-21 September 2001, Austria Center, Vienna). The newly elected Member States are: Bulgaria, Burkina Faso, Chile, Colombia, Islamic Republic of Iran, Kuwait, Morocco, Philippines, Romania, Spain, and Turkey. The other 24 Member States of the Board are also given
Rodan, Rania; Khlaifat, Feryal; Smadi, Leena; Azab, Reem; Abdalmohdi, Asma
A cross-sectional census was conducted on 994 public school students aged 6-11 years living in 3 different parts of Tafeleh Governorate-South of Jordan, to determine the prevalence, and severity of gingivitis and to evaluate the oral hygiene habits among them as a part a survey executed by National Woman's Health Care Center. All students were examined for gingival index (GI) and plaque index (PI), information about oral hygiene habits was recorded. Only 29.8 % had healthy gingiva, 38.5 % had mild gingivitis, 31.4 % had moderate gingivitis, and 0.3 % had severe gingivitis. The difference between both genders was not statistically significant P > 0.05. 36.8 % of the examined students never brushed their teeth. Average gingival index (GI) and average plaque index (PI) were 0.77 and 0.61 respectively. Fair oral hygiene with mild to moderate gingivitis is highly prevalent among Tafelah school children. This study indicated that oral health status among schoolchildren in Tafelah is poor and needs to be improved. Long-term school based oral health education programme is highly recommended.
Frequencies distribution of dihydrofolate reductase and dihydropteroate synthetase mutant alleles associated with sulfadoxine-pyrimethamine resistance in Plasmodium falciparum population from Hadhramout Governorate, Yemen.
Bamaga, Omar A A; Mahdy, Mohammed A K; Lim, Yvonne A L
Malaria in Yemen is mainly caused by Plasmodium falciparum and 25% of the population is at high risk. Sulfadoxine-pyrimethamine (SP) had been used as monotherapy against P. falciparum. Emergence of chloroquine resistance led to the shift in anti-malarial treatment policy in Yemen to artemisinin-based combination therapy, that is artesunate (AS) plus SP as first-line therapy for uncomplicated malaria and artemether-lumefantrine as second-line treatment. This study aimed to screen mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) genes associated with SP resistance among P. falciparum population in Hadhramout governorate, Yemen. Genomic DNA was extracted from dried blood spots of 137 P. falciparum isolates collected from a community-based study. DNA was amplified using nested polymerase chain reaction (PCR) and subsequently sequenced for Pfdhfr and Pfdhps genes. Sequences were analysed for mutations in Pfdhfr gene codons 51, 59, 108, and 164 and in Pfdhps gene codons 436, 437, and 540. A total of 128 and 114 P. falciparum isolates were successfully sequenced for Pfdhfr and Pfdhps genes, respectively. Each Pfdhfr mutant allele (I51 and N108) in P. falciparum population had a frequency of 84%. Pfdhfr R59 mutant allele was detected in one isolate. Mutation at codon 437 (G437) in the Pfdhps gene was detected in 44.7% of falciparum malaria isolates. Frequencies of Pfdhfr double mutant genotype (I51C59N108I164) and Pfdhfr/Pfdhps triple mutant genotype (I51C59N108I164-S436G437K540) were 82.8 and 39.3%, respectively. One isolate harboured Pfdhfr triple mutant genotype (I51, R59, N108, I164) and Pfdhfr/Pfdhps quadruple mutant genotype (I51R59N108I164-S436G437K540). High frequencies of Pfdhfr and Pfdhps mutant alleles and genotypes in P. falciparum population in Hadhramout, Yemen, highlight the risk of developing resistance for SP, the partner drug of AS, which subsequently will expose the parasite to AS monotherapy increasing then the
business. Governors are required to travel to conduct IDRC business, attend ... of Governors, liaise with Centre management, and perform specific representational functions on ..... Travel between Points of Origin and Destination - Air Travel.
State Employees Governor's Council on Disabilities and Special Education DHSS State of Alaska Home ; Governor's Council on Disabilities and Special Education Page Content Untitled Document Patrick Reinhart : follow GCDSE to 40404 The Governor's Council on Disabilities & Special Education is pleased to award
The second public meeting of Governor Kaine's Independent Virginia Tech Incident Review Panel will convene on Monday, May 21, at The Inn at Virginia Tech and Skelton Conference Center Latham Ballroom, 901 Prices Fork Road in Blacksburg.
The General Conference of the International Atomic Energy Agency at its fourth regular session, which was held in Vienna from 20 September to 1 October 1960, elected five Member States to serve a two-year term on the Agency's Board of Governors. The five were Argentina, El Salvador, the Federal Republic of Germany, Iraq and Thailand. The new members succeed Indonesia, the Netherlands, Peru, the United Arab Republic and Venezuela, which were elected for a two-year term by the second session of the General Conference in 1958
PROGRAM DESCRIPTION The Basic Science Program (BSP) pursues independent, multidisciplinary research in basic and applied molecular biology, immunology, retrovirology, cancer biology, and human genetics. Research efforts and support are an integral part of the Center for Cancer Research (CCR) at the Frederick National Laboratory for Cancer Research (FNLCR). KEY ROLES/RESPONSIBILITIES - Research Associate III Dr. Zbigniew Dauter is the head investigator of the Synchrotron Radiation Research Section (SRRS) of CCR’s Macromolecular Crystallography Laboratory. The Synchrotron Radiation Research Section is located at Argonne National Laboratory, Argonne, Illinois; this is the site of the largest U.S. synchrotron facility. The SRRS uses X-ray diffraction technique to solve crystal structures of various proteins and nucleic acids of biological and medical relevance. The section is also specializing in analyzing crystal structures at extremely high resolution and accuracy and in developing methods of effective diffraction data collection and in using weak anomalous dispersion effects to solve structures of macromolecules. The areas of expertise are: Structural and molecular biology Macromolecular crystallography Diffraction data collection Dr. Dauter requires research support in these areas, and the individual will engage in the purification and preparation of samples, crystallize proteins using various techniques, and derivatize them with heavy atoms/anomalous scatterers, and establish conditions for cryogenic freezing. Individual will also participate in diffraction data collection at the Advanced Photon Source. In addition, the candidate will perform spectroscopic and chromatographic analyses of protein and nucleic acid samples in the context of their purity, oligomeric state and photophysical properties.
Eladawi, Noha; Helal, Randah; Niazy, Nermeen A; Abdelsalam, Sherehan
Eating disorders (EDs) are serious illnesses associated with medical complications and have been increased, especially among societies with an excessive concern about weight, shape, or appearance. This study aimed to investigate the prevalence of EDs among the individuals attending weight management centers and its associated factors. A cross-sectional study was carried out among individuals attending four weight management centers in Tanta, Gharbia Governorate, Egypt during the period from July to December 2016. Precoded interview questionnaires were used to identify the following data: sociodemographic characteristics and medical history of depression or psychological disorders and the Eating Attitude Test (EAT-40) was used to assess the attitudes, behavior, and traits associated with the EDs. A total of 400 participants (112 males and 288 females) were included in the study. According to EAT-40 questionnaires, the prevalence of positive and negative EDs was 65.0% (n = 260) and 35.0% (n = 140), respectively. EDs were more likely reported by females, married singles, rural residents, those with higher education, and nonworking or part-time working patients, those who were overweight or obese, and who were suffering from depression or any psychological problems. Logistic regression analysis revealed that the independent predictors of EDs were age (adjusted odds ratio [OR]: 1.06), nonworking (adjusted OR: 2.32) or part-time working (adjusted OR: 2.18), increased body weight (adjusted OR: 2.66 for overweight and adjusted OR: 1.24 for obese), and having a history of depression or any psychological problem (adjusted OR: 2.76). Factor analysis of EAT-40 revealed four factors (eating behavior, diet-related lifestyle, weight concern, and food preoccupation) that were responsible for 33.2% of the total variance. EDs are prevalent among individuals attending the weight management centers in a northern city in Egypt. Specific management strategies are warranted to address
Full text: Miss Blanche Margaret Meagher was elected chairman of the IAEA Board of Governors for 1964-65, after the new Board had been constituted at the Eighth Session of the General Conference in September. Since 1962 Miss Meagher has been Canadian Ambassador to Austria, and Canadian Governor of the Agency. Miss Meagher joined the Canadian Department of External Affairs in 1942, and has held a number of foreign diplomatic appointments; she has also served on Canadian delegations to the UN Educational, Scientific and Cultural Organization, the International Telecommunication Union, the Economic and Social Council of UN and the UN Disarmament Sub-Committee. The Vice-Chairmen of the Board are Mr. Wilhelm Billig (Poland) and Mr. Hassan M. Tohamy (UAR). Mr. Billig is Chairman of the State Council for Atomic Energy, and High Commissioner for Peaceful Uses of Atomic Energy. Mr. Tohamy is Ambassador to Austria, and Resident Representative to the Agency. Of the twelve elected members of the Board, five were chosen by the General Conference in 1964 for two years, viz. Argentina, Chile, Netherlands, Thailand and the United Arab Republic. Seven were elected in 1963: Afghanistan, China, Congo (Leopoldville), Morocco, Romania, Switzerland and Uruguay. The remaining thirteen members have been designated by the Board: Australia, Belgium, Brazil, Canada, Finland, France, India, Japan, Poland, South Africa, USSR, United Kingdom and United States. (author)
With lives, infrastructure, and resources at stake, governors must become instant experts in emergency management when their states are affected by natural disaster. The purpose of A Governor's Guide to Emergency Management is to provide governors an...
Gislason, Gisli [Landsvirkjun, Reykjavik (Iceland). Electromechanical Dept.; Ferme, J.-M. [Voith Hydro, Heidenheim (Germany)
This article focuses on the examination of distribution management systems to identify any potential problems related to the year 2000 (Y2K) that would affect the operation of speed governors with date management capacity at Iceland's hydroelectric power plants. Details are given of the work carried out by Landsvirkjun, Iceland's main power generator, the use of date for monitoring functions, the different governor models, the testing of the digital speed governors, and the modification of software in cases where protection relays were untestable.
... 39 Postal Service 1 2010-07-01 2010-07-01 false Board of Governors. 221.2 Section 221.2 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION GENERAL ORGANIZATION § 221.2 Board of Governors. (a) Composition. The Board of Governors consists of 11 members. Nine governors are appointed by...
committee meetings and performing representative functions on behalf of ... This Policy demonstrates Governors' commitment to the prudent use of public funds, through the stipulation of payment of honoraria in relation to IDRC Business.
The Basic Science Program (BSP) at the Frederick National Laboratory for Cancer Research (FNLCR) pursues independent, multidisciplinary research programs in basic or applied molecular biology, immunology, retrovirology, cancer biology or human genetics. As part of the BSP, the Microbiome and Genetics Core (the Core) characterizes microbiomes by next-generation sequencing to determine their composition and variation, as influenced by immune, genetic, and host health factors. The Core provides support across a spectrum of processes, from nucleic acid isolation through bioinformatics and statistical analysis. KEY ROLES/RESPONSIBILITIES The Research Associate II will provide support in the areas of automated isolation, preparation, PCR and sequencing of DNA on next generation platforms (Illumina MiSeq and NextSeq). An opportunity exists to join the Core’s team of highly trained experimentalists and bioinformaticians working to characterize microbiome samples. The following represent requirements of the position: A minimum of five (5) years related of biomedical experience. Experience with high-throughput nucleic acid (DNA/RNA) extraction. Experience in performing PCR amplification (including quantitative real-time PCR). Experience or familiarity with robotic liquid handling protocols (especially on the Eppendorf epMotion 5073 or 5075 platforms). Experience in operating and maintaining benchtop Illumina sequencers (MiSeq and NextSeq). Ability to evaluate experimental quality and to troubleshoot molecular biology protocols. Experience with sample tracking, inventory management and biobanking. Ability to operate and communicate effectively in a team-oriented work environment.
The document reproduces the statement made by the Governor from Iraq in the Board of Governors on 20 February 1987 concerning the Iraqi Government's position on the protection of nuclear facilities from armed attacks. References are made to the Iranian Bushehr nuclear site
Nadeau-Fredette, Annie-Claire; Johnson, David W; Hawley, Carmel M; Pascoe, Elaine M; Cho, Yeoungjee; Clayton, Philip A; Borlace, Monique; Badve, Sunil V; Sud, Kamal; Boudville, Neil; McDonald, Stephen P
♦ Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations. ♦ All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model. ♦ Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02). ♦ This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies. Copyright © 2016 International Society for Peritoneal Dialysis.
... Bureau of Land Management (BLM) is publishing this notice to explain why the BLM Director is denying the...] BLM Director's Response to the Idaho Governor's Appeal of the BLM Idaho State Director's Governor's... (Finding) to the BLM Idaho State Director (State Director). The State Director determined the Governor's...
Al-Eryani, Samira M A; Mahdy, Mohammed A K; Al-Mekhlafi, Abdulsalam M; Abdul-Ghani, Rashad
Universal coverage of the targeted malaria-endemic areas with long-lasting insecticidal nets (LLINs) is implemented as one of the key interventions for malaria control and elimination in Yemen. In 2013, through a mass campaign, LLINs were distributed to the targeted communities in Al Hudaydah governorate. This study aimed to assess the ownership of, access to, and use of LLINs. It also aimed to identify factors associated with not using LLINs in malaria-endemic areas of Al Hudaydah in the Tihama region, west of Yemen. A cross-sectional survey was conducted in four districts (Ad Durayhimi, Al Marawi'ah, Al Mansuriyah and Bayt Al Faqiah) in Al Hudaydah during February 2016. A total of 701 households were included in this study. Data on socio-demographic characteristics and availability of LLINs were collected by interview and observation. Four indicators for malaria prevention using LLINs; proportion of households with at least one LLIN, proportion of households with at least one LLIN for every two people, proportion of population with access to LLINs in the surveyed households and proportion of population who slept under LLINs the previous night of the survey were calculated as indicated by Roll Back Malaria Monitoring and Evaluation Reference Group. Use to access ratio was assessed. Factors associated with not using LLINs among people with access were also investigated. Of 701 households with 4900 de facto population, ownership of at least one LLIN was 90.6%, while 24.1% owned at least one for every two people during the survey in 2016. The overall proportion of people with access to LLINs was 51.5% (95% CI 50.1-52.9). Only 19.0% (95% CI 17.9-20.1) slept under LLINs the night before the survey and the overall use to access ratio was 0.37. The proportions of children under 5 years of age with access to and use of LLINs were 13.7 and 42.5%, respectively. On the other hand, the proportions of pregnant women with access to and use of LLINs were 16.4 and 20
Hasan, Ahmad N.; Al-Attar, Mustafa S.
The present work studies the molecular investigation of 40 thalassemic carriers using polymerase chain reaction. Forty thalassemic carriers who were registered and treated at Erbil thalassemic center and twenty apparently healthy children have been included in the present study. Ages of both groups ranged between 1-18 years. Four primers used to detect four different beta thalassemia mutations they were codon 8/9, codon 8, codon 41/42 and IVS-1-5. The two most common mutations detected among thalassemia group were Cd8/9 with 8 cases (20%) and Cd-8 with 6 cases (15%) followed by codon 41/42 with 4 cases (10%) which investigated and detected for the first time in Erbil governorate through the present study and finally IVS-1-5 with 3 cases (7.5%), while no any cases detected among control group.
Anti-money laundering (AML) activities are part of an institutionalized, global, and increasingly prescriptive regime, covering a growing set of predicate offences. Yet with much of the responsibility for implementation and monitoring at the hands of private actors, compliance professionals within...... financial institutions have become foot soldiers in the fight against money laundering. This paper argues that AML professionals do not only implement and monitor, however, but, to protect their interests, also shape the content of governance. The process is two-fold. First, a professionalization process...... enabling such activities. From that position, the compliance industry has consolidated its role through the development of systematic professional standards and through identifiable skills and expertise as defined by professional associations. Second, anti-money laundering professionals interpret rules...
Natália Carolina Rodrigues Colombo Gomes
Full Text Available Abstract INTRODUCTION: The implementation of the rapid test (RT for syphilis increases access of vulnerable populations to early diagnosis and treatment, impacting the outcomes of infection. We aimed to assess the prevalence of and factors associated with syphilis in a Center for Testing and Counseling (CTC. METHODS: We conducted a cross-sectional study at a Reference Center for sexually transmitted disease (STD and acquired immune deficiency syndrome in Londrina, Northern Paraná State, Southern Brazil. Data regarding the 5,509 individuals who underwent RT from June 2012 to December 2014 were collected from patient records and the CTC Information System and served as the basis to check associations of syphilis cases (346 and cases without syphilis (5,163. Nine patients’ records were not found. OpenEpi was used to perform a prevalence analysis and determine odds ratios to assess the associations between sociodemographic and behavioral variables (independent variables and cases of syphilis (dependent variable. An alpha value <0.05 was considered statistically significant. RESULTS: The prevalence of syphilis was 6.3%; higher in males (7.5% than in females (4.3%, p <0.001. Syphilis was associated with an age of 25-34 years, little education, and single marital status. The main associated behavioral factors were men who have sex with men, drug users, STD patients, and those presenting with an STD in the last year. The use of alcohol, marijuana, cocaine, and crack was significantly associated with syphilis. CONCLUSIONS: Strategies for prevention and control of syphilis should be intensified, especially in populations identified as most vulnerable.
Gao, Chunyang; Yu, Xiangyang; Zhu, Yong; Feng, Baohao
The parameters of hydraulic turbine governor directly affect the dynamic characteristics of the hydraulic unit, thus affecting the regulation capacity and the power quality of power grid. The governor of conventional hydropower unit is mainly PID governor with three adjustable parameters, which are difficult to set up. In order to optimize the hydraulic turbine governor, this paper proposes wolf pack algorithm (WPA) for intelligent tuning since the good global optimization capability of WPA. Compared with the traditional optimization method and PSO algorithm, the results show that the PID controller designed by WPA achieves a dynamic quality of hydraulic system and inhibits overshoot.
Al-Ansari, Nadhir; Al-Oun, Salem; Hadad, Wafa; Knutsson, Sven
Jordan is located in the Middle East and covers an area of 89,342 km2. The total population of Jordan is 6,508,271. Jordan is rapidly facing a severe water supply crisis due to greater demands on a finite quantity of available water. If current trends continue, it has been estimated that the country will experience a chronic water shortage by 2020. Despite these shortages, water loss in the distribution network is relatively high where it reaches 46%. Mafraq Governorate has the maximum water ...
Human Engineering Inst., Cleveland, OH.
THIS MODULE OF A 30-MODULE COURSE IS DESIGNED TO DEVELOP AN UNDERSTANDING OF THE OPERATION AND MAINTENANCE OF MECHANICAL GOVERNORS USED ON DIESEL ENGINES. TOPICS ARE (1) TYPES OF GOVERNORS AND ENGINE LOCATION, (2) GOVERNOR APPLICATIONS, (3) LIMITING SPEED MECHANICAL GOVERNOR, (4) VARIABLE SPEED MECHANICAL GOVERNOR, AND (5) CONSTANT SPEED…
American Council of Trustees and Alumni, 2014
With this new tool, ACTA [American Council of Trustees and Alumni] is working to expand its outreach to governors nationwide on behalf of higher education reform, focusing on key issues of quality, cost, and accountability. ACTA has worked with governors and education leaders from across the country, and that experience has proven that innovative…
... POSTAL SERVICE Board of Governors; Sunshine Act Meeting DATES AND TIMES: Tuesday, September 21... 21, at 10 a.m. (Closed) 1. Strategic Issues. 2. Pricing. 3. Financial Matters. 4. Personnel Matters and Compensation Issues. 5. Governors' Executive Session--Discussion of prior agenda items and Board...
Bhattacharjee, Shayak; Kumar, Krishna
In this work we examine a potential source of instability in the Watt governor, which can occur when the governor is subjected to periodic variation of the load torque. Floquet analysis is used to obtain the condition for existence of the unstable solutions, and results are obtained which supplement the usual Maxwell–Vyshnegradskii conditions for governor stability. Pedagogically, this paper is relevant for senior undergraduate students. It presents a detailed yet simple exposition of classical Floquet theory, a subject often ignored in undergraduate education even though the related concept of Bloch's theorem is popular in quantum mechanics courses. At the same time, it touches on certain practical engineering applications of physical concepts, with its discussion on mechanical governors. (paper)
Homeland security is a complex challenge that demands significant investment; collaboration among local, state, and federal governments; and integration with the private sector. The purpose of A Governor's Guide to Emergency Management Volume Two: Ho...
AlZou, Amer Bin; Thabit, Mazen Abood Bin; AlSakkaf, Khalid Abdulla; Basaleem, Huda Omer
Skin cancer is a group of heterogeneous malignancies, in general classified into nonmelanoma skin cancer (NMSC) and melanoma skin cancer (MSC). Incidences are high in many parts in the world with considerable geographical and racial variation. In the Yemen, there has been scarce information about skin cancer. The aim of this study was to evaluate the demographic characteristics and histological trend of skin cancer in Southern Governorates of Yemen. This retrospective study covered 204 cases of skin cancer at the Modern Histopathology Laboratory and Aden Cancer Registry and Research Center, Faculty of Medicine and Health Sciences, University of Aden, for the period 20062013. Data were classified regarding different demographic and tumor related variables and analyzed using CanReg4 for cancer registry and SPSS (version 21). The commonest encountered skin cancer was NMSC (93.1%). Generally, skin cancer appears slightly more frequently in females than males with a 1:1.06 male: female ratio, with a mean age of 62.9 years. Slightly higher than onethird (36.3%) were from Aden governorate. The head and neck proved to be the most common site in both males and females (58%). Basal cell carcinoma (BCC) is the most common histological type of skin cancer (50.5%). Skin cancer is a common cancer in patients living in southern governorates of Yemen. The pattern appears nearly similar to the international figures with a low incidence of MSC.
It is now 15 years since the Board of Governors, at that time composed of 23 members, first met in Vienna on 4 October 1957 under the Chairmanship of Mr. Pavel Winkler from CSR. Since 1962, it had 25 representatives, two additional members having been elected in view of the increase in African membership of the Agency. Its composition is now due to increase to 34 as a result of an amendment to Art. VI which received the necessary approvals on 1 June this year. he total membership of the Agency, which was 57 in 1957, has risen to 103. The first Budget was of the order of $ 4 million; the Budget for 1973 is $ 18.1 million. Technical assistance provided in 1958 amounted to about $ 30,000 and in 1972 it amounted to $ 5.5 million. These figures give an indication of the way the Agency has grown and this short review will highlight some of the notable achievements of the Board, since its inception. (author)
Yee, S.K. [Siemens Transmission and Distribution Limited, Manchester (United Kingdom); Milanovic, J.V. [School of Electrical and Electronic Engineering, University of Manchester, PO Box 88, Manchester M60 1 QD (United Kingdom); Hughes, F.M. [Manchester (United Kingdom)
With market deregulation, there is constant pressure to utilise existing assets in more effective ways in order to achieve high levels of performance and as governor technologies mature the ability of governors to achieve much more than the standard power-frequency regulation function increases. Thus, this paper has focused on a more active use of governor control for a gas turbine to provide improved system stabilisation and performance via the inclusion of phase compensation in the governor control loop. Due to the decoupled nature of the mechanical power and excitation control loops, performance improvement via governor control does not interfere with generator voltage regulation, which is a drawback of conventional generator damping provision via a power system stabiliser (PSS). In addition, the mechanical power control loop is also less affected by the operating condition of the power system and is hence more robust. It is shown that inclusion of appropriate phase compensation in the governor control loop can improve dynamic and transient stability, either alone or in conjunction with a PSS in the exciter control loop, without adversely interfering with voltage control or changing steady state power-frequency regulation. (author)
Full Text Available Objectives: An outbreak of acute gastroenteritis due to Shigella flexneri occurred in August 2012 in the catchment area of the Wadi Sahtan Health Center in Rustaq, Al Batinah South Governorate, Oman. The aim of this study was to discover possible causes of this outbreak in the villages of Fassa, Rogh and Amk and to measure the risk of exposure among cases and controls. Methods: A case-control study was conducted in September 2012 in Fassa, Rogh and Amk. All households in the three villages were interviewed. Case and control households were compared to determine possible exposure avenues, including place of residence, source of drinking water, hand hygiene levels and practices related to drinking water, food preparation and environmental sanitation. Results: Residing in Fassa (P <0.0001; odds ratio [OR] = 4.86, 95% confidence interval [CI] = 2.22–10.63 and average hand hygiene practices (P = 0.008; OR = 13.97, 95% CI = 1.58–123.36 were associated with an increased risk of contracting shigellosis. No significant differences were found with regards to the other exposure avenues. Conclusion: This was the first study conducted in Oman regarding an outbreak of shigellosis in a community setting. The only variables that significantly impacted the risk of acute gastroenteritis were residing in Fassa and average hand hygiene practices. The source of the outbreak could not be identified. However, septic tank sanitation and water and food consumption practices were not satisfactory in the studied villages. These need to be addressed to prevent similar outbreaks of acute gastroenteritis in this region in the future.
Full Text Available As an important part of overspeed and fail-safe protection for elevators, the centrifugal elevator overspeed governor is a device for limiting overspeed of elevator cars. This paper researches on the vibration of the centrifugal block, which plays a key role in the performance of this overspeed governor. By performing dynamics analysis on the centrifugal block, the differential equation on the vibration of the centrifugal block is established. Based on this, the paper performs simulation analysis on the influence of systematic parameters such as the speed of the overspeed governor sheave, the mass of centrifugal block, the turning radius of the centrifugal block, the position where the spring acts, and the stiffness of the centrifugal block spring, on the vibration of the centrifugal block, and finds out their specific influence relationship.
Full Text Available In this study, ranging from public management of administrative authority with conception measure they motivated to the extent that their subordinates and by identifying the factors that influence the motivation in this context, is intended to make proposals for the improvement of the activity.The population of the study comprise the district governors who are serving actively in all the districts of Turkey. The survey was administered by governors sent through all the governorates. As a result of the research, it is necessary to motivate the employees of almost all of the local administrative authority, and which you be lieve would be helpful at this point to use all the motivational tools have been identified. However, previous studies did not adequately reflect the thinking of application the motivation of managers. Suggestions on how to motivate their employees to engage officials in the civil service are presented
Full Text Available In September 1999, the then governor-general of Australia, Sir William Deane, gave a speech to the Australian Conference on Lutheran Education where he offered an apology to members of the German Australian community for the 'tragic, and often shameful, discrimination against Australians of German origin fostered during the world wars'. This article reflects on a number of issues raised by the Governor-General's statement, most importantly on our understanding of the Anzac historiography and its various narratives.
The discovery of KSHV in 1994 was a historical landmark in tumor virology and human cancer research. KSHV's subsequent identification as a cause of Kaposi sarcoma and its association with primary effusion lymphoma and multicentric Castleman disease soon attracted the attention of hundreds of research laboratories and motivated thousands of virologists and oncologists to switch
Full Text Available Kathryn S Gray, Dena E Cohen, Steven M Brunelli DaVita Clinical Research, Minneapolis, MN, USA Objective: The aim of this study was to determine the rate of missed treatments among hemodialysis (HD patients, and the association between treatment nonadherence and clinical outcomes.Data source: The data used in this study were based on electronic medical records and Medicare claims.Study design: This is a retrospective, observational study.Principal findings: HD patients miss 9.9% of all treatments. Approximately half of the missed treatments are due to observable medical events, predominantly hospitalizations, while half result from nonadherence (“absence”. A single absence is associated with a 1.4-fold greater risk of hospitalization, and a 2.2-fold greater risk of death in the subsequent 30 days.Conclusion: Treatment nonadherence is common among HD patients and is associated with adverse outcomes. Interventions that improve adherence may improve patient health and reduce costs. Keywords: Medicare, ambulatory/outpatient care, epidemiology, chronic disease
... POSTAL SERVICE Board of Governors; Sunshine Act Meeting TIMES AND DATES: 3:30 p.m., Monday, January 11, 2010; and 7:30 a.m., Tuesday, January 12, 2010. PLACE: Newport Beach, California, at the Fairmont Hotel, 4500 MacArthur Boulevard. STATUS: (Closed) MATTERS TO BE CONSIDERED: Monday, January 11, at...
... POSTAL SERVICE Board of Governors; Sunshine Act Meeting TIMES AND DATES: 4 p.m., Monday, January 10, 2011; and 9 a.m., Tuesday, January 11, 2011. PLACE: Long Beach, California, at the Renaissance Hotel, 111 East Ocean Boulevard. STATUS: (Closed). MATTERS TO BE CONSIDERED: Monday, January 10, at 4 p...
Clapham, Andrew; Vickers, Rob
This paper considers how governors in the English "Further Education and Skills" (FE) sector examined their practice as ethnographers. The paper locates both FE governance and ethnography within the challenges of the performative and Panoptic environments facing English education. In doing so, the paper explores how the informants'…
Paskert, Shawna; Young, Tracy
Describes the role of South Dakota's governor in initiating technology plans for schools that would promote distance education. Discusses a conclave of leaders in technology and distance education that addressed the successful implementation of the Digital Dakota Network, a statewide intranet developed to help students, empower the workforce, and…
... POSTAL SERVICE Board of Governors; Sunshine Act Meeting Times and Dates: 4 p.m., Monday, June 21... Broadway. Status: (Closed). Matters To Be Considered: Monday, June 21, at 4 p.m. (Closed) 1. Strategic...' Executive Session--Discussion of prior agenda items and Board Governance. Tuesday, June 22, at 10 a.m...
.... 7. Tentative Agenda for the September 21-22, 2010, meeting in Washington, DC. Thursday, August 5 at 10:30 a.m. (Closed--if Needed) 1. Continuation of Wednesday's closed session agenda. Contact Person.... Personnel Matters and Compensation Issues. 5. Governors' Executive Session--Discussion of prior agenda items...
... Agenda for the June 21-23, 2010, meeting in Louisville, Kentucky. Thursday, May 6 at 10:30 a.m. (Closed--if needed) 1. Continuation of Wednesday's closed session agenda. Contact Person for More Information... and Compensation Issues. 5. Governors' Executive Session--Discussion of prior agenda items and Board...
Purpose: Board meetings. Date(s):. 2016-11-20 to 2016-11-25. Destination(s):. Ottawa. Airfare: $6,121.25. Other. Transportation: $0.00. Accommodation: $786.80. Meals and. Incidentals: $0.00. Other: $0.00. Total: $6,908.05. Comments: 2016-2017 Travel Expense Reports for. Dominique Corti, Governor.
Page 1. Purpose: Board meetings. Date(s):. 2016-06-20 to 2016-06-23. Destination(s):. Ottawa. Airfare: $6,065.80. Other. Transportation: $282.55. Accommodation: $393.40. Meals and. Incidentals: $107.43. Other: $0.00. Total: $6,849.18. Comments: 2016-2017 Travel Expense Report for. Uri Rosenthal, Governor.
Page 1. Purpose: Board meetings. Date(s):. 2016-11-21 to 2016-11-24. Destination(s):. Ottawa. Airfare: $5,981.69. Other. Transportation: $296.45. Accommodation: $393.40. Meals and. Incidentals: $120.80. Other: $0.00. Total: $6,792.34. Comments: 2016-2017 Travel Expense Reports for. Uri Rosenthal, Governor.
Purpose: Board meetings. Date(s):. 2017-03-20 to 2017-03-25. Destination(s):. Ottawa. Airfare: $6,900.65. Other. Transportation: $174.34. Accommodation: $926.48. Meals and. Incidentals: $298.39. Other: $0.00. Total: $8,299.86. Comments: 2016-2017 Travel Expense Reports for. Shainoor Khoja, Governor.
Destination(s):. Ottawa. Airfare: $2,396.52. Other. Transportation: $212.16. Accommodation: $0.00. Meals and. Incidentals: $0.00. Other: $0.00. Total: $2,608.68. Comments: Residence in Dubai, United Arab Emirates. This trip originated in Los. Angeles. 2017-2018 Travel Expense Reports for. Shainoor Khoja, Governor.
Purpose: Board meetings. Date(s):. 2017-03-20 to 2017-03-22. Destination(s):. Ottawa. Airfare: $5,791.85. Other. Transportation: $346.42. Accommodation: $463.24. Meals and. Incidentals: $120.80. Other: $0.00. Total: $6,722.31. Comments: 2016-2017 Travel Expense Reports for. Uri Rosenthal, Governor.
The document informs about the election of the Governor from Nigeria as Chairman of the IAEA Board of Governors for 2000-2001, and of the Governors from Austria and Poland as Vice-Chairmen. The Member States represented on the IAEA Board for 2000-2001 are also listed
... 39 Postal Service 1 2010-07-01 2010-07-01 false Office of the Board of Governors. 2.1 Section 2.1 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE GENERAL AND TECHNICAL PROVISIONS (ARTICLE II) § 2.1 Office of the Board of Governors. There shall be located in...
... propeller pitch by regulating oil pressure to the propeller pitch change mechanism. Changes in governor oil..., the propeller governor cannot control oil pressure to the propeller pitch control mechanism. This... proposing this AD to prevent loss of propeller pitch control, damage to the propeller governor, and internal...
... methods specified under ADDRESSES. Please explain why you believe a public meeting would be beneficial. If... 43[deg]01'57.4'' N, 087[deg]54'44.8'' W then west to an imaginary line running north and south along...'44.8'' W then west to an imaginary line running north and south along 6th street. (b) Effective...
Sawut, Umerujan; Tohti, Gheyret; Takigawa, Buso; Tsuji, Teruo
This paper presents a general purpose engine speed control system with an electronic governor in order to improve the current system with a mechanical governor which shows unstable characteristics by change of mecanical friction or A/F ratio (Air/Fuel ratio). For the control system above, there are problems that the feedback signal is only a crank angle because of cost and the controlled object is a general purpose engine which is strongly nonlinear. In order to overcome these problems, the system model is shown for the dynamic estimation of the amount of air flow and the robust controller is designed. That is, the proposed system includes the robust sliding-mode controller by the feedback signal of only a crank angle where Genetic Algorithm is applied for the controller design. The simulation and the experiments by MATLAB/Simulink are performed to show the effectiveness of our proposal.
Ahmad, Enas M.
Modern smartphones are limited by their short battery life. The advancement of the graphical performance is considered as one of the main reasons behind the massive battery drainage in smartphones. In this paper we present a novel implementation of the GPUFreq Scaling Governors, a Dynamic Voltage and Frequency Scaling (DVFS) model implemented in the Android Linux kernel for dynamically scaling smartphone Graphical Processing Units (GPUs). The GPUFreq governors offer users multiple variations and alternatives in controlling the power consumption and performance of their GPUs. We implemented and evaluated our model on a smartphone GPU and measured the energy performance using an external power monitor. The results show that the energy consumption of smartphone GPUs can be significantly reduced with a minor effect on the GPU performance.
Lyubov G. Polyakova
Full Text Available This survey article addresses the historiography of World War I in the territory of Black Sea Governorate. The author singles out three chronological periods, ante-revolutionary, Soviet, and present-day Russian, and discusses distinctive characteristics in the study of the history of each of the periods. Thus, for instance, a distinctive trait in the study of World War I during the Soviet period was a permanent search in it for preconditions for the socialist revolution, which led to the artificial politicization of events and phenomena. The author comes to the conclusion that the historiography of World War I in the territory of Black Sea Governorate has considerable gaps, while the topic itself is yet to become the subject of comprehensive study. Up until the present day the following topics have remained virtually unstudied: the activity of the hospital framework across Black Sea Governorate, the identification of distinctive characteristics of combating alcoholism during the war, and the activity of charity societies.
Harvey, Kevin; Wasiak, Joe; Kievit, James; Griffard, B. F; Blotzer, Larry
...: Kentucky Governor Patton Kicks Off the Center for Strategic Leadership's (CSL) Senior Executive Program, Global Guardian Exercise '99, Global Wargame '99, Democratization Initiatives Support Simulation, Deterrence in the 21st Century Symposium...
On 27 November 2008, the Governor of Japan delivered a statement in the Board of Governors concerning Japan's activities in technical cooperation. As requested in that statement, the full text of the statement is herewith circulated for the information of Member States
Abd El-Salam, Magda Magdy
This study investigated the hospital waste management practices used by eight randomly selected hospitals located in Damanhour City of El-Beheira Governorate and determined the total daily generation rate of their wastes. Physico-chemical characteristics of hospital wastes were determined according to standard methods. A survey was conducted using a questionnaire to collect information about the practices related to waste segregation, collection procedures, the type of temporary storage containers, on-site transport and central storage area, treatment of wastes, off-site transport, and final disposal options. This study indicated that the quantity of medical waste generated by these hospitals was 1.249tons/day. Almost two-thirds was waste similar to domestic waste. The remainder (38.9%) was considered to be hazardous waste. The survey results showed that segregation of all wastes was not conducted according to consistent rules and standards where some quantity of medical waste was disposed of with domestic wastes. The most frequently used treatment method for solid medical waste was incineration which is not accepted at the current time due to the risks associated with it. Only one of the hospitals was equipped with an incinerator which is devoid of any air pollution control system. Autoclaving was also used in only one of the selected hospitals. As for the liquid medical waste, the survey results indicated that nearly all of the surveyed hospitals were discharging it in the municipal sewerage system without any treatment. It was concluded that the inadequacies in the current hospital waste management practices in Damanhour City were mainly related to ineffective segregation at the source, inappropriate collection methods, unsafe storage of waste, insufficient financial and human resources for proper management, and poor control of waste disposal. The other issues that need to be considered are a lack of appropriate protective equipment and lack of training and
This paper reports on a study of the role of parent governors in five neighbouring rural primary schools in Zimbabwe. The study proposed that despite the presence of a legal decentralised school governance structure in which parents form the majority, they did not have the capacity to function effectively therein, and were still marginalised in school governance decision-making. Four areas of decision-making were investigated: school organisation; curriculum; employment and appraisal of teaching staff; and financial resources. Interviews were conducted with parent governors, school heads and teachers. Findings show that all the respondent groups perceived significant parental involvement in the area of school finances only. However, parents were perceived to lack the capacity to make decisions in all four areas. The study concludes that the role of parents in the running of schools in the country has not significantly grown from that of being school financiers and builders of infrastructure. Therefore, building school governance capacity among parents is necessary.
Imhauser, Carl; Mauro, Craig; Choi, Daniel; Rosenberg, Eric; Mathew, Stephen; Nguyen, Joseph; Ma, Yan; Wickiewicz, Thomas
Background Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the ACL-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics following ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress following ACL reconstruction? Hypothesis/Purpose Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics following ACL reconstruction will exist. Study Design Controlled laboratory study Methods Clinical tests of anterior and rotational stability were simulated on eleven cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau and mean contact stress was calculated regionally. Results ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however contact stress abnormalities remained. On average, kinematics were overconstrained following ACL reconstruction (≤1.8mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in ab/adduction and medial-lateral translation in response to combined moments, and axial rotation, anterior-posterior and medial-lateral translation in response to an anterior load were
Paul, Diane B; Stenhouse, John; Spencer, Hamish G
Robert FitzRoy, Captain of HMS Beagle and second governor of New Zealand, has two contradictory reputations among modern academics. Evolutionary biologists and Darwin scholars generally view FitzRoy as a supporter of slavery, famously quarrelling with the abolitionist Darwin over that topic during a Brazilian stopover early in the voyage of HMS Beagle. He is also regarded as a political and religious reactionary, taking a biblically creationist position at the infamous 1860 Oxford meeting of the British Association for the Advancement of Science. New Zealand historians, however, view his record as governor much more positively. They emphasize that FitzRoy was wildly unpopular with the British settlers because of his enlightened insistence that the native Maori should be treated fairly. We outline the history of these seemingly inconsistent views and examine the evidence for each. We conclude by suggesting that a more nuanced account of FitzRoy's career would surely be more thought-provoking as well as respectful of the facts.
Shafi, Shahid; Barnes, Sunni A; Rayan, Nadine; Kudyakov, Rustam; Foreman, Michael; Cryer, H Gil; Alam, Hasan B; Hoff, William; Holcomb, John
State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality. This retrospective observational study was conducted at 5 Level I trauma centers across the country. Participants were adult patients with moderate to severe injuries (n = 3,867). The association between compliance with 22 commonly recommended clinical practices and in-hospital mortality was measured after adjusting for patient demographics and injuries and their severity. Compliance with individual clinical practices ranged from as low as 12% to as high as 94%. After adjusting for patient demographics and injury severity, each 10% increase in compliance with recommended care was associated with a 14% reduction in the risk of death. Patients who received all recommended care were 58% less likely to die (odds ratio = 0.42; 95% CI, 0.28-0.62) compared with those who did not. Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Lewis, Catherine; Deardorff, Julianna; Lahiff, Maureen; Soleimanpour, Samira; Sakashita, Kimi; Brindis, Claire D.
Background: Bullying and victimization are ongoing concerns in schools. School health centers (SHCs) are well situated to support affected students because they provide crisis intervention, mental health care, and broader interventions to improve school climate. This study examined the association between urban adolescents' experiences of…
Lansberry, J.E.; Wozniak, L.; Goldberg, D.E.
Many techniques exist for developing optimal controllers. This paper investigates genetic algorithms as a means of finding optimal solutions over a parameter space. In particular, the genetic algorithm is applied to optimal tuning of a governor for a hydrogenerator plant. Analog and digital simulation methods are compared for use in conjunction with the genetic algorithm optimization process. It is shown that analog plant simulation provides advantages in speed over digital plant simulation. This speed advantage makes application of the genetic algorithm in an actual plant environment feasible. Furthermore, the genetic algorithm is shown to possess the ability to reject plant noise and other system anomalies in its search for optimizing solutions
Full Text Available OBJECTIVE: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. METHODS: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs and their 95% confidence intervals (CIs for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1, nested within 584 village locations (level 2, and in turn nested within 22 regions (level 3. We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia. RESULTS: Compared with those who lived >1.5-3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0-10.0 km away from a health center were 1.36 (95% CI: 0.92-2.01 and 1.42 (95% CI: 1.06-1.90, respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status. CONCLUSIONS: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve
... 39 Postal Service 1 2010-07-01 2010-07-01 false Matters reserved for decision by the Governors. 3... removal of the Postmaster General, 39 U.S.C. 202(c). (b) Appointment, term of service, and removal of the Deputy Postmaster General (by the Governors and the Postmaster General, 39 U.S.C. 202(d)); pay of the...
... BROADCASTING BOARD OF GOVERNORS Sunshine Act Meeting; Notice of Meeting of the Broadcasting Board of Governors DATE AND TIME: Friday, April 20, 2012, 10 a.m. PLACE: Office of Cuba Broadcasting, 4201... Strategy and Budget Committee on the implementation of the BBG strategy and a report from the Governance...
Francis, Leslie J.; Stone, Ernest A.
Charts attitudes of the first generation of governors appointed to the Church of England voluntary aided primary schools in the Chichester (England) diocese, following the new Instruments of Government implemented in 1985. The foundation governors remain highly committed to maintaining a distinctive church-related ethos in these schools. (60…
At the request of the outgoing Chairperson of the Board of Governors, her statement delivered in the Board of Governors meeting on 22 September 2009, regarding the working arrangements of the Board, is reproduced herewith for information
Over 1 million working registered nurses (RNs) currently do not have a bachelor's degree in nursing and comprise the critical group needing to return to school in order to achieve the Institute of Medicine's goal of 80% bachelors of science in nursing (BSNs) by 2020. Western Governors University (WGU) has developed a transformative educational model, incorporating 4 operational pillars (competency-based learning, technology, disaggregated faculty roles, and a student-centric management system), to revolutionize RN-BSN education. This article describes a successful contemporary model, disrupting most all of the traditional aspects of university education for professional nursing practice. The program design is of particular value to working adults and addresses the flexibility they need to accommodate academic advancement. The WGU nursing program currently serves over 5,000 students seeking BSN and Master of Science in Nursing degrees in all 50 states. © 2014.
Morsy, T A; el Okbi, L M; Kamal, A M; Ahmed, M M; Boshara, E F
Mosquitoes are among the most annoying and important vectors of human and animal diseases as malaria, filariasis, yellow fever, rift valley fever...etc. In this paper, it was aimed to study the present status of species of genus Culex in the Suez Canal Governorates after the reconstruction and developmental projects. Five species of Culex were identified: C. pipiens, C. univittatus, C. antennatus, C. poicilipes and C. pusillus. The latter species was represented by two specimens. C. pipiens was the commonest species both indoors and outdoors. C. antennatus and C. poicilipes were found only outdoors. C. pipiens was found all the year round particularly in Spring. Other species were found in Spring and Autumn, except C. antennatus which was found in Summer as well. The results were discussed on the light of work done before.
Weiss, Elliott Mark; Xie, Dawei; Cook, Noah; Coughlin, Katherine; Joffe, Steven
Little is known about how characteristics of particular clinical decisions influence decision-making preferences by patients or their surrogates. A better understanding of the factors underlying preferences is essential to improve the quality of shared decision making. To identify the characteristics of particular decisions that are associated with parents' preferences for family- vs medical team-centered decision making across the spectrum of clinical decisions that arise in the neonatal intensive care unit (NICU). This cross-sectional survey assessed parents' preferences for parent- vs medical team-centered decision making across 16 clinical decisions, along with parents' assessments of 7 characteristics of those decisions. Respondents included 136 parents of infants in 1 of 3 academically affiliated hospital NICUs in Philadelphia, Pennsylvania, from January 7 to July 8, 2016. Respondents represented a wide range of educational levels, employment status, and household income but were predominantly female (109 [80.1%]), white (68 [50.0%]) or African American (53 [39.0%]), and married (81 of 132 responding [61.4%]). Preferences for parent-centered decision making. For each decision characteristic (eg, urgency), multivariable analyses tested whether middle and high levels of that characteristic (compared with low levels) were associated with a preference for parent-centered decision making, resulting in 2 odds ratios (ORs) per decision characteristic. Among the 136 respondents (109 women [80.1%] and 27 men [19.9%]; median age, 30 years [range, 18-43 years]), preferences for parent-centered decision making were positively associated with decisions that involved big-picture goals (middle OR, 2.01 [99% CI, 0.83-4.86]; high OR, 3.38 [99% CI, 1.48-7.75]) and that had the potential to harm the infant (middle OR, 1.32 [99% CI, 0.84-2.08]; high OR, 2.62 [99% CI, 1.67-4.11]). In contrast, preferences for parent-centered decision making were inversely associated with the
... Bureau of Land Management (BLM) is publishing this notice to explain why the BLM Director is rejecting... Director's Response to the Alaska Governor's Appeal of the BLM Alaska State Director's Governor's... the BLM Alaska State Director. The State Director determined the Governor's Finding was outside the...
Gibson, James D.
This paper presents the experience and current practices employed within the United States (US) associated with the use of Centralized Rad waste Processing Centers for the processing of Low Level Radioactive Wastes (LLRW). Information is provided on the methods, technologies, and practices employed by Scientific Ecology Group, Inc. (SEG), which is the worlds largest processor of LLRW. SEG processes over 80,000 cubic meters of waste annually and achieves an overall volume reduction of 12 : 1. LLRW processing in the United States is currently performed primarily at Centralized Rad waste Processing Centers, such as SEG's Central Volume Reduction Facility (CVRF) in Oak Ridge, Tennessee. This is primarily due to the superior economical application of advanced waste processing technologies, equipment, and personnel maintained at these centers. Information is provided on how SEG uses supercompaction, incineration, metals recycling, vitrification, and various other waste processing techniques to process both dry and wet wastes from over 90 commercial nuclear power plants, government operated facilities, hospitals, universities, and various small generators of radioactive waste
Valéria Correa de Almeida
Full Text Available ABSTRACT OBJECTIVE We aim to analyze trend of syphilis and factors associated with recurrent episodes of syphilis among adults and adolescents attended in a STI/AIDS reference centers in Campinas, state of São Paulo, 2004 to 2012. METHODS Medical records, pharmacy data, and notification database were accessed to analyze trends of syphilis and sociodemographic, epidemiological and clinical variables associated with reinfection of syphilis. After univariate analysis, a hierarchical logistic regression model was adjusted to analyze variables associated with more than one episode of syphilis (dependent variable. First step (sex, age, and years of schooling were tested and in the second, epidemiological and clinical variables. RESULTS A total of 1,009 episodes of syphilis were identified among 860 adolescents and adults, 117 individuals (13.6% presented with more than one episode of syphilis. Factors associated with more than one episode of syphilis were sex (male (OR = 4.28; 95%CI 1.31–14.0, age (OR = 1.02; 95%CI 1.00–1.04, homosexual/bisexual orientation (OR = 2.29; 95%CI 1.22–4.32, HIV coinfection (OR = 3.54; 95%CI 2.22–5.63, and absence of STI symptoms at the time of syphilis diagnostic (OR = 1.70; 95%CI 1.03–2.80. CONCLUSIONS The number of cases of syphilis and proportion in relation to STI increased in recent years in a specific population attended in a STI/AIDS reference centers in Campinas. Association with HIV, homosexual/bisexual orientation and the silent clinical characteristic of cases confirm the necessity to implement more aggressive strategies to prevent the occurrence of syphilis and other STI in specific populations with higher disease risk.
Almeida, Valéria Correa de; Donalisio, Maria Rita; Cordeiro, Ricardo
We aim to analyze trend of syphilis and factors associated with recurrent episodes of syphilis among adults and adolescents attended in a STI/AIDS reference centers in Campinas, state of São Paulo, 2004 to 2012. Medical records, pharmacy data, and notification database were accessed to analyze trends of syphilis and sociodemographic, epidemiological and clinical variables associated with reinfection of syphilis. After univariate analysis, a hierarchical logistic regression model was adjusted to analyze variables associated with more than one episode of syphilis (dependent variable). First step (sex, age, and years of schooling) were tested and in the second, epidemiological and clinical variables. A total of 1,009 episodes of syphilis were identified among 860 adolescents and adults, 117 individuals (13.6%) presented with more than one episode of syphilis. Factors associated with more than one episode of syphilis were sex (male) (OR = 4.28; 95%CI 1.31-14.0), age (OR = 1.02; 95%CI 1.00-1.04), homosexual/bisexual orientation (OR = 2.29; 95%CI 1.22-4.32), HIV coinfection (OR = 3.54; 95%CI 2.22-5.63), and absence of STI symptoms at the time of syphilis diagnostic (OR = 1.70; 95%CI 1.03-2.80). The number of cases of syphilis and proportion in relation to STI increased in recent years in a specific population attended in a STI/AIDS reference centers in Campinas. Association with HIV, homosexual/bisexual orientation and the silent clinical characteristic of cases confirm the necessity to implement more aggressive strategies to prevent the occurrence of syphilis and other STI in specific populations with higher disease risk.
Ding, Hongliu; Sarokhan, Alison K.; Roderick, Sarah S.; Bakshi, Rachit; Maher, Nancy E.; Ashourian, Paymon; Kan, Caroline G.; Chang, Sunny; Santarlasci, Andrea; Swords, Kyleen E.; Ravina, Bernard M.; Hayes, Michael T.; Sohur, U. Shivraj; Wills, Anne-Marie; Flaherty, Alice W.; Unni, Vivek K.; Hung, Albert Y.; Selkoe, Dennis J.; Schwarzschild, Michael A.; Schlossmacher, Michael G.; Sudarsky, Lewis R.; Growdon, John H.; Ivinson, Adrian J.; Hyman, Bradley T.; Scherzer, Clemens R.
Background Mutations in the α-synuclein gene (SNCA) cause autosomal dominant forms of Parkinson’s disease, but the substantial risk conferred by this locus to the common sporadic disease has only recently emerged from genome-wide association studies. Methods Here we genotyped a prioritized non-coding variant in SNCA intron-4 in 344 patients with Parkinson’s and 275 controls from the longitudinal Harvard NeuroDiscovery Center Biomarker Study. Results The common minor allele of rs2736990 was associated with elevated disease susceptibility (odds ratio = 1.40, P value = 0.0032). Conclusions This result increases confidence in the notion that in many clinically well-characterized patients genetic variation in SNCA contributes to “sporadic” disease. PMID:21953863
Hur, Eunhye; Jeon, Lieny; Buettner, Cynthia K.
Background: Early childhood teachers' child-centered beliefs, defined as teachers' attitudes about how children learn, have been associated with teachers' developmentally appropriate practices and positive child outcomes. The predictors of teachers' child-centered beliefs, however, are less frequently explored. Objective: This study tested whether…
The agreement that has been reached by the Board on the budget and the associated 'package' of related issues. This is the first budget after a decade and a half of a preset financial ceiling that is based on real needs and provides the Secretariat with the increased resources required to implement an expanding programme. I am grateful for your understanding and support. The budget that has been agreed responds, in my view, in a balanced manner to the priorities of the Agency in both the regulatory and developmental fields. The bulk of the increase goes to the verification programme, because that programme has been experiencing the greatest demand for additional resources As always, the Secretariat is committed to achieving efficiency and effectiveness in all areas and to keeping our operations under continuing review. Some recent developments of particular importance are reported upon: The mission in Iraq was confined to verification of material subject to safeguards at Location C Nuclear Storage Facility near Tuwaitha, where the looting had reportedly taken place. The reports note that at least 10 kg of uranium compounds could have been dispersed. The IAEA mission was conducted in connection with the safeguards agreement between Iraq and the IAEA pursuant to the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). The Iranian authorities were warned once again about the need to clarify without delay outstanding safeguards issues (as noted in report to the June Board GOV/2003/40) and to co-operate fully and in a transparent manner with the Agency. The Iranian authorities, were urged, to sign an Additional Protocol that would enable the Agency to conduct the in-depth and comprehensive verification that could generate, particularly in a country like Iran with extensive nuclear activities, the required assurances. A technical meeting took place between our senior safeguards staff and Iranian counterparts. During that meeting, some of the outstanding issues were
Abbas, Moustafa A; Fiala, Lamiaa A; Abdel Rahman, Amira G; Fahim, Ayman E
Violence against health care workers (HCW) or workplace violence in general is a major problem affecting health and productivity of HCWs. To determine the prevalence and nature of workplace violence against nurses in Ismailia governorate, Egypt, and to identify its risk factors and how nurses manage it. Cross-sectional study, using a questionnaire for data collection, which includes demographic data, characteristics of workplace violence events, and risk factors contributing to workplace violence. All nursing staff in four hospitals and twelve Primary Health Care (PHC) Centers, randomly selected from Ismailia city were recruited. Out of 1600 distributed questionnaires, a total of completed 970 were returned (a 55% response rate). 269 (27.7%) of nurses reported abuse of any kind, 187 (69.5%) verbal abuse; and 25 (9.3%) physical abuse. Males were more exposed to violence events during the past 12 months than females (35.3% versus 24.2%, pWorkplace violence against nurses is a significant problem in health care settings all over the world and in Ismailia, Egypt. There is a need to increase awareness of the problem among health care workers as well as the general public. Further large-scale studies should be conducted to more closely examine the problem.
A. K. Azidah
Full Text Available The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel’s index. The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, P<0.05, age group more than 75 (OR: 2.97, P<0.05, retinopathy (OR: 2.19, P<0.05, and orthostatic hypotension (OR: 2.87, P<0.05 were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, P<0.05. In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score.
Lewis, Catherine; Deardorff, Julianna; Lahiff, Maureen; Soleimanpour, Samira; Sakashita, Kimi; Brindis, Claire D
Bullying and victimization are ongoing concerns in schools. School health centers (SHCs) are well situated to support affected students because they provide crisis intervention, mental health care, and broader interventions to improve school climate. This study examined the association between urban adolescents' experiences of school-based bullying and victimization and their use of SHCs. Data was analyzed from 2063 high school students in 5 Northern California school districts using the 2009-2010 California Healthy Kids Survey. Chi-square tests and multivariate logistic regression were used to measure associations. Students who were bullied or victimized at school had significantly higher odds of using the SHCs compared with students who were not, and were also significantly more likely to report confidentiality concerns. The magnitude of associations was largest for Asian/Pacific Islander students, though this was likely due to greater statistical power. African American students reported victimization experiences at approximately the same rate as their peers, but were significantly less likely to indicate they experienced bullying. Findings suggest that SHCs may be an important place to address bullying and victimization at school, but confidentiality concerns are barriers that may be more common among bullied and victimized youth. © 2015, American School Health Association.
An analysis is provided of a proposal to the Board of Governors of the California Community Colleges by the Antelope Valley Community College District (AVCCD) to develop an education center in Palmdale to accommodate rapid growth. First, pros and cons are discussed for the following major options: (1) increase utilization and/or expand the…
www.bioline.org.br/ja. Wintering Map for Honey Bee Colonies in El-Behera Governorate, Egypt by using ... F. ABOU-SHAARA. Plant Protection Department, Faculty of Agriculture, Damanhour University, Egypt. ..... Architecture of automatized ...
High school students from the Virginia Governor's School were recently treated to a unique experience of immersive virtual reality technology and how it is used in understanding and solving real problems facing the commonwealth and the country.
The frequency stability of a marine power system is determined by the dynamic characteristic of the diesel engine speed regulation system in a marine power station. In order to reduce the effect of load disturbances and improve the dynamic precision of a diesel engine speed governor, a controller was designed for a diesel engine speed regulation system using H2 control theory. This transforms the specifications of the system into a standard H2 control problem. Firstly, the mathematical model of a diesel engine speed regulation system using an H2 speed governor is presented. To counter external disturbances and model uncertainty, the design of an H2 speed governor rests on the problem of mixed sensitivity. Computer simulation verified that the H2 speed governor improves the dynamic precision of a system and the ability to adapt to load disturbances, thus enhancing the frequency stability of marine power systems.
McKinney, James S; Cheng, Jerry Q; Rybinnik, Igor; Kostis, John B
Comprehensive stroke centers (CSCs) provide a full spectrum of neurological and neurosurgical services to treat complex stroke patients. CSCs have been shown to improve clinical outcomes and mitigate disparities in ischemic stroke patients. It is believed that CSCs also improve outcomes in hemorrhagic stroke. We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes data on patients discharged with a primary diagnosis of intracerebral hemorrhage (ICH; International Classification of Diseases, Ninth Revision [ICD-9] 431) and subarachnoid hemorrhage (SAH; ICD-9 430) from all nonfederal acute care hospitals in New Jersey (NJ) between 1996 and 2012. Out-of-hospital deaths were assessed by matching MIDAS records with NJ death registration files. The primary outcome variable was 90-day all-cause mortality. The primary independent variable was CSC versus primary stroke center (PSC) and nonstroke center (NSC) admission. Multivariate logistic models were used to measure the effects of available covariates. Overall, 36 981 patients were admitted with a primary diagnosis of ICH or SAH during the study period, of which 40% were admitted to a CSC. Patients admitted to CSCs were more likely to have neurosurgical or endovascular interventions than those admitted to a PSC/NSC (18.9% vs. 4.7%; Pmortality (35.0% vs. 40.3%; odds ratio, 0.93; 95% confidence interval, 0.89 to 0.97) for hemorrhagic stroke. This was particularly true for those admitted with SAH. Hemorrhagic stroke patients admitted to CSCs are more likely to receive neurosurgical and endovascular treatments and be alive at 90 days than patients admitted to other hospitals. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
Full Text Available The hydroturbine generator regulating system can be considered as one system synthetically integrating water, machine, and electricity. It is a complex and nonlinear system, and its configuration and parameters are time-dependent. A one-step-ahead predictive control based on on-line trained neural networks (NNs for hydroturbine governor with variation in gate position is described in this paper. The proposed control algorithm consists of a one-step-ahead neuropredictor that tracks the dynamic characteristics of the plant and predicts its output and a neurocontroller to generate the optimal control signal. The weights of two NNs, initially trained off-line, are updated on-line according to the scalar error. The proposed controller can thus track operating conditions in real-time and produce the optimal control signal over the wide operating range. Only the inputs and outputs of the generator are measured and there is no need to determine the other states of the generator. Simulations have been performed with varying operating conditions and different disturbances to compare the performance of the proposed controller with that of a conventional PID controller and validate the feasibility of the proposed approach.
Alachkar, Amal; Jaddouh, Ahmad; Elsheikh, Muhammad Salem; Bilia, Anna Rita; Vincieri, Franco Francesco
The use of Traditional Arabic Medicine (TAM) for various diseases has been popular but scarcely studied in Syria. In the present study, we carried out ethnobotanical and ethnopharmacological research on the plants traditionally used to cure various diseases in northern Syria. The information was collected from the city and villages of the Aleppo governorate "Mohaafazah" in the north of Syria, collecting data directly on the basis of a detailed survey of inhabitants and herbalists. In this survey, we found that hundreds of plant species are still in use in TAM for the treatment of various diseases. We selected the most common 100 species, used in the treatment of more than 25 diseases. Among these plants, 53 are used for treating gastrointestinal disorders, 38 for respiratory system diseases, including asthma, bronchitis and cough, 34 for skin diseases, 21 for diabetes, 17 for kidney and urinary disorders, 16 for cardiac disorders, 14 for infertility and sexual impotency, 13 for treating liver diseases, 13 for several types of cancer, 9 for enhancing breast milk excretion, 8 for weight loss, 5 for reducing cholesterol, and three for weight gain. Plants were collected and identified: scientific Latin names, local names, the used parts of the plant, the herbal preparations and the local medical uses are described. Scientific literature concerning the activity of the investigated species is also reported and discussed according to their traditional uses.
Ghaniyoun, Aram; Shakeri, Khosro; Heidari, Mohammad
Workers in social service professions are the first candidates for job burnout. The researchers believe this is due to daily exposure to stressful situations and lack of positive conditions in the workplace. It seems that psychological empowerment of staff can affect their job burnout. This study aimed to investigate the relationship between psychological empowerment and job burnout in operational staff of emergency center. This was a descriptive correlational study. A total of 1100 operational staff of emergency center were evaluated, and of which, 285 persons were selected by simple random sampling method. Data were collected using Spritzer's psychological empowerment and Maslach Burnout Inventory questionnaires. SPSS software, version 18, was used for data analysis along with descriptive analytical tests. The findings of this study revealed that the majority of units (46%) were in intermediate level in terms of empowerment. Similarly, the majority of cases had intermediate level (77.5%), and a minor percentage (8.4%) had low levels of job burnout. Based on Pearson's correlation test, there was a significant invert correlation between psychological empowerment and job burnout. This inverse and significant relationship was also observed between the four components of psychological empowerment (competence, self-determination, impact, and meaning) and job burnout. According to the results of the study, policy makers and health planners can take some measures in enhancing psychological empowerment to prevent problems associated with job burnout, by identifying stressors and strategies to deal with them.
Natkunam, Y.; Vainer, G.; Zhao, S.C.
and tumorigenesis/metastasis. We generated an antibody that recognizes all three isoforms of VICKZ protein and characterized its expression in normal lymphoid tissue and in lymphoma subtypes. In normal tonsils, VICKZ protein showed a germinal center-specific pattern of expression with staining localized...... to the cytoplasm. Among 868 non-Hodgkin and Hodgkin lymphomas tested by immunohistochemistry on tissue microarrays, staining for VICKZ protein was present in 76% (126/165) of follicular lymphoma, 78% (155/200) of DLBCL, 90% (9/10) of mediastinal large B-cell lymphoma, and 100% (2/2) of Burkitt lymphoma. A subset...... protein in lymphoma subtypes suggests a potential utility for VICKZ in the identification of subgroups of DLBCL associated with different prognoses....
MacDonald, Dee; Barnes, Marian; Crawford, Mike; Omeni, Edward; Wilson, Aaron; Rose, Diana
National Health Foundation Trusts present opportunities for individual mental health service users to be active in the governance of trusts. This is one of a range of mechanisms for patient and public involvement and one which promotes an individual rather than collective approach to involvement. Within the context of a broader study of the impact of service user involvement in mental health services, the objective of this article was to explore the experience of service user governors in foundation trusts and their capacity to hold boards to account. The Council of Governors in three foundation trusts were observed for a year. Focus groups with service user governors were undertaken in each trust. Service users had different expectations and understandings of the role and approached it in different ways. Key themes that emerged concerned: the role of a governor, conduct and content of meetings, agenda setting, relationships and representation. The experiences of mental health service user governors need to be understood within the complex environment of patient and public involvement in general and of mental health service user involvement in particular. The dislocation of the service user governor role from other forms of service user activity and involvement result in confusion about how notions of holding a trust to account and representation of other service users can be addressed within a boundaried institutional environment. © 2014 John Wiley & Sons Ltd.
Cortellazzi, Karine Laura; Balbino, Edna Cesar; Guerra, Luciane Miranda; Vazquez, Fabiana de Lima; Bulgareli, Jaqueline Vilela; Ambrosano, Glaucia Maria Bovi; Pereira, Antonio Carlos; Mialhe, Fábio Luiz
The aim of this study was to evaluate the performance of the Centers for Dental Specialties (CDS) in the country and associations with sociodemographic indicators of the municipalities, structural variables of services and primary health care organization in the years 2004-2009. The study used secondary data from procedures performed in the CDS to the specialties of periodontics, endodontics, surgery and primary care. Bivariate analysis by χ2 test was used to test the association between the dependent variable (performance of the CDS) with the independents. Then, Poisson regression analysis was performed. With regard to the overall achievement of targets, it was observed that the majority of CDS (69.25%) performance was considered poor/regular. The independent factors associated with poor/regular performance of CDS were: municipalities belonging to the Northeast, South and Southeast regions, with lower Human Development Index (HDI), lower population density, and reduced time to deployment. HDI and population density are important for the performance of the CDS in Brazil. Similarly, the peculiarities related to less populated areas as well as regional location and time of service implementation CDS should be taken into account in the planning of these services.
Enoki, Mamiko; Maeda, Eri; Iwata, Toyoto; Murata, Katsuyuki
There is little epidemiological evidence linking subjective stress to objective etiologic indicators. To clarify an association between work-related stress and autonomic nervous function, we examined call center employees (167 males and 371 females) undergoing electrocardiography (ECG) at the time of annual health checkups. The questionnaire was composed of the Brief Job Stress Questionnaire based on the demand-control-support model and the Social Readjustment Rating Scale including detailed contents of home stress. The Bazett's corrected QT (QTc) interval, QT index, and heart rate were obtained from the ECG data. The male employees showed significantly higher scores of job demand, job control, and supervisor support than the female ones. In the male employees, QT index indicating the extent of autonomic imbalance and heart rate were associated with high score of supervisor support and low score of coworker support (P stress. By contrast, the female employees showed no significant links between any autonomic indicators and either work-related stress or home stress. These data suggest that work-related stress affected QT index in male employees suffering specific occupational stressors such as emotional abuse from unsatisfied customers. Specifically, supports from supervisors and coworkers were paradoxically associated with QT index, implying that supervisors may have failed to effectively support such male employees. Also, autonomic nervous function in male employees appears to be more vulnerable to work-related stress than that in female ones.
Reddy, Rakesh; Gogia, Ajay; Kumar, Lalit; Sharma, Atul; Bakhshi, Sameer; Sharma, Mehar C; Mallick, Saumyaranjan; Sahoo, Ranjit
Data on HIV associated hematologic malignancies is sparse from India. This study attempts to analyze the spectrum and features of this disease at a tertiary cancer center in India. Retrospective study from case records of patients registered with a diagnosis of hematologic malignancy and HIV infection between January 2010 and June 2015. Thirteen cases of HIV associated hematologic malignancies were identified, six of them pediatric. HIV diagnosis was concurrent to diagnosis of cancer in 12 and preceded it in one of them. ECOG PS at presentation was >1 in all of them. All patients, except one, had B symptoms. Six of the patients had bulky disease and six are stage 4. Predominant extranodal disease was seen in 67% of them. NHL accounted for 10 of 13 patients and DLBCL-Germinal center was the most common subtype. Mean CD4+ cell count was 235/μL (range, 32-494). HAART could be given along with chemotherapy to 11 patients. Two-thirds of patients received standard doses of therapy. Chemo-toxicity required hospitalization in 58%. CR was achieved in 45% and 36% had progressive disease with first-line therapy. At the time of last follow up, 3 patients were alive with responsive disease, 2 in CR and 1 in PR. None of the pediatric patients were long time responders. These malignancies were of advanced stage and higher grade. Goal of therapy, in the HAART era, is curative. Pediatric patients had dismal outcome despite good chemotherapy and HAART. There is an urgent need to improve data collection for HIV related cancers in India.
Abu Amr, S S; Yassin, M M
To assess total and faecal coliform contamination in water wells and distribution networks over the past 7 years, and their association with human health in Khan Yunis Governorate, Gaza Strip. Historical data and interview questionnaire. Data were obtained from the Palestinian Ministry of Health on total and faecal coliform contamination in water wells and distribution networks, and on the incidence of water-related diseases in Khan Yunis Governorate. An interview questionnaire was conducted with 210 residents of Khan Yunis Governorate. Total and faecal coliform contamination exceeded the World Health Organization's limit for water wells and networks. However, the contamination percentages were higher in networks than in wells. Diarrhoeal diseases were strongly correlated with faecal coliform contamination in water networks (r=0.98). This is consistent with the finding that diarrhoeal diseases were the most common self-reported diseases among the interviewees. Such diseases were more prevalent among subjects who drank municipal water than subjects who drank desalinated or home-filtered water (odds ratio=2.03). Intermittent water supply, insufficient chlorination and sewage flooding seem to be associated with self-reported diseases. Residents in the Gaza Strip have a good level of knowledge about drinking water contamination, and this is reflected in good practice. Water quality has deteriorated in the Gaza Strip, and this may contribute to the prevalence of water-related diseases. Self-reported diseases among interviewees in Khan Yunis Governorate were associated with source of drinking water, intermittent water supply, insufficient chlorination, sewage flooding and age of water networks.
Kakey, Musher Ismail Salih; Abdoulrahman, Kamaran Kaiani
The present study aims to evaluate iron related parameters in chronic renal failure (CRF) patients on hemodialysis (HD). The study was carried out in Kidney Dialysis Center of Hawler Teaching Hospital in Erbil governorate. This study comprised (76) patients with chronic renal failure on hemodialysis and 41 healthy subjects as a control group of same ages. All hemodialysis patients were taking erythropoietin. The blood samples were taken from the patients before and after the process of hemodialysis for liver parameters and oxidative stress estimations. The results of this study showed lower levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total bilirubin, total protein and total antioxidant capacity (TAC), while higher levels of alkaline phosphatase (ALP), direct bilirubin and malondialdeyhde (MDA) before analysis was seen. Hemodialysis causes increasing in AST, ALT, albumin, total bilirubin, total protein and decreasing in ALP, direct bilirubin MDA and TAC.
Chance Michael L
Full Text Available Abstract Background This is an investigation of anti-malarial molecular markers coupled with a therapeutic efficacy test of chloroquine (CQ against falciparum malaria in an area of unstable malaria in Lahj Governorate, Yemen. The study was aimed at assessment of therapeutic response to CQ and elucidation of baseline information on molecular markers for Plasmodium falciparum resistance against CQ and sulphadoxine/pyrimethamine (SP. Methods Between 2002 and 2003 the field test was conducted according to the standard WHO protocol to evaluate the therapeutic efficacy of CQ in 124 patients with falciparum malaria in an endemic area in Lahj Governorate in Yemen. Blood samples collected during this study were analysed for P. falciparum chloroquine resistance transporter gene (pfcrt-76 polymorphisms, mutation pfcrt-S163R and the antifolate resistance-associated mutations dihydrofolate reductase (dhfr-C59R and dihydropteroate synthase (dhps-K540E. Direct DNA sequencing of the pfcrt gene from three representative field samples was carried out after DNA amplification of the 13 exons of the pfcrt gene. Results Treatment failure was detected in 61% of the 122 cases that completed the 14-day follow-up. The prevalence of mutant pfcrt T76 was 98% in 112 amplified pre-treatment samples. The presence of pfcrt T76 was poorly predictive of in vivo CQ resistance (PPV = 61.8%, 95% CI = 52.7-70.9. The prevalence of dhfr Arg-59 mutation in 99 amplified samples was 5%, while the dhps Glu-540 was not detected in any of 119 amplified samples. Sequencing the pfcrt gene confirmed that Yemeni CQ resistant P. falciparum carry the old world (Asian and African CQ resistant haplotype CVIETSESI at positions 72,73,74,75,76,220,271, 326 and 371. Conclusion This is the first study to report baseline information on the characteristics and implications of anti-malarial drug resistance markers in Yemen. It is also the first report of the haplotype associated with CQR P. falciparum
Mubjer, Reem A; Adeel, Ahmed A; Chance, Michael L; Hassan, Amir A
This is an investigation of anti-malarial molecular markers coupled with a therapeutic efficacy test of chloroquine (CQ) against falciparum malaria in an area of unstable malaria in Lahj Governorate, Yemen. The study was aimed at assessment of therapeutic response to CQ and elucidation of baseline information on molecular markers for Plasmodium falciparum resistance against CQ and sulphadoxine/pyrimethamine (SP). Between 2002 and 2003 the field test was conducted according to the standard WHO protocol to evaluate the therapeutic efficacy of CQ in 124 patients with falciparum malaria in an endemic area in Lahj Governorate in Yemen. Blood samples collected during this study were analysed for P. falciparum chloroquine resistance transporter gene (pfcrt)-76 polymorphisms, mutation pfcrt-S163R and the antifolate resistance-associated mutations dihydrofolate reductase (dhfr)-C59R and dihydropteroate synthase (dhps)-K540E. Direct DNA sequencing of the pfcrt gene from three representative field samples was carried out after DNA amplification of the 13 exons of the pfcrt gene. Treatment failure was detected in 61% of the 122 cases that completed the 14-day follow-up. The prevalence of mutant pfcrt T76 was 98% in 112 amplified pre-treatment samples. The presence of pfcrt T76 was poorly predictive of in vivo CQ resistance (PPV = 61.8%, 95% CI = 52.7-70.9). The prevalence of dhfr Arg-59 mutation in 99 amplified samples was 5%, while the dhps Glu-540 was not detected in any of 119 amplified samples. Sequencing the pfcrt gene confirmed that Yemeni CQ resistant P. falciparum carry the old world (Asian and African) CQ resistant haplotype CVIETSESI at positions 72,73,74,75,76,220,271, 326 and 371. This is the first study to report baseline information on the characteristics and implications of anti-malarial drug resistance markers in Yemen. It is also the first report of the haplotype associated with CQR P. falciparum parasites from Yemen. Mutant pfcrtT76 is highly prevalent but it
Beal, Eliza W; Black, Sylvester M; Mumtaz, Khalid; Hayes, Don; El-Hinnawi, Ashraf; Washburn, Kenneth; Tumin, Dmitry
High-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival. It is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience. The United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume. The analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p donor risk index and center volume was not statistically significant (p = 0.747), confirming that the risk associated with using marginal donor livers was comparable between smaller and larger centers. Results were consistent when examining graft loss. At both small and large centers, high-risk donor allografts were associated with reduced patient and graft survival after liver transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.
Samah S. Abdel Gawad
Full Text Available Schistosomiasis and hepatitis C virus (HCV are endemic diseases with high prevalence in Africa especially in Egypt. Many sociodemographic and behavioral related determinants were implicated to be associated with schistosomiasis, HCV or coinfection. Recently, polymerase chain reaction (PCR is used as a diagnostic tool as it is a sensitive and a specific method especially in early stage of infection. But, diagnosis of S. mansoni is depending on microscopic examination remains the most widely used direct diagnostic method in endemic area. The current study was carried out to determine the prevalence of schistosomiasis mansoni, HCV and confection if any among the studied population, to identify any associated factors for schistosomiasis mansoni, HCV or coinfection if any.A descriptive cross sectional study was conducted on 400 participants, inhabitants in Beni-Suef Governorate, Upper Egypt. The studied population was screened for both schistosomiasis mansoni and HCV. They were subjected to fulfill a well-structured field tested interviewing questionnaire focusing on many suspected associated factors. Moreover, testing the performance characteristics of the used techniques was determined. The prevalence of schistosomiasis mansoni was (2.8% and HCV was (42.5% among the studied subjects. The study highlights on many behavioral and sociodemographic determinants significantly associated with HCV infection such as home crowding index, shaving at the community barber, sharing razors within the family, delivery at home and circumcision outside the health settings. Also, the study revealed that there are certain determinants associated with both schistosomiasis mansoni and HCV infection such as blood transfusion and liver cirrhosis. Studying the linked determinates with schistosomisis and HCV is the cornerstone to plan and implement a preventive strategy in the Upper Egypt. Thus, further studying the associated environmental determinants in relation to
Larkin, Ian; Ang, Desmond; Steinhart, Jonathan; Chao, Matthew; Patterson, Mark; Sah, Sunita; Wu, Tina; Schoenbaum, Michael; Hutchins, David; Brennan, Troyen; Loewenstein, George
In an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing. To analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs. The study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy. Academic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians. The monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability. The analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a
Full Text Available "nClostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero. Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion. Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1% were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P<0.05. Among the wards of selected hospitals, in gastroenterology of Children clinical center, Toxigenic C. difficile was isolated from patients most frequently. The sensitivity of isolates to vancomycin, Chloramphenicol and ceftriaxone were higher than other antibiotics. Toxigenic C. difficile is a common hospital-acquired infection. The organism was found in 6.1% hospitalized patients. Further studies to evaluate the rate and role of toxigenic C. difficile in nosocomial diarrheal processes, ecological and pathogenic terms are suggested.
Deriba, Beyazin Kebede; Sinke, Shimele Ololo; Ereso, Berhane Megersa; Badacho, Abebe Sorsa
Human resources are vital for delivering health services, and health systems cannot function effectively without sufficient numbers of skilled, motivated, and well-supported health workers. Job satisfaction of health workers is important for motivation and efficiency, as higher job satisfaction improves both employee performance and patient satisfaction. Even though several studies have addressed job satisfaction among healthcare professionals in different part of the world, there are relatively few studies on healthcare professionals' job satisfaction in Ethiopia. A facility-based cross-sectional study was conducted among health professionals working in health centers in April 2015 using self-administered structured questionnaires. All 322 health professionals working in 23 randomly selected public health centers were included. Factor scores were computed for the identified items by varimax rotation to represent satisfaction. Multivariate linear regression analysis was performed, and the effect of independent variables on the regression factor score quantified. Three hundred eight respondents participated with a response rate of 95.56%. The overall level of job satisfaction was 41.46%. Compensation (benefits) (beta 0.448 [95% CI 0.341 to 0.554]), recognition by management (beta 0.132 [95% CI 0.035 to 0.228]), and opportunity for development (beta 0.123 [95% CI 0.020 to 0.226]) were associated with job satisfaction. A unit increase in salary and incentives and recognition by management scores resulted in 0.459 (95% CI 0.356 to 0.561) and 0.156 (95% CI 0.065 to 0.247) unit increases in job satisfaction scores, respectively. The overall level of job satisfaction in health professionals was low. Salary and incentives, recognition by management, developmental opportunities, and patient appreciation were strong predictors of job satisfaction.
Timmermans, Sjoerd T.; Reijnierse, Esmee M.; Pasma, J.H.; Trappenburg, Marijke C.; Blauw, Gerard J.; Maier, Andrea B.; Meskers, Carel G M
Background: Orthostatic hypotension (OH), a blood pressure drop after postural change, is associated with impaired standing balance and falls in older adults. This study aimed to assess the association between blood pressure (BP) and a measure of quality of standing balance, i.e. Center of
Brunelli, Steven M; Sibbel, Scott; Dluzniewski, Paul J; Cooper, Kerry; Bensink, Mark E; Bradbury, Brian D
Missed in-center hemodialysis treatments (MHT) are a general indicator of health status in hemodialysis patients. This analysis was conducted to estimate the association between cinacalcet use and MHT rate. We studied patients receiving hemodialysis and prescription benefits services from a large dialysis organization. Incident cinacalcet users were propensity score matched to controls on 31 demographic, clinical, and laboratory variables. We applied inverse probability (IP) of censoring and crossover weights to account for informative censoring. Weighted negative binomial modeling was used to estimate MHT rates and pooled logistics models were used to estimate the association between cinacalcet use and MHT. Baseline demographic and clinical variables included serum calcium, phosphorus, parathyroid hormone, and vitamin D use, and were balanced between 15,474 new cinacalcet users and 15,474 matched controls. In an analysis based on intention-to-treat principles, 40.8% of cinacalcet users and 46.5% of nonusers were censored. MHT rate was 13% lower among cinacalcet initiators versus controls: IP of censoring weighted incidence rate ratio was 0.87 (95% confidence interval [CI]: 0.84-0.90 p < 0.001). In analyses based on as-treated principles, 72.8% and 61.5% of cinacalcet users and nonusers, respectively, crossed over or were censored. MHT rate was 15% lower among cinacalcet initiators versus controls: IP of censoring/crossover weighted incidence rate ratio was 0.85 (95%CI: 0.82-0.87 p < 0.001). After controlling for indication and differential censoring, cinacalcet treatment was associated with lower MHT rates, which may reflect better health status. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Deutsch, Tobias; Frese, Thomas; Sandholzer, Hagen
The importance of a family-centered approach in family practice has been emphasized. Knowledge about factors associated with higher family-centered involvement seems beneficial to stimulate its realization. German office-based family physicians completed a questionnaire addressing several aspects of family-centered care. Logistic regression was used to identify associations with the involvement overall and in different domains: routine inquiry and documentation of family-related information, family orientation regarding diagnosis and treatment, family-oriented dialogues, family conferences, and case-related collaboration with marriage and family therapists. We found significant associations between physicians' family-centered involvement and expected patient receptiveness, perceived impact of the family's influence on health, self-perceived psychosocial family-care competences (overall and concerning concepts for family orientation, psychosocial intervention in family conferences, and the communication of the idea of family counseling), advanced training in psychosocial primary care (PPC), personal acquaintance with family therapists (regarding case-related collaboration), and rural office environment. Increased emphasis on the family's influence on health in medical education and training, the provision of concepts for a family-centered perspective, and versatile skills for psychosocial intervention and inquiry of patient preferences, as well as the strengthening of networking between family physicians and family therapists, might promote the family-centered approach in family practice.
Al-Khaza'leh, Ja'far Mansur; Reiber, Christoph; Al Baqain, Raid; Valle Zárate, Anne
Goat production is an important agricultural activity in Jordan. The country is one of the poorest countries in the world in terms of water scarcity. Provision of sufficient quantity of good quality drinking water is important for goats to maintain feed intake and production. This study aimed to evaluate the seasonal availability and quality of goats' drinking water sources, accessibility, and utilization in different zones in the Karak Governorate in southern Jordan. Data collection methods comprised interviews with purposively selected farmers and quality assessment of water sources. The provision of drinking water was considered as one of the major constraints for goat production, particularly during the dry season (DS). Long travel distances to the water sources, waiting time at watering points, and high fuel and labor costs were the key reasons associated with the problem. All the values of water quality (WQ) parameters were within acceptable limits of the guidelines for livestock drinking WQ with exception of iron, which showed slightly elevated concentration in one borehole source in the DS. These findings show that water shortage is an important problem leading to consequences for goat keepers. To alleviate the water shortage constraint and in view of the depleted groundwater sources, alternative water sources at reasonable distance have to be tapped and monitored for water quality and more efficient use of rainwater harvesting systems in the study area is recommended.
Full Text Available Clostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero. Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion. Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1% were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P
Conclusions: EDs are prevalent among individuals attending the weight management centers in a northern city in Egypt. Specific management strategies are warranted to address this commonly prevalent disease.
Andrade, J G P; Ribeiro, L C L J; Junior, E L
There are several governor architectures, but in general, all of them are designed to maintain the controlled variable fluctuations within acceptable range. The Proportional, Integral and Derivative (PID) governor is one of the types used to regulate a hydraulic turbine, in which the deviation of the variable controlled is corrected through earnings proportional, integral and derivative. For a definition of the governor parameters and its stability analysis there are several methods that in general can be classified into a time domain and frequency domain. The frequency domain method, based on the control theory, have ease application, expeditious manner of obtaining the parameters, but the physical phenomena involved are linearized. However the time domain methods are more difficult to be applied, but have the advantage of being able to take into account the non-linearities presents in physical phenomena. Despite the time-domain method offers advantages, it does not provides a structured way to optimize the parameters of the governor, since the parameters are obtained through simulations with adopted values. This paper presents a methodology to obtain the turbine governor appropriate parameters through a hybrid model (simulation and optimization model), based on method of characteristic to the hydraulic simulation (time domain) and Genetic Algorithm (GA) to obtain appropriate values. Examples are presented showing the application of the proposed methodology.
Andrade, J G P; Ribeiro, L C L J [School of Technology, UNICAMP Rua Paschoal Marmo, 1888, Limeira, Postal Code:13484-332 (Brazil); Junior, E L, E-mail: email@example.com [School of Civil Engineering, Architecture and Urbanism, UNICAMP Avenida Albert Einstein, 951, Campinas, Postal Code: 13083-852 (Brazil)
There are several governor architectures, but in general, all of them are designed to maintain the controlled variable fluctuations within acceptable range. The Proportional, Integral and Derivative (PID) governor is one of the types used to regulate a hydraulic turbine, in which the deviation of the variable controlled is corrected through earnings proportional, integral and derivative. For a definition of the governor parameters and its stability analysis there are several methods that in general can be classified into a time domain and frequency domain. The frequency domain method, based on the control theory, have ease application, expeditious manner of obtaining the parameters, but the physical phenomena involved are linearized. However the time domain methods are more difficult to be applied, but have the advantage of being able to take into account the non-linearities presents in physical phenomena. Despite the time-domain method offers advantages, it does not provides a structured way to optimize the parameters of the governor, since the parameters are obtained through simulations with adopted values. This paper presents a methodology to obtain the turbine governor appropriate parameters through a hybrid model (simulation and optimization model), based on method of characteristic to the hydraulic simulation (time domain) and Genetic Algorithm (GA) to obtain appropriate values. Examples are presented showing the application of the proposed methodology.
Halanay, Andrei; Safta, Carmen A.; Dragoi, Constantin; Piraianu, Vlad F.
The paper aims to study the dynamic behavior of a speed governor for a hydraulic turbine using a mathematical model. The nonlinear mathematical model proposed consists in a system of delay differential equations (DDE) to be compared with already established mathematical models of ordinary differential equations (ODE). A new kind of nonlinearity is introduced as a time delay. The delays can characterize different running conditions of the speed governor. For example, it is considered that spool displacement of hydraulic amplifier might be blocked due to oil impurities in the oil supply system and so the hydraulic amplifier has a time delay in comparison to the time control. Numerical simulations are presented in a comparative manner. A stability analysis of the hydraulic control system is performed, too. Conclusions of the dynamic behavior using the DDE model of a hydraulic turbine speed governor are useful in modeling and controlling hydropower plants.
Qiang Lu; Yusong Sun; Yuanzhang Sun [Tsinghua University, Beijing (China). Dept. of Electrical Engineering; Felix F Wu; Yixin Ni [University of Hong Kong (China). Dept. of Electrical and Electronic Engineering; Yokoyama, Akihiko [University of Tokyo (Japan). Dept. of Electrical Engineering; Goto, Masuo; Konishi, Hiroo [Hitachi Ltd., Tokyo (Japan). Power System Div.
A novel nonlinear decentralized robust governor control for hydroturbine-generator sets in multi-machine power systems is suggested in this paper. The nonelastic water hammer effect and disturbances are considered in the modeling. The advanced differential geometry theory, nonlinear robust control theory and the dynamic feedback method are combined to solve the problem. The nonlinear decentralized robust control law for the speed governor of hydroturbine-generators has been derived. The input signals to the proposed controller are all local measurements and independent to the system parameters. The derived control law guarantees the integrated system stability with disturbance attenuation, which is significant to the real power system application. Computer tests on an 8-machine, 36-bus power system show clearly the effectiveness of the new control strategy in transient stability enhancement and disturbance attenuation. The computer test results based on the suggested controller are compared favorably with those based on the conventional linear governor control. (author)
Subiela, José D; Dapena, Elida
Adverse drug reactions (ADRs) represent the first cause of change of the first-line highly active antiretroviral therapy (HAART) regimen, therefore, they constitute the main limiting factor in the long-term follow up of HIV patients in treatment. A retrospective study was carried out in a specialized center in Lara State, Venezuela, including 99 patients over 18 years of age who had change of first-line HAART regimen due to ADRs, between 2010 and 2013. The aims of this research were to describe the sociodemographic and clinical variables, frequency of ADRs related to change of HAART, duration of the first-line HAART regimen, to determine the drugs associated with ARVs and to identify the risk factors. The ADRs constituted 47.5% of all causes of change of first-line HAART regimen, the median duration was 1.08±0.28 years. The most frequent ADRs were anemia (34.3%), hypersensitivity reactions (20.2%) and gastrointestinal intolerance (13.1%). The most frequent ARV regimen type was the protease inhibitors-based regimen (59.6%), but zidovudine was the ARV most linked to ADRs (41.4%). The regression analysis showed increased risk of ADRs in singles and students in the univariate analysis and heterosexuals and homosexuals in multivariate analysis; and decreased risk in active workers. The present work shows the high prevalence of ADRs in the studied population and represents the first case-based study that describes the pharmacoepidemiology of a cohort of HIV-positive patients treated in Venezuela.
Sharma, Ravi; Lebrun-Harris, Lydie A; Ngo-Metzger, Quyen
Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.
Phillips, Brad C.; Spurling, Steven; Armstrong, William A.
California faces a severe nursing shortage, with the number of registered nurses far below what is required to avert a potential state health care crisis. The Associate Degree Nursing (ADN) Project is a joint project involving scholars, educational researchers, and analysts from the Center for Student Success (CSS) housed at City College of San…
Yager, Ronald R.
The rapidly growing global interconnectivity, brought about to a large extent by the Internet, has dramatically increased the importance and diversity of social networks. Modern social networks cut across a spectrum from benign recreational focused websites such as Facebook to occupationally oriented websites such as LinkedIn to criminally focused groups such as drug cartels to devastation and terror focused groups such as Al-Qaeda. Many organizations are interested in analyzing and extracting information related to these social networks. Among these are governmental police and security agencies as well marketing and sales organizations. To aid these organizations there is a need for technologies to model social networks and intelligently extract information from these models. While established technologies exist for the modeling of relational networks [1-7] few technologies exist to extract information from these, compatible with human perception and understanding. Data bases is an example of a technology in which we have tools for representing our information as well as tools for querying and extracting the information contained. Our goal is in some sense analogous. We want to use the relational network model to represent information, in this case about relationships and interconnections, and then be able to query the social network using intelligent human-centered concepts. To extend our capabilities to interact with social relational networks we need to associate with these network human concepts and ideas. Since human beings predominantly use linguistic terms in which to reason and understand we need to build bridges between human conceptualization and the formal mathematical representation of the social network. Consider for example a concept such as "leader". An analyst may be able to express, in linguistic terms, using a network relevant vocabulary, properties of a leader. Our task is to translate this linguistic description into a mathematical formalism
Harsh, Sarah Wilmoth
Rhododendron Girls' State, a 5-day West Virginia citizenship and leadership program, offers female high school students the opportunity to directly experience the campaign and electoral process. Katie McGee White discusses her experiences as the first Girls' State governor in 1941, her love of politics, and how she encouraged her students to be…
NSF officials say approval of a science laboratory in the Homestake mine can come only after a multistep review process that takes 'many months to many years'. But a determined Republican governor and South Dakota's congressional delegation may bring politics to the science
Governor's Task Force on Rural Affairs, Olympia, WA.
Recognizing that urban and rural problems are interconnected, the Governor's Advisory Council on Urban Affairs (State of Washington), made a recommendation that led to formation (in 1970) of the Task Force on Rural Affairs. The report of that task force identifies the continuing technological revolution in agriculture as an important cause of (1)…
Mohamed A Talat
Conclusion: This study found a relatively high prevalence of overweight and obesity among adolescents aged 12–15 years in urban Sharkia Governorate. Risk factors of overweight and obesity were low level of parent education, faulty feeding habits and physical inactivity.
Klomp, J.G.; de Haan, J.
In this paper we confirm the hypothesis that central bank independence reforms reduce the likelihood that a central bank governor will be replaced. However, the strength of this effect depends on the rule of law and the degree of political polarization. (c) 2009 Elsevier B.V. All rights reserved.
Milliken, William G.; And Others
Following Governor Milliken's address, Dr. Dana Farnsworth defines the problem in terms of who's involved, to what extent, and with which drugs. His presentation focuses primarily on the motives of affluent young people who experiment with or become dependent upon hallucinogens, marihuana and amphetamines. He deals extensively with the drastically…
Cross, Jim; Uldrick, Virginia
The South Carolina Governor's School for the Arts is a summer residential program for high-school students talented in creative writing, visual arts, theatre, music, and dance. The School's internship component offers in-service education and preparation of art educators in the area of gifted education, in conjunction with Furman University. (JDD)
Page 1. Purpose: Board meetings. Date(s):. 2016-05-15 to 2016-05-16. Destination(s):. Ottawa. Airfare: $979.19. Other. Transportation: $0.00. Accommodation: $0.00. Meals and. Incidentals: $0.00. Other: $0.00. Total: $979.19. Comments: 2016-2017 Travel Expense Reports for Gordon. Houlden, Ex-Governor.
Purpose: Internal IDRC meetings. Date(s):. 2016-07-06. Destination(s):. Ottawa. Airfare: $866.40. Other. Transportation: $83.50. Accommodation: $0.00. Meals and. Incidentals: $84.53. Other: $0.00. Total: $1,034.43. Comments: 2016-2017 Travel Expense Reports for Sophie d'Amours, Governor.
Purpose: Board Meetings. Date(s):. 2016-11-21 to 2016-11-23. Destination(s):. Ottawa. Airfare: $350.81. Other. Transportation: $61.61. Accommodation: $590.10. Meals and. Incidentals: $172.79. Other: $0.00. Total: $1,175.31. Comments: 2016-2017 Travel Expense Reports for Sophie d'Amours, Governor.
Purpose: Board meetings. Date(s):. 2016-06-20 to 2016-06-22. Destination(s):. Ottawa. Airfare: $1,209.63. Other. Transportation: $158.36. Accommodation: $590.10. Meals and. Incidentals: $38.42. Other: $0.00. Total: $1,996.51. Comments: 2016-2017 Travel Expense Report for. Monte Solberg, Ex-Governor.
Purpose: Board meetings. Date(s):. 2016-06-20 to 2016-06-22. Destination(s):. Ottawa. Airfare: $1,011.70. Other. Transportation: $0.00. Accommodation: $393.40. Meals and. Incidentals: $0.00. Other: $0.00. Total: $1,405.10. Comments: 2016-2017 Travel Expense Reports for John. McArthur, Governor.
Purpose: Board meetings. Date(s):. 2016-11-21 to 2016-11-23. Destination(s):. Ottawa. Airfare: $707.13. Other. Transportation: $88.55. Accommodation: $393.40. Meals and. Incidentals: $76.79. Other: $0.00. Total: $1,265.87. Comments: 2016-2017 Travel Expense Reports for John. McArthur, Governor.
Coria, Elizabeth F.
California established the Board of Governors (BOG) fee waiver in 1984 to maintain educational access after the implementation of the state's first ever unit-based fees for community college attendance. Although it was not designed as an incentive to stimulate higher levels of academic achievement or student success, recent accountability policy…
Jong, W.; Dückers, M.L.A.; Velden, P.G. van der
The aim of this article is to provide a systematic review of peer-reviewed literature on leadership tasks and effectiveness of mayors and governors during drastic collective events. A total of 34 peer-reviewed articles met our criteria. They were analysed using the theoretical framework by Boin on
Delosreyes, G.; Gouchoe, D. R.
The objectives of this program were: to verify the model of off schedule compressor variable geometry in the T700 turboshaft engine nonlinear model; to evaluate the use of the pseudo-random binary noise (PRBN) technique for obtaining engine frequency response data; and to design a high performance power turbine speed governor using modern control methods. Reduction of T700 engine test data generated at NASA-Lewis indicated that the off schedule variable geometry effects were accurate as modeled. Analysis also showed that the PRBN technique combined with the maximum likelihood model identification method produced a Bode frequency response that was as accurate as the response obtained from standard sinewave testing methods. The frequency response verified the accuracy of linear models consisting of engine partial derivatives and used for design. A power turbine governor was designed using the Linear Quadratic Regulator (LQR) method of full state feedback control. A Kalman filter observer was used to estimate helicopter main rotor blade velocity. Compared to the baseline T700 power turbine speed governor, the LQR governor reduced droop up to 25 percent for a 490 shaft horsepower transient in 0.1 sec simulating a wind gust, and up to 85 percent for a 700 shaft horsepower transient in 0.5 sec simulating a large collective pitch angle transient.
Imhauser, Carl; Mauro, Craig; Choi, Daniel; Rosenberg, Eric; Mathew, Stephen; Nguyen, Joseph; Ma, Yan; Wickiewicz, Thomas
Abnormal tibiofemoral contact stress and aberrant kinematics may influence the progression of osteoarthritis in the anterior cruciate ligament (ACL)-deficient and the ACL-reconstructed knee. However, relationships between contact stress and kinematics after ACL reconstruction are poorly understood. Therefore, we posed the following research questions: (1) How do ACL deficiency and reconstruction affect the kinematics of and contact stress in the tibiofemoral joint? (2) What kinematic differences are associated with abnormal contact stress after ACL reconstruction? Center-center ACL reconstruction will not restore knee kinematics and contact stress. Correlations will exist between abnormal contact stress and aberrant kinematics after ACL reconstruction. Controlled laboratory study. Clinical tests of anterior and rotational stability were simulated on 11 cadaveric knees using an industrial robot. Tests were conducted with the ACL intact, sectioned, and after single-bundle ACL reconstruction using a quadrupled hamstring autograft with tunnels drilled through the center of the native footprints. Kinematics were recorded during the tests. Contact stress was continuously recorded from a stress transducer fixed to the tibial plateau, and mean contact stress was calculated regionally. ACL deficiency resulted in increased mean contact stress in the posterior sectors of the medial and lateral compartments under anterior and rotational loads, respectively. Reconstruction reduced stress in these locations; however, contact stress abnormalities remained. On average, kinematics were overconstrained after ACL reconstruction (≤1.8 mm and ≤2.6° in all directions). However, combinations of overconstrained and underconstrained motions in abduction/adduction and medial-lateral translation in response to combined moments, and anterior-posterior translation, medial-lateral translation, and axial rotation in response to an anterior load were associated with abnormal mean contact
Roberts, Henry; Myles, Ranell L; Truman, Benedict I; Dean, Hazel D
Employee performance evaluation motivates and rewards exceptional individual performance that advances the achievement of organizational goals. The Centers for Disease Control and Prevention (CDC) and its operating units evaluate employee performance annually and reward exceptional performance with a cash award or quality step increase in pay. A summary performance rating (SPR) of "exceptional" indicated personal achievements in 2011 that were beyond expectations described in the employee's performance plan. To determine whether personal attributes and job setting of civil service employees were associated with an exceptional SPR in National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) in 2011. Data from the CDC 2011 performance management database collected in 2012 were analyzed in 2013 to identify SPR, personal attributes, and job settings of full-time civil service employees. Multivariate logistic regression controlled for confounding and stratified analysis detected effect modifiers of the association between receiving an exceptional SPR in 2011 and gender, race/ethnicity, education, job location, job series, grade level, years in grade, years of federal service, supervisory role, and NCHHSTP division. Among the 1037 employees, exceptional SPR was independently associated with: female gender (adjusted odds ratio: 1.7 [1.3, 2.3]), advanced degrees (doctorate: 1.7 [1.1, 2.5] master's: [1.1, 2.0]), headquarters location (2.8 [1.9, 4.1]), higher pay grade (3.3 [2.4, 4.5]) and years in grade (0-1 years: 1.7 [1.3, 2.4]; 2-4 years: 1.5 [1.1, 2.0]), division level (Division A: 5.0 [2.5, 9.9]; Division B: 5.5 [3.5, 8.8]), and supervisory status (at a lower-pay grade) (odds ratio: 3.7 [1.1, 11.3]). Exceptional SPR is independently associated with personal employee attributes and job settings that are not modifiable by interventions designed to improve employee performance based on accomplishments.
Nebogin, S. A.; Ivanov, N. A.; Bryukvina, L. I.; V. Shipitsin, N.; E. Rzhechitskii, A.; Papernyi, V. L.
In the present paper, the effect of magnesium nanoparticles implanted in a LiF crystal on the optical properties of color centers is studied. The transmittance spectra and AFM images demonstrate effective formation of the color centers and magnesium nanoparticles in an implanted layer of ∼ 60-100 nm in thickness. Under thermal annealing, a periodical structure is formed on the surface of the crystal and in the implanted layer due to self-organization of the magnesium nanoparticles. Upon excitation by argon laser with a wavelength of 488 nm at 5 K, in a LiF crystal, implanted with magnesium ions as well as in heavily γ-irradiated LiF: Mg crystals, luminescence of the color centers at λmax = 640 nm with a zero-phonon line at 601.5 nm is observed. The interaction of magnesium nanoparticles and luminescing color centers in a layer implanted with magnesium ions has been revealed. It is shown that the luminescence intensity of the implanted layer at a wavelength of 640 nm is by more than two thousand times higher than that of a heavily γ-irradiated LiF: Mg crystal. The broadening of the zero-phonon line at 601.5 nm in the spectrum of the implanted layer indicates the interaction of the emitting quantum system with local field of the surface plasmons of magnesium nanoparticles. The focus of this work is to further optimize the processing parameters in a way to result in luminescence great enhancement of color centers by magnesium nanoparticles in LiF.
Noël, Polly Hitchcock; Wang, Chen-Pin; Finley, Erin P; Espinoza, Sara E; Parchman, Michael L; Bollinger, Mary J; Hazuda, Helen P
The Institute of Medicine (IOM) suggests that linkages between primary care practices and community-based resources can improve health in lower income and minority patients, but examples of these are rare. We conducted a prospective, mixed-methods observational study to identify indicators of primary care-community linkage associated with the frequency of visits to community-based senior centers and improvements in diabetes-related outcomes among 149 new senior center members (72% Hispanic). We used semistructured interviews at baseline and 9-month follow-up, obtaining visit frequency from member software and clinical assessments including hemoglobin A1c (HbA1c) from colocated primary care clinics. Members' discussion of their activities with their primary care providers (PCPs) was associated with increased visits to the senior centers, as well as diabetes-related improvements. Direct feedback from the senior centers to their PCPs was desired by the majority of members and may help to reinforce use of community resources for self-management support.
Full Text Available In the early sixteenth century, the de Foix family were both kin and intimate councillors to the Valois kings, Louis XII and François I. With a powerbase in Guyenne, the de Foix tried to use their connections at court to profit from the French conquest of Milan, 1499-1522. This paper will explore the career of one prominent family member, Odet de Foix, vicomte de Lautrec (1483-1528. Lautrec was a Marshal of France, who served in Italy as a soldier and governor. He was key to the royal entourage, amongst François I’s intimates at the Field of the Cloth of Gold. His sister, Françoise, was also the king’s mistress. The paper will examine Lautrec’s entourage from two aspects. Firstly, it asks how Lautrec established his entourage from his experience in Navarre and Italy and as a member of the royal retinue. It establishes the importance of familial and regional ties, but also demonstrates the important role played by men of talent. Secondly, it explores Lautrec's relationship to his entourage once governor of Milan. Were ties of blood, career or positions of Italian prestige the most important for a governor when he chose his intimates? Were compromises made with Italian traditions and elites to sustain his rule? Did he learn from the experience and failures of previous governors? The article contributes to a gap in scholarship for the later period of French Milan from 1515-1522. It also adds to our knowledge of the behaviour and ambitions of early modern governors.
Kuo, Dennis Z; Frick, Kevin D; Minkovitz, Cynthia S
Little is known about the association of family-centered care (FCC) with the quality of pediatric primary care. The objectives were to assess (1) associations between family-centered care (FCC), receipt of anticipatory guidance, and unmet need for health care; and (2) whether these associations vary for children with special health care needs (CSHCN). The study, a secondary data analysis of the 2004 Medical Expenditure Panel Survey, used a nationally representative sample of family members of children 0-17 years. We measured receipt of FCC in the last 12 months with a composite score average>3.5 on a 4 point Likert scale from 4 Consumer Assessment of Healthcare Providers and Systems questions. Outcome measures were six anticipatory guidance and six unmet health care service needs items. FCC was reported by 69.6% of family members. One-fifth (22.1%) were CSHCN. Thirty percent of parents reported≥4 of 6 anticipatory guidance topics discussed and 32.5% reported≥1 unmet need. FCC was positively associated with anticipatory guidance for all children (OR=1.45; 95% CI 1.19, 1.76), but no relation was found for CSHCN in stratified analyses (OR=1.01; 95% CI .75, 1.37). FCC was associated with reduced unmet needs (OR=.38; 95% CI .31, .46), with consistent findings for both non-CSHCN and CSHCN subgroups. Family-centered care is associated with greater receipt of anticipatory guidance and reduced unmet needs. The association between FCC and anticipatory guidance did not persist for CSHCN, suggesting the need for enhanced understanding of appropriate anticipatory guidance for this population.
Kinoshita, Masashi; Shinohara, Harumichi; Hori, Osamu; Ozaki, Noriyuki; Ueda, Fumiaki; Nakada, Mitsutoshi; Hamada, Jun-Ichiro; Hayashi, Yutaka
Recently, intraoperative mapping has disclosed that, in addition to the classic language centers (that is, the Broca and Wernicke centers), other cortical regions may also play an important role in language organization. In the prefrontal cortex, although the lateral superior frontal gyrus (LSFG) could have language-related functions, there are no detailed reports that demonstrate the anatomical connection between the LSFG and other well-known language cortices, such as the Broca center. To show the existence of the structural connection, white matter association fibers between the inferior frontal gyrus (IFG) and the LSFG were examined using fiber dissection (FD) and diffusion tensor (DT) imaging-based tractography. Eight cadaveric cerebral hemispheres were dissected to reveal the association fibers between the IFG and LSFG. The DT imaging-based tractography studies targeting the prefrontal cortex were obtained in 53 right-handed patients who had no organic cerebral lesions. The association fiber tract between Brodmann area 44/45 (the Broca center in the dominant hemisphere) and LSFG were detected in all specimens by FD. In the DT imaging-based tractography studies, the tract was identified in all patients bilaterally, except for the 4 in whom the tract was detected only in the left hemisphere. This tract was spread significantly wider in the left than in the right hemisphere, and left lateralization was evident in male patients. Based on its character, this tract was named the Broca-LSFG pathway. These findings suggest a close relationship between this pathway and language organization. The structural anatomy of the Broca-LSFG pathway may explain speech disturbances induced by LSFG stimulation that are sometimes observed during intraoperative language mapping.
The concept of the nuclear energy center is designed to consolidate a number of electrical power reactors and/or related fuel cycle activities on a single site. Such a siting strategy would concentrate a great deal of economic activity in one area and, as a consequence, generate significant impacts on state and local governments by increasing tax bases and public service demands and by altering intergovernmental fiscal relations. This study was designed to place rough empirical measures on relevant impact variables and to highlight areas for which a need for further research was indicated.
Nielsen, T K; Kjeldsen, M
Many Norwegian hydro power plants have complex lay-out with several reservoirs, broke intakes, surge shafts and even air cushion chambers. There are kilometers of excavated tunnels as well as long tail water systems. The stations are often equipped by multiple of turbines, both in series and parallel. A number of operation modes are therefore possible. Doing transient simulations and simulations of governor stability in the design phase, the problem is to find the worst case scenario regarding these operating modes. Svartisen power plant has been of particular interest these days. The power plant is originally designed for two 350 MW Francis turbines, however, only one turbine was installed. When designed, governor stability was regarded as problematic due to the long penstock. A long penstock will give a too high time constant for the hydraulic inertia. The main problem here is, however, the water hammer frequency that interferes with the governor performance. The frequency is in the same range as the cross frequency. Therefore the governor will react on these water hammer waves, which in its nature is notoriously unstable. The common solution is to build an air cushion and thereby increase the water hammer frequency above the cross frequency. The expenses were, however, deemed too high, and it was necessary to seek for other solutions. A pressure feedback on the governor was introduced in order to have stable operation at least for two turbines. With only one turbine installed, the pressure feedback has not been activated because, based on the simulations, it was regarded unnecessary. Even if the original simulations shows good stability margins when only one turbine is running, there has been some indications that the aggregate has suffered from instability. In 2004 Svartisen Power Plant was equipped with a comprehensive monitoring system. Both the turbine and the generator performance have been observed. This gives valuable information on how the hydropower
Nielsen, T. K.; Kjeldsen, M.
Many Norwegian hydro power plants have complex lay-out with several reservoirs, broke intakes, surge shafts and even air cushion chambers. There are kilometers of excavated tunnels as well as long tail water systems. The stations are often equipped by multiple of turbines, both in series and parallel. A number of operation modes are therefore possible. Doing transient simulations and simulations of governor stability in the design phase, the problem is to find the worst case scenario regarding these operating modes. Svartisen power plant has been of particular interest these days. The power plant is originally designed for two 350 MW Francis turbines, however, only one turbine was installed. When designed, governor stability was regarded as problematic due to the long penstock. A long penstock will give a too high time constant for the hydraulic inertia. The main problem here is, however, the water hammer frequency that interferes with the governor performance. The frequency is in the same range as the cross frequency. Therefore the governor will react on these water hammer waves, which in its nature is notoriously unstable. The common solution is to build an air cushion and thereby increase the water hammer frequency above the cross frequency. The expenses were, however, deemed too high, and it was necessary to seek for other solutions. A pressure feedback on the governor was introduced in order to have stable operation at least for two turbines. With only one turbine installed, the pressure feedback has not been activated because, based on the simulations, it was regarded unnecessary. Even if the original simulations shows good stability margins when only one turbine is running, there has been some indications that the aggregate has suffered from instability. In 2004 Svartisen Power Plant was equipped with a comprehensive monitoring system. Both the turbine and the generator performance have been observed. This gives valuable information on how the hydropower
The report includes a review of the current state-of-the-art of dry-cooling technology for industrial and power-generating facilities and an evaluation of its technical potential and cost for large nuclear power plants. Criteria are formulated for coarse screening of the arid regions of the Western United States to select a surrogate site for more detailed site-specific analyses. The screening criteria included seismic considerations, existing transportation facilities, institutional and jurisdictional constraints, waste heat dissipation effects, water requirements, and ecologic and socioeconomic considerations. The Galt site near Las Vegas, Nevada was selected for the surrogate site analysis to assess important issues related to the construction and operation of twelve dry-cooled nuclear power plants at an arid location remote from major load centers. The assessment covers geotechnical, atmospheric and hydrologic considerations, special aspects of transporting large equipment overland to the site from seaports, analyses of potential transmission routes to major load centers, local institutional and taxing provisions, and ecologic and socioeconomic impacts
The report includes a review of the current state-of-the-art of dry-cooling technology for industrial and power-generating facilities and an evaluation of its technical potential and cost for large nuclear power plants. Criteria are formulated for coarse screening of the arid regions of the Western United States to select a surrogate site for more detailed site-specific analyses. The screening criteria included seismic considerations, existing transportation facilities, institutional and jurisdictional constraints, waste heat dissipation effects, water requirements, and ecologic and socioeconomic considerations. The Galt site near Las Vegas, Nevada was selected for the surrogate site analysis to assess important issues related to the construction and operation of twelve dry-cooled nuclear power plants at an arid location remote from major load centers. The assessment covers geotechnical, atmospheric and hydrologic considerations, special aspects of transporting large equipment overland to the site from seaports, analyses of potential transmission routes to major load centers, local institutional and taxing provisions, and ecologic and socioeconomic impacts.
Full Text Available Jaime D Martinez,1 Anat Galor,2,3 Nallely Ramos-Betancourt,1 Andrés Lisker-Cervantes,1 Francisco Beltrán,1 Jorge Ozorno-Zárate,1 Valeria Sánchez-Huerta,1 Marco-Antonio Torres-Vera,1 Everardo Hernández-Quintela1 1Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico, Universidad Nacional Autónoma de México, Mexico City, Mexico; 2Department of Ophthalmology, Miami Veterans Affairs Medical Center, 3Cornea and External Diseases Division, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA Purpose: The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE among patients attending a tertiary care ophthalmology center in Mexico.Methods: Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer’s test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected.Results: The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22% in our population than evaporative deficiency (94%. Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry
Singer, Harvey S.
The entity Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) was initially proposed in 1998 (Swedo, et al. 1998). The formal diagnosis required that the affected individual meet five specific criteria: prepubertal onset, obsessive compulsive disorder (OCD) and/or a tic disorder, the dramatic sudden explosive onset of symptoms, a relapsing and remitting course of symptoms that are temporally associated with Group A beta-hemolytic streptococcal (G...
Vitale, Melissa A; Mertz, Kristen J; Gaines, Barbara; Zuckerbraun, Noel S
To describe injuries due to golf-related activities among pediatric patients requiring hospital admission. We conducted a retrospective analysis of all sports-related injuries from 2000 to 2006 using a level 1 trauma center database. Of 1005 children admitted with sports-related injuries, 60 (6%) had golf-related injuries. The mean injury severity score was significantly higher for golf-related injuries (11.0) than that for all other sports-related injuries (6.8). Most golf-related injuries occurred in children younger than 12 years (80%), at home (48%), and by a strike from a club (57%) and resulted in trauma to the head or neck (68%). Golf-related injuries, although an infrequent cause of sports-related injuries, have the potential to result in severe injuries, especially in younger children. Preventive efforts should target use of golf clubs by younger children in the home setting.
Zuchowski, Jessica L; Hamilton, Alison B; Pyne, Jeffrey M; Clark, Jack A; Naik, Aanand D; Smith, Donna L; Kanwal, Fasiha
In this era of a constantly changing landscape of antiviral treatment options for chronic viral hepatitis C (CHC), shared clinical decision-making addresses the need to engage patients in complex treatment decisions. However, little is known about the decision attributes that CHC patients consider when making treatment decisions. We identify key patient-centered decision attributes, and explore relationships among these attributes, to help inform the development of a future CHC shared decision-making aid. Semi-structured qualitative interviews with CHC patients at four Veterans Health Administration (VHA) hospitals, in three comparison groups: contemplating CHC treatment at the time of data collection (Group 1), recently declined CHC treatment (Group 2), or recently started CHC treatment (Group 3). Participant descriptions of decision attributes were analyzed for the entire sample as well as by patient group and by gender. Twenty-nine Veteran patients participated (21 males, eight females): 12 were contemplating treatment, nine had recently declined treatment, and eight had recently started treatment. Patients on average described eight (range 5-13) decision attributes. The attributes most frequently reported overall were: physical side effects (83%); treatment efficacy (79%), new treatment drugs in development (55%); psychological side effects (55%); and condition of the liver (52%), with some variation based on group and gender. Personal life circumstance attributes (such as availability of family support and the burden of financial responsibilities) influencing treatment decisions were also noted by all participants. Multiple decision attributes were interrelated in highly complex ways. Participants considered numerous attributes in their CHC treatment decisions. A better understanding of these attributes that influence patient decision-making is crucial in order to inform patient-centered clinical approaches to care (such as shared decision-making augmented
Gershon, Robyn R M; Qureshi, Kristine A; Rubin, Marcie S; Raveis, Victoria H
Due to the fact that most high-rise structures (i.e., >75 feet high, or eight to ten stories) are constructed with extensive and redundant fire safety features, current fire safety procedures typically only involve limited evacuation during minor to moderate fire emergencies. Therefore, full-scale evacuation of high-rise buildings is highly unusual and consequently, little is known about how readily and rapidly high-rise structures can be evacuated fully. Factors that either facilitate or inhibit the evacuation process remain under-studied. This paper presents results from the qualitative phase of the World Trade Center Evacuation Study, a three-year, five-phase study designed to improve our understanding of the individual, organizational, and environmental factors that helped or hindered evacuation from the World Trade Center (WTC) Towers 1 and 2, on 11 September 2001. Qualitative data from semi-structured, in-depth interviews and focus groups involving WTC evacuees were collected and analyzed. On the individual level, factors that affected evacuation included perception of risk (formed largely by sensory cues), preparedness training, degree of familiarity with the building, physical condition, health status, and footwear. Individual behavior also was affected by group behavior and leadership. At the organizational level, evacuation was affected by worksite preparedness planning, including the training and education of building occupants, and risk communication. The environmental conditions affecting evacuation included smoke, flames, debris, general condition and degree of crowdedness on staircases, and communication infrastructure systems (e.g., public address, landline, cellular and fire warden's telephones). Various factors at the individual, organizational, and environmental levels were identified that affected evacuation. Interventions that address the barriers to evacuation may improve the full-scale evacuation of other high-rise buildings under extreme
Adarosy, H A; Gad, Y Z; El-Baz, S A; El-Shazly, A M
Fascioliasis is an important food- and water-borne parasitic zoonosis caused by liver flukes of genus Fasciola (Digenea: Fasciolidae) of worldwide distribution. In Egypt, fascioliasis was encountered in nearly all Egyptian Governorates, particularly in the Nile Delta and specifically in Dakahlia. All enrolled cases were subjected to complete history taking, clinical examination, routine investigations and abdominal ultrasonography. Stool analysis, IHA and ELISA were used for fascioliasis diagnosis. Rural areas showed highest prevalence of fascioliasis than urban areas, however, but.without significance (x2= 0.042 & P= 0.837). Regarding human fascioliasis in examined the centers, no statistically significant difference (x2 =2.824 & P=0.243) was detected. Regarding gender variation, the difference was statistically insignificant (x2= 0.166 & P= 0.683). The difference between the age groups was statistically insignificant (x2= 3.882 & P=0.274). Clinically, 7 cases (35%) were asymptomatic and another 13 cases (65%) had different clinical pictures. Abdominal pain, anemia, eosinophilia, and tender hepatomegaly were seen in 70%, 80%, 70%, and 10%; respectively. Of them, 1 1cases showed positive abdominal ultrasonographic findings suggestive of fascioliasis.
Full Text Available Background: The environmental degradation products of pesticides may enter drinking water and result in serious health problems. Objective: To evaluate the occurrence of insecticides in drinking surface and ground water in Dakahlyia Governorate, northern Egypt in 2011. Methods: We studied blood samples collected from 36 consecutive patients diagnosed with pesticides poisoning and 36 tap drinking water (surface and ground. Blood and water samples were analyzed for pesticides using gas chromatography-electron captured detector (GC-ECD. In addition, blood samples were analyzed for plasma pseudo-cholinesterase level (PChE and red blood cells acetyl cholinesterase activity (AChE. Results: The results confirmed the presence of high concentrations of insecticides, including organonitrogenous and organochlorine in tap drinking surface and ground water. Conclusion: Drinking water contaminated with insecticides constitutes an important health concern in Dakahlyia governorate, Egypt.
Fang Hongqing; Chen Long; Shen Zuyi
In this paper, an improved particle swarm optimization (IPSO) algorithm is proposed. Besides the individual best position and the global best position, a nominal average position of the swarm is introduced in IPSO. The performance of IPSO is compared to different PSO variants with five well-known benchmark functions. The experimental results show that the proposed IPSO algorithm improves the searching performance on the benchmark functions. And then, IPSO, as well as other PSO variants, is applied to optimal tuning of Proportional-Integral-Derivative (PID) gains for a typical PID control system of water turbine governor. The computer simulation results of an actual hydro power plant in China show that IPSO algorithm has stable convergence characteristic and good computational ability, and it is an effective and easily implemented method for optimal tuning of PID gains of water turbine governor.
An analytical model is developed for the dynamics of a tilting proprotor aircraft engine and drive train, including a rotor speed governor and interconnect shaft. The dynamic stability of a proprotor and cantilever wing is calculated, including the engine-transmission-governor model. It is concluded that the rotor behaves much as if windmilling as far as its dynamic behavior is concerned, with some influence of the turboshaft engine inertia and damping. The interconnect shaft has a significant influence on the antisymmetric dynamics of proprotor aircraft. The proprotor aerodynamics model is extended to include reverse flow, and a refinement on the method used to calculate the kinematic pitch-bending coupling of the blade is developed.
Full Text Available In recent years, automatic driving control has attracted attention. To achieve a satisfactory driving control performance, the prediction accuracy of the traveling route is important. If a highly accurate prediction method can be used, an accurate traveling route can be obtained. Despite the considerable efforts that have been invested in improving prediction methods, prediction errors do occur in general. Thus, a method to minimize the influence of prediction errors on automatic driving control systems is required. This need motivated us to focus on the design of a mechanism for shaping prediction signals, which is called a prediction governor. In this study, we first extended our previous study to the input-affine nonlinear system case. Then, we analytically derived a solution to an optimal design problem of prediction governors. Finally, we applied the solution to an automatic driving control system, and demonstrated its usefulness through a numerical example and an experiment using a radio controlled car.
31 oct. 2017 ... You will ensure that systems are in place to provide guidance on risks associated with IDRC's business and protect the integrity of IDRC's internal controls and management information systems. You will also monitor the performance of the President and Chief Executive Officer, as well as assessing the ...
For the first time in South Africa's history, the franchise and associated political and civil ... determine the powers of SGBs related to the rights, obligations and functions of ... The SGB is the body functioning in terms of section 16 of SASA and also con- ... who provides professional educational services, including professional.
The joke in the title continues with John Q. Public approaching each character and inquiring "how;s the water? Each response represents a different perspective on assessing water resources. The Governor touts...
Shaimaa M. Abu Shabana
Conclusion: The introduction of DOTS in the Port Said governorate has led to a significant increase in the treatment success (82.7% (Near the WHO target “85%”, and a decrease in the default and failure rates.
Excerpts are given from the Introductory Statement to the Board of Governors by the IAEA Director General Dr. Mohamed ElBaradei. Major topics covered in his introductory remarks include: protection against terrorism, nuclear technology, water resource management, application of sterile insect technique, human health, nuclear power, radioactive waste management, management of nuclear knowledge, nuclear safety, safety of radioactive sources, safeguards agreements and additional protocols, conceptual framework for integrated safeguards, Democratic People's Republic of Korea, and Iraq
Tedesco, Francesco; Ocampo-Martínez, Carlos; Casavola, Alessandro; Puig Cayuela, Vicenç
This paper proposes the application of a distributed command governor (DCG) strategy for the operational control of drinking water networks (DWN). This approach is very suitable to this kind of management problems given the large-scale and complex nature of DWNs, the relevant effect of persistent disturbances (water demands) over the network evolutions and their marginal stability feature. The performance improvement offered by DCG is compared with the consideration of two non-centralized mod...
In his Introductory Statement at the IAEA Board of Governors (Vienna, 22 March 1999), the Director General of the IAEA reviewed the main recent activities of the Agency related to: safety aspects of the nuclear power, measures against illicit trafficking and for the physical protection of nuclear material, status of safeguards agreements and additional protocols, and issues concerning the Democratic People's Republic of Korea and Iraq
In his statement to the Board of Governors meeting in Vienna, Austria, IAEA Director General Mohamed ElBaradei focused on issues of the IAEA budget in the framework of the policy of zero growth for international organizations. He stressed the importance of the Agency's work in technical cooperation to prioritise on safety, security and non-proliferation. The priorities of the Agency are the priorities of everybody. The Agency needs the money to maintain a credible programme
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 11 September 2000. The following aspects from the Agency's activity are briefly presented: progress on small and medium sized reactors, plan for producing potable water economically, agreement with the Democratic People's Republic of Korea, and application of IAEA Safeguards in the Middle east
In his Introductory Statement at the IAEA Board of Governors, Vienna, 20 March 2000, the Director General of the IAEA focused on the following topics: the first Review Meeting of Parties to the Convention on Nuclear Safety, response to General Conference Resolutions, Safeguards Agreements and Additional Protocols, relations with DPRK and Iraq, Trilateral Initiative (IAEA, USA, Russian Federation) concerning the fissile material removed from nuclear weapon programmes, and IAEA's Programme and Budget for 2001
A general presentation of the National Waste Terminal Storage (NWTS) Program was given on July 26, 1976, to the Michigan Environmental Review Board and the Michigan Governor's Nuclear Waste Disposal Task Force. Following the presentation, Dr. William G. Taylor, Chairman of the Task Force, provided ERDA with a listing of questions which pertained to the NWTS program and ERDA/OWI's interest in northeast Michigan. This document contains copies of the information which was provided to Dr. Taylor in response to his inquiry
Ruprecht, J. S.; Bachmann, O.; Deering, C. D.; Huber, C.; Skopelitis, A.; Schnyder, C.
Multiple eruptions of silicic magma (dacite and rhyolites) occurred over the last ~ 3 My in the Kos-Nisyros volcanic center (eastern Aegean sea). Over the course of this period, magmas have changed from hornblende-biotite rich units with low eruption temperatures (≤750-800 °C; Kefalos and Kos units) to hotter (>800-850 °C), pyroxene-bearing units (Nisyros units) and are transitioning back to colder magmas (Yali units). Using bulk-rock compositions, mineral chemistry, and zircon Hf isotopes, we show that the two different types of silicic magmas followed the same differentiation trend; they all evolved by crystal fractionation (and minor assimilation) from parents with intermediate compositions characterized by high Sr/Y and low Nb content, following a wet, high oxygen fugacity liquid line of descent typical of subduction zones. As the transition between the Kos-Kefalos and Nisyros-type magmas occurred immediately and abruptly after the major caldera collapse in the area (the 161 ky Kos Plateau Tuff; KPT), we suggest that the efficient emptying of the magma chamber during the KPT drew most of the eruptible magma out and partly froze the silicic magma source zone in the upper crust due to rapid unloading, decompression and resulting crystallization. Therefore, the system had to reinstate a shallow silicic production zone from more mafic parents, recharged at temperatures typically around 850-900 °C from the mid to lower crust. The first silicic eruptions evolving from these parents after the caldera collapse (Nisyros units) were thus slightly hotter and less evolved than the Kefalos-Kos package. However, with time, the upper crustal intermediate mush grew and cooled, leading to interstitial melt compositions reaching again the highly-evolved, cold state that prevailed prior to the Kefalos-Kos. The recent (albeit not precisely dated) eruption of the high-SiO2 rhyolite of Yali suggests that another large, potentially explosive magma chamber is presently building
Shashi kumar manhotra
Full Text Available This paper detailing the problem of speed fluctuation of IDI engine Rpm i.e. hunting and dipping. It is due to E-RPM adjustment assembly for mechanical centrifugal flyweight governor system. E-RPM adjustment assembly works mainly for high speed adjustment ampidle speed adjustment. In mechanical centrifugal flyweight governor system of IDI engine issue at idle rpm hunting and dipping issue was reported in field.New designs of plunger type stopper cover with compressed coil spring are proposed for E-RPM adjustment assembly for mechanical centrifugal fly-weight governor system. 3D-Modeling of new design is done on Seimens NX. Kinematic simulation was done with the help of Altairs Motion-View amp Motion-Solver. Based on the results from MBD the prototype is made and tested in engine. As per the test results from engine testing with new design there is no hunting and dipping problem is reported at idle rpm.
Ahmad, Enas M.
Modern smartphones are being designed with increasing processing power, memory capacity, network communication, and graphics performance. Although all of these features are enriching and expanding the experience of a smartphone user, they are significantly adding an overhead on the limited energy of the battery. This thesis aims at enhancing the energy efficiency of modern smartphones and increasing their battery life by minimizing the energy consumption of smartphones Graphical Processing Unit (GPU). Smartphone operating systems are becoming fully hardware-accelerated, which implies relying on the GPU power for rendering all application graphics. In addition, the GPUs installed in smartphones are becoming more and more powerful by the day. This raises an energy consumption concern. We present a novel implementation of GPU Scaling Governors, a Dynamic Voltage and Frequency Scaling (DVFS) scheme implemented in the Android kernel to dynamically scale the GPU. The scheme includes four main governors: Performance, Powersave, Ondmand, and Conservative. Unlike previous studies which looked into the power efficiency of mobile GPUs only through simulation and power estimations, we have implemented our approach on a real modern smartphone GPU, and acquired actual energy measurements using an external power monitor. Our results show that the energy consumption of smartphones can be reduced up to 15% using the Conservative governor in 2D rendering mode, and up to 9% in 3D rendering mode, with minimal effect on the performance.
Díaz Villegas, Gregory Mishell; Runzer Colmenares, Fernando
To evaluate the association between calf circumference and gait speed in elderly patients 65 years or older at Geriatric day clinic at Peruvian Centro Médico Naval. Cross-sectional, retrospective study. We assessed 139 participants, 65 years or older at Peruvian Centro Médico Naval including calf circumference, gait speed and Short Physical Performance Battery. With bivariate analyses and logistic regression model we search for association between variables. The age mean was 79.37 years old (SD: 8.71). 59.71% were male, the 30.97% had a slow walking speed and the mean calf circumference was 33.42cm (SD: 5.61). After a bivariate analysis, we found a calf circumference mean of 30.35cm (SD: 3.74) in the slow speed group and, in normal gait group, a mean of 33.51cm (SD: 3.26) with significantly differences. We used logistic regression to analyze association with slow gait speed, founding statistically significant results adjusting model by disability and age. Low calf circumference is associated with slow speed walk in population over 65 years old. Copyright © 2014. Published by Elsevier Espana.
Rafael de Athayde Soares
Full Text Available Abstract Background Endovascular treatment (ET of iliac occlusive disease (IOD is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA, between January 2009 and January 2015. Patients with critical limb ischemia or incapacitating claudication were included. Results In total, 48 IA procedures were performed in 46 patients, with an initial technical success rate of 95.83%. Failure occurred in two patients, who were excluded, leaving 44 patients and 46 IA. The primary patency, secondary patency, limb salvage, and survival rates at 1200 days were 88%, 95.3%, 86.3%, and 69.9%, respectively. Univariate and multivariate Cox regression revealed that the primary patency rate was significantly worse in patients with TASC type C/D than in patients with TASC type A/B (p = 0.044. Analysis of factors associated with major amputation using Cox regression showed that the rate of limb loss was greater in patients with TASC type C/D (p = 0.043. Male gender was associated with reduced survival (p = 0.011. Conclusions TASC type C/D was associated with a higher number of reinterventions and with worse limb loss and primary patency rates. Male gender was associated with a worse survival rate after ET of IOD.
Full Text Available We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint in mentally ill inmates within two secure psychiatric hospitals (SPH and three regular prisons (RP in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP were studied. Isolation (41.35% was the most frequent coercive measure, followed by mechanical restraint (33.17% and forced medication (25.48%. The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.
Girela, E; López, A; Ortega, L; De-Juan, J; Ruiz, F; Bosch, J I; Barrios, L F; Luna, J D; Torres-González, F
We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.
Berlin, Nicholas L; Tuggle, Charles T; Steinbacher, Derek M
Previous studies assessing outcomes following orthognathic surgery rely primarily on single-center/surgeon experience. In addition to issues of generalizability, these studies are limited in evaluating the effect of operative volume on patient outcomes. Orthognathic procedures were identified in the 1999 to 2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Outcomes included occurrence of any in-hospital complication, extended length of stay (>2 days), and increased costs (>$10,784). High-volume hospitals were defined as the 90th percentile of case volume or higher (>31 cases/year). Univariate and multivariate analyses were conducted to identify independent predictors of outcomes. Trend analyses were performed to assess changes in the annual rate of patients treated at high-volume hospitals over the study period. Among 101,692 orthognathic surgery patients, 19.6 percent underwent concurrent ancillary procedures (i.e., genioplasty, rhinoplasty, or septoplasty), and 37.6 percent underwent double-jaw surgery. Fifty-three percent were treated at high-volume hospitals. High-volume hospitals more often performed ancillary procedures (21.4 percent versus 17.4 percent; p surgery (41.3 percent versus 33.4 percent; p orthognathic cases nationwide are performed at a small number of high-volume hospitals. These hospitals discharge patients earlier, perform more complex procedures, and have fewer complications. Risk, III.
Letchworth, Janet F.
Kennedy Space Center (KSC) has decided to write its agreements under the Commercial Space Launch Act (CSLA) authority to cover a broad range of categories of support that KSC could provide to our commercial partner. Our strategy was to go through the onerous process of getting the agreement in place once and allow added specificity and final cost estimates to be documented on a separate Task Order Request (TOR). This paper is written from the implementing engineering team's perspective. It describes how we developed the processes associated with getting Government support to our emerging commercial partners, such as SpaceX and reports on our success to date.
Golzene, A.; Meyer, B.; Schwab, C.
The thermal dependence of EPR spectra of fast neutron irradiated n-type GaAs over the whole 4.2 to 300 K temperature range has been studied using the decomposition of spectra into a quadruplet of four identical Gaussian lines and a Lorentzian singlet. Quadruplet and singlet spectra as well as their proper parameters (inverse of paramagnetic susceptibility, hyperfine constants) could be determined separately. Experiments give evidence that the neutron generated anionic antisites As/sub Ga/ in GaAs are constituting associated defect centers, most likely of intrinsic nature
Sera, Francesco; Ferrari, Pietro
In a multicenter study, the overall relationship between exposure and the risk of cancer can be broken down into a within-center component, which reflects the individual level association, and a between-center relationship, which captures the association at the aggregate level. A piecewise exponential proportional hazards model with random effects was used to evaluate the association between dietary fiber intake and colorectal cancer (CRC) risk in the EPIC study. During an average follow-up o...
de Perio, Marie A; Bernard, Bruce P; Delaney, Lisa J; Pesik, Nicki; Cohen, Nicole J
CDC is investigating reports of potential occupational exposure to human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Mycobacterium tuberculosis among workers performing preparation and dissection procedures on human nontransplant anatomical materials at a nontransplant anatomical donation center in Arizona. CDC is working with Arizona public health officials to inform persons exposed to these potentially infected materials. Nontransplant anatomical centers around the United States process thousands of donated cadavers annually. These materials (which might be fresh, frozen, or chemically preserved) are used by universities and surgical instrument and pharmaceutical companies for medical education and research. The American Association of Tissue Banks has developed accreditation policies for nontransplant anatomical donation organizations. It also has written standards that specify exclusion criteria for donor material, as well as use of proper environmental controls and safe work practices to prevent transmission of infectious agents during receipt and handling of nontransplant anatomical materials. At the center under investigation, which is now closed, these standards might not have been consistently implemented.
Khaled K Al-Dossari
Full Text Available Introduction: Epilepsy is one of the most stigmatizing disorders. Stigmas and negative attitudes associating epilepsy are due to poor public awareness and knowledge. This study evaluated Saudi public Knowledge, awareness, and attitude towards epilepsy. Materials and Methods: A cross-sectional study conducted during the period from September 16, 2014 to January 1st 2015. A 20-item questionnaire adapted from the literature was validated and distributed to 422 adults living in Al-Kharj governorate, and 22 participants were excluded as they have never heard or read about epilepsy. Results: About 94.79% of participants have heard or read about epilepsy, 63% of them knew someone with epilepsy, and 49.75% have witnessed a seizure attack. Seventy per cent of subjects thought that epilepsy is a neurological disease and 59% believed it is a brain disease. Almost 46.5% selected possession by demons or evil spirits and 51.25% cited envy or evil eye. More than half of subjects selected the medical treatment and follow-up as the most effective treatment of epilepsy. Rather, 41% believed in the faith healing. Most of respondents (81.5% believed that epileptic children could be successful in normal classes. The vast majority agreed with that epileptic woman can get married and have children. Moreover, 65.25% would allow their offspring to play with epileptic persons and surprisingly, 59% would let their offspring marrying a person with epilepsy. As much as 82.75% agreed to work with epileptic persons and 85.5% would easily become a close friend of them. The equal job opportunity for epileptic and normal persons should be practiced to about 53.75% of subjects. The predictors of good knowledge, limited misconception, and positive attitudes were female gender, being a relative of an epileptic person, and having high educational level. Conclusion: The public knowledge, awareness of and attitudes toward epilepsy were acceptable with regard to this study. However
Ortiz-Sanjuán, Francisco; Blanco, Ricardo; Hernández, José L; Pina, Trinitario; González-Vela, María C; Fernández-Llaca, Héctor; Calvo-Río, Vanesa; Loricera, Javier; Armesto, Susana; González-López, Marcos A; Rueda-Gotor, Javier; González-Gay, Miguel A
The 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides defined drug-associated immune complex vasculitis as a distinct entity included within the category of vasculitis associated with probable etiology. In the present study we assessed the clinical spectrum of patients with drug-associated cutaneous vasculitis (DACV). Case records were reviewed of patients with DACV treated at a tertiary referral hospital over a 36-year period. A diagnosis of DACV was considered if the drug was taken within a week before the onset of the disease. From a series of 773 unselected cutaneous vasculitis cases, 239 patients (30.9%; 133 men and 106 women; mean age 36 yrs) were diagnosed with DACV. Antibiotics (n=149; 62.3%), mainly β-lactams and nonsteroidal antiinflammatory drugs (NSAID; n=24; 10%) were the most common drugs. Besides skin lesions (100%), the most common clinical features were joint (51%) and gastrointestinal (38.1%) manifestations, nephropathy (34.7%), and fever (23.8%). The most remarkable laboratory data were increased erythrocyte sedimentation rate (40.2%), presence of serum cryoglobulins (26%), leukocytosis (24.7%), positive antinuclear antibodies (21.1%), anemia (18.8%), and positive rheumatoid factor (17.5%). Despite drug discontinuation and bed rest, 108 patients (45.2%) required medical treatment, mainly corticosteroids (n=71) or immunosuppressive drugs (n=7). After a median followup of 5 months, relapses occurred in 18.4% of patients, and persistent microhematuria or renal insufficiency in 3.3% and 5%, respectively. DACV is generally associated with antibiotics and NSAID. In most cases it has a favorable prognosis, although a small percentage of patients may develop residual renal damage.
Vassin, Vitaly M.; Wold, Marc S.; Borowiec, James A.
Mammalian replication protein A (RPA) undergoes DNA damage-dependent phosphorylation at numerous sites on the N terminus of the RPA2 subunit. To understand the functional significance of RPA phosphorylation, we expressed RPA2 variants in which the phosphorylation sites were converted to aspartate (RPA2D) or alanine (RPA2A). Although RPA2D was incorporated into RPA heterotrimers and supported simian virus 40 DNA replication in vitro, the RPA2D mutant was selectively unable to associate with re...
Wang, Weiling; Lester, Keith; Ofsthun, Norma; Lazarus, J. Michael; Hakim, Raymond M.
Background and objectives: The objective of this study was to evaluate epidemiology and outcomes of a large in-center nocturnal hemodialysis (INHD) program. Design, setting, participants, & measurements: This case-control study compared patients who were on thrice-weekly INHD from 56 Fresenius Medical Care, North America facilities with conventional hemodialysis patients from 244 facilities within the surrounding geographic area. All INHD cases and conventional hemodialysis control subjects who were active as of January 1, 2007, were followed until December 31, 2007, for evaluation of mortality and hospitalization. Results: As of January 1, 2007, 655 patients had been on INHD for 51 ± 73 d. Patients were younger, there were more male and black patients, and vintage was longer, but they had less diabetes compared with 15,334 control subjects. Unadjusted hazard ratio was 0.59 for mortality and 0.76 for hospitalization. After adjustment for case mix and access type, only hospitalization remained significant. Fewer INHD patients were hospitalized (48 versus 59%) with a normalized rate of 9.6 versus 13.5 hospital days per patient-year. INHD patients had greater interdialytic weight gains but lower BP. At baseline, hemoglobin values were similar, whereas albumin and phosphorus values favored INHD. Mean equilibrated Kt/V was higher in INHD patients related to longer treatment time, despite lower blood and dialysate flow rates. Conclusions: Patients who were on INHD exhibited excellent quality indicators, with better survival and lower hospitalization rates. The relative contributions of patient selection versus effect of therapy on outcomes remain to be elucidated in prospective clinical trials. PMID:19965529
Brink, Farah W; Thackeray, Jonathan D; Bridge, Jeffrey A; Letson, Megan M; Scribano, Philip V
Limited studies exist evaluating the multidisciplinary team (MDT) decision-making process and its outcomes. This study evaluates the MDT determination of the likelihood of child sexual abuse (CSA) and its association to the outcome of the child protective services (CPS) disposition. A retrospective cohort study of CSA patients was conducted. The MDT utilized an a priori Likert rating scale to determine the likelihood of abuse. Subjects were dichotomized into high versus low/intermediate likelihood of CSA as determined by the MDT. Clinical and demographic characteristics were compared based upon MDT and CPS decisions. Fourteen hundred twenty-two patients were identified. A high likelihood for abuse was determined in 997 cases (70%). CPS substantiated or indicated the allegation of CSA in 789 cases (79%, Kappa 0.54). Any CSA disclosure, particularly moderate risk disclosure (AOR 59.3, 95% CI 26.50-132.80) or increasing total number of CSA disclosures (AOR 1.3, 95% CI 1.11-1.57), was independently associated with a high likelihood for abuse determination. Specific clinical features associated with discordant cases in which MDT determined high likelihood for abuse and CPS did not substantiate or indicate CSA included being white or providing a low risk CSA disclosure or other non-CSA disclosure. MDT determination regarding likelihood of abuse demonstrated moderate agreement to CPS disposition outcome. CSA disclosure is predictive of the MDT determination for high likelihood of CSA. Agreement between MDT determination and CPS protection decisions appear to be driven by the type of disclosures, highlighting the importance of the forensic interview in ensuring appropriate child protection plans. Published by Elsevier Ltd.
Enome, S.; Tanaka, H.
In the flaring region of the sun, a large variety of plasmas with various densities and a wide range of temperatures or energies is implied. These plasmas are heated and accelerated to subrelativistic and relativistic energies. Observational evidence is given on the characteristics of active regions which produced proton flares and on the structure of the associated nonthermal microwave bursts of the sun. The behavior of subrelativistic electrons on the sun is also described. Data are based on observations made with the Toyota interferometers at 3 and 8 cm, which have the same spatial resolution. (U.S.)
de Carvalho, Guilherme Moreira; Sponchiado Junior, Emílio Carlos; Garrido, Angela Delfina Bittencourt; Lia, Raphael Carlos Comelli; Garcia, Lucas da Fonseca Roberti; Marques, André Augusto Franco
The aim of this study was to evaluate the apical transportation, the centering ability, and the cleaning effectiveness of a reciprocating single-file system associated to different glide path techniques. The mesial root canals of 52 mandibular molars were randomly distributed into 4 groups (n = 13) according to the different glide path techniques used before biomechanical preparation with Reciproc System (RS): KF/RS (sizes 10 and 15 K-files), NGP/RS (no glide path, only reciprocating system), PF/RS (sizes 13, 16, and 19 PathFile instruments), and NP (no preparation). Cone-beam computed tomography analysis was performed before and after instrumentation for apical third images acquisition. Apical transportation and its direction were evaluated by using the formula D = (X1 - X2) - (Y1 - Y2), and the centering ability was analyzed by the formula CC = (X1 - X2/Y1 - Y2 or Y1 - Y2/X1 - X2). The samples were submitted to histologic processing and analyzed under a digital microscope for debris quantification. The values were statistically analyzed (Kruskal-Wallis, the Dunn multiple comparisons test, P .05). Groups had a tendency toward transportation in the mesial direction. No technique had perfect centering ability (=1.0), with no significant difference among them. KF/RS had larger amount of debris, with statistically significant difference in comparison with NGP/RS (P > .05). The different glide path techniques promoted minimal apical transportation, and the reciprocating single-file system tested remained relatively centralized within the root canal. Also, the different techniques interfered in the cleaning effectiveness of the reciprocating system. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Poletti, Michele; Logi, Chiara; Lucetti, Claudio; Del Dotto, Paolo; Baldacci, Filippo; Vergallo, Andrea; Ulivi, Martina; Del Sarto, Simone; Rossi, Giuseppe; Ceravolo, Roberto; Bonuccelli, Ubaldo
The current study aimed at establishing the prevalence of impulse control disorders (ICDs) in patients with Parkinson disease (PD) and their association with demographic, drug-related, and disease-related characteristics. We performed a single-center cross-sectional study of 805 PD patients. Impulse control disorders were investigated with the Questionnaire for Impulsive Compulsive Disorders in Parkinson's Disease; also comorbid neuropsychiatric complications (dementia, delusions, visual hallucinations) were investigated with clinical interviews and ad hoc instruments (Parkinson Psychosis Questionnaire and Neuropsychiatry Inventory). Impulse control disorders were identified in 65 patients (prevalence, 8.1%), with pathological gambling and hypersexuality the most frequent. Impulse control disorders were present in 57 of 593 cognitively preserved patients (prevalence, 9.6%) and in 8 of 212 demented patients (prevalence, 3.8%). Impulse control disorders were significantly associated with dopamine agonists (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.60-12.46; P Impulse control disorders frequency was similar for pramipexole and ropinirole (16.6% vs 12.5%; OR, 1.45; 95% CI, 0.79-2.74; P = 0.227). Additional variables associated with ICDs were male sex and younger age. These findings suggested that dopaminergic treatments in PD are associated with increased odds of having an ICD, but also other demographic and clinical variables are associated with ICDs, suggesting the multifactorial nature of the ICD phenomenon in PD.
Full Text Available Human immunodeficiency virus (HIV comorbidities have become clinically more important due to antiretroviral therapy. Although therapy increases life expectancy, it does not completely suppress immune activation and its associated complications. The simian immunodeficiency virus (SIV-infected rhesus macaque (Macaca mulatta represents a valuable model for the investigation of SIV-associated diseases. Although cardiovascular (CV changes are common in HIV-infected patients, there are only a few reports on the incidence of CV findings in SIV-infected animals. In addition, potential associations between pathohistological findings and hematological parameters are still unclear. We therefore conducted a retrospective analysis of 195 SIV-infected rhesus macaques that were euthanized with AIDS-related symptoms at the German Primate Center, Goettingen, over a 25-year period. Pathological findings were correlated with hematological data. The main findings included myocarditis (12.8 %, endocarditis (9.7 %, and arteriopathy (10.3 % in various organs. Thrombocytopenia occurred more frequently in macaques with endocarditis or arteriopathy than in macaques without CV disease (80 % in animals with endocarditis, 60 % in animals with arteriopathy, p < 0. 0001 and p = 0. 0016, respectively. Further investigations of the interaction between coagulation markers, proinflammatory cytokines, and biomarkers associated with endothelial dysfunction (e.g., D-dimers and histological data (vascular wall structure may unravel the mechanisms underlying HIV/SIV-associated CV comorbidities.
Full Text Available Between June 4th and June 20th1996 rotavirus, adenovirus, and astrovirus (HAstrV were investigated in fecal samples from 27 children under three years old with acute diarrhea, attending the Bertha Lutz day care center, in Rio de Janeiro. All fecal samples were analyzed by polyacrylamide gel electrophoresis (PAGE, reverse transcriptase polymerase chain reaction (RT-PCR, enzyme immunoassays (EIA, and electron microscopy (EM. Nine of them (33% showed positive results for HAstrV by at least one of the employed methodologies. Eight were positive by RT-PCR and EIA, and six by EM. All positive samples were inoculated onto HT-29 (human colon adenocarcinoma cultured cells for HAstrV isolation and seven were positive after three passages. The sequencing analysis of eight RT-PCR products (449 bp from gene that codifies VP2 protein, showed a total nucleotide identity among them and 98% with HAstrV-1 (strain Oxford type 1. This is the first report of a gastroenteritis outbreak associated with HAstrv-1 in a day care center in Rio de Janeiro and it reinforces the importance of this virus in association with infantile acute gastroenteritis.
Poniatowska, Renata; Lusawa, Małgorzata; Skierczyńska, Agnieszka; Makowicz, Grzegorz; Habrat, Bogusław; Sienkiewicz-Jarosz, Halina
Manganese (Mn) is a well-known toxic agent causing symptoms of parkinsonism in employees of certain branches of industry. Home production of a psychostimulant ephedrone (methcathinone), involving the use of potassium permanganate, became a new cause of intoxications in Poland. This article presents clinical symptoms, initial brain MRI findings and characteristics of changes observed in follow-up examinations in 4 patients with manganese intoxication associated with intravenous administration of ephedrone. All patients in our case series presented symptoms of parkinsonism. T1-WI MRI revealed high intensity signal in globi pallidi in all patients; hyperintense lesions in midbrain were observed in three patients, while lesions located in cerebellar hemispheres and pituitary gland in just one patient. The reduction of signal intensity in the affected brain structures was observed in follow-up studies, with no significant improvement in clinical symptoms. Brain MRI is helpful in the assessment of distribution as well as dynamics of changes in ephedrone encephalopathy. Regression of signal intensity changes visible in brain MRI is not associated with clinical condition improvement. Although brain MRI findings are not characteristic for ephedrone encephalopathy, they may contribute to diagnosing this condition
Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Teixeira, Barbara de Sá Menezes; Silva, Marta Maria Alves da; Freitas, Maria Imaculada de Fátima
This study explored the association between demographic characteristics (age and sex) and other variables related to violence committed against children (form of violence perpetrator, place of occurrence, and nature of injury) using a sample of 404 children taken from the 2014 Violence and Accident Surveillance System (Sistema de Vigilância de Violências e Acidentes, VIVA) survey. Correspondence analysis was used to identify variables associated with the outcome violence against children. Victims were predominantly male. The most common form of violence was neglect/abandonment, followed by physical violence and sexual violence. The most common perpetrators were parents (ages zero to one and two to five years), followed by friends (ages six to nine years). The most common place of occurrence was the home. Notable levels of violence were observed at school, particularly among children aged between six and nine years. Neglect was most common in the age group zero to one year and two to five years, while physical violence was most common between children aged between six and nine years.
Abbas, R A; Hammam, R A M; El-Gohary, S S; Sabik, L M E; Hunter, M S
Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egypt. All participants were invited to complete a structured questionnaire through a semi-structured interview which included the self-reporting questionnaire 20 items (SRQ-20) and the work stress scale. Assessment of drug use included urine-based screening tests for common substances abused. The prevalence of job stress, common mental disorders and substance abuse, particularly tramadol and cannabis (Bango), was significantly higher in the studied temporary cleaners compared to permanent cleaners. Risk factors associated with increased susceptibility of the temporary cleaners to common mental disorders were family history of substance abuse, high crowding index, history of physical illness, low educational level, and smoking; while being unmarried, male sex, family history of mental disorder, age ≥40 years, smoking, and length of service ≥8 years, were associated with substance abuse among the same group. Temporary hired hospital cleaners suffered from impaired mental health more than permanent cleaners. Therefore, expanding the coverage of current laws and occupational safety and health standards to cover workers in the informal sector especially in developing countries is recommended.
Full Text Available Background: Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. Objectives: To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. Methods: A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egypt. All participants were invited to complete a structured questionnaire through a semi-structured interview which included the self-reporting questionnaire 20 items (SRQ-20 and the work stress scale. Assessment of drug use included urine-based screening tests for common substances abused. Results: The prevalence of job stress, common mental disorders and substance abuse, particularly tramadol and cannabis (Bango, was significantly higher in the studied temporary cleaners compared to permanent cleaners. Risk factors associated with increased susceptibility of the temporary cleaners to common mental disorders were family history of substance abuse, high crowding index, history of physical illness, low educational level, and smoking; while being unmarried, male sex, family history of mental disorder, age ≥40 years, smoking, and length of service ≥8 years, were associated with substance abuse among the same group. Conclusion: Temporary hired hospital cleaners suffered from impaired mental health more than permanent cleaners. Therefore, expanding the coverage of current laws and occupational safety and health standards to cover workers in the informal sector especially in developing countries is recommended.
Full Text Available Saeed T Alshahrani,1 Nicola G Ghazi,2 Saba Al-Rashaed2 1Ophthalmology Department, King Fahad Specialist Hospital, Dammam, 2Vitreoretinal Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia Purpose: To investigate the clinical findings and outcomes of rhegmatogenous retinal detachment (RRD in Stickler syndrome on affected and fellow eyes that underwent prophylactic retinopexy.Patients and methods: Chart review of 70 eyes (62 patients. Incidence of RRD, postoperative visual acuity, and risk factors were evaluated.Results: Twenty-two patients (35% had RRD in the fellow eye, 37% of the eyes had cataract, 93% had macular detachment, 50% had proliferative vitreoretinopathy, and 41% had posterior vitreous detachment. Success rates were: 60% of patients after scleral buckling; 57.1% after pars plana vitrectomy; and 75% after combined scleral buckling and pars plana vitrectomy. Sixty-one (93.8% of patients had successful surgery (including second surgery. Silicone oil tamponade was significantly associated with final anatomic outcome, with a protective odds ratio of 0.11 (P=0.027. Visual acuity improved in 54% of eyes and decreased in 5%. Statistically significant associations were present for eyes with final visual acuity ≥20/200, and total retinal detachment (P<0.001; preoperative cataract (P=0.023; and proliferative vitreoretinopathy (P<0.001. RRD developed in 16/44 eyes despite laser prophylaxis.Conclusion: Prophylactic retinopexy was not beneficial for Stickler syndrome patients. Success of primary surgery for RRD remains low. The primary surgery should be vitrectomy combined with scleral buckling and silicone oil tamponade. Keywords: Stickler syndrome, retinopexy, Gulf States, Saudi Arabia, ocular genetics, arthro-ophthalmopathy, collagen disorder
Both, M.; Jahnke, T.; Reinhold-Keller, E.; Reuter, M.; Grimm, J.; Biederer, J.; Brossmann, J.; Gross, W.L.; Heller, M.; Mueller-Huelsbeck, S.
The purpose of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty for occlusive arterial disease associated with vasculitis. Eleven patients(10 women, 1 man; ages 35-82 years) with the diagnosis of vasculitis of the large vessels underwent interventional treatment during intraarterial angiography. The causes included giant cell arteritis(n = 8) and Takayasu arteritis (n = 3).Thirty-three occlusive lesions (including brachiocephalic and renalarteries, and arteries of upper and lower extremities) were treated with balloon angioplasty and/or stent placement. Follow-up included clinical examination, angiography, and color duplex ultrasound.Technical success was 100% (25/25) for stenoses and 50% (4/8) for occlusive lesions, representing all lesions combined from different anatomic locations. Dissection (n = 3) and arterial rupture with retroperitoneal hematoma (n = 1) was found in three patients. During follow-up (mean 12 months), restenoses(n = 8) and re-restenoses (n = 1)occurred in 8 vascular areas. Three of these lesions were treated with repeated PTA (n = 4). The cumulative primary clinical success rate was 67.6%, cumulative secondary success rate 74.4%, and cumulative tertiary success rate 75.9%. Interventional therapy in systemic vasculitis provides promising results in technical success rates and followup. Angioplasty may result in arterial injury, but the rate of complications is low
Chen, Hui; Liu, Ying; Zhang, Menghui; Wang, Guoyang; Qi, Zhengnan; Bridgewater, Laura; Zhao, Liping; Tang, Zisheng; Pang, Xiaoyan
Periodontitis is a highly prevalent polymicrobial disease worldwide, yet the synergistic pattern of the multiple oral pathogens involved is still poorly characterized. Here, saliva, supragingival and subgingival plaque samples from periodontitis patients and periodontally healthy volunteers were collected and profiled with 16S rRNA gene pyrosequencing. Different oral habitats harbored significantly different microbiota, and segregation of microbiota composition between periodontitis and health was observed as well. Two-step redundancy analysis identified twenty-one OTUs, including Porphyromonas gingivalis, Tannerella forsythia and Filifactor alocis, as potential pathogens that were significantly associated with periodontitis and with two periodontitis diagnostic parameters (pocket depth and attachment loss) in both saliva and supragingival plaque habitats. Interestingly, pairwise correlation analysis among the 21 OTUs revealed that Filifactor alocis was positively correlated with seven other putative pathogens (R > 0.6, P periodontitis patients. This bacterial cluster showed a higher diagnostic value for periodontitis than did any individual potential pathogens, especially in saliva. Thus, our study identified a potential synergistic ecological pattern involving eight co-infecting pathogens across various oral habitats, providing a new framework for understanding the etiology of periodontitis and developing new diagnoses and therapies. PMID:25761675
Shim, Eun-Jung; Park, Jae-Hyun
The current study examined the prevalence and associated factors of suicidality among Korean cancer patients. Moreover, the association of multiple psychological morbidities with suicidality was investigated among cancer patients. A cross-sectional, multi-center survey of 400 cancer patients was administered in five cancer-treatment hospitals throughout South Korea. Study variables were assessed using standardized measures including the Mini International Neuropsychiatric Interview suicidality module, the Hospital Anxiety and Depression Scale, and the Impact of Event Scale-Revised. 20.1% (80/399) of patients were positive cases of suicidality. Having no religion (p = .010), poor performance status (p = .000), and psychological comorbidity (p = .021) were significantly associated with the experience of suicidality in the multivariate analysis. Compared to "fully active" patients, patients who were capable of self-care but unable to perform any work activities had about a six times higher risk of suicidality (p = .000). Compared to patients with no psychological morbidity, the risk of suicidality was significantly higher among patients with comorbid anxiety and depression (p = .024), those experiencing comorbid depression and post-traumatic stress disorder (PTSD) (p = 0.051), and those experiencing comorbid anxiety, depression and PTSD (p = .001). This study found that having no religion, impaired levels of overall functioning, and "multiple psychological morbidities" were associated with suicidality in Korean cancer patients. These findings suggest a need for careful monitoring of these factors and enhanced comprehensive care addressing both the physical and psychosocial functioning of patients with cancer in suicide prevention efforts.
Radha, K R; Reena, R P
The delay in detection of premalignant and malignant lesions can have an adverse impact on the outcome of carcinoma cervix. In spite of relatively good healthcare facilities, women in Kerala continue to report in advanced stages of cervical malignancy. To analyze factors associated with delayed reporting and to evaluate awareness about screening and vaccination programs for prevention of carcinoma cervix. A cross-sectional study design was used to evaluate the subjects diagnosed to have carcinoma cervix in the outpatient Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala for a period of two years. One-hundred and fifteen women diagnosed to have invasive carcinoma during the study were evaluated. Data analysis was done and expressed as means and percentages. One-hundred and fifteen women participated in the study. Only 26 (21.7 %) of the subjects were diagnosed in a relatively early stage, i.e., up to stage 2a. Most of them were from families living below poverty line (63.9 %) and were either widowed or divorced (57.3 %). Illiteracy was common (48.9 %) among them, and many (71.3 %) worked as manual laborers. None of the subjects was aware about the availability of screening and vaccination programs for prevention of carcinoma cervix. There is a wide gap between the awareness of availability of healthcare and its proper utilization by the poor. Scaling up of public awareness of preventive programs and the availability of healthcare facilities are essential to enable the timely utilization of such services to facilitate early detection of invasive carcinoma cervix.
Owusu-Edusei, Kwame; Gift, Thomas L; Leichliter, Jami S; Romaguera, Raul A
The number of categorical sexually transmitted disease (STD) clinics is declining in the United States. Federally qualified health centers (FQHCs) have the potential to supplement the needed sexually transmitted infection (STI) services. In this study, we describe the spatial distribution of FQHC sites and determine if reported county-level nonviral STI morbidity were associated with having FQHC(s) using spatial regression techniques. We extracted map data from the Health Resources and Services Administration data warehouse on FQHCs (ie, geocoded health care service delivery [HCSD] sites) and extracted county-level data on the reported rates of chlamydia, gonorrhea and, primary and secondary (P&S) syphilis (2008-2012) from surveillance data. A 3-equation seemingly unrelated regression estimation procedure (with a spatial regression specification that controlled for county-level multiyear (2008-2012) demographic and socioeconomic factors) was used to determine the association between reported county-level STI morbidity and HCSD sites. Counties with HCSD sites had higher STI, poverty, unemployment, and violent crime rates than counties with no HCSD sites (P < 0.05). The number of HCSD sites was associated (P < 0.01) with increases in the temporally smoothed rates of chlamydia, gonorrhea, and P&S syphilis, but there was no significant association between the number of HCSD per 100,000 population and reported STI rates. There is a positive association between STI morbidity and the number of HCSD sites; however, this association does not exist when adjusting by population size. Further work may determine the extent to which HCSD sites can meet unmet needs for safety net STI services.
Nakao, Masatsugu; Yamamoto, Izumi; Maruyama, Yukio; Nakashima, Akio; Matsuo, Nanae; Tanno, Yudo; Ohkido, Ichiro; Ikeda, Masato; Yamamoto, Hiroyasu; Yokoyama, Keitaro; Yokoo, Takashi
Peritoneal dialysis-associated peritonitis (PD-associated peritonitis) could influence the outcome of PD patients, including technique survival. Although the use of the twin-bag system has decreased the incidence of peritonitis, the effects of biocompatible PD solutions are controversial. Additionally, since both infection-causing microorganisms and antimicrobial therapies have changed over time, the duration of treatment of peritonitis (the duration of peritonitis) seems to have changed. The study included 527 patients who received PD between January 1980 and December 2012 at a single center. We divided patients undergoing PD into three groups according to the type of PD system used, namely single-bag and conventional PD solutions (S+C group, N = 145), twin-bag and conventional PD solutions (T+C group, N = 171) and twin-bag and biocompatible PD solutions (T+B group, N = 211), and analyzed PD-associated peritonitis incidences. Incidences of PD-associated peritonitis (times per patient-months) and peritonitis-free time were 1/59.4, 1/70.6 and 1/103.1, and 52, 97, and 100 months for the S+C, T+C and T+B groups, respectively. The duration of peritonitis, has thus, become dramatically shorter in recent years. Streptococcus sp. were associated with shortest and fungi with longest durations of peritonitis. Staphylococcus sp. and Pseudomonas aeruginosa were predominant in the S+C group. The twin-bag system has made a greater contribution to reductions in PD-associated peritonitis than biocompatible PD solutions. Furthermore, changes in microorganisms, antimicrobial therapies, patient education and improved PD system devices have presumably affected the reduction in the duration of peritonitis. © 2015 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.
During the opening of the IAEA Board of Governors (7 September 2009), Director General Mohamed ElBaradei reported on nuclear power, nuclear applications, security and safety as well as non-proliferation issues. Concerning Nuclear Applications the Director General reported that progress is being made in establishing comprehensive cancer control programmes under the Programme of Action for Cancer Therapy (PACT) and the newly established WHO-IAEA Joint Programme on Cancer Control. Dr. ElBaradei also highlighted the continued concern over the shortage of the medical isotope molybdenum-99. Concerning Nuclear Power the Director General reported that despite the global recession, and a few countries delaying nuclear power decisions, the Agency's new projections for nuclear power generating capacity in the medium term have actually been revised upward to between 511 GW(e) of generating capacity in 2030 at the low end and possibly 807 GW(e), more than double current capacity. 'The expected growth reflects the urgent need for energy, especially in the developing world, concerns about energy security, fluctuations in fossil fuel prices, the need to vigorously address climate change, as well as the good performance and safety record of nuclear power,' he said. The number of IAEA national and regional technical cooperation projects on the introduction of nuclear power has risen from 15 in 2008 to 44 this year. Concerning Nuclear Safety and Security Dr. ElBaradei also reported that nuclear trafficking is continuing unabated. Up to June of this year the Agency's Illicit Trafficking Database (ITDB) received reports of 215 incidents. 'It is vital that all Member States do their utmost to ensure that nuclear and radioactive materials are safe and secure,' he said. Concerning Non-Proliferation the Director General reported that although the Islamic Republic of Iran has cooperated with the Agency on some issues, several critical areas remain unaddressed. 'Iran has not suspended its
Takakura, Toshinari; Kawamura, Ryuichi; Kawano, Tetsuya; Ichiyanagi, Kimpei; Tanoue, Masahiro; Yoshimura, Kei
To clarify the time evolution of water origins in the vicinity of a tropical cyclone (TC)'s center, we have simulated Typhoon Man-yi (July 2007) in our case study, using an isotopic regional spectral model. The model results confirm that the replacement of water origins occurs successively as the TC develops and migrates northward over the western North Pacific. It is confirmed that, in this case, a significant proportion of total precipitable water around the cyclone center comes from external regions rather than the underlying ocean during the mature stage of a TC. Similar features can also be seen in the proportion of each oceanic origin to total condensation. Indian Ocean, South China Sea, and Maritime Continent water vapors begin to increase gradually at the developing stage and reach their peak at the decay stage when the TC approaches southwestern Japan. These remote ocean vapors are transported to the east of the cyclone via the moisture conveyor belt, a zone characterized by distinct low-level moisture flux that stretches from the Indian Ocean to the TC, and are further supplied into the inner region of the TC by inflow within the boundary layer associated with its secondary circulation. Since it takes time to undergo these two dynamic processes, the delayed influence of remote ocean vapors on the TC appears to become evident during the mature stage.
Sanz-Barbero, Belén; Otero-García, Laura; Blasco-Hernández, Teresa; San Sebastián, Miguel
Adequate access to primary care emergency centers is particularly important in rural areas isolated from urban centers. However, variability in utilization of emergency services located in primary care centers among inhabitants of nearby geographical areas is understudied. The objectives of this study are twofold: 1) to analyze the association between the availability of municipal emergency care centers and utilization of primary care emergency centers (PCEC), in a Spanish region with high population dispersion; and 2) to determine healthcare providers' perceptions regarding PCEC utilization. A mixed-methods study was conducted. Quantitative phase: multilevel logistic regression modeling using merged data from the 2003 Regional Health Survey of Castile and Leon and the 2001 census data (Spain). Qualitative phase:14 in-depth- interviews of rural-based PCEC providers. Having PCEC as the only emergency center in the municipality was directly associated with its utilization (p use. PCEC users were considered to be predominantly workers and students with scheduling conflicts with rural primary care opening hours. The location of emergency care centers is associated with PCEC utilization. Increasing access to primary care by extending hours may be an important step toward optimal PCEC utilization. Further research would determine whether lower PCEC use by certain groups is associated with disparities in access to care.
Djukanovic, M.; Novicevic, M.; Dobrijevic, D.; Babic, B. [Electrical Engineering Inst. Nikola Tesla, Belgrade (Yugoslavia); Sobajic, D.J. [Electric Power Research Inst., Palo Alto, CA (United States); Pao, Y.H. [Case Western Reserve Univ., Cleveland, OH (United States)]|[AI WARE, Inc., Cleveland, OH (United States)
This paper presents a design technique of a new adaptive optimal controller of the low head hydropower plant using artificial neural networks (ANN). The adaptive controller is to operate in real time to improve the generating unit transients through the exciter input, the guide vane position and the runner blade position. The new design procedure is based on self-organization and the predictive estimation capabilities of neural-nets implemented through the cluster-wise segmented associative memory scheme. The developed neural-net based controller (NNC) whose control signals are adjusted using the on-line measurements, can offer better damping effects for generator oscillations over a wide range of operating conditions than conventional controllers. Digital simulations of hydropower plant equipped with low head Kaplan turbine are performed and the comparisons of conventional excitation-governor control, state-space optimal control and neural-net based control are presented. Results obtained on the non-linear mathematical model demonstrate that the effects of the NNC closely agree with those obtained using the state-space multivariable discrete-time optimal controllers.
Mogalli, Nabil M; El Hossary, Shabaan S; Khatri, Mishri Lal; Mukred, Abdualdaim M; Kassem, Hala A; El Sawaf, Bahira M; Ramadan, Nadia F
The clinicoepidemiologic profile of 143 cases (93 males and 50 females) with cutaneous leishmaniasis from 18 villages of Hajjah governorate, Yemen was studied. Dry-type lesions were seen in 98.6% and wet-type lesions in 1.4% of patients. Lesions were localized in all cases with different morphological patterns. Microscopic examination of Giemsa-stained slit smears revealed amastigotes in 74.1% of patients with dry-type lesions and 0% in patients with wet-type lesions. The burden of the parasites in the lesions was high indicating active transmission of the disease. Most cases were from villages with moderate altitude range (8001-1600m). All age groups were affected, but most cases were seen in ages from 5 to 15 years. Leishmania species identification was done for all cases by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The biopsic material was scraped from both Giemsa-stained and methanol-fixed smears. The molecular characterization of Leishmania species revealed Leishmania tropica as the causative agent of cutaneous leishmaniasis in Hajjah, Yemen. The risk factors associated with the transmission of the disease and recommendations for improving case detection were discussed. Copyright © 2016 Elsevier B.V. All rights reserved.
Chen, Xiude; Qin, Quande; Wei, Y.-M.
Improving energy productivity is one of the most cost-effective ways to achieve a sustainable development target. The existing literature has shown some factors that have driven the improvement in China’s energy productivity. However, these studies do little to tackle the role of Chinese local officials. Political promotions can be seen as the most important career incentive for Chinese local officials. Hence, we intend to study whether energy productivity affects Chinese local officials’ promotions in this paper. The data of position changes for the 31 provincial governors during 1978‐2012 are utilized. We adopted probit models to empirically examine the correlation between provincial governors’ political promotions and energy productivity. The empirical results demonstrate that (1) energy productivity has a significantly positive impact on provincial governors’ political promotions in China, meaning that the provincial governors have the momentum to improve energy productivity; and (2) the effect of energy productivity on provincial governors’ political promotions has evolved, dynamically changing along with the transformation of the economic growth mode and the adjustment of the local officials’ promotion mechanism. The results are helpful in understanding the drivers of the improvement in China’s energy productivity and provide insightful implications for conducting energy policy in China. - Highlights: •The data of position changes for China’s provincial governors during 1978–2012 are utilized. •Energy productivity has a positive impact on provincial governors’ promotion in China. •Political incentive is an important driver of the improvement in China’s energy productivity. •The correlation between energy productivity and local officials’ promotions was evolved.
Full Text Available OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7 or signs and symptoms (8-13 was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching. A mean score was calculated ranging from 1 (completely absent to 5 (severe for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60. CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60.
The IAEA Board of Governors today approved in principal an action plan designed to upgrade worldwide protection against acts of terrorism involving nuclear and other radioactive materials. In approving the plan, the Board has recognized that the first line of defense against nuclear terrorism is the strong physical protection of nuclear facilities and materials. 'National measures for protecting nuclear material and facilities are uneven in their substance and application,' the IAEA says. 'There is wide recognition that the international physical protection regime needs to be strengthened.'
In his introductory statement to the IAEA Board of Governors, the IAEA Director General gave an overview of the Agency's activities regarding technological issues in nuclear power and non-power applications; safety issues related to nuclear power plants and research reactors; decommissioning of nuclear facilities; safety of radiation sources; and marine transport of radioactive materials. Further in the document he gives a brief description of the Agency's activities in the field of nuclear verification; Agency's participation in a field mission to Kosovo on environmental assessment of the consequences of the use of depleted uranium in ammunition; safety standards discussions with ICAO
A general presentation of the National Waste Terminal Storage (NWTS) Program was given on July 26, 1976, to the Michigan Environmental Review Board and the Michigan Governor's Nuclear Waste Disposal Task Force. Following the presentation, Dr. William G. Taylor, Chairman of the Task Force, provided ERDA with a listing of questions which pertained to the NWTS program and ERDA/OWI's interest in northeast Michigan. This document contains copies of the information which was provided to Dr. Taylor in response to his inquiry.
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 7 December 2000. The following aspects from the Agency's activities are briefly presented: nuclear verification (status of integrated safeguards, plan of action for safeguards agreements and additional protocols, safeguards related to the Democratic People's Republic of Korea), technology issues (results of the 6th Conference of the Parties to the Convention on Climate Change, international project on innovative reactor and fuel cycle technologies), and safety issues (depleted uranium, safety standard discussions with the International Civil Aviation Organization, exchange of regulators or other safety personnel, emergency response co-ordination)
Lin, Sue C; McKinley, Duane; Sripipatana, Alek; Makaroff, Laura
Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients. Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening. Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening. The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017
Pearson, Hattie; Fleming, Tyler; Chhoun, Pheak; Tuot, Sovannary; Brody, Carinne; Yi, Siyan
Traditional, complementary and alternative medicine (TCAM) is seen as a way to provide healthcare in both developed and developing countries across the world. In Cambodia, there is a long tradition of using TCAM. However, scant studies have been conducted on the extent of Cambodian TCAM use and how it interacts with allopathic health care to date. In this study, we examined the prevalence of and factors associated with utilization of herbal medicines among patients with chronic diseases in primary health care settings in Cambodia. A cross-sectional survey was conducted in 2015 with outpatients receiving treatment and care for chronic diseases in two urban and two rural primary health centers purposively selected from Phnom Penh, Kampong Cham and Siem Reap. Every eligible patient was randomly selected at the health centers using a systematic sampling procedure. I-CAM-Q was used to measure TCAM use. A multivariate logistic regression model was constructed to identify factors associated with herbal medicine use. In total, 1602 patients were included in this study, of whom 77.7% were female, and 51.2% were recruited from urban primary health centers with a mean age of 46.5 years (SD = 15.2). Of total, 27.0% reported at least one consultation with a TCAM provider in the past 12 months. The most common modality of TCAM used was herbal medicine (89%). Herbs were obtained at drug or folk stores (36.9%), from herbalists directly (28.5%) or from their own gardens (18.6%). Of herb users, 55.2% reported that herbs were somewhat helpful. After adjustment, herb users were significantly more likely to be female (AOR = 1.42, 95% CI = 1.12-2.67), have completed less schooling (AOR = 0.66, 95% CI = 0.45-0.96), were unemployed or homemakers (AOR = 0.23, 95% CI = 0.13-0.52) and have a gastrointestinal illness (AOR = 0.49, 95% CI = 0.39-0.62). Herbal medicines are broadly used among chronic disease patients in Cambodia. Understanding TCAM use in
Full Text Available The sound design of landfills is essential in order to protect human health and the environment (air, water, and soil. The study area, Babylon Governorate, is situated in the middle of Iraq, and is distinguished by a hot climate and shallow groundwater. The governorate did not have landfill sites that meet international criteria; in addition, the groundwater depth in Babylon Governorate is commonly shallow. Previously, the most important criteria for the study area and GIS software were used to select the best sites for locating landfills in the major cities of the governorate. In this study, the Hydrologic Evaluation of Landfill Performance (HELP 3.95D model was applied in order to ensure that there was no leakage of the leachate that results from the waste in the selected landfill sites. It is the most commonly utilized model for landfill design, and it is used to estimate water inflow through the soil layers. For the present study, to avoid groundwater pollution by leachate from a landfill site due to the shallow groundwater depth, compacted waste was placed on the surface using two height scenarios (2 m and 4 m. This design was developed using the soil properties of the selected sites coupled with the weather parameters in Babylon Governorate (precipitation, temperature, solar, and evapotranspiration for a 12-year period covering 2005 to 2016. The results from both of the suggested landfill designs showed an absence of leachate from the bottom liner.
Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick
The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.
Sánchez-Siancas, Luis E; Rodríguez-Medina, Angélica; Piscoya, Alejandro; Bernabe-Ortiz, Antonio
This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated. A cross-sectional study enrolling women aged 18-25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%-49.3%), and 17.4% (95%CI: 13.1%- 21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81-3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14-3.30) after controlling for confounders. There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed.
Seng, Elizabeth K.; Buse, Dawn C.; Klepper, Jaclyn E.; Mayson, Sarah Jo; Grinberg, Amy S.; Grosberg, Brian M.; Pavlovic, Jelena M.; Robbins, Matthew S.; Vollbracht, Sarah E.; Lipton, Richard B.
Objective To evaluate relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. Background Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. Methods Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors [depressive symptoms (Patient Health Questionnaire-9), anxious symptoms (Generalized Anxiety Disorder-7), Pain Catastrophizing Scale and Headache Specific Locus of Control]. Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. Results Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1,11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. Conclusions Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate relationships among naturalistic
Hayek, Samah; Dietz, Patricia M; Van Handel, Michelle; Zhang, Jun; Shrestha, Ram K; Huang, Ya-Lin A; Wan, Choi; Mermin, Jonathan
To assess the association between state per capita allocations of Centers for Disease Control and Prevention (CDC) funding for HIV testing and the percentage of persons tested for HIV. We examined data from 2 sources: 2011 Behavioral Risk Factor Surveillance System and 2010-2011 State HIV Budget Allocations Reports. Behavioral Risk Factor Surveillance System data were used to estimate the percentage of persons aged 18 to 64 years who had reported testing for HIV in the last 2 years in the United States by state. State HIV Budget Allocations Reports were used to calculate the state mean annual per capita allocations for CDC-funded HIV testing reported by state and local health departments in the United States. The association between the state fixed-effect per capita allocations for CDC-funded HIV testing and self-reported HIV testing in the last 2 years among persons aged 18 to 64 years was assessed with a hierarchical logistic regression model adjusting for individual-level characteristics. The percentage of persons tested for HIV in the last 2 years. In 2011, 18.7% (95% confidence interval = 18.4-19.0) of persons reported being tested for HIV in last 2 years (state range, 9.7%-28.2%). During 2010-2011, the state mean annual per capita allocation for CDC-funded HIV testing was $0.34 (state range, $0.04-$1.04). A $0.30 increase in per capita allocation for CDC-funded HIV testing was associated with an increase of 2.4 percentage points (14.0% vs 16.4%) in the percentage of persons tested for HIV per state. Providing HIV testing resources to health departments was associated with an increased percentage of state residents tested for HIV.
Dorota M. Rowczenio
Full Text Available Cryopyrin-associated periodic syndrome (CAPS is caused by gain-of-function NLRP3 mutations. Recently, somatic NLRP3 mosaicism has been reported in some CAPS patients who were previously classified as “mutation-negative.” We describe here the clinical and laboratory findings in eight British adult patients who presented with symptoms typical of CAPS other than an onset in mid-late adulthood. All patients underwent comprehensive clinical and laboratory investigations, including analysis of the NLRP3 gene using Sanger and amplicon-based deep sequencing (ADS along with measurements of extracellular apoptosis-associated speck-like protein with CARD domain (ASC aggregates. The clinical phenotype in all subjects was consistent with mid-spectrum CAPS, except a median age at disease onset of 50 years. Sanger sequencing of NLRP3 was non-diagnostic but ADS detected a somatic NLRP3 mutation in each case. In one patient, DNA isolated from blood demonstrated an increase in the mutant allele from 5 to 45% over 12 years. ASC aggregates in patients’ serum measured during active disease were significantly higher than healthy controls. This series represents 8% of CAPS patients diagnosed in a single center, suggesting that acquired NLRP3 mutations may not be an uncommon cause of the syndrome and should be sought in all patients with late-onset symptoms otherwise compatible with CAPS. Steadily worsening CAPS symptoms in one patient were associated with clonal expansion of the mutant allele predominantly affecting myeloid cells. Two patients developed AA amyloidosis, which previously has only been reported in CAPS in association with life-long germline NLRP3 mutations.
perinatal mortality rate for preterm babies in the study center was 46.1% (236/512. The stillbirth rate for preterm babies was 22.0% (149/678 and the adjusted early neonatal death rate was 24.0% (87/363.Conclusion: The prevalence of preterm births and associated perinatal mortality were high which may be a reflection of suboptimal prenatal and newborn care. An urgent improvement in prenatal and newborn care is therefore needed in the study center in order to improve the capacity to prevent or abate preterm labor, and preterm premature rupture of membranes; and to reduce avoidable stillbirths. Further upgrading of personnel and facilities in the newborn special care unit is also required to minimize early neonatal deaths.Keywords: preterm birth, prevalence, mortality, pattern, Nigeria
Padula, William V; Gibbons, Robert D; Valuck, Robert J; Makic, Mary B F; Mishra, Manish K; Pronovost, Peter J; Meltzer, David O
In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 University HealthSystem Consortium hospitals between 2007 and 2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding, and QI on HAPU rates. The models assumed level-2 random intercepts and random effects for CMS policy and EBP implementation to account for between-hospital variability in HAPU incidence. Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (-1.86 cases/quarter; P=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (-11.32 cases/quarter; P<0.001). HAPU rates were significantly lower after changes in CMS reimbursement. Reductions are associated with hospital-wide implementation of EBPs for HAPU prevention. Given that administrative data were used, it remains unknown whether these improvements were due to changes in coding or improved quality of care.
Sherman, Martin F; Gershon, Robyn R; Riley, Halley E M; Zhi, Qi; Magda, Lori A; Peyrot, Mark
We examined psychological outcomes in a sample of participants who evacuated from the World Trade Center towers on September 11, 2011. This study aimed to identify risk factors for psychological injury that might be amenable to change, thereby reducing adverse impacts associated with emergency high-rise evacuation. We used data from a cross-sectional survey conducted 2 years after the attacks to classify 789 evacuees into 3 self-reported psychological outcome categories: long-term psychological disorder diagnosed by a physician, short-term psychological disorder and/or memory problems, and no known psychological disorder. After nonmodifiable risk factors were controlled for, diagnosed psychological disorder was more likely for evacuees who reported lower "emergency preparedness safety climate" scores, more evacuation challenges (during exit from the towers), and evacuation-related physical injuries. Other variables associated with increased risk of psychological disorder outcome included gender (female), lower levels of education, preexisting physical disability, preexisting psychological disorder, greater distance to final exit, and more information sources during egress. Improving the "emergency preparedness safety climate" of high-rise business occupancies and reducing the number of egress challenges are potential strategies for reducing the risk of adverse psychological outcomes of high-rise evacuations. Focused safety training for individuals with physical disabilities is also warranted. (Disaster Med Public Health Preparedness. 2017;11:326-336).
Larsson, Anette; Palstam, Annie; Bjersing, Jan; Löfgren, Monika; Ernberg, Malin; Kosek, Eva; Gerdle, Björn; Mannerkorpi, Kaisa
Health and physical capacity are commonly associated with disease, age, and socioeconomic factors. The primary objective of this study was to investigate the degree to which physical capacity, defined as muscle strength and walking ability, is decreased in women with fibromyalgia (FM), as compared to healthy women, who are matched for age and level of education. The secondary aim was to investigate whether muscle strength and walking ability are associated with age, symptom duration, activity limitations and, Body Mass Index (BMI) in women with FM and control subjects. This controlled, cross-sectional, multi-center study comprised 118 women with FM and 93 age- and education-level-matched healthy women. The outcome measures were isometric knee-extension force, isometric elbow-flexion force, isometric hand-grip force, and walking ability. Differences between the groups were calculated, and for the women with FM analyses of correlations between the measures of physical capacity and variables were performed. The women with FM showed 20% (p BMI. It seems important to address this problem and to target interventions to prevent decline in muscle strength. Assessments of muscle strength and walking ability are easy to administer and should be routinely carried out in the clinical setting for women with FM. ClinicalTrials.gov identification number: NCT01226784 , Oct 21, 2010.
Full Text Available This paper proposes a decentralized nonlinear synergetic governor controller (NSGC for turbine generators to enhance power system stability by using synergetic control theory and the feedback linearization technique. The precise feedback linearization model of a turbine-generator with a steam valve control is obtained, at first, by using a feedback linearization technique. Then based on this model, a manifold is defined as a linear combination of the deviation of the rotor angle, speed deviation, and speed derivative. The control law of the proposed NSGC is deduced and the stability condition of the whole closed-loop system is subsequently analyzed. According to the requirement of the primary frequency regulation, an additional proportional integral (PI controller is designed to dynamically track the steady-state value of the rotor angle. Case studies are undertaken based on a single-machine infinite-bus system and the New England system, respectively. Simulation results show that the proposed NSGC can suppress the power oscillations and improve transient stability more effectively in comparison with the conventional proportional-integral-derivative (PID governor controller. Moreover, the proposed NSGC is robust to the variations of the system operating conditions.
Ismail, Asaad H.; Haji, Salih O.
Full text: This paper presents the results of radon level in drinking water in Erbil governorate and its districts. The measurements were carried out on 42 samples (tap water) of 21 major areas, and alpha track detectors (type Cr-39) were used for the estimations. The average values for radon concentration of tap water were variable from the district to another, and it was found to be (4.693±2.213 Bq/L) with a maximum of 9.61 Bq/L in Hugran region and minimum of 2.01 Bq/L in Haji-Omaran city. In addition, the average annual effective doses, and equilibrium factor between radon and its daughter were measured in each area and it was found to be (11.546±8.566 μSv/Yr) and (0.204±0.06) respectively. On the other hand, this paper presents an evaluation of the inhalation and ingestion doses from exposure to radon and also the contribution of radon concentration in drinking water to indoor radon concentration was estimated. When the results were compared with the internationally recommended reference levels (U.S Environmental Protection Agency limit 11.1 Bq/l), there were no indications of existence of radon problems in the water sources in this survey. Therefore the drinking water in Erbil governorate is safe as far as radon concentration is concerned. (author)
Full Text Available This paper presents the modeling and control of the excitation system via the automatic voltage regulator (AVR and governor system through the automatic generation control (AGC or frequency load control (FLC to improve stability on a micro hydro power plant (MHPP. Three main parts of the generation system are synchronous generator, AVR/excitation, AGC modelled linearly. Generator is modelled by a single machine connected to infinite bus (SMIB which is equipped by AVR and excitation linear model. Excitation control system made ??by optimizing the gain of the AVR (KA and the governor with the gain of the AGC (Ki. Optimization is done using the method improved particle swam optimization (IPSO. The main purpose of setting the gain of the AVR-AGC is to stabilize the oscillation frequency of the MHPP is connected to an infinite bus. Simulations are conducted by inputting step function with 5% load fluctuations as a representation of dynamic load. The simulation results show that the proposed method effectively raises the level of electromechanical damping oscillations the SMIB by generating the comprehensive damping index (CDI is minimum.
Harb, S.; El-Kamel, A.H.; Zahran, A.M.; Abbady, A.A.; Ahmed, F.A.
This paper presents the concentrations of naturally occurring radionuclides 226 Ra, 232 Th and 40 K measured in groundwater samples collected from Aden governorate South of Yemen region using gamma spectroscopy. A total of 37 groundwater samples were collected from four areas in Aden governorate. The average activity concentrations for groundwater from Beer Ahmed area were 1.60 Bq/L, 1.25 Bq/L and 16.90 Bq/L for 226 Ra, 232 Th and 40 K respectively and from Beer Fadle area were 1.45 Bq/L, 0.87 Bq/L and 19.8 Bq/L for 226 Ra, 232 Th and 40 K, respectively, while that for groundwater samples from Daar-saad area were 1.27 Bq/L, 1.18 Bq/L and 18.28 Bq/L for 226 Ra, 232 Th and 40 K, respectively and Al-Masabian area were 1.55 Bq/L, 1.421 Bq/L and 19.03 Bq/L for 226 Ra, 232 Th and 40 K respectively. Furthermore, annual effective dose equivalent of ingestion of these waters was calculated. The results showed that the annual dose obtained in the present study was much higher than the recommended value (0.1 mSv/year) as reported by WHO. The results were compared with those for drinking water. (author)
Full Text Available Egypt has the highest prevalence of hepatitis C virus (HCV worldwide. Most of data came from lower Egypt regions (Cairo and northern to it. So, we decided to study risk factors and prevalence of HCV transmission in our governorate. In this cross sectional study, we recruited 631 blood donors from April, 2011 to March 2012 who were tested for anti-HCV, HBs Ag, anti- HBc and anti-HIV. Fifty seven donors were excluded as they are HBs Ag and anti-HBc positive. We found 138 (24% HCV seropositive participants. Logistic regression final model demonstrated that endoscopy, hospital admission, socioeconomic status, IV drug use and age made a significant contribution to prediction (P=0.0001. The level of education also made significant contribution to prediction (P=0.014. In conclusion, it is wise to determine high HCV prevalence areas and risk factors for its seropositivity then build up a governorate suitable infection control program concentrating upon prevention more than treatment of HCV patients. Also, the introduction of pre-test and post-test counseling in blood banks will help in better donor selection and early detection of patients.
Morsy, T A; Mazyad, S A; Younis, M S
The study of the role played by birds in the distribution of various bacterial, viral and parasitic infections is increasingly from year to year, taking into consideration the flying ability of birds and their migration for food and vital processes. Two of the common Egyptian resident birds, house sparrow (Passer d. niloticus) and laughing dove (Streptopelia s. aegyptiaca) were chosen to study their mite fauna. The overall mite index was 4.74 on the house sparrow and 7.22 on the laughing dove. As to mites, a total of 31 species belonging to 23 genera, 17 families and 3 suborders were collected. The common mites on both types of birds were 22 species. Three species only on house sparrow, and six species only on laughing dove. The house sparrow served host for 25 mite species and the laughing dove served host for 28 mite species. The infestation rates of mites on house sparrow ranged between 1.11% to 23.33% and 0.21% to 34.54% in Sharkia and Qalyobia governorates respectively. For laughing dove, the mite infestation rates ranged between 0.82% to 50% and 3.45% to 55.17% for both governorates respectively. Some of the collected mites have medical and/or veterinary importance. The whole results were discussed.
Doocy, Shannon; Tappis, Hannah; Lyles, Emily; Witiw, Joseph; Aken, Vicki
The war in Syria has left millions struggling to survive amidst violent conflict, pervasive unemployment, and food insecurity. Although international assistance funding is also at an all-time high, it is insufficient to meet the needs of conflict-affected populations, and there is increasing pressure on humanitarian stakeholders to find more efficient, effective ways to provide assistance. To evaluate 3 different assistance programs (in-kind food commodities, food vouchers, and unrestricted vouchers) in Idleb Governorate of Syria from December 2014 and March 2015. The evaluation used repeated survey data from beneficiary households to determine whether assistance was successful in maintaining food security at the household level. Shopkeeper surveys and program monitoring data were used to assess the impact on markets at the district/governorate levels and compare the cost-efficiency and cost-effectiveness of transfer modalities. Both in-kind food assistance and voucher programs showed positive effects on household food security and economic measures in Idleb; however, no intervention was successful in improving all outcomes measured. Food transfers were more likely to improve food access and food security than vouchers and unrestricted vouchers. Voucher programs were found to be more cost-efficient than in-kind food assistance, and more cost-effective for increasing household food consumption. Continuation of multiple types of transfer programs, including both in-kind assistance and vouchers, will allow humanitarian actors to remain responsive to evolving access and security considerations, local needs, and market dynamics.
The Premiers-Governors energy discussions are aimed at promoting joint energy cooperation between provinces and states. This report outlines the major accomplishments in the implementation of the Climate Change Action Plan adopted by the Conference in 1998. The project priorities for the coming year are also outlined. In 2001, the New England Governors (NEG) and the Eastern Canadian Premiers (ECP) directed the Environment Committee and the Northeast International Committee on Energy (NICE) to implement a plan to develop a regional emissions inventory so that participating jurisdictions would have common data for measuring progress. The plan also identified specific climate actions that could be readily implemented. This report describes the results of 5 working groups which were created to focus on the following potential categories: energy, transportation, inventory and registry, adaptation, and 'lead by example'. In addition to the working groups, the Climate Change Steering Committee developed 4 proposals for consideration for implementation. These were the LED Traffic Light Proposal, the College and University Partnerships in Emissions Reductions, State/Provincial Purchasing Programs for High Efficiency-Low Emission Office Equipment, and Use of Cleaner, More Energy-Efficient Vehicles in State/Provincial Fleets. The Steering Committee will also pursue other tasks in the coming year, including the study of other proposals for cost-effective measures that could contribute to the goals of the Climate Change Action Plan, examine Internet options for coordinating internal project work, examine opportunities to pursue climate action, and identify opportunities to improve vehicle fuel efficiency
Kosut, Robert; Grace, Matthew
In The Human Use of Human Beings: Cybernetics and Society (1950), Norbert Wiener introduces feedback control in this way: ``This control of a machine on the basis of its actual performance rather than its expected performance is known as feedback ... It is the function of control ... to produce a temporary and local reversal of the normal direction of entropy.'' The classic classroom example of feedback control is the all-mechanical flyball governor used by James Watt in the 18th century to regulate the speed of rotating steam engines. What is it that is so compelling about this apparatus? First, it is easy to understand how it regulates the speed of a rotating steam engine. Secondly, and perhaps more importantly, it is a part of the device itself. A naive observer would not distinguish this mechanical piece from all the rest. So it is natural to ask, where is the all-quantum device which is self regulating, ie, the Quantum Flyball Governor? Is the goal of quantum error correction (QEC) to design such a device? Devloping the computational and mathematical tools to design this device is the topic of this talk.
Ueno, Masayuki; Ohara, Satoko; Inoue, Manami; Tsugane, Shoichiro; Kawaguchi, Yoko
Several studies have shown that parity is associated with oral health problems such as tooth loss and dental caries. In Japan, however, no studies have examined the association. The purpose of this study was to determine whether parity is related to dentition status, including the number of teeth present, dental caries and filled teeth, and the posterior occlusion, in a Japanese population by comparing women with men. A total of 1,211 subjects, who participated both in the Japan Public Health Center-Based (JPHC) Study Cohort I in 1990 and the dental survey in 2005, were used for the study. Information on parity or number of children was collected from a self-completed questionnaire administered in 1990 for the JPHC Study Cohort I, and health behaviors and clinical dentition status were obtained from the dental survey in 2005. The association between parity or number of children and dentition status was analyzed, by both unadjusted-for and adjusted-for socio-demographic and health behavioral factors, using a generalized linear regression model. Parity is significantly related to the number of teeth present and n-FTUs (Functional Tooth Units of natural teeth), regardless of socio-demographic and health behavioral factors, in female subjects. The values of these variables had a significantly decreasing trend with the rise of parity: numbers of teeth present (p for trend = 0.046) and n-FTUs (p for trend = 0.026). No relationships between the number of children and dentition status were found in male subjects. Higher-parity women are more likely to lose teeth, especially posterior occluding relations. These results suggest that measures to narrow the discrepancy by parity should be taken for promoting women's oral health. Delivery of appropriate information and messages to pregnant women as well as enlightenment of oral health professionals about dental management of pregnant women may be an effective strategy.
Full Text Available BACKGROUND: For decades the development of community health services has been emphasized in China to cope with the growing burden of chronic diseases by providing basic medical services. This survey aims at investigating factors associated with the use of Community Health Centers (CHCs for the management of hypertensive patients in Chengdu, China. METHODS: We used a systematic sampling method to select 2,030 patients with hypertension or diabetes registered in 29 CHCs in Chengdu in 2007. Researchers interviewed patients who consented to participate at their home. This paper reports findings from the survey of 1,716 hypertensive patients with completed questionnaires. Univariate analyses and multiple logistic regression analyses were conducted to explore factors influencing the use of CHCs for the management of hypertensive patients. RESULTS: 81.4% of hypertensive patients regularly used CHCs for hypertension monitoring and treatment in Chengdu. Univariate analyses indicated that use of CHCs was associated with the education level, occupation, types of medical insurance, Body Mass Index(BMI, patients' knowledge on hypertension, awareness of CHCs functions, satisfaction of the service of CHCs. Multiple regression analyses found that use of CHCs was positively associated with the following factors: the Urban Resident Basic Medical Insurance(URBMI, knowledge on blood pressure, awareness of the sites in CHCs to measure blood pressure, awareness of having to take life-long antihypertensive medicine once the treatment started, awareness of the health records registration in CHCs, regular follow up, improved convenience of seeing doctor. Patients with professional job were less likely to use the services of CHCs. CONCLUSIONS: The use of CHCs for hypertension management could be increased by improving residents' knowledge on the monitoring and treatment of hypertension, and the awareness of CHCs functions. The CHCs could play an important role in
Kang, Gu Hwa; Lee, Tae Hoon; Moon, Seung Jae; Lee, Jae Heon; Yoo, Ho Seon
In this work, the right management procedure for hydraulic power oil will be discussed and suggested. A thermal power plant turbine should respond to the change of load status. However, to satisfy the frequency of alternating current, the revolution per minute should be kept constant. Therefore, by controlling the flow rate of the steam to the turbine, the governor satisfies the load variation without alternating the revolution per minutes of the turbine. To protect the governor, the hydraulic power unit should be managed carefully by controlling the quality and the flow rate of the oil
Alkhateeb, Omar; Kraishan, Osama M.; Salah, Raid Omar
This study aimed at identifying the level of psychological burnout of a random sample of secondary phase teacher in Ma'an Governorate and its relationship with some other variables. The study sample consisted of 80 male and female Islamic education teachers in the schools of Ma'an Governorate in the southern part of Jordan. To this end, the…
Full Text Available Abstract: Menia El-Kamh province of the Sharkia Governorate constitutes one of the largest agricultural areas in Egypt. About 88% of the nearly 472,000 people living in this province rely on agricultural activities for subsistence. Several pesticides including organochloride, organophosphorus, carbamate, and pyrethroid insecticides, fungicides, and herbicides are commonly used in citrus, vegetable and other crop-growing areas to increase agricultural productivity. However, their use has also been associated with several cases of pesticide poisoning. In this research, we conducted a field survey to assess the knowledge, attitudes, and practices of the farmerÃ¢Â€Â™s community regarding the safe use of pesticides. We also evaluated the residual concentrations of selected pesticides in water, soil, milk, fish, and orange samples, and estimated the potential health risks associated with the exposure to these pesticides. Data obtained from the field survey indicate that more than 95% of farm workers do not practice safety precautions during pesticide formulation and application; leading to a considerable prevalence of pesticide-related illnesses in this agricultural community. Pesticide residues in various environmental samples varied greatly; from below detection levels (3-5 ng to as high as 325 ppb depending on the matrix of interest, and the specific pesticide of concern. The analysis of health risk estimates indicated that chlorpyrifos, DDT, dimethoate, methomyl, and larvin did not pose a direct hazard to human health, although present in water, milk, orange, and/or fish. However, aldicarb, and carbosulfan levels exceeded the reference doses, indicating a great potential for systemic toxicity, especially in children who are considered to be the most vulnerable population subgroup. The upper-bound values of cancer risk from DDT exposure were estimated to be about 8 (adults, and 55 (children excess cancers in a population of one million.
Full Text Available Anthropometric indices are of the best indicators for growth monitoring during neonatal period. The aim of this cross-sectional study was to determine the association ofanthropometric indices in Iranian and Afghan infants with maternal indices. The study was conducted in 230 mothers who had health profiles in the Eqbaliyeh health center, Qazvin during 2013. Data were collected through the records in mothers’ health profiles. Data were analyzed using T-test and Pearson’s correlation coefficient. Of 230 infants, 119 (51.7% were male. Mean weight and head circumference were significantly different between Iranian and Afghan infants.The Iranian mothers were older and had higher weight and height during pregnancy compared to the Afghan mothers and the difference was statistically significant. There was positive significant correlation between mothers’ age, weight, hemoglobin, and hematocrit and infants’ birth weight. There was also positive significant correlation between mothers’ hemoglobin and hematocrit and infants’ height. With regards to the results, proper nutrition, maternal health, and providing appropriate health services during pregnancy can be beneficial for improving infants’ health.
Full Text Available Acute kidney injury (AKI is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43% required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD. Most patients, 47 (81%, received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%, peritonitis 11 (20%, and catheter malfunction 5 (9%. Nine patients (16% needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5 × 103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS.
Full Text Available Clostridium difficile-associated diarrhea (CDAD has been recognized as the leading cause of diarrhea worldwide. In the last five years, it has become the leading cause of diarrhea in the Clinical Center of Vojvodina (CCV as well. The aim of this study was to determine the epidemiology and total cost of treatment for all patients with Clostridium difficile-associated diarrhea hospitalized at the Infectious Disease Clinic of the CCV; to analyze the costs of treatment with regard to therapeutic approach; to compare the costs of treatment in each year of the investigated period related to the number of patients, and to analyze the outcome of treatment. The study was retrospective, and the data were collected from the medical records of 472 patients with Clostridium difficile diarrhea treated from 2008 to 2012 and analyzed. Of the total 472 patients with CDAD, 54.23% were female and the average age was 65.84. A statistically significant majority of them had been previously treated in other hospitals and a minority in ambulatory settings (395 inpatients vs. 77 outpatients, p=0.000, p<0.05. Of the 395 previously hospitalized patients, most were from the Clinic of Urology of the CCV (58, 14.68%. When comparing therapeutic options, oral vancomycin was significantly more frequently used than other protocols. The average mortality rate during the study period was 6.51%. In this period, total hospital costs related to Clostridium difficile diarrhea in the Infectious Disease Clinic were $636,679.92. Implementation of infection-control measures and a restricted use of antibiotics would result in a great reduction in material costs.
da Rocha Silva, Júlia Prestes; Salles, Fernanda Junqueira; Leroux, Isabelle Nogueira; da Silva Ferreira, Ana Paula Sacone; da Silva, Agnes Soares; Assunção, Nilson Antonio; Nardocci, Adelaide Cassia; Sayuri Sato, Ana Paula; Barbosa, Fernando; Cardoso, Maria Regina Alves; Olympio, Kelly Polido Kaneshiro
A previous study observed high blood lead levels (BLL) in preschool children attending 50 day care centers (DCC) in São Paulo, Brazil. To identify whether lead levels found in both homes and DCC environments are associated with high blood lead levels. Children attending 4 DCCs, quoted here as NR, VA, PS and PF, were divided into two groups according to BLL: high exposure (HE: ≥13.9 μg/dL; 97.5 percentile of the 2013 year sample) and low exposure (LE: 600 μg/g, whereas such levels were observed in 77.1% of NR playground measurements. In VA DCC, 22% and 23% of the measurements in the building and in the playgrounds had levels higher than 600 μg/g, respectively. The percentage of high lead levels in the children's houses of the LE group was 5.9% (95% CI: 4.3-7.6%) and 13.2 (95% CI: 8.3-18.0%) in the HE group. Moreover, a significant association was found between high BLLs and lead levels found both in households and DCCs (p < 0.001). Most of the high lead measurements were found in tiles and playground equipment. Lead exposure estimated from the DCCs, where children spend about 10 h/day, can be as relevant as their household exposure. Therefore, public authorities should render efforts to provide a rigorous surveillance for lead-free painting supplies and for all objects offered to children. Copyright © 2018 Elsevier Ltd. All rights reserved.
Full text: 1. By Rule 23 (d) of the Provisional Rules of Procedure of the Board of Governors:' No Governor may address the Board without having previously obtained the permission of the presiding officer. The presiding officer shall call upon speakers in the order in which they signify their desire to speak. The presiding officer may call a speaker to order if his remarks are not relevant to the subject under discussion.' The following procedures are applied generally concerning the implementation of Rule 23. 2. Governors or other members of delegations who wish to speak on an item notify the Secretary of the Board of their intention to speak. A Secretariat staff member will also be present on the podium in the Boardroom each day from 9:30 a.m. until the Board meeting commences, to receive requests from delegations to be added to the list of speakers. After the meeting commences delegates wishing to speak should raise their flag to be recognized by the Secretary of the Board. The names of delegations are inscribed on a single list of speakers, maintained by the Secretary of the Board, in the order in which they have signified their wish to speak. e. It may be noted that, in the course of debate on a particular item, delegations may signify an intention to speak more than once, including speaking in response to issues raised by other delegations during the debate. When two or more delegations simultaneously indicate from the floor an intention to speak, their names are inscribed in the order in which they are brought to the attention of the Secretary. 4. The established practice is to first call on delegations wishing to speak on behalf of regional groups on any specific item, followed by individual delegations, in the order in which their names are inscribed on the list of speakers. 5. Member States will appreciate that these guidelines cannot cover all contingencies and that special cases may arise from time to time. The Chairman will exercise flexibility where
Chukwu, Emeka; Garg, Lalit; Eze, Godson
Nigeria contributes only 2% to the world's population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. The purpose of this study was to document costs associated with a mobile technology-supported, community-based health insurance scheme. This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (Phealth care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations
Full Text Available Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC in a medical center between October 2004 and September 2011. In addition to the two medical residents who had been trained in the intensive care unit (ICU, the RCC team also included attending physicians in charge, a nurse practitioner, a case manager, a dietitian, a pharmacist, a social worker, registered respiratory therapists, and nursing staff. Weaning from mechanical ventilation was done according to an established weaning protocol. The 84 months analyzed were classified into five groups according to the levels of the two residents working in the RCC: R2 + R1, R2 + R2, R3 + R1, R3 + R2, and R3 + R3. The monthly weaning rate and mortality rate were the major outcomes, while the mean ventilator days, rate of return to the ICU, and nosocomial infection incidence rate were the minor outcomes. The groups did not differ significantly in the monthly weaning rate, mortality rate, mean ventilator days, rate of return to the ICU, or nosocomial infection incidence rate (p > 0.1. Further analysis showed no significant difference in the monthly weaning rate and mortality rate between months with a first-year resident (R1 and those with two senior residents (p > 0.2. Although the weaning rate in the RCC gradually improved over time (p 0.7. Thus, we concluded that in a well-organized setting, the levels (experiences of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false May the Governor delegate responsibility for developing and submitting the State Plan? 641.310 Section 641.310 Employees' Benefits EMPLOYMENT AND TRAINING... developing and submitting the State Plan, provided that any such delegation is consistent with State law and...
Khaled, Mohammad S. Bani
This study considers school violence. It was investigated in secondary schools in the governorate of Mafraq. The aim is to identify the forms and causes of the phenomenon; hence to come out with the preventive and remedial measures, accordingly. The study was conducted in one of the secondary schools selected randomly in the city of Mafraq in the…
McKay, Sylvester; Relos, Ruth
In 1988, over one-third of all North Carolina magistrates, from 87 of 100 counties, responded to a survey from the Governor's Task Force on Domestic Violence. Ninety-nine percent of respondents indicated that they had handled at least one case in which a woman had complained about physical violence or threats from her husband or boyfriend. The…
Al-basel, D-Nagham Mohammad Abu
The present study aimed to identify the extent of knowledge of counselor behavior modification strategies. The current study sample consisted of (80) mentor and guide, were selected randomly from among all workers enrolled in regular public schools in the Balqa governorate represented the community study for the academic year 2012-2013. The study…
Helfrich, Christian D; Dolan, Emily D; Fihn, Stephan D; Rodriguez, Hector P; Meredith, Lisa S; Rosland, Ann-Marie; Lempa, Michele; Wakefield, Bonnie J; Joos, Sandra; Lawler, Lauren H; Harvey, Henry B; Stark, Richard; Schectman, Gordon; Nelson, Karin M
Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams׳ abilities to deliver patient-centered care. We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity. 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (β=32, Pteam processes). A stressful/chaotic clinic environment was associated with higher barriers to patient centered care (β=0.16-0.34, P=Team process and effectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures. Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics. Published by Elsevier Inc.
Al-Sulami, A A; Al-Taee, A M R; Yehyazarian, A A
This study in Iraq investigated the occurrence of Legionella. pneumophila in different drinking-water sources in Basra governorate as well as the susceptibility of isolates to several antibiotics. A total of 222 water samples were collected in 2008-2009: 49 samples from water purification plants (at entry points, from precipitation tanks, from filtration tanks and at exit points), 127 samples of tap water; and 46 samples from tankers and plants supplying water by reverse osmosis. The findings confirmed the presence of L. pneumophila in sources of crude water, in general drinking water supplies and drinking water tankers. Of 258 isolates 77.1% were serotype 1 and 22.9% serotypes 2-15. All examined isolates displayed drug resistance, particularly to ampicillin, but were 100% susceptible to doxycycline. The prevalence of L. pneumophila, especially serogroup 1, is a strong indicator of unsuitability of drinking water and requires appropriate action.
Ahmed K. Hassan
Full Text Available This work aimed to detect, identify and study the epidemiology of Arcobacter species in avian species in Upper Egypt. A total 600 samples, including cloacal swabs and intestinal samples were collected from chickens, turkeys and ducks in Assiut Governorate in Upper Egypt. Using conventional phenotypic methods for isolation and identification, Arcobacter species could be isolated and identified with percentage 25.5% in chickens, 9.5% in turkeys and 14% in ducks. Sixteen randomly selected phenotypically identified Arcobacter species isolates were confirmed using one step multiplex PCR assay. In conclusion, Arcobacter species could be detected and identified from various avian species with variable incidence. Conventional phenotypic methods for detection and differentiation of Arcobacter species are often hampered by many limitations, while molecular methods, and PCR, in particular can provide a sensitive and rapid alternative method for detection and identification of Arcobacter species in different domestic poultry species.
Ismail, N A; Aboul Ftouh, A M; El-Shoubary, W H; Mahaba, H
We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.
Ahmed, Hamdia M; Kareem, Mosleh S; Shabila, Nazar P; Mzori, Barzhang Q
Religious leaders are one of the key actors in the issue of female genital cutting (FGC) due to the influential position they have in the community and the frequent association of FGC with the religion. This study aimed to assess the knowledge and perspectives of the local religious leaders in Erbil governorate, Iraqi Kurdistan Region about different aspects of FGC. In-depth interviews were conducted with a sample of 29 local religious leaders. A semi-structured questionnaire was used that included questions about their knowledge, understanding, and perspectives on different aspects of FGC such as the reasons for practicing it, their contact and communication with the community regarding the practice and perspectives about banning the practice by law. Participants believed that FGC is useful for reducing or regulating the sexual desire of women to prevent adultery and engagement in pre and extramarital sexual relations and to enhance hygiene of women. They indicated that there is no any risk in doing FGC if there is no excessive cut. Most participants indicated that FGC is attributed to the religion and some considered it a tradition mixed with the religion. People rarely ask the advice of the religious leaders regarding FGC, but they frequently complain about the effects of the practice. Participants did not support having a law to ban FGC either because they thought it would be against the religion's advice on FGC or it will not work. The local religious leaders lack adequate knowledge about different aspects of FGC particularly the health consequences. There are different and disputing viewpoints about the reasons for practicing FGC, and there is poor support for having a law banning the practice. There is an essential need for enhancing the knowledge of the local religious leaders regarding FGC and its adverse effects on the women's health.
Radwan, Ghada Nasr; Wahid, Wafaa Yousif Abdel; El-Derwy, Doaa; El-Rabat, Maha
Avian influenza (H5N1) (AI) is becoming a serious public health threat in Egypt. The current study aimed to assess the existing knowledge, attitudes, and various practices regarding AI in household backyard poultry breeders residing in Fayoum Governorate, in rural Egypt. Of the 149 cases confirmed to date in Egypt, 51 have been fatal. This study was implemented in El Gendy and Manshat Abdllah villages in Fayoum Governorate. The latter village is the one in which a case of AI was confirmed in February 2007. A group of 150 women aged 15 years and above were recruited. A structured Arabic questionnaire was used to collect data. All interviewed women (N=150) had heard about AI. TV\\radio was the common source of information (83.3%). Nearly all interviewed women knew that AI is transmitted from birds to humans (99%). Most of the participants (>90%) correctly identified saliva, nasal secretions, feces, and contaminated vehicles as the modes of AI transmission. The knowledge regarding biosecurity measures (>70%) and measures of prevention (>90%) was generally good. More than 90% of the interviewed housewives agreed that AI is a serious disease that can be prevented, and that sanitary precautions during breeding and food preparation practices are effective measures for prevention of AI infection. Protective measures such as the use of gloves and masks, which minimize the risk of transmission of AI from poultry to humans, were seldom used by housewives in all their breeding, slaughtering, and cooking practices. However, washing hands either with water or with soap and water was reported by the vast majority of the respondents (>90%). There was a good level of knowledge and favorable attitude of the study participants regarding AI; however, practices appear to be inadequate to achieve full protection against AI. Comprehensive and multidisciplinary interventions should be widely used to enhance the complex behavior change process among the village residents.
Full Text Available Introduction: 238U decays with alpha particles emission into 234Th and the series ends with 206Pb. The unstable nucleus loses the energy with emitting ionizing alpha particles for reaching a stable state. It is undergoing alpha decay with decay energy (4.679 MeV. Alpha particles enter the human and animal bodies through inhalation of air or ingestion of contaminated food and water. This study aimed to perform a radiological analysis on the natural alpha particle emission rates of the human teeth as the biomarkers of radiation exposure and environmental pollution. Materials and Methods: This study was conducted on 68 teeth samples of 27 males and 41 females collected from the hospitals distributed across Najaf governorate, including many districts in Iraq. Alpha particle emission rates were measured using CR-39 nuclear track detector. Results: The mean emission rate of alpha particles in the female teeth was 0.0396±0.0070 mBq cm-2, which was relatively higher than that in the male teeth (0.0390±0.0048 mBq cm-2. Nevertheless, there was no significant difference between the female and male teeth regarding the emission rate of alpha particles. Furthermore, the emission rate of alpha particles in the teeth of the samples taken from Kufa (0.0417±0.0057 mBq cm-2 was higher than those obtained from Najaf (0.0384±0.0053 mBq cm-2. Conclusion: As the findings of this study revealed, Najaf governorate had a lower emission rate of alpha particles as compared to other sites of the worldwide. Therefore, it could be concluded that there is no negative consequence threatening the people’s health in this regard.
Choi, Sang Kyu; Kim, Cheol Keun; Jo, Dong In; Lee, Myung Chul; Kim, Jee Nam; Choi, Hyun Gon; Shin, Dong Hyeok; Kim, Soon Heum
We conducted this study to identify factors that may prolong the length of the hospital stay (LHS) in patients with diabetic foot (DF) in a single-institution setting. In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy), wound characteristics,type of surgery, the total medical cost, white blood cell (WBC) count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG) levels. Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647), WBC count (r=0.571), CRP levels (r=0.390), DN (r=0.020), and 7-day mean BG levels (r=0.120) (PLHS of >5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324-10.483; P=0.020), WBC count (OR=1.423; 95% CI, 0.046-0.356; P=0.000), CRP levels (OR=1.079; 95% CI, 1.015-1.147; P=0.014), albumin levels (OR=0.263; 95% CI, 0.113-3.673; P=0.007), and 7-day mean BG levels (OR=1.018; 95% CI, 1.001-1.035; P=0.020). Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.
Sang Kyu Choi
Full Text Available Background We conducted this study to identify factors that may prolong the length of the hospital stay (LHS in patients with diabetic foot (DF in a single-institution setting. Methods In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy, wound characteristics,type of surgery, the total medical cost, white blood cell (WBC count, C-reactive protein (CRP levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG levels. Results Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647, WBC count (r=0.571, CRP levels (r=0.390, DN (r=0.020, and 7-day mean BG levels (r=0.120 (P5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324–10.483; P=0.020, WBC count (OR=1.423; 95% CI, 0.046–0.356; P=0.000, CRP levels (OR=1.079; 95% CI, 1.015–1.147; P=0.014, albumin levels (OR=0.263; 95% CI, 0.113–3.673; P=0.007, and 7-day mean BG levels (OR=1.018; 95% CI, 1.001–1.035; P=0.020. Conclusions Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.
Shingina, Alexandra; Ou, George; Takach, Oliver; Svarta, Sigrid; Kwok, Ricky; Tong, Jessica; Donaldson, Kieran; Lam, Eric; Enns, Robert
To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during colonoscopy. A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at St. Paul's Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of sedatives. Potential predictor variables including age, gender, endoscopy indication, high sedation requirements during previous endoscopies, difficulty of the procedure, bowel preparation quality, interventions, findings as well as current use of benzodiazepines, opioids and alcohol were analyzed. The outcome of study was the use of high dose of sedation agents for the procedure. In particular, the high dose of sedation was defined as fentanyl greater than 50 mcg and midazolam greater than 3 mg. Analysis of 5282 patients (mean age 57 ± 12, 49% female) was performed. Most common indication for the procedure was screening colonoscopy (57%). Almost half of our patients received doses exceeding Fentanyl 50 mcg and Midazolam 3 mg. Logistic regression models identified the following variables associated with high sedation: Younger age (OR = 0.95 95%CI: 0.94-0.95; P value of high sedation requirements. Our prediction model using the following pre-procedural variables including age, gender, indication for the procedure, medication/substance use, previous surgeries, previous high sedation requirements for colonoscopy yielded an area under the curve of 0.76 for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg. Pre-procedural planning is the key in conducting successful, efficient colonoscopy. Logistic regression analysis of 5000 patients who underwent out-patient colonoscopy revealed the following factors associated with increased sedation requirement: Younger age, female gender, difficult endoscopy, specific indications as well as cardiopulmonary complications and current use of opioids/benzodiazepines. Age and gender
Gummin, David D; Mowry, James B; Spyker, Daniel A; Brooks, Daniel E; Fraser, Michael O; Banner, William
This is the 34th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2016, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 9.50 [7.33, 14.6] (median [25%, 75%]) min, facilitating a near real-time national exposure and information database and surveillance system. We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure. In 2016, 2,710,042 closed encounters were logged by NPDS: 2,159,032 human exposures, 54,019 animal exposures, 490,215 information cases, 6687 human confirmed non-exposures, and 89 animal confirmed non-exposures. US PCs also made 2,718,022 follow-up calls in 2016. Total encounters showed a 2.94% decline from 2015, while health care facility (HCF) human exposure cases increased by 3.63% from 2015. All information calls decreased by 12.5% but HCF information calls increased 0.454%, and while medication identification requests (Drug ID) decreased 29.6%, human exposure cases were essentially flat, decreasing by 0.431%. Human exposures with less serious outcomes have decreased 2.59% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.39% per year since 2000. The top five substance classes most frequently involved in all human exposures were analgesics (11.2%), household cleaning substances (7.54%), cosmetics/personal care products (7.20%), sedatives/hypnotics/antipsychotics (5.84%), and antidepressants (4.74%). As a class, sedative/hypnotics/antipsychotics exposures increased most rapidly, by 10.7% per year (2088 cases/year), over the last
Anderson, Norman B; Belar, Cynthia D; Cubic, Barbara A; Garrison, Ellen G; Johnson, Suzanne Bennett; Kaslow, Nadine J
Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"
Sera, Francesco; Ferrari, Pietro
In a multicenter study, the overall relationship between exposure and the risk of cancer can be broken down into a within-center component, which reflects the individual level association, and a between-center relationship, which captures the association at the aggregate level. A piecewise exponential proportional hazards model with random effects was used to evaluate the association between dietary fiber intake and colorectal cancer (CRC) risk in the EPIC study. During an average follow-up of 11.0 years, 4,517 CRC events occurred among study participants recruited in 28 centers from ten European countries. Models were adjusted by relevant confounding factors. Heterogeneity among centers was modelled with random effects. Linear regression calibration was used to account for errors in dietary questionnaire (DQ) measurements. Risk ratio estimates for a 10 g/day increment in dietary fiber were equal to 0.90 (95%CI: 0.85, 0.96) and 0.85 (0.64, 1.14), at the individual and aggregate levels, respectively, while calibrated estimates were 0.85 (0.76, 0.94), and 0.87 (0.65, 1.15), respectively. In multicenter studies, over a straightforward ecological analysis, random effects models allow information at the individual and ecologic levels to be captured, while controlling for confounding at both levels of evidence.
Full Text Available In a multicenter study, the overall relationship between exposure and the risk of cancer can be broken down into a within-center component, which reflects the individual level association, and a between-center relationship, which captures the association at the aggregate level. A piecewise exponential proportional hazards model with random effects was used to evaluate the association between dietary fiber intake and colorectal cancer (CRC risk in the EPIC study. During an average follow-up of 11.0 years, 4,517 CRC events occurred among study participants recruited in 28 centers from ten European countries. Models were adjusted by relevant confounding factors. Heterogeneity among centers was modelled with random effects. Linear regression calibration was used to account for errors in dietary questionnaire (DQ measurements. Risk ratio estimates for a 10 g/day increment in dietary fiber were equal to 0.90 (95%CI: 0.85, 0.96 and 0.85 (0.64, 1.14, at the individual and aggregate levels, respectively, while calibrated estimates were 0.85 (0.76, 0.94, and 0.87 (0.65, 1.15, respectively. In multicenter studies, over a straightforward ecological analysis, random effects models allow information at the individual and ecologic levels to be captured, while controlling for confounding at both levels of evidence.
... 1222 immediately. Name State American Association of Poison Control Centers Address AAPCC Central Office NOT A POISON ... not for emergency use. Arkansas ASPCA Animal Poison Control Center Address 1717 S. Philo Road, Suite 36 Urbana, ...
Ezz al Arab, G; Tawfik, N; El Gendy, R; Anwar, W; Courtright, P
Evidence of widespread distribution of trachoma in Egypt had not been clarified as previous surveys were limited to individual communities which may not have been representative of the general population. The Nile Delta of Egypt presents a unique environment for trachoma to persist. Economic improvements in the past decade have affected even the poorest rural environments; availability of electricity is now found in many rural communities. Availability of water in Nile Delta has always been good but poor hygienic conditions have been the primary factor in trachoma transmission. A survey of trachoma was undertaken in Menofiya governorate to determine if Egypt should be identified as trachoma endemic and targeted for trachoma control efforts. A multistage random cluster study design was used with the target population defined as adults aged 50 and over and children aged 2-6 years from throughout the governorate. Among preschool children only trachoma was graded while among adults presenting visual acuity and cause of vision loss or blindness were also recorded. Adults were interviewed regarding past trichiasis surgery; those currently with trichiasis or a history of trichiasis surgery were also interviewed regarding outcome of surgery. A total of 3272 children aged 2-6 and 3322 adults age 50+ were enumerated. Among the children 81.3% were examined and among the adults 73.0% were examined. Active trachoma (follicles (TF) and/or intense inflammation (TI)) was found among 36.5% (95% confidence interval (CI) 34.7-38.3%) of the children. TI was 1.89 (95% CI 1.22-2.94) times more common in rural children compared to urban children. The prevalence of trichiasis (TT) in adults was 6.5%; women had an age adjusted odds of trichiasis of 1.68 (95% CI 1.18-2.39) compared to men. Trichiasis was 2.11 times (95% CI 1.33-3.37) more common in rural Menofiya compared to urban Menofiya. TT accounts for blindness (presenting vision vision loss. These findings would suggest that continued
The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country.
Torres, Dara; González, Miriam L; Loera, Adriana; Aguilera, Marco; Relyea, George; Aristizabal, Paula; Caniza, Miguela A
The US National Healthcare Safety Network has provided a definition of mucosal barrier injury-associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its influence in pediatric oncology centers in low- to middle-income countries. To determine the influence of the definition on the rate of central line-associated bloodstream infection (CLABSI) and compare the clinical characteristics of MBI versus non-MBI LCBI cases. We retrospectively applied the National Healthcare Safety Network definition to all CLABSIs recorded at a pediatric oncology center in Tijuana, Mexico, from January 2011 through December 2014. CLABSI events were reclassified according to the MBI-LCBI definition. Clinical characteristics and outcomes of MBI and non-MBI CLABSIs were compared. Of 55 CLABSI events, 44% (24 out of 55) qualified as MBI-LCBIs; all were MBI-LCBI subcategory 1 (intestinal flora pathogens). After the number of MBI-LCBI cases was removed from the numerator, the CLABSI rate during the study period decreased from 5.72-3.22 infections per 1,000 central line days. Patients with MBI-LCBI were significantly younger than non-MBI-LCBI patients (P = .029) and had a significantly greater frequency of neutropenia (100% vs 39%; P = .001) and chemotherapy exposure (87% vs 58%; P = .020) and significantly longer median hospitalization (34 vs 23 days; P = .008). A substantial proportion of CLABSI events at our pediatric cancer center met the MBI-LCBI criteria. Our results support separate monitoring and reporting of MBI and non-MBI-LCBIs in low- to middle-income countries to allow accurate detection and tracking of preventable (non-MBI) bloodstream infections. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Spoelman, W.; Bonten, T.; Waal, M. de; Drenthen, T.; Smeele, I.; Nielen, M.; Chavannes, N.
Background: Health care costs and utilization are rising. High quality patient-centered online information may reduce health care utilization, but evidence of the effect of online health information on health care utilization is scarce. We hypothesized that the release of a nationwide evidence-based
Brooker, Rebecca J.; Alto, Kathleen M.; Marceau, Kristine; Najjar, Reema; Leve, Leslie D.; Ganiban, Jody M.; Shaw, Daniel S.; Reiss, David; Neiderhiser, Jenae M.
Studies of the role of the early environment in shaping children’s risk for anxiety problems have produced mixed results. It is possible that inconsistencies in previous findings result from a lack of consideration of a putative role for inherited influences moderators on the impact of early experiences. Early inherited influences not only contribute to vulnerabilities for anxiety problems throughout the lifespan, but can also modulate the ways that the early environment impacts child outcomes. In the current study, we tested the effects of child-centered parenting behaviors on putative anxiety risk in young children who differed in levels of inherited vulnerability. We tested this using a parent-offspring adoption design and a sample in which risk for anxiety problems and parenting behaviors were assessed in both mothers and fathers. Inherited influences on anxiety problems were assessed as anxiety symptoms in biological parents. Child-centered parenting was observed in adoptive mothers and fathers when children were 9 months old. Social inhibition, an early temperament marker of anxiety risk, was observed at child ages 9 and 18 months. Inherited influences on anxiety problems moderated the link between paternal child-centered parenting during infancy and social inhibition in toddlerhood. For children whose birth parents reported high levels of anxiety symptoms, greater child-centered parenting in adoptive fathers was related to greater social inhibition 9 months later. For children whose birth parents reported low levels of anxiety symptoms, greater child-centered parenting in adoptive fathers was related to less social inhibition across the same period. PMID:27572913
Brooker, R J; Alto, K M; Marceau, K; Najjar, R; Leve, L D; Ganiban, J M; Shaw, D S; Reiss, D; Neiderhiser, J M
Studies of the role of the early environment in shaping children's risk for anxiety problems have produced mixed results. It is possible that inconsistencies in previous findings result from a lack of consideration of a putative role for inherited influences moderators on the impact of early experiences. Early inherited influences not only contribute to vulnerabilities for anxiety problems throughout the lifespan, but can also modulate the ways that the early environment impacts child outcomes. In the current study, we tested the effects of child-centered parenting behaviors on putative anxiety risk in young children who differed in levels of inherited vulnerability. We tested this using a parent-offspring adoption design and a sample in which risk for anxiety problems and parenting behaviors were assessed in both mothers and fathers. Inherited influences on anxiety problems were assessed as anxiety symptoms in biological parents. Child-centered parenting was observed in adoptive mothers and fathers when children were 9 months old. Social inhibition, an early temperament marker of anxiety risk, was observed at child ages 9 and 18 months. Inherited influences on anxiety problems moderated the link between paternal child-centered parenting during infancy and social inhibition in toddlerhood. For children whose birth parents reported high levels of anxiety symptoms, greater child-centered parenting in adoptive fathers was related to greater social inhibition 9 months later. For children whose birth parents reported low levels of anxiety symptoms, greater child-centered parenting in adoptive fathers was related to less social inhibition across the same period.
Comparison of the New Adult Ventilator-Associated Event Criteria to the Centers for Disease Control and Prevention Pediatric Ventilator-Associated Pneumonia Definition (PNU2) in a Population of Pediatric Traumatic Brain Injury Patients.
Cirulis, Meghan M; Hamele, Mitchell T; Stockmann, Chris R; Bennett, Tellen D; Bratton, Susan L
The new Centers for Disease Control and Prevention paradigm for ventilator-associated events is intended to simplify surveillance of infectious and noninfectious complications of mechanical ventilation in adults. We assessed the ventilator-associated events algorithm in pediatric patients. A retrospective observational cohort study. This single-center study took place in a PICU at an urban academic medical facility. Pediatric (ages 0-18 yr old) trauma patients with moderate-to-severe traumatic brain injury ventilated for greater than or equal to 2 days. We assessed for pediatric ventilator-associated pneumonia (as defined by current Centers for Disease Control and Prevention PNU2 guidelines), adult ventilator-associated events, and an experimental ventilator-associated events definition modified for pediatric patients. We compared ventilator-associated events to ventilator-associated pneumonia to calculate the test characteristics. Thirty-nine of 119 patients (33%) developed ventilator-associated pneumonia. Sensitivity of the adult ventilator-associated condition definition was 23% (95% CI, 11-39%), which increased to 56% (95% CI, 40-72%) using the modified pediatric ventilator-associated pneumonia criterion. Specificity reached 100% for both original and modified pediatric probable ventilator-associated pneumonia using ventilator-associated events criteria. Children who developed ventilator-associated pneumonia or ventilator-associated condition had similar baseline characteristics: age, mechanism of injury, injury severity scores, and use of an intracranial pressure monitor. Diagnosis of ventilator-associated pneumonia and ventilator-associated condition portended similarly unfavorable outcomes: longer median duration of ventilation, ICU and hospital length of stay, and more discharges to rehabilitation, home health, or nursing care compared with patients with no pulmonary complication. Both current and modified ventilator-associated events criteria have poor
Full Text Available Introduction and purpose: Air pollution is an important risk factor for the environment and public health, associated with increased severity of respiratory diseases. This study aimed to evaluate the association between various air pollutants and number of cases with severe acute respiratory syndrome referred to emergency medical centers in Tehran, Iran in 2013. Methods: In this ecological study, the relationship between air pollution and acute respiratory symptoms in patients referred to the emergency centers of Tehran in 2013 was assessed. In total, 36787 patients with acute respiratory symptoms has been registered in these centers. Data on the number of cases with acute respiratory symptoms and air pollutants of emergency centers and air quality monitoring stations were collected. Moreover, Poisson regression was used to assess the relationship between air pollutant concentrations (PM2.5, SO2, NO2, O3, CO and the number of cases with severe acute respiratory syndrome. Results: The results of the current study demonstrated that CO (weekly average IRR=1.1 and SO2 (three days average IRR=1.03 and weekly average IRR= 1.04 increased the risk of respiratory diseases 10%, 3%, and 4%, respectively. Consequently, longer duration of pollutants would increase the risk of respiratory syndromes. Conclusion: According to the results of this study, increased air pollutant concentrations could be associated with escalated number of patients with acute respiratory symptoms referred to the emergency medical centers in Tehran.
Kanafani, Zeina A; Kara, Layla; Hayek, Shady; Kanj, Souha S
Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country. Prospective observational cohort study. The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries. All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed. Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate. Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.
El Gameel, E.A.
The present study discus the economic analysis of the establishing dry dates irradiation facility at El Wadi El Gadid governorate. This study was divided into three sections the first section includes the arrangement of the equation of simple regression foretelling the future production for dry dates and radiation source activity , the second section was studied the financial analysis for the project. The third section includes the suitable commodities mix to full off the capacity
Tedesco, Francesco; Ocampo-Martinez, Carlos; Cassavola, Alessandro; Puig, Vicenç
This paper evaluates the application of command governor (CG) strategy for the operational control of drinking water networks (DWN) given their large-scale and complex nature, the permanent and relevant effect of the disturbances (water demands) and their marginal stability feature. Moreover, the performance improvement offered by CG is compared with the application of model predictive control for the same management purposes and in the same context. The paper also discusses the effectiveness...
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 9 December 1999. The following aspects from the Agency's activity are briefly presented: IAEA's safeguards, physical protection of nuclear material, the status of Agency's involvement in safeguards verification in the Democratic People's Republic of Korea (DPRK), and Agency's actions in connection with Y2K possible problems
Vicente Angel S. Ybiernas
Full Text Available After a serious fiscal and financial crisis erupted in 1920 to 1921 (in the wake of the termination of World War I, the new American Governor General to the Philippines, U.S. Army Major General Leonard Wood, promised in his inaugural address to privatize the country’s government-owned and controlled corporations such as the Philippine National Bank and the Manila Railroad Company, among others. Wood’s neoliberal agenda in the Philippines was opposed by Filipino politicians in the executive and legislative departments from the start. This key policy disagreement climaxed in the resignation en masse of Governor Wood’s Filipino cabinet and the members of the executive-legislative Council of State in 1923. The particulars of the Cabinet Crisis of 1923 —the so-called Conley Affair— however, obscured from plain sight the true gravity of the broader conflict (i.e., Filipino opposition to Wood’s agenda.Moreover, the general perception that Governor Wood’s asset privatization program was successfully blocked by the Cabinet Crisis of 1923 is inaccurate. In truth, Wood was stymied by adverse international and national market conditions from 1921 to 1923. A further delay occurred from 1924 to 1926 when Governor Wood endeavored to get the Council of State and the Filipino Legislature’s Board of Control (an oversight committee on board his neoliberal agenda; he failed to get the support of the Filipino leaders in this regard. When Wood finally decided in 1926 to take unilateral steps, he was tied up by litigation (locally and in the United States arising from his actions until his death from an unsuccessful brain surgery in 1927.
RA Abbas; RAM Hammam; SS El-Gohary; LME Sabik; MS Hunter
Background: Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. Objectives: To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. Methods: A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egyp...
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 8 December 1997. The following aspects from the Agency's activity are presented: nuclear energy, Agency's inspections in Iraq in relation to its clandestine nuclear programme, Agency's involvement in safeguards verification in the Democratic People's Republic of Korea (DPRK), and conclusion of safeguards agreements and additional protocols
Basim Abbas Kraidy JASSMY
Full Text Available This study investigated the relationships between market turbulence, competitive intensity, customer orientation, competitor orientation, inter-functional coordination, organizational commitment and financial performance in the banks of Al-Qadissya governorate. A survey questionnaire was conducted for investigation and data was collected from 170 mangers that work in these banks. To test these relationships, the authors examined all the variables under (SPSS V 20. In order to reveal the effects of the variables, the findings showed that market instability and competitive intensity have effect on strategic orientation, while market instability has no effect on organizational commitment and financial performance. At the same time, inter-functional coordination has no effect on organizational commitment. Furthermore, the study findings showed correlations between competitive intensity and organizational commitment, while there is no correlation between competitive intensity and financial performance. At last, organizational commitment influences financial performance. According to the study results could be improved by all types of strategic orientation and enhance organizational commitment that increase financial performance.
Full Text Available Hamdy N El-Tallawy,1 Wafaa M A Farghaly,1 Reda Badry,1 Nabil A Metwally,2 Ghaydaa A Shehata,1 Tarek A Rageh,1 Mohamed Abd El Hamed,1 Mahmoud R Kandil1 1Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt; 2Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut Branch, Assiut, Egypt Background: Multiple sclerosis (MS is a chronic and disabling disorder with considerable social effects and economic sequelae. It is one of the major causes of disability in young adults.Objectives: This study aimed at detecting the prevalence of MS among the population of Al Quseir city.Methods: This study is a part of door-to-door survey of major neurological disorders that was conducted in Al Quseir city, Red Sea Governorate, Egypt. The sample size was 33,285 persons. The youngest patient was 17 years old. The number of people at and above 17 years of age was 21,827. They were screened by three neurologists. Then, the positive cases were subjected to meticulous clinical evaluation by three staff members of Department of Neurology, Assiut University Hospital, Egypt. Essential investigations were done.Results: A total of three cases of MS were diagnosed with an age-specific prevalence ≥17 years of 13.7/100,000. Keywords: prevalence, multiple sclerosis, Al Quseir, door-to-door survey
The Statement to the Board of Governors includes the Agency's Annual Report, the Technical Cooperation Report, the Safeguards Implementation Report, the report of the Programme and Budget Committee, and a number of specific nuclear technology, safety and verification issues. The Technical Cooperation Report deals with TC Programme Management; Programme of Action for Cancer Therapy; TC Programme Funding; TC Programme Oversight. The Nuclear Technology part is concerned with Action Plan on Decommissioning of nuclear facilities, which incorporates the recommendations from the Agency's conference on safe decommissioning for nuclear activities held in 2002 in Berlin; Status of the IAEA International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO). Nuclear Safety and Security covers Nuclear Installation Safety; Transport Safety; Emergency Preparedness and Response; Global Threat Reduction Initiative. Nuclear Verification is describing the Safeguards Implementation Report and Safeguards Statement for 2003; Implementation of Safeguards in the Democratic People's Republic of Korea, in the Islamic Republic of Iran; and in Iraq; Status of Safeguards Agreements and Additional Protocols; Integrated Safeguards. The Secretariat remains committed to the efficient and effective implementation of programmes that reflect the priorities of all our Member States
Zhang Jiangang; Li Xianfeng; Chu Yandong; Yu Jianning; Chang Yingxiang
In this paper, complex dynamical behavior of a class of centrifugal flywheel governor system is studied. These systems have a rich variety of nonlinear behavior, which are investigated here by numerically integrating the Lagrangian equations of motion. A tiny change in parameters can lead to an enormous difference in the long-term behavior of the system. Bubbles of periodic orbits may also occur within the bifurcation sequence. Hyperchaotic behavior is also observed in cases where two of the Lyapunov exponents are positive, one is zero, and one is negative. The routes to chaos are analyzed using Poincare maps, which are found to be more complicated than those of nonlinear rotational machines. Periodic and chaotic motions can be clearly distinguished by all of the analytical tools applied here, namely Poincare sections, bifurcation diagrams, Lyapunov exponents, and Lyapunov dimensions. This paper proposes a parametric open-plus-closed-loop approach to controlling chaos, which is capable of switching from chaotic motion to any desired periodic orbit. The theoretical work and numerical simulations of this paper can be extended to other systems. Finally, the results of this paper are of practical utility to designers of rotational machines.
Full Text Available Sub-clinical mastitis is a main pathology of dairy husbandry because it is not clinically recognized by the owners and the veterinarians. For this reason, its economic loss is usually underestimated in milk production. This study has been undertaken in order to evaluate the epidemiologic situation of sub-clinicalmastitis in Batna and Setif governorates (East of Algeria. For this purpose, a detailed bacteriological study of all bacterial strains isolated from sub-clinical mastitis followed by a study of their antibacterial susceptibility profiles has been undertaken. 89 bacterial strains distributed as follows were studied: 27 strains of staphylococci among which 23 were coagulase-negative staphylococci (CNS that are generally incriminated in sub-clinical mastitis. 39 strains of streptococci among which 10 were Lactococcus lactis ssp lactis strains. 23 strains of enterobacteria represented mainly by Escherichia coli (E.coli. All these bacterial strains were isolated from cow milk of 3 different farms. The antibacterial susceptibility profiles have revealed a susceptibility of the isolated strains to a large number of antibiotics mainly to the Neomycin, the Cephalexin and the Spiramycin. [Vet. World 2011; 4(12.000: 537-541
Ali, Anis Ahmed; Baharoon Aqil Abdulrahman
Concentrations of Gd, Pb, Zn, Cu, Ni, Co, Cr, Mn and Fe in surficial sediments (<63μm) from the shores in Aden Governorate were determined by atomic absorption spectrophotometry method. The obtained concentration data show significant regional variations concerning both the total and leachable metals in sediments. Total metal concentrations of Cd and Pb were greatest in sediments from labor Island; Cu, Cr, and Fe occurred in the highest levels in Bandar Fuqum sediments, while maximum levels of Mn, Co, and Ni were observed in sediments from Sahel Abyan and Fuqum. Labile, easily extractable species of metals such as Cd and Pb, are similar to their total concentrations, and additionally Cu, Zn, Cr, and Fe were found in the highest concentrations in sediments from labor Island. Sediments from Sahel Abyan and Khawr Bir Ahmed were characterized by a maximum accumulation of bioavailable species of Co and Mn, respectively. The linear regression slopes for metals correlated were <1, this explains the slow enrichment of these metals in the sediments, and attributes their geological nature. (author)
Al-Alawy, I. T.; Hasan, A. A.
There are numerous studies around the world about radon concentrations and their risks to the health of human beings. One of the most important social characteristics is the use of water wells for irrigation, which is a major source of water pollution with radon gas. In the present study, six well water samples have been collected from different locations in Karbala governorate to investigate radon concentration level using CR-39 technique. The maximum value 4.112±2.0Bq/L was in Al-Hurr (Al-Qarih Al-Easariah) region, and the lowest concentration of radon was in Hay Ramadan region which is 2.156±1.4Bq/L, with an average value 2.84±1.65Bq/L. The highest result of annual effective dose (AED) was in Al-Hurr (Al-Qarih Al-Easariah) region which is equal to 15.00±3.9μSv/y, while the minimum was recorded in Hay Ramadan 7.86±2.8μSv/y, with an average value 10.35±3.1μSv/y. The current results have shown that the radon concentrations in well water samples are lower than the recommended limit 11.1Bq/L and the annual effective dose in these samples are lower than the permissible international limit 1mSv/y.
Al-Dabbas, Moutaz A.; Mahdi, Khalid H.; Al-Khafaji, Raad; Obayes, Kawthar H.
Road-side dust samples were collected from selected areas of Diwaniyah city-Qadisiyah Governorate - Southern Iraq. The heavy metals (Fe, Co, Ni, Cu, Zn and Pb) in these streets dust samples were studied and used as indicator for pollution by using three of main indices (I-geo, CF, and PLI). Determination of heavy metal in the roadside dust is with XRD and XRF methods. I-geo for Co, Zn, Pb, and Ni in the studied sites shows relative values of class 1, which indicated the slightly polluted, while I-geo for Fe and Cu shows relative values of class 0, which indicated no pollution. The contamination factor for Co, Zn, Pb, and Ni classified as class 2, which indicate moderately contamination, while the contamination factor for Fe and Cu classified as class 1, which indicate low contamination. PLI values in the all of studied sites classified as class 2 (Deterioration on site quality) indicating local pollution, as well as denote perfection with (class 0) of no pollution. The distribution pattern of metals percentages was affected by gases emitted from transportation vehicles as well as the prevailing wind direction.
Hawramy, Tahir Abdullah Hussein; Saeed, Kamal Ahmed; Qaradaghy, Seerwan Hama Sharif; Karboli, Taha Ahmed; Nore, Beston Faiek; Bayati, Noora Hisham Abood
Fascioliasis is an often-neglected zoonotic disease and currently is an emerging infection in Iraq. Fascioliasis has two distinct phases, an acute phase, exhibiting the hepatic migratory stage of the fluke's life cycle, and a chronic biliary phase manifested with the presence of the parasite in the bile ducts through hepatic tissue. The incidence of Fascioliasis in Sulaimaniyah governorate was unexpected observation. We believe that shedding light on this disease in our locality will increase our physician awareness and experience in early detection, treatment in order to avoid unnecessary surgeries. We retrospectively evaluated this disease in terms of the demographic features, clinical presentations, and managements by reviewing the medical records of 18 patients, who were admitted to the Sulaimani Teaching Hospital and Kurdistan Centre for Gastroenterology and Hepatology. Patients were complained from hepatobiliary and/or upper gastrointestinal symptoms and diagnosed accidentally with Fascioliasis during hepatobiliary surgeries and ERCP by direct visualization of the flukes and stone analysis. Elevated liver enzymes, white blood cells count and eosinophilia were notable laboratory indices. The dilated CBD, gallstones, liver cysts and abscess were found common in radiological images. Fascioliasis diagnosed during conventional surgical CBD exploration and choledochodoudenostomy, open cholecystectomy, surgical drainage of liver abscess, ERCP and during gallstone analysis. Fascioliasis is indeed an emerging disease in our locality, but it is often underestimated and ignored. We recommend the differential diagnosis of patients suffering from Rt. Hypochondrial pain, fever and eosinophilia. The watercress ingestion was a common factor in patient's history.
Farahat, Taghreed; Alkot, Mohammad; Rajab, Afaf; Anbar, Reda
Background. Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral problem in children. Global variations in diagnostic criteria and rating scales of ADHD either by DSM-IV or ICD 10 may contribute to variations in its prevalence. Objectives. The study was conducted to estimate the prevalence of ADHD and to determine its risk factors. Methodology. A cross-section comparative study was conducted in a randomly selected four primary schools in Menoufia governorate, Egypt. All children after a valid consent of their parents (N. 1362) were subjected to complete history taking, medical and psychological assessment, and IQ estimation. Their parents and teachers were subjected to the corresponding Arabic forms of Conner's questionnaire. Suspected cases were confirmed and categorized by DSM-IV criteria. The sample was divided into cases and controls to study the risk factors. Results. Prevalence of ADHD was 6.9% and the male : female ratio was 3.5 : 1. The main risk factors were neonatal problems (OR = 4.3), family history of psychiatric and medical illnesses (OR = 3.5 and 2.8), and male gender (OR = 2.9). Conclusion. Prevalence of ADHD among Menoufia school children was 6.9%. Dealing with its risk factors is mandatory for prevention, early management, and better outcome.
Full Text Available This article tells the story of the 2003 resignation of Peter Hollingworth as Governor-General as part of an ongoing hyper-anxiety in Australia about the state and status of ‘the child’. The sexually abused child sits at the centre of this story and carries a heavy burden with respect to the past and future of the white Australian nation. The recuperation of that child to a state of innocence, repeatedly, as stories of its abuse keep returning to our front pages and political agendas, is necessary for the reproduction of the white nation. This article shows that the Hollingworth drama is entwined with the current politics of motherhood and fatherhood and the carriage of national feeling and temporality through the performances of these always racialised identities. Attending to the politics of the historical construction of the child, and the idealised parents who abuse or protect it (but never allow this child a voice or a sexuality of her or his own, thus becomes a part of the project of accountability to the past which has also occupied public life in Australia over recent years.
Nabil Ahmed Al-Rabeei
Full Text Available Introduction: At least 2 million people die every year from diseases preventable by vaccines recommended by the World Health Organization. Objective: To assess the routine immunization coverage among children aged 12-23 month and to determine the reasons for unvaccinated. Methods: We conducted a community-based survey in Al-Taizyah district, Taiz governorate, Yemen. Information about vaccination status and related barriers was collected for 420 children from 1st March to 31st March 2012. Results: 49.8% of the children had vaccination cards. About 69.5% of the children were fully vaccinated by cards and by history, 15.5% were partially vaccinated and 15% not vaccinated. As a regards to crude vaccination coverage, 82.9% of children were received BCG vaccine. OPV1 vaccine was 82.6%. Pentavalent1 was 82.6%. Measles 1 represented for 71.7% and vitamin A1 was 46.4%. 91% was valid doses for OPV1 and 93% for pentavalent1. Only 76% of measles1 dose was valid. The high scores14% of drop-out rate was recorded between BCG and Measles. The main reasons for partially vaccinated and unvaccinated of children were the lack of information 61.7%. Conclusion: There is low vaccination coverage among children aged 12-23 months. There is a need to raise the awareness of community about vaccination and EPI services in Al-Taizyah district.
Tawfiq, N.F.; Ali, L.T.; Al-Jobouri, H.A.
The sensitive and simple technique of fission track etch has been applied to determine trace concentration of uranium in blood samples for occupational and non-occupational workers, male and female, using CR-39 track detector that is employed for registration of induced fission tracks. The results show that the highest recorded uranium concentration in human blood of workers in the ministry of Science and Technology were 1.90 ppb (male, 36 years old, 12 years' work experience, and living in Basrah governorate) and minimum concentration 0.26 ppb (female, 40 years old, 10 years' work experience, and living in Baghdad), while for non-occupational worker, the maximum uranium concentration was 1.76 ppb (female, 63 years old, and living in Al-Muthana) and minimum concentration was 0.28 ppb (female, 20 years old, and living in Baghdad). It has also been found that the uranium concentration in human blood samples of workers in the ministry of Science and Technology are higher than those of non-occupational workers, and the uranium concentrations for female workers and for non-occupational workers were higher than those for male workers and non-occupational workers. (author)
The feasibility of a polygeneration plant at Kennedy Space Center was studied. Liquid hydrogen and gaseous nitrogen are the two principal products in consideration. Environmental parameters (air quality, water quality, biological diversity and hazardous waste disposal) necessary for the feasibility study were investigated. A National Environmental Policy Act (NEPA) project flow sheet was to be formulated for the environmental impact statement. Water quality criteria for Florida waters were to be established
Lerkkanen, Marja-Kristiina; Kiuru, Noona; Pakarinen, Eija; Poikkeus, Anna-Maija; Rasku-Puttonen, Helena; Siekkinen, Martti; Nurmi, Jari-Erik
This study examined the extent to which child-centered versus teacher-directed teaching practices predicted the development of children’s reading and math skills in the first year of elementary school. In addition, we investigated whether associations between teaching practices and children’s academic skills development in Grade 1 differed among children who had low, average, or high initial academic skills at the beginning of school. The reading and math skills of 1,132 Finnish c...
Sendhilkumar, M; Tripathy, JP; Harries, AD; Dongre, AR; Deepa, M; Vidyulatha, A; Poongothai, S; Venkatesan, U; Anjana, RM; Mohan, V
Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels w...
Full Text Available Philip II’s Quest: The Appointment of Governors-General during the Dutch Revolt (1559-1598Recent historiographical studies have presented the Habsburg appointment of governors-general during the Dutch Revolt as the outcome of factional infighting at the Spanish Court. While this so-called ‘faction model’ has yielded new insights, it also raises a number of problems. Firstly, in the new model, the role of the dynasty is unduly relegated to the background – even though Philip II’s appointment decisions were mainly driven by dynastic considerations. Secondly, the power struggle at the Spanish Court was not only a conflict between court factions, but also between noble houses vying for prestige and trying to secure positions for their offspring. Thirdly, there is an excessive focus on the Spanish Court, while the feuds between noble houses in the Low Countries also played a role in the interim appointments made during the Revolt. Finally, Philip II always looked for the most suitable candidate in terms of administration and warfare during the Dutch Revolt, in accordance with the constraints of the composite Spanish monarchy. Only the combination of these four (frequently contradictory motives reveals how Philip II’s appointment of governors can be seen as a quest for the right man or woman in the right place.
Michetti, Christopher P; Fakhry, Samir M; Ferguson, Pamela L; Cook, Alan; Moore, Forrest O; Gross, Ronald
Ventilator-associated pneumonia (VAP) rates reported by the National Healthcare Safety Network (NHSN) are used as a benchmark and quality measure, yet different rates are reported from many trauma centers. This multi-institutional study was undertaken to elucidate VAP rates at major trauma centers. VAP rate/1,000 ventilator days, diagnostic methods, institutional, and aggregate patient data were collected retrospectively from a convenience sample of trauma centers for 2008 and 2009 and analyzed with descriptive statistics. At 47 participating Level I and II centers, the pooled mean VAP rate was 17.2 versus 8.1 for NHSN (2006-2008). Hospitals' rates were highly variable (range, 1.8-57.6), with 72.3% being above NHSN's mean. Rates differed based on who determined the rate (trauma service, 27.5; infection control or quality or epidemiology, 11.9; or collaborative effort, 19.9) and the frequency with which VAP was excluded based on aspiration or diagnosis before hospital day 5. In 2008 and 2009, blunt trauma patients had higher VAP rates (17.3 and 17.6, respectively) than penetrating patients (11.0 and 10.9, respectively). More centers used a clinical diagnostic strategy (57%) than a bacteriologic strategy (43%). Patients with VAP had a mean Injury Severity Score of 28.7, mean Intensive Care Unit length of stay of 20.8 days, and a 12.2% mortality rate. 50.5% of VAP patients had a traumatic brain injury. VAP rates at major trauma centers are markedly higher than those reported by NHSN and vary significantly among centers. Available data are insufficient to set benchmarks, because it is questionable whether any one data set is truly representative of most trauma centers. Application of a single benchmark to all centers may be inappropriate, and reliable diagnostic and reporting standards are needed. Prospective analysis of a larger data set is warranted, with attention to injury severity, risk factors specific to trauma patients, diagnostic method used, VAP definitions
... § 400.4 of this chapter. This form is to be used by associated persons of financial institutions that... Governors of the Federal Reserve System, the Comptroller of the Currency, the Federal Deposit Insurance...
Full Text Available We aimed to assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV antibodies among patients on maintenance hemodialysis (HD in three centers in Aden, Yemen. The data from 219 patients and their records over the period between 2000-2013, was extracted and analyzed. The mean ± SD age of the patients was 47.08 ± 13.9 years; 74.4% of them were married and 14.6% were employed. The prevalence of validated anti-HCV-positive cases was 40.2% (95%CI 33.64%-46.73%. The mean ± SD duration on HD of all the patients was 35.09 ± 38 months. On bivariate analysis, the duration on HD and attending more than one center for HD associated significantly with anti-HCV positivity (P <0.05. On multivariate fully adjusted Poisson regression modelling, controlled for age, Patients attending more than one center and those who underwent HD for longer durations were more likely to be positive for anti- HCV antibodies [P = 0.004, adjusted prevalence rate ratio (APRR = 1.87, 95% confidence interval (CI: 1.22-2.88; P = 0.0005, APRR = 1.01, 95% CI: 1.00-1.02. In this study sample, the prevalence of HCV was significant. Patients attending more than one center and those who underwent HD for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to HD centers therefore warrants consideration.
Aman, Khadija; Al-Dubai, Sami AbdoRadman; Aman, Reema; Hawash, Aamenah; Alshagga, Mustafa; Kassim, Saba
We aimed to assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV) antibodies among patients on maintenance hemodialysis (HD) in three centers in Aden, Yemen. The data from 219 patients and their records over the period between 2000-2013, was extracted and analyzed. The mean ± SD age of the patients was 47.08 ± 13.9 years; 74.4% of them were married and 14.6% were employed. The prevalence of validated anti-HCV-positive cases was 40.2% (95%CI 33.64%-46.73%). The mean ± SD duration on HD of all the patients was 35.09 ± 38 months. On bivariate analysis, the duration on HD and attending more than one center for HD associated significantly with anti-HCV positivity (P <0.05). On multivariate fully adjusted Poisson regression modelling, controlled for age, Patients attending more than one center and those who underwent HD for longer durations were more likely to be positive for anti- HCV antibodies [P = 0.004, adjusted prevalence rate ratio (APRR) = 1.87, 95% confidence interval (CI): 1.22-2.88; P = 0.0005, APRR = 1.01, 95% CI: 1.00-1.02. In this study sample, the prevalence of HCV was significant. Patients attending more than one center and those who underwent HD for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to HD centers therefore warrants consideration.
Kateeb, Elham; Momany, Elizabeth
Beliefs about oral health during pregnancy demographic factors, such as level of education and socioeconomic status, are associated with an increased risk of oral diseases during pregnancy. The aim of this study was to assess the oral health status of pregnant women and the relation to the women's oral health knowledge, beliefs, behaviour, and access to dental care. For this cross-sectional study, pregnant women visiting pre-natal care clinics at the Palestinian Ministry of Health centres in the Jerusalem governorate were invited to complete a structured interview with questions about beliefs about oral health care and their oral hygiene practices. Screening for oral health conditions was done using the Decayed, Missed and Filled Teeth (DMFT) index to assess the women's dental caries experience, and gingival health indices (plaque, gingival, and calculus) were measured to assess gingival health. Ethical approval was obtained from Al-Quds University Ethics Committee. 152 pregnant women agreed to participate in this study. Participants had a mean DMFT score of 15·5 (SD 4·5). Bivariate analysis showed that women who had completed a degree after high school had a lower DMFT score than women who did not (F=4; p=0·024). Women who had visited a dentist in the past 6 months had a higher DMFT score than women who had never visited a dentist (F=2·4, p=0·05). Additionally, women who believed they could lose a tooth just because they are pregnant scored high DMFT scores (t=-4; p=0·037). Results of the multivariable analysis showed that age, level of education, recent dental visit, and the belief that it is unsafe to get routine dental care during pregnancy explained 25% of the variation in the DMFT score. Women in this study had high prevalence of dental disease and knew little about dental care during pregnancy. Faulty beliefs about oral health care and barriers to dental care were major factors in the high prevalence of the disease. This project was partially funded by
Once again, the Board is meeting to consider recent events relevant to the compliance by the Democratic People's Republic of Korea (DPRK) with its safeguards agreement with the Agency. As stated to the Board meeting on 6 January, the DPRK has been in chronic non-compliance with its safeguards agreement since 1993 when the Agency was unable to verify that the DPRK had declared to the Agency all nuclear material that is subject to safeguards. And since 1994 the DPRK has sought shelter behind the US-DPRK 'Agreed Framework,' claiming a legally untenable 'unique status' under the NPT to circumvent compliance with its non-proliferation obligations. This status claimed by the DPRK has been rejected by the Board of Governors and the General Conference, which unequivocally declared the safeguards agreement to be binding and in force. The events of December of last year further aggravated this situation. Not only did the DPRK fail to respond to the repeated requests of the Secretariat and the Board for clarification of reports concerning an alleged undeclared enrichment programme, but it displayed complete disregard for its obligations under the safeguards agreement by cutting all seals and impeding the functioning of all surveillance cameras that were in place in its nuclear facilities. These actions culminated in an order for the immediate departure of Agency inspectors at a time when the DPRK announced its intention to restart its nuclear facilities and when the presence of inspectors would have been critical. These unilateral acts by the DPRK took place against a backdrop of repeated requests by the Secretariat to the Government of the DPRK to work with the Agency to maintain the required continuity of safeguards by ensuring an orderly transition from a situation where activities in the facilities were frozen to one in which the facilities became operational. The result of this series of events, as reported to the Board of Governors in GOV/2002/62, was that the Agency
Abdul-Sattar, Amal B; Abou El Magd, Sahar
To investigate the role of perceived neighborhood characteristics, socioeconomic status (SES) and rural residency in influencing the health status outcome of Egyptian patients with systemic lupus erythematosus (SLE). Eighty patients affected with SLE were consecutively included in this a single-center cross-sectional study from July, 2011 to July, 2013. Outcome measures included the Systemic Lupus Activity Questionnaire (SLAQ) score, the Medical Outcomes Study Short Form-36 Health Survey physical functioning score and Center for Epidemiologic Studies-Depression (CES-D score of ≥ 19 points). Multivariate logistic regression analyses were conducted. Results from multivariate logistic regression analyses, a separate adjusted model of each perceived neighborhood characteristic, indicate associations of worse perceived social cohesion with higher SLAQ scores (P socioeconomic status and rural residency with health status outcomes, the results found association of poor socioeconomic status with the three health status outcome measures and association between rural residency and depression symptoms. Individuals had increased odds of depressive symptoms if they perceived worse neighborhood social cohesion (odds ratio [OR]: 2.14; CI: 1.42-2.80), if they perceived worse neighborhood safety (OR: 1.64; CI: 1.02-2.40) and if they perceived worse neighborhood aesthetic characteristics (OR: 2.79; CI: 1.84-3.38). Study findings indicate that poor socioeconomic status, rural residency and perceived neighborhood characteristics are associated with depression; worse perceived neighborhood aesthetics and safety are associated with lower SF-36 physical functioning, and worse neighborhood social cohesion is associated with higher disease activity among patients with SLE. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Last month, I had the honour of attending two very important ceremonies in my homeland in commemoration of the devastating nuclear catastrophes in Hiroshima and Nagasaki. This was the first time that the ceremonies were attended by the United Nations Secretary General, the U.S. Ambassador to Japan and the IAEA Director General. I sensed a new momentum towards achieving a world free of nuclear weapons. I used the occasion of my visit to Nagasaki to make my own personal commitment to redouble my efforts to help bring about a world free of nuclear weapons. There are four elements to this commitment: First, I believe the IAEA should do what it can to facilitate the implementation of nuclear disarmament through verification. We recently received a joint letter from Secretary of State Clinton and Minister of Foreign Affairs Lavrov, on behalf of the United States and the Russian Federation, requesting IAEA assistance to independently verify implementation of their agreement on the disposal of plutonium no longer required for defence purposes. Second, the IAEA should, when requested, work to support the creation of new nuclear-weapon- free zones and continue to help in implementing agreements relevant to such zones. Third, the Agency's safeguards activities should be strengthened in order to help prevent the proliferation of nuclear weapons. Fourth, the IAEA should redouble its efforts to support States in their national efforts to prevent terrorist groups from acquiring nuclear weapons. I intend to focus strongly on the goal of helping to achieve a world free of nuclear weapons, under the guidance of the Board of Governors
Full Text Available She-camel mastitis is relatively not well studied in camel-rearing areas worldwide. In Iraq, few reports have been done on the camelids in general and on mastitis in particular in compare to other livestock such as cattle, sheep and goat. This study intends to determine the clinical and subclinical mastitis and its etiological agents in shecamels in Samawah desert / Al Muthanna governorate. Thirty milk samples were collected from apparently clinical normal shecamels from 3 camelids herds during December 2016 to March 2017. The milk samples were aseptically collected from each quarter after stimulation milking process in she-camel. Each milk sample was subjected to physical and bacteriological examination and mastitis screening tests including (somatic cell count SCC and California mastitis test (CMT. The pH of fresh camel milk was varied from 6.1 to 6.5. All milk samples revealed a bright white color with upper thick creamy layer. No any signs of clinical mastitis were observed in all examined she-camels. Meanwhile, keratosis of the teats and udder due to severe tick infestation was observed in 83.33% percentage (25 out of 30. The subclinical mastitis was determined in 30% percentage (9 out of 30 lactating she-camels using SCC, CMT and revealed various bacterial growth. These bacteria were the Enterobacterium spp., Staphylococcus spp. and Streptococcus spp moreover, the percentage of isolates was 55.55% (5 out of 9, 33.33% (3 out of 9 and 11.11% (1 out of 9 respectively. In conclusion, this study confirmed the correlation between SCC and CMT in diagnosis of subclinical mastitis in 30% of the examined she-camel. Moreover, it approved the absence of clinical mastitis due to the nature of the milk production. The authors recommend to perform another future studies that including large number of the animals, in addition to study the natural physiological phenomena of milk production in shecamels.
Barheyan, Saad Awadh
The paper is considered as a preliminary study of pollution extent in some drinking water resources in Hadramout governorate by heavy elements which differ in their toxicity. The elements subjected to study are Cd, Pb, Fe, Cr, Mn, Zn, Co and Cu. Atomic absorption spectrometric method of analysis (AAS) is used for the determination of heavy elements concentrations. The elemental analysis of drinking water samples shows that the concentration of the above-mentioned elements in drinking water resources, lies in the permissible limit given by the WHO. Similarity of elements content is observed in Thela and Fuwah waters, bu the case is different for Ghail Bawzeer and Asshihir waters due to their different lithospheric structures. Drinking water used by the civilians is not subjected to physical, biological or chemical treatment which may lead to total or partial removal of heavy elements and other rejected impurities. Drinking water running in distribution nets is a hard water and has a weak base (Ph which explains the reason why heavy elements are absorbed and precipitated inside drinking water pipes before they reach consumers. This type of hard water causes accumulation of salt precipitates inside the water pipes which results in many economic and health disturbances to consumers. The slight increase of Cr, Mn, and Co concentration in drinking water flowing in the pipes may be due to the effect of some anions such as nitrates which form soluble compounds with the elements contained in the chemical composition of the drinking water pipes. This paper is a strong indicator for determination of heavy elements concentrations in different drinking water resources in Hadramout govemorate. Such approach seeks a further comprehensive work with special focus on the study of lithospheric structure of the feeding water regions of Hadramout aquifers. (author)
Ciccozzi, Massimo; Lo Presti, Alessandra; Cella, Eleonora; Giovanetti, Marta; Lai, Alessia; El-Sawaf, Gamal; Faggioni, Giovanni; Vescio, Fenicia; Al Ameri, Ranya; De Santis, Riccardo; Helaly, Ghada; Pomponi, Alice; Metwally, Dalia; Fantini, Massimo; Qadi, Hussein; Zehender, Gianguglielmo; Lista, Florigio; Rezza, Giovanni
Yemen, which is located in the southwestern end of the Arabian Peninsula, is one of countries most affected by recurrent epidemics caused by emerging vector-borne viruses. Dengue virus (DENV) outbreaks have been reported with increasing frequency in several governorates since the year 2000, and the Chikungunya virus (CHIKV) has been also responsible of large outbreaks and it is now a major public health problem in Yemen. We report the results of the phylogenetic analysis of DENV-2 and CHIKV isolates (NS1 and E1 genes, respectively) detected in an outbreak occurred in Al-Hudayda in 2012. Estimates of the introduction date of CHIKV and DENV-2, and the phylogeographic analysis of DENV-2 are also presented. Phylogenetic analysis showed that the Yemen isolates of DENV belonged to the lineage 2 Cosmopolitan subtype, whereas CHIKV isolates from Yemen belonged to the ECSA genotype. All the CHIKV isolates from Yemen were statistically supported and dated back to the year 2010 (95% HPD: 2009-2011); these sequences showed an alanine in the aminoacid position 226 of the E1 protein. Phylogeographic analysis of DENV-2 virus showed that cluster 1, which included Yemen isolates, dated back to 2003 Burkina Faso strains (95% HPD 1999-2007). The Yemen, cluster dated back to 2011 (95% HPD 2009-2012). Our study sheds light on the global spatiotemporal dynamics of DENV-2 and CHIKV in Yemen. This study reinforces both the need to monitor the spread of CHIKV and DENV, and to apply significant measures for vector control. Copyright © 2014 Elsevier B.V. All rights reserved.
Abdel-Halim, K Y; Salama, A K; El-Khateeb, E N; Bakry, N M
The study was carried out from spring 1999 to spring 2001 to monitor the residue levels of organophosphorus pollutants (OPP) in aquatic environment of the drainage canal surrounding a pesticide factory at Damietta Governorate. Water, sediment, and fish samples were collected at six different seasonal periods. OPPs were analyzed by GLC and confirmed using GC-MS. Chlorpyrifos, chlorpyrifos-methyl, malathion, diazinon, pirimiphos-methyl and profenofos were detected in most samples. Chlorpyrifos was dominant in all water and sediment samples. It was ranged from 24.5 to 303.8 and 0.9 to 303.8 ppb in water and sediment samples, respectively. Diazinon level was slightly similar to chlorpyrifos in fish samples. Data based on the grand total concentration of OPP showed that the most polluted samples were collected either at spring 1999 or autumn 2000. They were 675.5 and 303.8 ppb in water samples and 43.0 and 52.2 ppb in fish collected at spring 1999 and autumn 2000, respectively. The obtained results are in parallel to that found in case of cholinesterase activity where the activity of both acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) was declined at these seasonal period. The activity levels of AChE and BuChE were found to be 77.18% and 59.67% of control at spring 1999 and 78.62% and 85.80% of control, at autumn 2000, respectively. Thus, AChE and BuChE could be used as biomarkers for tracing and biomonitoring OPP pollution.
Rafraf, Ikbel Denden; Lekunberri, Itziar; Sànchez-Melsió, Alexandre; Aouni, Mahjoub; Borrego, Carles M; Balcázar, José Luis
Antimicrobial resistance is a growing and significant threat to global public health, requiring better understanding of the sources and mechanisms involved in its emergence and spread. We investigated the abundance of antibiotic resistance genes (ARGs) before and after treatment in five wastewater treatment plants (WWTPs) located in different areas of the Monastir Governorate (Tunisia). Three of these WWTPs (Frina, Sahline and Zaouiet) use a conventional activated sludge process as secondary treatment, whereas the WWTP located in Beni Hassen applies an ultraviolet disinfection step after the activated sludge process and the WWTP located in Moknine treats wastewater using naturally aerated lagoons as a secondary treatment process. The abundance of six ARGs (bla CTX-M , bla TEM , qnrA, qnrS, sul I and ermB) and the class 1 integron-integrase gene (intI1) were determined by quantitative PCR. All ARGs and the intI1 gene were detected in the wastewater samples, except the bla CTX-M gene, which was not detected in both influent and effluent samples from Sahline and Beni Hassen WWTPs, and the qnrS gene, which was not detected neither in the WWTP influent in Moknine nor in the WWTP effluent in Beni Hassen. Although the relative concentration of ARGs was generally found to be similar between samples collected before and after the wastewater treatment, the abundance of bla CTX-M , bla TEM , and qnrS genes was higher in the effluent of the Frina WWTP which, unlike other WWTPs, not only receives domestic or industrial sewage but also untreated hospital waste. To the best of our knowledge, this study quantified for the first time the abundance of ARGs in different Tunisian WWTPs, and the results agree with previous studies suggesting that conventional wastewater treatment does not efficiently reduce ARGs. Therefore, these findings could be useful to improve the design or operation of WWTPs. Copyright © 2016 Elsevier Ltd. All rights reserved.
Background Fascioliasis is an often-neglected zoonotic disease and currently is an emerging infection in Iraq. Fascioliasis has two distinct phases, an acute phase, exhibiting the hepatic migratory stage of the fluke’s life cycle, and a chronic biliary phase manifested with the presence of the parasite in the bile ducts through hepatic tissue. The incidence of Fascioliasis in Sulaimaniyah governorate was unexpected observation. We believe that shedding light on this disease in our locality will increase our physician awareness and experience in early detection, treatment in order to avoid unnecessary surgeries. Findings We retrospectively evaluated this disease in terms of the demographic features, clinical presentations, and managements by reviewing the medical records of 18 patients, who were admitted to the Sulaimani Teaching Hospital and Kurdistan Centre for Gastroenterology and Hepatology. Patients were complained from hepatobiliary and/or upper gastrointestinal symptoms and diagnosed accidentally with Fascioliasis during hepatobiliary surgeries and ERCP by direct visualization of the flukes and stone analysis. Elevated liver enzymes, white blood cells count and eosinophilia were notable laboratory indices. The dilated CBD, gallstones, liver cysts and abscess were found common in radiological images. Fascioliasis diagnosed during conventional surgical CBD exploration and choledochodoudenostomy, open cholecystectomy, surgical drainage of liver abscess, ERCP and during gallstone analysis. Conclusion Fascioliasis is indeed an emerging disease in our locality, but it is often underestimated and ignored. We recommend the differential diagnosis of patients suffering from Rt. Hypochondrial pain, fever and eosinophilia. The watercress ingestion was a common factor in patient’s history. PMID:23259859
Hawramy Tahir Abdullah Hussein
Full Text Available Abstract Background Fascioliasis is an often-neglected zoonotic disease and currently is an emerging infection in Iraq. Fascioliasis has two distinct phases, an acute phase, exhibiting the hepatic migratory stage of the fluke’s life cycle, and a chronic biliary phase manifested with the presence of the parasite in the bile ducts through hepatic tissue. The incidence of Fascioliasis in Sulaimaniyah governorate was unexpected observation. We believe that shedding light on this disease in our locality will increase our physician awareness and experience in early detection, treatment in order to avoid unnecessary surgeries. Findings We retrospectively evaluated this disease in terms of the demographic features, clinical presentations, and managements by reviewing the medical records of 18 patients, who were admitted to the Sulaimani Teaching Hospital and Kurdistan Centre for Gastroenterology and Hepatology. Patients were complained from hepatobiliary and/or upper gastrointestinal symptoms and diagnosed accidentally with Fascioliasis during hepatobiliary surgeries and ERCP by direct visualization of the flukes and stone analysis. Elevated liver enzymes, white blood cells count and eosinophilia were notable laboratory indices. The dilated CBD, gallstones, liver cysts and abscess were found common in radiological images. Fascioliasis diagnosed during conventional surgical CBD exploration and choledochodoudenostomy, open cholecystectomy, surgical drainage of liver abscess, ERCP and during gallstone analysis. Conclusion Fascioliasis is indeed an emerging disease in our locality, but it is often underestimated and ignored. We recommend the differential diagnosis of patients suffering from Rt. Hypochondrial pain, fever and eosinophilia. The watercress ingestion was a common factor in patient’s history.
El-Sayed, S.A.; Ezz El Din, M.R.; Deyab, M.E.
The hydraulic characteristics of surficial soils and materials of the Quaternary aquifer in the northern part of El-Sharkia Governorate were investigated. The surficial soil zone represents an aquitard for the aquifer and mainly composed of fine textured materials having vertical hydraulic conductivity ranged from 1.4 x10 -6 cm/sec to 2.15x10 -2 cm/sec. The semi-confined Quaternary aquifer is formed of sand and gravel with occasional clay lenses. The groundwater levels ranged from 9 m (MSL) to 5 m (MSL). The major trend of groundwater flow was from south to north and northwest directions. Another minor flow trend was observed to be from southwest to northeast direction. The aquifer is essentially recharged from Ismaillia Canal. The hydraulic gradient through the flow path was 1.9 x10 -4 , averagely. The hydraulic conductivity values differ vertically and laterally indicating the heterogeneity and anisotropy of the aquifer materials. They ranged from 40.1 to 222 m/day with an average value of about 95.8 m/day. The chemical compositions of groundwater and surface water bodies (canals and drains) were investigated. The chemistry of all water bodies was characterized by a basic nature (ph =7.2-7.9) and showed different salinities values and various hydrochemical facies. The average salinities values were 318.1 mg/l for canal water, 1013.4 mg/l for groundwater and 1260 mg/l for drain water. Canal water was fresh while groundwater and drain were fresh to brackish. The reasons causing the changes in salinity and hydrochemical facies were investigated using the relationships among water dissolved constituents and trends of ionic ratios. Subsurface flow, infiltration, evaporation, ion exchange, leaching, and dissolution were the hydrochemical processes leading to the groundwater modification. The suitability of groundwater and surface water for different uses are discussed and evaluated according to the international standards.
Houry, M.P.; Bourles, H.
The rotation speed of a turbogenerator is disturbed by its shaft torsion. Obtaining a filtered measure of this sped a problem of a great practical importance for turbine governor. A good filtering of this speed must meet two requirements: it must cut frequencies of the shaft torsion oscillation and it must not reduce or delay the signal in the pass-band. i.e. at lower frequencies. At Electricite de France, the speed measure is used to set in motion the fast valving system as quickly as possible, after a short circuit close to the unit (to contribute to the stability) or after an islanding (to quickly reach a balance with the house load). It is difficult to satisfy these two requirements by using conventional filtering methods. The standard solution consists in a first order filter: at Electricite de France, its time constant is equal to 80 ms; We have decided to improve this filtering by designing a new filter which cuts the frequencies of the shaft torsion oscillation without reducing the bandwidth of the speed measure. If one uses conventional methods to obtain a band-stop filter (for instance a Butterworth, a Chebyshev or an elliptic band-stop filter),it is easy to obtain the desired magnitude but not a phase near zero in the whole pass-band. Therefore, we have chosen to design the filter by using Kalman's theory. The measurement noise is modeled as a colored one, generated by a very lightly damped system driven by a white noise. The resulting Kalman filter is an effective band-stop filter, whose phase nicely remains near zero in the whole pass-band. (authors). 13 refs., 12 figs
de Joode, Anoek A. E.; Sanders, Jan Stephan; Smid, W. Martin; Stegeman, Coen A.
Objective: We evaluated 26 patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) with progressive disease despite treatment with cyclophosphamide and steroids treated with additional plasmapheresis and compared outcome with 50 matched-disease controls. Methods:
Burns, Lee; Decker, Ryan
Lightning strike location and peak current are monitored operationally in the Kennedy Space Center (KSC) Cape Canaveral Air Force Station (CCAFS) area by the Cloud to Ground Lightning Surveillance System (CGLSS). The present study compiles ten years worth of CGLSS data into a database of near strikes. Using shuffle launch platform LP39A as a convenient central point, all strikes recorded within a 20-mile radius for the period of record O R ) from January 1, 1993 to December 31,2002 were included in the subset database. Histograms and cumulative probability curves are produced for both strike intensity (peak current, in kA) and the corresponding magnetic inductance fields (in A/m). Results for the full POR have application to launch operations lightning monitoring and post-strike test procedures.
Subramaniyam, Shivakumar; Magro, Cynthia M; Gogineni, Swarna; Tam, Wayne; Mathew, Susan
Cytogenetic studies on cutaneous lymphomas are rare, and very little is known about their prognostic value. We present a rare case of primary cutaneous follicle center lymphoma (PCFCL) with a complex translocation presenting with cutaneous and extracutaneous dissemination in the lymph node. Morphologic, immunohistochemical, conventional cytogenetic, and fluorescence in situ hybridization (FISH) studies were performed on this patient. A combination of cytogenetic and FISH analysis identified a complex novel four-way t(2;14;9;3) (p11.2;q32;p13;q27) translocation involving rearrangements of BCL6, immunoglobulin light and heavy chain genes, and an unknown gene on 9p. Our report elaborates the morphologic and immunohistochemical features in combination with cytogenetic and molecular cytogenetic analysis of PCFCL, which provide additional insight into the clinical and biologic behavior of this lesion. Copyright© by the American Society for Clinical Pathology.
Fernández-Plata, Rosario; Olmedo-Torres, Daniel; Martínez-Briseño, David; García-Sancho, Cecilia; Franco-Marina, Francisco; González-Cruz, Herminia
Severe periodontal disease is a chronic inflammatory gingival process associated with systemic diseases. To determine the prevalence of severe periodontal disease and its association with respiratory diseases among hospitalized patients at the Institute of Respiratory Diseases "Ismael Cosio Villegas" (INER) in 2011. A cross-sectional study was developed. The severe periodontal disease was diagnosed by the Department of Stomatology. The International Classification of Diseases 10th revision was used. A multinomial logistic was fit to estimate relative-risk. Three thousand and fifty-nine patients were included; 772/3,059 (25.2%) had severe periodontal disease. After controlling for age, sex, inpatient days, death, and socioeconomic status, the infectious respiratory diseases that were significantly associated with severe periodontal disease were: HIV/AIDS (RR: 10.6; 95% CI: 9.1-23.3; p abscess (RR: 2.6; 95% CI: 1.6-7.8; p = 0.002). Lung cancer and pleural diseases were also significantly associated with severe periodontal disease. High prevalence of severe periodontal disease was observed in the different respiratory diseases. Severe periodontal disease was associated with both infectious and non-infectious respiratory diseases. It is important to study an oral health intervention.
Gupta, Pushpender; Barnwell, Jonathan C; Lenchik, Leon; Wuertzer, Scott D; Miller, Anna N
The objective of the present study is to evaluate multidetector computed tomographic (MDCT) fracture patterns and associated injuries in patients with spinopelvic dissociation (SPD). Our institutional trauma registry database was reviewed from Jan. 1, 2006, to Sept. 30, 2012, specifically evaluating patients with sacral fractures. MDCT scans of patients with sacral fractures were reviewed to determine the presence of SPD. SPD cases were characterized into the following fracture patterns: U-shaped, Y-shaped, T-shaped, H-shaped, and burst. The following MDCT features were recorded: level of the horizontal fracture, location of vertical fracture, kyphosis between major fracture fragments, displacement of fracture fragment, narrowing of central spinal canal, narrowing of neural foramina, and extension into sacroiliac joints. Quantitative evaluation of the sacral fractures was performed in accordance with the consensus statement by the Spine Trauma Study Group. Medical records were reviewed to determine associated pelvic and non-pelvic fractures, bladder and bowel injuries, nerve injuries, and type of surgical intervention. Twenty-one patients had SPD, of whom 13 were men and eight were women. Mean age was 41.8 years (range 18.8 to 87.7). Five fractures (24 %) were U-shaped, six (29 %) H-shaped, four (19 %) Y-shaped, and six (29 %) burst. Nine patients (43 %) had central canal narrowing, and 19 (90 %) had neural foramina narrowing. Eleven patients (52 %) had kyphotic angulation between major fracture fragments, and seven patients (33 %) had either anterior (24 %) or posterior (10 %) displacement of the proximal fracture fragment. Fourteen patients (67 %) had associated pelvic fractures, and 20 (95 %) had associated non-pelvic fractures. Two patients (10 %) had associated urethral injuries, and one (5 %) had an associated colon injury. Seven patients (33 %) had associated nerve injuries. Six patients (29 %) had surgical fixation while 15 (71 %) were
Bachmann, Olivier; Deering, Chad D.; Ruprecht, Janina S.; Huber, Christian; Skopelitis, Alexandra; Schnyder, Cedric
Multiple eruptions of silicic magma (dacite and rhyolites) occurred over the last ~3 My in the Kos-Nisyros volcanic center (eastern Aegean sea). During this period, magmas have changed from hornblende-biotite-rich units with low eruption temperatures (≤750-800°C; Kefalos and Kos dacites and rhyolites) to hotter, pyroxene-bearing units (>800-850°C; Nisyros rhyodacites) and are transitioning back to cooler magmas (Yali rhyolites). New whole-rock compositions, mineral chemistry, and zircon Hf isotopes show that these three types of silicic magmas followed the same differentiation trend: they all evolved by crystal fractionation and minor crustal assimilation (AFC) from parents with intermediate compositions characterized by high Sr/Y and low Nb content, following a wet, high oxygen fugacity liquid line of descent typical of subduction zones. As the transition between the Kos-Kefalos and Nisyros-type magmas occurred immediately and abruptly after the major caldera collapse in the area (the 161 ka Kos Plateau Tuff; KPT), we suggest that the efficient emptying of the magma chamber during the KPT drew out most of the eruptible, volatile-charged magma and partly solidified the unerupted mush zone in the upper crust due to rapid unloading, decompression, and coincident crystallization. Subsequently, the system reestablished a shallow silicic production zone from more mafic parents, recharged from the mid to lower crust. The first silicic eruptions evolving from these parents after the caldera collapse (Nisyros units) were hotter (up to >100°C) than the caldera-forming event and erupted from reservoirs characterized by different mineral proportions (more plagioclase and less amphibole). We interpret such a change as a reflection of slightly drier conditions in the magmatic column after the caldera collapse due to the decompression event. With time, the upper crustal intermediate mush progressively transitioned into the cold-wet state that prevailed during the Kefalos
Baracat, Patrícia Junqueira Ferraz; de Sá Ferreira, Arthur
The present study investigated the association between postural tasks and center of pressure spatial patterns of three-dimensional statokinesigrams. Young (n=35; 27.0±7.7years) and elderly (n=38; 67.3±8.7years) healthy volunteers maintained an undisturbed standing position during postural tasks characterized by combined sensory (vision/no vision) and biomechanical challenges (feet apart/together). A method for the analysis of three-dimensional statokinesigrams based on nonparametric statistics and image-processing analysis was employed. Four patterns of spatial distribution were derived from ankle and hip strategies according to the quantity (single; double; multi) and location (anteroposterior; mediolateral) of high-density regions on three-dimensional statokinesigrams. Significant associations between postural task and spatial pattern were observed (young: gamma=0.548, p<.001; elderly: gamma=0.582, p<.001). Robustness analysis revealed small changes related to parameter choices for histogram processing. MANOVA revealed multivariate main effects for postural task [Wilks' Lambda=0.245, p<.001] and age [Wilks' Lambda=0.308, p<.001], with interaction [Wilks' Lambda=0.732, p<.001]. The quantity of high-density regions was positively correlated to stabilogram and statokinesigram variables (p<.05 or lower). In conclusion, postural tasks are associated with center of pressure spatial patterns and are similar in young and elderly healthy volunteers. Single-centered patterns reflected more stable postural conditions and were more frequent with complete visual input and a wide base of support. Copyright © 2013 Elsevier B.V. All rights reserved.
Brody, Gene H; Yu, Tianyi; Chen, Edith; Miller, Gregory E
Individuals exposed to adverse childhood experiences (ACEs) are vulnerable to various health problems later in life. This study was designed to determine whether participation in an efficacious program to enhance supportive parenting would ameliorate the association between ACEs and prediabetes status at age 25. Rural African American parents and their 11-year-old children (N=390) participated in the Strong African American Families (SAAF) program or a control condition. Each youth at age 25 provided a total ACEs score and a blood sample from which overnight fasting glucose was assayed. Logistic regression equations were used to test the hypotheses. The logistic regression analyses revealed a significant interaction between total ACEs and random assignment to SAAF or control, OR=0.56, 95% CI [0.36, 0.88]. Follow-up analyses indicated that, for participants in the control condition, a 1-point increase in ACEs was associated with a 37.3% increase in risk of having prediabetes. ACEs were not associated with the likelihood of having prediabetes among participants in the SAAF condition. Control participants with high total ACEs scores were 3.54 times more likely to have prediabetes than were SAAF participants with similar scores. This study indicated that participation at age 11 in a randomized controlled trial designed to enhance supportive parenting ameliorated the association of ACEs with prediabetes at age 25. If substantiated, these findings may provide a strategy for preventing negative health consequences of ACEs. Copyright © 2017 Elsevier Inc. All rights reserved.
Scientists from CCR have generated a comprehensive structural map of Kaposi sarcoma-associated herpesvirus polyadenylated nuclear (PAN) RNA, a long non-coding RNA that helps the virus evade detection by its host’s immune system. The findings open new oppportunites to study the life cycle of this cancer-causing virus. Learn more...
Narra, Roberta; Maestri, Marcello; Budke, Christine M; Tamarozzi, Francesca; Mariconti, Mara; Nicoletti, Giovanni J; Rinaldi, Francesca; Brunetti, Enrico
Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach. © The American Society of Tropical Medicine and Hygiene.
Tsai, Shiau-Ting; Han, Chin-Hua; Chen, Li-Fang; Chou, Fan-Hao
The chronic shortage of nursing staffs in hospitals continues to increasingly and negatively impact the ability of medical care systems to deliver effective care and ensure the safety of patients. Bullying is one factor known to exacerbate turnover in the nursing workplace. This study explores workplace bullying and turnover intention among nurses working at a medical center in Southern Taiwan. A cross-sectional and correlation research design was conducted using the Negative Acts Questionnaire-Revised (NAQ-R) and the Turnover Intention Questionnaire. A convenience, purposive sample of 708 nurses was recruited. Inclusion criteria included: holding an RN license, able to communicate in both Mandarin and Hokkienese, >6 months of clinical experience, and an NAQ-R score higher than 23. Data were analyzed using SPSS19.0 software. Approximately 85% of participants had experienced some degree of workplace bullying during the previous 6-month period. The trend of the turnover intention tended to the right at a high degree. A moderate, positive, and significant correlation was found between turnover intention and bullying total scores (r=.39, pturnover intention (15.10%). Based on our findings, we suggest that nurses should enhance their awareness of the negative consequences of workplace bullying. Furthermore, hospitals should implement appropriate mechanisms to decrease the phenomenon of inter-staff bullying, improve the nursing workplace environment, and reduce the rate of turnover intention.
Riebeek Kohl, H.; Chambers, L. H.; Murphy, T.
For more that 20 years, the Global Learning and Observations to Benefit the Environment (GLOBE) Program has sought to increase environment literacy in students by involving them in the process of data collection and scientific research. In 2016, the program expanded to accept observations from citizen scientists of all ages through a relatively simple app. Called GLOBE Observer, the new program aims to help participants feel connected to a global community focused on advancing the scientific understanding of Earth system science while building climate literacy among participants and increasing valuable environmental data points to expand both student and scientific research. In October 2016, GLOBE Observer partnered with the Association of Science & Technology Centers (ASTC) in an international science experiment in which museums and patrons around the world collected cloud observations through GLOBE Observer to create a global cloud map in support of NASA satellite science. The experiment was an element of the International Science Center and Science Museum Day, an event planned in partnership with UNESCO and ASTC. Museums and science centers provided the climate context for the observations, while GLOBE Observer offered a uniform experience and a digital platform to build a connected global community. This talk will introduce GLOBE Observer and will present the results of the experiment, including evaluation feedback on gains in climate literacy through the event.
ALKindi, Said Y; Chai-Adisaksopha, Chatree; Cheah, Matthew; Linkins, Lori-Ann
Data on management of upper extremity deep vein thrombosis (UEDVT) in patients with cancer is limited. The objective of this study was to determine risk factors for UEDVT and the rates of recurrence and bleeding in a real-world setting. Retrospective review of consecutive patients assessed for cancer-associated UEDVT. Outcome measures were recurrent venous thromboembolism (VTE), and major and clinically relevant non-major bleeding (CRNMB). Risk factors for recurrent VTE and bleeding were assessed. Mean duration of follow-up was 7.2 months. Two hundred cases were identified; 69% were associated with a central line. Non-line associated UEDVT occurred more frequently in the setting of breast cancer, lung cancer and documented local mass effect. The incidence of recurrent VTE was 18.5%, of which 14 (37.8%) were ipsilateral UEDVT. The risk of recurrence is higher with male gender (HR 2.0, 95% CI; 1.0-4.0). Major and CRNMB occurred in 1% and 11.5%, respectively. Concurrent use of an antiplatelet agent was associated with a higher risk of CRNMB compared to anticoagulant therapy alone (HR 3.9, 95% CI; 1.4-10.7). Presence of a venous catheter was the primary risk factor for UEDVT, however, extrinsic compression by local tumour may be just as important for some cancer types. Furthermore, the majority of recurrent events did not occur in the same upper limb suggesting that UEDVT may be predictive of increased thrombotic risk rather than just a local effect of catheters. Copyright © 2018. Published by Elsevier Ltd.
Wildes, Tanya M; Farrington, Laura; Yeung, Cecilia; Harrington, Alexandra M; Foyil, Kelley V; Liu, Jingxia; Kreisel, Friederike; Bartlett, Nancy L; Fenske, Timothy S
Burkitt lymphoma (BL) is a rare, highly aggressive B-cell malignancy treated most successfully with brief-duration, high-intensity chemotherapeutic regimens. The benefit of the addition of rituximab to these regimens remains uncertain. We sought to examine the effectiveness of chemotherapy with and without rituximab in patients with BL. This study is a retrospective cohort study of all adult patients with BL diagnosed and treated with modern, dose-intense chemotherapeutic regimens from 1998-2008 at two tertiary care institutions. All cases were confirmed by application of WHO 2008 criteria by hematopathologists. Medical records were reviewed for patient-, disease-, and treatment- related factors as well as treatment response and survival. Factors associated with survival were analyzed using Cox proportional hazards modeling. A total of 35 patients were analyzed: 18 patients received rituximab with chemotherapy (R-chemo) and 17 received chemotherapy (chemo) alone. The median age was 42 (range 20-74 years); 57% were male; 71% had Ann Arbor Stage IV disease; 33% had central nervous system involvement; 78% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. R-chemo was associated with significantly longer overall survival (OS) than chemo alone (5-year OS 70% and 29%, respectively, p = 0.040). On multivariate regression analysis, poor performance status and central nervous system involvement were associated with poorer survival. The addition of rituximab to chemotherapy was associated with improved OS in patients with Burkitt lymphoma. Poor performance status and central nervous system involvement were prognostically significant on multivariate analysis.
Shain, Catherine; Ramgopal, Sriram; Fallil, Zianka; Parulkar, Isha; Alongi, Richard; Knowlton, Robert; Poduri, Annapurna
Purpose Polymicrogyria (PMG) is an epileptogenic malformation of cortical development. We describe the clinical epilepsy and imaging features of a large cohort with PMG-related epilepsy. Methods Participants were recruited through the Epilepsy Phenome/Genome Project, a multi-center collaborative effort to collect detailed phenotypic data on individuals with epilepsy. We reviewed phenotypic data from participants with epilepsy and PMG. Key Findings We identified 87 participants, 43 female and 44 male, with PMG and epilepsy. Median age of seizure onset was 3 years (range <1 month-37 years). Most presented with focal epilepsy (87.4%), some in combination with seizures generalized from onset (23.0%). Focal seizures with dyscognitive features were most common (54.3%). Of those presenting with generalized seizure types, infantile spasms were most prevalent (45.2%). The most common topographic pattern was perisylvian PMG (77.0%), of which the majority was bilateral (56.7%). Generalized PMG presented with an earlier age of seizure onset (median age of 8 months) and an increased prevalence of developmental delay prior to seizure onset (57.1%). Of the focal, unilateral and asymmetric bilateral groups where PMG was more involved in one hemisphere, the majority (71.4%) of participants had seizures that lateralized to the same hemisphere as the PMG or the hemisphere with greater involvement. Significance Participants with PMG had both focal and generalized onset of seizures. Our data confirm the involvement of known topographic patterns of PMG and suggest that more extensive distributions of PMG present with an earlier age of seizure onset and increased prevalence of developmental delay prior to seizure onset. PMID:23750890
Full Text Available Peritonitis is one of the most important causes of treatment failure in peritoneal dialysis (PD patients. This study describes changes in characteristics of causative organisms in PD-related peritonitis and antimicrobial susceptibility.In this single center study we analyzed retrospective 487 susceptibility profiles of the peritoneal fluid cultures of 351 adult patients with peritonitis from 1979 to 2014 (divided into three time periods, P1-P3.Staphylococcus aureus decreased from P1 compared to P2 and P3 (P<0.05 and P<0.01, respectively. Methicillin-resistant S. aureus (MRSA occurred only in P3. Methicillin-resistant Staphylococcus epidermidis (MRSE increased in P3 over P1 and P2 (P <0.0001, respectively. In P2 and P3, vancomycin resistant enterococci were detected. The percentage of gram-negative organisms remained unchanged. Third generation cephalosporin resistant gram-negative rods (3GCR-GN were found exclusively in P3. Cefazolin-susceptible gram-positive organisms decreased over the three decades (93% in P1, 75% in P2 and 58% in P3, P<0.01, P<0.05 and P<0.0001, respectively. Vancomycin susceptibility decreased and gentamicin susceptibility in gram-negatives was 94% in P1, 82% in P2 and 90% in P3. Ceftazidim susceptibility was 84% in P2 and 93% in P3.Peritonitis caused by MSSA decreased, but peritonitis caused by MRSE increased. MRSA peritonitis is still rare. Peritonitis caused by 3GCR-GN is increasing. An initial antibiotic treatment protocol should be adopted for PD patients to provide continuous surveillance.
Sherafati, Faranak; Homaie-Rad, Enayatollah; Afkar, Abolhassan; Gholampoor-Sigaroodi, Ramin; Sirusbakht, Soheil
To investigate the differences in death after receiving emergency services in traffic accidents between urban and rural regions, and decompose factors of the gap in Langerood, Northern Iran. This cross-sectional study was conducted in Langrood, Northern Iran during a 1-year period from 2013 to 2014. The hospital data of traffic crashes were used. Data contained those patients who survived at the scene of accident. Injury severity score, time to admission, age, gender, season of crash and type of collision were variables used in this study. Oaxaca decomposition technique was used to show the amount of inequity. In addition, three regression models were used to show the reason of inequity. Overall 1520 patients with road traffic accidents were admitted to our center during the study period. The mean age of the patients was 35.45 ± 17.9 years, and there were 1158 (76.1 %) men among the victims. Motorbike accidents accounted for 869 (57.1%) injuries and 833 (54.8 %) accidents occurred in rural regions. The in-hospital mortality rate was 60 (3.9%). The results of this study showed that 95% of inequity came from factors used in this study and 2.04% disadvantages were for rural crashes. Severity of crash and time to admission had relationship with death, while the effects of time to admission was higher in rural region and severity of the accident had more effect on mortality in urban regions in comparison with rural ones. The high rate of fatal accidents could be decreased by deleting the gap of access to health care services between urban and rural regions. This study suggested that more efforts of health system are needed to reduce the gap.
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 25 November 1998. The following aspects from the Agency's activity are presented: inspections in Iraq in relation to its clandestine nuclear programme, conclusion of Additional Protocols to safeguards agreements, the strengthened safeguards system, Agency's involvement in safeguards verification in the Democratic People's Republic of Korea (DPRK), safety review at the Mochovce nuclear power plant in Slovakia, and the year 2000 (Y2K) computer system problems in the Agency's Member States
Hayder M. Al-Rammahi
Full Text Available The study was carried out in Al-Qasim district/Babel governorate –Iraq, where 16 feral cats were captured and searched for parasitic pneumonia. The results showed that 5 out of 16 cats were infested with lung worm (31.25%. All infested cats demonstrated various degrees of respiratory signs in addition to obvious eosinophilia. The gross examination of infested lungs showed apparent consolidation as well as to pulmonary congestion and emphysema, while the microscopic investigation revealed emphysema, alveollar compression, congested blood vessels and presence of parasite eggs in numerous alveoli.
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 8 June 1998. The following aspects from the Agency's activity are presented: nuclear testing, technical co-operation, programme and budget, safeguards, safeguards implementation report, Agency's involvement in safeguards verification in the Democratic People's Republic of Korea (DPRK), Agency's inspections in Iraq in relation to its clandestine nuclear programme, security of material, measures to strengthen international co-operation in nuclear, radiation and waste safety, study of the radiological situation at the atolls of Mururoa and Fangataufa, and Agency's role in safety assessment of the Mochovce nuclear power plant
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 14 September 1998. The following aspects from the Agency's activity are presented: nuclear safety, technical co-operation programme, safeguards and verification, fissile material treaty, nuclear material released from the military sector, Agency's involvement in safeguards verification in the Democratic People's Republic of Korea (DPRK), Agency's inspections in Iraq in relation to its clandestine nuclear programme, and Agency's safeguards in the Middle East region
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 16 March 1998. The following aspects from the Agency's activity are presented: nuclear terrorism convention, Agency safety services, study of the radiological conditions at the atolls of Mururoa and Fangataufa, model additional protocols, Agency's involvement in safeguards verification in the Democratic People's Republic of Korea (DPRK), treaty of Bangkok, and Agency's inspections in Iraq in relation to its clandestine nuclear programme
Dr. Mohamed ElBaradei, Director General of the International Atomic Energy Agency (IAEA), said that he believes in two basic values: one, that we are one human family, irrespective of colour, religion, ethnicity. That is something he experiences every day with his colleagues in the Secretariat, and with the Board of Governors. He believes therefore that every one of us is entitled to the right to live in peace, dignity and freedom. The other basic value he shares is that we can go to new heights as human beings, but we can also stoop very low. He underlines that international institutions right now are indispensable. No single challenge or crisis can be resolved by any one country alone, whether it is arms control, whether it is climate change, whether it is communicable diseases or whether it is distorted ideologies. He stresses that we can only succeed if we are able to work together and at the same time applying basic core values like fairness, equity and human solidarity. We need international cooperation to implement national policies. He said that the Agency hinges on one key element, namely credibility, and that is based on independence and impartiality. Impartiality does not mean neutrality. It means sticking to what we believe is right, it means what is enshrined in the UN Charter. It is important to stick to the big picture, to stress the linkage between poverty and violence, the linkage between non-proliferation and disarmament. This is important to understand the root causes of some of the symptoms we are facing. He ends by saying that the Agency would not be here today had it not been for the wonderful people - the staff of this organization, who have spent a lot of time working with the utmost professionalism, dedication and loyalty to this organization - acting as one. It is the key hat Member States act also as one. We have managed to do it in the Secretariat by subscribing to the higher values that connect us all
Awad, M.A.; Hamza, M.S.; Elbakri, A.; Tantawi, M.
El-Minia governorate is located along the Nile valley between latitudes 27 degree 30' and 28 degree 45'N and longitudes 30 degree 30' and 31 degree 00'E. The investigated area is essentially occupied by sedimentary rocks belonging to tertiary and quaternary period. The valley on both sides is bounded by faulted steep slopes made up of eocene limestone. The quaternary alluvial aquifer is the most important aquifer in the area, its recharge takes place from infiltration of the surface Nile waters after the irrigation processes, and also from the upward leakage from deep fissured limestone and Nubian sandstone aquifers through the fault planes present in the area and from extensive pumping. Seventy four representative wells as well as twenty surface water from Nile water, main irrigation canals and drainage system were selected for chemical and isotopic analysis in the study area. The chemical composition of water along the valley is heterogeneous. The groundwater types are mainly sodium bicarbonate Na H C O 3 and calcium bicarbonate Ca(H C O 3 ) 2 , while the surface water is magnesium bicarbonate Mg(H CO 3 ) 2 water type. The sources of salinity in groundwater are due to contributions of: 1. halite and gypsum dissolution, 2. calcium carbonate dissolution, and 3. weathering of silicate minerals. With respect to (T.D.S.) content, the quality in most of Elminia groundwater was found to be good to moderate as a supply for drinking purposes. The hardness values of the surface and groundwater could be classified as 'SOFT' which makes it suitable for house-cleaning purposes. Based on the total dissolved salts (T.D.S.), sodium adsorption ratio (SAR) and the sodium percentage (Na %), the majority of Elminia groundwater might also be considered suitable for irrigation uses. The very low tritium content in a considerable part of Elminia wells, proves no direct contact with surface water recharge for more than four decades. These preserved water are free from pathogenic
Houry, M.P.; Bourles, H.
The rotation speed of a turbogenerator is disturbed by its shaft torsion. Obtaining a filtered measure of this speed is a problem of a great practical importance for turbine governor. A good filtering of this speed must meet two requirements: it must cut frequencies of the shaft torsion oscillation and it must not reduce or delay the signal in the pass-band, i.e. at lower frequencies. At Electricite de France, the speed measure is used to set in motion the fast valving system as quickly as possible, after a short circuit close to the unit or rather an islanding. It is difficult to satisfy these two requirements by using conventional filtering methods. The standard solution consists in a first order filter: at Electricite de France, its time constant is equal to 80 ms. We have decided to improve this filtering by designing a new filter which cuts the frequencies of the shaft torsion oscillation without reducing the bandwidth to the speed measure. If one uses conventional methods to obtain a band stop filter, it is easy to obtain the desired magnitude but not a phase near zero in the whole pass-band. Therefore, we have chosen to design the filter by using Kalman'a theory. The measurement noise is modeled as a colored one, generated by a very lightly damped system driven by a while noise. The resulting Kalman filter is an effective band stop filter, whose phase nicely remains near zero in the whole pass-band. The digital simulations we made and the tests we carried out with the Electricite de France Micro Network laboratory show the advantages of the rotation speed filter we designed using Kalman's theory. With the proposed filter, the speed measure filtering is better in terms of reduction and phase shift. the result is that there are less untimely solicitations of the fast valving system. Consequently, this device improves the power systems stability by minimizing the risks of deep perturbations due to a temporary lack of generation and the risks of under-speed loss
Sh AlOtaibi Eed L
Full Text Available Abstract Background Urban water sources of Khamis Mushait Governorate, southwestern Saudi Arabia, were studied to assess their bacteriological characteristics and suitability for potable purposes. A cross-sectional epidemiological method was adopted to investigate the four main urban water sources (i.e. bottled, desalinated, surface, and well water. These were sampled and examined between February and June 2007. Results A total of 95 water samples from bottled, desalinated, surface, and well water were collected randomly from the study area using different gathering and analysing techniques. The bacteriological examination of water samples included the most probable number of presumptive coliforms, faecal coliforms, and faecal streptococci (MPN/100 ml. The results showed that the total coliform count (MPN/100 ml was not detected in any samples taken from bottled water, while it was detected in those taken from desalinated, surface, and well water: percentages were 12.9, 80.0, and 100.0, respectively. Faecal coliforms were detected in desalinated, surface, and well water, with percentages of 3.23, 60.0 and 87.88, respectively. About 6.45% of desalinated water, 53.33% of surface water, and 57.58% of well water was found positive for faecal streptococci. Colonies of coliforms were identified in different micro-organisms with various percentages. Conclusion Water derived from traditional sources (wells showed increases in most of the investigated bacteriological parameters, followed by surface water as compared to bottled or desalinated water. This may be attributed to the fact that well and surface water are at risk of contamination as indicated by the higher levels of most bacteriological parameters. Moreover, well water is exposed to point sources of pollution such as septic wells and domestic and farming effluents, as well as to soil with a high humus content. The lower bacteriological characteristics in samples from bottled water indicate that
Leidman, Eva; Maliniak, Maret; Sultan, Abdul-Salam Saleh; Hassan, Ahmed; Hussain, Syed Jaffar; Bilukha, Oleg O
The insurgency tactics that characterize modern warfare, such as suicide car bombs and roadside bombs, have the potential to significantly impact road traffic injuries in conflict affected-countries. As road traffic incidents are one of the top ten causes of death in Iraq, changes in incidence have important implications for the health system. We aimed to describe patterns of road traffic fatalities for all demographic groups and types of road users in Iraq during a period characterized by a resurgence in insurgency activity. Iraqi Ministry of Health routine prospective injury surveillance collects information on all fatal injuries in eight governorates of Iraq: Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. From all injury fatalities documented at the coroner office, we analyzed only those attributed to road traffic that occurred between 1 January 2010 and 31 December 2013. Coroners ascertain information from physical examinations, police reports and family members. Analysis included 7,976 road traffic fatalities. Overall, 6,238 (78.2 %) fatalities were male and 2,272 (28.5 %) were children under 18 years of age. The highest numbers of road traffic fatalities were among males 15 to 34 years of age and children of both sexes under 5 years of age. 49.2 % of fatalities occurred among pedestrians. Among children and females, the majority of road traffic fatalities were pedestrians, 69.0 % and 56.6 %, respectively. Fatalities among motorcyclists (3.7 %) and bicyclists (0.4 %) were least common. Rates of road traffic fatalities ranged from 8.6 to 10.7 per 100,000 population. The injury surveillance system provides the first data from a conflict-affected country on road traffic fatalities disaggregated by type of road user. The highest numbers of fatalities were among children and young men. Nearly half of fatalities were pedestrians, a proportion nearly double that of any neighboring country. As insurgency activity increased in
Full Text Available This paper investigates governor design by reduced-order sliding mode for a hydropower plant with an upstream surge tank. The governing system is made up of a tunnel, a surge tank, a penstock, a wicket gate and servomechanism, a governor, a hydro-turbine and a grid. Concerning the components of the governing system, their mathematic models are established. Then, these models are interconnected to simulate the governing system. From the viewpoint of state space in modern control theory, the governing system is partially observed, which challenges the governor design. By introducing an additional state variable, the control method of reduced-order sliding mode is proposed, where the governor design is based on a reduced-order governing system. Since the governor is applied to the original governing system, the system stability is analyzed by means of the small gain theorem. An genetic algorithm is employed to search a group of parameters of the predefined sliding surface, and a fuzzy inference system is utilized to decrease the chattering problem. Some numerical simulations are illustrated to verify the feasibility and robustness of the control method.
Goldberg, David S.; French, Benjamin; Forde, Kimberly A.; Groeneveld, Peter W.; Bittermann, Therese; Backus, Lisa; Halpern, Scott D.; Kaplan, David E.
IMPORTANCE Centralization of specialized health care services such as organ transplantation and bariatric surgery is advocated to improve quality, increase efficiency, and reduce cost. The effect of increased travel on access and outcomes from these services is not fully understood. OBJECTIVE To evaluate the association between distance from a Veterans Affairs (VA) transplant center (VATC) and access to being waitlisted for liver transplantation, actually having a liver transplant, and mortality. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of veterans meeting liver transplantation eligibility criteria from January 1, 2003, until December 31, 2010, using data from the Veterans Health Administration’s integrated, national, electronic medical record linked to Organ Procurement and Transplantation Network data. MAIN OUTCOMES AND MEASURES The primary outcome was being waitlisted for transplantation at a VATC. Secondary outcomes included being waitlisted at any transplant center, undergoing a transplantation, and survival. RESULTS From 2003–2010, 50 637 veterans were classified as potentially eligible for transplant; 2895 (6%) were waitlisted and 1418 of those were waitlisted (49%) at 1 of the 5 VATCs. Of 3417 veterans receiving care at a VA hospital located within 100 miles from a VATC, 244 (7.1%) were waitlisted at a VATC and 372 (10.9%) at any transplant center (VATC and non-VATCs). Of 47 219 veterans receiving care at a VA hospital located more than 100 miles from a VATC, 1174 (2.5%) were waitlisted at a VATC and 2523 (5.3%) at any transplant center (VATC and non-VATCs). In multivariable models, increasing distance to closest VATC was associated with significantly lower odds of being waitlisted at a VATC (odds ratio [OR], 0.91 [95% CI, 0.89–0.93] for each doubling in distance) or any transplant center (OR, 0.94 [95% CI, 0.92–0.96] for each doubling in distance). For example, a veteran living 25 miles from a VATC would have a 7.4% (95% CI, 6.6%–8
Wasfi, Rania; Steinmetz-Wood, Madeleine; Kestens, Yan
This study examined the influence of walkability on walking behaviour and assessed whether associations varied according to life-stage and population center (PC) size. Walkability scores were obtained for the six-digit postal codes of residential neighbourhoods of 11,200 Canadians, who participated in biennial assessments of the National Population Health Survey from 1994 to 2010. Participants were stratified by age-group. Mixed-effects logistic regression models were used to estimate the influence of cumulative exposure to neighborhood walkability on utilitarian and exercise walking by PC size and life-stage. Associations of neighbourhood walkability with utilitarian and exercise walking varied according to age-group and PC size. Exposure to high walkable neighborhoods was associated with utilitarian walking in younger and older adults in all PC sizes, except for older adults living in a medium PC. Living in a highly walkable neighborhood in a large PC was associated with walking for exercise in younger (OR: 1.42; 95%CI: 1.20-1.67) and older adults (OR: 2.09; 95%CI: 1.51-2.89). Living in highly walkable neighbourhood in a medium PC was associated with walking for exercise in older adults (OR: 1.62; 95%CI: 1.15-2.29). These results emphasize the need to consider the size and nature of every community, and the age-group of a population when implementing strategies to promote walking.
Cubic, Barbara A; Shaffer, Laura A
This paper outlines the perspectives of the two currently appointed representatives of the Association of Psychologists in Academic Health Centers (APAHC) to the Council of Faculty and Academic Societies (CFAS) of the Association of American Medical Colleges (AAMC). The authors focus on why it is important for psychologists, especially those in academic health centers (AHCs), to be part of CFAS. The goal of the paper is to demonstrate how involvement in organizations like the AAMC helps AHC psychologists serve as ambassadors for psychology in AHCs and assists AHC psychologists in staying fluent regarding hot topics within academic medicine. The first author is a more senior member of APAHC, and so reflects the perspective of long-serving APAHC members; the second author reflects the perspectives of newer generations of APAHC members, those who have been active in APAHC for 10 years or less. The authors discuss their experiences being at national CFAS meetings. They describe meeting events including presentations such as those by national policy experts and scholars; and speed mentoring with medical residents from the AAMC Organization of Resident Representatives. Of special importance has been their opportunities for informal conversations with the AAMC's President and CEO, Board Chair, and Chief Public Policy Officer. They also have participated in networking functions that encourage interdisciplinary knowledge sharing and relationship building.
Full Text Available Background: Conflicting studies link several conditions and risk factors to Dupuytren’s disease (DD. A questionnaire-based case-control study was set to investigate associated conditions and clinical features of DD in a sample of Italian patients. The main purpose was the identification of predicting factors for: DD development; involvement of multiple rays; involvement of both hands; development of radial DD; development of recurrences and extensions. Methods: A self-administered questionnaire was used to investigate medical and drug histories, working and life habits, DD clinical features, familial history, recurrences and extensions. Binary logistic regression, Mann Whitney U-test and Fisher’s exact test were used for the statistical analysis. Results: A role in DD development was found for male sex, cigarette smoking, diabetes and heavy manual work. The development of aggressive DD has been linked to age, male sex, high alcohol intake, dyslipidemias and positive familial history. Conclusion: Further studies might explain the dual relationship between ischemic heart disease and DD. According to our results, the questionnaire used for this study revealed to be an easy-handling instrument to analyze the conditions associated to DD. Nevertheless, its use in further and larger studies is needed to confirm our results as well as the role of the questionnaire itself as investigation tool for clinical studies.
Full Text Available Introduction: Association between rheumatoid arthritis (RA, periodontitis and temporomandibular disorder (TMD can be an outcome of the existing inflammatory conditions or involvement of joints at a different level of severity. Aim: This study aims to find an association between periodontal disease and TMDs and RA among patients visiting various Rheumatology centers in Bengaluru city. Materials and Methods: A total of 100 RA patients and age- and gender-matched comparison group were recruited from various Rheumatology centers in Bengaluru city. Periodontal status and loss of attachment (LOA were measured from the World Health Organization (2013 criteria and TMDs and severity were assessed using Helkimo index (1987. Data were analyzed and comparisons were done using Chi-square test and independent t-test (P < 0.05. Correlation and association are measured through spearman's correlation and logistic regression analysis. Results: There was a significant difference regarding shallow and deep periodontal pocket depth among RA (4.62 ± 2.33, 1.48 ± 1.7 and comparison (3.48 ± 2.53, 0.83 ± 1.05 groups (P = 0.01. Impaired mobility (P = 0.012, altered function (P = 0.032, painful function (P = 0.023, muscle pain (P = 0.028, and temporomandibular joint pain (P = 0.048 differed significantly between RA group and comparison group. RA patients were more likely to suffer from TMD (OR = 4.88 and LOA (OR = 2.16 than the comparison group. Conclusion: Periodontitis and TMD are found to be associated with RA. A dental check-up for patients suffering from RA should be part of the routine RA assessment.
Full Text Available Shasha Zhao,1,2 Lin Zhang,3 Zhenyang Gu,1 Chengying Zhu,1,2 Shu Fang,1 Nan Yang,1 Feiyan Wang,1,2 Lixun Guan,1 Lan Luo,1 Chunji Gao1 1Department of Hematology, Chinese People’s Liberation Army (PLA General Hospital, Beijing, 2School of Medicine, Nankai University, Tianjin, 3Department of Hematology, First Hospital of Qinhuangdao, Qinhuangdao, China Purpose: Pulmonary mucosa-associated lymphoid tissue (MALT lymphoma is a rare entity. To date, the optimal treatment for this disease is still under debate. The aim of this study was to analyze and summarize the clinical manifestations and therapeutic experience of 18 pulmonary MALT lymphoma patients to collect information about the optimal treatment modality. Patients and methods: A retrospective analysis was performed in patients who were diagnosed with pulmonary MALT lymphoma at the Chinese People’s Liberation Army General Hospital from April 1995 to April 2016. Results: Clinical data of 18 patients were available. The median age was 55 (range, 34–67 years. Also, 61.1% of the patients were male. Only 33.3% had a history of smoking and 27.8% of the patients had tuberculosis. Treatment modalities included surgery alone in 1 patient (5.6%, chemotherapy in 10 patients (55.5%, surgery in combination with chemotherapy in 6 patients (33.3% and observation in 1 patient (5.6%. Over the median observation period of 93 months, 2 patients died, the median progression-free survival was 6 years, and the estimated 5- and 10-year overall survival rates were 94.1% and 83.7%, respectively. The survival data confirmed the indolent nature of the disease. There was no difference in progression-free survival between the chemotherapy group and the surgery in combination with chemotherapy group. Conclusion: Pulmonary MALT lymphoma tended to be an indolent disease. In order to preserve the lung function and reduce the risks associated with surgery, chemotherapy might be an optimal choice for the treatment of
Anna C. Phillips
Full Text Available This article examines the coincident effects of new-onset depression post hip fracture on length of hospital stay, readmission rates, and incidence of infections in older adults. Participants were 101 hip fracture patients aged 60+ years; 38 developed depressive symptoms following their fracture. Infection rates, readmissions to hospital and rehabilitation units, and length of hospital stay were assessed over the 6 months post hip fracture from hospital and general practitioner notes. Patients who developed depression by Week 6 post fracture were likely to spend more time in hospital/rehabilitation wards (p = .02 and more likely to be discharged to a rehabilitation unit (p < .05. There were no group differences in readmissions or infection rates. New-onset depression coincident with hip fracture in older adults is associated with longer hospital ward stays and greater need for rehabilitation.
Duval, Mathieu; Guilarte, Verónica
The present study aims at investigating several key aspects of ESR dose reconstruction of quartz grains based on the analysis of the Ti-center: (i) the evaluation of the ESR intensity, (ii) its impact on measurements precision, and (iii) the potential of various fitting functions to describe the behavior of the signal with the radiation absorbed dose. In contrast with the Al center, the various Ti centers have quite low ESR signal intensities. It is thus crucial to adapt the experimental conditions for the optimization of the signal-to-noise ratio and to perform repeated measurements in order to take into consideration the uncertainty associated to angular dependence of the signal as well as day-to-day variations. Several options (named A to E) for evaluating the ESR intensity of the Ti–Li and Ti–H centers are explored and some of them yield too much experimental uncertainty (e.g. options C and E) and are apparently not suitable for accurate ESR dosimetry. In contrast, options A and D usually provide similar equivalent dose (D E ) results and can be used together for assessing the dose absorbed by the Ti–Li center. Our results show a systematic non-monotonic behavior of the ESR signal of the Ti center with the dose, which raise some questions about the suitability of the single saturating exponential (SSE) function that is classically used in ESR dating. Consequently, we explored the potential of other functions that can describe the “radiation bleaching” phenomenon observed at high doses. We recommend the use of a specific fitting function (called Ti-2 in the present paper) previously proposed by Woda and Wagner (2007) for any dose reconstruction, and define some criteria to ensure a good fitting. The SSE function provides D E results that are, in most cases, relatively consistent with those derived from the Ti-2, suggesting that the Ti centers apparently follow a SSE behavior up to, at least, 6.0–6.5 kGy However, the reliability of the D E values
Cholangiocarcinomas associated with long-term inflammation express the activation-induced cytidine deaminase and germinal center-associated nuclear protein involved in immunoglobulin V-region diversification.
Chan-On, Waraporn; Kuwahara, Kazuhiko; Kobayashi, Naoya; Ohta, Kazutaka; Shimasaki, Tatsuya; Sripa, Banchob; Leelayuwat, Chanvit; Sakaguchi, Nobuo
Cholangiocarcinoma (CCA) represents a model of tumor development after long-term inflammation which causes DNA damage or impairs DNA repair mechanism. AID and GANP, both appearing in antigen-driven B cells, are involved in affinity maturation of the immunoglobulin V-region with increased somatic mutation. A normal cholangiocyte line showed the induction of AID transcripts after stimulation with TNF-alpha, whereas ganp transcripts appeared constitutively in this cell line. Next, we examined the expression of AID and GANP in clinical CCA specimens to obtain information whether their expression levels are associated with the malignant grade of CCA. AID expression was similarly detected in the clinical cases of both well-differentiated and poorly-differentiated CCAs. On the contrary, GANP expression was detected in CCA cells at a higher level in the nucleus of poorly-differentiated CCAs with shorter survivals than in that of well-differentiated CCAs. The high and low cases of nuclear GANP expression showed no change in the frequency of the TP53 mutations, however, further investigation by in vitro experiment demonstrated that the high GANP expression caused the increased number of gammaH2AX foci after DNA damage by ionizing-irradiation. These results suggest that GANP is involved in regulation of DNA repair mechanism and the abnormal over-expression of GANP together with AID might be associated with rigorous DNA damage, potentially causing the malignant development of CCAs during long-term inflammation.
Zhang, Yupeng; Hu, Quan; Xue, Hao; Zhang, Mingran; Shen, Jie; Deng, Lin; Liu, Qinglin; Li, Gang
Ruptured middle cerebral artery (MCA) aneurysms usually lead to subarachnoid hemorrhage (SAH), and several cases have shown concomitant intrasylvian or intracerebral hematomas. The objective of this study was to compare the clinical and radiographic characteristics with their different outcomes. The charts of 30 consecutive patients with ruptured MCA aneurysm-related intracranial hematoma were retrospectively reviewed. These patients were dichotomized into an intrasylvian hematoma (ISH) group and an intracerebral hematoma (ICH) group by the presence of intrahematomal contrast-enhancing vessel; for patients under open surgery, hematoma type was further confirmed by intraoperative observation. The characteristics were compared between these 2 groups (ie, age, gender, history of hypertension, history of smoking, systolic pressure at admission, hematoma volume, size and side of aneurysms, the angle between the pointing direction of the aneurysm and the MCA trunk [denoted as α], middle line shifting, treatment modality, and outcome). All the angles are measured in the anterior-posterior projection. In our series, only hematoma volume, the angle α, and the middle line shift showed statistical significance regarding prognosis between 2 hematoma groups. An angle α between 109.0°and 216.0° is associated with ISH, whereas aneurysm with an angle beyond this range indicates ICH. In our series, patients in the ICH group had a larger hematoma volume compared with the ISH patients (33.3 ± 17.6 vs. 11.5 ± 10.5; P = 0.002). There exists no statistical difference regarding prognosis between these 2 groups, even although there is a trend toward worse recovery for patients in the ISH group (Glasgow Outcome Scale score, 3.0 ± 1.3 vs. 3.8 ± 1.9; P = 0.07). In our series, the prognosis of patients with ICH was worse than that of patients with ISH. Early discrimination of these 2 types of hematoma helps to predict future outcome; an angle (between the pointing direction of
Khan, Samee Ullah
This handbook offers a comprehensive review of the state-of-the-art research achievements in the field of data centers. Contributions from international, leading researchers and scholars offer topics in cloud computing, virtualization in data centers, energy efficient data centers, and next generation data center architecture. It also comprises current research trends in emerging areas, such as data security, data protection management, and network resource management in data centers. Specific attention is devoted to industry needs associated with the challenges faced by data centers, such as various power, cooling, floor space, and associated environmental health and safety issues, while still working to support growth without disrupting quality of service. The contributions cut across various IT data technology domains as a single source to discuss the interdependencies that need to be supported to enable a virtualized, next-generation, energy efficient, economical, and environmentally friendly data cente...
Full Text Available This paper addresses chaos suppression of the mechanical centrifugal flywheel governor system with output constraint and fully unknown parameters via adaptive dynamic surface control. To have a certain understanding of chaotic nature of the mechanical centrifugal flywheel governor system and subsequently design its controller, the useful tools like the phase diagrams and corresponding time histories are employed. By using tangent barrier Lyapunov function, a dynamic surface control scheme with neural network and tracking differentiator is developed to transform chaos oscillation into regular motion and the output constraint rule is not broken in whole process. Plugging second-order tracking differentiator into chaos controller tackles the “explosion of complexity” of backstepping and improves the accuracy in contrast with the first-order filter. Meanwhile, Chebyshev neural network with adaptive law whose input only depends on a subset of Chebyshev polynomials is derived to learn the behavior of unknown dynamics. The boundedness of all signals of the closed-loop system is verified in stability analysis. Finally, the results of numerical simulations illustrate effectiveness and exhibit the superior performance of the proposed scheme by comparing with the existing ADSC method.
Elisana Costa Dourado
Full Text Available ABSTRACT Purpose: to investigate the prevalence of the ear canal collapse when using supra-aural earphones and to verify if this event is influenced by sex, age, color of the skin and prominent ear. Methods: the collapse was assessed by a visual inspection after the positioning of a detached cushion, pressured against the external ear. Results: a total of 436 individuals, aged 3 to 97 years, participated in the study. Ear canal collapse was observed in 11.4% of the subjects, being mostly bilateral (90.0%. The prevalence ranged from 6.3% to 36.6% across age groups. Males, aged 65 years or above and presence of prominent ear were independently identified as associated factors for the occurrence of ear canal collapse (p<0.05. Despite a higher prevalence for those self-identified as white skinned when compared to non-whites, the difference was not statistically significant. Conclusion: the ear canal collapse, when supra-aural earphones are used, is more likely to occur in men, in elderly people, and among those with prominent ears. The prevalence of the event in this population raises the necessity of a careful examination, previous to any evaluation using supra-aural earphones.
Full Text Available Objectives: The aim of this study was to determine the patient and UI-related factors affecting help seeking behavior of Turkish women with undiagnosed urinary incontinence Methods: This cross-sectional study was conducted on 490 female patients aged > 18 years old and were seen in general gynecology outpatients’ clinic of Denizli State Hospital. According to referral complaint and results of UDI-6 questionnaire, the participants were classified into 3 groups: Group A: Help seeker patient, Group B: Non help seeker patient and Group C: Continent patient. Results: Overall UI prevelance was 24%. Nearly two thirds ( 67% of the UI patients do not complaint about their UI symptoms unless they were asked specifically about UI. Consultation rate increased with age, duration of incontinence, menopause and the severity of UI. After logistic regression analyses, only increasing age, UDI-6 score and severity (SSS were found to be associated independently with help seeking behavior. Conclusions: This study showed that, older, more bothered and severe UI patients visit physician and seek medical help. Still nearly half of women who are suffering from clinically significant UI remain undiagnosed and untreated. Regardless the visiting reason if its asked specifically for UI symptoms by using simple questionnaires, we can reveal and diagnose this patients’ group that is suffering from UI but yet keeps it disguise . Keywords: Urinary incontinence, help seeking behavior, undiagnosed urinary incontinence
McKinney, Cliff; Gadke, Daniel L; Malkin, Mallory L
Research on parenting children with autism spectrum disorder (ASD) indicates these children receive parenting tailored to their condition. However, little is known about ASD in adulthood, especially in emerging adults at college, and how they are parented. The current study examined how emerging adults in a non-clinical typically-developing sample differed in their current perceptions of parenting as a function of ASD traits. Participants completed questionnaires about their current perceptions of parenting and self-reported ASD traits. Parenting characteristics assessed included parenting style, discipline, parent-child relationship quality, and parental distress. Results indicated that higher levels of self-reported ASD traits were associated with increasingly ineffective parenting characteristics including lower authoritative style, harsher discipline, poorer parent-child relationship quality (e.g., lower involvement), and higher parental distress. Researchers are encouraged to extend ASD research into adulthood by validating diagnostic methods with adults and investigating processes in adulthood that have been well-established in the childhood ASD literature.
Recursion relations determining the guiding center Langrangian Λ and the associated guiding center variables to all orders are derived. We consider some particularly simple forms of Λ obtainable by specific choices of certain arbitrary functions appearing as free parameters in the theory. It is, for example, possible to locally define the guiding center variables so that the expression for the corresponding Langrangian is unchanged by all higher order terms. (orig.)
Iosifidis, Elias; Chochliourou, Elpis; Violaki, Asimenia; Chorafa, Elisavet; Psachna, Stavroula; Roumpou, Afroditi; Sdougka, Maria; Roilides, Emmanuel
OBJECTIVE To evaluate the new adult Centers for Disease Control and Prevention (CDC) ventilator-associated event (VAE) module in critically ill children and compare with the traditionally used CDC definition for ventilator-associated pneumonia (VAP). DESIGN Retrospective observational study of mechanically ventilated children in a pediatric intensive care unit in Greece January 1-December 31, 2011. METHODS Assessment of new adult CDC VAE module including 3 definition tiers: ventilator-associated condition (VAC), infection-related VAC, and possible/probable ventilator-associated pneumonia (VAE-VAP); comparison with traditional CDC criteria for clinically defined pneumonia in mechanically ventilated children (PNEU-VAP). We recorded Pediatric Risk of Mortality score at admission (PRISM III), number of ventilator-days, and outcome. RESULTS Among 119 patients with mechanical ventilation (median [range] number of ventilator-days, 7 [1-183]), 19 patients experienced VAC. Criteria for VAE-VAP were fulfilled in 12 of 19 patients with VAC (63%). Children with either VAC or VAE-VAP were on ventilation more days than patients without these conditions (16.5 vs 5 d, P=.0006 and 18 vs 5 d, PVAC (31.6%), than the patients without new VAE-VAP (14%, P=.007) or VAC (15%, P=.1), respectively. No significant association was found between PNEU-VAP and death. Incidences of PNEU-VAP and VAE-VAP were similar, but the agreement was poor. CONCLUSIONS VAE-VAP and PNEU-VAP found similar prevalence in critically ill children but with poor agreement. However, excess of death was significantly associated only with VAE-VAP. Infect Control Hosp Epidemiol 2016:1-5.
Saraya, Takeshi; Kimura, Hirokazu; Kurai, Daisuke; Ishii, Haruyuki; Takizawa, Hajime
Few reports have described the significance of viral respiratory infections (VRIs) in exacerbation of asthma in adult patients. The aim of this study was to elucidate the profiles of VRIs in adult patients with asthma along with their molecular epidemiology.A cross-sectional observational study was conducted at Kyorin University Hospital from August 2012 to May 2015. To identify respiratory pathogens in inpatients and outpatients suffering from asthma attacks, RT-PCR/sequencing/phylogenetic analysis methods were applied alongside conventional microbiological methods. Phylogenetic and pairwise distance analyses of 10 viruses were performed.A total of 106 asthma attack patients enrolled in this study in both inpatient (n = 49) and outpatient (n = 57) settings. The total 106 respiratory samples were obtained from nasopharyngeal swab (n = 68) or sputum (n = 38). Among these, patients with virus alone (n = 39), virus and bacterial (n = 5), and bacterial alone (n = 5) were identified. The ratio of virus-positive patients in inpatient or outpatient to the total cases were 31.1% (n = 33) and 10.4% (n = 11), respectively. The frequency of virus-positive patients was significantly higher in inpatients (75.3%, n = 33) than in outpatients (19.3%, n = 11). Major VRIs included human rhinovirus (HRV) (n = 24), human metapneumovirus (hMPV) (n = 9), influenza virus (Inf-V) (n = 8), and respiratory syncytial virus (RSV) (n = 3) infections with seasonal variations. HRV-A and HRV-C were the most commonly detected viruses, with wide genetic divergence on phylogenetic analysis.Asthmatic exacerbations in adults are highly associated with VRIs such as HRV-A or HRV-C, hMPV, RSV, and Inf-V infections with seasonal variations and genetic divergence, but similar frequencies of VRIs occurred in asthma attack patients throughout the seasons.
Lockhart, D.J.; Boxer, S.G.
The magnitude and direction of the change in dipole moment, ..delta mu.., associated with the Q/sub y/ transition of the dimeric primary electron donor (special pair or P870) in Rhodopseudomonas sphaeroides reaction centers have been measured by Stark spectroscopy at 20 /sup 0/C. The magnitude of ..delta mu.. is found to be f/sup -1/ (10.3 +/- 0.7) D, where f is a correction factor for the local dielectric properties of the protein matrix. With the spherical cavity approximation and an effective local dielectric constant of 2, f = 1.2, and absolute value of ..delta mu.. is 8.6 +/- 0.6 D. Absolute value of ..delta mu.. for the Q/sub y/ transition of the special pair is approximately a factor of 3.4 and 2 greater than for the monomeric bacteriochlorophylls and bacteriopheophytins, respectively, in the reaction center. The angle between ..delta mu.. and the transition dipole moment for excitation of the first singlet electron state of the special pair was found to be 24 +/- 2/sup 0/. The measured values are combined to suggest a physical model in which the lowest excited singlet state of the special pair has substantial charge-transfer character and where charge is separated between the two monomers comprising the dimeric special pair. This leads to the hypothesis that the first charge-separated state in bacterial photosynthesis is formed directly upon photoexcitation. These data provide stringent values for comparison with theoretical calculations of the electronic structure of the chromophores in the reaction center.
In his statement to the Board of Governors meeting in Vienna, Austria, IAEA Director General Mohamed ElBaradei focused on issues of nuclear safety and security, nuclear power, nuclear applications, verification of nuclear non-proliferation as well as the Agency's programme and budget. Nuclear Safety and Security. Dr. ElBaradei noted that work still needs to be done to strengthen nuclear safety and security worldwide. He said the IAEA must focus on improving the Incident and Emergency Centre to enhance its accident response capabilities, and to provide more effective support for Member States, especially for new entrants to nuclear power. Nuclear Power. The Nuclear Technology Review indicates that expectations for the use of nuclear power continue to rise, with growth targets for nuclear power being raised in China and the Russian Federation. Asia remains the focus of growth in nuclear power. The Director General said, 'The ending of restrictions on India's nuclear trade should allow an acceleration of its planned expansion of nuclear power.' Dr. ElBaradei proceeded to outline plans for the establishment of non-political multinational mechanisms to assure access for all countries to nuclear fuel and reactor technology. He circulated, at the request of the Russian Federation, a proposal for a low enriched uranium reserve to be used by Member States. The proposal provides assured export licences and covers all long term costs. The Director General also reported a positive response to the Nuclear Threat Initiative's offer of $50 million for a low enriched uranium reserve, contingent on contributions of an additional $100 million by others. So far, contributions and pledges have been made by Norway ($5 million), the USA ($50 million), the United Arab Emirates ($10 million) and the European Union ($25 million). 'The ideal scenario would be to start with a nuclear fuel bank under IAEA auspices. The next step would be to agree that all new enrichment and reprocessing
The agenda for the meeting includes nuclear technology, safety and verification - all three of the Agency's areas of activity. In his introductory statement to the Board of Governors, 05 March 2007, the Director General of the IAEA, discussed the status and trends concerning nuclear power which will have an increasing role as part of the global energy mix and that the growth in demand will mainly be from developing countries. He presented the 'Nuclear technology Review 2007' and an information document entitled 'Considerations to Launch a Nuclear power Programme'. To assist with subsequent steps in nuclear power planning the IAEA has established an inter-departmental nuclear power support programme. The IAEA has also produced an information document summarizing key considerations from all perspectives like safety, security, infrastructure development, technical cooperation, legal considerations and others. The Agency's International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO) is moving to phase 2. The IAEA is also developing common user requirements for small and medium size reactors. The 'Nuclear Safety Review for the Year 2006' provides an overview of current and emerging nuclear safety trends and issues. The newly established 'Integrated Regulatory Review Service (IRRS)' is intended to help Member States enhance their legislative and regulatory infrastructures, and to harmonize regulatory approaches in all areas of safety. Two workshop on the shipment of radioactive material are scheduled for latin America and Asia. Concerning the issue of nuclear verification the status of safeguards agreements and additional protocols was discussed. The return of IAEA personnel to the Democratic People's Republic of Korea is envisioned to conduct all necessary monitoring and verification as agreed by the IAEA and the DPRK. The report on the implementation of the NPT safeguards agreement and relevant provisions of UN Security Council resolution 1737 in the
Next Monday is the second anniversary of the accident at the Fukushima Daiichi Nuclear Power Plant in Japan. It has been a challenging two years, especially for the people and Government of Japan, but also for the IAEA. However, the worst elements of the accident are behind us and we are now in the post-accident phase. The Agency continues to work hard to help Japan deal with the consequences of the accident. Member States are also making serious efforts to implement the lessons learned from this and from previous accidents. You have received the Nuclear Safety Review 2013 and my report on Progress in the Implementation of the IAEA Action Plan on Nuclear Safety. Both show that continuous safety improvements are being made at nuclear facilities throughout the world. At the Fukushima Ministerial Conference on Nuclear Safety in December, the Co-Presidents emphasized the importance of strengthening the central role of the IAEA in promoting international cooperation in nuclear safety. During that Conference, I signed a Memorandum of Cooperation with the Governor of Fukushima Prefecture. We will work together on projects on radiation monitoring, remediation, human health, and capacity building in emergency preparedness and response within the RANET framework. The first meeting to launch four radiation and waste safety projects has just take place. A fourth post-Fukushima international expert meeting took place in January. This was on the subject of Decommissionin and Remediation after a Nuclear Accident. The Emergency Preparedness and Response Expert Group held its first meeting in February and agreed on priorities for its work. The series of international IAEA expert meetings will continue this year. In addition, the Agency is organizing a Conference on Effective Regulatory Systems in Ottawa in April, hosted by the Government of Canada. We have started work on a comprehensive IAEA report on the Fukushima Daiichi accident, which we hope to finalize in 2014. This is a
In his introductory Statement to the Board of Governors Dr. Mohamed ElBaradei, Director General of the IAEA, reports on all areas of IAEA's activity, namely technology, safety and security, and verification. The statement includes the Agency's Technical Cooperation Programmes' last year key projects about regional collaboration in sickle cell disease control mechanisms in Africa, radiation induced mutation activities to improve crops in Asia and the Pacific, a joint scientific investigation on marine pollution in the Mediterranean, and improved agricultural practices in Latin America. Regarding the issue of nuclear non-proliferation it stressed the fact that the Agency has been verifying and monitoring the shutting down and sealing of the Yongbyyon nuclear facilities since July 2007. The nuclear material produced during the disabling activities at the Nuclear Fuel fabrication Plant remains under Agency containment and surveillance as well as the one third of the spent fuel rods discharged form the 5 MW(e) Experimental Nuclear Power Plant and the two thirds remaining in the reactor core. The Agency's safeguard responsibilities towards the DPRK remain uncertain until the legal status of the DPRK vis a vis the NPT has been clarified. The Agency has been able to continue to verify the non-diversion of declared nuclear material in Iran however made no progress in clarifying the cluster of allegations and Secretariat questions relevant to possible military dimensions to Iran's nuclear programme. The Secretariat is continuing to assess the information and explanations provided by Iran, including additional information received on 23 May. However, Iran has not yet agreed to implement all the transparency measures required to clarify this cluster of allegations and questions. Following Libya's disclosure of its undeclared nuclear activities in December 2003, the Agency has continued its efforts to verify the correctness and completeness of Libya's declarations about its
In his introductory Statement to the Board of Governors Dr. Mohamed ElBaradei, Director General of the IAEA, reports on all areas of IAEA's activity, namely technology, safety and security, and verification including the draft Nuclear Safety Review for the Year 2007 and information about the 4th review meeting of the Contracting Parties of the Convention on Nuclear Safety. The review meeting in April will have to consider two important challenges - the number of new nuclear power programmes under consideration around the world and how to bring new momentum and focus to the review process. At the request of contracting parties, the Secretariat prepared an Issues and Trends paper for countries to take into account when preparing their national reports. Concerning nuclear power the draft Nuclear Technology Review 2008 is presented which indicates that rising expectations for nuclear power are starting to translate into increased construction. Expansion and growth prospects remain centred in Asia. In 2007, the Agency's projections for the future of nuclear power were revised upwards to between 450 and 690 GW(e) of installed nuclear capacity by 2030. The Review also notes major recent consolidations and increased internationalization among the suppliers of nuclear reactor technology. Concerning the assurance of supply the Director General has been advocating for some time the establishment of a multinational mechanism to assure access for all countries to nuclear fuel and reactor technology, and simultaneously to strengthen the non-proliferation regime. The ultimate goal should be to bring sensitive aspects of the fuel cycle under multinational control, so that no one country has the exclusive capability to produce the material for nuclear weapons. A number of Member States are working on proposals. Since March 2007, the Agency's Programme of Action for Cancer Therapy (PACT) has secured pledges, grants and donations amounting to over $3 million for the PACT Model
The IAEA's Director General Dr. Mohamed ElBarardei reported that the IAEA has been dealing with the verification issue in North Korea for seventeen years and things have gone from bad to worse. It started to improve when there was a dialogue. When there was no dialogue, things got much worse. There was a dialogue under the agreed framework and there were no weapons, just spent fuel under an Agency freeze. When the dialogue stopped, there was a nuclear test. With the six-party framework, things started to move and there was a dismantlement and shutdown. But when the six-party talks came to a halt, there was another nuclear test and in addition there was an announcement that North Korea will also start an enrichment programme. This means that it is important to have a meaningful dialogue between parties and that they talk to each other and understand the security dimension of proliferation issues. The Director General said that he will not have anything to report at the next Board of Governors meeting since the IAEA is not in North Korea and is not part of the six party talks. Since more and more countries are going into enrichment and fuel cycle processes it is recommended that there should be total multinationalization of the fuel cycle, as part of a world free of nuclear weapons and on the basis of equality and universality. There are four pillars which have to work together: the Agency, the Security Council, multilateral dialogues and bilateral talks. What we can do can be very much influenced by the Security Council, by multilateral dialogue and by bilateral talks. The Security Council should not necessarily mean just sanctions. The Security Council is supposed to be a forum to try to find solutions. The Security Council is supposed to intervene early and do preventive measures and try to find solutions. When things are moving in the bilateral/multilateral dialogue, such as in the six-party talks, then they move here. When there is a dialogue, there is some
Pan, Kunming; Ma, Lingyun; Xiang, Qian; Li, Xueying; Li, Haixia; Zhou, Ying; Yang, Li; Cui, Yimin
The objective of this study was to investigate the current situation of vancomycin (VAN)-associated acute kidney injury (VA-AKI) in China and identify the risk factors for VA-AKI, as well as to comprehensively examine the risk related to concurrent drug use. Further, we assessed the outcomes of patients who developed VA-AKI and the risk factors for these outcomes. Finally, we aimed to provide suggestions for improving the prevention and treatment of VA-AKI in China. We conducted a retrospective observational study of inpatients who had been treated with VAN between January 2013 and December 2013 at Peking University First Hospital. AKI was defined as an increase in SCr of ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours or an increase to ≥1.5 times the baseline certainly or presumably within the past 7 days. VA-AKI was defined as the development of AKI during VAN therapy or within 7 days following the termination of VAN therapy. In addition, we compared patients with NO-AKI, who did not develop AKI during their hospitalization, with those with VA-AKI. Of the 934 patients treated with VAN during their hospital stay, 740 were included in this study. Among those excluded, 38.1% (74/194) were excluded because of a lack of data on serum creatinine (SCr). Among the included patients, 120 had confirmed VA-AKI, with an incidence of 16.2% (120/740). Multiple logistic regression analysis revealed that an elevated baseline estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 1.009; p = 0.017) and concomitant vasopressor therapy (OR = 2.942; p = 0.009), nitrate use (OR = 2.869; p = 0.007), imipenem-cilastatin treatment (OR = 4.708; p = 0.000), and contrast medium administration (OR = 6.609 p = 0.005) were independent risk factors for VA-AKI; in addition, the receipt of orthopedic/trauma/burn surgery (OR = 0.3575; p = 0.011) and concomitant compound glycyrrhizin use (OR = 0.290; p = 0.017) were independent protective factors for VA-AKI. Multiple logistic regression
Harewood, Gavin C; Alsaffar, Omar
The Centers for Medicare and Medicaid Services recently published data on Medicare payments to physicians for 2012. We investigated regional variations in payments to gastroenterologists and evaluated whether payments correlated with the number of Medicare patients in each state. We found that the mean payment per gastroenterologist in each state ranged from $35,293 in Minnesota to $175,028 in Mississippi. Adjusted per-physician payments ranged from $11 per patient in Hawaii to $62 per patient in Washington, DC. There was no correlation between the mean per-physician payment and the mean number of Medicare patients per physician (r = 0.09), there also was no correlation between the mean per-physician payment and the overall mean per-capita health care costs for each state (r = -0.22). There was a 5.6-fold difference between the states with the lowest and highest adjusted Medicare payments to gastroenterologists. Therefore, the Centers for Medicare and Medicaid Services payments do not appear to be associated with the volume of Medicare beneficiaries or overall per-capita health care costs for each state. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
Full Text Available ABSTRACT Background: Anemia is a global public health problem affecting both developing and developed countries; approximately 1.3 billion individuals suffer from it. Pregnant women are the most vulnerable groups to anemia. The aim of this study was to assess the prevalence and risk factors for anemia in pregnant women attending antenatal care in Azezo Health Center, Gondar town, Northwest Ethiopia. Method: A cross-sectional study was conducted at Azezo Health Center from February to May 2011. Red blood cell morphology, Hgb level determination and intestinal parasites were assessed following the standard procedures. Socio-demographic data was collected by using a structured questionnaire. The data entered and analyzed by using the SPSS version 16.0 statistical software. P34, rural residence, history of malaria attack, hookworm infection and absence of iron supplements are significantly associated with increased risk of anemia. The most prevalent intestinal parasite among pregnant women was hookworm 18 (4.7%. Conclusion: In the present study, the prevalence of anemia was low when compared with the previous studies carried out in different countries including Ethiopia. More should be done in respect to the importance of regular visit to maternal care centres and health education promotion programs to succeed more. [J Interdiscipl Histopathol 2013; 1(3.000: 137-144
Full Text Available Abstract Background Epstein-Barr virus (EBV has been shown to be associated with gastric cancer. However, inconsistent findings have been reported regarding the distribution of EBV infected cells (in normal gastric epithelium vs. intestinal metaplastic cells vs. in neoplastic cells and the characteristics of EBV-associated gastric cancer. Lymph node positive EBV-associated gastric cancer has not been systematically studied. The aims of this study were to evaluate EBV-associated gastric cancer, to assess the distribution of EBV infected cells including all positive lymph nodes, and to define the characteristics of EBV-associated gastric cancer. Design The study included primary gastric cancer patients who underwent surgical resection with no preoperative treatment at M.D. Anderson Cancer Center between 1987 and 2006. Formalin-fixed paraffin-embedded tissue from these resection specimens were assessed for EBV by in situ hybridization, the gold standard for EBV detection in tissue. EBV status was analyzed along with clinicopathologic parameters including age, gender, tumor type, lymph node status, and pathologic stage of the tumor. Results Among 235 patients, 12 had intranuclear expression of EBV. EBV staining was seen only in tumor cells and no detectable EBV was observed in normal gastric mucosa, intestinal metaplasia or stromal cells. Eight of 12 patients with EBV-associated gastric cancer had regional lymph node metastasis. Of note, metastatic tumor cells in all of the involved lymph nodes of these 8 cases contained EBV. The epidemiologic data showed 11 of the 12 patients with EBV-associated gastric cancer were men, ranging in age from 54 to 78 years (mean age, 60 years; median age, 62.1 years. The age distribution for non-EBV associated gastric cancer patients ranged from 21 to 93 years (mean age, 67 years; median age, 66.4 years. Conclusion Our study demonstrated that EBV is present exclusively in gastric cancer cells. The detection of EBV in
Matta, Sumathi; Park, Jiwon; Palamaner Subash Shantha, Ghanshyam; Khanna, Rohit C; Rao, Gullapalli N
To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity gender discrimination in terms of outcome continues to be an issue and needs further investigation.
Associations Among Depressive Symptoms, Wellness, Patient Involvement, Provider Cultural Competency, and Treatment Nonadherence: A Pilot Study Among Community Patients Seen at a University Medical Center.
Hooper, Lisa M; Huffman, Lauren E; Higginbotham, John C; Mugoya, George C T; Smith, Annie K; Dumas, Tia N
Treatment nonadherence is a pernicious problem associated with increasing rates of chronic diseases, escalating healthcare costs, and rising mortality in some patients. Although researchers have suggested numerous factors related to treatment nonadherence, several understudied aspects warrant attention, such as primary-care settings, provider cultural competence, and patient involvement. Adding to the research base, the present pilot study examined 88 primarily Black American and White American community patients from a large university medical center in the southern part of the United States. The study explored two research questions: (a) To what extent are there associations among depressive symptoms, wellness, patient involvement, cultural competency, and treatment nonadherence in a racially diverse community patient population? And (b) to what extent do the study exploratory variables and background characteristics predict treatment nonadherence, both separately and jointly? Depressive symptoms, the patient's perception of a provider's cultural competence, and marital/partnered status were found to be statistically significantly associated with treatment nonadherence, but not entirely in the directions expected.
Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto
The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.
Stout, Somava; Zallman, Leah; Arsenault, Lisa; Sayah, Assaad; Hacker, Karen
Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of 12 primary care sites of Cambridge Health Alliance at different stages of PCMH transformation. Bivariate and multivariate analyses of factors associated with teamwork perceptions were conducted. In multivariate models, having effective leadership was the main factor associated with practice teamwork perceptions (odds ratio [OR], 10.49; 95% confidence interval [CI], 5.39-20.43); in addition, practicing at a site in an intermediate stage of PCMH transformation was also associated with enhanced team perceptions (OR, 2.44; 95% CI, 1.28-4.64). In a model excluding effective leadership, respondents at sites in an intermediate stage of PCMH transformation (OR, 1.95; 95% CI, 1.1-3.4) and who had higher care team behaviors (such as huddles and weekly meetings; OR, 3.41; 95% CI, 1.30-8.92), higher care team perceptions (OR, 2.65; 95% CI, 1.15-6.11), and higher job satisfaction (OR, 2.00; 95% CI, 1.02-3.92) had higher practice teamwork perceptions. This study highlights the strong association between effective leadership, care team behaviors and perceptions, and job satisfaction with perceptions that practices operate as real teams. Although we cannot infer causality with these cross-sectional data, this study raises the possibility that providing attention to these factors may be important in augmenting practice teamwork perceptions.
Full Text Available Sexual health status of married women in the reproductive age, one of the most important community health issues. Recent research has highlighted the effects of religious beliefs with sexual life and sexual problem may be mediated This study aimed to investigate the association of religiousness and .through individual differences in spirituality. sexual disorders in a cross-sectional study in women of reproductive . This cross-sectional study was conducted on women aged 15-45 years old referring to Shiraz health centers in 2015 with a sample size of 210. Cluster sampling was done firstly. Then, purpose ful sampling was conducted in each center. Data collection was done using Religious Attitude Questionnaire and Female Sexual Dysfunction index. Correlation coefficient and Fisher's test The mean age of the study population was 30.67±6.60 . were performed for data analysis in SPSS software. According to the findings, 74.3% had sexual dysfunction. Furthermore, the rate of impaired sexual desire was 72.9 % and 62.4% in sexual arousal . Orgasmic disorder was the highest reported sexual dysfunction. There was a statistically significant correlation between religious thoughts and different dimensions of sexual function such as sexual desire (P= 0.005, psychological stimulation (p= 0.05, lubrication (p= 0.02, orgasm (p=0.013, and satisfaction ( p= 0.001. Religious thoughts with dimensions of sexual function (libido, orgasm, etc. was associated.So, the improvement in families and society ’s sexual health could result from the increase in the individuals' knowledge about sex related issues and religious thoughts in this regard. Therefore, sexual health education, in accordance with religious values, is one of the priorities in community health system.
Knebel, J.U.; Sanchez Espinoza, V.H.
The First Ph.D. Student Workshop ''Nuclear Safety Research'' of the Helmholtz Association of National Research Centers (HGF)'' was jointly organized by the Research Center Karlsruhe GmbH and the Energie Baden-Wuerttemberg AG (EnBW) from Wednesday 9th to Friday 11th March 2005. The workshop was opened with welcome greetings by Dr. Peter Fritz, Forschungszentrum Karlsruhe. Subsequently Dr. Joachim U. Knebel explained the main goals and the content of the workshop. The young scientists reported in 28 high-level presentations about their research work which covered a wide spectrum from reactor safety, partitions and transmutation, and innovative reactor systems, to safety research for nuclear waste disposal. The junior researchs showed excellent professional competence and demonstrated presentation qualities at the highest level. The successful funding of two Virtual Institutes, namely: the ''Competence in Nuclear Technologies'' and ''Functional Characteristics of Aquatic Interfaces both co-ordinated by Forschungszentrum Karlsruhe'', by the President of the Helmholtz Association Prof. Walter Kroell was the motivation for the organization of this first Ph.D. Student Workshop. Thanks to these two Virtual Institutes, the Reseach Center Karlsruhe and Juelich together with several univer-sities i.e. RWTH Aachen, Heidelberg, Karlsruhe, Muenster, and Stuttgart, have successfully financed eight Ph.D. and two post-doctoral students. Moreover, young scientists of the European Institute for Transuranium Elements (ITU) and additional seven Ph.D. Students, who are sponsored by the German nuclear industry (Framatome ANP, RWE Power, EnBW) in the frame of the Alliance Competence in on Nuclear Technology, and who are trained at Forschungszentrum Karlsruhe, actively contributed to this workshop. The EnBW-Award was handed over by Dr. Hans-Josef Zimmer, member of the board of directors of the EnBW-Kraftwerksgesellschaft, to Mrs. Ayelet Walter from the University of Stuttgart for the best
Alidina, Shehnaz; Goldhaber-Fiebert, Sara N; Hannenberg, Alexander A; Hepner, David L; Singer, Sara J; Neville, Bridget A; Sachetta, James R; Lipsitz, Stuart R; Berry, William R
Operating room (OR) crises are high-acuity events requiring rapid, coordinated management. Medical judgment and decision-making can be compromised in stressful situations, and clinicians may not experience a crisis for many years. A cognitive aid (e.g., checklist) for the most common types of crises in the OR may improve management during unexpected and rare events. While implementation strategies for innovations such as cognitive aids for routine use are becoming better understood, cognitive aids that are rarely used are not yet well understood. We examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. We conducted a cross-sectional study using a Web-based survey of individuals who had downloaded OR cognitive aids from the websites of Ariadne Labs or Stanford University between January 2013 and January 2016. In this paper, we report on the experience of 368 respondents from US hospitals and ambulatory surgical centers. We analyzed the relationship of more successful implementation (measured as reported regular cognitive aid use during applicable clinical events) with organizational context and with participation in a multi-step implementation process. We used multivariable logistic regression to identify significant predictors of reported, regular OR cognitive aid use during OR crises. In the multivariable logistic regression, small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation (p = 0.0092). Completing more implementation steps was also significantly associated with more successful implementation; each implementation step completed was associated with just over 50% higher odds of more successful implementation (p ≤ 0.0001). More successful implementation was associated with leadership support (p organizational context and following a multi-step implementation process. Building strong organizational support and
Jose E Vidal
Full Text Available Information about resistance profile of darunavir (DRV is scarce in Brazil. Our objectives were to estimate the prevalence of DRV resistance mutations in patients failing protease inhibitors (PI and to identify factors associated with having more DRV resistance mutations. All HIV-infected patients failing PI-based regimens with genotyping performed between 2007 and 2008 in a referral teaching center in São Paulo, Brazil, were included. DRV-specific resistance mutations listed by December 2008 IAS-USA panel update were considered. Two Poisson regression models were constructed to assess factors related to the presence of more DRV resistance mutations. A total of 171 HIV-infected patients with available genotyping were included. The number of patients with lopinavir, saquinavir, and amprenavir used in previous regimen were 130 (76%, 83 (49%, and 35 (20%, respectively. The prevalence of major DRV resistance mutations was 50V: 5%; 54M: 1%; 76V: 4%; 84V: 15%. For minor mutations, the rates were 11I: 3%; 32I: 7%; 33F: 23%; 47V: 6%; 54L: 6%; 74P: 3%; 89V: 6%. Only 11 (6% of the genotypes had > 3 DRV resistance mutations. In the clinical model, time of HIV infection of > 10 years and use of amprenavir were independently associated with having more DRV resistance mutations. In the genotyping-based model, only total number of PI resistance mutations was associated with our outcome. In conclusion, the prevalence of DRV mutations was low. Time of HIV infection, use of amprenavir and total number of PI resistance mutations were associated with having more DRV mutations.
Demirkan, A; Lahti, J; Direk, N; Viktorin, A; Lunetta, K L; Terracciano, A; Nalls, M A; Tanaka, T; Hek, K; Fornage, M; Wellmann, J; Cornelis, M C; Ollila, H M; Yu, L; Smith, J A; Pilling, L C; Isaacs, A; Palotie, A; Zhuang, W V; Zonderman, A; Faul, J D; Sutin, A; Meirelles, O; Mulas, A; Hofman, A; Uitterlinden, A; Rivadeneira, F; Perola, M; Zhao, W; Salomaa, V; Yaffe, K; Luik, A I; Liu, Y; Ding, J; Lichtenstein, P; Landén, M; Widen, E; Weir, D R; Llewellyn, D J; Murray, A; Kardia, S L R; Eriksson, J G; Koenen, K; Magnusson, P K E; Ferrucci, L; Mosley, T H; Cucca, F; Oostra, B A; Bennett, D A; Paunio, T; Berger, K; Harris, T B; Pedersen, N L; Murabito, J M; Tiemeier, H; van Duijn, C M; Räikkönen, K
Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains. We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons). One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (p discovery = 3.82 × 10-8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (p discovery+replication = 1.10 × 10-6) with evidence of heterogeneity. Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings.
Ho, Gwendolyn; Wun, Ted; Muffly, Lori; Li, Qian; Brunson, Ann; Rosenberg, Aaron S; Jonas, Brian A; Keegan, Theresa H M
To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis). Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs. The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society. © 2018 American Cancer Society.
This study aimed to identify the work-related stress and its subsequent problems among teachers of the public schools which operated the school-based Violence Reduction Program (VRP) in the governorate of Tulkarm during the second semester of 2015-2016. Besides, it aimed to identify the effect of specific variables, such as gender, specialization,…
Conditions in higher education in Michigan and the role of the Governor's Commission on the Future of Higher Education in Michigan are highlighted. The average college tuition rate in Michigan is the highest in the nation, and a critical maintenance and equipment problem exists. The Commission is composed of knowledgeable persons without vested…
There are major structural issues in the higher education system in Pakistan leading to poor governance of institutions and questionable quality of education. This paper looks at the differences in the role of boards of governors in maintaining quality of education in both the public and the private sector universities in Pakistan. After having…
Menazel, Basil H.
The study aimed to identify the use of educational technology in social studies teaching and the obstacles to availability and use of educational technology in teaching social studies at schools in the North West Badiya Education Directorate in Mafraq governorate, the Hashemite Kingdom of Jordan. The study population comprised of 137 male and…
Campêlo, Selva Rios; Barbosa, Maria Alves; Dias, Danilo Rocha; Caixeta, Camila Cardoso; Leles, Cláudio Rodrigues; Porto, Celmo Celeno
Quality of life must be one of the main purposes for the treatment of drug users, requiring a better understanding of the association between the quality of life and the severity of dependency. This study aimed to investigate the correlation between severity of substance use in various areas of human functioning and quality of life of illicit drug users in a psychosocial care center for alcohol and drugs. This cross-sectional study included 60 participants - illicit drug users - treated at a psychosocial care center for alcohol and drugs. Participants were evaluated with the short version of World Health Organization Quality of Life (WHOQOL-Bref) instrument to measure the quality of life, the 6th version of Addiction Severity Index (ASI-6) to assess the severity of dependence in several areas and the Mini International Neuropsychiatric Interview (MINI) to identify the presence of psychiatric disorders. Pearson and Spearman correlation tests and linear regression were applied to verify the association between the severity of dependence and the quality of life, and Student's t-test to compare the mean quality of life between individuals with and without psychiatric comorbidities. Negative correlation was found between the severity of dependence on the drugs dimensions: alcohol, psychiatric, medical, legal, family/social support and family/social problems of ASI-6, and the quality of life domains measured by the WHOQOL-Bref. The evidence was strongest in the psychiatric and medical dimensions. There was a significant difference in the quality of life mean among participants presenting or not presenting psychiatric comorbidities, for the psychological domain in anxiety disorders, and for the physical and psychological domains in mood disorders. The quality of life decreased as the severity of dependence increased, with different results in the various areas of the participant's life. This result emphasizes the need for training the professional team which works in the
Song, Won O; Song, SuJin; Nieves, Violeta; Gonzalez, Andie; Crockett, Elahé T
Children enrolled in Migrant and Seasonal Head Start (MSHS) programs are at high risks of health problems. Although non-family child care providers play important roles on children's health status as role models, educators, program deliverers, and information mediators, little is known about their nutritional health attitudes and behaviors, and weight status. Therefore, we investigated nutritional health attitudes and behaviors and their associations with overweight/obesity among child care providers in Michigan MSHS centers. A total of 307 child care providers aged ≥ 18 years working in 17 Michigan MSHS centers were included in this cross-sectional study conducted in 2013. An online survey questionnaire was used to collect data on nutritional health attitudes and behaviors of child care providers. Weight status was categorized into normal weight (18.5 ≤ BMI obese (BMI ≥ 30 kg/m(2)) based on child care providers' self-reported height and weight. Factor analysis was performed to investigate patterns of nutritional health attitudes and behaviors. Multivariate logistic regression was conducted to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs) of overweight/obesity across tertiles of pattern scores taking the lowest tertile group as the reference group after adjustment for potential confounding variables. Three patterns of nutritional health attitudes and behaviors were identified: pattern 1) "weight loss practices with weight dissatisfaction", pattern 2) "healthy eating behaviors", and pattern 3) "better knowledge of nutrition and health". The pattern 1 scores were positively associated with overweight/obesity (Tertile 2 vs. Tertile 1: OR = 5.81, 95 % CI = 2.81-12.05; Tertile 3 vs. Tertile 1: OR = 14.89, 95 % CI = 6.18-35.92). Within the pattern 2, the OR for overweight/obesity in individuals with the highest scores was 0.37 (95 % CI = 0.19-0.75) compared with those with the lowest scores. However, the
Sigler, Lauren M; Baccetti, Tiziano; McNamara, James A
Our aim was to investigate the effect of rapid maxillary expansion and transpalatal arch therapy combined with deciduous canine extraction on the eruption rate of palatally displaced canines (PDCs) in patients in the late mixed dentition in a 2-center prospective study. Seventy subjects were enrolled based on PDCs diagnosed on panoramic radiographs. The treatment group (TG, 40 subjects) underwent RME followed by TPA therapy and extraction of the deciduous canines. The control group (CG, 30 subjects) received no orthodontic treatment. At the start of the trial, panoramic radiographs and dental casts were compared between the TG and the CG with the Mann-Whitney U test (P anomalies was reported. No statistically significant difference was found for any measurement at the start of the trial between the 2 groups. The prevalence rates of eruption of the maxillary canines were 80% for the TG and 28% in the CG, a statistically significant difference (chi-square =16.26, P mixed dentition with PDCs. Pretreatment variables indicating success of treatment on the eruption of PDCs were less severe sectors of displacement, prepubertal stages of skeletal maturity, and open root apices of PDCs. Several dental anomalies were associated significantly with PDCs, thus confirming the genetic etiology of this eruption disturbance. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.
Sendhilkumar, Muthappan; Tripathy, Jaya Prasad; Harries, Anthony D.; Dongre, Amol R.; Deepa, Mohan; Vidyulatha, Ashok; Poongothai, Subramanian; Venkatesan, Ulaganathan; Anjana, Ranjit Mohan; Mohan, Viswanathan
Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. Results: The prevalence of high/very high stress was 35% among DM patients. Age 30–40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. Conclusions: This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity. PMID:28217499
Full Text Available Objective: We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. Methods: A mixed-methods (triangulation design study with quantitative methodology (survey and qualitative methodology (interviews was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. Results: The prevalence of high/very high stress was 35% among DM patients. Age 30–40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. Conclusions: This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity.
Sendhilkumar, Muthappan; Tripathy, Jaya Prasad; Harries, Anthony D; Dongre, Amol R; Deepa, Mohan; Vidyulatha, Ashok; Poongothai, Subramanian; Venkatesan, Ulaganathan; Anjana, Ranjit Mohan; Mohan, Viswanathan
We aimed to determine perceived stress levels among adults aged >20 years with type 2 diabetes mellitus (DM) in a tertiary care diabetes center, Chennai, Tamil Nadu, India, assess their association with sociodemographic and clinical characteristics and assess the possible risk factors for stress and coping strategies. A mixed-methods (triangulation design) study with quantitative methodology (survey) and qualitative methodology (interviews) was carried out. Stress levels were assessed among type 2 DM patients attending a diabetes clinic using a 5-point perceived stress scale-10. One-on-one interviews were carried out with 376 participants with DM having high/very high stress levels to understand the reasons for perceived stress and explore their coping mechanisms. The prevalence of high/very high stress was 35% among DM patients. Age 30-40 years, working in professional jobs, and lack of physical activity were factors significantly associated with stress. The perceived major stress inducers were related to family, work, financial issues, and the disease itself. This study showed high levels of stress in more than one-third of DM patients. Potential solutions include regular, formal assessment of stress levels in the clinic, providing integrated counseling and psychological care for DM patients, and promoting physical activity.
Oh, Hyunsung; Ell, Kathleen
This study examined whether changes in depressive symptoms and social support prospectively predicted diabetes management among Hispanic patients with probable depression in patient-centered medical homes at safety-net clinics in East Los Angeles, CA. Data were collected from 251 patients enrolled in a randomized clinical trial testing the effectiveness of a promotora-assisted self-management intervention. Cross-lagged analyses examined associations between changes in depression symptoms and social support between baseline and 6-month follow-up and self-efficacy and adherence to diabetes management at the 6- and 12-month follow-ups. Changes in depressive symptoms predicted self-efficacy and level of adherence at the 6- and 12-month follow-ups. Changes in total social support and emotional social support were correlated only with self-efficacy regarding diabetes management at 6-month follow-up. Decline in depressive symptoms is a reliable predictor of improvement in self-efficacy and adherence to diabetes management. Further studies are recommended to study psychosocial mechanisms related to social relationships other than social support that affect diabetes management. © 2018 by the American Diabetes Association.
Selby, Luke V; Rifkin, Marissa B; Yoon, Sam S; Ariyan, Charlotte E; Strong, Vivian E
Standardization of postoperative care has been shown to decrease postoperative length of stay. In June 2009, we standardized postoperative care for all gastrectomies at our institution. Four years' worth of total gastrectomies (2 years prior to standardization and 2 years after standardization) were reviewed to determine the effect of standardization on postoperative care, length of stay, complications, and readmissions. Between June 2007 and July 2011, 99 patients underwent curative intent open total gastrectomy: 51 patients prior to standardization, and 48 patients poststandardization. Patients were predominantly male (70%); median age was 63; and median body mass index was 26. Standardization of postoperative care was associated with a decrease in median time to beginning both clear liquids and a postgastrectomy diet, earlier removal of epidural catheters, earlier use of oral pain medication, less time receiving intravenous fluids, and decreased length of stay (all P Care Center, or readmission. Institution of standardized postoperative orders for total gastrectomy was associated with a significantly decreased length of stay and earlier oral feeding without increasing postoperative complications, early postoperative outpatient visits, or readmissions. Copyright © 2016 Elsevier Inc. All rights reserved.
Mérida R. Rodríguez
Full Text Available Objective: this study’s goal was to determine the most prevalent mental disorders and the impact on the perception of disability and suicidal ideation among the population from a primary health care center in the city of Cali. Methodology: a cross sectional study was conducted on 254 patients who were screened with the prime-md instrument. Descriptive statistics was used in the analysis to determine the most frequent disorders. Similarly, a multiple analysis with logistic and Poisson regressions using robust variance was conducted to determine the influence of mental disorders on disability and suicidal ideation. Results: most patients were female, young, and mature adults. Depression was present in 66.8% of all cases, followed by somatization disorder and anxiety. Half of the patients had had suicidal ideations at some point in their lives, and three out of four patients claimed to suffer from some kind of disability. Upon adjusting for the covariables, depression and anxiety disorders had a strong association with suicidal ideation and perceived disability that was overestimated by the logistic regression. Conclusion: depression and anxiety were the most common disorders and showed a strong association with suicidal ideation and disability. This is why it is necessary to screen for those disorders among adults using primary health care services. Likewise, we suggest considering Poisson regression with robust variance in cross-sectional studies in health services.
Konstantin V. Taran
Full Text Available This article discusses the activity of far-left organizations across Black Sea Governorate in 1907–1909. During this period, the bodies of internal affairs detected in the region a subversive activity of SR Maximalists, Communist Anarchists, and other terrorist groups. The activity of these destructive forces would come down to the physical liquidation of government officials, representatives of right parties, as well as extortion of money from merchants. The author comes to the conclusion that in Novorossiysk the two-year period following the end of the First Russian Revolution saw the party organizations of Social Democrats, Socialist Revolutionaries, Maximalists, Anarchists, etc., to virtually degrade and take on forms of organized criminal groups.
Sirdah, M M; Al Laham, N A; El Madhoun, R A
Liquefied petroleum gas (LPG) is widely used in the Gaza Strip for domestic purposes, in agriculture and industry and, illegally, in cars. This study aimed to identify possible health effects on workers exposed to LPG in Gaza governorates. Data were collected by a questionnaire interview, and haematological and biochemical analyses of venous blood samples were made from 30 workers at filling and distribution stations and 30 apparently healthy controls. Statistically significant differences were found in all self-reported health-related complaints among LPG workers versus controls. LPG workers had significantly higher values of red blood cell counts, haemoglobin, haematocrit mean corpuscular haemoglobin and platelet counts. They also had significantly higher values of kidney function tests (urea, creatinine and uric acid) and liver function enzyme activities (aspartate aminotransferase and alanine aminotransferase). LPG workers at Gaza Strip petroleum stations are at higher risk for health-related symptoms and clinical abnormalities.
Al Antary, Tawfiq M; Alawi, Mahmoud A; Estityah, Hussein; Haddad, Nizar
One hundred samples of mother breast milk were gathered from six middle governorates and districts in Jordan in 2013/2014 to monitor Organochlorine pesticides pollutants. The results showed clearly that banned organochlorine pesticides are still detected in the monitored samples in low concentration despite banning of these persistent pollutants in Jordan since 36 years ago. However, the results indicated that 1% of the contaminated samples contained β-HCH, 5% γ-HCH, 3% p,p'-DDD, 2% heptachlor, 45% p,p'-DDE and 3% p,p'-DDT. In addition, these monitored samples had no residues of aldrin, dieldrin, α-endosulfan, β-endosulfan, HCB, o,p'-DD, o,p'-DDT and o,p'-DDE. In conclusion, there was a decline in the residues of Organochlorine pesticides, particularly DDT group members.
the DPRK informed the Agency that it had decided to cease all cooperation with the IAEA, to request IAEA personnel to remove all Agency containment and surveillance equipment from the Yongbyon facilities and to require Agency inspectors to leave the DPRK. The Agency has been able to continue to verify the non-diversion of declared nuclear material in Iran. Regrettably, however, Iran has not implemented any of the measures called for by the Security Council and by the Agency's Board of Governors. And there has been no movement by Iran on outstanding issues which need to be clarified to exclude the possibility of military dimensions to Iran's nuclear programme. Syria is urged to be fully cooperative and transparent, to provide the additional information and documentation requested by the Agency and to grant access to other locations, including those relevant for the sampling of destroyed and salvaged equipment and debris from the Dair Alzour site. The Director General informed about a proposal on establishing a low enriched uranium (LEU) reserve under Agency auspices, which I have put forward for your consideration, as well as a proposal from the Russian Federation in support of the idea of an assurance of supply mechanism. His proposal is rooted in the Agency Statute and envisages the Agency providing LEU as a fall-back service to Member States. The purpose of the IAEA LEU bank and of the Russian proposal is to provide assurance of supply over and above countries' existing rights. It does not limit countries' rights in any way but is intended to avoid a repeat of the type of disruption for political reasons seen in the past. The proposed Agency LEU bank would be a physical stockpile of LEU at the disposal of the Agency as a last-resort reserve for countries with nuclear power programmes which face a supply disruption for non-commercial reasons. The Russian initiative to set up an LEU reserve for the supply of LEU to the Agency is fully funded by the Russian Federation
In its introductory statement to the Board of Governors, 06 March 2006, the Director General of the IAEA discussed some issues on nuclear technology, safety and verification - all three of the Agency's areas of activity. He emphasized that, in recent years, expectations for nuclear power as an energy source have been rising measurably. The outlook for nuclear power takes different forms in countries and regions. Research continues on advanced reactor designs - both evolutionary and innovative - with improvements sought in three principal areas: cost reductions, safety enhancements and proliferation resistance. In addition to a broad array of national projects, the Generation IV International Forum and the Agency's International Project on Nuclear Reactors and Fuel Cycles (INPRO) are helping to promote evaluation of and cooperative research on innovative nuclear energy designs. The United States of America also recently launched its 'Global Nuclear Energy Partnership', focused on developing proliferation-resistant recycling technologies and reactor systems that would facilitate the use of nuclear energy by developing countries. For nuclear energy to be a viable option for more countries, the international community will also need innovation in terms of policy and infrastructure development. One example is for the international nuclear community to become more creative in developing regional approaches to energy needs. Regional approaches might be useful in addressing a number of issues that have made nuclear energy impractical for some countries, including: electrical grid capacity, upfront capital costs, infrastructure and workforce needs, design certification, licensing and operation. In this regard, I would note the announcement last week, by the Prime Ministers of Estonia, Latvia and Lithuania, of their intention to cooperate in building a new nuclear plant and integrating the Baltic electricity market. Such regional approaches are also consistent with concepts
In his introductory Statement to the Board of Governors Dr. Mohamed ElBaradei, Director General of the IAEA, reports on all areas of IAEA's activity, namely technology, safety and security, and verification. It includes the Agency's International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO) which has grown to include 27 members. PACT needs funding to support its activities until it achieves the level of extrabudgetary funding needed to be self-sufficient; safety standards the quality of thereof has notably improved, and identified gaps in coverage are being addressed by new standards; safety review services use the IAEA Safety Standards as a reference point, and play an important part in evaluating their effectiveness; Integrated Regulatory Review Service (IRRS) combines a number of previous services, on topics ranging from radiation safety and transport safety to emergency preparedness and nuclear security; projects on radiological protection of patients; the Agency has undertaken to strengthen its Incident and Emergency Centre to better support Member States in dealing with both accidents and security incidents; the Agency's nuclear security programme continues to progress at a rapid pace. To assist Member States in implementing the variety of international instruments relevant to nuclear security, guidance is being developed and published as part of a new IAEA Nuclear Security Series; results of missions have provided valuable inputs for the development of Integrated Nuclear Security Support Plans (INSSPs) for individual countries; nuclear security training courses were provided, detection and monitoring equipment procured to improve the security of nuclear power plants and other installations; and assistance in protecting locations containing high activity radioactive sources; the Agency has worked with the Russian Federation and the United States of America on a tripartite initiative to secure and manage radioactive sources in countries of
Hegazy, Yamen M; Moawad, Amgad; Osman, Salama; Ridler, Anne; Guitian, Javier
Brucellosis is a neglected tropical zoonosis allegedly reemerging in Middle Eastern countries. Infected ruminants are the primary source of human infection; consequently, estimates of the frequency of ruminant brucellosis are useful elements for building effective control strategies. Unfortunately, these estimates are lacking in most Middle East countries including Egypt. Our objectives are to estimate the frequency of ruminant brucellosis and to describe its spatial distribution in Kafr El Sheikh Governorate, Nile Delta, Egypt. We conducted a cross-sectional study in which 791 sheep, 383 goats, 188 cattle milk tanks and 173 buffalo milk tanks were randomly selected in 40 villages and tested for the presence of antibodies against Brucella spp. The seroprevalence among different species was estimated and visualized using choropleth maps. A spatial scanning method was used to identify areas with significantly higher proportions of seropositive flocks and milk tanks. We estimated that 12.2% of sheep and 11.3% of goats in the study area were seropositive against Brucella spp. and that 12.2% and 12% of cattle and buffalo milk tanks had antibodies against Brucella spp. The southern part of the governorate had the highest seroprevalence with significant spatial clustering of seropositive flocks in the proximity of its capital and around the main animal markets. Our study revealed that brucellosis is endemic at high levels in all ruminant species in the study area and questions the efficacy of the control measures in place. The high intensity of infection transmission among ruminants combined with high livestock and human density and widespread marketing of unpasteurized milk and dairy products may explain why Egypt has one of the highest rates of human brucellosis worldwide. An effective integrated human-animal brucellosis control strategy is urgently needed. If resources are not sufficient for nationwide implementation, high-risk areas could be prioritized.
Yamen M Hegazy
Full Text Available BACKGROUND: Brucellosis is a neglected tropical zoonosis allegedly reemerging in Middle Eastern countries. Infected ruminants are the primary source of human infection; consequently, estimates of the frequency of ruminant brucellosis are useful elements for building effective control strategies. Unfortunately, these estimates are lacking in most Middle East countries including Egypt. Our objectives are to estimate the frequency of ruminant brucellosis and to describe its spatial distribution in Kafr El Sheikh Governorate, Nile Delta, Egypt. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional study in which 791 sheep, 383 goats, 188 cattle milk tanks and 173 buffalo milk tanks were randomly selected in 40 villages and tested for the presence of antibodies against Brucella spp. The seroprevalence among different species was estimated and visualized using choropleth maps. A spatial scanning method was used to identify areas with significantly higher proportions of seropositive flocks and milk tanks. We estimated that 12.2% of sheep and 11.3% of goats in the study area were seropositive against Brucella spp. and that 12.2% and 12% of cattle and buffalo milk tanks had antibodies against Brucella spp. The southern part of the governorate had the highest seroprevalence with significant spatial clustering of seropositive flocks in the proximity of its capital and around the main animal markets. CONCLUSIONS/ SIGNIFICANCE: Our study revealed that brucellosis is endemic at high levels in all ruminant species in the study area and questions the efficacy of the control measures in place. The high intensity of infection transmission among ruminants combined with high livestock and human density and widespread marketing of unpasteurized milk and dairy products may explain why Egypt has one of the highest rates of human brucellosis worldwide. An effective integrated human-animal brucellosis control strategy is urgently needed. If resources are not
Walter, Frank G; Stolz, Uwe; Shirazi, Farshad; McNally, Jude
The only U.S. Food and Drug Administration-approved coral snake antivenom was officially discontinued in 2007, causing ever-diminishing supplies. This study describes the severity of U.S. coral snakebites during the last 25 years to determine trends in annual rates of these bites' medical outcomes. This study retrospectively analyzed all human coral snakebites voluntarily reported by the public and/or health care professionals to poison centers that were subsequently published in the Annual Reports of the American Association of Poison Control Centers (AAPCC) from 1983 through 2007. Annual rates of medical outcomes from coral snakebites were calculated by dividing the annual number of people bitten by coral snakes who developed fatal, major, moderate, minor, or no effect outcomes by the total annual number of people bitten by coral snakes. Negative binomial regression was used to examine trends in annual rates. From 1983 through 2007, the incidence rate of coral snakebites producing no effects significantly decreased by 4.7% per year [incidence rate ratio (IRR) = 0.953; 95% confidence interval (CI) = 0.920-0.987]. From 1985 through 2007, the incidence rates of minor and major outcomes did not significantly change; however, moderate outcomes significantly increased by 3.4% per year (IRR = 1.034; 95% CI = 1.004-1.064). No fatalities were reported from 1983 through 2007. Annual rates of coral snakebites producing no effects significantly decreased and those producing moderate outcomes significantly increased in our analyses of data from the last 25 years of published AAPCC Annual Reports. This study has important limitations that must be considered when interpreting these conclusions.
Kleinaltenkamp, Michael; Plewa, Carolin; Gudergan, Siegfried
Purpose: The purpose of this paper is to advance extant theorizing around resourceintegration by conceptualizing and delineating the notion of a usage center. Ausage center consists of a combination of interdependent actors that draw onresources across their individual usage processes to create v...
Zarrouq, B; Bendaou, B; El Asri, A; Achour, S; Rammouz, I; Aalouane, R; Lyoussi, B; Khelafa, S; Bout, A; Berhili, N; Hlal, H; Najdi, A; Nejjari, C; El Rhazi, K
Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region. A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses. A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family. The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.
Bone, Curtis W; Goodfellow, Amelia M; Vahidi, Mani; Gelberg, Lillian
Sexual violence (SV) is common; however, the prevalence of SV and its long term sequela vary geographically and among subpopulations within the USA. As such, the aims of this study are the following: (1) to determine the prevalence of SV, (2) to identify correlates of SV, and (3) to determine if SV is associated with depression among male and female risky drug users in urban Federally Qualified Health Centers (FQHCs) in Los Angeles. This study includes adult patients of five urban FQHCs who self-reported risky drug use. We identified survivors of SV and those experiencing depression through survey questions that queried, before or after age 18, "Were you ever sexually assaulted, molested or raped?" and with the RAND Mental Health Index (MHI-5). We utilized Pearson's chi-square tests to assess predictors of SV and logistic regression to assess for an association between SV and depression. Data collection took place from February 2011 to November 2012. Of the 334 study patients, 49% of females and 25% of males reported surviving SV. Exposure to SV, (both before 18 years of age and after 18 years of age) was the strongest predictor of depression among men and women in this study (OR 4.7, p < 0.05). These data demonstrate that sexual violence is prevalent in this urban FQHC population and is strongly associated with depression. Providers should consider screening both men and women with risky drug use for SV while health systems should continue to align mental health and primary care services to appropriately care for these extremely vulnerable patients. Trial Registration Clinical Trials. gov ID NCT01942876, Protocol ID DESPR DA022445, http://www.clinicaltrials.gov.
Brown, Carlos V R; Teixeira, Pedro G; Furay, Elisa; Sharpe, John P; Musonza, Tashinga; Holcomb, John; Bui, Eric; Bruns, Brandon; Hopper, H Andrew; Truitt, Michael S; Burlew, Clay C; Schellenberg, Morgan; Sava, Jack; VanHorn, John; Eastridge, Pa-C Brian; Cross, Alicia M; Vasak, Richard; Vercruysse, Gary; Curtis, Eleanor E; Haan, James; Coimbra, Raul; Bohan, Phillip; Gale, Stephen; Bendix, Peter G
Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three
Full Text Available Abstract Background Data on psychoactive substance (PAS consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region. Methods A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11–23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses. Results A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family. Conclusions The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive
Full Text Available Self-control is considered broadly important for many domains of life. One of its unfortunate features, however, is that it tends to wane over time, with little agreement about why this is the case. Recently, there has been a push to address this problem by looking to the literature in exercise physiology, specifically the work on the central governor model of physical fatigue. Trying to explain how and why mental performance wanes over time, the central governor model suggests that exertion is throttled by some central nervous system mechanism that receives information about energetic bodily needs and motivational drives to regulate exertion and, ultimately, to prevent homeostatic breakdown, chiefly energy depletion. While we admire the spirit of integration and the attempt to shed light on an important topic in psychology, our concern is that the central governor model is very controversial in exercise physiologists, with increasing calls to abandon it altogether, making it a poor fit for psychology. Our concerns are threefold. First, while we agree that preservation of bodily homeostasis makes for an elegant ultimate account, the fact that such important homeostatic concerns can be regularly overturned with even slight incentives (e.g., a smile renders the ultimate account impotent and points to other ultimate functions for fatigue. Second, despite the central governor being thought to take as input information about the metabolic needs of the body, there is no credible evidence that mental effort actually consumes inordinate amounts of energy that are not already circulating in the brain. Third, recent modifications of the model make the central governor appear like an all-knowing homunculus and unfalsifiable in principle, thus contributing very little to our understanding of why people tend to disengage from effortful tasks over time. We note that the latest models in exercise physiology have actually borrowed concepts and models from
Engel, R M
The Didusch Center for Urologic History encompasses a rich and varied collection of drawings, photographs, and instruments of historical importance to urology, many displayed in the urological exhibits during the American Urological Association (AUA) conventions. The Center also houses a library devoted to urological and early medical texts and the AUA archives and is the institution of research in all fields of urologic history in the USA. The museum collection features most of Didusch's original drawings, as well as an impressive instrument collection acquired primarily through donations by urologists. The original William P. Didusch Museum (now known as the William P. Didusch Center for Urologic History) was originally housed in the AUA's Baltimore City headquarters building. Upon the association's move to Linthicum, MD in 2003, the museum has evolved into the William P. Didusch Center for Urologic History and taken on new tasks and responsibilities that include the topic of research in urologic history.
Full Text Available Background. Globally, about 47.4% of children under five are suffering from anemia. In Ethiopia, 60.9% of children under two years are suffering from anemia. Anemia during infancy and young childhood period is associated with poor health and impaired cognitive development, leading to reduced academic achievement and earnings potential in their adulthood life. However, there is scarcity of information showing the magnitude of iron deficiency anemia among young children in Ethiopia. Therefore, this study aimed at assessing prevalence and associated factors of iron deficiency anemia among children under two (6–23 months. Methods. Institution based cross-sectional study was carried out from March to May, 2014, at Tsitsika Health Center in Wag-Himra Zone, Northeast Ethiopia. Systematic random sampling technique was employed. Automated hemoglobin machine was used to determine the hemoglobin level. Socioeconomic and demographic data were collected by using a pretested and structured questionnaire. Binary logistic regression analysis was used to identify associated factors and odds ratio with 95% CI was computed to assess the strength of association. Results. Total of 347 children participated in this study. The overall prevalence of anemia was 66.6%. In multivariate logistic regression analysis, male sex (AOR = 3.1 (95% CI: 1.60–5.81, 9–11 months of age (AOR = 9.6 (95% CI: 3.61–25.47, poor dietary diversity (AOR = 3.2 (95% CI: 1.35–7.38, stunting (AOR = 2.7 (95% CI: 1.20–6.05, diarrhea (AOR = 4.9 (1.63–14.59, no formal education (AOR = 2.6 (95% CI: 1.26–5.27, early initiation of complementary food (AOR = 11.1 (95% CI: 4.08–30.31, and lowest wealth quintile (AOR = 3.0 (95% CI: 1.01–8.88 were significantly associated with anemia. Conclusion. The overall prevalence of anemia among children who aged 6–23 months has sever public health importance in the study area. Integrated efforts need to be prioritized to improve health as well as
Doubova, Svetlana V; Guanais, Frederico C; Pérez-Cuevas, Ricardo; Canning, David; Macinko, James; Reich, Michael R
This study evaluated primary care attributes of patient-centered care associated with the public perception of good quality in Brazil, Colombia, Mexico and El Salvador. We conducted a secondary data analysis of a Latin American survey on public perceptions and experiences with healthcare systems. The primary care attributes examined were access, coordination, provider-patient communication, provision of health-related information and emotional support. A double-weighted multiple Poisson regression with robust variance model was performed. The study included between 1500 and 1503 adults in each country. The results identified four significant gaps in the provision of primary care: not all respondents had a regular place of care or a regular primary care doctor (Brazil 35.7%, Colombia 28.4%, Mexico 22% and El Salvador 45.4%). The communication with the primary care clinic was difficult (Brazil 44.2%, Colombia 41.3%, Mexico 45.1% and El Salvador 56.7%). There was a lack of coordination of care (Brazil 78.4%, Colombia 52.3%, Mexico 48% and El Salvador 55.9%). Also, there was a lack of information about healthy diet (Brazil 21.7%, Colombia 32.9%, Mexico 16.9% and El Salvador 20.8%). The public's perception of good quality was variable (Brazil 67%, Colombia 71.1%, Mexico 79.6% and El Salvador 79.5%). The primary care attributes associated with the perception of good quality were a primary care provider 'who knows relevant information about a patient's medical history', 'solves most of the health problems', 'spends enough time with the patient', 'coordinates healthcare' and a 'primary care clinic that is easy to communicate with'. In conclusion, the public has a positive perception of the quality of primary care, although it has unfulfilled expectations; further efforts are necessary to improve the provision of patient-centered primary care services in these four Latin American countries. © The Author 2016. Published by Oxford University Press. All rights reserved. For
Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.
Nelson, Karin M; Helfrich, Christian; Sun, Haili; Hebert, Paul L; Liu, Chuan-Fen; Dolan, Emily; Taylor, Leslie; Wong, Edwin; Maynard, Charles; Hernandez, Susan E; Sanders, William; Randall, Ian; Curtis, Idamay; Schectman, Gordon; Stark, Richard; Fihn, Stephan D
In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. To create an index that measures the extent of PCMH implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. We conducted an observational study using data on more than 5.6 million veterans who received care at 913 VHA hospital-based and community-based primary care clinics and 5404 primary care staff from (1) VHA clinical and administrative databases, (2) a national patient survey administered to a weighted random sample of veterans who received outpatient care from June 1 to December 31, 2012, and (3) a survey of all VHA primary care staff in June 2012. Composite scores were constructed for 8 core domains of PACT: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and team-based care. Patient satisfaction, rates of hospitalization and emergency department use, quality of care, and staff burnout. Fifty-three items were included in the PACT Implementation Progress Index (Pi2). Compared with the 87 clinics in the lowest decile of the Pi2, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs 7.53; P hospitalization rates for ambulatory care-sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P < .001), and lower emergency department use (188 vs 245 visits per 1000 patients; P < .001). The extent of PCMH implementation, as measured by the Pi2, was highly associated with important outcomes for both
Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011-2014.
Weiner, Lindsey M; Webb, Amy K; Limbago, Brandi; Dudeck, Margaret A; Patel, Jean; Kallen, Alexander J; Edwards, Jonathan R; Sievert, Dawn M
OBJECTIVE To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred in 2011-2014 and were reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network. METHODS Data from central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical site infections were analyzed. These HAIs were reported from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities. Pooled mean proportions of pathogens that tested resistant (or nonsusceptible) to selected antimicrobials were calculated by year and HAI type. RESULTS Overall, 4,515 hospitals reported that at least 1 HAI occurred in 2011-2014. There were 408,151 pathogens from 365,490 HAIs reported to the National Healthcare Safety Network, most of which were reported from acute care hospitals with greater than 200 beds. Fifteen pathogen groups accounted for 87% of reported pathogens; the most common included Escherichia coli (15%), Staphylococcus aureus (12%), Klebsiella species (8%), and coagulase-negative staphylococci (8%). In general, the proportion of isolates with common resistance phenotypes was higher among device-associated HAIs compared with surgical site infections. Although the percent resistance for most phenotypes was similar to earlier reports, an increase in the magnitude of the resistance percentages among E. coli pathogens was noted, especially related to fluoroquinolone resistance. CONCLUSION This report represents a national summary of antimicrobial resistance among select HAIs and phenotypes. The distribution of frequent pathogens and some resistance patterns appear to have changed from 2009-2010, highlighting the need for continual, careful monitoring of these data across the spectrum of HAI types. Infect Control Hosp Epidemiol 2016;1-14.
Helfrich, Christian D; Dolan, Emily D; Simonetti, Joseph; Reid, Robert J; Joos, Sandra; Wakefield, Bonnie J; Schectman, Gordon; Stark, Richard; Fihn, Stephan D; Harvey, Henry B; Nelson, Karin
A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed. To determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT). Web-based, cross-sectional survey and administrative data from May 2012. A total of 4,539 VA primary care personnel from 588 VA primary care clinics. The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity. Overall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout. Lower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.
Derso, Adane; Nibret, Endalkachew; Munshea, Abaineh
Parasitic infections affect tens of millions of pregnant women worldwide, and directly or indirectly lead to a spectrum of adverse maternal and fetal/placental effects. The objective of this study was to assess the prevalence of intestinal parasite infections and associated risk factors among pregnant women attending antenatal care center in Felege Hiwot Referral Hospital, Bahir Dar city, northwest Ethiopia. A cross-sectional hospital based study was conducted from November 2013 to January 2014 among 384 pregnant women. Stool samples were examined for the presence of trophozoites, cysts, oocysts, and ova using direct, formal-ether sedimentation, and modified Ziehl-Neelsen techniques. An overall prevalence of 31.5 % intestinal parasite infections was recorded. Eight different species of intestinal parasites were found: two protozoan and six helminth species. The highest prevalence was due to Giardia lamblia (13.3 %) followed by Entamoeba histolytica/dispar (7.8 %), hookworm (5.5 %), Ascaris lumbricoides (2.9 %), Schistosoma mansoni (2.9 %), Strongyloides stercoralis (1.6 %), Taenia spp. (0.8 %), and Hymenolepis nana (0.3 %). A relatively high prevalence of intestinal parasite infections was observed among pregnant women. Routine stool examination and provision of health education are required for early medical intervention that would affect the pregnant mothers and their foetuses.
Frey, Stefan; Reschka, Eva J; Pöggeler, Stefanie
The striatin-interacting phosphatase and kinase (STRIPAK) complex is composed of striatin, protein phosphatase PP2A and protein kinases that regulate development in animals and fungi. In the filamentous ascomycete Sordaria macrospora, it is required for fruiting-body development and cell fusion. Here, we report on the presence and function of STRIPAK-associated kinases in ascomycetes. Using the mammalian germinal center kinases (GCKs) MST4, STK24, STK25 and MINK1 as query, we identified the two putative homologs SmKIN3 and SmKIN24 in S. macrospora. A BLASTP search revealed that both kinases are conserved among filamentous ascomycetes. The physical interaction of the striatin homolog PRO11 with SmKIN3 and SmKIN24 were verified by yeast two-hybrid (Y2H) interaction studies and for SmKIN3 by co-Immunoprecipitation (co-IP). In vivo localization found that both kinases were present at the septa and deletion of both Smkin3 and Smkin24 led to abnormal septum distribution. While deletion of Smkin3 caused larger distances between adjacent septa and increased aerial hyphae, deletion of Smkin24 led to closer spacing of septa and to sterility. Although phenotypically distinct, both kinases appear to function independently because the double-knockout strain ΔSmkin3/ΔSmkin24 displayed the combined phenotypes of each single-deletion strain.
Full Text Available The striatin-interacting phosphatase and kinase (STRIPAK complex is composed of striatin, protein phosphatase PP2A and protein kinases that regulate development in animals and fungi. In the filamentous ascomycete Sordaria macrospora, it is required for fruiting-body development and cell fusion. Here, we report on the presence and function of STRIPAK-associated kinases in ascomycetes. Using the mammalian germinal center kinases (GCKs MST4, STK24, STK25 and MINK1 as query, we identified the two putative homologs SmKIN3 and SmKIN24 in S. macrospora. A BLASTP search revealed that both kinases are conserved among filamentous ascomycetes. The physical interaction of the striatin homolog PRO11 with SmKIN3 and SmKIN24 were verified by yeast two-hybrid (Y2H interaction studies and for SmKIN3 by co-Immunoprecipitation (co-IP. In vivo localization found that both kinases were present at the septa and deletion of both Smkin3 and Smkin24 led to abnormal septum distribution. While deletion of Smkin3 caused larger distances between adjacent septa and increased aerial hyphae, deletion of Smkin24 led to closer spacing of septa and to sterility. Although phenotypically distinct, both kinases appear to function independently because the double-knockout strain ΔSmkin3/ΔSmkin24 displayed the combined phenotypes of each single-deletion strain.
Almeida, Cláudio W L; Castro, Charlles H M; Pedreira, Paulo G; Heymann, Roberto E; Szejnfeld, Vera L
Falls are a serious health problem for aged people, causing social and economic burden. Despite being an important determinant of balance, the positioning of the center of mass (COM) has not been evaluated as a risk factor for falls. This study examined the association between the percentage height of COM (%COM) and the risk of falls in the elderly. Healthy women aged 60 years and older were consecutively selected in a case-control study. Forty-eight individuals classified as "fallers" (having suffered two or more falls in the previous year) were the cases while 48 age and weight-matched women with one fall or no falls in the previous year were the controls ("non-fallers"). Body composition and bone mineral density (BMD) by DXA, 30-second chair stand test, abdominal circumference, Berg's balance scale and %COM using the reaction board method were evaluated in all participants. Body composition parameters were not significantly different between groups. Spine and hip BMD tended to be lower in the fallers, but the difference was significant only at the femoral neck (0.80±0.10g/cm(2) versus 0.87±0.76g/cm(2); pfalls. Further work is needed in order to determine the value of board reaction measurements in a clinical setting to identify patients at high risk. Copyright © 2011 Elsevier B.V. All rights reserved.
Jenks, Christopher L; Hernandez, Ana; Stavinoha, Peter L; Morris, Michael C; Tian, Fenghua; Liu, Hanli; Garg, Parvesh; Forbess, Joseph M; Koch, Joshua
To determine if a non-invasive, repeatable test can be used to predict neurodevelopmental outcomes in patients with congenital heart disease. This was a prospective study of pediatric patients less than two months of age undergoing congenital heart surgery at the Children's Health Children's Medical Center at Dallas. Multichannel near-infrared spectroscopy (NIRS) was utilized during the surgery, and ultrasound (US) resistive indices (RI) of the major cranial vessels were obtained prior to surgery, immediately post-operatively, and prior to discharge. Pearson's correlation, Fischer exact t test, and Fischer r to z transformation were used where appropriate. A total of 16 patients were enrolled. All had US data. Of the sixteen patients, two died prior to the neurodevelopmental testing, six did not return for the neurodevelopmental testing, and eight patients completed the neurodevelopmental testing. There were no significant correlations between the prior to surgery and prior to discharge US RI and neurodevelopmental outcomes. The immediate post-operative US RI demonstrated a strong positive correlation with standardized neurodevelopmental outcome measures. We were able to demonstrate qualitative differences using multichannel NIRS during surgery, but experienced significant technical difficulties implementing consistent monitoring. A higher resistive index in the major cerebral blood vessels following cardiac surgery in the neonatal period is associated with improved neurological outcomes one year after surgery. Obtaining an ultrasound with resistive indices of the major cerebral vessels prior to and after surgery may yield information that is predictive of neurodevelopmental outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.
Turki A. Alzahrani
Full Text Available Objectives: To estimate the prevalence of intimate partner violence (IPV among female patients, age 18-60 years, attending primary health care centers (PHCCs and to measure its determinants, and reporting behavior. Methods: A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA from January to February 2015 was employed. A 2-stage probability sampling was adopted for selection of PHCCs in the first stage, and then participants in the second stage. Results: The estimated prevalence of IPV during the last year was 11.9%. Predictors of IPV related to abused women included divorced status and divorced parents; while those related to abusers (husbands included widowed parents, exposure to violence in childhood, and alcohol or drugs addiction. Most of the abused wives (56% talked regarding their IPV to their families, their husbands’ families (15.2%, or their friends (11.8%; while only a minority (3.3% complained to the police or to a judge, and no one reported this to a family physician, or to women protection agency. Conclusion: One out of 10 women is a victim of IPV in Taif, KSA. Intimate partner violence is significantly associated with a number of victim and abuser-related psychosocial factors, the detection of which might help screening for individuals at risk.
Cortes, Margarida Barreto; Fernandes, Samuel Raimundo; Aranha, Patricia; Avô, Luís Brito; Falcão, Luís Menezes
Acute bacterial pneumonia is a common and potentially fatal disease where early recognition and treatment are crucial. Increasing medical literature suggests worse outcomes in patients admitted for medical and surgical conditions during the weekend. Little is known about this effect in patients with acute bacterial pneumonia. Obective: The aim of this study was to evaluate the impact of weekend and holiday hospital admission on the outcomes of acute bacterial pneumonia. Retrospective analysis of adult patients (> 18 years) with acute bacterial pneumonia collected from a tertiary referral center database. Length of stay, total cost, admission to intensive care unit, development of sepsis and organ failure, and mortality were compared between patients admitted on a weekday and patients admitted during a weekend or holiday. We analyzed 53 854 hospital admissions from 42 512 patients (median age 84.0 years, range 18 - 118 years), corresponding to 30 554 admissions during weekdays, 21 222 at weekends and 2078 during public holidays. Weekend and holiday admission was not associated with increased costs, length of stay, intensive care unit admission, development of sepsis, organ failure, and mortality. A weekend/holiday effect in acute bacterial pneumonia was not evident in our series.
Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial.
Fujimoto, Hiroko; Yamaguchi, Osamu; Hayami, Hajime; Shimosaka, Mika; Tsuboi, Sayaka; Sato, Mitsunori; Takebayashi, Shigeo; Morita, Satoshi; Saito, Mari; Goto, Takahisa; Kurahashi, Kiyoyasu
Aspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP. A single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay. Fifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days). Although continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.
Alzahrani, Turki A; Abaalkhail, Bahaa A; Ramadan, Iman K
To estimate the prevalence of intimate partner violence (IPV) among female patients, age 18-60 years, attending primary health care centers (PHCCs) and to measure its determinants, and reporting behavior. A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA) from January to February 2015 was employed. A 2-stage probability sampling was adopted for selection of PHCCs in the first stage, and then participants in the second stage. The estimated prevalence of IPV during the last year was 11.9%. Predictors of IPV related to abused women included divorced status and divorced parents; while those related to abusers (husbands) included widowed parents, exposure to violence in childhood, and alcohol or drugs addiction. Most of the abused wives (56%) talked regarding their IPV to their families, their husbands' families (15.2%), or their friends (11.8%); while only a minority (3.3%) complained to the police or to a judge, and no one reported this to a family physician, or to women protection agency. One out of 10 women is a victim of IPV in Taif, KSA. Intimate partner violence is significantly associated with a number of victims and abuser-related psychosocial factors, the detection of which might help screening for individuals at risk.
R Krishna Kumar
Full Text Available Aim: To evaluate the prevalence of oral lesions status in human immunodeficiency virus (HIV infected children of age 1 to 14 years in Anti Retro viral therapy (ART centres in Tamil Nadu. Materials and Methods: A of total 326 HIV infected children, age 1 to 14 years of which 174 male children and 152 female children were examined for Oral lesions in the Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University in association with the ART centers in Villupuram, Vellore and HIV Homes in Thiruvannamalai, Trichy and Salem in Tamil Nadu towns. Statistical Analysis: Statistical Package for Social Science for Windows (version 11 code: 3000135939012345. Result: Of the total 326 children, 201 (61.65% had oral lesions. (68 [20.86%] with Oral Candidiasis [OC], 54 [16.56%] with Angular Cheilitis, 27 [8.28%] with Necrotizing Ulcerative Gingivitis [NUG], 25 [7.66%] with Necrotizing Ulcerative Periodontitis [NUP], 18 [5.53%] with Linear Gingival Erythema [LGE] and 9 [2.76%] with Apthous Ulcer. Conclusion Among the oral lesions in HIV infected children, OC 20.86% was the predominant oral lesion followed by Angular Chelitis 16.56%, NUG 8.28%, NUP 7.66%, LGE5.53% and Apthous Ulcer 2.76%.
Cartagena, L J; Kang, A; Munnangi, S; Jordan, A; Nweze, I C; Sasthakonar, V; Boutin, A; George Angus, L D
Falls are a significant cause of mortality in the elderly patients. Despite this, the literature on in-hospital mortality related to elderly falls remains sparse. Our study aims to determine the risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. All elderly case records with fall-related injuries between 2003 and 2013 were retrospectively analyzed for demographic characteristics, injury severities, comorbidity factors and clinical outcomes. Logistic regression analysis was used to examine the risk factors associated with in-hospital mortality. In total, 1026 elderly patients with fall-related injuries were included in the study. The average age of patients was 80.94 ± 8.16 years. Seventy seven percent of the patients had at least one comorbid condition. Majority of the falls occurred at home. More than half of the patients fell from ground level. Overall, the in-hospital mortality rate was 16 %. Head injury constituted the most common injury sustained in patients who died (77 %). In addition to age, ISS, GCS, ICU admission and anemia were significantly (P fall patients. Ground-level falls in the elderly can be devastating and carry a significant mortality rate. Elderly patients with anemia were two times more likely to die in the hospital after sustaining a fall in our study population. Increased focus on anemia which is often underappreciated in elderly fall patients can be beneficial in improving outcomes and reducing in-hospital mortality.
Sopirala, Madhuri M; Syed, Asma; Jandarov, Roman; Lewis, Margaret
In January 2015, the Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) changed the definition of catheter-associated urinary tract infection (CAUTI). We evaluated the outcomes of a robust CAUTI prevention program when we performed surveillance using the old definition (before 2015) versus the new definition (after 2015). This is the first study to evaluate how the change in CDC/NHSN definitions affected the outcomes of a CAUTI reduction program. Baseline was from January 2012 to September 2014; the intervention period was from October 2014 to February 2016. Staff nurses were trained to be liaisons of infection prevention (Link Nurses) with clearly defined CAUTI prevention goals and with ongoing monthly activities. CAUTI incidence per 1000 catheter days was compared between the baseline and intervention periods, using the 2 definitions. With the new definition, CAUTIs decreased by 33%, from 2.69 to 1.81 cases per 1000 catheter days (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI]: 0.48-0.93; P definition, CAUTIs increased by 12%, from 3.38 to 3.80 cases per 1000 catheter days (IRR = 1.12; 95% CI: 0.88-1.43; P = .348). We aggressively targeted CAUTI prevention, but a reduction was observed only with the new definition. Our findings stress the importance of having a reasonably accurate surveillance definition to monitor infection prevention initiatives. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Shirani, Kiana; Mostafavizadeh, Kamyar; Ataei, Behrouz; Akhani, Khatere
Due to the high incidence and prevalence of infection in neonatal ward, especially Neonatal Intensive Care Units (NICUs) reported by different studies and the important role of colonization with hospital germs in the development of nosocomial infections, we intended to evaluate the risk of colonization with hospital germs in neonates and its associated risk factors. This cross-sectional, descriptive-analytical study was conducted in 2016 in a Teaching Center in Iran. In total, 51 neonates were selected based on the inclusion criteria, and after recording their information in a checklist, samples were taken by swab from outer ear, axilla, and groin for culture. Neonates with negative culture from mentioned regions were enrolled in the study. The swab samples again were taken and sent for culture from mentioned regions in at least 3 days after hospitalization. Culture results from first and second sampling were collected and analyzed statistically. This study was conducted on 51 neonates. The mean gestational age among the neonates ranged from 35.25 (Week) ± 2.98. 22 girls (43.1%) and 29 boys (56.9%), most of them were born by cesarean. Based on the results of logistic regression, a significant association was found between the occurrence of colonization of hospital flora and the place hospitalization of the newborns (odds ratio (OR): 4.750; 95% confidence interval (CI): 1.26-17.85). This study revealed that the only risk factors of colonization with hospital flora in neonates are the type of delivery and place of hospitalization. Based on findings of the study, it is recommended to focus on efforts in increasing the rate of natural birth as well as improving conditions of infection control in NICUs to reduce the number of incidences of colonization with hospital flora in neonates.
Pozzoni, Pietro; Riva, Alessia; Bellatorre, Alessandro Giacco; Amigoni, Maria; Redaelli, Elena; Ronchetti, Anna; Stefani, Mariangela; Tironi, Rosangela; Molteni, Edoardo Ennio; Conte, Dario; Casazza, Giovanni; Colli, Agostino
Antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD) are common complications of antibiotic use. Probiotics were effective in preventing AAD and CDAD in several randomized controlled trials. This study was aimed at testing the effect of Saccharomyces boulardii on the occurrence of AAD and CDAD in hospitalized patients. A single-center, randomized, double-blind, placebo-controlled, parallel-group trial was performed. Patients being prescribed antibiotics or on antibiotic therapy for boulardii or an indistinguishable placebo twice daily within 48 h of beginning antibiotic therapy, continued treatment for 7 days after antibiotic withdrawal, and were followed for 12 weeks after ending antibiotic treatment. Of 562 consecutive eligible patients, 275 patients aged 79.2 ± 9.8 years (134 on placebo) were randomized and 204 aged 78.4 ± 10.0 years (98 on placebo) completed the follow-up. AAD developed in 13.3% (13/98) of the patients receiving placebo and in 15.1% (16/106) of those receiving S. boulardii (odds ratio for S. boulardii vs. placebo, 1.16; 95% confidence interval (CI), 0.53-2.56). Five cases of CDAD occurred, 2 in the placebo group (2.0%) and 3 in the probiotic group (2.8%; odds ratio for S. boulardii vs. placebo, 1.40; 95% CI, 0.23-8.55). There was no difference in mortality rates (12.7% vs. 15.6%, P=0.60). In elderly hospitalized patients, S. boulardii was not effective in preventing the development of AAD.
Hernández-Cruz, B; Tapia, N; Villa-Romero, A R; Reyes, E; Cardiel, M H
To identify the mortality risk factors in a group of Mexican patients with SLE. A case-control autopsy study in a tertiary care center in Mexico, City. Patients with SLE who died during 1958 to 1994 with an autopsy study were selected as cases, and alive patients matched by age (+/- 3 years), decade of SLE onset, and disease duration (+/- 5 years) were defined as controls. Clinical charts were reviewed looking at clinical variables. SLE disease activity was evaluated with the MexSledai index, and SLE disease severity with the Severity Index. Variables were classified as present at any moment during the follow-up and 3 months before death in cases or cut-off date in controls. matched univariate and multivariate analysis by multiple logistic regression were performed, and the results were presented as odds ratio and 95% confidence intervals (OR, 95%CI). 76 matched pairs of patients were studied. Age, gender, and years offormal education were similar in the cases and controls. Variables associated with mortality three months before death were: lung involvement OR= 15.6, 95%CI (4.8-50.3), p<0.001; severe thrombocytopenia 9.6 (2.9-31.7), p<0.001; heart involvement 5.8 (2.6-13.0), p<0.001; and the severity index (cases 8.8 mu, 2.4 sigma vs controls 3.5, 2.0, respectively) 2.2 (1.5-3.4), p<0.001. Variables associated with mortality detected at any moment before death were kidney involvement 2.16 (1.09-4.29), p<0.02; the steroid therapeutic index 2.3 (1.2-4.5), p<0.001; number of previous admissions 2.4 (1.4-4.3), p<0.001; the MEX-SLEDAI index (cases 21.6 mu 6.3 sigma vs controls 12.6, 5.8), 1.2 (1.1-1.3), p<0.001; and the number of severe infections 14.4 (4.4-46.2), p<0.001. Protective variables were skin involvement 0.1 (0.3-0.6), p<0.001; daily dose of chloroquine (cases 3.9 mu, 24.1 sigma vs controls 39.4, 60.0 mg), p <0.0001 and the time from thefirst SLE symptom to the patient's demise or the cut-off date 0.7(0.6-0.9), p<0.001. Multiple logistic regression showed
Full Text Available Background. Antibiotic-associated diarrhea (AAD develops through the loss of normal bacterial intestinal flora. We have conducted a case-control study in order to assess whether prophylactic administration of Saccharomyces boulardii (S. boulardii prevents occurrence of AAD among adult hospitalized patients. Methods. Single-center hospital based case-control study was conducted in University Clinic “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia. Hospital records were screened in order to identify all the patients developing AAD in period January 1. 2010 – August 31. 2015. For every case, one age and gender matched control was randomly selected among patients hospitalized at the same time at the same department who were administered with antibiotics and did not develop AAD. For both cases and controls data were extracted on demographics, medical history, indication for use of antibiotics, antibiotics used, and prophylactic use of S.boulardii probiotics. The relationship between occurrence of AAD and putative risk factors were measured using the odds ratios (ORs and their 95% confidence interval (CI derived from logistic regression analysis. Results. Number of 59 cases and 59 controls were included in the study. Most of AAD cases were associated with old age (mean age of 78.05, and almost half (49.15% were hospitalized on geriatrics department. Most prescribed class of antibiotics among cases was III generation cephalosporins (50.85%, followed by fluoroquinolones (28.81% and trimethoprim-sulfamethoxazole (20.34%. Significantly more cases than controls were treated with carbapenems (16.95% vs. 5.08% respectively, p=0.04. Significantly less cases were administered with prophylactic S. boulardii probiotics (18.64% vs. 42.37% p=0.005. We identified prophylactic use of S. boulardii to act protectively against development of AAD from both univariate (OR: 0.31, 95% CI: 0.14-0.72 and multivariate analysis (OR:0.36, 95% CI: 0.14-0.80. Use of
Dowell, Joshua D.; Wagner, Daniel; Elliott, Eric; Yildiz, Vedat O.; Pan, Xueliang
PurposeTo identify factors associated with advanced inferior vena cava filter (IVCF) retrieval to raise awareness on technical considerations, retrieval efficiency, and patient safety.Materials and MethodsA single-center retrospective review was performed of 203 consecutive retrievable IVC filters placed between 2007 and 2014. Attempted retrievals were classified as advanced if the routine “snare and sheath” technique was initially unsuccessful after multiple attempts, or an alternate endovascular maneuver or access site was utilized. Patient and filter characteristics were recorded.Results203 attempted retrievals were reviewed (48.7 % male, 51.2 % female, mean age 52.7 years, mean dwell time 109 days). Advanced retrievals were observed in 20 patients (9.8 %) (15 females, 5 males). Fluoroscopy time (p ≤ 0.01, 34.3 ± 21.1 and 5.3 ± 4.5 min for advanced retrievals and routine retrievals respectively, same below), gender (p = 0.031), and retrieval tilt angle (p ≤ 0.01, 5.7 ± 5.10° vs. 11.9 ± 11.03°) were associated with advanced retrievals. Females were 3.16 times more likely to have an advanced retrieval performed than males with a significantly higher tilt angle in those with advanced retrieval. History of cancer (p = 0.502), dwell time (p = 0.916), retrieval caval diameter (p = 0.053), placement caval diameter (p = 0.365), filter type (p = 0.710), strut perforation (p = 0.506), placement tilt angle (p = 0.311), and age (p = 0.558) were not found significantly associated with advanced retrievals.ConclusionsWomen are at increased risk for advanced filter retrieval secondary to a significant change in filter tilt over time compared to men, independent of filter type or competing demographic or filter risks, likely placing them at increased risk for higher procedural fluoroscopy times
Dowell, Joshua D., E-mail: Joshua.Dowell@osumc.edu; Wagner, Daniel, E-mail: Daniel.Wagner@osumc.edu; Elliott, Eric, E-mail: Eric.Elliott@osumc.edu [The Ohio State University Wexner Medical Center, Department of Radiology, Division of Interventional Radiology (United States); Yildiz, Vedat O., E-mail: Vedat.Yildiz@osumc.edu; Pan, Xueliang, E-mail: Jeff.Pan@osumc.edu [The Ohio State University Wexner Medical Center, Center for Biostatistics (United States)
PurposeTo identify factors associated with advanced inferior vena cava filter (IVCF) retrieval to raise awareness on technical considerations, retrieval efficiency, and patient safety.Materials and MethodsA single-center retrospective review was performed of 203 consecutive retrievable IVC filters placed between 2007 and 2014. Attempted retrievals were classified as advanced if the routine “snare and sheath” technique was initially unsuccessful after multiple attempts, or an alternate endovascular maneuver or access site was utilized. Patient and filter characteristics were recorded.Results203 attempted retrievals were reviewed (48.7 % male, 51.2 % female, mean age 52.7 years, mean dwell time 109 days). Advanced retrievals were observed in 20 patients (9.8 %) (15 females, 5 males). Fluoroscopy time (p ≤ 0.01, 34.3 ± 21.1 and 5.3 ± 4.5 min for advanced retrievals and routine retrievals respectively, same below), gender (p = 0.031), and retrieval tilt angle (p ≤ 0.01, 5.7 ± 5.10° vs. 11.9 ± 11.03°) were associated with advanced retrievals. Females were 3.16 times more likely to have an advanced retrieval performed than males with a significantly higher tilt angle in those with advanced retrieval. History of cancer (p = 0.502), dwell time (p = 0.916), retrieval caval diameter (p = 0.053), placement caval diameter (p = 0.365), filter type (p = 0.710), strut perforation (p = 0.506), placement tilt angle (p = 0.311), and age (p = 0.558) were not found significantly associated with advanced retrievals.ConclusionsWomen are at increased risk for advanced filter retrieval secondary to a significant change in filter tilt over time compared to men, independent of filter type or competing demographic or filter risks, likely placing them at increased risk for higher procedural fluoroscopy times.
Nozue, Miho; Shimazu, Taichi; Sasazuki, Shizuka; Charvat, Hadrien; Mori, Nagisa; Mutoh, Michihiro; Sawada, Norie; Iwasaki, Motoki; Yamaji, Taiki; Inoue, Manami; Kokubo, Yoshihiro; Yamagishi, Kazumasa; Iso, Hiroyasu; Tsugane, Shoichiro
Background: Randomized controlled studies have investigated the short-term effect of soy product intake on blood pressure (BP) in normotensive people. To our knowledge, no prospective studies exist on the effect of habitual intake of fermented soy products, separate from total soy products, on BP in the general population. Objective: We examined the association between the habitual intake of soy products, including fermented soy products, and the development of high BP during a 5-y period among participants in a population-based prospective cohort study in Japan. Methods: The study included normotensive participants aged 40-69 y at baseline (926 men and 3239 women) who completed 2 questionnaires and whose BP was measured at the baseline survey between 1993 and 1994 and the 5-y follow-up in the Japan Public Health Center-Based Prospective Study Cohort II. The intake of soy products was assessed with a food-frequency questionnaire. High BP was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥85 mm Hg, or antihypertensive medication use. ORs and 95% CIs of high BP by frequency of soy products (miso, natto, and tofu) consumption, intake of total and fermented soy products, and intake of isoflavones from total and fermented soy products were estimated with the use of multiple logistic regression analysis. Results: Multivariable-adjusted ORs of high BP for the highest compared with the lowest tertile of total and fermented soy product intake were 1.03 (95% CI: 0.84, 1.25; P -trend = 0.786) and 0.72 (95% CI: 0.56, 0.92; P -trend = 0.009), respectively. The frequency of nonfermented soy product (tofu) intake was not associated with the development of high BP ( P -trend = 0.597). Conclusions: The intake of fermented soy products, but not total or nonfermented soy products, was inversely associated with developing high BP in men and women with normal BP. © 2017 American Society for Nutrition.
Mahmoud, M A; Khafagi, M H
To isolate, identify, and differentiate Capripoxviruses (CaPV) (sheep pox virus and goat pox virus) infections by egg inoculation, transmission electron microscopy (TEM), and 30 kDa RNA polymerase subunit gene-based polymerase chain reaction (PCR) (RPO30) in clinically affected animals in Hawamdia township of Giza Governorate, Egypt. A total of 37 scab samples were collected from clinically suspected field cases of sheep pox and goat pox. These samples were collected during (2014-2015) during different outbreaks of sheep pox and goat pox from Hawamdia township of Giza Governorate, Egypt. The samples were subjected to egg inoculation, TEM, and (RPO30) gene-based PCR. By using the egg inoculation: Previously prepared 37 scab samples (n=23 sheep and n=14 goats) were inoculated on the chorioallantoic membrane of specific pathogen free (SPF) embryonated chicken eggs (12 days old age). In the presence of the suitable percentage of humidity and candling, the inoculated eggs were incubated at 37°C. By using the TEM: Samples showed positive pock lesions on the chorioallantoic membranes, were fixed in glutaraldehyde, then processed and sectioned for TEM. Using the (RPO30) gene-based PCR assay, 30 of positive samples after egg inoculation (n=19 sheep and n=11 goats) were screened. Using the egg inoculation, a characteristic pock lesions for poxviruses were seen in 30/37 (n=19 sheep and n=11 goats) (81.08%). Using the TEM, examination of the positive samples after egg inoculation revealed positive result in 23/30 (n=15 sheep and n=8 goats) (76.66%). The positive results represented by the presence of negatively stained oval-shape virus particles. Using the (RPO30) gene-based PCR assay, out of 30 total of positive samples after egg inoculation (n=19 sheep and n=11 goats) were screened, 27 (90%) samples (n=17 sheep and n=10 goats) were positive. The given band sizes of sheep and goats were 172 and 152 bp, respectively. PCR assay depended on RPO30 gene can be used lonely for the
Turković, Tihana Magdić; Grginić, Ana Gverić; Cucujić, Branka Đuras; Gašpar, Božena; Širanović, Mladen; Perić, Mladen
Ventilator-associated pneumonia (VAP) is very common in many intensive care Units, but there are still many uncertainties about VAP, especially about the choice of initial empiric antibiotics. The incidence of specific pathogens with different susceptibility patterns causing VAP varies from hospital to hospital. This is the reason why empiric initial antibiotic treatment for VAP should be based not only on general guidelines (that recommend therapy according to the presence of risk factors for multidrug-resistant bacteria), but also on up-to-date information on local epidemiology. The aim of this study was to determine the microbial profile of pathogens causing VAP and their antibiotic susceptibility patterns. The study was conducted in the 15-bed surgical and neurosurgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center, Zagreb, Croatia. Retrospective data were collected from September 2009 to March 2013. All patients that developed VAP during the study period were eligible for the study. According to study results, the incidence of VAP was 29.4%. The most commonly isolated bacterium was Staphylococcus aureus (21.1%), followed by Pseudomonas aeruginosa (19.0%) and Acinetobacter species (13.6%). All Staphylococcus aureus isolates were susceptible to vancomycin and linezolid. Pseudomonas aeruginosa showed 100% susceptibility to cefepime and very high susceptibility to pip'eracillin-tazobactam (96%), ceftazidime (93%) and ciprofloxacin (89%). Ampicillin-sulbactam was highly effective for Acinetobacter species, showing resistance in only 8% of isolates. In conclusion, according to study data, appropriate empiric antibiotic therapy for patients with VAP without risk factors for multidrug-resistant bacteria is ceftriaxone and for patients with risk factors for multidrug-resistant bacteria ampicillin-sulbactam plus cefepime plus vancomycin or linezolid.
Cha, Min Jae; Chong, Semin [Dept. of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul (Korea, Republic of); Chung, Myung Jin; Lee, Kyung Soo; KIm, Tae Jung; Kim, Tae Sung; Han, Jung Ho [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)
To describe radiologic findings of adenovirus pneumonia and to understand clinico-radiological features associated with progression to acute respiratory distress syndrome (ARDS) in patients with adenovirus pneumonia. This study included 19 patients diagnosed with adenovirus pneumonia at a tertiary referral center, in the period between March 2003 and April 2015. Clinical findings were reviewed, and two radiologists assessed imaging findings by consensus. Chi-square, Fisher's exact, and Student's t tests were used for comparing patients with and without subsequent development of ARDS. Of 19 patients, nine were immunocompromised, and 10 were immunocompetent. Twelve patients (63%) progressed to ARDS, six of whom (32%) eventually died from the disease. The average time for progression to ARDS from symptom onset was 9.6 days. Initial chest radiographic findings were normal (n = 2), focal opacity (n = 9), or multifocal or diffuse opacity (n = 8). Computed tomography (CT) findings included bilateral (n = 17) or unilateral (n = 2) ground-glass opacity with consolidation (n = 14) or pleural effusion (n = 11). Patients having subsequent ARDS had a higher probability of pleural effusion and a higher total CT extent compared with the non-ARDS group (p = 0.010 and 0.007, respectively). However, there were no significant differences in clinical variables such as patient age and premorbid condition. Adenovirus pneumonia demonstrates high rates of ARDS and mortality, regardless of patient age and premorbid conditions, in the tertiary care setting. Large disease extent and presence of pleural effusion on CT are factors suggestive of progression to ARDS.
Jackson, Sarah S; Leekha, Surbhi; Magder, Laurence S; Pineles, Lisa; Anderson, Deverick J; Trick, William E; Woeltje, Keith F; Kaye, Keith S; Stafford, Kristen; Thom, Kerri; Lowe, Timothy J; Harris, Anthony D
BACKGROUND Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes. METHODS Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank. RESULTS Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51-0.59) for the ICU-type model and 0.64 (95% CI, 0.60-0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model. CONCLUSIONS Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals. Infect Control Hosp Epidemiol 2017;38:1019-1024.
Kristal, Ross B; Blank, Arthur E; Wylie-Rosett, Judith; Selwyn, Peter A
Consumption of sugar-sweetened beverages (SSBs) is associated with cardiovascular disease risk factors. This study examined the relationships between SSB consumption and demographic, health behavior, health service, and health condition characteristics of adult patients of a network of federally qualified health centers (FQHCs) in a low-income, urban setting. Validated, standardized self-reported health behavior questions were incorporated into the electronic health record (EHR) and asked of patients yearly, at 4 FQHCs. We conducted cross-sectional analysis of EHR data collected in 2013 from 12,214 adult patients by using logistic regression. Forty percent of adult patients consumed 1 or more SSBs daily. The adjusted odds ratios indicated that patients who consumed more than 1 SSB daily were more likely to be aged 18 to 29 years versus age 70 or older, current smokers versus never smoking, eating no servings of fruits and/or vegetables daily or 1 to 4 servings daily versus 5 or more servings daily, and not walking or biking more than 10 blocks in the past 30 days. Patients consuming 1 or more servings of SSBs daily were less likely to speak Spanish than English, be women than men, be diagnosed with type 2 diabetes versus no diabetes, and be diagnosed with hypertension versus no hypertension. SSB consumption differed by certain demographic characteristics, health behaviors, and health conditions. Recording SSB intake and other health behaviors data in the EHR could help clinicians in identifying and counseling patients to promote health behavior changes. Future studies should investigate how EHR data on patient health behavior can be used to improve the health of patients and communities.
Matta, Stephanie; Chammas, Elie; Alraies, Chadi; Abchee, Antoine; AlJaroudi, Wael
Sedentary lifestyle has become prevalent in our community. Recent data showed controversy on the effect of regular exercise on left ventricular compliance and myocardial relaxation. We sought to assess whether physical inactivity is an independent predictor of diastolic dysfunction in or community, after adjustment for several covariates. Consecutive outpatients presenting to the echocardiography laboratory between July 2013 and June 2014 were prospectively enrolled. Clinical variables were collected prospectively at enrollment. Patients were considered physically active if they exercised regularly ≥3× a week, ≥30 minutes each time. The primary endpoint was presence of diastolic dysfunction. The final cohort included 1356 patients (mean age [SD] 52.9 [17.4] years, 51.3% female). Compared with physically active patients, the 1009 (74.4%) physically inactive patients were older, more often female, and had more comorbidities and worse diastolic function (51.3% vs 38.3%; P < 0.001). On univariate analysis, physical inactivity was associated with 70% increased odds of having diastolic dysfunction (odds ratio: 1.70, 95% confidence interval: 1.32-2.18, P < 0.001). There was significant interaction between physical activity and left ventricular mass index (LVMI; P = 0.026). On multivariate analysis, patients who were physically inactive and had LVMI ≥ median had significantly higher odds of having diastolic dysfunction (odds ratio: 2.82, 95% confidence interval: 1.58-5.05, P < 0.001). In a large, prospectively enrolled cohort from a single tertiary center in the Middle East, physically inactive patients with increased LVMI had 2- to 3-fold increased odds of having diastolic dysfunction after multivariate adjustment. © 2016 Wiley Periodicals, Inc.
Younan, Duraid; Griffin, Russell; Swain, Thomas; Pittet, Jean-Francois; Camins, Bernard
The Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) replaced its old definition for ventilator-associated pneumonia (VAP) with the ventilator-associated events algorithm in 2013. We sought to compare the outcome of trauma patients meeting the definitions for VAP in the two modules. Trauma patients with blunt or penetrating injuries and with at least 2 d of ventilator support were identified from the trauma registry from 2013 to 2014. VAP was determined using two methods: (1) VAP as defined by the "old," clinically based NHSN definition and (2) possible VAP as defined by the updated "new" NHSN definition. Cohen's kappa statistic was determined to compare the two definitions for VAP. To compare demographic and clinical outcomes, the chi-square and Student's t-tests were used for categorical and continuous variables, respectively. From 2013 to 2014, there were 1165 trauma patients admitted who had at least 2 d of ventilator support. Seventy-eight patients (6.6%) met the "new" NHSN definition for possible VAP, 361 patients (30.9%) met the "old" definition of VAP, and 68 patients (5.8%) met both definitions. The kappa statistic between VAP as defined by the "new" and "old" definitions was 0.22 (95% confidence interval, 0.17-0.27). There were no differences in age, gender, race, or injury severity score when comparing patients who met the different definitions. Those satisfying both definitions had longer ventilator support days (P = 0.0009), intensive care unit length of stay (LOS; P = 0.0003), and hospital LOS (P = 0.0344) when compared with those meeting only one definition. There was no difference in mortality for those meeting both and those meeting the old definition for VAP; patients meeting both definitions had higher respiratory rate at arrival (P = 0.0178). There was no difference in mortality between patients meeting the "old" and "new" NHSN definitions for VAP; those who met "both" definitions had longer
Tamir, Kassahun; Wasie, Belaynew; Azage, Muluken
Tuberculosis (TB) remains a major global health problem. The emerging epidemic of multi- and extensively drug-resistant (M/XDR) TB further imperils health workers, patients and public health. Health facilities with inadequate infection control are risky environments for the emergence and transmission of TB. There was no study that presented data on infection control practices of health care workers. This study aimed to assess tuberculosis infection control practices and associated factors among health care workers in West Gojjam Zone, Northwest Ethiopia. Institution based quantitative cross-sectional study triangulated with qualitative observation and key informant interview was conducted. Six hundred sixty two health care workers were selected by multistage random sampling method. Self-administered structured questionnaire was used to collect quantitative data. Observation checklists and key informant interview guides were used to collect qualitative data. Quantitative data were entered in to Epi Info version 3.5.3 and analyzed using SPSS version 20. Odds ratio with 95 % confidence interval was used to identify factors associated with TB infection control practice of health care workers. Qualitative data were translated, transcribed, analyzed and triangulated with the quantitative findings. The proportion of proper TB infection control (TBIC) practices was 38 %. Qualitative data showed that administrative, environmental and personal respiratory protection control measures were not practiced well. Knowledge on the presence of TBIC plan [AOR = 4.25, 95 % CI: 2.46 - 7.35], knowledge on the presence of national guideline [AOR = 8.95, 95 % CI: 4.35 - 18.40] and working department of the health care workers were independent predictors of TBIC practices. The proportion of proper TBIC practices of health care workers was low. TBIC practices were determined by knowing the presence of TBIC plan and national guideline and working department. Hence, supportive
Wu, Junyan; Wang, Jie; Zhang, Junlong
Through the consultation of TCM ancient classical theory, the relationship of kidney essence, marrow and brain is analyzed. It is discovered that the degenerative brain diseases, represented by Alzheimer's disease (AD) and Parkinson's disease (PD) share the same etiological basis as "kidney essence deficiency and brain marrow emptiness" and have the mutual pathological outcomes as yang qi declining. The Governor Vessel gathers yang qi of the whole body and maintains the normal functional activity of zangfu organs in the human body through the storage, regulation and invigoration of yang qi. It is viewed that the theory of the Governor Vessel is applied to treat the different degenerative brain diseases, which provides the theoretic support and practice guide for the thought of TCM as the same therapeutic program for the different diseases. As a result, the degenerative brain diseases can be retarded and the approach is provided to the effective prevention and treatment of degenerative diseases in central nerve system:
Aragon Han, Patricia; Kim, Hyun-seok; Cho, Soonweng; Fazeli, Roghayeh; Najafian, Alireza; Khawaja, Hunain; McAlexander, Melissa; Dy, Benzon; Sorensen, Meredith; Aronova, Anna; Sebo, Thomas J.; Giordano, Thomas J.; Fahey, Thomas J.; Thompson, Geoffrey B.; Gauger, Paul G.; Somervell, Helina; Bishop, Justin A.; Eshleman, James R.; Schneider, Eric B.; Witwer, Kenneth W.; Umbricht, Christopher B.
Background: Studies have demonstrated an association of the BRAFV600E mutation and microRNA (miR) expression with aggressive clinicopathologic features in papillary thyroid cancer (PTC). Analysis of BRAFV600E mutations with miR expression data may improve perioperative decision making for patients with PTC, specifically in identifying patients harboring central lymph node metastases (CLNM). Methods: Between January 2012 and June 2013, 237 consecutive patients underwent total thyroidectomy and prophylactic central lymph node dissection (CLND) at four endocrine surgery centers. All tumors were tested for the presence of the BRAFV600E mutation and miR-21, miR-146b-3p, miR-146b-5p, miR-204, miR-221, miR-222, and miR-375 expression. Bivariate and multivariable analyses were performed to examine associations between molecular markers and aggressive clinicopathologic features of PTC. Results: Multivariable logistic regression analysis of all clinicopathologic features found miR-146b-3p and miR-146b-5p to be independent predictors of CLNM, while the presence of BRAFV600E almost reached significance. Multivariable logistic regression analysis limited to only predictors available preoperatively (molecular markers, age, sex, and tumor size) found miR-146b-3p, miR-146b-5p, miR-222, and BRAFV600E mutation to predict CLNM independently. While BRAFV600E was found to be associated with CLNM (48% mutated in node-positive cases vs. 28% mutated in node-negative cases), its positive and negative predictive values (48% and 72%, respectively) limit its clinical utility as a stand-alone marker. In the subgroup analysis focusing on only classical variant of PTC cases (CVPTC), undergoing prophylactic lymph node dissection, multivariable logistic regression analysis found only miR-146b-5p and miR-222 to be independent predictors of CLNM, while BRAFV600E was not significantly associated with CLNM. Conclusion: In the patients undergoing prophylactic CLNDs, miR-146b-3p, miR-146b-5p, and mi
The document contains excerpts from the Introductory Statement made by the Director General of the IAEA at the IAEA Board of Governors on 22 March 1999. The following aspects from the Agency's activity are presented: nuclear safety, measures against illicit trafficking and for the physical protection of nuclear material, status of safeguards agreements and additional protocols, Agency's involvement in safeguards verification in the Democratic People's Republic of Korea (DPRK), and inspections in Iraq in relation to its clandestine nuclear programme
The Director General has received a communication from the Governor of Norway, attaching the Chair's Summary of the discussions held during the International Symposium of Minimisation of Highly Enriched Uranium in the Civilian Nuclear Sector which was held in Oslo from 17 to 20 June 2006 as well as the summary from the technical workshop of the Symposium. The communication and, as requested therein, the attached two summaries, are herewith circulated for the information of Member States
Mazyad, Said A M; el-Nemr, Hossam I
Examination of sheep and goats in four areas in North Sinai revealed an overall infection of 12.70% with Fasciola species, 11.8% with Paramphistomum cerve, 12.80% with Moniezia expansa, 47.11% with Trichostrongylus colubriformis, 4.59% Trichuris ovis and 44.85% Coccidia. The highly infected sheep and goats were diagnosed in El Hassanah center (90.49%), followed by Al Arish city (87.31%), then Rafah city (74.39%), and lastly Bir Al Abd (54.71%). The elevation of the overall percent of infection in the four areas was due to Coccidia infection. This parasite was a concomitant infection in nearly all animals. On the other hand, examination of fifteen of the shepherds revealed Ascaris lumbricoides in four, T. colubriformis in three, Fasciala in one, Giardia lamblia in ten and Coccidia in three. Double and rarely, triple infection was seen. The correlation between parasitic infections in sheep and goats, and their shepherd was discussed.
Radwa R. El-Tahan
Full Text Available Chronic hepatitis C virus (HCV infection is a main health problem in Egypt causing high rates of mortalities. Egypt has the highest HCV prevalence in the world, with specific HCV subtypes epidemic and circulating extensively in the country. Different antiviral therapy protocols have been implemented for treating Egyptian HCV patients. Due to the limited data about HCV in Egypt, this study aimed to genotype HCV strains circulating in the Nile Delta Damietta governorate and to investigate the variation in the nonstructural 5B (NS5B region targeted by the newly approved antiviral drugs. Thirty HCV samples from treatment-naïve patients were genotyped by restriction fragment length polymorphism. Some samples were genotyped by direct sequencing of their 5′ untranslated region (UTR and NS5B regions. Phylogenetic analysis was also performed on the sequences of their NS5B regions. Fourteen new sequences have been deposited in the GenBank database. Results showed that subtype 4a was prevalent in addition to subtype 1g. None of the previously reported NS5B substitutions were detected in the sequenced isolates from treatment-naïve patients, which may be a good predictor for efficient treatment of HCV Egyptian patients with Sofosbuvir. Further studies on Sofosbuvir treated-HCV Egyptian patients are required to investigate whether any NS5B substitutions can confer resistance to treatment.
Zamani, Abbasali; Barakati, S Masoud; Yousofi-Darmian, Saeed
Load-frequency control is one of the most important issues in power system operation. In this paper, a Fractional Order PID (FOPID) controller based on Gases Brownian Motion Optimization (GBMO) is used in order to mitigate frequency and exchanged power deviation in two-area power system with considering governor saturation limit. In a FOPID controller derivative and integrator parts have non-integer orders which should be determined by designer. FOPID controller has more flexibility than PID controller. The GBMO algorithm is a recently introduced search method that has suitable accuracy and convergence rate. Thus, this paper uses the advantages of FOPID controller as well as GBMO algorithm to solve load-frequency control. However, computational load will higher than conventional controllers due to more complexity of design procedure. Also, a GBMO based fuzzy controller is designed and analyzed in detail. The performance of the proposed controller in time domain and its robustness are verified according to comparison with other controllers like GBMO based fuzzy controller and PI controller that used for load-frequency control system in confronting with model parameters variations. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.
Mortada, Wael I; Shokeir, Ahmed A
A total of 1291 drinking water samples were examined for nitrite and nitrate during 6 months from December, 2015 to May, 2016 at 17 cities of Dakahlia governorate (Nile Delta, north of Egypt), and the results were utilized for assessment of health risk of the exposure from drinking water by calculating average daily intake (ADI), hazard quotient (HQ), and the hazard index (HI). The nitrite and nitrate in drinking water had a concentration range of 0.030-0.113 and 2.41-8.70 mg L -1 , with mean values of 0.059 ± 0.014 and 5.25 ± 1.61 mg L -1 , respectively. Nitrite and nitrate levels in rural areas and ground water samples were significantly higher than that in the urban ones. None of the analyzed samples exceeded WHO guideline values that set out to prevent methemoglobinemia. The values of HQ and HI for all age groups do not exceed unity indicating a low risk of methaemoglobinaemia for the population in this area. Results of the present study indicate that there is no health risk of residents from nitrite and nitrate through drinking water in the studied area. However, the other sources of exposure to nitrite and nitrate should be investigated in further studies.
Full Text Available A surveillance survey was conducted over a period of 12 months between September 2004 and August 2005 by the Tropical Medicine Department of Zagazig University in collaboration with Naval Medical Research Unit No. 3 (NAMRU-3, Egypt, to evaluate the role of ruminants as a reservoir host for Crimean-Congo haemorrhagic fever virus (CCHFV. A total of 1 022 serum samples from 313 cattle, 264 water buffalo (Bubalus bubalis, 270 sheep and 175 goats were included in the survey. All samples were collected from the Sharkia Governorate of Egypt and were examined for anti-CCHFV IgG. Of the total of 1 022 samples examined, 32 (3.13% were positive to IgG ELISA. Out of 270 sheep examined, 17 (6.30% were confirmed to have anti-CCHFV IgG with the highest titre recorded at 1:800. However, CCHFV-specific IgG-positive cases among the cattle, buffalo and goats were 3.83%, 0.38% and 1.14%, respectively. Positive cases in age group B (=2 years old were significantly higher (p<0.001 than those in age group A (<2 years old (5.7% versus 1.6%. Belbis City was found to have the highest number of positive cases compared to all other localities (p<0.001.
Ahmed Mohamed Semeida
Full Text Available In the last decades, there has been substantial development in modeling techniques of travel demand estimation. For low population areas the external trip estimation is important but usually neglected in travel demand modeling process. In Egypt, the researches in this field are scarce due to lack of data. Accordingly, this paper aims to identify and estimate the main variables that affect the travel demand in low population areas, and to develop models to predict them. The study focused on the Port Said Governorate in North East Egypt. A special questionnaire had been prepared in 2010 depending on interviews of passengers at basic taxi terminals in Port Said. And 2211 filled questionnaires were offering for research. To analyze the data, two modeling procedures were used. One is the multiple linear regression and the other is the generalized linear modeling (GLM applying normal distributions. It is found that GLM procedure offers more suitable and accurate approach than the linear regression for developing number of trips. The final demand models have statistics within the acceptable regions and, also, they are conceptually reasonable. These results are so important for Egyptian highway authorities to improve the efficiency of highway transportation system in Egypt.
Mryoush, A.Q.; Salim, H.M.
The aim of this work is to determine the uranium concentration in soil samples taken from the north, south, east, west and center of the city of Baghdad and measure its impact on the rate of cell division for non-smokers peoples and living in those areas and that between the ages 25-30 year.The uranium concentration in the samples determined by using CR-39 track detector.As calculated for the ten samples of each site when irradiated by thermal neutrons from the (Am - Be) source with flux (5x 10 3 n S -1 cm -2 ), the concentration values were calculated by a comparison with standard geological samples. The results indicate that the extent of the concentration of uranium in the soil north and east of Baghdad was 12.9 ± 0.7 in Al- Taji north of Baghdad and 12.4 ± 0.23ppm in the Diyala- Bridge area east of Baghdad and the results were recorded lower concentration of uranium in the western, central and southern Baghdad, which stood at 0.60 ± 0.21 in the Abu Ghraib area west of Baghdad, and 4.6 ± 0.7ppm in the Bab-Al-Sharqee of central Baghdad and 0.87 ± 0.7ppm in Al-Mhmodya area south of Baghdad.The mitotic index assay MI in the north and east of Baghdad was 2.3 ± 0.059 in the north and 2.43 ± 0.059 in eastern Baghdad, while the lowest rate in West and Central and South compared with the threshold level of 0.6 . Which indicates contamination north and east of Baghdad as a result of uranium wars on Iraq passed in 2003 which negatively affects the behavior of lymphocytes and on the rate of division
Hiwa Omer Ahmed
Full Text Available Background: One of the top worldwide health problems is overweight and obesity, Body weight gain over a number of years could be achieved through cumulative positive energy balances, which may be the result of habitual behaviors adopted through personal choice. Despite the increased in physical activity, the percentage of people who are overweight has increased, after decades-old efforts and awareness on the issue to nudge consumers towards healthier lifestyles through dietary guidelines, diet-related diseases are still on the rise. Is there potential variables need to be evaluated for any relation with gaining weight and obesity in the patient's life styles? Objectives: Exploration of the possible factors in the life style of overweight and obese patients, resulting in weight gain. Patients and Methods: A prospective randomized study including 440 overweight or obese patients from a total of 689 patients, who consulted for advice, diet and or drugs and various bariatric operations. This was conducted in the period of 5 years from January 2, 2012 to October 1, 2017. For the information collection, each patient was interviewed face-to-face, by three Surgical Board Trainees were interviewing patients face-to-face to fill an originally-designed questionnaire in English translated to the Kurdish language. The questionnaire was composed of demographic data, medical data, biological data, and potential factors of their overweight or obesity. A comparison was made between these patients in the conception of case matching to 446 patients who were of normal body weight, and a normal BMI. Results: Most of the patients (females; n = 200, 86.95% and males; n = 167, 79.52% in group A, while (females; n = 14, 5.90% and males; n = 21, 10.05% were drinking water within 30 min after every meals, meanwhile (females; n = 202, 85.23%, and males; n = 173, 82.77% from group B patients were drinking water 60 min after every meals.Nearly half of the patients have a Television in their kitchen/dining room (n = 239/440, 54.39%, however only (51.59%, (13.90% of the patients from group A, and B respectively were watching TV while eating, A great number of the patients (Group A: n = 358, 81.36% were operating their computers while eating, versus minority (n = 53, 11.88%, in Group B, and majority of the patients in group A were using their smart phones or making phone calls while eating (n = 390/440, 88.63% versus small number (n = 49/460, 10.65% in group B. Conclusion: Excessive habitual usage of a cell phone, early drinking (within 30 min of water or other liquids after meals may be the potential factors in the initiation of becoming overweight and obese. University students living in the areas where entertainments are not affordable for all, the only remaining entertainment is using cellphones for social media and communication may be more vulnerable to gain weight, overweight and obesity. Keywords: Lifestyle, Overweight, Obesity, Cellphone, Chewing, Drinking water
Abdulmajeed, Ahmed; Rabab, Mohamed A; Sliem, Hamdy A; Hebatallah, Nour Eldein
Introduction Irritable bowel syndrome (IBS) is one of the most common disorders diagnosed by gastroenterologists and a common cause of general practice visits. Although this disease is not life threatening, patients with IBS seem to be seriously affected in their everyday life. The study was designed to explore the pattern of IBS in clinical practice and the impact on the quality of life. Methods This is a case control descriptive study. 117 individuals were included in this study. Rome II criteria were used for the diagnosis of IBS. Impact of IBS on patient's quality of life was determined by irritable bowel syndrome quality of life (IBS-QOL) questionnaire. Results Prevalence of IBS among the study sample was 34.2%. 10% were IBS-Diarrhea, 37.5% were IBS-Constipation and 52.5% were alternators. There is statistical insignificant relationship between IBS (+) and age while it was a significant relation regarding gender (more common among women 80%). There is statistical significance relationship between IBS (+) on one hand and marital status and occupational status on the other hand. Patients with IBS had statistically significant lower scores for all IBS- QOL domains compared with the control group. Conclusion IBS is a prevalent disorder that affects females more than males and it has significant impacts on work, lifestyle and social well-being. PMID:22145053
Hanan E.M. El Azab
Full Text Available The study area was selected in El Saf District of El Giza Governorate in Egypt, covering 21461.4 ha of Nile sediments and their outskirts of alluvial higher and lower terraces. The aim of this study was to assess the impact of informal irrigation practices on drainage deterioration, soil pollution and land suitability for agricultural use using the satellite LDCM data 2013. From the lower alluvial terraces (partly cultivated using wastewater, the drainage flows westward via descending slopes resulting in land deterioration in both the alluvial lower terraces and alluvial plain of River Nile. The drainage conditions are excessively drained soils in the alluvial upper terraces within soils of Typic Haplocalcids, sandy skeletal, but in the lower terraces it partly occurred within soils of Typic Torriorthents, sandy skeletal. Moderately well drained soils occurred in soils of Typic Torriorthents, sandy in the alluvial lower terraces, while in the alluvial plain of Nile sediments are Sodic Haplotorrerts, fine. Poorly drained soils in the lower alluvial terraces have soils of Typic Epiaquents, sandy associated with Sodic Psammaquents and Aquic Haplocalcids, coarse loamy, while in the alluvial plain of River Nile the soils are Halic Epiaquerts, fine. Very poorly drained soils (submerged areas are scattered spots in both the lower alluvial terraces and the alluvial plain. In the alluvial plain of River Nile, 1967.1 ha become not suitable for the traditional cultivated crops, while in the alluvial terraces 3251.0 ha are not suitable for the proposed cultivation of Jojoba plants. Heavy metals of Cadmium (Cd, Cobalt (Co, Lead (Pb and Nickel (Ni were added to the soil surface and sub-surface in the irrigated areas by wastewater in the lower alluvial terraces (moderately well drained soils, but Cd and Co exceeded the standards of permissible total concentrations in these soils. The same metals were added to soil sub-surface layers in the alluvial plain
Astronomy, UCSC's CfAO and ISEE, and Maui Community College, runs education and internship programs in / Jacobs Retina Center Department of Psychology University of California, San Francisco Department of University School of Optometry Maui Community College Maui Community College Space Grant Program Montana
Wallin Lundell, Inger; Sundström Poromaa, Inger; Ekselius, Lisa; Georgsson, Susanne; Frans, Örjan; Helström, Lotti; Högberg, Ulf; Skoog Svanberg, Agneta
Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion. A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion. Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2-5.6) and 2.9 (CI 95% 1.3-6.6), respectively. High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument
Full Text Available To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI, India.The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs and attached vision centres (VCs that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.Mean age was 61.8 years (SD: 8.9 years and 1,133 (55.3% surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%. The most common procedure was small incision cataract surgery (SICS with intraocular lens (IOL implantation (91.8%. Intraoperative complications were seen in 29 eyes (1.4%. At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA, 61.8% had a good outcome and based on best-corrected visual acuity (BCVA, 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30, in females (OR 1.58; 95% CI 1.04, 2.41, those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57, with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04, eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25 and those undergoing extracapsular cataract extraction (OR 9
Seedhom, Amany Edward; Kamal, Nashwa Nabil
This study was conducted to determine breast cancer survival time and the association between breast cancer survival and socio-demographic and pathologic factors among women, in El-Minia, Egypt. While there has been much researches regarding prognostic factors for breast cancer but the majority of these studies were from developed countries. El-Minia has a population of approximately 4 million. To date, no research has been performed to determine breast cancer survival and the factors affecting it in El-minia. This retrospective study used data obtained from the cancer registry in the National Institute of Oncology in El-Minia and included 1207 women diagnosed with first primary breast cancer between 1(st) January 2005 and 31(st) December 2009 and followed to 30(th) June 2010. The association between survival and sociodemographic and pathological factors and distant metastasis at diagnosis, and treatment options was investigated using unifactorial chi-square test and multi-factorial (Cox regression) analyses. Kaplan-Meier analysis was used to compare survival time among different groups. Median survival time was 83.8 ± 3.2. Cox regression showed that high vs low educational level (Hazard ratio (HR)= 0.35, 95% CI; 0.27-0.46), metastases to bone (HR = 3.22, 95% CI: 1.71-6.05), metastases to lung (HR= 2.314, 95% CI: 1.225-4.373), tumor size (≤ 2 cm vs ≥ 5 cm: HR = 1.4, 95% CI: 1.1-1.8) and number of involved nodes (1 vs > 10 HR = 5.21, 95%CI: 3.1-9.01) were significantly related to survival. The results showed the need to develop screening programs and standardized treatment regimens in a tax-funded health care system.
Full Text Available A survey of insect pollinators associated with sesame, Sesamun indicum L. (Pedaliaceae was conducted at the Agriculture Research Farm, Faculty of Agriculture, University of Suez Canal during the growing seasons of 2011 and 2012. All different insect pollinators which found on the experimental site were collected for identification. Sampling was done once a week and three times a day. Three methods were used to collect and identify insects from the sesame plants (a sweep net, pitfall traps, digital camera and eye observation. A total of 29 insect species were collected and properly identified during the survey. Insect pollinators which recorded on the plants were divided into four groups, 18 belonged to Hymenoptera, 7 to Diptera, 3 to Lepidoptera and one to Coleoptera. Results revealed that Honybee, Apis mellifera was the most dominant species in the 2011 season and the second one in the 2012 season. Whereas small carpenter bee, Ceratina tarsata was the most dominant species in the 2012 season and the second one in the 2011 season. The percentage of Hymenoptera was higher in the two studied seasons by 90.94% and 89.59%, followed by Diptera by 3.93% and 5.38%, then Lepidoptera by 3.58% and 3.62, and in the last Coleoptera by 1.53% and 1.39%, respectively.
van Imhoff, Gustaaf W.; Boerma, Evert-Jan G.; van der Holt, Bronno; Schuuring, Ed; Verdonck, Leo F.; Kluin-Nelemans, Hanneke C.; Kluin, Philip M.
Purpose Outcome of diffuse large B-cell lymphoma (DLBCL) with a germinal center B-cell (GCB) expression profile is superior to that of non-GCB DLBCL. This conclusion is mainly derived from patients with mixed international prognostic index (IPI) risk profiles treated with CHOP-like therapy
El Tallawy HN
Full Text Available Hamdy NA El Tallawy,1 Wafaa MA Farghaly,1 Tarek A Rageh,1 Ghaydaa A Shehata,1 Reda Badry,1 Nabil A Metwally,2 Esam A El Moselhy,2 Mahmoud Hassan,2 Mohamed A Sayed,3 Ahmed A Waris,1 Yaser Hamed,2 Islam Shaaban,2 Mohamed A Hamed,1 Mahmoud Raafat Kandil11Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Neurology and Public Health, Faculty of Medicine, Al-Azhar University (Assiut branch, Assiut, Egypt; 3Department of Neurology, Faculty of Medicine, Sohag University, Sohag, EgyptAbstract: A door-to-door survey, including every household, was conducted for all inhabitants of Al Quseir City (33,283, Red Sea Governorate, Egypt by three specialists of neurology as well as nine senior staff members of neurology and 15 female social workers to assess the epidemiology of major neurological disorders. Over six phases, from July 1, 2009 to January 31, 2012, screening of all eligible people in the population was carried out, by which case ascertainment of all major neurological disorders included in the study was done according to the accepted definitions and diagnostic criteria of the World Health Organization. The order of frequency of prevalence of the studied neurological disorders was dementia (3.83% for those aged > 60 years, migraine (2.8% for those aged > 8 years, stroke (6.2/1000 for those aged > 20 years, epilepsy (5.5/1000, Parkinson’s disease (452.1/100,000 for those aged > 40 years, cerebral palsy (3.6/1000 among children 37 years, chorea (21.03/100,000, athetosis (15/100,000, and multiple sclerosis (13.74/100,000. The incidence rates of stroke, epilepsy, and Bell’s palsy were 181/100,000, 48/100,000, and 98.9/100,000 per year, respectively.Keywords: prevalence, incidence, neurological disorders
A. A. Al-Sulami
Full Text Available Helicobacter pylori is recognized by the World Health Organization to be the primary cause of peptic ulcers, chronic gastritis, and stomach cancer, though the source of human infection is not well understood. One of the problems in understanding the source of human contamination is the difficulty in isolating the organism from the environment. However, the combination of PCR results with those of culturing of 471 drinking water samples can provide a more accurate picture of H. pylori detection. In this method 78 presumptive H. pylori colonies out of 266 tap water samples were obtained in the preliminary detection on modified Columbia agar (MCUA slant relying on urease positivity with a rate of 29.3%. However, only 11 out of them were confirmed by Gram staining and biochemical tests reducing the rate to 4.13% whereas only 3 (1.46% from 205 reverse osmosis (RO water samples. Furthermore, only 6 (54.5% out of the 11 isolates from tap water and 1 (33.3% of the 3 RO isolates were confirmed by 16SrRNA PCR. Thus PCR confirmation reduced the rate to 2.2%. In addition, only 4 (4% of 100 tap water samples negative for H. pylori by culture method were H. pylori positive by 16SrRNA. Water samples were collected from 24 districts of Basrah Governorate from February–December 2009. The direct recovery of H. pylori from drinking water is both alarming and scientifically exciting in terms of the investigation of its epidemiology.
Eljedi, Ashraf; Dalo, Shareef
Nosocomial infections are a significant burden for both patients and the healthcare system. For this reason, infection prevention and control (IPC) practices are extremely important. The Palestinian Ministry of Health adopted the national IPC Protocol in 2004. This study aimed to assess the compliance of healthcare providers (HCPs) with the Protocol in three governmental paediatric hospitals in Gaza governorates. This descriptive cross-sectional study was conducted from February to November 2010. Data were collected from a sample of doctors, nurses and physiotherapists (N = 334) using a self-administered questionnaire and observation checklists to record HCP practices and assess the hospital environment. The response rate was 92%. The most important reasons for non-compliance with the IPC Protocol were the absence of an education programme (61.5%), lack of knowledge (52.4%) and the scarcity of required supplies (46.9%). Only 2.3% of respondents had a copy of the IPC Protocol, while 65.8% did not know of its existence. Only 16.9% had participated in training sessions regarding general IPC practices. The observation checklist regarding HCP practices revealed low levels of compliance in hand washing (45.9%), wearing gloves (40.7%) and using antiseptics/disinfectants (49.16%). The health facilities checklist indicated that there was a lack of certain essential equipment and materials, such as covered waste containers and heavy-duty gloves. Due to the lack of HPC knowledge, the authors recommend that the IPC Protocol be made available in all hospitals. In addition, a qualified team should implement intensive IPC education and training programmes and facilities should provide the required equipment and materials.
Watson, Michael D.; Epps, Amy; Woodruff, Van; Vachon, Michael Jacob; Monreal, Julio; Williams, Randall; McLaughlin, Tom
This analysis is a survey of control center architectures of the NASA Space Launch System (SLS), United Launch Alliance (ULA) Atlas V and Delta IV, and the European Space Agency (ESA) Ariane 5. Each of these control center architectures have similarities in basic structure, and differences in functional distribution of responsibilities for the phases of operations: (a) Launch vehicles in the international community vary greatly in configuration and process; (b) Each launch site has a unique processing flow based on the specific configurations; (c) Launch and flight operations are managed through a set of control centers associated with each launch site, however the flight operations may be a different control center than the launch center; and (d) The engineering support centers are primarily located at the design center with a small engineering support team at the launch site.
In 2005, national TC programmes were in place in 109 countries and one territory, an increase of five countries over the previous year. With a total budget of $116 million - made up of the Technical Cooperation Fund and extrabudgetary contributions, including government cost-sharing - the programme was the largest ever, showing an increase of nearly $12 million over 2004. The Agency's Programme of Action for Cancer Therapy (PACT) continues to make progress. In April, a memorandum of understanding was signed with the World Health Organization's Eastern Mediterranean regional office, with a view towards working together to improve cancer prevention and treatment in that region. PACT also hosted a meeting in April that brought together leading international organizations focused on the full range of measures needed to provide comprehensive cancer control in the developing world. The participants will be meeting again to discuss specific implementation frameworks and funding strategies. Progress has also been made on projects associated with the IAEA Nobel Cancer and Nutrition Fund. Three regional training events for both topics will be organized in Asia and the Pacific, Africa and Latin America in the last quarter of this year. Fellowships in these areas are also being organized for young professionals from developing countries. For activities related to nutrition, the Agency assists in the use of stable isotopes to develop and evaluate nutritional intervention strategies. In Asia and the Pacific, the focus will be on intervention to combat under-nutrition for infants, young children, and pregnant women. In Africa, the theme will be integrating nutrition into the management of HIV/AIDS, particularly for young children. In Latin America, the focus will be on the double burden of malnutrition and obesity. Regarding cancer, the Nobel Fund will be used to establish three Regional Cancer Training Institutes in Africa, Asia and Pacific, and Latin America. In the area of
Full Text Available Procedural pain is an important aspect of care in pediatrics, and particularly in pediatric oncology where children often consider this to be the most painful experience during their illness. Best recommended practice to control procedural pain includes both sedative-analgesic administration and non-pharmacological treatments, practiced in an adequate and pleasant setting by skilled staff. A nationwide survey has been conducted among the Italian Centers of Pediatric Hematology-Oncology to register operators’ awareness on procedural pain, state of the art procedural pain management, operators’ opinions about pain control in their center, and possible barriers impeding sedation-analgesia administration. Based on indications in the literature, we discuss the results of the survey to highlight critical issues and suggest future directions for improvement. Future objectives will be to overcome differences depending on size, improve operators’ beliefs about the complexity of pain experience, and promote a global approach to procedural pain.
United States of America. Following the recent earthquake that affected the Kashiwazaki-Kariwa Nuclear Power Plant in Japan, the Agency dispatched a team of international experts at the request of the Japanese Government. Revision began early this year on the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources, known as the BSS. A first draft of the revised BSS was reviewed in July by a technical meeting, which included participation from professional technical associations and potential co-sponsor organizations in addition to Member State experts. The Agency's nuclear security programme has maintained its rapid pace of programme delivery. The international community has taken on board a variety of international instruments relevant to nuclear security. The rapid entry into force of the International Convention on the Suppression of Acts of Nuclear Terrorism is a welcome step forward. However, progress on ratifying the Amendment to the Convention on the Physical Protection of Nuclear Material remains slow. Out of 128 States Parties, only 11 so far have accepted the Amendment. The Agency is foreseen as playing an important role in the implementation of these instruments. To that end, we have started an effort to provide nuclear security guidance that would facilitate implementation. The part on verification of nuclear non-proliferation covers the status of Safeguards agreements and Additional Protocols, the application of safeguards in the Democratic People's Republic of Korea, the implementation of the NPT safeguards agreement in the Islamic Republic of Iran and the application of IAEA safeguards in the Middle East. The IAEA has been able to verify the DPRK's shutdown of this facility, including the nuclear fuel fabrication plant, the radiochemical laboratory, the 5 megawatt experimental nuclear power plant, and the 50 megawatt nuclear power plant - as well as the 200 megawatt nuclear power plant in
Mr. Chairman, Next Sunday is the first anniversary of the accident at the Fukushima Daiichi Nuclear Power Plant in Japan. Considerable effort has been made to restore normality at the plant and the Japanese authorities have declared that they have reached cold shut down status. But there is still much to be done in the coming months and years. I will begin today by updating you on developments in the area of nuclear safety, which is the subject of three items on your Agenda. You have before you my second report on Progress in the Implementation of the IAEA Action Plan on Nuclear Safety. Good progress has been made. At a technical briefing to Member States in January, we outlined the broad range of activities still to be undertaken by the Agency and Member States under the Action Plan. We launched the Nuclear Safety Action Plan Web Platform, which provides up-to-date information on implementation and enables Member States to share safety-related technical information. The new IAEA methodology for assessing the safety vulnerabilities of nuclear power plants was used as the basis for an IAEA international expert mission to Japan in January to review the country's approach to carrying out so-called stress tests. We completed a systematic review of the IAEA Safety Standards. A number of areas were identified for strengthening and proposals will be considered by the Safety Standards Committees this month. I look forward to receiving a report from the Commission on Safety Standards later in the year. IAEA peer reviews have been strengthened to incorporate lessons learned to date. Last December, we held discussions at a senior level with the World Association of Nuclear Operators and agreed to improve coordination of our activities. A review of the application of the International Nuclear and Radiological Event Scale (INES) as a communication tool was initiated last month. An International Experts' Meeting on Reactor and Spent Fuel Safety will take place later this month
Full text: As you are aware, at the invitation of the Democratic People's Republic of Korea (DPRK), an Agency team visited the DPRK during the last week of June with a view to agreeing on modalities for verification and monitoring by the IAEA of the shutdown and sealing of the Yongbyon nuclear facility, as foreseen in the 'Initial Actions' agreed at the Six Party Talks in Beijing on 13 February 2007. Document GOV/2007/36 details the ad hoc monitoring and verification arrangement that was worked out between the DPRK and the Agency. I welcome the return of the DPRK to the verification process. I am particularly pleased with the active cooperation of the DPRK that the IAEA team received during the visit and I look forward to continuing to work with the DPRK as the verification process evolves as envisaged in the Initial Actions. You may recall that the Board concluded in June that, 'a successfully negotiated settlement of the Korean nuclear issue, maintaining the essential verification role of the Agency, would be a significant accomplishment for international peace and security'. In this context, I would invite the Board to take the actions recommended in document GOV/2007/36. As explained in my report, the conduct of the verification activities requested by the DPRK was not foreseen in the Agency's budget. The initial costs of these activities, estimated at Euros 1.7 million for 2007 and Euros 2.2 million for 2008, would cover inter alia the replacement of cameras and installation of containment and surveillance devices, the purchase of other needed equipment, and logistical and staff costs. I am requesting Member States therefore to provide funding for the implementation of these verification activities in 2007 and 2008. I should emphasize that, as with all our verification work under the Statute, verification in the DPRK should not have to rely on donations by individual States. I intend therefore to include the associated costs in the draft regular budget for
The urban district of Nancy and the Town of Nancy, France, have taken the initiative of creating an International Center of Water (Centre International de l'Eau à Nancy—NAN.C.I.E.) in association with two universities, six engineering colleges, the Research Centers of Nancy, the Rhine-Meuse Basin Agency, and the Chamber of Commerce and Industry. The aim of this center is to promote research and technology transfer in the areas of water and sanitation. In 1985 it will initiate a research program drawing on the experience of 350 researchers and engineers of various disciplines who have already been assigned to research in these fields. The research themes, the majority of which will be multidisciplinary, concern aspects of hygiene and health, the engineering of industrial processes, water resources, and the environment and agriculture. A specialist training program offering five types of training aimed at university graduates, graduates of engineering colleges, or experts, will start in October 1984.
Alzahrani, Turki A.; Abaalkhail, Bahaa A.; Ramadan, Iman K.
Objectives: To estimate the prevalence of intimate partner violence (IPV) among female patients, age 18-60 years, attending primary health care centers (PHCCs) and to measure its determinants, and reporting behavior. Methods: A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA) from January to February 2015 was employed. A 2-stage probability sampling was ad...
Gelber, Allan C; Manno, Rebecca L; Shah, Ami A; Woods, Adrianne; Le, Elizabeth N; Boin, Francesco; Hummers, Laura K; Wigley, Fredrick M
Experience suggests that African Americans may express autoimmune disease differently than other racial groups. In the context of systemic sclerosis (scleroderma), we sought to determine whether race was related to a more adverse expression of disease. Between January 1, 1990, and December 31, 2009, a total of 409 African American and 1808 white patients with scleroderma were evaluated at a single university medical center. While the distribution by sex was virtually identical in both groups, at 82% female, African American patients presented to the center at a younger mean age than white patients (47 vs. 53 yr; p scleroderma-specific autoantibody status, and for the socioeconomic measures of educational attainment and health insurance status, diminished these risk estimates (RR, 1.3; 95% CI, 1.0-1.6). The heightened risk of mortality persisted in strata defined by age at disease onset, diffuse cutaneous disease, anticentromere seropositivity, decade of care at the center, and among women. These findings support the notion that race is related to a distinct phenotypic profile in scleroderma, and a more unfavorable prognosis among African Americans, warranting heightened diagnostic evaluation and vigilant care of these patients. Further, we provide a chronologic review of the literature regarding race, organ system involvement, and mortality in scleroderma; we furnish synopses of relevant reports, and summarize findings.
Lorentzen, Håkon; Henriksen, Lars Skov
the Norwegian centers lacked a national coordinating unit. Third, an independent legal form in which local associations are members may have helped Danish centers bring about a sense of local ownership. In Norway, volunteer centers had weak ties to other local voluntary associations and were at times perceived...
Full Text Available Climate change and its effect on human life and comfort have taken increase attraction. In this paper effect of UHI is analyzed using quantitative thermal, temporal remote sensing and GIS techniques. Series of Landsat TM/ETM, 8 and ASTER images of Suez Governorate acquired in winter season were used to investigate the variation in land surface temperature (LST from 1988 to 2014 as well as land-use/cover change. NDVI NDBI and LST have been used for classification of the study area. Vulnerable areas for UHI have been assessed over Suez district. The effect of UHI was quantitatively described using urban thermal field variance index (UTFVI. Results indicate that there are increases in the overall temperature between years 1988 and 2014. Suez and Al-Arbin districts which are the most populated, highly density built-up and rarely vegetation zones in Suez governorate experiences a huge problem of UHI. UHI phenomenon represents total weight of 40.84% and 46.3% of their areas respectively. It is found that the mean temperature of UHI areas of Al-Arbin and Al-Suez districts was 7.5 above mean of District temperature. While the value of UHI of suburban zone e.g. Ataqa and AL-Ganayin was 2.5 degree above district mean. The results indicate that changes in UTFVI distribution can be predominantly related to the expansion of urban area during the study time period. The hot spot of UTFVI were found mainly in the built-up areas especially densely populated district and in heavily industrial district. It is the vulnerable areas to UHI. Keywords: Climate change, UHI, Suez Canal, Suez Governorate, Land surface temperature, Land/use land/cover change, Urban sprawl
Muh. Ryman Napirah
Full Text Available Aim: In order to determine the fares of surgery, there are two types of fares used by hospitals namely Indonesian Case Based Groups fare (INA-CBG s and Governor Regulation fare. This study aimed to identify and analyze both types of fares in orthopedic surgery, general, eyes, midwifery, mouth, ENT, urology at inpatient room of Undata Regional Public Hospital in Palu during year 2014. Method: This was a quantitative study with descriptive approach with 46 cases as the number of surgery. Data were collected through observation and analysis of secondary data were gotten from medical record, pharmaceutical installation of IBS/IDR, inpatient therapy room (Matahari, Aster, and Teratai pavilions and cashier of inpatient room in form of cost details and patient data from January to December 2014. Data Presentation was formed on tables, where the existing fares are grouped based on the component of each cost then summed and calculated the deviation between the two types of fares. Results: This study indicated that orthopedic surgery with deviation of Rp 11.311.365, general surgery with deviation of Rp 6.438.409, eyes surgery with deviation of Rp 45.173.741, midwifery surgery with deviation of Rp 6.645.765, oral surgery with deviation of Rp 6.105.659, and urological surgery with deviation of Rp. 3.809.959. Conclusion: It can be concluded that INA-CBG's fares are higher than Governor Regulation fares except orthopedic surgery, where the Governor Regulation faresare higher than INA-CBG’s fares.
Abdel-Halim M. Ismail
Full Text Available The present work is the 1st part of 3-part study carried out at Fayoum Governorate, Egypt to evaluate the pollen species collected by honey bee, Apis mellifera L., colonies during two successive years, 2009 and 2010. Obtained results showed that, in 2009, total amount of trapped pollen (fresh weight was 2354.89 g/colony/year (mean 588.72 g/colony/season, with peaks in summer and spring, while declined in autumn and winter. Correlation between mean maximum and minimum temperatures and weekly pollen weights was highly positive, while it was insignificant for relative humidity. In 2010, total amount of trapped pollen decreased to 1635.36 g/colony/year (mean 408.84 g/colony/season. The largest amounts were collected in summer followed by winter then spring, while least ones were in autumn. Correlation was highly positive between weekly mean of pollen weights and maximum temperature, while it was insignificant for minimum temperature or relative humidity. There were 24 plant species of 16 botanical families from which bees collected pollen. These sources were ranked according to their predominant quantities in the 1st and 2nd years by two numbers, respectively as the following: sesame 1 and 1, maize 2 and 2, clover 3 and 7, sunflower 4 and 8, wild mustard 5 and 3, casuarina 6 and 13, olive 7 and 11, eucalyptus 8 and 4, pumpkin 9 and 9, cocklebur 10 and 5, date palm 11 and 10, chamomile 12 and 12, field bindweed 13 and 6, pepper 14 and 20, coriander 15 and 16, acacia 16 and 24, citrus 17 and 0, marigold 18 and 0, common red 19 and 17, Christ’s thorn 20 and 22, tooth pick 21 and 21, brood bean 22 and 15, belladonna 23 and 23, pea 0 and 14, marjoram 0 and 18 and fennel 0 and 19. The 1st five plants seem to be the main pollen sources for honey bee colonies and consequently pollen producing during the whole year in the tested region. These sources represented 75.61% and 66.95% of the total annual yield in the two surveyed years, respectively.
Schmidt, Palle Nordblad; Novovic, Srdan; Roug, Stine
OBJECTIVE: Endoscopic transmural drainage and necrosectomy (ETDN) is a promising alternative to percutaneous drainage and surgical intervention in the treatment of walled-off pancreatic and peripancreatic necroses (WONs). We assessed the outcome and safety profile of ETDN in a single-center patient......). Gallstones were the predominant etiology of pancreatitis (41%), followed by alcohol (33%). Median time from debut of symptoms to first endoscopic treatment was 44 (9-246) days. Culture-proven infected necrosis was found in 71% of the cases. Twenty-three patients (28%) required admission in intensive care...
Large, Matthew; Nielssen, Olav; Lackersteen, Steven; Smith, Glen
Previous studies have found that rates of homicide of children aged under one (infant homicide) are associated with rates of suicide, but not with rates of homicide. Linear regression was used to examine associations among infant homicide, homicide, and suicide in samples of regions in the United States and other countries. Infant homicide rates…
Center Director Gene Goldman and special guests celebrate the opening of the site's new Emergency Operations Center on June 2. Participants included (l t r): Steven Cooper, deputy director of the National Weather Service Southern Region; Tom Luedtke, NASA associate administrator for institutions and management; Charles Scales, NASA associate deputy administrator; Mississippi Gov. Haley Barbour; Gene Goldman, director of Stennis Space Center; Jack Forsythe, NASA assistant administrator for the Office of Security and Program Protection; Dr. Richard Williams, NASA chief health and medical officer; and Weldon Starks, president of Starks Contracting Company Inc. of Biloxi.
Full Text Available Background: Brucellosis is one of the most common diseases among humans and livestock. Using contaminated and unpasteurized dairy products, having contact with infected livestock and, in general, inappropriate dietary patterns, as well as lack of hygiene, can be noted as the most common modes of transmission for such a disease. Objectives: Since the establishment of Alborz province in Iran and, accordingly, Alborz university of medical sciences, Karaj, Iran, there has been no study on the epidemiological situation of the disease. Therefore, the present study examines the epidemiology of Brucellosis at Karaj Health center No. 2, Karaj, Iran, during 2011 - 2012. Patients and Methods: This research was a cross-sectional descriptive study, on patients with Brucellosis, during 2011 - 2012, in the area covered by Karaj health center No. 2, Karaj, Iran. The data about all suspected cases, collected from polyclinic, laboratories and health centers, and confirmed by Wright, combs Wright and 2ME tests were reviewed. After recording the demographic data and laboratory results, they were entered into STATA 11 software and analyzed. Results: The number of patients reported in this study was 67. The incidence of the disease during 2011 - 2012 was, respectively, 3.75 and 4.6 per hundred thousand and the average incidence of the disease was 4.2 per hundred thousand. The highest rate of infection, in terms of occupation, was found among ranchers (40.29%. In 100% of the cases, there was a history of consumption of cottage cheese, fresh cow milk or other unpasteurized dairy products. Considering the incidence season, most cases of the disease (38.80% had occurred in the spring. In terms of gender, 56.71% were male and 43.28% of patients were female. As well, in terms of age, more 50% of the patients were in the age groups of 31 - 40 and 41 - 50 years old. Conclusions: Given the occurrence of more cases of the disease among individuals with risk factors, such as
Saito, Eiko; Inoue, Manami; Sawada, Norie; Shimazu, Taichi; Yamaji, Taiki; Iwasaki, Motoki; Sasazuki, Shizuka; Noda, Mitsuhiko; Iso, Hiroyasu; Tsugane, Shoichiro
Despite the rising consumption of coffee worldwide, few prospective cohort studies assessed the association of coffee intake with mortality including total and major causes of death. We aimed to investigate the association between habitual coffee drinking and mortality from all causes, cancer, heart disease, cerebrovascular disease, respiratory disease, injuries, and other causes of death in a large-scale, population-based cohort study in Japan. We studied 90,914 Japanese persons aged between 40 and 69 y without a history of cancer, cerebrovascular disease, or ischemic heart disease at the time of the baseline study. Subjects were followed up for an average of 18.7 y, during which 12,874 total deaths were reported. The association between coffee intake and risk of total and cause-specific mortality was assessed by using a Cox proportional hazards regression model with adjustment for potential confounders. We showed an inverse association between coffee intake and total mortality in both men and women. HRs (95% CIs) for total death in subjects who consumed coffee compared with those who never drank coffee were 0.91 (0.86-0.95) for 5 cups/d (P-trend Coffee was inversely associated with mortality from heart disease, cerebrovascular disease, and respiratory disease. With this prospective study, we suggest that the habitual intake of coffee is associated with lower risk of total mortality and 3 leading causes of death in Japan. © 2015 American Society for Nutrition.
Opening remarks at the press conference on the outcome of the Board of Governors' consideration of the implementation of safeguards in the Islamic Republic of Iran. 26 November 2003, Vienna, Austria. IAEA Board of Governors
and welcome steps which I very much hope will be sustained. 4. While much progress has been achieved, much work remains to be done. This is work in progress. We naturally still have much verification work to do before we can provide the assurances expected by the international community, specifically that all nuclear activities in Iran are fully declared and are exclusively for peaceful purposes. These assurances could clearly help build confidence and could open the way for a new chapter of co-operation between Iran and the international community. Our success and pace of progress in generating the required assurance will, however, depend on Iran's full co-operation and transparency; the ball is now in Iran's court to demonstrate through verification the peaceful nature of its programme. Our success will also depend on getting full co-operation from all relevant countries, particularly those that were the source of some of the nuclear material and equipment in Iran. In the next few weeks and months the IAEA will be fully engaged in Iran and will carry out intensive verification activities. I will be reporting again to the IAEA Board of Governors in February or earlier if appropriate. (IAEA)
Cai, Shuying; Liu, Zhenhuan; Peng, Guilan; Huang, Xinfa; Li, Yinlan; Hu, Shuxiang
To explore the repair effects of acupuncture for promoting the governor vessel and tranquilizing the mind (acupuncture technique) on cerebral white matter injury of premature infants. A total of 56 cases of cerebral whiter matter injury of premature infants, the fetal age less than 35 weeks were selected and randomized into an observation group (27 cases) and a control group (29 cases). The routine basic rehabilitation therapy was used in the two groups. Additionally, in the observation group, the acupuncture technique was added, once a day and the treatment for 15 days was as 1 course. Totally, 3 courses of treatment were required. Before and after treatment, the cranial magnetic resonance imaging (MRI) and the diffusion tensor imaging (DTI) were adopted to observe the location and severity of cerebral white matter injury. The Gesell developmental scale was used to assess the nerve motor development. After treatment, the difference was not significant statistically in the severity of cerebral white matter injury in the infants between the two groups ( P >0.05). The FA value of cerebral white matter in the interesting zone was increased as compared with that before treatment in the infants of the two groups (both P control groups ( P control group (all P 0.05). Acupuncture technique for promoting the governor vessel and tranquilizing the mind promotes the repair of the function in the premature infants with cerebral white matter injury and further benefits the promotion of the intelligence.
The IPCC in 2015 has recognized the critical role of local governments in scaling up the adaptation of communities to climate change. The role will be executed properly if the leaders have an awareness of climate change as a strategic agenda in his administration. In the context of Indonesia, the vision and mission of a regional head can be a clue as to how he supports efforts in tackling climate change. The five-year regional development plan is an elaboration of the development agendas offered by a regional head in his vision and mission. Therefore, this paper aims to analyze the future of climate change policy in some provincial governments based on the vision and mission of the elected governors. To achieve the