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  1. Advance Directives in Hospice Healthcare Providers: A Clinical Challenge.

    Science.gov (United States)

    Luck, George R; Eggenberger, Terry; Newman, David; Cortizo, Jacqueline; Blankenship, Derek C; Hennekens, Charles H

    2017-11-01

    On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We therefore explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers. Surveys that included 32 items to explore completion rates, as well as barriers, knowledge, and demographics, were e-mailed to 2097 healthcare providers, including employees and volunteers, at a nonprofit hospice. Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates, whereas years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive, and 45% will talk to patients and families about their wishes. The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Because, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Stress and strain provide positional and directional cues in development.

    Science.gov (United States)

    Bozorg, Behruz; Krupinski, Pawel; Jönsson, Henrik

    2014-01-01

    The morphogenesis of organs necessarily involves mechanical interactions and changes in mechanical properties of a tissue. A long standing question is how such changes are directed on a cellular scale while being coordinated at a tissular scale. Growing evidence suggests that mechanical cues are participating in the control of growth and morphogenesis during development. We introduce a mechanical model that represents the deposition of cellulose fibers in primary plant walls. In the model both the degree of material anisotropy and the anisotropy direction are regulated by stress anisotropy. We show that the finite element shell model and the simpler triangular biquadratic springs approach provide equally adequate descriptions of cell mechanics in tissue pressure simulations of the epidermis. In a growing organ, where circumferentially organized fibers act as a main controller of longitudinal growth, we show that the fiber direction can be correlated with both the maximal stress direction and the direction orthogonal to the maximal strain direction. However, when dynamic updates of the fiber direction are introduced, the mechanical stress provides a robust directional cue for the circumferential organization of the fibers, whereas the orthogonal to maximal strain model leads to an unstable situation where the fibers reorient longitudinally. Our investigation of the more complex shape and growth patterns in the shoot apical meristem where new organs are initiated shows that a stress based feedback on fiber directions is capable of reproducing the main features of in vivo cellulose fiber directions, deformations and material properties in different regions of the shoot. In particular, we show that this purely mechanical model can create radially distinct regions such that cells expand slowly and isotropically in the central zone while cells at the periphery expand more quickly and in the radial direction, which is a well established growth pattern in the meristem.

  3. Stress and strain provide positional and directional cues in development.

    Directory of Open Access Journals (Sweden)

    Behruz Bozorg

    2014-01-01

    Full Text Available The morphogenesis of organs necessarily involves mechanical interactions and changes in mechanical properties of a tissue. A long standing question is how such changes are directed on a cellular scale while being coordinated at a tissular scale. Growing evidence suggests that mechanical cues are participating in the control of growth and morphogenesis during development. We introduce a mechanical model that represents the deposition of cellulose fibers in primary plant walls. In the model both the degree of material anisotropy and the anisotropy direction are regulated by stress anisotropy. We show that the finite element shell model and the simpler triangular biquadratic springs approach provide equally adequate descriptions of cell mechanics in tissue pressure simulations of the epidermis. In a growing organ, where circumferentially organized fibers act as a main controller of longitudinal growth, we show that the fiber direction can be correlated with both the maximal stress direction and the direction orthogonal to the maximal strain direction. However, when dynamic updates of the fiber direction are introduced, the mechanical stress provides a robust directional cue for the circumferential organization of the fibers, whereas the orthogonal to maximal strain model leads to an unstable situation where the fibers reorient longitudinally. Our investigation of the more complex shape and growth patterns in the shoot apical meristem where new organs are initiated shows that a stress based feedback on fiber directions is capable of reproducing the main features of in vivo cellulose fiber directions, deformations and material properties in different regions of the shoot. In particular, we show that this purely mechanical model can create radially distinct regions such that cells expand slowly and isotropically in the central zone while cells at the periphery expand more quickly and in the radial direction, which is a well established growth pattern

  4. Forest rodents provide directed dispersal of Jeffrey pine seeds

    Science.gov (United States)

    Briggs, J.S.; Wall, S.B.V.; Jenkins, S.H.

    2009-01-01

    Some species of animals provide directed dispersal of plant seeds by transporting them nonrandomly to microsites where their chances of producing healthy seedlings are enhanced. We investigated whether this mutualistic interaction occurs between granivorous rodents and Jeffrey pine (Pinus jeffreyi) in the eastern Sierra Nevada by comparing the effectiveness of random abiotic seed dispersal with the dispersal performed by four species of rodents: deer mice (Peromyscus maniculatus), yellow-pine and long-eared chipmunks (Tamias amoenus and T. quadrimaculatus), and golden-mantled ground squirrels (Spermophilus lateralis). We conducted two caching studies using radio-labeled seeds, the first with individual animals in field enclosures and the second with a community of rodents in open forest. We used artificial caches to compare the fates of seeds placed at the range of microsites and depths used by animals with the fates of seeds dispersed abiotically. Finally, we examined the distribution and survival of naturally establishing seedlings over an eight-year period.Several lines of evidence suggested that this community of rodents provided directed dispersal. Animals preferred to cache seeds in microsites that were favorable for emergence or survival of seedlings and avoided caching in microsites in which seedlings fared worst. Seeds buried at depths typical of animal caches (5–25 mm) produced at least five times more seedlings than did seeds on the forest floor. The four species of rodents differed in the quality of dispersal they provided. Small, shallow caches made by deer mice most resembled seeds dispersed by abiotic processes, whereas many of the large caches made by ground squirrels were buried too deeply for successful emergence of seedlings. Chipmunks made the greatest number of caches within the range of depths and microsites favorable for establishment of pine seedlings. Directed dispersal is an important element of the population dynamics of Jeffrey pine, a

  5. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-02-17

    ... Options'' tab. 2. By regular mail. You may mail written comments to the following address ONLY: Centers... provide for payment that is consistent with efficiency, economy, and quality of care. With the...

  6. Comparing consumer-directed and agency models for providing supportive services at home.

    Science.gov (United States)

    Benjamin, A E; Matthias, R; Franke, T M

    2000-04-01

    To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. A survey of a random sample of 1,095 clients, age 18 and over, who receive services in California's In-Home Supportive Services (IHSS) program funded primarily by Medicaid. Other data were obtained from the California Management and Payrolling System (CMIPS). The sample was stratified by service model (agency-directed or consumer-directed), client age (over or under age 65), and severity. Data were collected on client demographics, condition/functional status, and supportive service experience. Outcome measures were developed in three areas: safety, unmet need, and service satisfaction. Factor analysis was used to reduce multiple outcome measures to nine dimensions. Multiple regression analysis was used to assess the effect of service model on each outcome dimension, taking into account the client-provider relationship, client demographics, and case mix. Recipients of IHSS services as of mid-1996 were interviewed by telephone. The survey was conducted in late 1996 and early 1997. On various outcomes, recipients in the consumer-directed model report more positive outcomes than those in the agency model, or they report no difference. Statistically significant differences emerge on recipient safety, unmet needs, and service satisfaction. A family member present as a paid provider is also associated with more positive reported outcomes within the consumer-directed model, but model differences persist even when this is taken into account. Although both models have strengths and weaknesses, from a recipient perspective the consumer-directed model is associated with more positive outcomes. Although health professionals have expressed concerns about the capacity of consumer direction to assure quality, particularly with respect to safety, meeting unmet

  7. Pipe elbow stiffness coefficients including shear and bend flexibility factors for use in direct stiffness codes

    International Nuclear Information System (INIS)

    Perry, R.F.

    1977-01-01

    Historically, developments of computer codes used for piping analysis were based upon the flexibility method of structural analysis. Because of the specialized techniques employed in this method, the codes handled systems composed of only piping elements. Over the past ten years, the direct stiffness method has gained great popularity because of its systematic solution procedure regardless of the type of structural elements composing the system. A great advantage is realized with a direct stiffness code that combines piping elements along with other structural elements such as beams, plates, and shells, in a single model. One common problem, however, has been the lack of an accurate pipe elbow element that would adequately represent the effects of transverse shear and bend flexibility factors. The purpose of the present paper is to present a systematic derivation of the required 12x12 stiffness matrix and load vectors for a three dimensional pipe elbow element which includes the effects of transverse shear and pipe bend flexibility according to the ASME Boiler and Pressure Vessel Code, Section III. The results are presented analytically and as FORTRAN subroutines to be directly incorporated into existing direct stiffness codes. (Auth.)

  8. Modeling of the Direct Current Generator Including the Magnetic Saturation and Temperature Effects

    Directory of Open Access Journals (Sweden)

    Alfonso J. Mercado-Samur

    2013-11-01

    Full Text Available In this paper the inclusion of temperature effect on the field resistance on the direct current generator model DC1A, which is valid to stability studies is proposed. First, the linear generator model is presented, after the effect of magnetic saturation and the change in the resistance value due to temperature produced by the field current are included. The comparison of experimental results and model simulations to validate the model is used. A direct current generator model which is a better representation of the generator is obtained. Visual comparison between simulations and experimental results shows the success of the proposed model, because it presents the lowest error of the compared models. The accuracy of the proposed model is observed via Modified Normalized Sum of Squared Errors index equal to 3.8979%.

  9. Survey of users and providers of recycled water: quality concerns and directions for applied research.

    Science.gov (United States)

    Higgins, J; Warnken, J; Sherman, P P; Teasdale, P R

    2002-12-01

    Users and providers of recycled water in Queensland, Australia, were canvassed to ascertain concerns about recycled water quality and directions for applied research. Some 79% of respondents had concerns about recycled water quality including microbiological components, such as viruses, parasites and bacteria, salinity related components, aggregate components, such as pH and solids, nutrients, organic components, including pesticides and endocrine disruptors, as well as quality variability. Relative differences in the proportion of concern for some quality characteristics were observed between the areas of different population density with those from the low population areas being more concerned than those from medium or high areas. Some users and providers observed changes in recycled water quality during distribution including nutrients, chlorine, solids, colour and odour. Some 52% of providers and 19% of current users propose to expand their usage and 30% of non-users propose to commence doing so in the next 5 years. Recycled water quality characteristics identified for applied research included microbiological components, organic components, nutrients and salinity.

  10. Direct-phase-variable model of a synchronous reluctance motor including all slot and winding harmonics

    International Nuclear Information System (INIS)

    Obe, Emeka S.; Binder, A.

    2011-01-01

    A detailed model in direct-phase variables of a synchronous reluctance motor operating at mains voltage and frequency is presented. The model includes the stator and rotor slot openings, the actual winding layout and the reluctance rotor geometry. Hence, all mmf and permeance harmonics are taken into account. It is seen that non-negligible harmonics introduced by slots are present in the inductances computed by the winding function procedure. These harmonics are usually ignored in d-q models. The machine performance is simulated in the stator reference frame to depict the difference between this new direct-phase model including all harmonics and the conventional rotor reference frame d-q model. Saturation is included by using a polynomial fitting the variation of d-axis inductance with stator current obtained by finite-element software FEMAG DC (registered) . The detailed phase-variable model can yield torque pulsations comparable to those obtained from finite elements while the d-q model cannot.

  11. Modeling the distribution of ammonia across Europe including bi-directional surface–atmosphere exchange

    Directory of Open Access Journals (Sweden)

    R. J. Wichink Kruit

    2012-12-01

    Full Text Available A large shortcoming of current chemistry transport models (CTM for simulating the fate of ammonia in the atmosphere is the lack of a description of the bi-directional surface–atmosphere exchange. In this paper, results of an update of the surface–atmosphere exchange module DEPAC, i.e. DEPosition of Acidifying Compounds, in the chemistry transport model LOTOS-EUROS are discussed. It is shown that with the new description, which includes bi-directional surface–atmosphere exchange, the modeled ammonia concentrations increase almost everywhere, in particular in agricultural source areas. The reason is that by using a compensation point the ammonia lifetime and transport distance is increased. As a consequence, deposition of ammonia and ammonium decreases in agricultural source areas, while it increases in large nature areas and remote regions especially in southern Scandinavia. The inclusion of a compensation point for water reduces the dry deposition over sea and allows reproducing the observed marine background concentrations at coastal locations to a better extent. A comparison with measurements shows that the model results better represent the measured ammonia concentrations. The concentrations in nature areas are slightly overestimated, while the concentrations in agricultural source areas are still underestimated. Although the introduction of the compensation point improves the model performance, the modeling of ammonia remains challenging. Important aspects are emission patterns in space and time as well as a proper approach to deal with the high concentration gradients in relation to model resolution. In short, the inclusion of a bi-directional surface–atmosphere exchange is a significant step forward for modeling ammonia.

  12. Theta sequences of grid cell populations can provide a movement-direction signal.

    Science.gov (United States)

    Zutshi, Ipshita; Leutgeb, Jill K; Leutgeb, Stefan

    2017-10-01

    It has been proposed that path integration in mammals is performed by the convergence of internally generated speed and directional inputs onto grid cells. Although this hypothesis has been supported by the discovery that head direction, speed, and grid cells are intermixed within entorhinal cortex and by the recent finding that head-direction inputs are necessary for grid firing, many details on how grid cells are generated have remained elusive. For example, analysis of recording data suggests that substituting head direction for movement direction accrues errors that preclude the formation of grid patterns. To address this discrepancy, we propose that the organization of grid networks makes it plausible that movement-direction signals are an output from grid cells and that temporally precise grid cell sequences provide a robust directional signal to other spatial and directional cell types.

  13. Expanding oral care opportunities: direct access care provided by dental hygienists in the United States.

    Science.gov (United States)

    Naughton, Doreen K

    2014-06-01

    Dental hygienists expand access to oral care in the United States. Many Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs. Publications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data. Dental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs. Dental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Sensorless Direct Flux Vector Control of Synchronous Reluctance Motors Including Standstill, MTPA and Flux Weakening

    OpenAIRE

    Yousefi-Talouki, Arzhang; Pescetto, Paolo; Pellegrino, Gian-Mario Luigi

    2017-01-01

    This paper proposes a sensorless direct flux vector control scheme for synchronous reluctance motor drives. Torque is controlled at constant switching frequency, via the closed loop regulation of the stator flux linkage vector and of the current component in quadrature with it, using the stator flux oriented reference frame. A hybrid flux and position observer combines back-electromotive force integration with pulsating voltage injection around zero speed. Around zero speed, the position obse...

  15. Consumer Perceptions of Interactions With Primary Care Providers After Direct-to-Consumer Personal Genomic Testing

    NARCIS (Netherlands)

    van der Wouden, Cathelijne H.; Carere, Deanna Alexis; Maitland-van der Zee, Anke H.; Ruffin, Mack T.; Roberts, J. Scott; Green, Robert C.; IV, Mack T. Ruffin; Krier, Joel B.; Helm, Margaret H.; Lehmann, Lisa S.; Kraft, Peter; Le, Lan Q.; Ostergren, Jenny; Uhlmann, Wendy R.; Couper, Mick P.; Mountain, Joanna L.; Kiefer, Amy K.; Braunstein, Glenn D.; Crawford, Scott D.; Cupples, L. Adrienne; Chen, Clara A.; Wang, Catharine; Gray, Stacy W.; Koenig, Barbara A.; Kaphingst, Kimberly; Gollust, Sarah

    2016-01-01

    Background: Direct-to-consumer (DTC) personal genomic testing (PGT) allows individuals to learn about their genetic makeup without going through a physician, but some consumers share their results with their primary care provider (PCP). Objective: To describe the characteristics and perceptions of

  16. Training mid-level providers on palliative care: bringing advanced directives and symptom assessment and management to community oncology practices.

    Science.gov (United States)

    Lesperance, Mary; Shannon, Robert; Pumphrey, Phyllis K; Dunbar, Erin; Genther, Renee; Coleman, C Lynn; Tabano, Margaret; Maurer, Jennifer; Vazquez, Adrienne; Capp, Elizabeth; McMillan, Jessica; Wilkerson, Katie; Robbins, Gerald; Phillips, Dorothy Green; Howick, Priscilla; Solaun, Catherine; Sloan, Jeff; Colón-Otero, Gerardo

    2014-05-01

    Palliative care services are not available in most outpatient oncology practices. A program training 11 mid-level providers from oncology practices on advanced directive discussions and supportive symptom assessment and management performed by palliative care specialists was completed. A follow-up session 9 months later identified barriers to implementation. Of the 11 mid-level providers, 8 participated in the follow-up session, and 9 of the 11 providers implemented advanced directive's discussions and symptom assessment and management for patients with metastatic cancer. Main barriers included uncertainties about reimbursement, patients' lack of knowledge about palliative care, and lack of access to supportive services. This program successfully promoted advanced directive discussions and supportive/palliative care symptom assessment and management to community oncology practices, which will hopefully translate into improved quality of life for patients with metastatic cancer.

  17. A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices

    Directory of Open Access Journals (Sweden)

    Stephen Wotman

    2010-05-01

    Full Text Available Stephen Wotman1, Catherine A Demko1, Kristin Victoroff1, Joseph J Sudano2, James A Lalumandier11Department of Community Dentistry, Case Western Reserve University, School of Dental Medicine, Cleveland, OH, USA; 2Center of Health Care Research and Policy, Case Western Reserve University, School of Medicine, Cleveland, OH, USAAbstract: This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist’s and half of the hygienist’s patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction.Keywords: dental practice, dental practice core activities, direct observation of dental practice, Dental Davis Observation Code, dentist, hygienist patient behaviors

  18. Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes

    Science.gov (United States)

    Lorincz, Ilona S.; Lawson, Brittany C. T.

    2012-01-01

    Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined. PMID:23225214

  19. A new force field including charge directionality for TMAO in aqueous solution

    Energy Technology Data Exchange (ETDEWEB)

    Usui, Kota; Nagata, Yuki, E-mail: sulpizi@uni-mainz.de, E-mail: nagata@mpip-mainz.mpg.de; Hunger, Johannes; Bonn, Mischa [Max Planck Institute for Polymer Research, Ackermannweg 10, 55128 Mainz (Germany); Sulpizi, Marialore, E-mail: sulpizi@uni-mainz.de, E-mail: nagata@mpip-mainz.mpg.de [Johannes Gutenberg University Mainz, Staudingerweg 7, 55099 Mainz (Germany)

    2016-08-14

    We propose a new force field for trimethylamine N-oxide (TMAO), which is designed to reproduce the long-lived and highly directional hydrogen bond between the TMAO oxygen (O{sub TMAO}) atom and surrounding water molecules. Based on the data obtained by ab initio molecular dynamics simulations, we introduce three dummy sites around O{sub TMAO} to mimic the O{sub TMAO} lone pairs and we migrate the negative charge on the O{sub TMAO} to the dummy sites. The force field model developed here improves both structural and dynamical properties of aqueous TMAO solutions. Moreover, it reproduces the experimentally observed dependence of viscosity upon increasing TMAO concentration quantitatively. The simple procedure of the force field construction makes it easy to implement in molecular dynamics simulation packages and makes it compatible with the existing biomolecular force fields. This paves the path for further investigation of protein-TMAO interaction in aqueous solutions.

  20. A new force field including charge directionality for TMAO in aqueous solution

    International Nuclear Information System (INIS)

    Usui, Kota; Nagata, Yuki; Hunger, Johannes; Bonn, Mischa; Sulpizi, Marialore

    2016-01-01

    We propose a new force field for trimethylamine N-oxide (TMAO), which is designed to reproduce the long-lived and highly directional hydrogen bond between the TMAO oxygen (O TMAO ) atom and surrounding water molecules. Based on the data obtained by ab initio molecular dynamics simulations, we introduce three dummy sites around O TMAO to mimic the O TMAO lone pairs and we migrate the negative charge on the O TMAO to the dummy sites. The force field model developed here improves both structural and dynamical properties of aqueous TMAO solutions. Moreover, it reproduces the experimentally observed dependence of viscosity upon increasing TMAO concentration quantitatively. The simple procedure of the force field construction makes it easy to implement in molecular dynamics simulation packages and makes it compatible with the existing biomolecular force fields. This paves the path for further investigation of protein-TMAO interaction in aqueous solutions.

  1. Carbon Footprint of Inbound Tourism to Iceland: A Consumption-Based Life-Cycle Assessment including Direct and Indirect Emissions

    Directory of Open Access Journals (Sweden)

    Hannah Sharp

    2016-11-01

    Full Text Available The greenhouse gas (GHG emissions caused by tourism have been studied from several perspectives, but few studies exist that include all direct and indirect emissions, particularly those from aviation. In this study, an input/output-based hybrid life-cycle assessment (LCA method is developed to assess the consumption-based carbon footprint of the average tourist including direct and indirect emissions. The total inbound tourism-related GHG emissions are also calculated within a certain region. As a demonstration of the method, the full carbon footprint of an average tourist is assessed as well as the total GHG emissions induced by tourism to Iceland over the period of 2010–2015, with the presented approach applicable in other contexts as well. Iceland provides an interesting case due to three features: (1 the tourism sector in Iceland is the fastest-growing industry in the country with an annual growth rate of over 20% over the past five years; (2 almost all tourists arrive by air; and (3 the country has an almost emissions-free energy industry and an import-dominated economy, which emphasise the role of the indirect emissions. According to the assessment, the carbon footprint for the average tourist is 1.35 tons of CO2-eq, but ranges from 1.1 to 3.2 tons of CO2-eq depending on the distance travelled by air. Furthermore, this footprint is increasing due to the rise in average flight distances travelled to reach the country. The total GHG emissions caused by tourism in Iceland have tripled from approximately 600,000 tons of CO2-eq in 2010 to 1,800,000 tons in 2015. Aviation accounts for 50%–82% of this impact (depending on the flight distance underlining the importance of air travel, especially as tourism-related aviation is forecasted to grow significantly in the near future. From a method perspective, the carbon footprinting application presented in the study would seem to provide an efficient way to study both the direct and indirect

  2. Self-directed exploration provides a Ncs1-dependent learning bonus.

    Science.gov (United States)

    Mun, Ho-Suk; Saab, Bechara J; Ng, Enoch; McGirr, Alexander; Lipina, Tatiana V; Gondo, Yoichi; Georgiou, John; Roder, John C

    2015-12-07

    Understanding the mechanisms of memory formation is fundamental to establishing optimal educational practices and restoring cognitive function in brain disease. Here, we show for the first time in a non-primate species, that spatial learning receives a special bonus from self-directed exploration. In contrast, when exploration is escape-oriented, or when the full repertoire of exploratory behaviors is reduced, no learning bonus occurs. These findings permitted the first molecular and cellular examinations into the coupling of exploration to learning. We found elevated expression of neuronal calcium sensor 1 (Ncs1) and dopamine type-2 receptors upon self-directed exploration, in concert with increased neuronal activity in the hippocampal dentate gyrus and area CA3, as well as the nucleus accumbens. We probed further into the learning bonus by developing a point mutant mouse (Ncs1(P144S/P144S)) harboring a destabilized NCS-1 protein, and found this line lacked the equivalent self-directed exploration learning bonus. Acute knock-down of Ncs1 in the hippocampus also decoupled exploration from efficient learning. These results are potentially relevant for augmenting learning and memory in health and disease, and provide the basis for further molecular and circuit analyses in this direction.

  3. Weight management including dietary and physical activity advice provided by Australian physiotherapists: a pilot cross-sectional survey.

    Science.gov (United States)

    Snodgrass, Suzanne J; Carter, Amy E; Guest, Maya; Collins, Clare E; James, Carole; Kable, Ashley K; Ashby, Samantha E; Plotnikoff, Ronald C

    2014-08-01

    Physiotherapists may have an impact on obesity prevention and treatment by providing nutrition and physical activity advice to overweight or obese clients; yet little is known about physiotherapists' beliefs and practices related to client weight management. The aim of this pilot study was to determine the practices, beliefs, attitudes and knowledge of physiotherapists regarding the provision of weight management advice to overweight or obese clients. Physiotherapists (n = 65) working in multiple practice settings completed a self-administered questionnaire. Logistic regression determined factors associated with the provision of dietary and physical activity advice for weight management. The majority of physiotherapists (n = 53 [81.5%]) believed providing weight management advice was within their scope of practice, yet only a minority had received training during their professional entry level education (n = 13 [20%]) or through professional development (n = 7 [11%]). Most physiotherapists (n = 55 [84.6%]) provided physical activity advice for weight management, but a minority (n = 27 [41.5%]) provided dietary advice. Having received training in weight management during their professional entry level education was associated with providing dietary advice (Odds ratio 8.8, 95% confidence interval 2.0-38.9, p = 0.004). Training in weight management may increase the likelihood of physiotherapists providing dietary advice, improving physiotherapists' management of obesity.

  4. Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players

    DEFF Research Database (Denmark)

    Harøy, Joar; Thorborg, Kristian; Serner, Andreas

    2017-01-01

    BACKGROUND: The FIFA 11+ was developed as a complete warm-up program to prevent injuries in soccer players. Although reduced hip adduction strength is associated with groin injuries, none of the exercises included in the FIFA 11+ seem to specifically target hip adduction strength. PURPOSE......: To investigate the effect on eccentric hip adduction strength of the FIFA 11+ warm-up program with or without the Copenhagen adduction exercise. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: We recruited 45 eligible players from 2 U19 elite male soccer teams. Players were randomized...... into 2 groups; 1 group carried out the standard FIFA 11+ program, while the other carried out the FIFA 11+ but replaced the Nordic hamstring exercise with the Copenhagen adduction exercise. Both groups performed the intervention 3 times weekly for 8 weeks. Players completed eccentric strength and sprint...

  5. Main directions of providing of industrial enterprises effective development and conditions of their choice

    Directory of Open Access Journals (Sweden)

    Y. V. Zhuravlev

    2016-01-01

    Full Text Available Difficulties in managing the effective development of an industrial enterprise is largely due to the lack of complex tools to measure it, which is aggravated by the lack of identification of the factors that affect the food industry enterprises. In the article, we investigated directions of providing of industrial enterprises effective development and determined conditions of their choice depending on organizational assets and enterprise’s added value dynamics. For every possible combination, we offered certain mechanism of effective development: internal – by means of enterprise’s self-potential activation, and external – by means of deep, moderate or shallow integration. Deep integration means full merger of the enterprise and is recommended in case of critical level of enterprise’s potential. Moderate integration is implemented by purchase of controlling block of shares and is carried out in case of critical or high enterprise’s potential combined with growth of added value. Shallow integration can be used in any combination of resources and added value and is implemented on a contractual basis without institutional and legal change. The concept of directions of providing of industrial enterprises development, that we worked out, is of applicable character and can be used by industrial enterprises regardless field and specific character of industry. Implementation of offered measures will provide industrial enterprises effective development, which will help to form organizational assets base of Russian economics, which is a powerful driver of modernization of Russian industrial enterprises and economics as a whole.

  6. Health care providers and direct-to-consumer access and advertising of genetic testing in the United States.

    Science.gov (United States)

    Myers, Melanie F

    2011-12-28

    Marketing pressures, regulatory policies, clinical guidelines, and consumer demand all affect health care providers' knowledge and use of health-related genetic tests that are sold and/or advertised to consumers. In addition, clinical guidelines, regulatory policies, and educational efforts are needed to promote the informed use of genetic tests that are sold and advertised to consumers and health care providers. A shift in culture regarding the regulation of genetic tests that are sold directly to consumers is suggested: by recent actions taken by the US Food and Drug Administration (FDA), including letters sent to direct-to-consumer (DTC) genetic testing companies stating that their tests meet the definition of medical devices; by public meetings held by the FDA to discuss laboratory developed tests; and by the convening of the Molecular and Clinical Genetics Panel to gather input on scientific issues concerning DTC genetic tests that make medical claims. This review provides a brief overview of DTC advertising and the regulation of pharmaceuticals and genetic tests in the United States. It highlights recent changes in the regulatory culture regarding genetic tests that are sold to consumers, and discusses the impact on health care providers of selling and advertising genetic tests directly to consumers.

  7. Terra, Aqua, and Aura Direct Broadcast - Providing Earth Science Data for Realtime Applications

    Science.gov (United States)

    Kelly, Angelita C.; Coronado, Patrick L.; Case, Warren F.; Franklin, Ameilia

    2010-01-01

    The need for realtime data to aid in disaster management and monitoring has been clearly demonstrated for the past several years, e.g., during the tsunami in Indonesia in 2004, the hurricane Katrina in 2005, fires, etc. Users want (and often require) the means to get earth observation data for operational regional use as soon as they are generated by satellites. This is especially true for events that can cause loss of human life and/or property. To meet this need, NASA's Earth Observing System (EOS) satellites, Terra and Aqua, provide realtime data useful to disaster management teams. This paper describes the satellites, their Direct Broadcast (DB) capabilities, the data uses, what it takes to deploy a DB ground station, and the future of the DB.

  8. Training Direct-Care Staff to Provide Communication Intervention to Adults With Intellectual Disability: A Systematic Review.

    Science.gov (United States)

    van der Meer, Larah; Matthews, Tamyra; Ogilvie, Emily; Berry, Alice; Waddington, Hannah; Balandin, Susan; O'Reilly, Mark F; Lancioni, Giulio; Sigafoos, Jeff

    2017-11-08

    The aim of this review was to summarize and evaluate studies on training direct-care staff to provide communication intervention to adults with intellectual disability. Systematic searches identified 22 studies. These were summarized and evaluated in terms of (a) participants; (b) settings; (c) training aims and procedures; (d) research designs; (e) reliability, integrity, and social validity; (f) outcomes; (g) generalization and follow-up; and (h) certainty of evidence. A total of 437 staff and 254+ adults with intellectual disability participated. Staff training most frequently involved combinations of verbal instruction, role play, modeling, practice, and feedback. Reliability was assessed in 18 studies with acceptable standards for most of these studies. Treatment integrity and social validity were assessed in 1 and 3 studies, respectively, with positive outcomes. Generalization and maintenance were assessed in 5 and 8 studies, respectively, with predominantly positive outcomes. Most studies reported positive outcomes for staff and positive or mixed outcomes for the adults with intellectual disability. Certainty of evidence was rated as conclusive in 1 study, suggestive in 14 studies, and inconclusive in 7 studies. There is sufficient evidence to conclude that direct-care staff can be taught to provide effective communication intervention to adults with intellectual disability. Professionals involved in providing training and support to direct-care staff could expect positive outcomes from multicomponent training programs that include opportunities for practice and feedback.

  9. The Nordic welfare model providing energy transition? A political geography approach to the EU RES directive

    International Nuclear Information System (INIS)

    Westholm, Erik; Beland Lindahl, Karin

    2012-01-01

    The EU Renewable Energy Strategy (RES) Directive requires that each member state obtain 20% of its energy supply from renewable sources by 2020. If fully implemented, this implies major changes in institutions, infrastructure, land use, and natural resource flows. This study applies a political geography perspective to explore the transition to renewable energy use in the heating and cooling segment of the Swedish energy system, 1980–2010. The Nordic welfare model, which developed mainly after the Second World War, required relatively uniform, standardized local and regional authorities functioning as implementation agents for national politics. Since 1980, the welfare orientation has gradually been complemented by competition politics promoting technological change, innovation, and entrepreneurship. This combination of welfare state organization and competition politics provided the dynamics necessary for energy transition, which occurred in a semi-public sphere of actors at various geographical scales. However, our analysis, suggest that this was partly an unintended policy outcome, since it was based on a welfare model with no significant energy aims. Our case study suggests that state organization plays a significant role, and that the EU RES Directive implementation will be uneven across Europe, reflecting various welfare models with different institutional pre-requisites for energy transition. - Highlights: ► We explore the energy transition in the heating/cooling sector in Sweden 1980–2000. ► The role of the state is studied from a political geography perspective. ► The changing welfare model offered the necessary institutional framework. ► Institutional arrangements stand out as central to explain the relative success. ► The use of renewables in EU member states will continue to vary significantly.

  10. Directed evolution of a model primordial enzyme provides insights into the development of the genetic code.

    Directory of Open Access Journals (Sweden)

    Manuel M Müller

    Full Text Available The contemporary proteinogenic repertoire contains 20 amino acids with diverse functional groups and side chain geometries. Primordial proteins, in contrast, were presumably constructed from a subset of these building blocks. Subsequent expansion of the proteinogenic alphabet would have enhanced their capabilities, fostering the metabolic prowess and organismal fitness of early living systems. While the addition of amino acids bearing innovative functional groups directly enhances the chemical repertoire of proteomes, the inclusion of chemically redundant monomers is difficult to rationalize. Here, we studied how a simplified chorismate mutase evolves upon expanding its amino acid alphabet from nine to potentially 20 letters. Continuous evolution provided an enhanced enzyme variant that has only two point mutations, both of which extend the alphabet and jointly improve protein stability by >4 kcal/mol and catalytic activity tenfold. The same, seemingly innocuous substitutions (Ile→Thr, Leu→Val occurred in several independent evolutionary trajectories. The increase in fitness they confer indicates that building blocks with very similar side chain structures are highly beneficial for fine-tuning protein structure and function.

  11. Directed evolution provides insight into conformational substrate sampling by SrtA.

    Directory of Open Access Journals (Sweden)

    Muna Suliman

    Full Text Available The Sortase family of transpeptidases are found in numerous gram-positive bacteria and involved in divergent physiological processes including anchoring of surface proteins to the cell wall as well as pili assembly. As essential proteins, sortase enzymes have been the focus of considerable interest for the development of novel anti-microbials, however, more recently their function as unique transpeptidases has been exploited for the synthesis of novel bio-conjugates. Yet, for synthetic purposes, SrtA-mediated conjugation suffers from the enzyme's inherently poor catalytic efficiency. Therefore, to identify SrtA variants with improved catalytic efficiency, we used directed evolution to select a catalytically enhanced SrtA enzyme. An analysis of improved SrtA variants in the context of sequence conservation, NMR and x-ray crystal structures, and kinetic data suggests a novel mechanism for catalysis involving large conformational changes that delivers substrate to the active site pocket. Indeed, using DEER-EPR spectroscopy, we reveal that upon substrate binding, SrtA undergoes a large scissors-like conformational change that simultaneously translates the sort-tag substrate to the active site in addition to repositioning key catalytic residues for esterification. A better understanding of Sortase dynamics will significantly enhance future engineering and drug discovery efforts.

  12. Influenza vaccination and decisional conflict among regulated and unregulated direct nursing care providers in long-term-care homes.

    Science.gov (United States)

    Sullivan, Shannon M; Pierrynowski-Gallant, Donna; Chambers, Larry; O'Connor, Annette; Bowman, Sherry; McNeil, Shelly; Strang, Robert; Knoefel, Frank

    2008-02-01

    The purpose of this study was to determine whether direct nursing care providers have decisional conflict about receiving influenza vaccinations and characteristics associated with decisional conflict. The researchers used a self-administered questionnaire mailed to direct nursing care providers in two long-term-care organizations. Most direct nursing care providers in both organizations (80% and 93%, respectively) intended to get the influenza vaccine. Unregulated direct nursing care providers had more decisional conflict than regulated providers, especially related to feeling uninformed about the pros and cons of influenza vaccination. Unclear valuing of the pros and cons of influenza vaccination was related to the age of the direct care providers in both organizations. Decisional conflict and influenza vaccination practices may be determined, in part, by age and by the culture of a health care organization. A decision aid to improve knowledge and clarify values may improve decision quality and increase influenza vaccination rates.

  13. Isotopic and molecular fractionation in combustion; three routes to molecular marker validation, including direct molecular 'dating' (GC/AMS)

    Science.gov (United States)

    Currie, L. A.; Klouda, G. A.; Benner, B. A.; Garrity, K.; Eglinton, T. I.

    The identification of unique isotopic, elemental, and molecular markers for sources of combustion aerosol has growing practical importance because of the potential effects of fine particle aerosol on health, visibility and global climate. It is urgent, therefore, that substantial efforts be directed toward the validation of assumptions involving the use of such tracers for source apportionment. We describe here three independent routes toward carbonaceous aerosol molecular marker identification and validation: (1) tracer regression and multivariate statistical techniques applied to field measurements of mixed source, carbonaceous aerosols; (2) a new development in aerosol 14C metrology: direct, pure compound accelerator mass spectrometry (AMS) by off-line GC/AMS ('molecular dating'); and (3) direct observation of isotopic and molecular source emissions during controlled laboratory combustion of specific fuels. Findings from the combined studies include: independent support for benzo( ghi)perylene as a motor vehicle tracer from the first (statistical) and second (direct 'dating') studies; a new indication, from the third (controlled combustion) study, of a relation between 13C isotopic fractionation and PAH molecular fractionation, also linked with fuel and stage of combustion; and quantitative data showing the influence of both fuel type and combustion conditions on the yields of such species as elemental carbon and PAH, reinforcing the importance of exercising caution when applying presumed conservative elemental or organic tracers to fossil or biomass burning field data as in the first study.

  14. The impact of pharmacists providing direct patient care as members of interprofessional teams on diabetes management

    Directory of Open Access Journals (Sweden)

    Osamah M. Alfayez

    2017-11-01

    The results suggest that involvement of pharmacists in direct patient care as members of interprofessional team in our specialty ambulatory care clinic is associated with a positive impact on the glycemic control in patients with diabetes.

  15. Direct and indirect patient costs of dermatology clinic visits and their impact on access to care and provider preference.

    Science.gov (United States)

    Rothstein, Brooke E; Gonzalez, Jessica; Cunningham, Kiera; Saraiya, Ami; Dornelles, Adriana C; Nguyen, Bichchau M

    2017-12-01

    The direct and indirect costs of dermatology clinic visits are infrequently quantified. Indirect costs, such as the time spent traveling to and from appointments and the value of lost earnings from time away from work, are substantial costs that often are not included in economic analyses but may pose barriers to receiving care. Due to the national shortage of dermatologists, patients may have to wait longer for appointments or travel further to see dermatologists outside of their local community, resulting in high time and travel costs for patients. Patients' lost time and earnings comprise the opportunity cost of obtaining care. A monetary value for this opportunity cost can be calculated by multiplying a patient's hourly wage by the number of hours that the patient dedicated to attending the dermatology appointment. Using a single institution survey, this study quantified the direct and indirect patient costs, including opportunity costs and time burden, associated with dermatology clinic visits to better appreciate the impact of these factors on health care access and dermatologic provider preference.

  16. Objectively Optimized Observation Direction System Providing Situational Awareness for a Sensor Web

    Science.gov (United States)

    Aulov, O.; Lary, D. J.

    2010-12-01

    There is great utility in having a flexible and automated objective observation direction system for the decadal survey missions and beyond. Such a system allows us to optimize the observations made by suite of sensors to address specific goals from long term monitoring to rapid response. We have developed such a prototype using a network of communicating software elements to control a heterogeneous network of sensor systems, which can have multiple modes and flexible viewing geometries. Our system makes sensor systems intelligent and situationally aware. Together they form a sensor web of multiple sensors working together and capable of automated target selection, i.e. the sensors “know” where they are, what they are able to observe, what targets and with what priorities they should observe. This system is implemented in three components. The first component is a Sensor Web simulator. The Sensor Web simulator describes the capabilities and locations of each sensor as a function of time, whether they are orbital, sub-orbital, or ground based. The simulator has been implemented using AGIs Satellite Tool Kit (STK). STK makes it easy to analyze and visualize optimal solutions for complex space scenarios, and perform complex analysis of land, sea, air, space assets, and shares results in one integrated solution. The second component is target scheduler that was implemented with STK Scheduler. STK Scheduler is powered by a scheduling engine that finds better solutions in a shorter amount of time than traditional heuristic algorithms. The global search algorithm within this engine is based on neural network technology that is capable of finding solutions to larger and more complex problems and maximizing the value of limited resources. The third component is a modeling and data assimilation system. It provides situational awareness by supplying the time evolution of uncertainty and information content metrics that are used to tell us what we need to observe and the

  17. 3-dimensional magnetotelluric inversion including topography using deformed hexahedral edge finite elements and direct solvers parallelized on symmetric multiprocessor computers - Part II: direct data-space inverse solution

    Science.gov (United States)

    Kordy, M.; Wannamaker, P.; Maris, V.; Cherkaev, E.; Hill, G.

    2016-01-01

    Following the creation described in Part I of a deformable edge finite-element simulator for 3-D magnetotelluric (MT) responses using direct solvers, in Part II we develop an algorithm named HexMT for 3-D regularized inversion of MT data including topography. Direct solvers parallelized on large-RAM, symmetric multiprocessor (SMP) workstations are used also for the Gauss-Newton model update. By exploiting the data-space approach, the computational cost of the model update becomes much less in both time and computer memory than the cost of the forward simulation. In order to regularize using the second norm of the gradient, we factor the matrix related to the regularization term and apply its inverse to the Jacobian, which is done using the MKL PARDISO library. For dense matrix multiplication and factorization related to the model update, we use the PLASMA library which shows very good scalability across processor cores. A synthetic test inversion using a simple hill model shows that including topography can be important; in this case depression of the electric field by the hill can cause false conductors at depth or mask the presence of resistive structure. With a simple model of two buried bricks, a uniform spatial weighting for the norm of model smoothing recovered more accurate locations for the tomographic images compared to weightings which were a function of parameter Jacobians. We implement joint inversion for static distortion matrices tested using the Dublin secret model 2, for which we are able to reduce nRMS to ˜1.1 while avoiding oscillatory convergence. Finally we test the code on field data by inverting full impedance and tipper MT responses collected around Mount St Helens in the Cascade volcanic chain. Among several prominent structures, the north-south trending, eruption-controlling shear zone is clearly imaged in the inversion.

  18. Direct Measurement of Tree Height Provides Different Results on the Assessment of LiDAR Accuracy

    Directory of Open Access Journals (Sweden)

    Emanuele Sibona

    2016-12-01

    Full Text Available In this study, airborne laser scanning-based and traditional field-based survey methods for tree heights estimation are assessed by using one hundred felled trees as a reference dataset. Comparisons between remote sensing and field-based methods were applied to four circular permanent plots located in the western Italian Alps and established within the Alpine Space project NewFor. Remote sensing (Airborne Laser Scanning, ALS, traditional field-based (indirect measurement, IND, and direct measurement of felled trees (DIR methods were compared by using summary statistics, linear regression models, and variation partitioning. Our results show that tree height estimates by Airborne Laser Scanning (ALS approximated to real heights (DIR of felled trees. Considering the species separately, Larix decidua was the species that showed the smaller mean absolute difference (0.95 m between remote sensing (ALS and direct field (DIR data, followed by Picea abies and Pinus sylvestris (1.13 m and 1.04 m, respectively. Our results cannot be generalized to ALS surveys with low pulses density (<5/m2 and with view angles far from zero (nadir. We observed that the tree heights estimation by laser scanner is closer to actual tree heights (DIR than traditional field-based survey, and this was particularly valid for tall trees with conical shape crowns.

  19. Antioxidant effects of coumarins include direct radical scavenging, metal chelation and inhibition of ROS-producing enzymes.

    Science.gov (United States)

    Filipský, Tomáš; Říha, Michal; Macáková, Kateřina; Anzenbacherová, Eva; Karlíčková, Jana; Mladěnka, Přemysl

    2015-01-01

    Coumarins represent a large group of 1,2-benzopyrone derivatives which have been identified in many natural sources and synthetized as well. Several studies have shown that their antioxidant capacity is not based only on direct scavenging of reactive oxygen and nitrogen species (RONS) but other mechanisms are also involved. These include: a) the chelation of transient metals iron and copper, which are known to catalyse the Fenton reaction; and b) the inhibition of RONS-producing enzymes (e.g. xanthine oxidase, myeloperoxidase and lipoxygenase), suggesting that mechanism(s) involved on cellular level are complex and synergistic. Moreover, many factors must be taken into account when analysing structure-antioxidant capacity relationships of coumarins due to different in vitro/in vivo methodological approaches. The structural features necessary for the direct RONS scavenging and metal chelation are apparently similar and the ideal structures are 6,7-dihydroxy- or 7,8-dihydroxycoumarins. However, the clinical outcome is unknown, because these coumarins are able to reduce copper and iron, and may thus paradoxically potentiate the Fenton chemistry. The similar structural features appear to be associated with inhibition of lipoxygenase, probably due to interference with iron in its active site. Contrarily, 6,7-dihydroxycoumarin seems to be the most active coumarin in the inhibition of xanthine oxidase while its derivative bearing the 4-methyl group or 7,8-dihydroxycoumarin are less active or inactive. In addition, coumarins may hinder the induction of inducible NO-synthase and cyclooxygenase- 2. Sparse data on inhibition of myeloperoxidase do not enable any clear conclusion, but some coumarins may block it.

  20. Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India.

    Science.gov (United States)

    Lindquist, Benjamin; Strehlow, Matthew C; Rao, G V Ramana; Newberry, Jennifer A

    2016-07-08

    Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India. A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion. 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week. This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.

  1. The management of metastatic radioiodine-refractory differentiated thyroid cancer requires an integrated approach including both directed and systemic therapies.

    Science.gov (United States)

    Cooray, Shamil D; Topliss, Duncan J

    2017-01-01

    A 58-year-old man with metastatic radioiodine-refractory differentiated thyroid cancer (DTC) presented with left thigh and right flank numbness. He had known progressive and widespread bony metastases, for which he received palliative radiotherapy, and multiple bilateral asymptomatic pulmonary metastases. CT scan and MRI of the spine revealed metastases at right T10-L1 vertebrae with extension into the central canal and epidural disease at T10 and T11 causing cord displacement and canal stenosis but retention of spinal cord signal. Spinal surgery was followed by palliative radiotherapy resulting in symptom resolution. Two months later, sorafenib received approval for use in Australia and was commenced and up-titrated with symptomatic management of mild adverse effects. Follow-up CT scan three months after commencement of sorafenib revealed regression of pulmonary metastases but no evident change in most bone metastases except for an advancing lesion eroding into the right acetabulum. The patient underwent a right total hip replacement, intra-lesional curettage and cementing. After six months of sorafenib therapy, CT scanning showed enlarging liver lesions with marked elevation of serum thyroglobulin. Lenvatinib was commenced and sorafenib was ceased. He now has stable disease with a falling thyroglobulin more than 5 years after metastatic radioiodine-refractory DTC was diagnosed. In DTC, 5% of distant metastases become radioiodine-refractory, resulting in a median overall survival of 2.5-3.5 years. Tyrosine kinase inhibitor (TKI) therapy has recently been demonstrated to increase progression-free survival in these patients but poses some unique management issues and is best used as part of an integrated approach with directed therapy. Directed therapies may have greater potential to control localised disease and related symptoms when compared to systemic therapies.Consider TKI therapy in progressive disease where benefits outweigh risks.Active surveillance and

  2. Direct-to-consumer promotion of prescription drugs. Economic implications for patients, payers and providers.

    Science.gov (United States)

    Findlay, S D

    2001-01-01

    Spending on outpatient prescription drugs in the US is accelerating rapidly. Although numerous factors are driving this trend, attention has recently focused on the role played by the marketing, promotion and advertising of pharmaceuticals, in particular direct-to-consumer (DTC) advertising. In 1997, the US Food and Drug Administration (FDA) issued a 'guidance' on such mass media promotion. The guidance altered existing FDA rules and effectively permitted pharmaceutical companies to promote prescription drugs on television and radio without giving detailed or even summary information on indications, efficacy or potential adverse effects. Since then, television commercials, in particular, and print advertisements in consumer magazines and newspapers have proliferated rapidly. Pharmaceutical companies spent $US1.8 billion on DTC advertising in 1999, a 40% increase over 1998. This spending in 1999 was heavily concentrated on about 50 drugs. Evidence is growing that DTC promotion of prescription drugs is: (i) alerting consumers to the existence of new drugs and the conditions they treat; (ii) increasing consumer demand for many drugs; (iii) contributing increasingly to the recent sharp increase in the number of prescriptions being dispensed; (iv) raising sales revenues; and, thus, (v) contributing to the higher pharmaceutical costs of health insurers, government and consumers. The public policy issues surrounding DTC advertisements centre on the following questions: (i) are the advertisements leading to the inappropriate clinical use of some drugs? (ii) are the advertisements inducing both consumers and physicians to choose more costly new brand-name drugs over less expensive, but equally effective, older brand or generic drugs? (iii) do television advertisements for prescription drugs contain a balanced amount of information on benefits versus potential adverse effects? and (iv) will the revenue benefits generated by DTC advertising cause pharmaceutical companies to

  3. Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in Diabetes Management.

    Science.gov (United States)

    Kowitt, Sarah D; Ayala, Guadalupe X; Cherrington, Andrea L; Horton, Lucy A; Safford, Monika M; Soto, Sandra; Tang, Tricia S; Fisher, Edwin B

    2017-12-01

    Little research has examined the characteristics of peer support. Pertinent to such examination may be characteristics such as the distinction between nondirective support (accepting recipients' feelings and cooperative with their plans) and directive (prescribing "correct" choices and feelings). In a peer support program for individuals with diabetes, this study examined (a) whether the distinction between nondirective and directive support was reflected in participants' ratings of support provided by peer supporters and (b) how nondirective and directive support were related to depressive symptoms, diabetes distress, and Hemoglobin A1c (HbA1c). Three hundred fourteen participants with type 2 diabetes provided data on depressive symptoms, diabetes distress, and HbA1c before and after a diabetes management intervention delivered by peer supporters. At post-intervention, participants reported how the support provided by peer supporters was nondirective or directive. Confirmatory factor analysis (CFA), correlation analyses, and structural equation modeling examined the relationships among reports of nondirective and directive support, depressive symptoms, diabetes distress, and measured HbA1c. CFA confirmed the factor structure distinguishing between nondirective and directive support in participants' reports of support delivered by peer supporters. Controlling for demographic factors, baseline clinical values, and site, structural equation models indicated that at post-intervention, participants' reports of nondirective support were significantly associated with lower, while reports of directive support were significantly associated with greater depressive symptoms, altogether (with control variables) accounting for 51% of the variance in depressive symptoms. Peer supporters' nondirective support was associated with lower, but directive support was associated with greater depressive symptoms.

  4. Innovations in basic life support education for healthcare providers: improving competence in cardiopulmonary resuscitation through self-directed learning.

    Science.gov (United States)

    Cason, Carolyn L; Kardong-Edgren, Suzan; Cazzell, Mary; Behan, Deborah; Mancini, Mary Elizabeth

    2009-01-01

    Providing cardiopulmonary resuscitation is an essential competency for nurses. Nurse educators involved in staff development and continuing education spend numerous hours offering basic life support courses and conducting performance improvement activities such as mock codes. This study provides evidence that cardiopulmonary resuscitation performance skills using self-directed learning methods are as good as or, on a number of parameters, better than those achieved with a more resource- and time-intensive traditional approach.

  5. Effect of Instructor-Provided Concept Maps and Self-Directed Learning Ability on Students' Online Hypermedia Learning Performance

    Science.gov (United States)

    Chou, Pao-Nan

    2013-01-01

    The purpose of this experimental study was to explore the instructional effectiveness of integrating varied instructor-provided concept maps into an online hypertext learning environment, and the effect of learners' self-directed learning abilities on their learning performance. The research adopted a randomized posttest with two-control-group…

  6. Attitudes toward empirically-supported treatments among pastoral mental health care providers: exploratory findings and future directions.

    Science.gov (United States)

    Jameson, Matthew T; Naugle, Amy

    2013-01-01

    The current study describes the findings of an online survey of pastoral mental health care providers The survey included brief demographic information, and a validated measure of attitudes toward empirically-supported psychological interventions, the Evidence-based Practices Attitude Scale (EBPAS; Aarons, 2004). The responses of 55 pastoral providers' are described and compared to national norms (Aarons et al., 2010). Recommendations for future collaboration between EST developers and pastoral clinicians are provided.

  7. The experiences of clients and healthcare providers regarding the provision of reproductive health services including the prevention of HIV and AIDS in an informal settlement in Tshwane

    Directory of Open Access Journals (Sweden)

    M. L.S. Mataboge

    2016-10-01

    Full Text Available Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV and to acquired immunodeficiency syndrome (AIDS than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. The objective of this study was to explore and describe the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. Tesch's method for qualitative data analysis was used. Ethical principles guided the study, and certain strategies were followed to ensure trustworthiness. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs. The HCPs acknowledged that healthcare provision was negatively affected by policies. It was found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.

  8. The experiences of clients and healthcare providers regarding the provision of reproductive health services including the prevention of HIV and AIDS in an informal settlement in Tshwane

    Directory of Open Access Journals (Sweden)

    M.L.S. Mataboge

    2016-12-01

    Full Text Available Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV and to acquired immunodeficiency syndrome (AIDS than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. The objective of this study was to explore and describe the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. Tesch's method for qualitative data analysis was used. Ethical principles guided the study, and certain strategies were followed to ensure trustworthiness. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs. The HCPs acknowledged that healthcare provision was negatively affected by policies. It was found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.

  9. A STUDY OF CHINESE YUAN (RMB APPRECIATION ACCOMPANYING WITH OTHERS FACTORS INCLUDING FOREIGN DIRECT INVESTMENT (FDI AND THEIR EFFECT ON CHINA ECONOMY

    Directory of Open Access Journals (Sweden)

    Ping-fu (Brian LAI

    2014-07-01

    Full Text Available The Chinese Yuan (RMB has been on the trend of appreciation over the last decade, and such a trend will likely be continuing for some years over the next decade. According to some scholars in their published literatures, the appreciation of RMB, the influx of Foreign Direct Investment (FDI has been ongoing accompanying the sustained growing economy in mainland China over the past decade. It is believed that the China economy has an implication from some significant factors including appreciation of RMB, interest rate of RMB, inflation and continuous increase of FDI for the next several years. The present study aims to provide an emphasis on investigation into effect on China economy as a result of appreciation of RMB and FDI together with some other factors, and to provide an outlook on the economy in China for the coming decades. First, a review was carried on relevant background information and development history of RMB and FDI. There are many reasons and factors behind leading to the sustained growth in the economy in China in the last decade and such effects were in coverage in the literature review. An overview of the development of RMB exchange mechanism, and other variables including (1 RMB exchange rate, (2 China interest rate, (3 Foreign Direct Investment (FDI, (4 Trade Balance of China, (5 Annual Inflation rate in China, (6 Energy Consumption in China, (7 Foreign Exchange Reserve in China, (8 China wages, (9 China External Debt and (10 China Consumer Price Index, which may have effect on the growth of the economy in China is covered in the literature review conducted in Chapter 2.

  10. The management of metastatic radioiodine-refractory differentiated thyroid cancer requires an integrated approach including both directed and systemic therapies

    Directory of Open Access Journals (Sweden)

    Shamil D Cooray

    2017-02-01

    Full Text Available A 58-year-old man with metastatic radioiodine-refractory differentiated thyroid cancer (DTC presented with left thigh and right flank numbness. He had known progressive and widespread bony metastases, for which he received palliative radiotherapy, and multiple bilateral asymptomatic pulmonary metastases. CT scan and MRI of the spine revealed metastases at right T10–L1 vertebrae with extension into the central canal and epidural disease at T10 and T11 causing cord displacement and canal stenosis but retention of spinal cord signal. Spinal surgery was followed by palliative radiotherapy resulting in symptom resolution. Two months later, sorafenib received approval for use in Australia and was commenced and up-titrated with symptomatic management of mild adverse effects. Follow-up CT scan three months after commencement of sorafenib revealed regression of pulmonary metastases but no evident change in most bone metastases except for an advancing lesion eroding into the right acetabulum. The patient underwent a right total hip replacement, intra-lesional curettage and cementing. After six months of sorafenib therapy, CT scanning showed enlarging liver lesions with marked elevation of serum thyroglobulin. Lenvatinib was commenced and sorafenib was ceased. He now has stable disease with a falling thyroglobulin more than 5 years after metastatic radioiodine-refractory DTC was diagnosed. In DTC, 5% of distant metastases become radioiodine-refractory, resulting in a median overall survival of 2.5–3.5 years. Tyrosine kinase inhibitor (TKI therapy has recently been demonstrated to increase progression-free survival in these patients but poses some unique management issues and is best used as part of an integrated approach with directed therapy.

  11. SREB, a GATA transcription factor that directs disparate fates in Blastomyces dermatitidis including morphogenesis and siderophore biosynthesis.

    Directory of Open Access Journals (Sweden)

    Gregory M Gauthier

    2010-04-01

    Full Text Available Blastomyces dermatitidis belongs to a group of human pathogenic fungi that exhibit thermal dimorphism. At 22 degrees C, these fungi grow as mold that produce conidia or infectious particles, whereas at 37 degrees C they convert to budding yeast. The ability to switch between these forms is essential for virulence in mammals and may enable these organisms to survive in the soil. To identify genes that regulate this phase transition, we used Agrobacterium tumefaciens to mutagenize B. dermatitidis conidia and screened transformants for defects in morphogenesis. We found that the GATA transcription factor SREB governs multiple fates in B. dermatitidis: phase transition from yeast to mold, cell growth at 22 degrees C, and biosynthesis of siderophores under iron-replete conditions. Insertional and null mutants fail to convert to mold, do not accumulate significant biomass at 22 degrees C, and are unable to suppress siderophore biosynthesis under iron-replete conditions. The defect in morphogenesis in the SREB mutant was independent of exogenous iron concentration, suggesting that SREB promotes the phase transition by altering the expression of genes that are unrelated to siderophore biosynthesis. Using bioinformatic and gene expression analyses, we identified candidate genes with upstream GATA sites whose expression is altered in the null mutant that may be direct or indirect targets of SREB and promote the phase transition. We conclude that SREB functions as a transcription factor that promotes morphogenesis and regulates siderophore biosynthesis. To our knowledge, this is the first gene identified that promotes the conversion from yeast to mold in the dimorphic fungi, and may shed light on environmental persistence of these pathogens.

  12. Tracking the direct impact of rainfall on groundwater at Mt. Fuji by multiple analyses including microbial DNA

    Science.gov (United States)

    Sugiyama, Ayumi; Masuda, Suguru; Nagaosa, Kazuyo; Tsujimura, Maki; Kato, Kenji

    2018-02-01

    A total of 2 to 3 million tons of spring water flushes out from the foot of Mt. Fuji, the largest volcanic mountain in Japan. Based on the concept of piston flow transport, residence time of stored groundwater at Mt. Fuji was estimated at ˜ 15-30 years by the 36Cl / Cl ratio (Tosaki et al., 2011). This range, however, represents the average residence time of groundwater that was mixed before it flushed out. To elucidate the route of groundwater in a given system, we determined signatures of direct impacts of rainfall on groundwater, using microbial, stable isotopic (δ18O), and chemical analyses (concentration of silica). Chemical analysis of the groundwater gave an average value of the water, which was already mixed with waters from various sources and routes in the subsurface environment. The microbial analysis suggested locations of water origin and paths. In situ observation during four rainfall events revealed that the stable oxygen isotopic signature obtained from spring water (at 726 m a.s.l., site SP-0 m) and shallow groundwater (at 150 m a.s.l., site GW-42 m), where the average recharge height from rainfall was 1700-1800 m, became greater than values observed prior to a torrential rain producing more than 300 mm of precipitation. The concentration of silica decreased after this event. In addition, the abundance of Bacteria in spring water increased, suggesting the influence of heavy rain. Such changes did not appear when rainfall was less than 100 mm per event. The above findings indicate a rapid flow of rain through the shallow part of the aquifer, which appeared within a few weeks of torrential rain extracting abundant microbes from soil in the studied geologic setting. Interestingly, we found that after the torrential rain, the abundance of Archaea increased in the deep groundwater at site GW-550 m, ˜ 12 km downstream of SP-0 m. However, chemical parameters did not show any change after the event. This suggests that strengthened piston flow caused by

  13. Electronic Coherence Provides a Direct Proof for Energy-Level Crossing in Photoexcited Lutein and β-Carotene

    Science.gov (United States)

    Ostroumov, Evgeny; Müller, Marc G.; Marian, Christel M.; Kleinschmidt, Martin; Holzwarth, Alfred R.

    2009-09-01

    We investigate femtosecond transient absorption dynamics of lutein and β-carotene. Strong oscillations up to about 400 fs are observed, depending on excitation or detection wavelength and solvent. We propose electronic quantum beats as the origin of these oscillations. They provide direct proof for strong coupling of the 1Bu+ with another electronic “dark” state predicted by quantum chemical calculations to be the 1Bu- state resulting in a crossing within a dynamic relaxation model. The overall dynamics can be described well by an optical Bloch equation approach.

  14. Structure, Stability and Emissions of Lean Direct Injection Combustion, including a Novel Multi-Point LDI System for NOx Reduction

    Science.gov (United States)

    Villalva Gomez, Rodrigo

    Experimental research on Lean Direct Injection (LDI) combustors for gas turbine applications is presented. LDI combustion is an alternative to lean premixed combustion which has the potential of equivalent reduction of oxides of nitrogen (NOx) emissions and of peak combustor exit temperatures, but without some drawbacks of premixed combustors, such as flashback and autoignition. Simultaneous observations of the velocity field and reaction zone of an LDI swirl-stabilized combustor with a mixing tube at atmospheric conditions, with the goal of studying the flame stabilization mechanism, are shown. The flame was consistently anchored at the shear layer formed by the high-speed reactants exiting the mixing tube and the low speed recirculation region. Individual image analysis of the location of the tip of the recirculation zone and tip of the reaction region confirmed previously observed trends, but showed that calculation of the distance between these two points for corresponding image pairs yields results no different than when calculated from random image pairs. This most likely indicates a lag in the anchoring of the flame to changes in the recirculation zone, coupled with significant stochastic variation. An alternate LDI approach, multi-point LDI (MLDI), is also tested experimentally. A single large fuel nozzle is replaced by multiple small fuel nozzles to improve atomization and reduce the total volume of the high-temperature, low velocity recirculation zones, reducing NOx formation. The combustor researched employs a novel staged approach to allow good performance across a wide range of conditions by using a combination of nozzle types optimized to various power settings. The combustor has three independent fuel circuits referenced as pilot, intermediate, and outer. Emissions measurements, OH* chemiluminescence imaging, and thermoacoustic instability studies were run in a pressurized combustion facility at pressures from 2.0 to 5.3 bar. Combustor performance

  15. Tracking the direct impact of rainfall on groundwater at Mt. Fuji by multiple analyses including microbial DNA

    Directory of Open Access Journals (Sweden)

    A. Sugiyama

    2018-02-01

    Full Text Available A total of 2 to 3 million tons of spring water flushes out from the foot of Mt. Fuji, the largest volcanic mountain in Japan. Based on the concept of piston flow transport, residence time of stored groundwater at Mt. Fuji was estimated at  ∼  15–30 years by the 36Cl ∕ Cl ratio (Tosaki et al., 2011. This range, however, represents the average residence time of groundwater that was mixed before it flushed out. To elucidate the route of groundwater in a given system, we determined signatures of direct impacts of rainfall on groundwater, using microbial, stable isotopic (δ18O, and chemical analyses (concentration of silica. Chemical analysis of the groundwater gave an average value of the water, which was already mixed with waters from various sources and routes in the subsurface environment. The microbial analysis suggested locations of water origin and paths. In situ observation during four rainfall events revealed that the stable oxygen isotopic signature obtained from spring water (at 726 m a.s.l., site SP-0 m and shallow groundwater (at 150 m a.s.l., site GW-42 m, where the average recharge height from rainfall was 1700–1800 m, became greater than values observed prior to a torrential rain producing more than 300 mm of precipitation. The concentration of silica decreased after this event. In addition, the abundance of Bacteria in spring water increased, suggesting the influence of heavy rain. Such changes did not appear when rainfall was less than 100 mm per event. The above findings indicate a rapid flow of rain through the shallow part of the aquifer, which appeared within a few weeks of torrential rain extracting abundant microbes from soil in the studied geologic setting. Interestingly, we found that after the torrential rain, the abundance of Archaea increased in the deep groundwater at site GW-550 m,  ∼  12 km downstream of SP-0 m. However, chemical parameters did not show any change

  16. Cytoplasmic-genetic male sterility gene provides direct evidence for some hybrid rice recently evolving into weedy rice

    Science.gov (United States)

    Zhang, Jingxu; Lu, Zuomei; Dai, Weimin; Song, Xiaoling; Peng, Yufa; Valverde, Bernal E.; Qiang, Sheng

    2015-01-01

    Weedy rice infests paddy fields worldwide at an alarmingly increasing rate. There is substantial evidence indicating that many weedy rice forms originated from or are closely related to cultivated rice. There is suspicion that the outbreak of weedy rice in China may be related to widely grown hybrid rice due to its heterosis and the diversity of its progeny, but this notion remains unsupported by direct evidence. We screened weedy rice accessions by both genetic and molecular marker tests for the cytoplasmic male sterility (CMS) genes (Wild abortive, WA, and Boro type, BT) most widely used in the production of indica and japonica three-line hybrid rice as a diagnostic trait of direct parenthood. Sixteen weedy rice accessions of the 358 tested (4.5%) contained the CMS-WA gene; none contained the CMS-BT gene. These 16 accessions represent weedy rices recently evolved from maternal hybrid rice derivatives, given the primarily maternal inheritance of this trait. Our results provide key direct evidence that hybrid rice can be involved in the evolution of some weedy rice accessions, but is not a primary factor in the recent outbreak of weedy rice in China. PMID:26012494

  17. Electron tomography provides a direct link between the Payne effect and the inter-particle spacing of rubber composites

    Science.gov (United States)

    Staniewicz, Lech; Vaudey, Thomas; Degrandcourt, Christophe; Couty, Marc; Gaboriaud, Fabien; Midgley, Paul

    2014-01-01

    Rubber-filler composites are a key component in the manufacture of tyres. The filler provides mechanical reinforcement and additional wear resistance to the rubber, but it in turn introduces non-linear mechanical behaviour to the material which most likely arises from interactions between the filler particles, mediated by the rubber matrix. While various studies have been made on the bulk mechanical properties and of the filler network structure (both imaging and by simulations), there presently does not exist any work directly linking filler particle spacing and mechanical properties. Here we show that using STEM tomography, aided by a machine learning image analysis procedure, to measure silica particle spacings provides a direct link between the inter-particle spacing and the reduction in shear modulus as a function of strain (the Payne effect), measured using dynamic mechanical analysis. Simulations of filler network formation using attractive, repulsive and non-interacting potentials were processed using the same method and compared with the experimental data, with the net result being that an attractive inter-particle potential is the most accurate way of modelling styrene-butadiene rubber-silica composite formation. PMID:25487130

  18. Directional R-Loop Formation by the CRISPR-Cas Surveillance Complex Cascade Provides Efficient Off-Target Site Rejection

    Directory of Open Access Journals (Sweden)

    Marius Rutkauskas

    2015-03-01

    Full Text Available CRISPR-Cas systems provide bacteria and archaea with adaptive immunity against foreign nucleic acids. In type I CRISPR-Cas systems, invading DNA is detected by a large ribonucleoprotein surveillance complex called Cascade. The crRNA component of Cascade is used to recognize target sites in foreign DNA (protospacers by formation of an R-loop driven by base-pairing complementarity. Using single-molecule supercoiling experiments with near base-pair resolution, we probe here the mechanism of R-loop formation and detect short-lived R-loop intermediates on off-target sites bearing single mismatches. We show that R-loops propagate directionally starting from the protospacer-adjacent motif (PAM. Upon reaching a mismatch, R-loop propagation stalls and collapses in a length-dependent manner. This unambiguously demonstrates that directional zipping of the R-loop accomplishes efficient target recognition by rapidly rejecting binding to off-target sites with PAM-proximal mutations. R-loops that reach the protospacer end become locked to license DNA degradation by the auxiliary Cas3 nuclease/helicase without further target verification.

  19. Road Bridges and Culverts, Bridge dataset only includes bridges maintained by Johnson County Public Works in the unincorporated areas, Published in Not Provided, Johnson County Government.

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Road Bridges and Culverts dataset current as of unknown. Bridge dataset only includes bridges maintained by Johnson County Public Works in the unincorporated areas.

  20. Applying the model of Goal-Directed Behavior, including descriptive norms, to physical activity intentions: A contribution to improving the Theory of Planned Behavior

    Science.gov (United States)

    The theory of planned behavior (TPB) has received its fair share of criticism lately, including calls for it to retire. We contributed to improving the theory by testing extensions such as the model of goal-directed behavior (MGDB, which adds desire and anticipated positive and negative emotions) ap...

  1. Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players: A Randomized Controlled Trial.

    Science.gov (United States)

    Harøy, Joar; Thorborg, Kristian; Serner, Andreas; Bjørkheim, André; Rolstad, Linn E; Hölmich, Per; Bahr, Roald; Andersen, Thor Einar

    2017-11-01

    The FIFA 11+ was developed as a complete warm-up program to prevent injuries in soccer players. Although reduced hip adduction strength is associated with groin injuries, none of the exercises included in the FIFA 11+ seem to specifically target hip adduction strength. To investigate the effect on eccentric hip adduction strength of the FIFA 11+ warm-up program with or without the Copenhagen adduction exercise. Randomized controlled trial; Level of evidence, 1. We recruited 45 eligible players from 2 U19 elite male soccer teams. Players were randomized into 2 groups; 1 group carried out the standard FIFA 11+ program, while the other carried out the FIFA 11+ but replaced the Nordic hamstring exercise with the Copenhagen adduction exercise. Both groups performed the intervention 3 times weekly for 8 weeks. Players completed eccentric strength and sprint testing before and after the intervention. Per-protocol analyses were performed, and 12 players were excluded due to low compliance (<67% of sessions completed). The main outcome was eccentric hip adduction strength (N·m/kg). Between-group analyses revealed a significantly greater increase in eccentric hip adduction strength of 0.29 Nm/kg (8.9%; P = .01) in favor of the group performing the Copenhagen adduction exercise, whereas no within-group change was noted in the group that used the standard FIFA 11+ program (-0.02 N·m/kg [-0.7%]; P = .69). Including the Copenhagen adduction exercise in the FIFA 11+ program increases eccentric hip adduction strength, while the standard FIFA 11+ program does not. Registration: Registration: ISRCTN13731446 (International Standard Randomised Controlled Trial Number registry).

  2. The choice of primary energy source including PV installation for providing electric energy to a public utility building - a case study

    Science.gov (United States)

    Radomski, Bartosz; Ćwiek, Barbara; Mróz, Tomasz M.

    2017-11-01

    The paper presents multicriteria decision aid analysis of the choice of PV installation providing electric energy to a public utility building. From the energy management point of view electricity obtained by solar radiation has become crucial renewable energy source. Application of PV installations may occur a profitable solution from energy, economic and ecologic point of view for both existing and newly erected buildings. Featured variants of PV installations have been assessed by multicriteria analysis based on ANP (Analytic Network Process) method. Technical, economical, energy and environmental criteria have been identified as main decision criteria. Defined set of decision criteria has an open character and can be modified in the dialog process between the decision-maker and the expert - in the present case, an expert in planning of development of energy supply systems. The proposed approach has been used to evaluate three variants of PV installation acceptable for existing educational building located in Poznań, Poland - the building of Faculty of Chemical Technology, Poznań University of Technology. Multi-criteria analysis based on ANP method and the calculation software Super Decisions has proven to be an effective tool for energy planning, leading to the indication of the recommended variant of PV installation in existing and newly erected public buildings. Achieved results show prospects and possibilities of rational renewable energy usage as complex solution to public utility buildings.

  3. Delegation decision-making by registered nurses who provide direct care for patients with spinal cord impairment.

    Science.gov (United States)

    Parsons, Lynn C

    2004-01-01

    Delegation and coordination of patient care are critical skills for registered nurses (RN). Most educational programs and clinical experiences in nursing school have not prepared nurses to function in a delegation decision-making capacity. Nurses caring for individuals with spinal cord impairment (SCI) are especially challenged to provide partial or total assistance to meet the requisite care needs of this patient population. Hospital length of stay has decreased for individuals with SCI. RNs employed in long-term care (LTC) facilities have found admissions of patients with SCI occur more frequently with the onset of managed care and the increased longevity of Americans. Capitated markets within managed care require a nursing care delivery model that safely and judiciously uses nursing personnel to their fullest potential. Conger's (1993) Delegation Decision-Making Model (DDMM) utilizes all levels of personnel to their maximum potential while staying within the confines of individuals state nurse practice acts. The ability of RNs to direct the health care team is crucial to affect positive patient outcomes. The purpose of this descriptive comparative study was to ascertain baseline information on nurse delegation decision-making knowledge, job satisfaction, and level of comfort with this skill for RNs practicing in hospital and LTC settings. After reading a case study on a patient with SCI, RNs in the hospital and LTC facilities used Conger's (1993) DDMM. Scores for delegation decision-making were determined using the Nursing Assessment Decision Grid. Delegation knowledge scores were the same for RNs practicing in the hospital and LTC settings. Of interest was that RNs practicing in LTC settings cited learning delegation skills "on the job" 50% of the time compared to hospital nurses who reported learning these skills on the job 19% of the time. Additional research in the area of nurse delegation with this patient population needs to be investigated to support the

  4. Order no 000003/ME/P/DRH from January 21,2014 provides for the organization and attributions of the Human ResourcesDirection of Ministry of Energy and Oil

    International Nuclear Information System (INIS)

    Foumakoye, Gado

    2014-01-01

    This order provides fore the organzation and attributions of the human resouces Direction. So the Direction includs two Divisions: Administrative Division and Personal Division. Administrative Division assures administrative sevice and social service and the personal Division take care of persanal service ,improvement and formation [fr

  5. Neither as harmful as feared by critics nor as empowering as promised by providers: risk information offered direct to consumer by personal genomics companies.

    Science.gov (United States)

    Nordgren, Anders

    2014-01-01

    In this paper, I investigate ethical and policy aspects of the genetic services and web-rhetoric of companies offering genetic information direct to consumer, and I do so with a special focus on genetic risk information. On their websites, the companies stress that genetic risk testing for multifactorial complex medical conditions such as cardiovascular disease and cancer may empower the consumer and provide valuable input to personal identity. Critics maintain, on the other hand, that testing can be psychologically harmful, is of limited clinical and preventive value, and vulnerable to misinterpretation. I stress the importance of empirical studies in assessing the pros and cons of direct-to-consumer testing and point out that recent empirical studies indicate that this testing is neither as harmful as feared by critics nor as empowering as promised by the companies. However, the testing is not entirely harmless. Remaining problems include testing of third parties without consent and ownership of genotypic and phenotypic information. Moreover, the testing, although not particularly empowering, may still provide input to self-understanding that some people find valuable. Regarding policy-making, I suggest that self-regulation in terms of best practice guidelines may play an important role, but I also stress that national and international regulation may be necessary.

  6. Phase shifts in binaural stimuli provide directional cues for sound localisation in the field cricket Gryllus bimaculatus.

    Science.gov (United States)

    Seagraves, Kelly M; Hedwig, Berthold

    2014-07-01

    The cricket's auditory system is a highly directional pressure difference receiver whose function is hypothesised to depend on phase relationships between the sound waves propagating through the auditory trachea that connects the left and right hearing organs. We tested this hypothesis by measuring the effect of experimentally constructed phase shifts in acoustic stimuli on phonotactic behavior of Gryllus bimaculatus, the oscillatory response patterns of the tympanic membrane, and the activity of the auditory afferents. The same artificial calling song was played simultaneously at the left and right sides of the cricket, but one sound pattern was shifted in phase by 90 deg (carrier frequencies between 3.6 and 5.4 kHz). All three levels of auditory processing are sensitive to experimentally induced acoustic phase shifts, and the response characteristics are dependent on the carrier frequency of the sound stimulus. At lower frequencies, crickets steered away from the sound leading in phase, while tympanic membrane vibrations and auditory afferent responses were smaller when the ipsilateral sound was leading. In contrast, opposite responses were observed at higher frequencies in all three levels of auditory processing. Minimal responses occurred near the carrier frequency of the cricket's calling song, suggesting a stability at this frequency. Our results indicate that crickets may use directional cues arising from phase shifts in acoustic signals for sound localisation, and that the response properties of pressure difference receivers may be analysed with phase-shifted sound stimuli to further our understanding of how insect auditory systems are adapted for directional processing. © 2014. Published by The Company of Biologists Ltd.

  7. Productivity loss and resource utilization, and associated indirect and direct costs in individuals providing care for adults with schizophrenia in the EU5

    Directory of Open Access Journals (Sweden)

    Gupta S

    2015-11-01

    Full Text Available Shaloo Gupta,1 Gina Isherwood,2 Kevin Jones,3 Kristel Van Impe4 1Kantar Health, Princeton, NJ, USA; 2Kantar Health, Epsom, Surrey, UK; 3European Federation of Associations of Families of People with Mental Illness, Diestsevest, Leuven, Belgium; 4Janssen-Cilag GmbH, Neuss, Germany Objective: This study aimed to understand the impact of providing care for adults with schizophrenia on productivity, resource utilization, and costs in the EU5 (France, Germany, Italy, Spain, and UK. Methods: Data from the 2010, 2011, and 2013 EU5 National Health and Wellness Survey, an online questionnaire of a nationwide sample of adults, were analyzed. Schizophrenia caregivers (n=398 were matched to noncaregivers (n=158,989 and other caregivers (n=14,341 via propensity scores. Outcome measures included health care utilization, Work Productivity and Activity Impairment questionnaire-based scores, and associated direct and indirect costs (estimated from the literature. Significant differences between schizophrenia caregivers vs noncaregivers and other caregivers (eg, cancer and Alzheimer's disease were examined. Results: After matching, schizophrenia caregivers reported greater activity impairment (38.4% vs 26.1%, provider visits (8.0 vs 5.7, emergency room visits (0.9 vs 0.2, hospitalizations (0.8 vs 0.1, and direct costs (€2,258 vs €617 than noncaregivers, all P<0.001. Employed schizophrenia caregivers reported greater absenteeism, presenteeism, overall work impairment (35.0% vs 20.7%, and indirect costs (€6,667 vs €3,795 than noncaregivers, all P<0.001. Schizophrenia caregivers (vs other caregivers reported greater activity impairment (38.4% vs 32.3% and provider visits (8.0 vs 6.6, P<0.05. A greater proportion of schizophrenia caregivers (vs other caregivers reported at least one emergency room visit (26.1% vs 20.2% and hospitalization (20.4% vs 14.3%, P<0.05. Employed schizophrenia caregivers incurred greater indirect costs than other caregivers (€6

  8. Applying the Model of Goal-Directed Behavior, Including Descriptive Norms, to Physical Activity Intentions: A Contribution to Improving the Theory of Planned Behavior.

    Science.gov (United States)

    Esposito, Gabriele; van Bavel, René; Baranowski, Tom; Duch-Brown, Néstor

    2016-08-01

    The theory of planned behavior (TPB) has received its fair share of criticism lately, including calls for it to retire. We contribute to improving the theory by testing extensions such as the model of goal-directed behavior (MGDB, which adds desire and anticipated positive and negative emotions) applied to physical activity (PA) intention. We also test the inclusion of a descriptive norms construct as an addition to the subjective norms construct, also applied to PA, resulting in two additional models: TPB including descriptive norms (TPB + DN) and MGDB including descriptive norms (MGDB + DN). The study is based on an online survey of 400 young adult Internet users, previously enrolled in a subject pool. Confirmatory factor analysis (CFA) showed that TPB and TPB + DN were not fit for purpose, while MGDB and MGDB + DN were. Structural equation modelling (SEM) conducted on MGDB and MGDB + DN showed that the inclusion of descriptive norms took over the significance of injunctive norms, and increased the model's account of total variance in intention to be physically active. © The Author(s) 2016.

  9. A Business Case Analysis of the Direct Health Care Provider Program Womack Army Medical Center, Fort Bragg, N.C.

    Science.gov (United States)

    2001-05-01

    recover remedies in malpractice claims? -Will TRICARE be a catalyst for change with regard to provider liability and beneficiary recovery for malpractice...Croup (464.4) Hemorrhoids , NOS (455.6) Concussion, NOS (850.9) Diarrhea (787.91) Hernia, NOS (553.9) Dementia, Senile (290.0) Gastroenteritis...behind the scenes work that she did with others involved in the continuum of her patients’ care such as schools, home health nursing agencies, other

  10. Mitsunobu mischief: Neighbor-directed histidine N(π)–alkylation provides access to peptides containing selectively functionalized imidazolium heterocycles

    Science.gov (United States)

    Qian, Wen-Jian

    2015-01-01

    There are few methodologies that yield peptides containing His residues with selective N(π), N(π)-bis-alkylated imidazole rings. We have found that, under certain conditions, on-resin Mitsunobu coupling of alcohols with peptides having a N(π)-alkylated His residue results in selective and high-yield alkylation of the imidazole N(π) nitrogen. The reaction requires the presence of a proximal phosphoric, carboxylic or sulfonic acid, and proceeds through an apparent intramolecular mechanism involving Mitsunobu intermediates. These transformations have particular application to phosphopeptides, where “charge masking” of one phosphoryl anionic charge by the cationic histidine imidazolium ion is now possible. This chemistry opens selective access to peptides containing differentially functionalized imidazolium heterocycles, which provide access to new classes of peptides and peptide mimetics. PMID:25739367

  11. The global availability of rabies immune globulin and rabies vaccine in clinics providing direct care to travelers.

    Science.gov (United States)

    Jentes, Emily S; Blanton, Jesse D; Johnson, Katherine J; Petersen, Brett W; Lamias, Mark J; Robertson, Kis; Franka, Richard; Briggs, Deborah; Costa, Peter; Lai, Irene; Quarry, Doug; Rupprecht, Charles E; Marano, Nina; Brunette, Gary W

    2013-01-01

    Rabies, which is globally endemic, poses a risk to international travelers. To improve recommendations for travelers, we assessed the global availability of rabies vaccine (RV) and rabies immune globulin (RIG). We conducted a 20-question online survey, in English, Spanish, and French, distributed via e-mail to travel medicine providers and other clinicians worldwide from February 1 to March 30, 2011. Results were compiled according to the region. Among total respondents, only 190 indicated that they provided traveler postexposure care. Most responses came from North America (38%), Western Europe (19%), Australia and South and West Pacific Islands (11%), East and Southeast Asia (8%), and Southern Africa (6%). Approximately one third of 187 respondents stated that patients presented with wounds from an animal exposure that were seldom or never adequately cleansed. RIG was often or always accessible for 100% (n = 5) of respondents in the Middle East and North Africa; 94% (n = 17) in Australia and South and West Pacific Islands; 20% (n = 1) in Tropical South America; and 56% (n = 5) in Eastern Europe and Northern Asia. Ninety-one percent (n = 158) of all respondents reported that RV was often or always accessible. For all regions, 35% (n = 58) and 26% (n = 43) of respondents felt that the cost was too high for RIG and RV, respectively. The availability of RV and RIG varied by geographic region. All travelers should be informed that RIG and RV might not be readily available at their destination and that travel health and medical evacuation insurance should be considered prior to departure. Travelers should be educated to avoid animal exposures; to clean all animal bites, licks, and scratches thoroughly with soap and water; and to seek medical care immediately, even if overseas. © 2013 International Society of Travel Medicine.

  12. Climate Feedback: Bringing the Scientific Community to Provide Direct Feedback on the Credibility of Climate Media Coverage

    Science.gov (United States)

    Vincent, E. M.; Matlock, T.; Westerling, A. L.

    2015-12-01

    While most scientists recognize climate change as a major societal and environmental issue, social and political will to tackle the problem is still lacking. One of the biggest obstacles is inaccurate reporting or even outright misinformation in climate change coverage that result in the confusion of the general public on the issue.In today's era of instant access to information, what we read online usually falls outside our field of expertise and it is a real challenge to evaluate what is credible. The emerging technology of web annotation could be a game changer as it allows knowledgeable individuals to attach notes to any piece of text of a webpage and to share them with readers who will be able to see the annotations in-context -like comments on a pdf.Here we present the Climate Feedback initiative that is bringing together a community of climate scientists who collectively evaluate the scientific accuracy of influential climate change media coverage. Scientists annotate articles sentence by sentence and assess whether they are consistent with scientific knowledge allowing readers to see where and why the coverage is -or is not- based on science. Scientists also summarize the essence of their critical commentary in the form of a simple article-level overall credibility rating that quickly informs readers about the credibility of the entire piece.Web-annotation allows readers to 'hear' directly from the experts and to sense the consensus in a personal way as one can literaly see how many scientists agree with a given statement. It also allows a broad population of scientists to interact with the media, notably early career scientists.In this talk, we will present results on the impacts annotations have on readers -regarding their evaluation of the trustworthiness of the information they read- and on journalists -regarding their reception of scientists comments.Several dozen scientists have contributed to this effort to date and the system offers potential to

  13. Persistence of mixed cryoglobulinemia despite cure of hepatitis C with new oral antiviral therapy including direct-acting antiviral sofosbuvir: A case series.

    Science.gov (United States)

    Cornella, Scott L; Stine, Jonathan G; Kelly, Virginia; Caldwell, Stephen H; Shah, Neeral L

    2015-05-01

    Obtaining a sustained virologic response (SVR) in patients with chronic hepatitis C virus (HCV) can decrease hepatic complications and be curative, however, extrahepatic manifestations including mixed cryoglobulinemia (MCN) may persist with interferon-based therapy. Our objective was to review our experience in treating patients with new oral antiviral agents and to assess common factors associated with MCN persistence despite SVR. We analyzed a case series of five patients with genotype one chronic HCV complicated by MCN who had persistence of cryoglobulins despite completion of triple therapy with oral antiviral agents (boceprivir, telaprivir or sofosbuvir). Patients with cirrhosis appear to have a decreased ability to clear immune complexes. We observed that early viral response by week 8 of therapy and longer periods of undetectable virus on treatment correlated with eventual clearance of serum cryoglobulins in patients without cirrhosis. Two patients were treated with anti-B-cell agent rituximab prior to starting therapy for HCV; this did not lead to a more effective clearance of cryoglobulins. We suggest that a longer treatment course than the standard 24 weeks with triple therapy could aid in the clearance of these immune complexes and cryoglobulins in cirrhotics. More studies to determine the ideal duration of treatment for chronic HCV and coincident MCN are needed, especially in light of the new all oral direct-acting antiviral regimens that are now recommended for HCV treatment.

  14. A comparison of stresses in molar teeth restored with inlays and direct restorations, including polymerization shrinkage of composite resin and tooth loading during mastication.

    Science.gov (United States)

    Dejak, Beata; Młotkowski, Andrzej

    2015-03-01

    Polymerization shrinkage of composites is one of the main causes of leakage around dental restorations. Despite the large numbers of studies there is no consensus, what kind of teeth reconstruction--direct or indirect composite restorations are the most beneficial and the most durable. The aim was to compare equivalent stresses and contact adhesive stresses in molar teeth with class II MOD cavities, which were restored with inlays and direct restorations (taking into account polymerization shrinkage of composite resin) during simulated mastication. The study was conducted using the finite elements method with the application of contact elements. Three 3D models of first molars were created: model A was an intact tooth; model B--a tooth with a composite inlay, and model C--a tooth with a direct composite restoration. Polymerization linear shrinkage 0.7% of a direct composite restoration and resin luting cement was simulated (load 1). A computer simulation of mastication was performed (load 2). In these 2 situations, equivalent stresses according to the modified von Mises criterion (mvM) in the materials of mandibular first molar models with different restorations were calculated and compared. Contact stresses in the luting cement-tooth tissue adhesive interface around the restorations were also assessed and analyzed. Equivalent stresses in a tooth with a direct composite restoration (the entire volume of which was affected by polymerization shrinkage) were many times higher than in the tooth restored with a composite inlay (where shrinkage was present only in a thin layer of the luting cement). In dentin and enamel the stress values were 8-14 times higher, and were 13 times higher in the direct restoration than in the inlay. Likewise, contact stresses in the adhesive bond around the direct restoration were 6.5-7.7 times higher compared to an extraorally cured restoration. In the masticatory simulation, shear contact stresses in the adhesive bond around the direct

  15. Three-dimensional magnetotelluric inversion including topography using deformed hexahedral edge finite elements, direct solvers and data space Gauss-Newton, parallelized on SMP computers

    Science.gov (United States)

    Kordy, M. A.; Wannamaker, P. E.; Maris, V.; Cherkaev, E.; Hill, G. J.

    2014-12-01

    We have developed an algorithm for 3D simulation and inversion of magnetotelluric (MT) responses using deformable hexahedral finite elements that permits incorporation of topography. Direct solvers parallelized on symmetric multiprocessor (SMP), single-chassis workstations with large RAM are used for the forward solution, parameter jacobians, and model update. The forward simulator, jacobians calculations, as well as synthetic and real data inversion are presented. We use first-order edge elements to represent the secondary electric field (E), yielding accuracy O(h) for E and its curl (magnetic field). For very low frequency or small material admittivity, the E-field requires divergence correction. Using Hodge decomposition, correction may be applied after the forward solution is calculated. It allows accurate E-field solutions in dielectric air. The system matrix factorization is computed using the MUMPS library, which shows moderately good scalability through 12 processor cores but limited gains beyond that. The factored matrix is used to calculate the forward response as well as the jacobians of field and MT responses using the reciprocity theorem. Comparison with other codes demonstrates accuracy of our forward calculations. We consider a popular conductive/resistive double brick structure and several topographic models. In particular, the ability of finite elements to represent smooth topographic slopes permits accurate simulation of refraction of electromagnetic waves normal to the slopes at high frequencies. Run time tests indicate that for meshes as large as 150x150x60 elements, MT forward response and jacobians can be calculated in ~2.5 hours per frequency. For inversion, we implemented data space Gauss-Newton method, which offers reduction in memory requirement and a significant speedup of the parameter step versus model space approach. For dense matrix operations we use tiling approach of PLASMA library, which shows very good scalability. In synthetic

  16. Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment.

    Science.gov (United States)

    Dillon, Ellis; Chuang, Judith; Gupta, Atul; Tapper, Sharon; Lai, Steve; Yu, Peter; Ritchie, Christine; Tai-Seale, Ming

    2017-12-01

    Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates. Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. Results suggest that providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for health-care systems to address barriers to ACP documentation.

  17. Study of direct Cp violation in B decay into vector mesons including rho zero-omega mixing in the framework of the LHCb experiment

    International Nuclear Information System (INIS)

    Rimbault, C.

    2004-02-01

    ρ 0 - ω mixing effect on direct CP violation in B decay into vector mesons is one of the main studies of this work. The first part is dedicated to the calculation of the decay amplitudes of the channels B → Vρ 0 (ω) which have been represented by a model. We have used the helicity formalism. In such a way branching ratios and asymmetries depending on form factor models and other parameters are predicted. Direct CP violation appears at several levels: in branching ratios, in angular distributions and in differential asymmetry as a function of ρ 0 - ω mass. The dominance of the longitudinal polarization in the studied channels is confirmed by Babar and Belle experimental results. We calculated too the strong phase and the ratio of Penguin to Tree amplitudes for each channel. In a second part, was developed an analysis of the channel B 0 → K *0 ρ 0 (ω) in the framework of LHCb experiment. It will start in 2007 and is dedicated to b flavor study and CP violation. The realistic analysis which has been performed shows that this channel is not appropriate to observe ρ 0 - ω mixing effect on asymmetry in LHCb, while the ρ + ρ 0 (ω) channel, for which we have predicted a branching ratio value confirmed by Babar and Belle, is much more promising. (author)

  18. The daily life of patients with dementia: A comparative study between the information provided by the caregiver and direct patient assessment

    Directory of Open Access Journals (Sweden)

    Lucia Aparecida Bressan

    Full Text Available Abstract The functionality concept is very important, as the diagnosis of dementia presupposes the existence of functional impairment. Instruments assessing functional performance present some limitations. In most cases, the assessment is based on the caregiver's report. Some studies in international literature have evaluated this issue and concluded that a difference exists between the caregiver's report and direct patient assessment. American and European caregivers tend to underestimate the patient's functional limitations. However, this issue has hitherto not been investigated in our context. Objective: To compare the caregiver's information with direct assessment of the patient's performance based on the same functional assessment questionnaire. Methods: Seventy-two patients and caregivers were attended by the Occupational Therapy service of the Behavioral Neurology Outpatient Clinic between 1999 and 2001, 25 of whom fulfilled the inclusion criteria: having a confirmed diagnosis of dementia according to the DSM-IV; having attended three or more return appointments, and where the caregiver belonged to the patient's family nucleus. The remaining subjects were excluded because of non-adherence to treatment or refusal to participate in the study. The Functional Activities Questionnaire by Pfeffer et al., 1982 was applied to patients in a laboratory simulation, while another evaluator interviewed the respective caregivers. The data were analyzed based on the weighted Kappa coefficient, and Wilcoxon test. Results: There were significative differences between caregiver's answers and direct observation of the patient's performance. The information provided by the caregivers proved unreliable since caregivers underestimated the patient's functional capacity.

  19. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

    Science.gov (United States)

    Veitch, Andrew M; Vanbiervliet, Geoffroy; Gershlick, Anthony H; Boustiere, Christian; Baglin, Trevor P; Smith, Lesley-Ann; Radaelli, Franco; Knight, Evelyn; Gralnek, Ian M; Hassan, Cesare; Dumonceau, Jean-Marc

    2016-01-01

    The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation). For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin The advice for warfarin is fundamentally unchanged from British Society of Gastroenterology (BSG) 2008 guidance. Direct Oral Anticoagulants (DOAC) For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation); For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥48 h before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30–50 mL/min we recommend that the last dose of DOAC be taken 72 h before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation). PMID:26873868

  20. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines.

    Science.gov (United States)

    Veitch, Andrew M; Vanbiervliet, Geoffroy; Gershlick, Anthony H; Boustiere, Christian; Baglin, Trevor P; Smith, Lesley-Ann; Radaelli, Franco; Knight, Evelyn; Gralnek, Ian M; Hassan, Cesare; Dumonceau, Jean-Marc

    2016-04-01

    The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage vs. thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor): For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation);For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation).For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin: The advice for warfarin is fundamentally unchanged from BSG 2008 guidance. Direct Oral Anticoagulants (DOAC): For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation). For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥ 48 hours before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30 - 50 mL/min we recommend that the last dose of DOAC be taken 72 hours before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation). © Georg Thieme Verlag KG Stuttgart · New York.

  1. EspC, an Autotransporter Protein Secreted by Enteropathogenic Escherichia coli, Causes Apoptosis and Necrosis through Caspase and Calpain Activation, Including Direct Procaspase-3 Cleavage

    Directory of Open Access Journals (Sweden)

    Antonio Serapio-Palacios

    2016-06-01

    Full Text Available Enteropathogenic Escherichia coli (EPEC has the ability to antagonize host apoptosis during infection through promotion and inhibition of effectors injected by the type III secretion system (T3SS, but the total number of these effectors and the overall functional relationships between these effectors during infection are poorly understood. EspC produced by EPEC cleaves fodrin, paxillin, and focal adhesion kinase (FAK, which are also cleaved by caspases and calpains during apoptosis. Here we show the role of EspC in cell death induced by EPEC. EspC is involved in EPEC-mediated cell death and induces both apoptosis and necrosis in epithelial cells. EspC induces apoptosis through the mitochondrial apoptotic pathway by provoking (i a decrease in the expression levels of antiapoptotic protein Bcl-2, (ii translocation of the proapoptotic protein Bax from cytosol to mitochondria, (iii cytochrome c release from mitochondria to the cytoplasm, (iv loss of mitochondrial membrane potential, (v caspase-9 activation, (vi cleavage of procaspase-3 and (vii an increase in caspase-3 activity, (viii PARP proteolysis, and (ix nuclear fragmentation and an increase in the sub-G1 population. Interestingly, EspC-induced apoptosis was triggered through a dual mechanism involving both independent and dependent functions of its EspC serine protease motif, the direct cleavage of procaspase-3 being dependent on this motif. This is the first report showing a shortcut for induction of apoptosis by the catalytic activity of an EPEC protein. Furthermore, this atypical intrinsic apoptosis appeared to induce necrosis through the activation of calpain and through the increase of intracellular calcium induced by EspC. Our data indicate that EspC plays a relevant role in cell death induced by EPEC.

  2. Investigating Direct Links between Depression, Emotional Control, and Physical Punishment with Adolescent Drive for Thinness and Bulimic Behaviors, Including Possible Moderation by the Serotonin Transporter 5-HTTLPR Polymorphism

    Directory of Open Access Journals (Sweden)

    Vanja Rozenblat

    2017-08-01

    Full Text Available Objectives: To examine the relationship between psychological and social factors (depression, emotional control, sexual abuse, and parental physical punishment and adolescent drive for Thinness and Bulimic behaviors in a large community sample, and to investigate possible genetic moderation.Method: Data were drawn from the Australian Temperament Project (ATP, a population-based cohort study that has followed a representative sample of 2443 participants from infancy to adulthood across 16 waves since 1983. A subsample of 650 participants (50.2% female of Caucasian descent who provided DNA were genotyped for a serotonin transporter promoter polymorphism (5-HTTLPR. Adolescent disordered eating attitudes and behaviors were assessed using the Bulimia and Drive for Thinness scales of the Eating Disorder Inventory-2 (15–16 years. Depression and emotional control were examined at the same age using the Short Mood and Feelings Questionnaire, and an ATP-devised measure of emotional control. History of sexual abuse and physical punishment were assessed retrospectively (23–24 years in a subsample of 467 of those providing DNA.Results: EDI-2 scores were associated with depression, emotional control, and retrospectively reported parental physical punishment. Although there was statistically significant moderation of the relationship between parental physical punishment and bulimic behaviors by 5-HTTLPR (p = 0.0048, genotypes in this subsample were not in Hardy–Weinberg Equilibrium. No other G×E interactions were significant. Conclusion: Findings from this study affirm the central importance of psychosocial processes in disordered eating patterns in adolescence. Evidence of moderation by 5-HTTLPR was not conclusive; however, genetic moderation observed in a subsample not in Hardy–Weinberg Equilibrium warrants further investigation.

  3. Direct Visualization of RNA-DNA Primer Removal from Okazaki Fragments Provides Support for Flap Cleavage and Exonucleolytic Pathways in Eukaryotic Cells.

    Science.gov (United States)

    Liu, Bochao; Hu, Jiazhi; Wang, Jingna; Kong, Daochun

    2017-03-24

    During DNA replication in eukaryotic cells, short single-stranded DNA segments known as Okazaki fragments are first synthesized on the lagging strand. The Okazaki fragments originate from ∼35-nucleotide-long RNA-DNA primers. After Okazaki fragment synthesis, these primers must be removed to allow fragment joining into a continuous lagging strand. To date, the models of enzymatic machinery that removes the RNA-DNA primers have come almost exclusively from biochemical reconstitution studies and some genetic interaction assays, and there is little direct evidence to confirm these models. One obstacle to elucidating Okazaki fragment processing has been the lack of methods that can directly examine primer removal in vivo In this study, we developed an electron microscopy assay that can visualize nucleotide flap structures on DNA replication forks in fission yeast ( Schizosaccharomyces pombe ). With this assay, we first demonstrated the generation of flap structures during Okazaki fragment processing in vivo The mean and median lengths of the flaps in wild-type cells were ∼51 and ∼41 nucleotides, respectively. We also used yeast mutants to investigate the impact of deleting key DNA replication nucleases on these flap structures. Our results provided direct in vivo evidence for a previously proposed flap cleavage pathway and the critical function of Dna2 and Fen1 in cleaving these flaps. In addition, we found evidence for another previously proposed exonucleolytic pathway involving RNA-DNA primer digestion by exonucleases RNase H2 and Exo1. Taken together, our observations suggest a dual mechanism for Okazaki fragment maturation in lagging strand synthesis and establish a new strategy for interrogation of this fascinating process. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

  4. Dopamine D1-histamine H3 Receptor Heteromers Provide a Selective Link to MAPK Signaling in GABAergic Neurons of the Direct Striatal Pathway*

    Science.gov (United States)

    Moreno, Estefanía; Hoffmann, Hanne; Gonzalez-Sepúlveda, Marta; Navarro, Gemma; Casadó, Vicent; Cortés, Antoni; Mallol, Josefa; Vignes, Michel; McCormick, Peter J.; Canela, Enric I.; Lluís, Carme; Moratalla, Rosario; Ferré, Sergi; Ortiz, Jordi; Franco, Rafael

    2011-01-01

    Previously, using artificial cell systems, we identified receptor heteromers between the dopamine D1 or D2 receptors and the histamine H3 receptor. In addition, we demonstrated two biochemical characteristics of the dopamine D1 receptor-histamine H3 receptor heteromer. We have now extended this work to show the dopamine D1 receptor-histamine H3 receptor heteromer exists in the brain and serves to provide a novel link between the MAPK pathway and the GABAergic neurons in the direct striatal efferent pathway. Using the biochemical characteristics identified previously, we found that the ability of H3 receptor activation to stimulate p44 and p42 extracellular signal-regulated MAPK (ERK 1/2) phosphorylation was only observed in striatal slices of mice expressing D1 receptors but not in D1 receptor-deficient mice. On the other hand, the ability of both D1 and H3 receptor antagonists to block MAPK activation induced by either D1 or H3 receptor agonists was also found in striatal slices. Taken together, these data indicate the occurrence of D1-H3 receptor complexes in the striatum and, more importantly, that H3 receptor agonist-induced ERK 1/2 phosphorylation in striatal slices is mediated by D1-H3 receptor heteromers. Moreover, H3 receptor-mediated phospho-ERK 1/2 labeling co-distributed with D1 receptor-containing but not with D2 receptor-containing striatal neurons. These results indicate that D1-H3 receptor heteromers work as processors integrating dopamine- and histamine-related signals involved in controlling the function of striatal neurons of the direct striatal pathway. PMID:21173143

  5. Local anesthetic delivery via surgical drain provides improved pain control versus direct skin infiltration following axillary node dissection for breast cancer.

    Science.gov (United States)

    Khpal, Muska; Miller, James R C; Petrovic, Zika; Hassanally, Delilah

    2018-03-01

    Axillary node dissection has a central role in the surgical management of breast cancer; however, it is associated with a significant risk of lymphoedema and chronic pain. Peri-operative administration of local anesthesia reduces acute and persistent post-surgical pain, but there is currently no consensus on the optimal method of local anesthetic delivery. Patients undergoing axillary dissection for breast cancer were randomly assigned to receive a one-off dose of levobupivacaine 0.5% (up to 2 mg/kg) following surgery, either via the surgical drain or by direct skin infiltration. Post-operative pain control at rest and on shoulder abduction was assessed using a numerical rating scale. Total analgesia consumption 48 h after surgery was also recorded. Pain scores were significantly lower when local anesthesia was administered via surgical drain at both 3 and 12 h after surgery; this trend extended to 24 h post-operatively. However, pain scores on shoulder abduction did not differ at the 12 or 24 h time points. No differences were found in the total analgesia consumption or length of hospital stay between treatment groups. This study demonstrates that local anesthetic delivery via a surgical drain provides improved pain control compared to direct skin infiltration following axillary node dissection. This is likely to be important for the management of acute pain in the immediate post-operative period; however, further studies may be required to validate this in specific patient subgroups, e.g., breast-conserving surgery versus mastectomy.

  6. Order no 058/MME/DAAF from June 13, 2003 provides for the creation, attributions and organization of Departmental Directorates, Direction of urban Niamey's communauty and Arlit's Arrondissement Service of the Ministry of Mines and Energy

    International Nuclear Information System (INIS)

    Rabiou Hassane, Yari

    2003-01-01

    This order provides for the creation, attributions and organization of Departemental Directorates, Direction of urban Niamey's communauty and Arlit's Arrondissement Service of the Ministry of Mines and Energy. It is created a Departmental Directorate of Mines and Energy into each of the following places of region: AGADEZ, DIFFA, , MARADI, TAHOUA, TILLABERI and ZINDER, and Direction of urban Niamey's communauty and Arlit's Arrondissement Service of the Ministry of Mines and Energy. Each Departmental and communal Directorate is constitued of: a service of the Geology's Research and Mining, Mines service, a Service of Electricity and new Energies and renewlables, a Service of hydrocarbures and an Administrative and Financial Service. Arrondissement Service includes: a Division of Mines and Geology, a Division of Energy and an admistrative and Financial Division. [fr

  7. The mother or the fetus? 11beta-hydroxysteroid dehydrogenase type 2 null mice provide evidence for direct fetal programming of behavior by endogenous glucocorticoids.

    Science.gov (United States)

    Holmes, Megan C; Abrahamsen, Christian T; French, Karen L; Paterson, Janice M; Mullins, John J; Seckl, Jonathan R

    2006-04-05

    Low birth weight associates with increased susceptibility to adult cardiometabolic and affective disorders spawning the notion of fetal "programming." Prenatal exposure to excess glucocorticoids may be causal. In support, maternal stress or treatment during pregnancy with dexamethasone (which crosses the placenta) or inhibitors of fetoplacental 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2), the physiological "barrier" to maternal glucocorticoids, reduces birth weight and programs permanent offspring hypertension, hyperglycemia, and anxiety behaviors. It remains uncertain whether such effects are mediated indirectly via altered maternal function or directly on the fetus and its placenta. To dissect this critical issue, we mated 11beta-HSD2(+/-) mice such that each pregnant female produces +/+, +/-, and -/- offspring and compared them with offspring of homozygous wild-type and -/- matings. We show that 11beta-HSD2(-/-) offspring of either +/- or -/- mothers have lower birth weight and exhibit greater anxiety than 11beta-HSD2(+/+) littermates. This provides clear evidence for the key role of fetoplacental 11beta-HSD2 in prenatal glucocorticoid programming.

  8. TeleWound care – providing remote wound assessment and treatment in the home care setting: current status and future directions

    Directory of Open Access Journals (Sweden)

    Santamaria N

    2013-11-01

    Full Text Available Nick Santamaria,1 Suzanne Kapp2 1University of Melbourne and Melbourne Health, Royal Melbourne Hospital, Melbourne, VIC, Australia; 2Royal District Nursing Service Institute, Melbourne, VIC, Australia Abstract: The use of wound telemedicine systems in the home care environment has been expanding for the last decade. These systems can generally be grouped into two main types: store and forward systems and video conference type systems; additionally, there are also hybrid systems available that include elements of both. Evidence to date suggests that these systems provide significant benefits to patients, clinicians, and to the health care system generally. Reductions in resource use, visit substitution, costs, and high patient and clinician satisfaction have been reported; however, there is a lack of integration with existing health care technology and no clearly defined technical or clinical standards as yet. Similarly, the legalities associated with wound telemedicine and remote consultation remain unclear. As wound telemedicine systems continue to evolve and be deployed in different locations, there remains significant potential to harness their power to benefit patients being treated at home. Keywords: telemedicine, home care, e-health

  9. Order no 000062/MME/DAAF from June 15, 2009 provides for the creation, attributions and organization of Regional Directions, and departmental Arlit's Direction of the Ministry of Mines and Energy

    International Nuclear Information System (INIS)

    Mohamed, Abdoullahi

    2009-01-01

    This order provides for the creation, attributions and organization of Regional Directorates, and departmental Arlit's Directorate of the Ministry of Mines and Energy. It is created Regionale Directorates of Mines and Energy into each of the following places of region: Agadez, DIFFA, Dosso, Maradi, Niamey, TAHOUA, TILLABERI and ZINDER, and a Departmental Directorate of Mines and the Energy at Arlit. Each Regional Directorate is constituted of five divisions: Division of Geology, Division of Mines, Division of Energy, Division of Administration and Financial Matters, Documentation and Archives, and a division of Small Scale Operations Minieres and Careers. Regional Directorates are responsible for monitoring and control of the provisions of the Mining Code, the petroleum code and the code of the electricity and the application of all regulatory provisions relating to the sector of Mines and Energy. The Departemental Directorate includes: a service of the Geology, a service of Energy, Mines service, and service of a Small Scale Operations Minieres and Careers. [fr

  10. Prolonged direct hemoperfusion using a polymyxin B immobilized fiber cartridge provides sustained circulatory stabilization in patients with septic shock: a retrospective observational before-after study

    Directory of Open Access Journals (Sweden)

    Kyohei Miyamoto

    2017-02-01

    Full Text Available Abstract Background Direct hemoperfusion therapy with polymyxin B immobilized fiber cartridges (PMX-DHP is widely used for septic shock in Japan and parts of Europe. Although this treatment is usually administered for 2 h, the optimal duration has not been established. Methods This retrospective study compared the effects of prolonged and conventional PMX-DHP durations (2 and 12 h, respectively for septic shock. Between October 2013 and March 2015, 18 patients underwent conventional PMX-DHP, and between April 2015 and May 2016, 18 patients underwent prolonged PMX-DHP. The primary outcome was the vasopressor dependency index during the 12 h after starting the first PMX-DHP session. The vasopressor dependency index was calculated as (inotropic score/(mean blood pressure. Results The patients’ characteristics were almost similar in the conventional and prolonged PMX-DHP groups. The major site of infection was the abdomen in both groups (61 and 72%, respectively. The conventional PMX-DHP group had mean blood pressure values of 68.4 ± 8.9 mmHg and 78.2 ± 16.9 mmHg at 0 and 12 h after starting PMX-DHP (P = 0.13. The prolonged PMX-DHP group had mean blood pressure values of 70.3 ± 15.7 mmHg and 87.7 ± 16.9 mmHg at 0 and 12 h after starting PMX-DHP (P = 0.004. The conventional PMX-DHP group had vasopressor dependency index values of 0.52 ± 0.29 and 0.39 ± 0.25 at 0 and 12 h after starting PMX-DHP (P = 0.29. The prolonged PMX-DHP group had vasopressor dependency index values of 0.50 ± 0.26 and 0.28 ± 0.18 at 0 and 12 h after starting PMX-DHP (P = 0.01. Hospital mortality was similar in both groups (8/18 [44%] and 8/18 [44%]. Conclusions These findings suggest that prolonged PMX-DHP provides more sustained circulatory stabilization compared to conventional PMX-DHP. However, our study failed to detect any improvement in mortality. Well-designed prospective trials are needed to examine the

  11. The Use of a Self-Directed Learning Program to Provide Introductory Training in Pivotal Response Treatment to Parents of Children with Autism

    Science.gov (United States)

    Nefdt, Nicolette; Koegel, Robert; Singer, George; Gerber, Michael

    2010-01-01

    There is increasing demand for access to effective interventions for families who have children with autism. Self-directed learning models have been successfully used with other populations as a way to reduce the service-need discrepancy. The purpose of this study was to evaluate, through a randomized clinical trial, whether the use of a…

  12. Teaching Applied Behavior Analysis Knowledge Competencies to Direct-Care Service Providers: Outcome Assessment and Social Validation of a Training Program

    Science.gov (United States)

    Luiselli, James K.; Bass, Jennifer D.; Whitcomb, Sara A.

    2010-01-01

    Staff training is a critical performance improvement objective within behavioral health care organizations. This study evaluated a systematic training program for teaching applied behavior analysis knowledge competencies to newly hired direct-care employees at a day and residential habilitation services agency for adults with intellectual and…

  13. Self-administered versus provider-directed sampling in the Anishinaabek Cervical Cancer Screening Study (ACCSS): a qualitative investigation with Canadian First Nations women.

    Science.gov (United States)

    Zehbe, Ingeborg; Wakewich, Pamela; King, Amy-Dee; Morrisseau, Kyla; Tuck, Candace

    2017-09-01

    While (Pap)anicolaou screening has helped to decrease cervical cancer incidence in Canada, First Nations women continue to have a higher burden and mortality relative to mainstream populations. Many First Nations women may feel uncomfortable with the invasiveness of this test, contributing to this statistic. Implemented from 2009 to 2015 in 10 Northwest Ontario First Nations communities, the Anishinaabek Cervical Cancer Screening Study (ACCSS) uniquely addressed this Indigenous health inequity through a mixed methods approach. Our goal was to offer an alternative test which the women could do themselves: human papillomavirus (HPV) testing based on self-sampling. We investigated whether First Nations women preferred HPV self-sampling over healthcare provider (HCP)-administered Pap screening. Participatory action researchinformed by the ethical space concept has guided all stages of the ACCSS. We conducted qualitative interviews with 16 HCPs and 8 focus group discussions with 69 female community members followed by a cluster-randomised controlled trial (RCT). Here, we draw on the qualitative field data and an end-of-study community update gathering to disseminate and contextualise research findings. Informant data were evaluated using thematic analysis. We discuss factors influencing participants' strong preference for HPV self-sampling over physician-conducted Pap screening. Key arguments included enhanced accessibility and more personal control, less physical and emotional discomfort and fewer concerns regarding privacy of test results. For future implementation of HPV self-sampling, study participants emphasised the need for more culturally sensitive education addressed to community members of all genders, starting at school, clarifying that HPV causes cervical cancer. Further, HPV infection should be de-stigmatised by accentuating that it affects men and women alike. Here we show that self-sampling in conjunction with community engagement and culturally sensitive

  14. Evaluation of the role of access providers. Discussion of Dutch Pirate Bay case law and introducing principles on directness, effectiveness, costs, relevance, and time

    NARCIS (Netherlands)

    Lodder, A.R.; van der Meulen, N.S.

    2013-01-01

    Internet service providers (ISPs) play a pivotal role in contemporary society because they provide access to the Internet. The primary task of ISPs – to blindly transfer information across the network – has recently come under pressure, as has their status as neutral third parties. Both the public

  15. An Interferon Regulated MicroRNA Provides Broad Cell-Intrinsic Antiviral Immunity through Multihit Host-Directed Targeting of the Sterol Pathway.

    Directory of Open Access Journals (Sweden)

    Kevin A Robertson

    2016-03-01

    Full Text Available In invertebrates, small interfering RNAs are at the vanguard of cell-autonomous antiviral immunity. In contrast, antiviral mechanisms initiated by interferon (IFN signaling predominate in mammals. Whilst mammalian IFN-induced miRNA are known to inhibit specific viruses, it is not known whether host-directed microRNAs, downstream of IFN-signaling, have a role in mediating broad antiviral resistance. By performing an integrative, systematic, global analysis of RNA turnover utilizing 4-thiouridine labeling of newly transcribed RNA and pri/pre-miRNA in IFN-activated macrophages, we identify a new post-transcriptional viral defense mechanism mediated by miR-342-5p. On the basis of ChIP and site-directed promoter mutagenesis experiments, we find the synthesis of miR-342-5p is coupled to the antiviral IFN response via the IFN-induced transcription factor, IRF1. Strikingly, we find miR-342-5p targets mevalonate-sterol biosynthesis using a multihit mechanism suppressing the pathway at different functional levels: transcriptionally via SREBF2, post-transcriptionally via miR-33, and enzymatically via IDI1 and SC4MOL. Mass spectrometry-based lipidomics and enzymatic assays demonstrate the targeting mechanisms reduce intermediate sterol pathway metabolites and total cholesterol in macrophages. These results reveal a previously unrecognized mechanism by which IFN regulates the sterol pathway. The sterol pathway is known to be an integral part of the macrophage IFN antiviral response, and we show that miR-342-5p exerts broad antiviral effects against multiple, unrelated pathogenic viruses such Cytomegalovirus and Influenza A (H1N1. Metabolic rescue experiments confirm the specificity of these effects and demonstrate that unrelated viruses have differential mevalonate and sterol pathway requirements for their replication. This study, therefore, advances the general concept of broad antiviral defense through multihit targeting of a single host pathway.

  16. Directions in low-level radioactive-waste management. Incentives and compensation: providing resources for communities hosting low-level waste facilities

    International Nuclear Information System (INIS)

    1982-10-01

    State responsibility for the management of low-level radioactive waste necessitates the selection of candidate locations for a disposal facility. Concern over potential impacts can be expected from segments of the citizenry neighboring a proposed site. A number of national organizations comprising state and local officials have recommended the use of incentives and compensation to help offset the negative local impacts. This document explores that concept. Discussion provides background information on potential local impacts from a low-level waste facility and considers the nature and types of incentives and compensation benefits that could be provided. The document then examines realistic options for planning and implementing the benefit program. This information is intended, primarily, to assist state officials - executive, legislative, and agency - in planning for and managing low-level waste disposal facilities

  17. Analysis of the influence of recent reforms in China: cardiovascular and cerebrovascular medicines as a case history to provide future direction.

    Science.gov (United States)

    Zeng, Wenjie; Zhen, Junjie; Feng, Mengying; Campbell, Stephen M; Finlayson, Alexander E; Godman, Brian

    2014-07-01

    Pharmaceutical expenditure has grown by 16% per annum in China, enhanced by incentives for physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, accounting for 46% of total hospital expenditure. Principal measures to moderate drug expenditure growth include pricing initiatives as limited demand-side measures. Assess current utilization and expenditure including traditional Chinese medicines (TCMs) between 2006 and 2012. Uncontrolled retrospective study of medicines to treat cardiovascular and cerebrovascular diseases in one of the largest hospitals in southwest China. Utilization increased 3.3-fold for cerebrovascular medicines, greatest for TCMs, with expenditure increasing 4.85-fold. Low prices for generics were seen, similar to Europe. However, there was variable utilization of generics at 29-31% of total product volumes in recent years. There continued to be irrationality in prescribing with high use of TCMs, and the utilization of different medicines dropping significantly once they achieved low prices. Prices still have an appreciable impact on utilization in China. Potential measures similar to those implemented among western European countries could improve prescribing rationality and conserve resources.

  18. A Novel Implementation Strategy in Residential Care Settings to Promote EBP: Direct Care Provider Perceptions and Development of a Conceptual Framework.

    Science.gov (United States)

    Slaughter, Susan E; Bampton, Erin; Erin, Daniel F; Ickert, Carla; Jones, C Allyson; Estabrooks, Carole A

    2017-06-01

    Innovative approaches are required to facilitate the adoption and sustainability of evidence-based care practices. We propose a novel implementation strategy, a peer reminder role, which involves offering a brief formal reminder to peers during structured unit meetings. This study aims to (a) identify healthcare aide (HCA) perceptions of a peer reminder role for HCAs, and (b) develop a conceptual framework for the role based on these perceptions. In 2013, a qualitative focus group study was conducted in five purposively sampled residential care facilities in western Canada. A convenience sample of 24 HCAs agreed to participate in five focus groups. Concurrent with data collection, two researchers coded the transcripts and identified themes by consensus. They jointly determined when saturation was achieved and took steps to optimize the trustworthiness of the findings. Five HCAs from the original focus groups commented on the resulting conceptual framework. HCAs were cautious about accepting a role that might alienate them from their co-workers. They emphasized feeling comfortable with the peer reminder role and identified circumstances that would optimize their comfort including: effective implementation strategies, perceptions of the role, role credibility and a supportive context. These intersecting themes formed a peer reminder conceptual framework. We identified HCAs' perspectives of a new peer reminder role designed specifically for them. Based on their perceptions, a conceptual framework was developed to guide the implementation of a peer reminder role for HCAs. This role may be a strategic implementation strategy to optimize the sustainability of new practices in residential care settings, and the related framework could offer guidance on how to implement this role. © 2017 Sigma Theta Tau International.

  19. Optical modulator including grapene

    Science.gov (United States)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang

    2016-06-07

    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  20. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  1. The tightness of control procedures in the legal protection provided by jurisdiction against directives issued by the Federal Government - a problem of competence distribution between the Federal Constitutional Court and the Federal Administrative Court?

    International Nuclear Information System (INIS)

    Zimmermann, B.

    1992-01-01

    The tightness of control procedures in the legal protection provided by jurisdiction against directives issued by the Federal Government - a problem of competence distribution between the Federal Constitutional Court and the Federal Administrative Court? The article examines questions of recourse to the competent court, problems concerning the admissibility of legal proceedings before the Federal Admininstrative Court, the competence of the Laender in performing administrative acts on behalf of the Federation, the effectiveness of legal protection and the relationship between the Laender and the Federation in terms of responsibility for constitutional rights. The legal protection offered by administrative law, against a directive of the Federal Government is wholly ineffective, as there is no legal position a Land could bring into play to defened itself against a directive leading to unlawful action. Inequites which thus occur can however be met via a dispute between the Federation and the Laender as provided by the constitution, as the content of a directive becomes relevant in attempts to exert influence on the competence issue. Ultimately the rulings of the Basic Law on competence serve to protect the citizen and the community against excesses. In this connection the constitutional rights in their capacity as negative competence rulings disqualify executive acts. (orig./HSCH) [de

  2. Provider Info

    Data.gov (United States)

    U.S. Department of Health & Human Services — General information on currently active nursing homes, including number of certified beds, quality measure scores, staffing and other information used in the...

  3. Presentations provided

    International Nuclear Information System (INIS)

    Hashemian, H.; Beverly, D.

    1998-01-01

    The following topics covered in detail at the workshop included: temperature instrumentation; pressure instrumentation; in-situ calibration and response time testing of RTDs and pressure transmitters; on-line performance monitoring and preventive maintenance of critical equipment; automated measurement of critical parameters; nuclear power plant infrastructure, management and Quality Assurance issues and recent developments for WWER and RBMK reactors. Conclusions drawn were: aging can adversely affect the performance of nuclear plant pressure transmitters; current testing interval of once in every fuel cycle is adequate for aging management; in-situ response time measurements and on-line calibration testing methods have been developed and validated for nuclear plant pressure transmitters; NUREG/CR-5851 should be taken into account for details of aging research on pressure transmitters

  4. Directional radiation detectors

    Science.gov (United States)

    Dowell, Jonathan L.

    2017-09-12

    Directional radiation detectors and systems, methods, and computer-readable media for using directional radiation detectors to locate a radiation source are provided herein. A directional radiation detector includes a radiation sensor. A radiation attenuator partially surrounds the radiation sensor and defines an aperture through which incident radiation is received by the radiation sensor. The aperture is positioned such that when incident radiation is received directly through the aperture and by the radiation sensor, a source of the incident radiation is located within a solid angle defined by the aperture. The radiation sensor senses at least one of alpha particles, beta particles, gamma particles, or neutrons.

  5. A Study to Determine the Feasibility of Including the Direct Experiences of Microteaching and Team Teaching, and Interaction Analysis Training in the Pre-Service Training of Foreign Language Teachers.

    Science.gov (United States)

    Wolfe, David Edwin

    This study examines potentially significant factors in the training of foreign language teachers. Remarks on microteaching and interaction analysis precede a review and analysis of related literature. Included in this section are the Stanford University Summer Intern Program, Amidon's model of microteaching and interaction analysis, and…

  6. Talking about Complementary and Alternative Medicine with Your Health Care Providers: A Workbook and Tips

    Science.gov (United States)

    ... everyone involved in your care, including conventional and complementary therapy providers. Other resources included in this workbook are: • ... care providers are concerned about your use of complementary therapies. • Ask your health care providers to direct you ...

  7. Direct Democracy

    DEFF Research Database (Denmark)

    Beramendi, Virginia; Ellis, Andrew; Kaufman, Bruno

    of direct democracy mechanisms in specific contexts. These country case studies allow for in depth discussion of particular issues, including signature collection and voter participation, campaign financing, media coverage, national variations in the usage of direct democracy procedures and national lessons...

  8. Pump apparatus including deconsolidator

    Energy Technology Data Exchange (ETDEWEB)

    Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew

    2014-10-07

    A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.

  9. The Directed Case Method.

    Science.gov (United States)

    Cliff, William H.; Curtin, Leslie Nesbitt

    2000-01-01

    Provides an example of a directed case on human anatomy and physiology. Uses brief real life newspaper articles and clinical descriptions of medical reference texts to describe an actual, fictitious, or composite event. Includes interrelated human anatomy and physiology topics in the scenario. (YDS)

  10. Scanning ion-selective electrode technique and X-ray microanalysis provide direct evidence of contrasting Na+ transport ability from root to shoot in salt-sensitive cucumber and salt-tolerant pumpkin under NaCl stress.

    Science.gov (United States)

    Lei, Bo; Huang, Yuan; Sun, Jingyu; Xie, Junjun; Niu, Mengliang; Liu, Zhixiong; Fan, Molin; Bie, Zhilong

    2014-12-01

    Grafting onto salt-tolerant pumpkin rootstock can increase cucumber salt tolerance. Previous studies have suggested that this can be attributed to pumpkin roots with higher capacity to limit the transport of Na(+) to the shoot than cucumber roots. However, the mechanism remains unclear. This study investigated the transport of Na(+) in salt-tolerant pumpkin and salt-sensitive cucumber plants under high (200 mM) or moderate (90 mM) NaCl stress. Scanning ion-selective electrode technique showed that pumpkin roots exhibited a higher capacity to extrude Na(+), and a correspondingly increased H(+) influx under 200 or 90 mM NaCl stress. The 200 mM NaCl induced Na(+)/H(+) exchange in the root was inhibited by amiloride (a Na(+)/H(+) antiporter inhibitor) or vanadate [a plasma membrane (PM) H(+) -ATPase inhibitor], indicating that Na(+) exclusion in salt stressed pumpkin and cucumber roots was the result of an active Na(+)/H(+) antiporter across the PM, and the Na(+)/H(+) antiporter system in salt stressed pumpkin roots was sufficient to exclude Na(+) X-ray microanalysis showed higher Na(+) in the cortex, but lower Na(+) in the stele of pumpkin roots than that in cucumber roots under 90 mM NaCl stress, suggesting that the highly vacuolated root cortical cells of pumpkin roots could sequester more Na(+), limit the radial transport of Na(+) to the stele and thus restrict the transport of Na(+) to the shoot. These results provide direct evidence for pumpkin roots with higher capacity to limit the transport of Na(+) to the shoot than cucumber roots. © 2014 Scandinavian Plant Physiology Society.

  11. Provider Health and Wellness.

    Science.gov (United States)

    Nanda, Anil; Wasan, Anita; Sussman, James

    Provider health and wellness is a significant issue and can impact patient care, including patient satisfaction, quality of care, medical errors, malpractice risk, as well as provider and office staff turnover and early retirement. Health and wellness encompasses various areas including burnout, depression, divorce, and suicide and affects providers of all specialties and at all levels of training. Providers deal with many everyday stresses, including electronic health records, office politics, insurance and billing issues, dissatisfied patients, and their own personal and family issues. Approximately half of all physicians suffer from burnout, and the rate of burnout among physicians of all specialties is increasing. An important first step in dealing with burnout is recognition and then seeking assistance. Strategies to prevent and treat burnout include increasing provider resiliency as well as implementing practical changes in the everyday practice of medicine. There is currently very little data regarding health and wellness specifically in the field of allergy and immunology, and studies are necessary to determine the prevalence of burnout and related issues in this field. Many medical specialties as well as state and national medical associations have health and wellness committees and other resources, which are essential for providers. Health and wellness programs should be introduced early in a provider's training and continued throughout a provider's career. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  12. Regional impacts of abolishing direct payments

    DEFF Research Database (Denmark)

    Uthes, Sandra; Priorr, Annette; Zander, Peter

    2011-01-01

    The direct payment system of the Common Agricultural Policy (CAP) provides income transfers to European farmers. Recently, several countries including England and Sweden have advocated the elimination of direct payments after 2013. The extent to which an elimination of direct payments would affec...

  13. Ecosystem services provided by waterbirds.

    Science.gov (United States)

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  14. A Comparison of the Effects of Direct Modeling and Video Modeling Provided by Peers to Students with Autism Who Are Attending in Rural Play Teaching in an Inclusive Setting

    Science.gov (United States)

    Odluyurt, Serhat

    2013-01-01

    In the present research, the peers of children with autism at primary school level and in an inclusive environment were taught using direct modeling and video modeling education processes, and it was observed whether or not they could effectively and efficiently teach how to play games to their friends with autism. This study used adapted…

  15. Direct Heat

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.J.

    1990-01-01

    Potential resources and applications of earth heat in the form of geothermal energy are large. United States direct uses amount to 2,100 MWt thermal and worldwide 8,850 MWt above a reference temperature of 35 degrees Celsius. Space and district heating are the major direct uses of geothermal energy. Equipment employed in direct use projects is of standard manufacture and includes downhole and circulation pumps, transmission and distribution pipelines, heat exchangers and convectors, heat pumps and chillers. Direct uses of earth heat discussed are space and district heating, greenhouse heating and fish farming, process and industrial applications. The economic feasibility of direct use projects is governed by site specific factors such as location of user and resource, resource quality, system load factor and load density, as well as financing. Examples are presented of district heating in Klamath Falls, and Elko. Further developments of direct uses of geothermal energy will depend on matching user needs to the resource, and improving load factors and load density.

  16. TERRAIN, PROVIDENCE COUNTY, RHODE ISLAND

    Data.gov (United States)

    Federal Emergency Management Agency, Department of Homeland Security — The Providence AOI consists of the costal portion of the county, and meshes up seamlessly with the Kent county AOI directly south. Ground Control is collected...

  17. Providing x-rays

    International Nuclear Information System (INIS)

    Mallozzi, P.J.; Epstein, H.M.

    1985-01-01

    This invention provides an apparatus for providing x-rays to an object that may be in an ordinary environment such as air at approximately atmospheric pressure. The apparatus comprises: means (typically a laser beam) for directing energy onto a target to produce x-rays of a selected spectrum and intensity at the target; a fluid-tight enclosure around the target; means for maintaining the pressure in the first enclosure substantially below atmospheric pressure; a fluid-tight second enclosure adjoining the first enclosure, the common wall portion having an opening large enough to permit x-rays to pass through but small enough to allow the pressure reducing means to evacuate gas from the first enclosure at least as fast as it enters through the opening; the second enclosure filled with a gas that is highly transparent to x-rays; the wall of the second enclosure to which the x-rays travel having a portion that is highly transparent to x-rays (usually a beryllium or plastic foil), so that the object to which the x-rays are to be provided may be located outside the second enclosure and adjacent thereto and thus receive the x-rays substantially unimpeded by air or other intervening matter. The apparatus is particularly suited to obtaining EXAFS (extended x-ray fine structure spectroscopy) data on a material

  18. Direct ELISA.

    Science.gov (United States)

    Lin, Alice V

    2015-01-01

    First described by Engvall and Perlmann, the enzyme-linked immunosorbent assay (ELISA) is a rapid and sensitive method for detection and quantitation of an antigen using an enzyme-labeled antibody. Besides routine laboratory usage, ELISA has been utilized in medical field and food industry as diagnostic and quality control tools. Traditionally performed in 96-well or 384-well polystyrene plates, the technology has expanded to other platforms with increase in automation. Depending on the antigen epitope and availability of specific antibody, there are variations in ELISA setup. The four basic formats are direct, indirect, sandwich, and competitive ELISAs. Direct ELISA is the simplest format requiring an antigen and an enzyme-conjugated antibody specific to the antigen. This chapter describes the individual steps for detection of a plate-bound antigen using a horseradish peroxidase (HRP)-conjugated antibody and luminol-based enhanced chemiluminescence (ECL) substrate. The methodological approach to optimize the assay by chessboard titration is also provided.

  19. Direct RF modulation transmitter, sampling clock frequency setting method for direct RF modulation transmitter

    NARCIS (Netherlands)

    Fukuda, Shuichi; Nauta, Bram

    2013-01-01

    PROBLEM TO BE SOLVED: To provide a direct RF modulation transmitter capable of satisfying a radiation level regulation even without providing a SAW filter. SOLUTION: A direct RF modulation transmitter includes: digital/RF converters 105, 106 to which an I digital baseband signal, a Q digital

  20. Direct RF modulation transmitter, sampling clock frequency setting method for direct RF modulation transmitter

    NARCIS (Netherlands)

    Fukuda, Shuichi; Nauta, Bram

    2014-01-01

    PROBLEM TO BE SOLVED: To provide a direct RF modulation transmitter capable of satisfying a radiation level regulation even without providing a SAW filter. SOLUTION: A direct RF modulation transmitter includes: digital/RF converters 105, 106 to which an I digital baseband signal, a Q digital

  1. Environmental standards provide competitive advantage

    International Nuclear Information System (INIS)

    Chynoweth, E.; Kirshner, E.

    1993-01-01

    Quality organizations are breaking new ground with the development of international standards for environmental management. These promise to provide the platform for chemical companies wanting to establish their environmental credibility with a global audience. open-quotes It will be similar to auditing our customers to ISO 9000 close-quote, says the environmental manager for a European chemical firm. open-quote We will only want to deal with people who have got their environmental act together. And we'll be in a better competitive positions close-quote. The International Organization for Standardization (ISO;Geneva) has set up a taskforce to develop an environmental management standard, which is expected to be completed by the mid-1990s. Observers think the ISO standard will draw heavily on the British Standard Institute's (BSI;London) environmental management standard, BS7750, which will likely be the first system adopted in the world. Published last year, BS7750 has been extensively piloted in the UK (CW, Sept. 30, 1992, p. 62) and is now set to be revised before being offically adopted by BSI. The UK's Chemical Industries Association (CIA;London) is anxious to prevent a proliferation of standards, and its report on BS7750 pilot projects calls for an approach integrating quality, environment, and health and safety. But standard setters, including ISO, appear to be moving in the opposite direction. In the US, the American national Standards Institute (ANSI;Washington) has started work on an environmental management standard

  2. Static, Lightweight Includes Resolution for PHP

    NARCIS (Netherlands)

    M.A. Hills (Mark); P. Klint (Paul); J.J. Vinju (Jurgen)

    2014-01-01

    htmlabstractDynamic languages include a number of features that are challenging to model properly in static analysis tools. In PHP, one of these features is the include expression, where an arbitrary expression provides the path of the file to include at runtime. In this paper we present two

  3. Therapy Provider Phase Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Therapy Provider Phase Information dataset is a tool for providers to search by their National Provider Identifier (NPI) number to determine their phase for...

  4. Parent-provider communication during hospitalization.

    Science.gov (United States)

    Fisher, Mark J; Broome, Marion E

    2011-02-01

    Parents and health care providers interact and communicate with each other during a child's hospitalization. The purpose of this study was to compare communication experiences of parents, nurses, and physicians. A unique aspect of this study involved combining three individual data sources into a collective unit of study (triad). Triads involved in the care of three children in the inpatient setting of an urban children's hospital served as the sample for this study (n = 10). Participants were asked semistructured questions during face-to-face interviews. Findings included (a) the importance of providing information by health care providers using a caring and inclusive approach, (b) the benefits of establishing interpersonal connections and nurturing relationships, and (c) the identification of specific behaviors in all members of the triad that contribute to and sustain positively perceived communication. Future research directions examining triadic interactions, communication, and relationships among parents, nurses, and physicians are recommended. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Systems and methods for producing metal clusters; functionalized surfaces; and droplets including solvated metal ions

    Science.gov (United States)

    Cooks, Robert Graham; Li, Anyin; Luo, Qingjie

    2017-08-01

    The invention generally relates to systems and methods for producing metal clusters; functionalized surfaces; and droplets including solvated metal ions. In certain aspects, the invention provides methods that involve providing a metal and a solvent. The methods additionally involve applying voltage to the solvated metal to thereby produce solvent droplets including ions of the metal containing compound, and directing the solvent droplets including the metal ions to a target. In certain embodiments, once at the target, the metal ions can react directly or catalyze reactions.

  6. Direct selling particularities

    OpenAIRE

    Greifová, Daniela

    2009-01-01

    Bachelor thesis is focused on the parcularities of direct selling, self regulation of this industry, multi-level marketing which is the most used sales method in the field of direct selling. The part of the thesis is dedicated to the issue of customer psychology that is very important for achieving success in direct selling. Main goals are to provide readers with the general view of direct selling and analysis of growing possibilities of the industry in the future.

  7. Wounds on Rapanea melanophloeos provide habitat for a large diversity of Ophiostomatales including four new species

    Czech Academy of Sciences Publication Activity Database

    Musvuugwa, T.; de Beer, Z.W.; Duong, T.A.; Dreyer, L. L.; Oberlander, Kenneth; Roets, F.

    2016-01-01

    Roč. 109, č. 6 (2016), s. 877-894 ISSN 0003-6072 Institutional support: RVO:67985939 Keywords : afromonatane forests * insect transmission * Cape floristic region Subject RIV: EF - Botanics Impact factor: 1.795, year: 2016

  8. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-06-06

    ... conformity with all Federal requirements. The Federal government pays its share of medical assistance... policies through some other authority like State law or administrative procedures will be required to... collaboratively to develop policies and implement reporting systems that would complement existing payment...

  9. Directed homology

    DEFF Research Database (Denmark)

    Fahrenberg, Uli

    2004-01-01

    We introduce a new notion of directed homology for semicubical sets. We show that it respects directed homotopy and is functorial, and that it appears to enjoy some good algebraic properties. Our work has applications to higher-dimensional automata.......We introduce a new notion of directed homology for semicubical sets. We show that it respects directed homotopy and is functorial, and that it appears to enjoy some good algebraic properties. Our work has applications to higher-dimensional automata....

  10. Direct Conversion of Energy

    Energy Technology Data Exchange (ETDEWEB)

    Corliss, William R

    1964-01-01

    Topics include: direct versus dynamic energy conversion; laws governing energy conversion; thermoelectricity; thermionic conversion; magnetohydrodynamic conversion; chemical batteries; the fuel cell; solar cells; nuclear batteries; and advanced concepts including ferroelectric conversion and thermomagnetic conversion.

  11. Providers? perspectives on collaboration

    OpenAIRE

    Bruner, Patricia; Waite, Roberta; Davey, Maureen P

    2011-01-01

    Objective: Changes in models of health care are required to better meet the needs of diverse, underserved patient populations. Collaboration among providers is one way to promote accessible, comprehensive and continuous care in healthcare organizations. This paper describes the quantitative findings from two time points that examined providers' views of collaboration among a sample of diverse personnel (e.g. clinical nurses, social workers, dental providers, mental health providers, clerical ...

  12. Selecting Security Technology Providers

    Science.gov (United States)

    Schneider, Tod

    2009-01-01

    The world of security technology holds great promise, but it is fraught with opportunities for expensive missteps and misapplications. The quality of the security technology consultants and system integrators one uses will have a direct bearing on how well his school masters this complex subject. Security technology consultants help determine…

  13. Direct Deposit Applications filed via the Internet - FY 2016 (53rd week)

    Data.gov (United States)

    Social Security Administration — This dataset provides monthly volumes at the national level from federal fiscal year 2016 for Internet Direct Deposit applications. This dataset includes data from...

  14. Providing free autopoweroff plugs

    DEFF Research Database (Denmark)

    Jensen, Carsten Lynge; Hansen, Lars Gårn; Fjordbak, Troels

    2012-01-01

    Experimental evidence of the effect of providing households with cheap energy saving technology is sparse. We present results from a field experiment in which autopoweroff plugs were provided free of charge to randomly selected households. We use propensity score matching to find treatment effects...

  15. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

    Brandl, Kristin; Jaura, Manya; Ørberg Jensen, Peter D.

    In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process of the ...

  16. (including travel dates) Proposed itinerary

    Indian Academy of Sciences (India)

    Ashok

    31 July to 22 August 2012 (including travel dates). Proposed itinerary: Arrival in Bangalore on 1 August. 1-5 August: Bangalore, Karnataka. Suggested institutions: Indian Institute of Science, Bangalore. St Johns Medical College & Hospital, Bangalore. Jawaharlal Nehru Centre, Bangalore. 6-8 August: Chennai, TN.

  17. Malignant lymphomas (including myeloproliferative disorders)

    International Nuclear Information System (INIS)

    Todd, I.D.H.

    1985-01-01

    This chapter deals with the radiotherapy and cytotoxic chemotherapy of the malignant lymphomas. Included within this group are Hodgkin's disease, non-Hodgkin's lymphoma, mycosis fungoides, and chronic lymphatic leukaemia. A further section deals with the myeloproliferative disorders, including granulocytic leukaemia, polycythaemia vera, and primary thrombocythaemia. Excluded are myeloma and reticulum cell sarcoma of bone and acute leukaemia. With regard to Hodgkin's disease, the past 25 years have seen general recognition of the curative potential of radiotherapy, at least in the local stages, and, more recently, awareness of the ability to achieve long-term survival after combination chemotherapy in generalised or in recurrent disease. At the same time the importance of staging has become appreciated and the introduction of procedures such as lymphography, staging laparotomy, and computer tomography (CT) has enormously increased its reliability. Advances have not been so dramatic in the complex group of non-Hodgkins's lymphomas, but are still very real

  18. Radial lean direct injection burner

    Science.gov (United States)

    Khan, Abdul Rafey; Kraemer, Gilbert Otto; Stevenson, Christian Xavier

    2012-09-04

    A burner for use in a gas turbine engine includes a burner tube having an inlet end and an outlet end; a plurality of air passages extending axially in the burner tube configured to convey air flows from the inlet end to the outlet end; a plurality of fuel passages extending axially along the burner tube and spaced around the plurality of air passage configured to convey fuel from the inlet end to the outlet end; and a radial air swirler provided at the outlet end configured to direct the air flows radially toward the outlet end and impart swirl to the air flows. The radial air swirler includes a plurality of vanes to direct and swirl the air flows and an end plate. The end plate includes a plurality of fuel injection holes to inject the fuel radially into the swirling air flows. A method of mixing air and fuel in a burner of a gas turbine is also provided. The burner includes a burner tube including an inlet end, an outlet end, a plurality of axial air passages, and a plurality of axial fuel passages. The method includes introducing an air flow into the air passages at the inlet end; introducing a fuel into fuel passages; swirling the air flow at the outlet end; and radially injecting the fuel into the swirling air flow.

  19. Direct volume estimation without segmentation

    Science.gov (United States)

    Zhen, X.; Wang, Z.; Islam, A.; Bhaduri, M.; Chan, I.; Li, S.

    2015-03-01

    Volume estimation plays an important role in clinical diagnosis. For example, cardiac ventricular volumes including left ventricle (LV) and right ventricle (RV) are important clinical indicators of cardiac functions. Accurate and automatic estimation of the ventricular volumes is essential to the assessment of cardiac functions and diagnosis of heart diseases. Conventional methods are dependent on an intermediate segmentation step which is obtained either manually or automatically. However, manual segmentation is extremely time-consuming, subjective and highly non-reproducible; automatic segmentation is still challenging, computationally expensive, and completely unsolved for the RV. Towards accurate and efficient direct volume estimation, our group has been researching on learning based methods without segmentation by leveraging state-of-the-art machine learning techniques. Our direct estimation methods remove the accessional step of segmentation and can naturally deal with various volume estimation tasks. Moreover, they are extremely flexible to be used for volume estimation of either joint bi-ventricles (LV and RV) or individual LV/RV. We comparatively study the performance of direct methods on cardiac ventricular volume estimation by comparing with segmentation based methods. Experimental results show that direct estimation methods provide more accurate estimation of cardiac ventricular volumes than segmentation based methods. This indicates that direct estimation methods not only provide a convenient and mature clinical tool for cardiac volume estimation but also enables diagnosis of cardiac diseases to be conducted in a more efficient and reliable way.

  20. Including social impacts in LCIA

    DEFF Research Database (Denmark)

    Dreyer, Louise Camilla; Hauschild, Michael Zwicky; Schierbeck, Jens

    2004-01-01

    environmental impacts and, therefore, recommendations based on LCA fail to address both social and economic concerns. This has raised questions about LCA's ability to support sustainable development decisions. In a research project carried out at Brødrene Hartmann A/S and the Technical University of Denmark...... a frameowork for social LCA is currently being developed. The project quantifies social impacts and makes them operational in the traditional LCIA framework by developing measureable indicators. These indicators are selected to provide a meaningful and sufficient overall description of social impacts of all...

  1. Do pastoral care providers recognize nurses as spiritual care providers?

    Science.gov (United States)

    Cavendish, Roberta; Edelman, Maryann; Naradovy, Linda; Bajo, Maryann McPartlan; Perosi, Irene; Lanza, Melissa

    2007-01-01

    This descriptive qualitative study was conducted to explicate pastoral care providers' perceptions of nurses as spiritual providers. Spirituality is especially meaningful in contemporary society as a whole with spiritual care an expectation of hospitalized patients. Spiritual care given by nurses is grounded in nursing's history, inherent in its philosophical framework, and supported by research and professional mandates. In hospitals today, the primary responsibility for the spiritual care of patients resides with pastoral care providers. Collaboration between pastoral care providers and nurses may improve patients' spiritual care outcomes. Before collaboration can occur, it is important to learn whether pastoral care providers recognize nurses as spiritual providers. Guided by qualitative research methods, participants were sought until data saturation occurred. This qualitative study consisted of 8 participants who were experienced, full-time pastoral care providers from general and religious-affiliated hospitals. Data were collected through audiotaped open-ended interviews, a demographic data form, and exploratory questions or probes. The analysis included concurrent data collection, constant examination of conceptual interactions, linkages, and the conditions under which they occurred. Themes emerged: quest, conscious response, and essence of caring. Pastoral care providers perceive nurses as spiritual providers. Few felt comfortable initiating collaboration. Study findings are not generalizable.

  2. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file contains data on characteristics of hospitals and other types of healthcare facilities, including the name and address of the facility and the type of...

  3. Direct RF modulation transmitter

    NARCIS (Netherlands)

    Fukuda, Shuichi; Nauta, Bram

    2013-01-01

    PROBLEM TO BE SOLVED: To provide a direct RF modulation transmitter capable of saving more power consumption. SOLUTION: The direct RF modulation transmitter comprises: a passive mixer circuit 100 which inputs digital baseband data D of 1 bit, inverted data DN, a first RF signal, and a second RF

  4. Advance Directives

    Science.gov (United States)

    ... Types Bladder Cancer Breast Cancer Colorectal Cancer Kidney (Renal Cell) Cancer Leukemia Liver Cancer Lung Cancer Lymphoma ... about advance directives. Two well-known ones are: Aging With Dignity Aging with Dignity is a national ...

  5. Directing Creativity

    DEFF Research Database (Denmark)

    Darsø, Lotte; Ibbotson, Piers

    2008-01-01

    . Like leaders, who are caught in paradoxical situations where they have to manage production and logistics simultaneously with making space for creativity and innovation, theatre directors need to find the delicate balance between on one hand renewal of perceptions, acting and interaction......In this article we argue that leaders facing complex challenges can learn from the arts, specifically that leaders can learn by examining how theatre directors direct creativity through creative constraints. We suggest that perceiving creativity as a boundary phenomenon is helpful for directing it...... and on the other hand getting ready for the opening night. We conclude that the art of directing creativity is linked to developing competencies of conscious presence, attention and vigilance, whereas the craft of directing creativity concerns communication, framing and choice....

  6. Device including a contact detector

    DEFF Research Database (Denmark)

    2011-01-01

    The present invention relates to a probe for determining an electrical property of an area of a surface of a test sample, the probe is intended to be in a specific orientation relative to the test sample. The probe may comprise a supporting body defining a first surface. A plurality of cantilever...... of cantilever arms (12) contacting the surface of the test sample when performing the movement....... arms (12) may extend from the supporting body in co-planar relationship with the first surface. The plurality of cantilever arms (12) may extend substantially parallel to each other and each of the plurality of cantilever arms (12) may include an electrical conductive tip for contacting the area...

  7. Drug delivery device including electrolytic pump

    KAUST Repository

    Foulds, Ian G.

    2016-03-31

    Systems and methods are provided for a drug delivery device and use of the device for drug delivery. In various aspects, the drug delivery device combines a “solid drug in reservoir” (SDR) system with an electrolytic pump. In various aspects an improved electrolytic pump is provided including, in particular, an improved electrolytic pump for use with a drug delivery device, for example an implantable drug delivery device. A catalytic reformer can be incorporated in a periodically pulsed electrolytic pump to provide stable pumping performance and reduced actuation cycle.

  8. Geothermal direct use engineering and design guidebook

    Energy Technology Data Exchange (ETDEWEB)

    Bloomquist, R.G.; Culver, G.; Ellis, P.F.; Higbee, C.; Kindle, C.; Lienau, P.J.; Lunis, B.C.; Rafferty, K.; Stiger, S.; Wright, P.M.

    1989-03-01

    The Geothermal Direct Use Engineering and Design Guidebook is designed to be a comprehensive, thoroughly practical reference guide for engineers and designers of direct heat projects. These projects could include the conversion of geothermal energy into space heating cooling of buildings, district heating, greenhouse heating, aquaculture and industrial processing. The Guidebook is directed at understanding the nature of geothermal resources and the exploration of these resources, fluid sampling techniques, drilling, and completion of geothermal wells through well testing, and reservoir evaluation. It presents information useful to engineers on the specification of equipment including well pumps, piping, heat exchangers, space heating equipment, heat pumps and absorption refrigeration. A compilation of current information about greenhouse, aquaculture and industrial applications is included together with a discussion of engineering cost analysis, regulation requirements, and environmental considerations. The purpose of the Guidebook is to provide an integrated view for the development of direct use projects for which there is a very potential in the United States.

  9. Geothermal direct use engineering and design guidebook

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.J.; Lunis, B.C. (eds.)

    1991-01-01

    The Geothermal Direct Use Engineering and Design Guidebook is designed to be a comprehensive, thoroughly practical reference guide for engineers and designers of direct heat projects. These projects could include the conversion of geothermal energy into space heating and cooling of buildings, district heating, greenhouse heating, aquaculture and industrial processing. The Guidebook is directed at understanding the nature of geothermal resources and the exploration of the resources, fluid sampling techniques, drilling, and completion of geothermal wells through well testing, and reservoir evaluation. It presents information useful to engineers on the specification of equipment including well pumps, piping, heat exchangers, space heating equipment, heat pumps and absorption refrigeration. A compilation of current information about greenhouse aquaculture and industrial applications is included together with a discussion of engineering cost analysis, regulation requirements, and environmental consideration. The purpose of the Guidebook is to provide an integrated view for the development of direct use projects for which there is a very large potential in the United States.

  10. Geothermal direct use engineering and design guidebook

    International Nuclear Information System (INIS)

    Lienau, P.J.; Lunis, B.C.

    1991-01-01

    The Geothermal Direct Use Engineering and Design Guidebook is designed to be a comprehensive, thoroughly practical reference guide for engineers and designers of direct heat projects. These projects could include the conversion of geothermal energy into space heating and cooling of buildings, district heating, greenhouse heating, aquaculture and industrial processing. The Guidebook is directed at understanding the nature of geothermal resources and the exploration of the resources, fluid sampling techniques, drilling, and completion of geothermal wells through well testing, and reservoir evaluation. It presents information useful to engineers on the specification of equipment including well pumps, piping, heat exchangers, space heating equipment, heat pumps and absorption refrigeration. A compilation of current information about greenhouse aquaculture and industrial applications is included together with a discussion of engineering cost analysis, regulation requirements, and environmental consideration. The purpose of the Guidebook is to provide an integrated view for the development of direct use projects for which there is a very large potential in the United States

  11. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it...

  12. care Providers in Ibadan

    African Journals Online (AJOL)

    Perception et pratique de la prophylaxie du paludisme pendant la grossesse chez les dispensateurs des soins de santé à Ibadan ... 2007; ll[2]:69-78). Key Words: malaria in pregnancy, intermittent preventive treatment, malaria control, health care providers ..... changing practice8; incorporating new strategies into routine ...

  13. What HERA may provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes [DESY, Hamburg (Germany); De Roeck, Albert [CERN, Genf (Switzerland); Bartles, Jochen [Univ. Hamburg (DE). Institut fuer Theoretische Physik II] (and others)

    2008-09-15

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. (orig.)

  14. General presentation including new structure

    Science.gov (United States)

    Soons, A.

    2002-12-01

    Electrical, electronic and electro-mechanical components play an essential role in the functional performance, quality, life cycle and costs of space systems. Their standardisation, product specification, development, evaluation, qualification and procurement must be based on a coherent and efficient approach, paying due attention to present and prospective European space policies and must be commensurate with user needs, market developments and technology trends. The European Space Components Coordination (ESCC) is established with the objective of harmonising the efforts concerning the various aspects of EEE space components by ESA. European national and international public space organisations, the component manufacturers and the user industries. The goal of the ESCC is to improve the availability of strategic EEE space components with the required performance and at affordable costs for institutional and commercial space programmes. It is the objective of ESCC to achieve this goal by harmonising the resources and development efforts for space components in the ESA Member States and by providing a single and unified system for the standardisation, product specification, evaluation, qualification and procurement of European EEE space components and for the certification of components and component manufacturers.

  15. Including Students with Visual Impairments: Softball

    Science.gov (United States)

    Brian, Ali; Haegele, Justin A.

    2014-01-01

    Research has shown that while students with visual impairments are likely to be included in general physical education programs, they may not be as active as their typically developing peers. This article provides ideas for equipment modifications and game-like progressions for one popular physical education unit, softball. The purpose of these…

  16. Achieving Provider Engagement

    Science.gov (United States)

    Greenfield, Geva; Pappas, Yannis; Car, Josip; Majeed, Azeem; Harris, Matthew

    2014-01-01

    The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. PMID:25212855

  17. Providing plastic zone extrusion

    Science.gov (United States)

    Manchiraju, Venkata Kiran; Feng, Zhili; David, Stan A.; Yu, Zhenzhen

    2017-04-11

    Plastic zone extrusion may be provided. First, a compressor may generate frictional heat in stock to place the stock in a plastic zone of the stock. Then, a conveyer may receive the stock in its plastic zone from the compressor and transport the stock in its plastic zone from the compressor. Next, a die may receive the stock in its plastic zone from the conveyer and extrude the stock to form a wire.

  18. PROVIDING WOMEN, KEPT MEN

    Science.gov (United States)

    Mojola, Sanyu A

    2014-01-01

    This paper draws on ethnographic and interview based fieldwork to explore accounts of intimate relationships between widowed women and poor young men that emerged in the wake of economic crisis and a devastating HIV epidemic among the Luo ethnic group in Western Kenya. I show how the cooptation of widow inheritance practices in the wake of an overwhelming number of widows as well as economic crisis resulted in widows becoming providing women and poor young men becoming kept men. I illustrate how widows in this setting, by performing a set of practices central to what it meant to be a man in this society – pursuing and providing for their partners - were effectively doing masculinity. I will also show how young men, rather than being feminized by being kept, deployed other sets of practices to prove their masculinity and live in a manner congruent with cultural ideals. I argue that ultimately, women’s practice of masculinity in large part seemed to serve patriarchal ends. It not only facilitated the fulfillment of patriarchal expectations of femininity – to being inherited – but also served, in the end, to provide a material base for young men’s deployment of legitimizing and culturally valued sets of masculine practice. PMID:25489121

  19. Providing value in ambulatory anesthesia.

    Science.gov (United States)

    Fosnot, Caroline D; Fleisher, Lee A; Keogh, John

    2015-12-01

    The purpose of this review is to discuss current practices and changes in the field of ambulatory anesthesia, in both hospital and ambulatory surgery center settings. New trends in ambulatory settings are discussed and a review of the most current and comprehensive guidelines for the care of ambulatory patients with comorbid conditions such as postoperative nausea and vomiting (PONV), obstructive sleep apnea and diabetes mellitus are reviewed. Future direction and challenges to the field are highlighted. Ambulatory anesthesia continues to be in high demand for many reasons; patients and surgeons want their surgical procedures to be swift, involve minimal postoperative pain, have a transient recovery time, and avoid an admission to the hospital. Factors that have made this possible for patients are improved surgical equipment, volatile anesthetic improvement, ultrasound-guided regional techniques, non-narcotic adjuncts for pain control, and the minimization of PONV. The decrease in time spent in a hospital also decreases the risk of wound infection, minimizes missed days from work, and is a socioeconomically favorable model, when possible. Recently proposed strategies which will allow surgeons and anesthesiologists to continue to meet the growing demand for a majority of surgical cases being same-day include pharmacotherapies with less undesirable side-effects, integration of ultrasound-guided regional techniques, and preoperative evaluations in appropriate candidates via a telephone call the night prior to surgery. Multidisciplinary communication amongst caregivers continues to make ambulatory settings efficient, safe, and socioeconomically favorable.It is also important to note the future impact that healthcare reform will have specifically on ambulatory anesthesia. The enactment of the Patient Protection and Affordable Care Act of 2010 will allow 32 million more people to gain access to preventive services that will require anesthesia such as screening

  20. Providing Compassion through Flow

    Directory of Open Access Journals (Sweden)

    Lydia Royeen

    2015-07-01

    Full Text Available Meg Kral, MS, OTR/L, CLT, is the cover artist for the Summer 2015 issue of The Open Journal of Occupational Therapy. Her untitled piece of art is an oil painting and is a re-creation of a photograph taken while on vacation. Meg is currently supervisor of outpatient services at Rush University Medical Center. She is lymphedema certified and has a specific interest in breast cancer lymphedema. Art and occupational therapy serve similar purposes for Meg: both provide a sense of flow. She values the outcomes, whether it is a piece of art or improved functional status

  1. Direct marketing

    Directory of Open Access Journals (Sweden)

    Čičić Muris

    2002-01-01

    Full Text Available Direct Marketing (DM is usually treated as unworthy activity, with actions at the edge of legality and activities minded cheating. Despite obvious problems regarding ethics and privacy threat, DM with its size, importance and role in a concept of integrated marketing communication deserves respect and sufficient analysis and review

  2. Energy providers: customer expectations

    International Nuclear Information System (INIS)

    Pridham, N.F.

    1997-01-01

    The deregulation of the gas and electric power industries, and how it will impact on customer service and pricing rates was discussed. This paper described the present situation, reviewed core competencies, and outlined future expectations. The bottom line is that major energy consumers are very conscious of energy costs and go to great lengths to keep them under control. At the same time, solutions proposed to reduce energy costs must benefit all classes of consumers, be they industrial, commercial, institutional or residential. Deregulation and competition at an accelerated pace is the most likely answer. This may be forced by external forces such as foreign energy providers who are eager to enter the Canadian energy market. It is also likely that the competition and convergence between gas and electricity is just the beginning, and may well be overshadowed by other deregulated industries as they determine their core competencies

  3. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  4. Isolators Including Main Spring Linear Guide Systems

    Science.gov (United States)

    Goold, Ryan (Inventor); Buchele, Paul (Inventor); Hindle, Timothy (Inventor); Ruebsamen, Dale Thomas (Inventor)

    2017-01-01

    Embodiments of isolators, such as three parameter isolators, including a main spring linear guide system are provided. In one embodiment, the isolator includes first and second opposing end portions, a main spring mechanically coupled between the first and second end portions, and a linear guide system extending from the first end portion, across the main spring, and toward the second end portion. The linear guide system expands and contracts in conjunction with deflection of the main spring along the working axis, while restricting displacement and rotation of the main spring along first and second axes orthogonal to the working axis.

  5. Electric Power Monthly, August 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-29

    The Electric Power Monthly (EPM) presents monthly summaries of electric utility statistics at the national, Census division, and State level. The purpose of this publication is to provide energy decisionmakers with accurate and timely information that may be used in forming various perspectives on electric issues that lie ahead. Data includes generation by energy source (coal, oil, gas, hydroelectric, and nuclear); generation by region; consumption of fossil fuels for power generation; sales of electric power, cost data; and unusual occurrences. A glossary is included.

  6. What HERA May Provide?

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hannes; /DESY; De Roeck, Albert; /CERN; Bartels, Jochen; /Hamburg U., Inst. Theor. Phys. II; Behnke, Olaf; Blumlein, Johannes; /DESY; Brodsky, Stanley; /SLAC /Durham U., IPPP; Cooper-Sarkar, Amanda; /Oxford U.; Deak, Michal; /DESY; Devenish, Robin; /Oxford U.; Diehl, Markus; /DESY; Gehrmann, Thomas; /Zurich U.; Grindhammer, Guenter; /Munich, Max Planck Inst.; Gustafson, Gosta; /CERN /Lund U., Dept. Theor. Phys.; Khoze, Valery; /Durham U., IPPP; Knutsson, Albert; /DESY; Klein, Max; /Liverpool U.; Krauss, Frank; /Durham U., IPPP; Kutak, Krzysztof; /DESY; Laenen, Eric; /NIKHEF, Amsterdam; Lonnblad, Leif; /Lund U., Dept. Theor. Phys.; Motyka, Leszek; /Hamburg U., Inst. Theor. Phys. II /Birmingham U. /Southern Methodist U. /DESY /Piemonte Orientale U., Novara /CERN /Paris, LPTHE /Hamburg U. /Penn State U.

    2011-11-10

    More than 100 people participated in a discussion session at the DIS08 workshop on the topic What HERA may provide. A summary of the discussion with a structured outlook and list of desirable measurements and theory calculations is given. The HERA accelerator and the HERA experiments H1, HERMES and ZEUS stopped running in the end of June 2007. This was after 15 years of very successful operation since the first collisions in 1992. A total luminosity of {approx} 500 pb{sup -1} has been accumulated by each of the collider experiments H1 and ZEUS. During the years the increasingly better understood and upgraded detectors and HERA accelerator have contributed significantly to this success. The physics program remains in full swing and plenty of new results were presented at DIS08 which are approaching the anticipated final precision, fulfilling and exceeding the physics plans and the previsions of the upgrade program. Most of the analyses presented at DIS08 were still based on the so called HERA I data sample, i.e. data taken until 2000, before the shutdown for the luminosity upgrade. This sample has an integrated luminosity of {approx} 100 pb{sup -1}, and the four times larger statistics sample from HERA II is still in the process of being analyzed.

  7. Electric power monthly, September 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-17

    The purpose of this report is to provide energy decision makers with accurate and timely information that may be used in forming various perspectives on electric issues. The power plants considered include coal, petroleum, natural gas, hydroelectric, and nuclear power plants. Data are presented for power generation, fuel consumption, fuel receipts and cost, sales of electricity, and unusual occurrences at power plants. Data are compared at the national, Census division, and state levels. 4 figs., 52 tabs. (CK)

  8. Patient ties to ambulatory care providers: the concept of provider loyalty.

    Science.gov (United States)

    Kingstrom, P O

    1983-01-01

    This paper introduces a cognitive measure of provider loyalty. Correlates of provider loyalty are investigated, and results are presented comparing provider loyalty with traditionally used measures of patient ties for predicting interest in and choice of a new health care provider. Implications for planning and marketing new forms of ambulatory care delivery systems are discussed and directions for future research are suggested.

  9. Development of Direct-Use Projects: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Lund, J.

    2011-01-01

    A geothermal direct-use project utilizes a natural resource, a flow of geothermal fluid at elevated temperatures, which is capable of providing heat and/or cooling to buildings, greenhouses, aquaculture ponds, and industrial processes. Geothermal utilization requires matching the varied needs of the user and characteristics of the resource in order to development a successful project. Each application is unique; guidelines are provided for the logical steps required to implement a project. Recommended temperature and flows are suggested for spas and pools, space and district heating, greenhouse and aquaculture pond heating, and industrial applications. Guidelines are provided for selecting the necessary equipment for successfully implementing a direct-use project, including downhole pumps, piping, heat exchangers, and heat convectors. Additionally, the relationship between temperature, flow rate, and the use of heat exchangers to provide heat to a space with hot water or hot air is provided for a number of applications, with suggested 'rules of thumb'.

  10. GGVS, Ordinance on road transport of hazardous materials, latest amendment as of 1993, including the European agreement on international road transport of hazardous materials (ADR). Annexes A and B. Selected directives, Act on Transport of Hazardous Materials, list of materials. 8. rev. ed.

    International Nuclear Information System (INIS)

    Ridder, K.

    1993-01-01

    The publication presents the authentic texts of the: (1) Ordinance on road transport of hazardous materials (GGVS) with the ADR, as of 1993, skeleton ordinance, annexes A and B, reasons underlying the 4th ordinance amending the GGVS, directives for implementation, RS 002, instructions for accident management, RS-006, design approval standards for packaging materials and IBC-R002. (2) Ordinance on exemptions under the GGVS (GGAV). (3) Guiding principles for the training of vehicle drivers. (4) Catalogue of monetary fines under the GGVS, BKatV. (5) Draft version of catalogue of on-the-spot cautionary fines. (6) List of materials. (7) Technical rules TR IBC 003, non-electrical equipment, TRS 003, TRS 004, TRS 005, TRS 006. (HP) [de

  11. Choosing a health care provider.

    Science.gov (United States)

    Harris, Katherine M; Beeuwkes Buntin, Melinda

    2008-05-01

    In a consumer-driven health care model, consumers, armed with information, would select providers based on quality and cost, thus increasing competition. This synthesis examines the availability of quality information and the evidence of how consumers use such information to choose a provider. Key findings include: information is publicly available from multiple sources regarding hospitals, but not individual doctors. Hospital information is predominantly made available online; but this limits awareness and access. Awareness is low overall, but highest among well-educated, healthy people. Even when consumers are aware of the data available, they rarely use it because they do not find it relevant: they do not foresee needing a hospital soon; are happy with their current provider; or did not find information pertinent to their specific health condition or hospital. While there is some evidence that hospitals that do poorly on public quality scorecards lose market share, there is better evidence that the providers themselves react to the quality scores by addressing care problems. Studies consistently show that consumers value health care quality and want information, but instead they rely on input from friends, family and their personal physicians about the quality of providers.

  12. Role of accrediting bodies in providing education leadership in medical education

    Directory of Open Access Journals (Sweden)

    Sam Leinster

    2014-01-01

    Role of accreditation authorities: If accreditation authorities are to provide leadership in medical education they must undertake regular review of their standards. This should be informed by all stakeholders and include experts in medical education. The format of the standards must provide clear direction to medical schools. Accreditation should take place regularly and should result in the production of a publicly accessible report.

  13. Protecting me from my Directive: Ensuring Appropriate Safeguards for Advance Directives in Dementia.

    Science.gov (United States)

    Auckland, Cressida

    2018-02-01

    With one in six people over 80 now suffering from dementia, advance directives provide an important means of empowerment. Upholding directives in the context of dementia, however, raises extra challenges, given the potential for the directive to conflict with an assessment of what is in the person's current best interests. Given the profound harm that tying a person with dementia to their previous wishes can do, it is essential that we have sufficient safeguards in place to ensure that we only uphold such directives where we can be sure they are truly autonomous and are intended to apply to the situation at hand-safeguards which are at present, severely lacking. This article will consider various mechanisms by which safeguards can be built into the legal regime to ensure that the original decision is autonomous, including making it mandatory for the person to undergo a consultation with a healthcare professional, which would involve a contemporaneous capacity assessment. Clinicians must also be confident that the directive applies to the situation at hand. Introducing formalities, including a standardised (though not mandatory) proforma, may help to enhance specificity about when the directive is triggered, and to what treatments it relates, to enable clinicians to better assess the directive's applicability. A national registry for advance directives might also be beneficial. It will be argued that health care professionals will have to play a much greater role in the drafting and registering of advance directives, if we are to feel comfortable in upholding them.

  14. Directional Darwinian Selection in proteins.

    Science.gov (United States)

    McClellan, David A

    2013-01-01

    Molecular evolution is a very active field of research, with several complementary approaches, including dN/dS, HON90, MM01, and others. Each has documented strengths and weaknesses, and no one approach provides a clear picture of how natural selection works at the molecular level. The purpose of this work is to present a simple new method that uses quantitative amino acid properties to identify and characterize directional selection in proteins. Inferred amino acid replacements are viewed through the prism of a single physicochemical property to determine the amount and direction of change caused by each replacement. This allows the calculation of the probability that the mean change in the single property associated with the amino acid replacements is equal to zero (H0: μ = 0; i.e., no net change) using a simple two-tailed t-test. Example data from calanoid and cyclopoid copepod cytochrome oxidase subunit I sequence pairs are presented to demonstrate how directional selection may be linked to major shifts in adaptive zones, and that convergent evolution at the whole organism level may be the result of convergent protein adaptations. Rather than replace previous methods, this new method further complements existing methods to provide a holistic glimpse of how natural selection shapes protein structure and function over evolutionary time.

  15. Future directions of nuclear verification

    International Nuclear Information System (INIS)

    Blix, H.

    1997-01-01

    Future directions of nuclear verification are discussed including the following topics: verification of non-proliferation commitments; practicalities of strengthening safeguards; new tasks in nuclear verification

  16. Project Interface Requirements Process Including Shuttle Lessons Learned

    Science.gov (United States)

    Bauch, Garland T.

    2010-01-01

    Most failures occur at interfaces between organizations and hardware. Processing interface requirements at the start of a project life cycle will reduce the likelihood of costly interface changes/failures later. This can be done by adding Interface Control Documents (ICDs) to the Project top level drawing tree, providing technical direction to the Projects for interface requirements, and by funding the interface requirements function directly from the Project Manager's office. The interface requirements function within the Project Systems Engineering and Integration (SE&I) Office would work in-line with the project element design engineers early in the life cycle to enhance communications and negotiate technical issues between the elements. This function would work as the technical arm of the Project Manager to help ensure that the Project cost, schedule, and risk objectives can be met during the Life Cycle. Some ICD Lessons Learned during the Space Shuttle Program (SSP) Life Cycle will include the use of hardware interface photos in the ICD, progressive life cycle design certification by analysis, test, & operations experience, assigning interface design engineers to Element Interface (EI) and Project technical panels, and linking interface design drawings with project build drawings

  17. Summary and future directions

    Science.gov (United States)

    Janaki R.R. Alavalapati; D. Evan Mercer

    2004-01-01

    This chapter summarizes the main results from the preceding chapters, identifies gaps, and provides direction for fbture economics research on agroforestry systems. Although a common theme throughout the 1990s was that economic research on agroforestry continued to lag the advances made in the bio-physical sciences, the wide range of systems, regions, and techniques...

  18. Future directions.

    Science.gov (United States)

    Lhotska, L; Armstrong, H

    2000-11-01

    Despite progress in promotion and support of breastfeeding over the past decade, the HIV pandemic necessitates new actions based on human rights, such as voluntary and confidential testing and counseling, offering HIV-positive women objective information on the risks and costs of all infant feeding options, and providing appropriate support for their decisions. Implementation of the Baby-Friendly Hospital Initiative and the International Code of Marketing are essential components of a rights-based policy response to HIV and will lessen spillover of replacement feeding among HIV-negative women. Protective effects of nevirapine and exclusive breastfeeding, as well as the listed additional topics, require further research. We have yet to make exclusive breastfeeding easy and common when mothers choose to breastfeed.

  19. Host-Directed Therapies for Tuberculosis.

    Science.gov (United States)

    Tobin, David M

    2015-05-18

    Host-directed therapies are a relatively new and promising approach to treatment of tuberculosis. Modulation of specific host immune pathways, including those that impact inflammation and immunopathology, can limit mycobacterial infection and pathology, both in cell culture and in animal models. This review explores a range of host pathways and drugs, some already approved for clinical use that have the potential to provide new adjunctive therapies for tuberculosis. Drugs targeting host processes may largely avoid the development of bacterial antibiotic resistance, a major public health concern for tuberculosis. However, these drugs may also have generally increased risk for side effects on the host. Understanding the specific mechanisms by which these drugs act and the relationship of these mechanisms to Mycobacterium tuberculosis pathogenesis will be critical in selecting appropriate host-directed therapy. Overall, these host-directed compounds provide a novel strategy for antituberculosis therapy. Copyright © 2015 Cold Spring Harbor Laboratory Press; all rights reserved.

  20. Future directions for QCD

    International Nuclear Information System (INIS)

    Bjorken, J.D.

    1996-10-01

    New directions for exploring QCD at future high-energy colliders are sketched. These include jets within jets. BFKL dynamics, soft and hard diffraction, searches for disoriented chiral condensate, and doing a better job on minimum bias physics. The new experimental opportunities include electron-ion collisions at HERA, a new collider detector at the C0 region of the TeVatron, and the FELIX initiative at the LHC

  1. Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review.

    Science.gov (United States)

    Luu, Ngoc-Phuong; Pitts, Samantha; Petty, Brent; Sawyer, Melinda D; Dennison-Himmelfarb, Cheryl; Boonyasai, Romsai Tony; Maruthur, Nisa M

    2016-04-01

    Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.

  2. Effect of Including Extruded, Rolled or Ground Corn in Dairy Cow Diets Based on Direct Cut Grass Silage Efecto de la Inclusión de Maíz Extruido, Rolado o Molido en Dietas de Vacas Lecheras Basadas en Ensilaje de Pradera de Corte Directo

    Directory of Open Access Journals (Sweden)

    Christian Alvarado G

    2009-09-01

    Full Text Available A study was conducted to determine the effect of corn (Zea mays L. grain processing on intake, digestibility of nutrients and milk production and composition. The effect of extrusion on nutrient digestibility was evaluated in trial 1, using ground corn as a control. In trial 2, the effect of extrusion on intake was evaluated, comparing extruded corn of two densities (357 and 308 g L-1 with rolled corn (507 g L-1 as a control. In trial 3, the effects of extrusion on milk production, digestibility and intake were evaluated; using steam rolled corn and ground corn as controls. No effects on dry matter and metabolizable energy intakes due to differences in the extruded corn grains were observed. Digestibility of dry matter, organic matter, crude protein, gross energy and neutral detergent fiber did not differ among treatments, although a greater digestibility of non-fibrous carbohydrates was observed. Higher milk production was obtained in treatments including extruded and steam rolled corn (21.4 and 21.6 L d-1, compared to ground corn (20.5 L d-1 but differences disappeared when standardizing for fat content. Milk composition was not affected by treatments. Daily protein production was greater (P Se estudiaron los efectos del procesamiento del grano de maíz (Zea mays L. en el consumo y digestibilidad de la dieta, y en la composición y producción láctea. En el ensayo 1, se evaluó el efecto de la extrusión en la digestibilidad de la dieta utilizando maíz molido como control. En el ensayo 2, se evaluó el efecto de la extrusión en el consumo comparando maíz extruido de dos densidades (357 y 308 g L-1 usando maíz rolado (507 gL-1 como control. En el ensayo 3, se evaluó el efecto de la extrusión sobre la producción de leche, digestibilidad y consumo, empleando maíz rolado y maíz molido como controles. No se observaron diferencias en consumo de materia seca (MS ni de energía metabolizable atribuibles a diferencias de densidad del ma

  3. Education Program on Fossil Resources Including Coal

    Science.gov (United States)

    Usami, Masahiro

    Fossil fuels including coal play a key role as crucial energies in contributing to economic development in Asia. On the other hand, its limited quantity and the environmental problems causing from its usage have become a serious global issue and a countermeasure to solve such problems is very much demanded. Along with the pursuit of sustainable development, environmentally-friendly use of highly efficient fossil resources should be therefore, accompanied. Kyushu-university‧s sophisticated research through long years of accumulated experience on the fossil resources and environmental sectors together with the advanced large-scale commercial and empirical equipments will enable us to foster cooperative research and provide internship program for the future researchers. Then, this program is executed as a consignment business from the Ministry of Economy, Trade and Industry from 2007 fiscal year to 2009 fiscal year. The lecture that uses the textbooks developed by this program is scheduled to be started a course in fiscal year 2010.

  4. AMS at the ANU including biomedical applications

    International Nuclear Information System (INIS)

    Fifield, L.K.; Allan, G.L.; Cresswell, R.G.; Ophel, T.R.; King, S.J.; Day, J.P.

    1993-01-01

    An extensive accelerator mass spectrometry program has been conducted on the 14UD accelerator at the Australian National University since 1986. In the two years since the previous conference, the research program has expanded significantly to include biomedical applications of 26 Al and studies of landform evolution using isotopes produced in situ in surface rocks by cosmic ray bombardment. The system is now used for the measurement of 10 Be, 14 C, 26 Al, 36 Cl, 59 Ni and 129 I, and research is being undertaken in hydrology, environmental geochemistry, archaeology and biomedicine. On the technical side, a new test system has permitted the successful off-line development of a high-intensity ion source. A new injection line to the 14UD has been established and the new source is now in position and providing beams to the accelerator. 4 refs

  5. AMS at the ANU including biomedical applications

    Energy Technology Data Exchange (ETDEWEB)

    Fifield, L.K.; Allan, G.L.; Cresswell, R.G.; Ophel, T.R. [Australian National Univ., Canberra, ACT (Australia); King, S.J.; Day, J.P. [Manchester Univ. (United Kingdom). Dept. of Chemistry

    1993-12-31

    An extensive accelerator mass spectrometry program has been conducted on the 14UD accelerator at the Australian National University since 1986. In the two years since the previous conference, the research program has expanded significantly to include biomedical applications of {sup 26}Al and studies of landform evolution using isotopes produced in situ in surface rocks by cosmic ray bombardment. The system is now used for the measurement of {sup 10}Be, {sup 14}C, {sup 26}Al, {sup 36}Cl, {sup 59}Ni and {sup 129}I, and research is being undertaken in hydrology, environmental geochemistry, archaeology and biomedicine. On the technical side, a new test system has permitted the successful off-line development of a high-intensity ion source. A new injection line to the 14UD has been established and the new source is now in position and providing beams to the accelerator. 4 refs.

  6. Observation of directional storybook reading influences young children's counting direction.

    Science.gov (United States)

    Göbel, Silke M; McCrink, Koleen; Fischer, Martin H; Shaki, Samuel

    2018-02-01

    Even before formal schooling, children map numbers onto space in a directional manner. The origin of this preliterate spatial-numerical association is still debated. We investigated the role of enculturation for shaping the directionality of the association between numbers and space, focusing on counting behavior in 3- to 5-year-old preliterate children. Two studies provide evidence that, after observing reading from storybooks (left-to-right or right-to-left reading) children change their counting direction in line with the direction of observed reading. Just observing visuospatial directional movements had no such effect on counting direction. Complementarily, we document that book illustrations, prevalent in children's cultures, exhibit directionality that conforms to the direction of a culture's written language. We propose that shared book reading activates spatiotemporal representations of order in young children, which in turn affect their spatial representation of numbers. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Providing cleaner air to Canadians

    International Nuclear Information System (INIS)

    2001-02-01

    This booklet is designed to explain salient aspects of the Ozone Annex, negotiated and signed recently by Canada and the United States, in a joint effort to improve air quality in North America. By significantly reducing the transboundary flows of air pollutants that cause smog, the Ozone Annex will benefit some 16 million people in central and eastern Canada and provide an example for a future round of negotiations to address concerns of the millions of Canadians and Americans who live in the border area between British Columbia and Washington State. The brochure provide summaries of the Canadian and American commitments, focusing on transportation, monitoring and reporting. The Ozone Annex complements other air quality initiatives by the Government of Canada enacted under the Environmental Protection Act, 1999. These measures include regulations to reduce sulphur content to 30 parts per million by Jan 1, 2005; proposing to restrict toxic particulate matter (PM) to less than 10 microns; establishing daily smog forecasts in the Maritimes and committing to a national program built upon existing smog advisories and forecasts in Quebec, Ontario and British Columbia; and investing in more clean air research through the newly created Canadian Foundation for Climate and Atmospheric Sciences

  8. Personalized direct marketing using digital publishing

    Science.gov (United States)

    Kutty, Cheeniyil L.; Prabhakaran, Jayasree K.

    2006-02-01

    In today's cost-conscious business climate, marketing and customer service decision makers are increasingly concerned with how to increase customer response and retention rates. Companies spend large amounts of money on Customer Relationship Management (CRM) solutions and data acquisition but they don't know how to use the information stored in these systems to improve the effectiveness of their direct marketing campaigns. By leveraging the customer information they already have, companies can create personalized, printed direct mail programs that generate high response rates, greater returns, and stronger customer loyalty, while gaining a significant edge over their competitors. To reach the promised land of one-to-one direct marketing (personalized direct marketing - PDM), companies need an end-to-end solution for creating, managing, printing, and distributing personalized direct mail "on demand." Having access to digital printing is just one piece of the solution. A more complete approach includes leveraging personalization technology into a useful direct marketing tool that provides true one-to-one marketing, allowing variable images and text in a personalized direct mail. This paper discusses integration of CRM with a Print-on-Demand solution so as to create truly personalized printed marketing campaigns for one or many individuals based on the profile information, preferences and purchase history stored in the CRM.

  9. Considerations When Including Students with Disabilities in Test Security Policies. NCEO Policy Directions. Number 23

    Science.gov (United States)

    Lazarus, Sheryl; Thurlow, Martha

    2015-01-01

    Sound test security policies and procedures are needed to ensure test security and confidentiality, and to help prevent cheating. In this era when cheating on tests draws regular media attention, there is a need for thoughtful consideration of the ways in which possible test security measures may affect accessibility for some students with…

  10. Directed network modules

    International Nuclear Information System (INIS)

    Palla, Gergely; Farkas, Illes J; Pollner, Peter; Derenyi, Imre; Vicsek, Tamas

    2007-01-01

    A search technique locating network modules, i.e. internally densely connected groups of nodes in directed networks is introduced by extending the clique percolation method originally proposed for undirected networks. After giving a suitable definition for directed modules we investigate their percolation transition in the Erdos-Renyi graph both analytically and numerically. We also analyse four real-world directed networks, including Google's own web-pages, an email network, a word association graph and the transcriptional regulatory network of the yeast Saccharomyces cerevisiae. The obtained directed modules are validated by additional information available for the nodes. We find that directed modules of real-world graphs inherently overlap and the investigated networks can be classified into two major groups in terms of the overlaps between the modules. Accordingly, in the word-association network and Google's web-pages, overlaps are likely to contain in-hubs, whereas the modules in the email and transcriptional regulatory network tend to overlap via out-hubs

  11. The direct manipulation shell

    International Nuclear Information System (INIS)

    Allen, M.E.; Christiansen, M.

    1992-01-01

    Accelerator controls systems provide parameter display pages which allow the operator to monitor and manipulate selected control points in the system. Display pages are generally implemented as either hand-crafted, purpose-built programs; or by using a specialized display page layout tool. These two methods of display page development exhibit the classic trade-off between functionality vs. ease of implementation. In the Direct Manipulation Shell we approach the process of developing a display page in a manifestly object-oriented manner. This is done by providing a general framework for interactively instantiating and manipulating display objects. (author)

  12. SEEPAGE MODEL FOR PA INCLUDING DRIFT COLLAPSE

    International Nuclear Information System (INIS)

    C. Tsang

    2004-01-01

    The purpose of this report is to document the predictions and analyses performed using the seepage model for performance assessment (SMPA) for both the Topopah Spring middle nonlithophysal (Tptpmn) and lower lithophysal (Tptpll) lithostratigraphic units at Yucca Mountain, Nevada. Look-up tables of seepage flow rates into a drift (and their uncertainty) are generated by performing numerical simulations with the seepage model for many combinations of the three most important seepage-relevant parameters: the fracture permeability, the capillary-strength parameter 1/a, and the percolation flux. The percolation flux values chosen take into account flow focusing effects, which are evaluated based on a flow-focusing model. Moreover, multiple realizations of the underlying stochastic permeability field are conducted. Selected sensitivity studies are performed, including the effects of an alternative drift geometry representing a partially collapsed drift from an independent drift-degradation analysis (BSC 2004 [DIRS 166107]). The intended purpose of the seepage model is to provide results of drift-scale seepage rates under a series of parameters and scenarios in support of the Total System Performance Assessment for License Application (TSPA-LA). The SMPA is intended for the evaluation of drift-scale seepage rates under the full range of parameter values for three parameters found to be key (fracture permeability, the van Genuchten 1/a parameter, and percolation flux) and drift degradation shape scenarios in support of the TSPA-LA during the period of compliance for postclosure performance [Technical Work Plan for: Performance Assessment Unsaturated Zone (BSC 2002 [DIRS 160819], Section I-4-2-1)]. The flow-focusing model in the Topopah Spring welded (TSw) unit is intended to provide an estimate of flow focusing factors (FFFs) that (1) bridge the gap between the mountain-scale and drift-scale models, and (2) account for variability in local percolation flux due to

  13. Determinants of patient loyalty to healthcare providers: An integrative review.

    Science.gov (United States)

    Zhou, Wei-Jiao; Wan, Qiao-Qin; Liu, Cong-Ying; Feng, Xiao-Lin; Shang, Shao-Mei

    2017-08-01

    Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors. PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched. Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included. Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles. Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty. This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  14. Including gauge corrections to thermal leptogenesis

    International Nuclear Information System (INIS)

    Huetig, Janine

    2013-01-01

    This thesis provides the first approach of a systematic inclusion of gauge corrections to leading order to the ansatz of thermal leptogenesis. We have derived a complete expression for the integrated lepton number matrix including all resummations needed. For this purpose, a new class of diagram has been invented, namely the cylindrical diagram, which allows diverse investigations into the topic of leptogenesis such as the case of resonant leptogenesis. After a brief introduction of the topic of the baryon asymmetry in the universe and a discussion of its most promising solutions as well as their advantages and disadvantages, we have presented our framework of thermal leptogenesis. An effective model was described as well as the associated Feynman rules. The basis for using nonequilibrium quantum field theory has been built in chapter 3. At first, the main definitions have been presented for equilibrium thermal field theory, afterwards we have discussed the Kadanoff-Baym equations for systems out of equilibrium using the example of the Majorana neutrino. The equations have also been solved in the context of leptogenesis in chapter 4. Since gauge corrections play a crucial role throughout this thesis, we have also repeated the naive ansatz by replacing the free equilibrium propagator by propagators including thermal damping rates due to the Standard Model damping widths for lepton and Higgs fields. It is shown that this leads to a comparable result to the solutions of the Boltzmann equations for thermal leptogenesis. Thus it becomes obvious that Standard Model corrections are not negligible for thermal leptogenesis and therefore need to be included systematically from first principles. In order to achieve this we have started discussing the calculation of ladder rung diagrams for Majorana neutrinos using the HTL and the CTL approach in chapter 5. All gauge corrections are included in this framework and thus it has become the basis for the following considerations

  15. Direct photon production and PDF fits reloaded

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, John M.; Rojo, Juan; Slade, Emma; Williams, Ciaran

    2018-02-08

    Direct photon production in hadronic collisions provides a handle on the gluon PDF by means of the QCD Compton scattering process. In this work we revisit the impact of direct photon production on a global PDF analysis, motivated by the recent availability of the next-to-next-to-leading (NNLO) calculation for this process. We demonstrate that the inclusion of NNLO QCD and leading-logarithmic electroweak corrections leads to a good quantitative agreement with the ATLAS measurements at 8 TeV and 13 TeV, except for the most forward rapidity region in the former case. By including the ATLAS 8 TeV direct photon production data in the NNPDF3.1 NNLO global analysis, we assess its impact on the medium-x gluon. We also study the constraining power of the direct photon production measurements on PDF fits based on different datasets, in particular on the NNPDF3.1 no-LHC and collider-only fits. We also present updated NNLO theoretical predictions for direct photon production at 13 TeV that include the constraints from the 8 TeV measurements.

  16. Medicare Provider Utilization and Payment Data - Inpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...

  17. VT Wireless Internet Service Providers 2007

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The VT Wireless Internet Service Provider (ISP) dataset (WISP2007) includes polygons depicting the extent of Vermont's WISP broadband system as of...

  18. Nursing Home Provider Perceptions of Telemedicine for Providing Specialty Consults.

    Science.gov (United States)

    Driessen, Julia; Chang, Woody; Patel, Palak; Wright, Rollin M; Ernst, Kambria; Handler, Steven M

    2018-01-02

    Nursing homes (NHs) provide care to a complex patient population and face the ongoing challenge of meeting resident needs for specialty care. A NH telemedicine care model could improve access to remote specialty providers. Little is known about provider interest in telemedicine for specialty consults in the NH setting. The goal of this study was to survey a national sample of NH physicians and advanced practice providers to document their views on telemedicine for providing specialty consults in the NH. We surveyed physician and advanced practice providers who attended the 2016 AMDA-The Society for Post-Acute and Long-Term Care Medicine Annual Conference about their likelihood of referral to and perceptions of a telemedicine program for providing specialty consults in the NH. We received surveys from 524 of the 1,274 conference attendees for a 41.1% response rate. Respondents expressed confidence in the ability of telemedicine to fill existing service gaps and provide appropriate, timelier care. Providers showed the highest level of interest in telemedicine for dermatology, geriatric psychiatry, and infectious disease. Only 13% of respondents indicated that telemedicine was available for use in one of their facilities. There appears to be unmet demand for telemedicine in NHs for providing specialty consults to residents. The responses of NH providers suggest support for the concept of telemedicine as a modality of care that can be used to offer specialty consults to NH residents.

  19. Approximate von Neumann entropy for directed graphs.

    Science.gov (United States)

    Ye, Cheng; Wilson, Richard C; Comin, César H; Costa, Luciano da F; Hancock, Edwin R

    2014-05-01

    In this paper, we develop an entropy measure for assessing the structural complexity of directed graphs. Although there are many existing alternative measures for quantifying the structural properties of undirected graphs, there are relatively few corresponding measures for directed graphs. To fill this gap in the literature, we explore an alternative technique that is applicable to directed graphs. We commence by using Chung's generalization of the Laplacian of a directed graph to extend the computation of von Neumann entropy from undirected to directed graphs. We provide a simplified form of the entropy which can be expressed in terms of simple node in-degree and out-degree statistics. Moreover, we find approximate forms of the von Neumann entropy that apply to both weakly and strongly directed graphs, and that can be used to characterize network structure. We illustrate the usefulness of these simplified entropy forms defined in this paper on both artificial and real-world data sets, including structures from protein databases and high energy physics theory citation networks.

  20. Directional wave measurements and modelling

    Digital Repository Service at National Institute of Oceanography (India)

    Anand, N.M.; Nayak, B.U.; Bhat, S.S.; SanilKumar, V.

    -dimensional spectra and sech@u2@@ (beta theta) spreading function seem to provide a better estimate of the directional energy distribution for the monsoon conditions. While non-linear wave-wave interaction seems to be the major governing factor in the directional...

  1. New directions in information organization

    CERN Document Server

    Park, Jung-ran; Spink, Amanda

    2013-01-01

    New Directions in Information Organization, co-edited by Dr. Jung-ran Park and Dr. Lynne Howarth seeks to provide an overview and understanding of the future directions, leading edge theories and models for research and practice in information organization.

  2. An Integrated Biochemistry Laboratory, Including Molecular Modeling

    Science.gov (United States)

    Hall, Adele J. Wolfson Mona L.; Branham, Thomas R.

    1996-11-01

    appropriate final project, since by then the students have an appreciation for the complexities of dealing with proteins and should be capable of planning an extension of the project. The students by this point are familiar with the structure of hen egg-white lysozyme (1). The structure of the corresponding enzyme from bacteriophage T4 has also been established (10) and rational site-directed mutagenesis has been carried out to answer specific questions about the factors that affect protein stability (11). The relationship between the two lysozymes can provide a starting point for the students' manipulations of the enzyme from hen egg white, especially since there are many amino acids conserved in the two structures (12). Many mutations for the hen enzyme have also been described (13), and students are expected to carry out literature searches beyond the references supplied. The students examine structure - function relationships and decide on changes they would like to make in the lysozyme molecule, based on energy calculations and the scientific literature describing previous mutations in this and similar proteins. Several potential mutation sites are illustrated in Figure 2. Figure 2.The active site of hen egg-white lysozyme. The back-bone structure of lysozyme is illustrated as a ribbon model, with side-chains for tryptophan 62, 63, and 108 as stick models. Atomic coordinates for lysozyme were obtained from the Protein Data Bank. The molecule was displayed and manipulated using Quanta (MSI) on an Iris Indigo Workstation (Silicon Graphics). The active site of the enzyme is depicted, with side-chains of three tryptophan residues indicated. These residues have been implicated in lysozyme's mechanism of action, although not in actual catalysis. Tryptophan residues 62 and 63 participate in hydrogen bonding to substrate, and steric hindrance with Trp 108 has been thought to induce conformational strain in the substrate, favoring the transition state (reviewed in ref 13). In

  3. Including Curriculum Content on Lesbian and Gay Issues.

    Science.gov (United States)

    Newman, Bernie S.

    1989-01-01

    A rationale for requiring content on gay and lesbian issues in the social work curriculum, to decrease homophobic attitudes and prepare students to provide effective practice, is presented. Methods and resources for incorporating lesbian and gay issues in human behavior, direct practice, policy, community organization, and research courses are…

  4. Piezo pump and pressurized circuit provided therewith

    NARCIS (Netherlands)

    Van Es, Johannes; Wits, Wessel Willems

    2015-01-01

    A piezo pump for use in a pressurized circuit includes a pump chamber with an inlet provided with a one way inlet valve, for connection to a feeding line of the pressurized circuit and an outlet provided with a one way outlet valve, for connection to a discharge line of the pressurized circuit and a

  5. Providing Continuing Education for International Nurses.

    Science.gov (United States)

    Case, Debra L

    2015-10-01

    In an increasingly globalized world, providing continuing education (CE) for nurses is becoming a more common opportunity for U.S. educators. It is important for educators to provide CE programs in a culturally competent and sensitive environment. The challenges involved include effective communication, appropriate teaching methodologies, contextually appropriate content, and awareness of cultural-specific needs and customs. Copyright 2015, SLACK Incorporated.

  6. Advanced directives: open issues

    Directory of Open Access Journals (Sweden)

    Gabriella Negrini

    2013-05-01

    Full Text Available BACKGROUND In Italy Advanced directives have not been regulated by law yet. Moreover, there is a confusion of concepts: advanced directives, refusal of treatment, medical futility and euthanasia are not synonymous.DISCUSSION The following aspects are then discussed: object of directives; elapse of time between their expression and their application; knowledge of the directives and their obligatory nature. The refusal of a treatment that can save a person’s life is a critical subject. There are different ethical points of view: according to lay ethics, the patient’s self-determination prevails; the religious viewpoint, instead, says that life is a gift which we cannot dispose of. In any case, the patient will be confronted with the professional autonomy of the doctor. Should the doctor save a patient’s life in any case or should he achieve best clinical practice, in respect of his will? The doctor should interpret the patient’s will but with caution and judgment. An exemption from responsibility should be provided by law for doctors who respect patient’s living will.

  7. Would it provide Free Education?

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Would it provide Free Education? Would it provide Free Education? Would it provide Compulsory Education? Would it guarantee education of equitable quality? Would it prevent discrimination? Would it stop schools that promote inequality & discrimination? NO! NO!

  8. Home Care Providers to the Rescue

    DEFF Research Database (Denmark)

    Hansen, Steen M; Brøndum, Stig; Thomas, Grethe

    2015-01-01

    and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. CONCLUSION: Home care...... providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival....

  9. Launch Lock Assemblies Including Axial Gap Amplification Devices and Spacecraft Isolation Systems Including the Same

    Science.gov (United States)

    Barber, Tim Daniel (Inventor); Hindle, Timothy (Inventor); Young, Ken (Inventor); Davis, Torey (Inventor)

    2014-01-01

    Embodiments of a launch lock assembly are provided, as are embodiments of a spacecraft isolation system including one or more launch lock assemblies. In one embodiment, the launch lock assembly includes first and second mount pieces, a releasable clamp device, and an axial gap amplification device. The releasable clamp device normally maintains the first and second mount pieces in clamped engagement; and, when actuated, releases the first and second mount pieces from clamped engagement to allow relative axial motion there between. The axial gap amplification device normally residing in a blocking position wherein the gap amplification device obstructs relative axial motion between the first and second mount pieces. The axial gap amplification device moves into a non-blocking position when the first and second mount pieces are released from clamped engagement to increase the range of axial motion between the first and second mount pieces.

  10. Information for Teachers (Including Classroom Activities), Skylab Student Project.

    Science.gov (United States)

    National Aeronautics and Space Administration, Washington, DC.

    This program is intended to directly involve the educational community in space experiments, many of which can be related to existing curricula. Included in this first packet are: 1) a brief description of the Skylab Program and the National Science Teachers Association-National Aeronautics and Space Administration (NSTA-NASA) Skylab Student…

  11. The Case for Strategies that Include Men

    African Journals Online (AJOL)

    five years has identified the direct and indirect medical causes of maternal mortality in developing countries. .... riage, the review notes that short-term strategies to improve maternal health outcomes must also take .... health promotion and outreach teams.?” This same review also notes that ensuring the availability of.

  12. Direct cooled power electronics substrate

    Science.gov (United States)

    Wiles, Randy H [Powell, TN; Wereszczak, Andrew A [Oak Ridge, TN; Ayers, Curtis W [Kingston, TN; Lowe, Kirk T [Knoxville, TN

    2010-09-14

    The disclosure describes directly cooling a three-dimensional, direct metallization (DM) layer in a power electronics device. To enable sufficient cooling, coolant flow channels are formed within the ceramic substrate. The direct metallization layer (typically copper) may be bonded to the ceramic substrate, and semiconductor chips (such as IGBT and diodes) may be soldered or sintered onto the direct metallization layer to form a power electronics module. Multiple modules may be attached to cooling headers that provide in-flow and out-flow of coolant through the channels in the ceramic substrate. The modules and cooling header assembly are preferably sized to fit inside the core of a toroidal shaped capacitor.

  13. Article Including Environmental Barrier Coating System

    Science.gov (United States)

    Lee, Kang N. (Inventor)

    2015-01-01

    An enhanced environmental barrier coating for a silicon containing substrate. The enhanced barrier coating may include a bond coat doped with at least one of an alkali metal oxide and an alkali earth metal oxide. The enhanced barrier coating may include a composite mullite bond coat including BSAS and another distinct second phase oxide applied over said surface.

  14. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  15. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; Zwan, J.M.V.D.; Izarzugaza, I.; Jaal, J.; Treasure, T.; Foschi, R.; Ricardi, U.; Groen, H.; Tavilla, A.; Ardanaz, E.

    2012-01-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  16. Direct dating of human fossils.

    Science.gov (United States)

    Grün, Rainer

    2006-01-01

    The methods that can be used for the direct dating of human remains comprise of radiocarbon, U-series, electron spin resonance (ESR), and amino acid racemization (AAR). This review gives an introduction to these methods in the context of dating human bones and teeth. Recent advances in ultrafiltration techniques have expanded the dating range of radiocarbon. It now seems feasible to reliably date bones up to 55,000 years. New developments in laser ablation mass spectrometry permit the in situ analysis of U-series isotopes, thus providing a rapid and virtually non-destructive dating method back to about 300,000 years. This is of particular importance when used in conjunction with non-destructive ESR analysis. New approaches in AAR analysis may lead to a renaissance of this method. The potential and present limitations of these direct dating techniques are discussed for sites relevant to the reconstruction of modern human evolution, including Florisbad, Border Cave, Tabun, Skhul, Qafzeh, Vindija, Banyoles, and Lake Mungo. (c) 2006 Wiley-Liss, Inc.

  17. Direct thermal neutron capture

    International Nuclear Information System (INIS)

    Raman, S.; Kahane, S.; Lynn, J.E.

    1987-01-01

    We discuss the direct-capture theory pertaining to primary electric dipole (E1) transitions following slow-neutron capture. For light nuclides that we have studied (including 9 Be, 12 C, 13 C, 24 Mg, 25 Mg, 26 Mg, 32 S, 33 S, 34 S, 40 Ca, and 44 Ca), estimates of direct-capture cross sections using optical-model potentials with physically realistic parameters, are in reasonable agreement with the data. Minor disagreements that exist are consistent with extrapolations to light nuclides of generally accepted formulations of compound-nucleus capture. We also discuss the channel-capture approximation which is, in general, a good representation of these cross sections in heavier nuclei particularly if the scattering lengths are not different from the corresponding potential radii. We also draw attention to cases where the use of this formula leads to inaccurate predictions. 9 refs., 1 fig., 2 tab

  18. Direction sensitive neutron detector

    Science.gov (United States)

    Ahlen, Steven; Fisher, Peter; Dujmic, Denis; Wellenstein, Hermann F.; Inglis, Andrew

    2017-01-31

    A neutron detector includes a pressure vessel, an electrically conductive field cage assembly within the pressure vessel and an imaging subsystem. A pressurized gas mixture of CF.sub.4, .sup.3He and .sup.4He at respective partial pressures is used. The field cage establishes a relatively large drift region of low field strength, in which ionization electrons generated by neutron-He interactions are directed toward a substantially smaller amplification region of substantially higher field strength in which the ionization electrons undergo avalanche multiplication resulting in scintillation of the CF.sub.4 along scintillation tracks. The imaging system generates two-dimensional images of the scintillation patterns and employs track-finding to identify tracks and deduce the rate and direction of incident neutrons. One or more photo-multiplier tubes record the time-profile of the scintillation tracks permitting the determination of the third coordinate.

  19. Diabetic Eye Screening: Knowledge and Perspectives from Providers and Patients.

    Science.gov (United States)

    Liu, Yao; Swearingen, Rebecca

    2017-08-31

    Diabetic retinopathy remains the leading cause of blindness among working-age US adults even though timely screening and treatment prevent 90% of blindness. We summarize current knowledge and perspectives to better understand why diabetic eye screening rates remain low and future directions towards preventing blindness from diabetes. Significant advancements in the past 10 years include primary care and patient-oriented interventions as well as the use of teleophthalmology. In England, diabetic eye disease is no longer the leading cause of certifiable blindness following the implementation of a national teleophthalmology program for diabetic retinopathy. Multiple workflow and systems-level barriers affect providers. Patient barriers include a limited understanding of screening and lack of access to care. Interventions have been developed, but new barriers exist towards sustaining their impact. More research is needed to identify and implement the best practices to increase diabetic eye screening rates long-term.

  20. The Providence of Associated Minds

    DEFF Research Database (Denmark)

    Tateo, Luca

    2015-01-01

    , for instance, by Wilhelm Wundt and Carlo Cattaneo. The intellectual project that Vico pursued all his life was to develop a specific theory and method to account for the history of human development of civilization as well as to the full range of human products, arts, law, customs, language, institutions, etc....... Besides, he developed several concepts—such as imagination, common sense, verum factum principle, embodiment, poetic logic, imaginative universals, genetic principle, etc.—that directly questioned the mechanistic and reductionist view of mental processes. For these reasons, it is worth rediscovering today...... Giambattista Vico as a fundamental source of ideas that could contribute to the development of new reflections and directions in psychological science....

  1. AngularJS directives

    CERN Document Server

    Vanston, Alex

    2013-01-01

    This book uses a practical, step-by-step approach, starting with how to build directives from the ground up before moving on to creating web applications comprised of multiple modules all working together to provide the best user experience possible.This book is intended for intermediate JavaScript developers who are looking to enhance their understanding of single-page web application development with a focus on AngularJS and the JavaScript MVC frameworks.It is expected that readers will understand basic JavaScript patterns and idioms and can recognize JSON formatted data.

  2. Do dogs provide information helpfully?

    OpenAIRE

    Piotti, Patrizia; Kaminski, Juliane

    2016-01-01

    Dogs are particularly skilful during communicative interactions with humans. Dogs' abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. Howeve...

  3. Babesiosis for Health Care Providers

    Centers for Disease Control (CDC) Podcasts

    2012-04-25

    This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages.  Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria.   Date Released: 4/25/2012.

  4. Perspectives of addiction treatment providers

    African Journals Online (AJOL)

    Background. General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector. Objectives. To investigate the ...

  5. Incentives and provider payment methods.

    Science.gov (United States)

    Barnum, H; Kutzin, J; Saxenian, H

    1995-01-01

    The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

  6. Composite Pressure Vessel Including Crack Arresting Barrier

    Science.gov (United States)

    DeLay, Thomas K. (Inventor)

    2013-01-01

    A pressure vessel includes a ported fitting having an annular flange formed on an end thereof and a tank that envelopes the annular flange. A crack arresting barrier is bonded to and forming a lining of the tank within the outer surface thereof. The crack arresting barrier includes a cured resin having a post-curing ductility rating of at least approximately 60% through the cured resin, and further includes randomly-oriented fibers positioned in and throughout the cured resin.

  7. Including Organizational Cultural Parameters in Work Processes

    National Research Council Canada - National Science Library

    Handley, Holly A; Heacox, Nancy J

    2004-01-01

    .... In order to represent the organizational impact on the work process, five organizational cultural parameters were identified and included in an algorithm for modeling and simulation of cultural...

  8. Haemophilus influenzae Disease (Including Hib) Symptoms

    Science.gov (United States)

    ... Links Global Hib Vaccination Hib Vaccination Meningitis Pneumonia Sepsis ... Haemophilus influenzae , including H. influenzae type b or Hib, can cause many different kinds of infections . Symptoms depend on ...

  9. Laboratory directed research and development. FY 1995 progress report

    Energy Technology Data Exchange (ETDEWEB)

    Vigil, J.; Prono, J. [comps.

    1996-03-01

    This document presents an overview of Laboratory Directed Research and Development Programs at Los Alamos. The nine technical disciplines in which research is described include materials, engineering and base technologies, plasma, fluids, and particle beams, chemistry, mathematics and computational science, atmic and molecular physics, geoscience, space science, and astrophysics, nuclear and particle physics, and biosciences. Brief descriptions are provided in the above programs.

  10. Artificial Intelligence in ADA: Pattern-Directed Processing. Final Report.

    Science.gov (United States)

    Reeker, Larry H.; And Others

    To demonstrate to computer programmers that the programming language Ada provides superior facilities for use in artificial intelligence applications, the three papers included in this report investigate the capabilities that exist within Ada for "pattern-directed" programming. The first paper (Larry H. Reeker, Tulane University) is…

  11. Instrument comprising a cable or tube provided provided with a propulsion device

    NARCIS (Netherlands)

    Breedveld, P.

    2006-01-01

    The invention relates to an instrument (1) comprising a cable or tube (3), at a distal end of which a propulsion device (4) is provided for moving the cable or tube in a hollow space, the propulsion device being shaped like a donut lying in a plane at right angles to the longitudinal direction of

  12. Universal cell frame for high-pressure water electrolyzer and electrolyzer including the same

    Science.gov (United States)

    Schmitt, Edwin W.; Norman, Timothy J.

    2013-01-08

    Universal cell frame generic for use as an anode frame and as a cathode frame in a water electrolyzer. According to one embodiment, the universal cell frame includes a unitary annular member having a central opening. Four trios of transverse openings are provided in the annular member, each trio being spaced apart by about 90 degrees. A plurality of internal radial passageways fluidly interconnect the central opening and each of the transverse openings of two diametrically-opposed trios of openings, the other two trios of openings lacking corresponding radial passageways. Sealing ribs are provided on the top and bottom surfaces of the annular member. The present invention is also directed at a water electrolyzer that includes two such cell frames, one being used as the anode frame and the other being used as the cathode frame, the cathode frame being rotated 90 degrees relative to the anode frame.

  13. Premixed direct injection disk

    Science.gov (United States)

    York, William David; Ziminsky, Willy Steve; Johnson, Thomas Edward; Lacy, Benjamin; Zuo, Baifang; Uhm, Jong Ho

    2013-04-23

    A fuel/air mixing disk for use in a fuel/air mixing combustor assembly is provided. The disk includes a first face, a second face, and at least one fuel plenum disposed therebetween. A plurality of fuel/air mixing tubes extend through the pre-mixing disk, each mixing tube including an outer tube wall extending axially along a tube axis and in fluid communication with the at least one fuel plenum. At least a portion of the plurality of fuel/air mixing tubes further includes at least one fuel injection hole have a fuel injection hole diameter extending through said outer tube wall, the fuel injection hole having an injection angle relative to the tube axis. The invention provides good fuel air mixing with low combustion generated NOx and low flow pressure loss translating to a high gas turbine efficiency, that is durable, and resistant to flame holding and flash back.

  14. Medicare Referring Provider DMEPOS PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset, which is part of CMSs Medicare Provider Utilization and Payment Data, details information on Durable Medical Equipment, Prosthetics, Orthotics and...

  15. Types of health care providers

    Science.gov (United States)

    ... article describes health care providers involved in primary care, nursing care, and specialty care. ... MD) or a Doctor of Osteopathic Medicine (DO). NURSING CARE Licensed practical nurses (LPNs) are state-licensed caregivers ...

  16. Lodging Update: Providence, Rhode Island

    Directory of Open Access Journals (Sweden)

    Ragel Roginsky

    2013-04-01

    Full Text Available Each quarter, Pinnacle Advisory Group prepares an analysis of the New England lodging industry, which provides a regional summary and then focuses in depth on a particular market. These reviews look at recent and proposed supply changes, factors affecting demand and growth rates, and the effects of interactions between such supply and demand trends. In this issue, the authors spotlight the lodging market in Providence, Rhode Island.

  17. Ball Screw Actuator Including an Axial Soft Stop

    Science.gov (United States)

    Wingett, Paul T. (Inventor); Forrest, Steven Talbert (Inventor); Abel, Steve (Inventor); Woessner, George (Inventor); Hanlon, Casey (Inventor)

    2016-01-01

    An actuator includes an actuator housing, a ball screw, and an axial soft stop assembly. The ball screw extends through the actuator housing and has a first end and a second end. The ball screw is coupled to receive a drive force and is configured, upon receipt of the drive force, to selectively move in a retract direction and an extend direction. The axial soft stop assembly is disposed within the actuator housing. The axial soft stop assembly is configured to be selectively engaged by the ball screw and, upon being engaged thereby, to translate, with compliance, a predetermined distance in the extend direction, and to prevent further movement of the ball screw upon translating the predetermined distance.

  18. Direct access to INIS

    International Nuclear Information System (INIS)

    Zheludev, I.S.; Romanenko, A.G.

    1981-01-01

    Librarians, researchers, and information specialists throughout the world now have the opportunity for direct access to coverage of almost 95% of the world's literature dealing with the peaceful uses of atomic energy and nuclear science. This opportunity has been provided by the International Nuclear Information System (INIS) of the IAEA. INIS, with the voluntary collaboration of more than 60 of the Agency's Member States, maintains a comprehensive, computer-resident data-base, containing the bibliographic details plus informative abstracts of the bulk of the world's literature on nuclear science and technology. Since this data-base is growing at a rate of 75,000 items per year, and already contains more than 500,000 items, it is obviously important to be able to search this collection conveniently and efficiently. The usefulness of this ability is enhanced when other data-bases on related subjects are made available on an information network. During the early 1970s, on-line interrogation of large bibliographic data-bases became the accepted method for searching this type of information resource. Direct interaction between the searcher and the data-base provides quick feed-back resulting in improved literature listings for launching research and development projects. On-line access enables organizations which cannot store a large data-base on their own computer to expand the information resources at their command. Because of these advantages, INIS undertook to extend to interested Member States on-line access to its data-base in Vienna

  19. Direct detector for terahertz radiation

    Science.gov (United States)

    Wanke, Michael C [Albuquerque, NM; Lee, Mark [Albuquerque, NM; Shaner, Eric A [Albuquerque, NM; Allen, S James [Santa Barbara, CA

    2008-09-02

    A direct detector for terahertz radiation comprises a grating-gated field-effect transistor with one or more quantum wells that provide a two-dimensional electron gas in the channel region. The grating gate can be a split-grating gate having at least one finger that can be individually biased. Biasing an individual finger of the split-grating gate to near pinch-off greatly increases the detector's resonant response magnitude over prior QW FET detectors while maintaining frequency selectivity. The split-grating-gated QW FET shows a tunable resonant plasmon response to FIR radiation that makes possible an electrically sweepable spectrometer-on-a-chip with no moving mechanical optical parts. Further, the narrow spectral response and signal-to-noise are adequate for use of the split-grating-gated QW FET in a passive, multispectral terahertz imaging system. The detector can be operated in a photoconductive or a photovoltaic mode. Other embodiments include uniform front and back gates to independently vary the carrier densities in the channel region, a thinned substrate to increase bolometric responsivity, and a resistive shunt to connect the fingers of the grating gate in parallel and provide a uniform gate-channel voltage along the length of the channel to increase the responsivity and improve the spectral resolution.

  20. The surgery of peripheral nerves (including tumors)

    DEFF Research Database (Denmark)

    Fugleholm, Kåre

    2013-01-01

    Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved...

  1. Including Indigenous Minorities in Decision-Making

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    Based on theories of public sphere participation and deliberative democracy, this book presents empirical results from a study of experiences with including Aboriginal and Maori groups in political decision-making in respectively Western Australia and New Zealand...

  2. Lung Disease Including Asthma and Adult Vaccination

    Science.gov (United States)

    ... Diseases Resources Lung Disease including Asthma and Adult Vaccination Language: English (US) Español (Spanish) Recommend on Facebook ... more about health insurance options. Learn about adult vaccination and other health conditions Asplenia Diabetes Heart Disease, ...

  3. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  4. Ancillary Services Provided from DER

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J.B.

    2005-12-21

    Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

  5. Remote direct memory access

    Science.gov (United States)

    Archer, Charles J.; Blocksome, Michael A.

    2012-12-11

    Methods, parallel computers, and computer program products are disclosed for remote direct memory access. Embodiments include transmitting, from an origin DMA engine on an origin compute node to a plurality target DMA engines on target compute nodes, a request to send message, the request to send message specifying a data to be transferred from the origin DMA engine to data storage on each target compute node; receiving, by each target DMA engine on each target compute node, the request to send message; preparing, by each target DMA engine, to store data according to the data storage reference and the data length, including assigning a base storage address for the data storage reference; sending, by one or more of the target DMA engines, an acknowledgment message acknowledging that all the target DMA engines are prepared to receive a data transmission from the origin DMA engine; receiving, by the origin DMA engine, the acknowledgement message from the one or more of the target DMA engines; and transferring, by the origin DMA engine, data to data storage on each of the target compute nodes according to the data storage reference using a single direct put operation.

  6. Enstore with Chimera namespace provider

    Energy Technology Data Exchange (ETDEWEB)

    Litvintsev, Dmitry [Fermilab; Moibenko, Alexander [Fermilab; Oleynik, Gene [Fermilab; Zalokar, Michael [Fermilab

    2012-01-01

    Enstore is a mass storage system developed by Fermilab that provides distributed access and management of data stored on tapes. It uses a namespace service, PNFS, developed by DESY to provide a filesystem-like view of the stored data. PNFS is a legacy product and is being replaced by a new implementation, called Chimera, which is also developed by DESY. Chimera offers multiple advantages over PNFS in terms of performance and functionality. The Enstore client component, encp, has been modified to work with Chimera, as well as with any other namespace provider. We performed high load end-to-end acceptance test of Enstore with the Chimera namespace. This paper describes the modifications to Enstore, the test procedure and the results of the acceptance testing.

  7. Spillovers from Foreign Direct Investment

    DEFF Research Database (Denmark)

    Meyer, Klaus E.; Sinani, Evis

    2005-01-01

    The extensive empirical literature analyzing productivity spillovers from foreign direct investment to local firms provides inconclusive results. Some studies find that foreign presence has a positive impact on the productivity of domestic firms, while others find no evidence or a negative effect...... for industrialized countries in the 1990s. Transition economies may experience spillovers, but these have been declining in recent years. Keywords: developing countries, transition economies, spillovers, foreign direct investment, technology transfer, meta-analysis...

  8. Device provides controlled gas leaks

    Science.gov (United States)

    Kami, S. K.; King, H. J.

    1968-01-01

    Modified palladium leak device provides a controlled release /leak/ of very small quantities of gas at low or medium pressures. It has no moving parts, requires less than 5 watts to operate, and is capable of releasing the gas either continuously or in pulses at adjustable flow rates.

  9. Twitter for travel medicine providers.

    Science.gov (United States)

    Mills, Deborah J; Kohl, Sarah E

    2016-03-01

    Travel medicine practitioners, perhaps more so than medical practitioners working in other areas of medicine, require a constant flow of information to stay up-to-date, and provide best practice information and care to their patients. Many travel medicine providers are unaware of the popularity and potential of the Twitter platform. Twitter use among our travellers, as well as by physicians and health providers, is growing exponentially. There is a rapidly expanding body of published literature on this information tool. This review provides a brief overview of the ways Twitter is being used by health practitioners, the advantages that are peculiar to Twitter as a platform of social media, and how the interested practitioner can get started. Some key points about the dark side of Twitter are highlighted, as well as the potential benefits of using Twitter as a way to disseminate accurate medical information to the public. This article will help readers develop an increased understanding of Twitter as a tool for extracting useful facts and insights from the ever increasing volume of health information. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  10. Enhanced battery model including temperature effects

    NARCIS (Netherlands)

    Rosca, B.; Wilkins, S.

    2013-01-01

    Within electric and hybrid vehicles, batteries are used to provide/buffer the energy required for driving. However, battery performance varies throughout the temperature range specific to automotive applications, and as such, models that describe this behaviour are required. This paper presents a

  11. 47 CFR 65.820 - Included items.

    Science.gov (United States)

    2010-10-01

    ...) Cash working capital. The average amount of investor-supplied capital needed to provide funds for a carrier's day-to-day interstate operations. Class A carriers may calculate a cash working capital... study or using the formula in paragraph (e) of this section, may calculate the cash working capital...

  12. Electrochemical cell structure including an ionomeric barrier

    Science.gov (United States)

    Lambert, Timothy N.; Hibbs, Michael

    2017-06-20

    An apparatus includes an electrochemical half-cell comprising: an electrolyte, an anode; and an ionomeric barrier positioned between the electrolyte and the anode. The anode may comprise a multi-electron vanadium phosphorous alloy, such as VP.sub.x, wherein x is 1-5. The electrochemical half-cell is configured to oxidize the vanadium and phosphorous alloy to release electrons. A method of mitigating corrosion in an electrochemical cell includes disposing an ionomeric barrier in a path of electrolyte or ion flow to an anode and mitigating anion accumulation on the surface of the anode.

  13. Chapter 1: Direct Normal Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Myer, Daryl R.

    2016-04-15

    This chapter addresses the quantitative and qualitative aspects of the solar resource, the direct solar radiation. It discusses the total or integrated broadband direct beam extraterrestrial radiation (ETR). This total integrated irradiance is comprised of photons of electromagnetic radiation. The chapter also discusses the impact of the atmosphere and its effect upon the direct normal irradiance (DNI) beam radiation. The gases and particulates present in the atmosphere traversed by the direct beam reflect, absorb, and scatter differing spectral regions and proportions of the direct beam, and act as a variable filter. Knowledge of the available broadband DNI beam radiation resource data is essential in designing a concentrating photovoltaic (CPV) system. Spectral variations in the DNI beam radiation affect the performance of a CPV system depending on the solar cell technology used. The chapter describes propagation and scattering processes of circumsolar radiation (CSR), which includes the Mie scattering from large particles.

  14. Direct oral anticoagulants: An update.

    Science.gov (United States)

    Franco Moreno, Ana Isabel; Martín Díaz, Rosa María; García Navarro, María José

    2017-12-30

    Vitamin K antagonists were the only choice for chronic oral anticoagulation for more than half a century. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). In randomised controlled trials comparing direct oral anticoagulants with traditional vitamin K antagonists, the direct oral anticoagulants all showed a favourable benefit-risk balance in their safety and efficacy profile, in prevention of thromboembolic events in patients with atrial fibrillation and in the prevention and treatment of venous thromboembolism and acute coronary syndrome. In 2008, dabigatran was the first direct oral anticoagulant approved by the European Medicine Agency. Subsequently, rivaroxaban, apixaban and edoxaban were also authorised. This article reviews the evidence related to the use of these drugs. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  15. Providing traceability for neuroimaging analyses.

    Science.gov (United States)

    McClatchey, Richard; Branson, Andrew; Anjum, Ashiq; Bloodsworth, Peter; Habib, Irfan; Munir, Kamran; Shamdasani, Jetendr; Soomro, Kamran

    2013-09-01

    With the increasingly digital nature of biomedical data and as the complexity of analyses in medical research increases, the need for accurate information capture, traceability and accessibility has become crucial to medical researchers in the pursuance of their research goals. Grid- or Cloud-based technologies, often based on so-called Service Oriented Architectures (SOA), are increasingly being seen as viable solutions for managing distributed data and algorithms in the bio-medical domain. For neuroscientific analyses, especially those centred on complex image analysis, traceability of processes and datasets is essential but up to now this has not been captured in a manner that facilitates collaborative study. Few examples exist, of deployed medical systems based on Grids that provide the traceability of research data needed to facilitate complex analyses and none have been evaluated in practice. Over the past decade, we have been working with mammographers, paediatricians and neuroscientists in three generations of projects to provide the data management and provenance services now required for 21st century medical research. This paper outlines the finding of a requirements study and a resulting system architecture for the production of services to support neuroscientific studies of biomarkers for Alzheimer's disease. The paper proposes a software infrastructure and services that provide the foundation for such support. It introduces the use of the CRISTAL software to provide provenance management as one of a number of services delivered on a SOA, deployed to manage neuroimaging projects that have been studying biomarkers for Alzheimer's disease. In the neuGRID and N4U projects a Provenance Service has been delivered that captures and reconstructs the workflow information needed to facilitate researchers in conducting neuroimaging analyses. The software enables neuroscientists to track the evolution of workflows and datasets. It also tracks the outcomes of

  16. An Immunization Education Program for Childcare Providers

    Science.gov (United States)

    Hayney, Mary S.; Bartell, Julie C.

    2005-01-01

    The childhood immunization schedule includes at least 17 scheduled immunizations prior to the age of 24 months. Immunization laws require childcare centers to maintain immunization records and enforce immunization standards for children who attend these centers. Childcare providers generally receive little formal education about infectious…

  17. Healthcare providers' knowledge, attitude and behaviour towards ...

    African Journals Online (AJOL)

    Healthcare providers' knowledge, attitude and behaviour towards breast cancer diagnosis and treatment in Malaysia – a mini systematic review. ... Criteria for eligibility include studies conducted in Malaysia and published from the year 2008 to 2015, and written in English language. A total of fifteen articles were identified ...

  18. Spillovers from Foreign Direct Investment

    DEFF Research Database (Denmark)

    Meyer, Klaus E.; Sinani, Evis

    2005-01-01

    The extensive empirical literature analyzing productivity spillovers from foreign direct investment to local firms provides inconclusive results. Some studies find that foreign presence has a positive impact on the productivity of domestic firms, while others find no evidence or a negative effect...... for industrialized countries in the 1990s. Transition economies may experience spillovers, but these have been declining in recent years. Keywords: developing countries, transition economies, spillovers, foreign direct investment, technology transfer, meta-analysis......The extensive empirical literature analyzing productivity spillovers from foreign direct investment to local firms provides inconclusive results. Some studies find that foreign presence has a positive impact on the productivity of domestic firms, while others find no evidence or a negative effect...... data analysis. We conduct a meta-analysis to investigate reasons for these conflicting results, and provide a revised interpretation of earlier research and its policy implications, and new priorities for future research. Our analysis suggests that the hypothesized spillovers are not confirmed...

  19. Diversification of Smallholder Tobacco Systems to include ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Tobacco is the mainstay of the economy of Malawi, accounting for over 70% of export earnings. Of the 100 000 members of the National Smallholder Farmers' Association of Malawi (NASFAM), 60% rely on tobacco for their sole source of income. Like their counterparts elsewhere, they face many difficulties, including: ...

  20. BIOLOGIC AND ECONOMIC EFFECTS OF INCLUDING DIFFERENT ...

    African Journals Online (AJOL)

    The biologic and economic effects of including three agro-industrial by-products as ingredients in turkey poult diets were investigated using 48 turkey poults in a completely randomised design experiment. Diets were formulated to contain the three by-products – wheat offal, rice husk and palm kernel meal, each at 20% level ...

  1. Extending flood damage assessment methodology to include ...

    African Journals Online (AJOL)

    Optimal and sustainable flood plain management, including flood control, can only be achieved when the impacts of flood control measures are considered for both the man-made and natural environments, and the sociological aspects are fully considered. Until now, methods/models developed to determine the influences ...

  2. Including Children Dependent on Ventilators in School.

    Science.gov (United States)

    Levine, Jack M.

    1996-01-01

    Guidelines for including ventilator-dependent children in school are offered, based on experience with six such students at a New York State school. Guidelines stress adherence to the medical management plan, the school-family partnership, roles of the social worker and psychologist, orientation, transportation, classroom issues, and steps toward…

  3. Musculoskeletal ultrasound including definitions for ultrasonographic pathology

    DEFF Research Database (Denmark)

    Wakefield, RJ; Balint, PV; Szkudlarek, Marcin

    2005-01-01

    Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joint...

  4. Modernizing Agrifood Markets : Including Small Producers in ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Against this baseline data, they will endeavor to identify success stories or examples of interventions that ensure small farmers' access to modernizing agrifood markets. The research will inform a set of policy recommendations to be promoted through policy platforms in a large number of developing countries, including but ...

  5. Numerical simulation of spark ignition including ionization

    NARCIS (Netherlands)

    Thiele, M; Selle, S; Riedel, U; Warnatz, J; Maas, U

    2000-01-01

    A detailed understanding of the processes associated Midi spark ignition, as a first step during combustion, is of great importance fur clean operation of spark ignition engines. In the past 10 years. a growing concern for environmental protection, including low emission of pollutants, has increased

  6. Herdable Systems Over Signed, Directed Graphs

    KAUST Repository

    Ruf, Sebastian F.

    2018-04-11

    This paper considers the notion of herdability, a set-based reachability condition, which asks whether the state of a system can be controlled to be element-wise larger than a non-negative threshold. The basic theory of herdable systems is presented, including a necessary and sufficient condition for herdability. This paper then considers the impact of the underlying graph structure of a linear system on the herdability of the system, for the case where the graph is represented as signed and directed. By classifying nodes based on the length and sign of walks from an input, we find a class of completely herdable systems as well as provide a complete characterization of nodes that can be herded in systems with an underlying graph that is a directed out-branching rooted at a single input.

  7. Earthquake analysis of structures including structure-soil interaction by a substructure method

    International Nuclear Information System (INIS)

    Chopra, A.K.; Guttierrez, J.A.

    1977-01-01

    A general substructure method for analysis of response of nuclear power plant structures to earthquake ground motion, including the effects of structure-soil interaction, is summarized. The method is applicable to complex structures idealized as finite element systems and the soil region treated as either a continuum, for example as a viscoelastic halfspace, or idealized as a finite element system. The halfspace idealization permits reliable analysis for sites where essentially similar soils extend to large depths and there is no rigid boundary such as soil-rock interface. For sites where layers of soft soil are underlain by rock at shallow depth, finite element idealization of the soil region is appropriate; in this case, the direct and substructure methods would lead to equivalent results but the latter provides the better alternative. Treating the free field motion directly as the earthquake input in the substructure eliminates the deconvolution calculations and the related assumption-regarding type and direction of earthquake waves-required in the direct method. (Auth.)

  8. Management systems for service providers

    International Nuclear Information System (INIS)

    Bolokonya, Herbert Chiwalo

    2015-02-01

    In the field of radiation safety and protection there are a number of institutions that are involved in achieving different goals and strategies. These strategies and objectives are achieved based on a number of tools and systems, one of these tools and systems is the use of a management system. This study aimed at reviewing the management system concept for Technical Service Providers in the field of radiation safety and protection. The main focus was on personal monitoring services provided by personal dosimetry laboratories. A number of key issues were found to be prominent to make the management system efficient. These are laboratory accreditation, approval; having a customer driven operating criteria; and controlling of records and good reporting. (au)

  9. Providing solutions to engineering problems

    International Nuclear Information System (INIS)

    Connop, R.P.P.

    1991-01-01

    BNFL has acquired unique experience over a period of 40 years in specifying, designing and constructing spent fuel reprocessing and associated waste management plant. This experience is currently used to support a pound 5.5 billion capital investment programme. This paper reviews a number of engineering problems and their solutions to highlight BNFL experience in providing comprehensive specification, design and engineering and project management services. (author)

  10. Do Dogs Provide Information Helpfully?

    Directory of Open Access Journals (Sweden)

    Patrizia Piotti

    Full Text Available Dogs are particularly skilful during communicative interactions with humans. Dogs' abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human's goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs' behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs' behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs' neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor. The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human's vocal communication and the

  11. Do Dogs Provide Information Helpfully?

    Science.gov (United States)

    Piotti, Patrizia; Kaminski, Juliane

    2016-01-01

    Dogs are particularly skilful during communicative interactions with humans. Dogs' abilities to use human communicative cues in cooperative contexts outcompete those of other species, and might be the result of selection pressures during domestication. Dogs also produce signals to direct the attention of humans towards outside entities, a behaviour often referred to as showing behaviour. This showing behaviour in dogs is thought to be something dogs use intentionally and referentially. However, there is currently no evidence that dogs communicate helpfully, i.e. to inform an ignorant human about a target that is of interest to the human but not to the dog. Communicating with a helpful motive is particularly interesting because it might suggest that dogs understand the human's goals and need for information. In study 1, we assessed whether dogs would abandon an object that they find interesting in favour of an object useful for their human partner, a random novel distractor, or an empty container. Results showed that it was mainly self-interest that was driving the dogs' behaviour. The dogs mainly directed their behaviour towards the object they had an interest in, but dogs were more persistent when showing the object relevant to the human, suggesting that to some extent they took the humans interest into account. Another possibility is that dogs' behaviour was driven by an egocentric motivation to interact with novel targets and that the dogs' neophila might have masked their helpful tendencies. Therefore, in study 2 the dogs had initial access to both objects, and were expected to indicate only one (relevant or distractor). The human partner interacted with the dog using vocal communication in half of the trials, and remaining silent in the other half. Dogs from both experimental groups, i.e. indicating the relevant object or indicating the distractor, established joint attention with the human. However, the human's vocal communication and the presence of the

  12. Organizational culture associated with provider satisfaction.

    Science.gov (United States)

    Scammon, Debra L; Tabler, Jennifer; Brunisholz, Kimberly; Gren, Lisa H; Kim, Jaewhan; Tomoaia-Cotisel, Andrada; Day, Julie; Farrell, Timothy W; Waitzman, Norman J; Magill, Michael K

    2014-01-01

    Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Providers were most satisfied with quality of care (mean, 4.14; scale of 1-5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P ≤ .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended.

  13. Photoactive devices including porphyrinoids with coordinating additives

    Science.gov (United States)

    Forrest, Stephen R; Zimmerman, Jeramy; Yu, Eric K; Thompson, Mark E; Trinh, Cong; Whited, Matthew; Diev, Vlacheslav

    2015-05-12

    Coordinating additives are included in porphyrinoid-based materials to promote intermolecular organization and improve one or more photoelectric characteristics of the materials. The coordinating additives are selected from fullerene compounds and organic compounds having free electron pairs. Combinations of different coordinating additives can be used to tailor the characteristic properties of such porphyrinoid-based materials, including porphyrin oligomers. Bidentate ligands are one type of coordinating additive that can form coordination bonds with a central metal ion of two different porphyrinoid compounds to promote porphyrinoid alignment and/or pi-stacking. The coordinating additives can shift the absorption spectrum of a photoactive material toward higher wavelengths, increase the external quantum efficiency of the material, or both.

  14. Power generation method including membrane separation

    Science.gov (United States)

    Lokhandwala, Kaaeid A.

    2000-01-01

    A method for generating electric power, such as at, or close to, natural gas fields. The method includes conditioning natural gas containing C.sub.3+ hydrocarbons and/or acid gas by means of a membrane separation step. This step creates a leaner, sweeter, drier gas, which is then used as combustion fuel to run a turbine, which is in turn used for power generation.

  15. Should Trade Agreements Include Environmental Policy?

    OpenAIRE

    Josh Ederington

    2010-01-01

    This article examines the extent to which environmental and trade policies should be treated equally, or symmetrically, in international negotiations. It reviews the recent economics literature on trade and the environment to address two questions. First, should trade negotiations include negotiations over environmental policies and the setting of binding environmental standards? Second, if there are grounds for international environmental negotiations, should environmental agreements b...

  16. Jet-calculus approach including coherence effects

    International Nuclear Information System (INIS)

    Jones, L.M.; Migneron, R.; Narayanan, K.S.S.

    1987-01-01

    We show how integrodifferential equations typical of jet calculus can be combined with an averaging procedure to obtain jet-calculus-based results including the Mueller interference graphs. Results in longitudinal-momentum fraction x for physical quantities are higher at intermediate x and lower at large x than with the conventional ''incoherent'' jet calculus. These results resemble those of Marchesini and Webber, who used a Monte Carlo approach based on the same dynamics

  17. Revisiting Hansen Solubility Parameters by Including Thermodynamics.

    Science.gov (United States)

    Louwerse, Manuel J; Maldonado, Ana; Rousseau, Simon; Moreau-Masselon, Chloe; Roux, Bernard; Rothenberg, Gadi

    2017-11-03

    The Hansen solubility parameter approach is revisited by implementing the thermodynamics of dissolution and mixing. Hansen's pragmatic approach has earned its spurs in predicting solvents for polymer solutions, but for molecular solutes improvements are needed. By going into the details of entropy and enthalpy, several corrections are suggested that make the methodology thermodynamically sound without losing its ease of use. The most important corrections include accounting for the solvent molecules' size, the destruction of the solid's crystal structure, and the specificity of hydrogen-bonding interactions, as well as opportunities to predict the solubility at extrapolated temperatures. Testing the original and the improved methods on a large industrial dataset including solvent blends, fit qualities improved from 0.89 to 0.97 and the percentage of correct predictions rose from 54 % to 78 %. Full Matlab scripts are included in the Supporting Information, allowing readers to implement these improvements on their own datasets. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. Does direct experience matter?

    DEFF Research Database (Denmark)

    Miralles, Francesc; Giones, Ferran; Gozun, Brian

    2017-01-01

    of being engaged in entrepreneurial behavior on entrepreneurial intention. We aim to shed light on whether the direct experience reinforces an individual’s entrepreneurial intention or reduces it. Building on an extended version of the planned behavior theory, we use the behavioral reasoning theory...... between older and younger participants. The results suggest that engagement in entrepreneurial activity modifies entrepreneurial intention and that these effects are contingent to the individual’s age. This research work contributes to the extant call to explore reverse causality between actual behavior...... and an individual’s intention by introducing behavioral reasoning theory. These results provide support to initiatives to adapt entrepreneurship promotion efforts to the specific characteristics of the participants....

  19. Direct Drive Hall Thruster System Development

    Science.gov (United States)

    Hoskins, W. Andrew; Homiak, Daniel; Cassady, R. Joseph; Kerslake, Tom; Peterson, Todd; Ferguson, Dale; Snyder, Dave; Mikellides, Ioannis; Jongeward, Gary; Schneider, Todd

    2003-01-01

    The sta:us of development of a Direct Drive Ha!! Thruster System is presented. 13 the first part. a s:udy of the impacts to spacecraft systems and mass benefits of a direct-drive architecture is reviewed. The study initially examines four cases of SPT-100 and BPT-4000 Hall thrusters used for north-south station keeping on an EXPRESS-like geosynchronous spacecraft and for primary propulsion for a Deep Space- 1 based science spacecraft. The study is also extended the impact of direct drive on orbit raising for higher power geosynchronous spacecraft and on other deep space missions as a function of power and delta velocity. The major system considerations for accommodating a direct drive Hall thruster are discussed, including array regulation, system grounding, distribution of power to the spacecraft bus, and interactions between current-voltage characteristics for the arrays and thrusters. The mass benefit analysis shows that, for the initial cases, up to 42 kg of dry mass savings is attributable directly to changes in the propulsion hardware. When projected mass impacts of operating the arrays and the electric power system at 300V are included, up to 63 kg is saved for the four initial cases. Adoption of high voltage lithium ion battery technology is projected to further improve these savings. Orbit raising of higher powered geosynchronous spacecraft, is the mission for which direct drive provides the most benefit, allowing higher efficiency electric orbit raising to be accomplished in a limited period of time, as well as nearly eliminating significant power processing heat rejection mass. The total increase in useful payload to orbit ranges up to 278 kg for a 25 kW spacecraft, launched from an Atlas IIA. For deep space missions, direct drive is found to be most applicable to higher power missions with delta velocities up to several km/s , typical of several Discovery-class missions. In the second part, the status of development of direct drive propulsion power

  20. Matlab Source Code for Species Transport through Nafion Membranes in Direct Ethanol, Direct Methanol, and Direct Glucose Fuel Cells

    OpenAIRE

    JH, Summerfield; MW, Manley

    2016-01-01

    A simple simulation of chemical species movement is presented. The species traverse a Nafion membrane in a fuel cell. Three cells are examined: direct methanol, direct ethanol, and direct glucose. The species are tracked using excess proton concentration, electric field strength, and voltage. The Matlab computer code is provided.

  1. Including environmental concerns in energy policies

    International Nuclear Information System (INIS)

    Potier, Michel

    2014-05-01

    In this article, the author comments the different impacts on the environment and risks related to energy, provided that all energies have an impact on the environment (renewable energies are generally cleaner than fossil energies) and these impacts can be on human health, ecosystems, buildings, crops, landscapes, and climate change. He comments the efforts made in the search for a higher energetic efficiency, and proposes an overview of the various available tools implemented by environmental policies in the energy sector: regulatory instruments, economic instruments, negotiated agreements, and informational instruments. He comments the implementation of an energetic taxing aimed at developing a greater respect of the environment

  2. Direct access: how is it working?

    Science.gov (United States)

    Turner, S; Ross, M

    2017-02-10

    Aim The aim of this study was to identify and survey dental hygienists and therapists working in direct access practices in the UK, obtain their views on its benefits and disadvantages, establish which treatments they provided, and what barriers they had encountered.Method The study used a purposive sample of GDC-registered hygienists and therapists working in practices offering direct access, identified through a 'Google' search. An online survey was set up through the University of Edinburgh, and non-responses followed up by post.Results The initial search identified 243 individuals working in direct access practices. Where a practice listed more than one hygienist/therapist, one was randomly selected. This gave a total of 179 potential respondents. Eighty-six responses were received, representing a response rate of 48%. A large majority of respondents (58, 73%) were favourable in their view of the GDC decision to allow direct access, and most thought advantages outnumbered disadvantages for patients, hygienists, therapists and dentists. There were no statistically significant differences in views between hygienists and therapists. Although direct access patients formed a small minority of their caseload for most respondents, it is estimated that on average respondents saw approximately 13 per month. Treatment was mainly restricted to periodontal work, irrespective of whether the respondent was singly or dually qualified. One third of respondents reported encountering barriers to successful practice, including issues relating to teamwork and dentists' unfavourable attitudes. However, almost two thirds (64%) felt that direct access had enhanced their job satisfaction, and 45% felt their clinical skills had increased.Discussion Comments were mainly positive, but sometimes raised worrying issues, for example in respect to training, lack of dental nurse support and the limited availability of periodontal treatment under NHS regulations.

  3. Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management.

    Science.gov (United States)

    Turner, Kea; Samuel, Cleo A; Donovan, Heidi As; Beckjord, Ellen; Cardy, Alexandra; Dew, Mary Amanda; van Londen, G J

    2017-04-01

    Providers' communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care. We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street's (2007) Framework for Patient-Centered Communication in Cancer Care. The findings of this study suggest providers' communication behaviors including managing survivors' uncertainty, responding to survivors' emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers' discipline. There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers' roles in symptom assessment, and determine best practices for AET symptom communication.

  4. Antiemetic research: future directions

    DEFF Research Database (Denmark)

    Olver, Ian; Molassiotis, Alexander; Aapro, Matti

    2011-01-01

    PURPOSE AND METHODS: As a part of reviewing the Multinational Association of Supportive Care in Cancer (MASCC) antiemetic guidelines in Perugia in 2009, an expert group identified directions for future antiemetic research. RESULTS AND CONCLUSIONS: In future trials, the prediction of nausea...... and vomiting may combine algorithms based on observed prognostic factors relating to the patient and the anticancer therapy, the identification of the genes that code for receptors, and pharmacogenetic studies of the metabolism of drugs. Design issues for future trials include standardising the emetic stimulus...... of an antiemetic. With current high rates of control of acute vomiting, future trials will need to consider new primary endpoints such as nausea, a complex symptom, where improvement is needed. Economic endpoints should be incorporated to ascertain the cost benefit of antiemetic prophylaxis, taking into account...

  5. Information Management, Managed Care, and the Patient-Provider Relationship

    National Research Council Canada - National Science Library

    Carter, Tony

    1999-01-01

    .... Implementation of this paradigm will strengthen the patient-provider relationship, and improve overall health of the population. Finally, the paper suggests new directions for further application of information technology to health care.

  6. Providing Research Experience for Students in Environmental Psychology Courses.

    Science.gov (United States)

    Jay, Timothy B.

    1980-01-01

    Describes a college level psychology course which was designed to provide research experience to students by directing them to undertake a research project using their immediate college campus environment as the subject. (DB)

  7. Aerosol simulation including chemical and nuclear reactions

    International Nuclear Information System (INIS)

    Marwil, E.S.; Lemmon, E.C.

    1985-01-01

    The numerical simulation of aerosol transport, including the effects of chemical and nuclear reactions presents a challenging dynamic accounting problem. Particles of different sizes agglomerate and settle out due to various mechanisms, such as diffusion, diffusiophoresis, thermophoresis, gravitational settling, turbulent acceleration, and centrifugal acceleration. Particles also change size, due to the condensation and evaporation of materials on the particle. Heterogeneous chemical reactions occur at the interface between a particle and the suspending medium, or a surface and the gas in the aerosol. Homogeneous chemical reactions occur within the aersol suspending medium, within a particle, and on a surface. These reactions may include a phase change. Nuclear reactions occur in all locations. These spontaneous transmutations from one element form to another occur at greatly varying rates and may result in phase or chemical changes which complicate the accounting process. This paper presents an approach for inclusion of these effects on the transport of aerosols. The accounting system is very complex and results in a large set of stiff ordinary differential equations (ODEs). The techniques for numerical solution of these ODEs require special attention to achieve their solution in an efficient and affordable manner. 4 refs

  8. Wind Turbine Providing Grid Support

    DEFF Research Database (Denmark)

    2011-01-01

    A variable speed wind turbine is arranged to provide additional electrical power to counteract non-periodic disturbances in an electrical grid. A controller monitors events indicating a need to increase the electrical output power from the wind turbine to the electrical grid. The controller...... is arranged to control the wind turbine as follows: after an indicating event has been detected, the wind turbine enters an overproduction period in which the electrical output power is increased, wherein the additional electrical output power is taken from kinetic energy stored in the rotor and without...... changing the operation of the wind turbine to a more efficient working point.; When the rotational speed of the rotor reaches a minimum value, the wind turbine enters a recovery period to re-accelerate the rotor to the nominal rotational speed while further contributing to the stability of the electrical...

  9. Electrochemical system including lamella settler crystallizer

    Science.gov (United States)

    Maimoni, Arturo

    1988-01-01

    A crystallizer which incorporates a lamella settler and which is particularly applicable for use in batteries and power cells for electric vehicles or stationary applications. The lamella settler can be utilized for coarse particle separation or for agglomeration, and is particularly applicable to aluminum-air batteries or power cells for solving the hydrargillite (aluminum-hydroxide) removal problems from such batteries. This invention provides the advantages of very low energy consumption, turbulence, shear, cost and maintenance. Thus, due to the low shear and low turbulence of this invention, it is particularly effective in the control of aluminum hydroxide particle size distribution in the various sections of an aluminum-air system, as will as in other elecrochemical systems requiring separation for phases of different densities.

  10. Distal radioulnar joint: functional anatomy, including pathomechanics.

    Science.gov (United States)

    Haugstvedt, J R; Langer, M F; Berger, R A

    2017-05-01

    The distal radioulnar joint allows the human to rotate the forearm to place the hand in a desired position to perform different tasks, without interfering with the grasping function of the hand. The ulna is the stable part of the forearm around which the radius rotates; the stability of the distal radioulnar joint is provided by the interaction between ligaments, muscles and bones. The stabilizing structures are the triangular fibrocartilage complex, the ulnocarpal ligament complex, the extensor carpi ulnaris tendon and tendon sheath, the pronator quadratus, the interosseous membrane and ligament, the bone itself and the joint capsule. The purpose of this review article is to present and illustrate the current understanding of the functional anatomy and pathomechanics of this joint.

  11. Armor systems including coated core materials

    Science.gov (United States)

    Chu, Henry S [Idaho Falls, ID; Lillo, Thomas M [Idaho Falls, ID; McHugh, Kevin M [Idaho Falls, ID

    2012-07-31

    An armor system and method involves providing a core material and a stream of atomized coating material that comprises a liquid fraction and a solid fraction. An initial layer is deposited on the core material by positioning the core material in the stream of atomized coating material wherein the solid fraction of the stream of atomized coating material is less than the liquid fraction of the stream of atomized coating material on a weight basis. An outer layer is then deposited on the initial layer by positioning the core material in the stream of atomized coating material wherein the solid fraction of the stream of atomized coating material is greater than the liquid fraction of the stream of atomized coating material on a weight basis.

  12. Grand unified models including extra Z bosons

    International Nuclear Information System (INIS)

    Li Tiezhong

    1989-01-01

    The grand unified theories (GUT) of the simple Lie groups including extra Z bosons are discussed. Under authors's hypothesis there are only SU 5+m SO 6+4n and E 6 groups. The general discussion of SU 5+m is given, then the SU 6 and SU 7 are considered. In SU 6 the 15+6 * +6 * fermion representations are used, which are not same as others in fermion content, Yukawa coupling and broken scales. A conception of clans of particles, which are not families, is suggested. These clans consist of extra Z bosons and the corresponding fermions of the scale. The all of fermions in the clans are down quarks except for the standard model which consists of Z bosons and 15 fermions, therefore, the spectrum of the hadrons which are composed of these down quarks are different from hadrons at present

  13. CLIC expands to include the Southern Hemisphere

    CERN Multimedia

    Roberto Cantoni

    2010-01-01

    Australia has recently joined the CLIC collaboration: the enlargement will bring new expertise and resources to the project, and is especially welcome in the wake of CERN budget redistributions following the recent adoption of the Medium Term Plan.   The countries involved in CLIC collaboration With the signing of a Memorandum of Understanding on 26 August 2010, the ACAS network (Australian Collaboration for Accelerator Science) became the 40th member of in the multilateral CLIC collaboration making Australia the 22nd country to join the collaboration. “The new MoU was signed by the ACAS network, which includes the Australian Synchrotron and the University of Melbourne”, explains Jean-Pierre Delahaye, CLIC Study Leader. “Thanks to their expertise, the Australian institutes will contribute greatly to the CLIC damping rings and the two-beam test modules." Institutes from any country wishing to join the CLIC collaboration are invited to assume responsibility o...

  14. Musculoskeletal ultrasound including definitions for ultrasonographic pathology

    DEFF Research Database (Denmark)

    Wakefield, RJ; Balint, PV; Szkudlarek, Marcin

    2005-01-01

    Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints...... in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US...... pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis....

  15. Should Broca's area include Brodmann area 47?

    Science.gov (United States)

    Ardila, Alfredo; Bernal, Byron; Rosselli, Monica

    2017-02-01

    Understanding brain organization of speech production has been a principal goal of neuroscience. Historically, brain speech production has been associated with so-called Broca’s area (Brodmann area –BA- 44 and 45), however, modern neuroimaging developments suggest speech production is associated with networks rather than with areas. The purpose of this paper was to analyze the connectivity of BA47 ( pars orbitalis) in relation to language . A meta-analysis was conducted to assess the language network in which BA47 is involved. The Brainmap database was used. Twenty papers corresponding to 29 experimental conditions with a total of 373 subjects were included. Our results suggest that BA47 participates in a “frontal language production system” (or extended Broca’s system). The BA47  connectivity found is also concordant with a minor role in language semantics. BA47 plays a central role in the language production system.

  16. Pulmonary disorders, including vocal cord dysfunction.

    Science.gov (United States)

    Greenberger, Paul A; Grammer, Leslie C

    2010-02-01

    The lung is a very complex immunologic organ and responds in a variety of ways to inhaled antigens, organic or inorganic materials, infectious or saprophytic agents, fumes, and irritants. There might be airways obstruction, restriction, neither, or both accompanied by inflammatory destruction of the pulmonary interstitium, alveoli, or bronchioles. This review focuses on diseases organized by their predominant immunologic responses, either innate or acquired. Pulmonary innate immune conditions include transfusion-related acute lung injury, World Trade Center cough, and acute respiratory distress syndrome. Adaptive immunity responses involve the systemic and mucosal immune systems, activated lymphocytes, cytokines, and antibodies that produce CD4(+) T(H)1 phenotypes, such as for tuberculosis or acute forms of hypersensitivity pneumonitis, and CD4(+) T(H)2 phenotypes, such as for asthma, Churg-Strauss syndrome, and allergic bronchopulmonary aspergillosis. Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  17. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

    The contents of the "LabView Basic I" and "LabView Intermediate II" courses have recently been changed to include, respectively, an introduction to and expert training in the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to developing expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course pr...

  18. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

    The contents of "LabView Basic I" and "LabView Intermediate II" trainings have been recently changed to include, respectively, an introduction and an expert training on the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to develop expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course prepare...

  19. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

    The contents of the "LabView Basic I" and "LabView Intermediate II" courses have recently been changed to include, respectively, an introduction to and expert training in the Rapid Application Development Environment (RADE). RADE is a LabView-based application developed at CERN to integrate LabView in the accelerator and experiment control infrastructure. It is a suitable solution to developing expert tools, machine development analysis and independent test facilities. The course names have also been changed to "LabVIEW Basics I with RADE Introduction" and "LabVIEW Intermediate II with Advanced RADE Application". " LabVIEW Basics I with RADE Introduction" is designed for: Users preparing to develop applications using LabVIEW, or NI Developer Suite; users and technical managers evaluating LabVIEW or NI Developer Suite in purchasing decisions; users pursuing the Certified LabVIEW Developer certification. The course prepares participants to develop test and measurement, da...

  20. Research Directions in Anthropological Pragmatics

    Directory of Open Access Journals (Sweden)

    Piotr P. Chruszczewski

    2011-08-01

    Full Text Available Anthropological linguistics, and by default also anthropological pragmatics, grew as sub-disciplines of both anthropology and linguistics. “The intellectual basis for anthropological linguistics in the United States derives from Boas ([1911] 1966, whose interests and concerns led to the anthropological view of language, which is that language is an integral part of culture (…” (Klein 2006: 296. Pragmatics enters the scene, telling the researcher how to analyse the aforementioned phenomena. Therefore, anthropological pragmatics would be responsible for equipping the researcher with tools, for it is language and language-oriented mechanisms of communication, the study of which provides a much clearer insight into cultural phenomena which often direct the use of language representing culture from both the synchronic and the diachronic point of view. “[O]ne approaches language from an anthropological view, which includes the uses of language and the uses of silence, as well as the cultural problems involved in silence and speech” (ibid..

  1. Future directions for nursing administration.

    Science.gov (United States)

    Poulin, M A

    1984-03-01

    As the age of centralization wanes, nurse executives must look ahead. The author, noting a terrain obscured by the increasing complexity of nursing practice, points out the advantages of decentralizing decision making and of providing a distinctive nursing stamp to research and administration theory. Nurse executives, trained in management from early in their professional formation, can provide enlightened direction and flexible support for tomorrow's opportunities.

  2. Direct Manipulation in Virtual Reality

    Science.gov (United States)

    Bryson, Steve

    2003-01-01

    Virtual Reality interfaces offer several advantages for scientific visualization such as the ability to perceive three-dimensional data structures in a natural way. The focus of this chapter is direct manipulation, the ability for a user in virtual reality to control objects in the virtual environment in a direct and natural way, much as objects are manipulated in the real world. Direct manipulation provides many advantages for the exploration of complex, multi-dimensional data sets, by allowing the investigator the ability to intuitively explore the data environment. Because direct manipulation is essentially a control interface, it is better suited for the exploration and analysis of a data set than for the publishing or communication of features found in that data set. Thus direct manipulation is most relevant to the analysis of complex data that fills a volume of three-dimensional space, such as a fluid flow data set. Direct manipulation allows the intuitive exploration of that data, which facilitates the discovery of data features that would be difficult to find using more conventional visualization methods. Using a direct manipulation interface in virtual reality, an investigator can, for example, move a data probe about in space, watching the results and getting a sense of how the data varies within its spatial volume.

  3. Systems and Methods for Providing Insulation

    Science.gov (United States)

    Golden, Johnny L. (Inventor)

    2015-01-01

    Systems and methods provide a multi-layer insulation (MLI) that includes a plurality of sealed metalized volumes in a stacked arrangement, wherein the plurality of sealed metalized volumes encapsulate a gas therein, with the gas having one of a thermal insulating property, an acoustic insulating property, or a combination insulating property thereof. The MLI also includes at least one spacer between adjacent sealed metalized volumes of the plurality of sealed metalized volumes and a protective cover surrounding the plurality of sealed metalized volumes.

  4. Providing global WLCG transfer monitoring

    CERN Document Server

    Andreeva, J; Campana, S; Flix, J; Flix, J; Keeble, O; Magini, N; Molnar, Z; Oleynik, D; Petrosyan, A; Ro, G; Saiz, P; Salichos, M; Tuckett, D; Uzhinsky, A; Wildish, T

    2012-01-01

    The WLCG[1] Transfers Dashboard is a monitoring system which aims to provide a global view of WLCG data transfers and to reduce redundancy in monitoring tasks performed by the LHC experiments. The system is designed to work transparently across LHC experiments and across the various technologies used for data transfer. Currently each LHC experiment monitors data transfers via experiment-specific systems but the overall cross-experiment picture is missing. Even for data transfers handled by FTS, which is used by 3 LHC experiments, monitoring tasks such as aggregation of FTS transfer statistics or estimation of transfer latencies are performed by every experiment separately. These tasks could be performed once, centrally, and then served to all experiments via a well-defined set of APIs. In the design and development of the new system, experience accumulated by the LHC experiments in the data management monitoring area is taken into account and a considerable part of the code of the ATLAS DDM Dashboard is being...

  5. Providing global WLCG transfer monitoring

    International Nuclear Information System (INIS)

    Andreeva, J; Dieguez Arias, D; Campana, S; Keeble, O; Magini, N; Molnar, Z; Ro, G; Saiz, P; Salichos, M; Tuckett, D; Flix, J; Oleynik, D; Petrosyan, A; Uzhinsky, A; Wildish, T

    2012-01-01

    The WLCG[1] Transfers Dashboard is a monitoring system which aims to provide a global view of WLCG data transfers and to reduce redundancy in monitoring tasks performed by the LHC experiments. The system is designed to work transparently across LHC experiments and across the various technologies used for data transfer. Currently each LHC experiment monitors data transfers via experiment-specific systems but the overall cross-experiment picture is missing. Even for data transfers handled by FTS, which is used by 3 LHC experiments, monitoring tasks such as aggregation of FTS transfer statistics or estimation of transfer latencies are performed by every experiment separately. These tasks could be performed once, centrally, and then served to all experiments via a well-defined set of APIs. In the design and development of the new system, experience accumulated by the LHC experiments in the data management monitoring area is taken into account and a considerable part of the code of the ATLAS DDM Dashboard is being re-used. The paper describes the architecture of the Global Transfer monitoring system, the implementation of its components and the first prototype.

  6. Transport and Reactivity of Decontaminants to Provide Hazard Mitigation of Chemical Warfare Agents from Materials

    Science.gov (United States)

    2016-06-01

    directions for future decontamination formulation approaches. 15. SUBJECT TERMS GD HD Decontamination Hazard mitigation VX Chemical warfare agent...agent from materials. The objective of this study was to provide a screening tool to identify decontamination chemistries and formulations that will...mitigation. The materials included a water-dispersible polyurethane (WDP) paint (MIL-DTL-53039) and an alkyd paint (MIL-PRF-24635). Two polymers were also

  7. Invariants of directed spaces

    DEFF Research Database (Denmark)

    Raussen, Martin

    2007-01-01

    Directed spaces are the objects of study within directed algebraic topology. They are characterised by spaces of directed paths associated to a source and a target, both elements of an underlying topological space. The algebraic topology of these path spaces and their connections are studied from...... a categorical perspective. In particular, we study the preorder category associated to a directed space and various "quotient" categories arising from algebraic topological functors. Furthermore, we propose and study a new notion of directed homotopy equivalence between directed spaces....

  8. Direction-dependent exponential biassing

    International Nuclear Information System (INIS)

    Bending, R.C.

    1974-01-01

    When Monte Carlo methods are applied to penetration problems, the use of variance reduction techniques is essential if realistic computing times are to be achieved. A technique known as direction-dependent exponential biassing is described which is simple to apply and therefore suitable for problems with difficult geometry. The material cross section in any region is multiplied by a factor which depends on the particle direction, so that particles travelling in a preferred direction ''see'' a smaller cross section than those travelling in the opposite direction. A theoretical study shows that substantial gains may be obtained, and that the choice of biassing parameter is not critical. The method has been implemented alongside other importance sampling techniques in the general Monte Carlo code SPARTAN, and results obtained for simple problems using this code are included. 4 references. (U.S.)

  9. A micromanipulation cell including a tool changer

    Science.gov (United States)

    Clévy, Cédric; Hubert, Arnaud; Agnus, Joël; Chaillet, Nicolas

    2005-10-01

    This paper deals with the design, fabrication and characterization of a tool changer for micromanipulation cells. This tool changer is part of a manipulation cell including a three linear axes robot and a piezoelectric microgripper. All these parts are designed to perform micromanipulation tasks in confined spaces such as a microfactory or in the chamber of a scanning electron microscope (SEM). The tool changer principle is to fix a pair of tools (i.e. the gripper tips) either on the tips of the microgripper actuator (piezoceramic bulk) or on a tool magazine. The temperature control of a thermal glue enables one to fix or release this pair of tools. Liquefaction and solidification are generated by surface mounted device (SMD) resistances fixed on the surface of the actuator or magazine. Based on this principle, the tool changer can be adapted to other kinds of micromanipulation cells. Hundreds of automatic tool exchanges were performed with a maximum positioning error between two consecutive tool exchanges of 3.2 µm, 2.3 µm and 2.8 µm on the X, Y and Z axes respectively (Z refers to the vertical axis). Finally, temperature measurements achieved under atmospheric pressure and in a vacuum environment and pressure measurements confirm the possibility of using this device in the air as well as in a SEM.

  10. Robust Unit Commitment Including Frequency Stability Constraints

    Directory of Open Access Journals (Sweden)

    Felipe Pérez-Illanes

    2016-11-01

    Full Text Available An increased use of variable generation technologies such as wind power and photovoltaic generation can have important effects on system frequency performance during normal operation as well as contingencies. The main reasons are the operational principles and inherent characteristics of these power plants like operation at maximum power point and no inertial response during power system imbalances. This has led to new challenges for Transmission System Operators in terms of ensuring system security during contingencies. In this context, this paper proposes a Robust Unit Commitment including a set of additional frequency stability constraints. To do this, a simplified dynamic model of the initial system frequency response is used in combination with historical frequency nadir data during contingencies. The proposed approach is especially suitable for power systems with cost-based economic dispatch like those in most Latin American countries. The study is done considering the Northern Interconnected System of Chile, a 50-Hz medium size isolated power system. The results obtained were validated by means of dynamic simulations of different system contingencies.

  11. Unifying all elementary particle forces including gravity

    International Nuclear Information System (INIS)

    Terazawa, H.

    1979-01-01

    It is a final goal in physics to unify all four basic forces, strong, weak, electromagnetic and gravitational. First, the unified gauge theories of strong, weak and electromagnetic interactions are discussed. There are two standard models, the model of Pati and Salam in which leptons have the fourth color, and the model of Georgi and Glashow in which a simple group SU (5) is assumed for grand unification. Two mass relations for leptons and quarks were derived, and the extension of the Georgi-Glashow model to a grand unified model of SU (6) gauge group has been made. The quantization of the electric charge of elementary particles is one of the most satisfactory features in grand unified gauge theories. The constraint relations between the gauge couplings, the weak mixing angle and the mass scale of symmetry breaking owing to the renormalization effect are not so severe as those in the grand unified models. However, the mass scale becomes far above the Planck mass in some cases. The baryon number non-conservation is one of the most intriguing features common to grand unified gauge theories. The unified models of all elementary particle forces including gravity are discussed. The discovery of weak vector bosons and the production of subquark pairs are anticipated. (Kako, I.)

  12. JSTOR: Providing New Access to Old Research

    OpenAIRE

    K.M. Guthrie

    1998-01-01

    Much has transpired in a short period of time. The JSTOR database now includes well over two million pages from 47 core journals in 11 academic disciplines. Additional journal content is being digitized at a rate of approximately 100,000 pages per month. More than 250 libraries in the United States and Canada have become participating institutions, providing support for the creation, maintenance and growth of this database. Outside of North America, we have recently announced the establishmen...

  13. Foreign Direct Investment in Central and Eastern Europe

    DEFF Research Database (Denmark)

    Marinov, Marin Alexandrov; Marinova, Svetla Trifonova

    facilities there. These processes result in intensive penetration of companies through foreign direct investment into the CEE region. Simultaneously, the foreign investing companies face the specific context of a region that poses new requirements to their investment strategies, approaches and practices....... Covering a diverse range of CEE countries, as well as referring to the characteristics of the region as a whole, this book examines the inflow and outflow of foreign direct investment from both home and host company and country perspectives. By analyzing foreign direct investment in terms of process......, content and context, the book provides a holist approach towards foreign direct investment in the transitional context of CEE. The book includes a comprehensive study of the motives of multi-national companies for investing in Central and Eastern Europe through various investment modes and the degree...

  14. A Study On Direct Selling Through Multi Level Marketing

    Science.gov (United States)

    Merlin, F. Mary

    2012-09-01

    Direct selling is a multi-level marketing in which the sales force is compensated not only for the sales they make but also for the sales done through their recruit. This recruited sales force is referred to as the participants who can provide multiple levels of compensation.A person's job would be to recruit others to sell their product, and in return, receive a percentage of their sales. The next person's job then is to recruit people even more so below them, and receive a percentage of their sales. Other terms for Multi-level marketing include network marketing and referral marketing. Commonly, the salespeople are expected to sell products directly to consumers by means of relationship through referrals marketing. Some people use direct selling as a synonym for MLM, although MLM is only one type of direct selling

  15. Sexually transmitted infections, including HIV, in the Netherlands in 2006

    NARCIS (Netherlands)

    MG van Veen; FDH Koedijk; IVF van der Broek; ELM Op de Coul; IM de Boer; AI van Sighem; MAB van der Sande; soa-centra; Stichting HIV Monitoring; EPI/Cib

    2007-01-01

    The nationally covered low threshold STI centres offering STI care targeted at high risk groups, provide surveillance data to monitor national trends in STI, including HIV. In 2006, chlamydia remained the most commonly diagnosed bacterial STI in the Netherlands in the STI centres, in spite of

  16. Payment Services for Global Online Systems Including Internet.

    Science.gov (United States)

    Seebeck, Bill; And Others

    1995-01-01

    A panel of four conference presenters address issues related to paying for services provided through online systems. Discussion includes the following topics: metering devices; electronic/digital cash; working within existing banking/credit card structures; provision of payment mechanisms in countries without extensive credit card usage; and…

  17. A method for analyzing the business case for provider participation in the National Cancer Institute's Community Clinical Oncology Program and similar federally funded, provider-based research networks.

    Science.gov (United States)

    Reiter, Kristin L; Song, Paula H; Minasian, Lori; Good, Marjorie; Weiner, Bryan J; McAlearney, Ann Scheck

    2012-09-01

    The Community Clinical Oncology Program (CCOP) plays an essential role in the efforts of the National Cancer Institute (NCI) to increase enrollment in clinical trials. Currently, there is little practical guidance in the literature to assist provider organizations in analyzing the return on investment (ROI), or business case, for establishing and operating a provider-based research network (PBRN) such as the CCOP. In this article, the authors present a conceptual model of the business case for PBRN participation, a spreadsheet-based tool and advice for evaluating the business case for provider participation in a CCOP organization. A comparative, case-study approach was used to identify key components of the business case for hospitals attempting to support a CCOP research infrastructure. Semistructured interviews were conducted with providers and administrators. Key themes were identified and used to develop the financial analysis tool. Key components of the business case included CCOP start-up costs, direct revenue from the NCI CCOP grant, direct expenses required to maintain the CCOP research infrastructure, and incidental benefits, most notably downstream revenues from CCOP patients. The authors recognized the value of incidental benefits as an important contributor to the business case for CCOP participation; however, currently, this component is not calculated. The current results indicated that providing a method for documenting the business case for CCOP or other PBRN involvement will contribute to the long-term sustainability and expansion of these programs by improving providers' understanding of the financial implications of participation. Copyright © 2011 American Cancer Society.

  18. Clinical social networking--a new revolution in provider communication and delivery of clinical information across providers of care?

    Science.gov (United States)

    Kolowitz, Brian J; Lauro, Gonzalo Romero; Venturella, James; Georgiev, Veliyan; Barone, Michael; Deible, Christopher; Shrestha, Rasu

    2014-04-01

    The adoption of social media technologies appears to enhance clinical outcomes through improved communications as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). The ability of providers to more effectively, directly, and rapidly communicate among themselves as well as with patients should strengthen collaboration and treatment as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). This paper is a case study in one organization's development of an internally designed and developed social technology solution termed "Unite." The Unite system combines social technologies' features including push notifications, messaging, community groups, and user lists with clinical workflow and applications to construct dynamic provider networks, simplify communications, and facilitate clinical workflow optimization. Modeling Unite as a social technology may ease adoption barriers. Developing a social network that is integrated with healthcare information systems in the clinical space opens the doors to capturing and studying the way in which providers communicate. The Unite system appears to have the potential to breaking down existing communication paradigms. With Unite, a rich set of usage data tied to clinical events may unravel alternative networks that can be leveraged to advance patient care.

  19. [Contracts including performance and management of uncertainty].

    Science.gov (United States)

    Duru, G; Garassus, P; Auray, J-P

    2013-09-01

    Since many decades in France, the most important part of ambulatory health care expenditure is represented by drug consumption. By the fact, French patient is indeed the greatest world consumer of pharmaceuticals treatments. Therefore, the regulation authorities by successive strategies, attempt to limit or even restrict market access for new drugs in the health care sector secured by public social insurance coverage. Common objectives are to assess the reimbursement to scientific studies and to fix the price of therapeutics at an acceptable level for both industries and government. New trends try then to determine recently the drug price in a dual approach, as a component of global and effective contract, including performance and outcome. The first diffusion authorization is diffusion concerned, but this concept takes into account the eventual success of new produces in long-term survey. Signed for a fixed period as reciprocal partnership between regulation authorities and pharmaceutics industries, the contract integrates two dimensions of incertitude. The first one is represented by the strategy of new treatments development according to efficacy and adapted price, and the second one is linked to the result of diffusion and determines adapted rules if eventual non-respects of the previous engagement are registered. This paper discusses problems related to this new dimension of incertitude affected by conditional drug prices in market access strategy and the adapted follow-up of new treatment diffusion fixed by "outcome" contract between French regulation administration and pharmaceutics industries in our recent economic context. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  20. Resection of thymoma should include nodal sampling.

    Science.gov (United States)

    Weksler, Benny; Pennathur, Arjun; Sullivan, Jennifer L; Nason, Katie S

    2015-03-01

    Thymoma is best treated by surgical resection; however, no clear guidelines have been created regarding lymph node sampling at the time of resection. Additionally, the prognostic implications of nodal metastases are unclear. The aim of this study was to analyze the prognostic implications of nodal metastases in thymoma. The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgical resection of thymoma with documented pathologic examination of lymph nodes. The impact of nodal status on survival and thymoma staging was examined. We identified 442 patients who underwent thymoma resection with pathologic evaluation of 1 or more lymph nodes. A median of 2 nodes were sampled per patient. Fifty-nine patients (59 of 442, 13.3%) had ≥ 1 positive node. Patients with positive nodes were younger and had smaller tumors than node-negative patients. Median survival in the node-positive patients was 98 months, compared with 144 months in node-negative patients (P = .013). In multivariable analysis, the presence of positive nodes had a significant, independent, adverse impact on survival (hazard ratio 1.945, 95% confidence interval 1.296-2.919, P = .001). The presence of nodal metastases resulted in a change in classification to a higher stage in 80% of patients, the majority from Masaoka-Koga stage III to stage IV. Nodal status seems to be an important prognostic factor in patients with thymoma. Until the prognostic significance of nodal metastases is better understood, surgical therapy for thymoma should include sampling of regional lymph nodes. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  1. Premixed direct injection nozzle

    Science.gov (United States)

    Zuo, Baifang [Simpsonville, SC; Johnson, Thomas Edward [Greer, SC; Lacy, Benjamin Paul [Greer, SC; Ziminsky, Willy Steve [Simpsonville, SC

    2011-02-15

    An injection nozzle having a main body portion with an outer peripheral wall is disclosed. The nozzle includes a plurality of fuel/air mixing tubes disposed within the main body portion and a fuel flow passage fluidly connected to the plurality of fuel/air mixing tubes. Fuel and air are partially premixed inside the plurality of the tubes. A second body portion, having an outer peripheral wall extending between a first end and an opposite second end, is connected to the main body portion. The partially premixed fuel and air mixture from the first body portion gets further mixed inside the second body portion. The second body portion converges from the first end toward said second end. The second body portion also includes cooling passages that extend along all the walls around the second body to provide thermal damage resistance for occasional flame flash back into the second body.

  2. Composite armor, armor system and vehicle including armor system

    Science.gov (United States)

    Chu, Henry S.; Jones, Warren F.; Lacy, Jeffrey M.; Thinnes, Gary L.

    2013-01-01

    Composite armor panels are disclosed. Each panel comprises a plurality of functional layers comprising at least an outermost layer, an intermediate layer and a base layer. An armor system incorporating armor panels is also disclosed. Armor panels are mounted on carriages movably secured to adjacent rails of a rail system. Each panel may be moved on its associated rail and into partially overlapping relationship with another panel on an adjacent rail for protection against incoming ordnance from various directions. The rail system may be configured as at least a part of a ring, and be disposed about a hatch on a vehicle. Vehicles including an armor system are also disclosed.

  3. Directions for advanced use of nuclear power in century XXI

    International Nuclear Information System (INIS)

    Walter, C.E.

    1999-01-01

    Nuclear power can provide a significant contribution to electricity generation and meet other needs of the world and the US during the next century provided that certain directions are taken to achieve its public acceptance. These directions include formulation of projections of population, energy consumption, and energy resources over a responsible period of time. These projections will allow assessment of cumulative effects on the environment and on fixed resources. Use of fossil energy resources in a century of growing demand for energy must be considered in the context of long-term environmental damage and resource depletion. Although some question the validity of these consequences, they can be mitigated by use of advanced fast reactor technology. It must be demonstrated that nuclear power technology is safe, resistant to material diversion for weapon use, and economical. An unbiased examination of all the issues related to energy use, especially of electricity, is an essential direction to take

  4. Directed transport in a ratchet with internal and chemical freedoms

    Energy Technology Data Exchange (ETDEWEB)

    Dittrich, T., E-mail: tdittrich@unal.edu.co [Departamento de Fisica, Universidad Nacional de Colombia, Bogota D.C. (Colombia); CeiBA-Complejidad, Bogota D.C. (Colombia); Naranjo, N.A. [Departamento de Fisica, Universidad Nacional de Colombia, Bogota D.C. (Colombia); CeiBA-Complejidad, Bogota D.C. (Colombia)

    2010-10-05

    Graphical abstract: Directed currents in a ratchet including a chemical freedom that provides energy input and an internal freedom modeled as a functional mode of a motor molecule show a direct relation to the structure of the underlying attaractor, limit cycle or chaotic, as reflected in their dependence on the coupling between external and chemical degrees of freedom. - Abstract: We consider mechanisms of directed current in a ratchet model comprising, besides the external freedom where transport occurs, a chemical freedom that replaces the familiar external driving by an autonomous dynamics providing energy input, and an internal freedom representing a functional mode of a motor molecule. The dependence of the current on various parameters is studied in numerical simulations of our model. In particular, we point out the role of the internal freedom as a buffer between energy input and output of mechanical work that allows a temporary storage of injected energy and can contribute to the efficiency of current generation.

  5. Direct manipulation of virtual objects

    Science.gov (United States)

    Nguyen, Long K.

    Interacting with a Virtual Environment (VE) generally requires the user to correctly perceive the relative position and orientation of virtual objects. For applications requiring interaction in personal space, the user may also need to accurately judge the position of the virtual object relative to that of a real object, for example, a virtual button and the user's real hand. This is difficult since VEs generally only provide a subset of the cues experienced in the real world. Complicating matters further, VEs presented by currently available visual displays may be inaccurate or distorted due to technological limitations. Fundamental physiological and psychological aspects of vision as they pertain to the task of object manipulation were thoroughly reviewed. Other sensory modalities -- proprioception, haptics, and audition -- and their cross-interactions with each other and with vision are briefly discussed. Visual display technologies, the primary component of any VE, were canvassed and compared. Current applications and research were gathered and categorized by different VE types and object interaction techniques. While object interaction research abounds in the literature, pockets of research gaps remain. Direct, dexterous, manual interaction with virtual objects in Mixed Reality (MR), where the real, seen hand accurately and effectively interacts with virtual objects, has not yet been fully quantified. An experimental test bed was designed to provide the highest accuracy attainable for salient visual cues in personal space. Optical alignment and user calibration were carefully performed. The test bed accommodated the full continuum of VE types and sensory modalities for comprehensive comparison studies. Experimental designs included two sets, each measuring depth perception and object interaction. The first set addressed the extreme end points of the Reality-Virtuality (R-V) continuum -- Immersive Virtual Environment (IVE) and Reality Environment (RE). This

  6. Slag processing system for direct coal-fired gas turbines

    Science.gov (United States)

    Pillsbury, Paul W.

    1990-01-01

    Direct coal-fired gas turbine systems and methods for their operation are provided by this invention. The systems include a primary combustion compartment coupled to an impact separator for removing molten slag from hot combustion gases. Quenching means are provided for solidifying the molten slag removed by the impact separator, and processing means are provided forming a slurry from the solidified slag for facilitating removal of the solidified slag from the system. The released hot combustion gases, substantially free of molten slag, are then ducted to a lean combustion compartment and then to an expander section of a gas turbine.

  7. Directivity of basic linear arrays

    DEFF Research Database (Denmark)

    Bach, Henning

    1970-01-01

    For a linear uniform array ofnelements, an expression is derived for the directivity as a function of the spacing and the phase constants. The cases of isotropic elements, collinear short dipoles, and parallel short dipoles are included. The formula obtained is discussed in some detail and contour...

  8. Direct immunofluorescence microscopy

    NARCIS (Netherlands)

    Diercks, G.F.H.; Pas, Hendrikus; Jonkman, Marcel

    2016-01-01

    Direct immunofluorescence plays an important role in the diagnosis of autoimmune bullous diseases. The purpose of direct immunofluorescence microscopy is to detect in vivo antibodies in patient's skin or mucosa. Direct immunofluorescence of pemphigus shows depositions of immunoglobulins and/or

  9. QCD Reggeon field theory for every day: Pomeron loops included

    International Nuclear Information System (INIS)

    Altinoluk, Tolga; Kovner, Alex; Peressutti, Javier; Lublinsky, Michael

    2009-01-01

    We derive the evolution equation for hadronic scattering amplitude at high energy. Our derivation includes the nonlinear effects of finite partonic density in the hadronic wave function as well as the effect of multiple scatterings for scattering on dense hadronic target. It thus includes Pomeron loops. It is based on the evolution of the hadronic wave function derived in /cite{foam}. The kernel of the evolution equation defines the second quantized Hamiltonian of the QCD Reggeon Field Theory, H RFT beyond the limits considered so far. The two previously known limits of the evolution: dilute target (JIMWLK limit) and dilute projectile (KLWMIJ limit) are recovered directly from our final result. The Hamiltonian H RFT is applicable for the evolution of scattering amplitude for arbitrarily dense hadronic projectiles/targets - from 'dipole-dipole' to 'nucleus-nucleus' scattering processes.

  10. Moral Distress in Nurses Providing Direct Patient Care at an Academic Medical Center.

    Science.gov (United States)

    Sirilla, Janet; Thompson, Kathrynn; Yamokoski, Todd; Risser, Mark D; Chipps, Esther

    2017-04-01

    Moral distress is the psychological response to knowing the appropriate action but not being able to act due to constraints. Previous authors reported moral distress among nurses, especially those that work in critical care units. The aims of this study were: (1) to examine the level of moral distress among nurses who work at an academic health system, (2) to compare the level of moral distress in nurses who work across specialty units at an academic health system, (3) to compare moral distress by the demographic characteristics of nurses and work experience variables, and (4) to identify demographic characteristics and type of clinical setting that may predict which nurses are at high risk for moral distress. A cross-sectional survey design was used with staff nurses who work on inpatient units and ambulatory units at an academic medical center. The moral distress scale-revised (MDS-R) was used to assess the intensity and frequency of moral distress. The overall mean MDS-R score in this project was low at 94.97 with mean scores in the low to moderate range (44.57 to 134.58). Nurses who work in critical care, perioperative services, and procedure areas had the highest mean MDS-R scores. There have been no previous reports of higher scores for nurses working in perioperative and procedure areas. There was weak positive correlation between MDS-R scores and years of experience (Rho = .17, p = .003) but no correlation between age (Rho = .02, p = .78) or education (Rho = .05, p = .802) and moral distress. Three variables were found useful in predicting moral distress: the type of unit and responses to two qualitative questions related to quitting their job. Identification of these variables allows organizations to focus their interventions. © 2017 Sigma Theta Tau International.

  11. Using Public Opinions of Water Quality to Provide Direction for Extension

    Science.gov (United States)

    Kopiyawattage, Kumudu P. P.; Lamm, Alexa J.

    2017-01-01

    Extension educators can help the public learn about critical issues that contribute to existing problems in communities. Water is just such an issue in Florida--in fact, water is the top issue in Florida. The purpose of the study reported in this article was to identify Florida residents' opinions about clean water and their preferred modes of…

  12. Providing Feasible Implementation Support: Direct Training and Implementation Planning in Consultation

    Science.gov (United States)

    Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Boyle, Ashley M.

    2016-01-01

    To deliver interventions completely and consistently (i.e., with adequate treatment integrity) and, thus, have a positive impact on student outcomes, implementers, such as teachers and paraprofessionals, often require support. To efficiently deliver implementation support, school psychologists could embed research-based strategies into their…

  13. [Direct costs involved in providing medical attention associated with traffic accidents in Bogotá].

    Science.gov (United States)

    Gómez-Restrepo, Carlos; Quitian, Hoover; Maldonado, Patricia; Naranjo-Lujan, Salomé; Rondón, Martín; Acosta, Andrés; Arango-Villegas, Carlos; Hurtado, Jaime; Hernández, Juan C; Angarita, María Del Pilar; Peña, Marcela; Saavedra, Miguel Á

    2014-01-01

    To determine the cost of medical attention associated with traffic accidents in Bogotá, Colombia. Prospective observational study with data from adult patients attended to in the emergency centers of 6 hospitals. Average total cost per patient was $1'112.000 COP. Average daily cost of hospitalized patients was $1'200.000 COP. Average cost of ambulatory treated patients ascended to $247.400 COP. Cost per accident calculated was $2'333.700 COP. In the whole city during study period, total medical costs were around $2.301'028.200 COP. All data was expressed in 2011 Colombian pesos. The medical cost of transit accidents is a significant economic burden.

  14. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Science.gov (United States)

    2010-10-01

    ... quality of— (i) The routine storage and prompt disposal of trash and medical waste; (ii) Light... Administration (NARA). For information on the availability of this material at NARA, call 202-741-6030, or go to... the National Archives and Records Administration (NARA). For information on the availability of this...

  15. 48 CFR 9.505-1 - Providing systems engineering and technical direction.

    Science.gov (United States)

    2010-10-01

    ... ACQUISITION REGULATION ACQUISITION PLANNING CONTRACTOR QUALIFICATIONS Organizational and Consultant Conflicts... responsibility for its development, its integration, assembly, and checkout, or its production shall not (1) be...

  16. Laboratory Directed Research and Development FY-15 Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    Pillai, Rekha Sukamar [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-03-01

    The Laboratory Directed Research and Development (LDRD) Program at Idaho National Laboratory (INL) reports its status to the U.S. Department of Energy (DOE) by March of each year. The program operates under the authority of DOE Order 413.2B, “Laboratory Directed Research and Development” (April 19, 2006), which establishes DOE’s requirements for the program while providing the laboratory director broad flexibility for program implementation. LDRD funds are obtained through a charge to all INL programs. This report includes summaries of all INL LDRD research activities supported during Fiscal Year (FY) 2015.

  17. Latest trends and directions of development of crowdfunding

    Directory of Open Access Journals (Sweden)

    Joanna Pieniążek

    2014-09-01

    Full Text Available The article discusses the latest trends and directions of development of crowdfunding on selected examples of English-language websites.The scope of work includes topics such as aggregates of crowdfunding sites, local investing, franchise, pre-sales platforms, open source sites and leveraging the competitive advantages of e-commerce platforms which offer product crowdfunding. This article aims to discuss the latest trends and directions of crowdfunding, assess their usefulness and the chances of popularising the ideas presented. The article provides an overview of the literature on the subject and an analysis of the selected sites, comparison sites and crowdfunding search engines.

  18. Asymmetric Wettability Directs Leidenfrost Droplets

    Energy Technology Data Exchange (ETDEWEB)

    Agapov, Rebecca L [ORNL; Boreyko, Jonathan B [ORNL; Briggs, Dayrl P [ORNL; Srijanto, Bernadeta R [ORNL; Retterer, Scott T [ORNL; Collier, Pat [ORNL; Lavrik, Nickolay V [ORNL

    2014-01-01

    Leidenfrost phenomena on nano- and microstructured surfaces are of great importance for increasing control over heat transfer in high power density systems utilizing boiling phenomena. They also provide an elegant means to direct droplet motion in a variety of recently emerging fluidic systems. Here, we report the fabrication and characterization of tilted nanopillar arrays (TNPAs) that exhibit directional Leidenfrost water droplets under dynamic conditions, namely on impact with Weber numbers 40 at T 325 C. The batch fabrication of the TNPAs was achieved by glancing-angle anisotropic reactive ion etching of a thermally dewet platinum mask, with mean pillar diameters of 100 nm and heights of 200-500 nm. In contrast to previously implemented macro- and microscopic Leidenfrost ratchets, our TNPAs induce no preferential directional movement of Leidenfrost droplets under conditions approaching steady-state film boiling, suggesting that the observed droplet directionality is not a result of asymmetric vapor flow. Using high-speed imaging, phase diagrams were constructed for the boiling behavior upon impact for droplets falling onto TNPAs, straight nanopillar arrays, and smooth silicon surfaces. The asymmetric impact and directional trajectory of droplets was exclusive to the TNPAs for impacts corresponding to the transition boiling regime, revealing that asymmetric wettability upon impact is the mechanism for the droplet directionality.

  19. Are dental providers the next line of HPV-related prevention? Providers' perceived role and needs.

    Science.gov (United States)

    Kline, Nolan; Vamos, Cheryl; Thompson, Erika; Catalanotto, Frank; Petrila, John; DeBate, Rita; Griner, Stacey; Vázquez-Otero, Coralia; Merrell, Laura; Daley, Ellen

    2018-03-07

    The rise in HPV-related oropharyngeal cancer incidence necessitates novel prevention efforts including multiple provider types. Although dental providers screen for HPV-related oropharyngeal cancers, little is known about their needs to advance "primordial prevention," or interventions at the earliest possible stage, to prevent HPV-related cancers. This study assessed dentists' and dental hygienists' perceived roles and needs regarding HPV-related primordial prevention. We conducted a mixed-method study with data from focus groups with dentists (n= 33) and dental hygienists (n= 48) and surveys from both provider types (n= 203) among providers from a diverse set of practice settings and geographic communities. Data were analyzed using qualitative thematic analysis and chi square tests. Participants affirmed dental professionals' roles in preventing HPV-related cancers and identified needs to overcome barriers to fulfilling prevention objectives. Barriers included: (1) practice environment and patient characteristics, and (2) the sensitive topic of HPV. Further, participants identified needs to improve HPV-related cancer prevention. Findings from this study suggest that dental providers may become the next line of prevention for HPV-related cancers. Dental providers' professional associations have provided guidance on HPV and oropharyngeal cancers, but our study reveals dental providers' needs for following professional organizations' guidance to advance prevention efforts and reduce HPV-related cancer incidence. Copyright © 2018. Published by Elsevier B.V.

  20. [Acupuncture direction and analgesia].

    Science.gov (United States)

    Sun, Lu; Kou, Renzhong; Liu, Lanqing; Fan, Gangqi

    2017-03-12

    The acupuncture direction is closely related with the efficacy of acupuncture analgesia. In this article, the relationship between efficacy of acupuncture analgesia and factors, such as whether the needle towards disease location, whether the needle towards meridian direction, whether the needle following spinal cord direction and whether the needle following muscle direction, were analyzed. The previous clinical and literature research indicated that the needle towards disease location was superior to reverse direction, however, the efficacy of analgesia between needle following and reversing meridian, needle towards and at disease location, needles following and reversing spinal cord direction, needles following and reversing muscle direction was controversial. Therefore, the solutions to these problems will benefit the optimized acupuncture treatment plan for pain disorders.

  1. Directions for improved fusion reactors

    International Nuclear Information System (INIS)

    Krakowski, R.A.; Miller, R.L.; Delene, J.G.

    1986-01-01

    Conceptual fusion reactor studies over the past 10 to 15 years have projected systems that may be too large, complex, and costly to be of commercial interest. One main direction for improved fusion reactors points towards smaller, higher-power-density approaches. First-order economic issues (i.e., unit direct cost and cost of electricity) are used to support the need for more compact fusion reactors. A generic fusion physics/engineering/costing model is used to provide a quantiative basis for these arguments for specific fusion concepts

  2. Direction Selectivity in Drosophila Emerges from Preferred-Direction Enhancement and Null-Direction Suppression.

    Science.gov (United States)

    Leong, Jonathan Chit Sing; Esch, Jennifer Judson; Poole, Ben; Ganguli, Surya; Clandinin, Thomas Robert

    2016-08-03

    Across animal phyla, motion vision relies on neurons that respond preferentially to stimuli moving in one, preferred direction over the opposite, null direction. In the elementary motion detector of Drosophila, direction selectivity emerges in two neuron types, T4 and T5, but the computational algorithm underlying this selectivity remains unknown. We find that the receptive fields of both T4 and T5 exhibit spatiotemporally offset light-preferring and dark-preferring subfields, each obliquely oriented in spacetime. In a linear-nonlinear modeling framework, the spatiotemporal organization of the T5 receptive field predicts the activity of T5 in response to motion stimuli. These findings demonstrate that direction selectivity emerges from the enhancement of responses to motion in the preferred direction, as well as the suppression of responses to motion in the null direction. Thus, remarkably, T5 incorporates the essential algorithmic strategies used by the Hassenstein-Reichardt correlator and the Barlow-Levick detector. Our model for T5 also provides an algorithmic explanation for the selectivity of T5 for moving dark edges: our model captures all two- and three-point spacetime correlations relevant to motion in this stimulus class. More broadly, our findings reveal the contribution of input pathway visual processing, specifically center-surround, temporally biphasic receptive fields, to the generation of direction selectivity in T5. As the spatiotemporal receptive field of T5 in Drosophila is common to the simple cell in vertebrate visual cortex, our stimulus-response model of T5 will inform efforts in an experimentally tractable context to identify more detailed, mechanistic models of a prevalent computation. Feature selective neurons respond preferentially to astonishingly specific stimuli, providing the neurobiological basis for perception. Direction selectivity serves as a paradigmatic model of feature selectivity that has been examined in many species. While

  3. Mechanisms and direction of allocation bias in randomised clinical trials.

    Science.gov (United States)

    Paludan-Müller, Asger; Teindl Laursen, David Ruben; Hróbjartsson, Asbjørn

    2016-10-07

    Selective allocation of patients into the compared groups of a randomised trial may cause allocation bias, but the mechanisms behind the bias and its directionality are incompletely understood. We therefore analysed the mechanisms and directionality of allocation bias in randomised clinical trials. Two systematic reviews and a theoretical analysis. We conducted one systematic review of empirical studies of motives/methods for deciphering patient allocation sequences; and another review of methods publications commenting on allocation bias. We theoretically analysed the mechanisms of allocation bias and hypothesised which main factors predicts its direction. Three empirical studies addressed motives/methods for deciphering allocation sequences. Main motives included ensuring best care for patients and ensuring best outcome for the trial. Main methods included various manipulations with randomisation envelopes. Out of 57 methods publications 11 (19 %) mentioned explicitly that allocation bias can go in either direction. We hypothesised that the direction of allocation bias is mainly decided by the interaction between the patient allocators' motives and treatment preference. Inadequate allocation concealment may exaggerate treatment effects in some trials while underestimate effects in others. Our hypothesis provides a theoretical overview of the main factors responsible for the direction of allocation bias.

  4. Direct-to-consumer advertising: its effects on stakeholders.

    Science.gov (United States)

    Montoya, Isaac D; Lee-Dukes, Gwen; Shah, Dhvani

    2008-01-01

    The escalating growth in the development of pharmaceutical drugs has caused the pharmaceutical industry to market drugs directly to consumers. Direct-to-consumer (DTC) advertising has increased immensely in the past 15 years and continues to grow each year. The advantages of DTC advertising include an increase in consumer knowledge, patient autonomy, and possibly providing physicians and pharmacists with up-to-date information about the recent trends in the marketplace. However, there is also an equally notable list of disadvantages, which include concerns about the quality of information provided, loss in physician productivity due to time spent convincing patients that what they want is not in their best interest, and increases in the reimbursement expenditure of the insurers. Because of these conflicting outcomes, the issue of DTC advertising has become controversial. This report offers an overview of DTC advertising and focuses on its effects on physicians, pharmacists, consumers, insurers, the government, and pharmaceutical manufacturers.

  5. Provider volume and outcomes for oncological procedures.

    LENUS (Irish Health Repository)

    Killeen, S D

    2012-02-03

    BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

  6. Ecosystem function and services provided by the deep sea

    Science.gov (United States)

    Thurber, A. R.; Sweetman, A. K.; Narayanaswamy, B. E.; Jones, D. O. B.; Ingels, J.; Hansman, R. L.

    2014-07-01

    The deep sea is often viewed as a vast, dark, remote, and inhospitable environment, yet the deep ocean and seafloor are crucial to our lives through the services that they provide. Our understanding of how the deep sea functions remains limited, but when treated synoptically, a diversity of supporting, provisioning, regulating and cultural services becomes apparent. The biological pump transports carbon from the atmosphere into deep-ocean water masses that are separated over prolonged periods, reducing the impact of anthropogenic carbon release. Microbial oxidation of methane keeps another potent greenhouse gas out of the atmosphere while trapping carbon in authigenic carbonates. Nutrient regeneration by all faunal size classes provides the elements necessary for fueling surface productivity and fisheries, and microbial processes detoxify a diversity of compounds. Each of these processes occur on a very small scale, yet considering the vast area over which they occur they become important for the global functioning of the ocean. The deep sea also provides a wealth of resources, including fish stocks, enormous bioprospecting potential, and elements and energy reserves that are currently being extracted and will be increasingly important in the near future. Society benefits from the intrigue and mystery, the strange life forms, and the great unknown that has acted as a muse for inspiration and imagination since near the beginning of civilization. While many functions occur on the scale of microns to meters and timescales up to years, the derived services that result are only useful after centuries of integrated activity. This vast dark habitat, which covers the majority of the globe, harbors processes that directly impact humans in a variety of ways; however, the same traits that differentiate it from terrestrial or shallow marine systems also result in a greater need for integrated spatial and temporal understanding as it experiences increased use by society. In

  7. Directed Evolution of Enzymes for Industrial Biocatalysis.

    Science.gov (United States)

    Porter, Joanne L; Rusli, Rukhairul A; Ollis, David L

    2016-02-02

    Enzymes have the potential to catalyse a wide variety of chemical reactions. They are increasingly being sought as environmentally friendly and cost-effective alternatives to conventional catalysts used in industries ranging from bioremediation to applications in medicine and pharmaceutics. Despite the benefits, they are not without their limitations. Many naturally occurring enzymes are not suitable for use outside of their native cellular environments. However, protein engineering can be used to generate enzymes tailored for specific industrial applications. Directed evolution is particularly useful and can be employed even when lack of structural information impedes the use of rational design. The aim of this review is to provide an overview of current industrial applications of enzyme technology and to show how directed evolution can be used to modify and to enhance enzyme properties. This includes a brief discussion on library generation and a more detailed focus on library screening methods, which are critical to any directed evolution experiment. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  8. Social capital and trust in providers.

    Science.gov (United States)

    Ahern, Melissa M; Hendryx, Michael S

    2003-10-01

    Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association. Independent variables include individual socio-demographic variables, HMO enrollment, community-level health sector variables, and social capital. The dependent variable is self-reported trust in physicians. Data are merged from the various sources and analyzed using SUDAAN. Subjects include adults in the Household Survey who responded to the items on trust in physicians (N=17,653). Trust in physicians is independently predicted by community social capital (peffect of HMOs is not uniform across all communities. Social capital plays a role in how health care is perceived by citizens, and how health care is delivered by providers. Efforts to build trust and collaboration in a community may improve trust in physicians, health care quality, access, and preserve local health care control.

  9. National Water Model: Providing the Nation with Actionable Water Intelligence

    Science.gov (United States)

    Aggett, G. R.; Bates, B.

    2017-12-01

    The National Water Model (NWM) provides national, street-level detail of water movement through time and space. Operating hourly, this flood of information offers enormous benefits in the form of water resource management, natural disaster preparedness, and the protection of life and property. The Geo-Intelligence Division at the NOAA National Water Center supplies forecasters and decision-makers with timely, actionable water intelligence through the processing of billions of NWM data points every hour. These datasets include current streamflow estimates, short and medium range streamflow forecasts, and many other ancillary datasets. The sheer amount of NWM data produced yields a dataset too large to allow for direct human comprehension. As such, it is necessary to undergo model data post-processing, filtering, and data ingestion by visualization web apps that make use of cartographic techniques to bring attention to the areas of highest urgency. This poster illustrates NWM output post-processing and cartographic visualization techniques being developed and employed by the Geo-Intelligence Division at the NOAA National Water Center to provide national actionable water intelligence.

  10. 77 FR 6463 - Revisions to Labeling Requirements for Blood and Blood Components, Including Source Plasma...

    Science.gov (United States)

    2012-02-08

    ... Blood Components, Including Source Plasma; Correction AGENCY: Food and Drug Administration, HHS. ACTION..., Including Source Plasma,'' which provided incorrect publication information regarding a 60-day notice that...

  11. Engaging service providers in improving industry performance

    International Nuclear Information System (INIS)

    Oberth, R.

    2012-01-01

    Effective task leadership is the key to achieving results in the nuclear industry and in most other industries. One of the themes of this conference is to discuss how the nuclear industry can undertake Issue-Identification and Definition as a means of 'identifying what needs attention' and then 'defining what needs to be done to make that happen'. I will explore this theme from the perspective of the 'Service Provider' - which by the definition of this conference includes everyone not within an operating utility - meaning 'those involved in everything from inspection and repair to research and plant architecture' - basically the member companies of my association, OCI. Our members take the definition of the roles and responsibilities of the 'Service Provider' community very seriously. In the context of this discussion a key utility function is the early definition of requirements and expectations of Service Providers in supplying to these requirements. Let's explore for a moment the Service Provider role and perspective. Service Providers are by nature pro-active - they seek ways to engage with utilities (and tier one vendors) to solve problems and achieve good outcomes. They come to industry conferences like this one to learn about upcoming utility programs and supply opportunities and how they can improve performance. Service Providers particularly want to hear senior utility people comment on emerging issues even those at the very early identification stage. Some Clarification of Roles is in Order - as that is the focus of this conference: 'Issue-Identification and Definition'. 'Issue-Identification' is the utility's job - it is the utility's role to identify as early as possible 'what needs attention and what their needs and expectations are'. This takes place before service provider engagement. 'Issue-Definition' is more challenging. It means &apos

  12. Direct and flexible marginal inference for semicontinuous data.

    Science.gov (United States)

    Smith, Valerie A; Preisser, John S

    2017-12-01

    The marginalized two-part (MTP) model for semicontinuous data proposed by Smith et al. provides direct inference for the effect of covariates on the marginal mean of positively continuous data with zeros. This brief note addresses mischaracterizations of the MTP model by Gebregziabher et al. Additionally, the MTP model is extended to incorporate the three-parameter generalized gamma distribution, which takes many well-known distributions as special cases, including the Weibull, gamma, inverse gamma, and log-normal distributions.

  13. Decree No 524 of 8 June 1982 of the President of the Republic implementing CEC. Directive No 77/576 for standardization of Member States' legislative, regulatory and administrative provisions on safety signs in workplaces and CEC Directive No 79/640 amending the Annexes of the latter

    International Nuclear Information System (INIS)

    1982-01-01

    This Decree implements at national level Directive No 77/576 of 27 July 1977 of the Commission of the European Communities, as amended by Directive No 79/640 of 21 June 1979. The Directive provides for the standardization by Member States of their legislative, regulatory and administrative provisions concerning safety signs in workplaces, including radioactivity symbols. (NEA) [fr

  14. Solar Energy Education. Renewable energy: a background text. [Includes glossary

    Energy Technology Data Exchange (ETDEWEB)

    1985-01-01

    Some of the most common forms of renewable energy are presented in this textbook for students. The topics include solar energy, wind power hydroelectric power, biomass ocean thermal energy, and tidal and geothermal energy. The main emphasis of the text is on the sun and the solar energy that it yields. Discussions on the sun's composition and the relationship between the earth, sun and atmosphere are provided. Insolation, active and passive solar systems, and solar collectors are the subtopics included under solar energy. (BCS)

  15. Meta-structure and tunable optical device including the same

    Energy Technology Data Exchange (ETDEWEB)

    Han, Seunghoon; Papadakis, Georgia Theano; Atwater, Harry

    2017-12-26

    A meta-structure and a tunable optical device including the same are provided. The meta-structure includes a plurality of metal layers spaced apart from one another, an active layer spaced apart from the plurality of metal layers and having a carrier concentration that is tuned according to an electric signal applied to the active layer and the plurality of metal layers, and a plurality of dielectric layers spaced apart from one another and each having one surface contacting a metal layer among the plurality of metal layers and another surface contacting the active layer.

  16. Logistic service providers and sustainable physical distribution

    Directory of Open Access Journals (Sweden)

    Stef Weijers

    2012-06-01

    Full Text Available Background: Logistic Service Providers main concern was to ensure reliability for a low price (Christopher, 2005. Dutch Logistic Service Providers still have these two aspects at the top of their list, but also have to take in a new aspect: sustainability. 88% Of the investigated Logistic Service Providers have included sustainability in the company's goals. These Logistic Service Providers have developed different strategies to achieve a higher level of sustainability. This paper presents the results of a study into what Logistic Service Providers say what they are doing, or intend to do, to improve sustainability for their transport services. In this way insight is given in the attitude of Dutch Logistic Service Providers towards sustainability and how they intend to translate this into business practise: internal solutions or new methods incorporating external partners. Methods: Various methods of the investigations were used, among which the analysis of the statements about the sustainabilityon the websites of various companies as well as the questionnaire per Internet. The research covered 50 largest logistics companies operating in the Netherlands and 60 companies that competed for the award "Lean and Green" advertised in the Netherlands. In addition, the Internet survey was answered by 41 companies that belong to the network of our university. Results: The investigation has shown that sustainability is handled by the logistics company as an integral part of the corporate strategy. In contrast, shippers depend in the choice of logistics services primarily on such classical aspects as the reliability or the price and the sustainability play a minor role. Conclusions: Trying to find methods to improve the sustainability, Dutch logistics service providers, in the first place, look for solutions that increase the efficiency and therefore the cost reduction potential. Solutions, which require the involvement of clients, were less often

  17. Brown spider dermonecrotic toxin directly induces nephrotoxicity

    International Nuclear Information System (INIS)

    Chaim, Olga Meiri; Sade, Youssef Bacila; Bertoni da Silveira, Rafael; Toma, Leny; Kalapothakis, Evanguedes; Chavez-Olortegui, Carlos; Mangili, Oldemir Carlos; Gremski, Waldemiro; Dietrich, Carl Peter von; Nader, Helena B.; Sanches Veiga, Silvio

    2006-01-01

    Brown spider (Loxosceles genus) venom can induce dermonecrotic lesions at the bite site and systemic manifestations including fever, vomiting, convulsions, disseminated intravascular coagulation, hemolytic anemia and acute renal failure. The venom is composed of a mixture of proteins with several molecules biochemically and biologically well characterized. The mechanism by which the venom induces renal damage is unknown. By using mice exposed to Loxosceles intermedia recombinant dermonecrotic toxin (LiRecDT), we showed direct induction of renal injuries. Microscopic analysis of renal biopsies from dermonecrotic toxin-treated mice showed histological alterations including glomerular edema and tubular necrosis. Hyalinization of tubules with deposition of proteinaceous material in the tubule lumen, tubule epithelial cell vacuoles, tubular edema and epithelial cell lysis was also observed. Leukocytic infiltration was neither observed in the glomerulus nor the tubules. Renal vessels showed no sign of inflammatory response. Additionally, biochemical analyses showed such toxin-induced changes in renal function as urine alkalinization, hematuria and azotemia with elevation of blood urea nitrogen levels. Immunofluorescence with dermonecrotic toxin antibodies and confocal microscopy analysis showed deposition and direct binding of this toxin to renal intrinsic structures. By immunoblotting with a hyperimmune dermonecrotic toxin antiserum on renal lysates from toxin-treated mice, we detected a positive signal at the region of 33-35 kDa, which strengthens the idea that renal failure is directly induced by dermonecrotic toxin. Immunofluorescence reaction with dermonecrotic toxin antibodies revealed deposition and binding of this toxin directly in MDCK epithelial cells in culture. Similarly, dermonecrotic toxin treatment caused morphological alterations of MDCK cells including cytoplasmic vacuoles, blebs, evoked impaired spreading and detached cells from each other and from

  18. Directional analysis of extreme winds under mixed climate conditions

    CSIR Research Space (South Africa)

    Kruger, A

    2013-07-01

    Full Text Available Directional statistics provide design engineers with the opportunity to realise considerable cost savings, but these are not yet provided for in the South African standard for wind loading. The development of the directional statistics of extreme...

  19. Outpatient provider concentration and commercial colonoscopy prices.

    Science.gov (United States)

    Pozen, Alexis

    2015-01-01

    The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178,433 claims from 169 providers (104 systems). The mean system market share was 76% (SD = 0.34) and the mean real (deflated) price was US$1363 (SD = 374), ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility's bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices. © The Author(s) 2015.

  20. Descendants and advance directives.

    Science.gov (United States)

    Buford, Christopher

    2014-01-01

    Some of the concerns that have been raised in connection to the use of advance directives are of the epistemic variety. Such concerns highlight the possibility that adhering to an advance directive may conflict with what the author of the directive actually wants (or would want) at the time of treatment. However, at least one objection to the employment of advance directives is metaphysical in nature. The objection to be discussed here, first formulated by Rebecca Dresser and labeled by Allen Buchanan as the slavery argument and David DeGrazia the someone else problem, aims to undermine the legitimacy of certain uses of advance directives by concluding that such uses rest upon an incorrect assumption about the identity over time of those ostensibly governed by the directives. There have been numerous attempts to respond to this objection. This paper aims to assess two strategies that have been pursued to cope with the problem.

  1. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    Science.gov (United States)

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

  2. Comprehensive Care For Joint Replacement Model - Provider Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — Comprehensive Care for Joint Replacement Model - provider data. This data set includes provider data for two quality measures tracked during an episode of care:...

  3. Ionic liquids, electrolyte solutions including the ionic liquids, and energy storage devices including the ionic liquids

    Science.gov (United States)

    Gering, Kevin L.; Harrup, Mason K.; Rollins, Harry W.

    2015-12-08

    An ionic liquid including a phosphazene compound that has a plurality of phosphorus-nitrogen units and at least one pendant group bonded to each phosphorus atom of the plurality of phosphorus-nitrogen units. One pendant group of the at least one pendant group comprises a positively charged pendant group. Additional embodiments of ionic liquids are disclosed, as are electrolyte solutions and energy storage devices including the embodiments of the ionic liquid.

  4. [Analyses of deaths can provide meaningful learning].

    Science.gov (United States)

    Jensen, Marie Rosenørn Hviid; Jørsboe, Hanne Blæhr

    2016-05-16

    Learning based on deceased patients has provided medicine with substantial knowledge and is still a source of new information. The basic learning approach has been autopsies, but focus has shifted towards analysis of registry data. This article evaluates different ways to analyse the natural deaths, including autopsies, audits, clinical databases and hospital standardised mortality ratios in regard of clinical learning. We claim that data-powered analysis cannot stand alone, and recommend that clinicians should organise multidisciplinary theoretically based audits, in order to keep learning from the deceased.

  5. Optical fiber head for providing lateral viewing

    Science.gov (United States)

    Everett, Matthew J.; Colston, Billy W.; James, Dale L.; Brown, Steve; Da Silva, Luiz

    2002-01-01

    The head of an optical fiber comprising the sensing probe of an optical heterodyne sensing device includes a planar surface that intersects the perpendicular to axial centerline of the fiber at a polishing angle .theta.. The planar surface is coated with a reflective material so that light traveling axially through the fiber is reflected transverse to the fiber's axial centerline, and is emitted laterally through the side of the fiber. Alternatively, the planar surface can be left uncoated. The polishing angle .theta. must be no greater than 39.degree. or must be at least 51.degree.. The emitted light is reflected from adjacent biological tissue, collected by the head, and then processed to provide real-time images of the tissue. The method for forming the planar surface includes shearing the end of the optical fiber and applying the reflective material before removing the buffer that circumscribes the cladding and the core.

  6. Directed Energy Anechoic Chamber

    Data.gov (United States)

    Federal Laboratory Consortium — The Directed Energy Anechoic Chamber comprises a power anechoic chamber and one transverse electromagnetic cell for characterizing radiofrequency (RF) responses of...

  7. Earthquake analysis of structures including structure-soil interaction by a substructure method

    International Nuclear Information System (INIS)

    Chopra, A.K.; Guttierrez, J.A.

    1977-01-01

    A general substructure method for analysis of response of nuclear power plant structures to earthquake ground motion, including the effects of structure-soil interaction, is summarized. The method is applicable to complex structures idealized as finite element systems and the soil region treated as either a continuum, for example as a viscoelastic halfspace, or idealized as a finite element system. The halfspace idealization permits reliable analysis for sites where essentially similar soils extend to large depths and there is no rigid boundary such as soil-rock interface. For sites where layers of soft soil are underlain by rock at shallow depth, finite element idealization of the soil region is appropriate; in this case, the direct and substructure methods would lead to equivalent results but the latter provides the better alternative. Treating the free field motion directly as the earthquake input in the substructure method eliminates the deconvolution calculations and the related assumption -regarding type and direction of earthquake waves- required in the direct method. The substructure method is computationally efficient because the two substructures-the structure and the soil region- are analyzed separately; and, more important, it permits taking advantage of the important feature that response to earthquake ground motion is essentially contained in the lower few natural modes of vibration of the structure on fixed base. For sites where essentially similar soils extend to large depths and there is no obvious rigid boundary such as a soil-rock interface, numerical results for earthquake response of a nuclear reactor structure are presented to demonstrate that the commonly used finite element method may lead to unacceptable errors; but the substructure method leads to reliable results

  8. Provider-based Medicare risk contracting and subcontracting: opportunities and risks for provider sponsored organizations.

    Science.gov (United States)

    Levin, H A; Zenner, P A; Kipp, R A; Whitney, E L

    1997-01-01

    Provider sponsored organizations (PSOs) are increasingly acquiring the risk for the management of Medicare Risk patients by accepting capitation directly from the Health Care Financing Administration (HCFA) or through contracts with HMOs or other organizations contracting with HCFA. The Medicare population and the requirements that the federal administration has put into place with respect to risk contracting are unique and demand specific responses on the part of the PSO for a contract to be successful. The PSO is cautioned to understand the actuarial risk, the clinical uniqueness of the Medicare beneficiary, Medicare reimbursement regulatory requirements, utilization management needs, and necessary reporting before entering into a contractual arrangement. This article attempts to describe some of the more common issues a provider organization must consider.

  9. Internet addiction neuroscientific approaches and therapeutical implications including smartphone addiction

    CERN Document Server

    Reuter, Martin

    2017-01-01

    The second edition of this successful book provides further and in-depth insight into theoretical models dealing with Internet addiction, as well as includes new therapeutical approaches. The editors also broach the emerging topic of smartphone addiction. This book combines a scholarly introduction with state-of-the-art research in the characterization of Internet addiction. It is intended for a broad audience including scientists, students and practitioners. The first part of the book contains an introduction to Internet addiction and their pathogenesis. The second part of the book is dedicated to an in-depth review of neuroscientific findings which cover studies using a variety of biological techniques including brain imaging and molecular genetics. The third part of the book focuses on therapeutic interventions for Internet addiction. The fourth part of the present book is an extension to the first edition and deals with a new emerging potential disorder related to Internet addiction – smartphone addicti...

  10. Classical mechanics including an introduction to the theory of elasticity

    CERN Document Server

    Hentschke, Reinhard

    2017-01-01

    This textbook teaches classical mechanics as one of the foundations of physics. It describes the mechanical stability and motion in physical systems ranging from the molecular to the galactic scale. Aside from the standard topics of mechanics in the physics curriculum, this book includes an introduction to the theory of elasticity and its use in selected modern engineering applications, e.g. dynamic mechanical analysis of viscoelastic materials. The text also covers many aspects of numerical mechanics, ranging from the solution of ordinary differential equations, including molecular dynamics simulation of many particle systems, to the finite element method. Attendant Mathematica programs or parts thereof are provided in conjunction with selected examples. Numerous links allow the reader to connect to related subjects and research topics. Among others this includes statistical mechanics (separate chapter), quantum mechanics, space flight, galactic dynamics, friction, and vibration spectroscopy. An introductory...

  11. The Consumer Rights Directive

    NARCIS (Netherlands)

    Luzak, J.A.; Mak, V.; Hartkamp, A.S.; Sieburgh, C.H.; Keus, L.A.D.; Kortmann, J.S.; Wissink, M.H.

    2014-01-01

    This contribution discusses the impact of the CRD on Dutch private law. How will the new directive influence consumer rights and how does this fit with existing law? Considering the background of the directive and its importance for European consumer law, however, we discuss these questions in the

  12. Mounting Systems for Structural Members, Fastening Assemblies Thereof, and Vibration Isolation Systems Including the Same

    Science.gov (United States)

    Young, Ken (Inventor); Hindle, Timothy (Inventor); Barber, Tim Daniel (Inventor)

    2016-01-01

    Mounting systems for structural members, fastening assemblies thereof, and vibration isolation systems including the same are provided. Mounting systems comprise a pair of mounting brackets, each clamped against a fastening assembly forming a mounting assembly. Fastening assemblies comprise a spherical rod end comprising a spherical member having a through opening and an integrally threaded shaft, first and second seating members on opposite sides of the spherical member and each having a through opening that is substantially coaxial with the spherical member through opening, and a partially threaded fastener that threadably engages each mounting bracket forming the mounting assembly. Structural members have axial end portions, each releasably coupled to a mounting bracket by the integrally threaded shaft. Axial end portions are threaded in opposite directions for permitting structural member rotation to adjust a length thereof to a substantially zero strain position. Structural members may be vibration isolator struts in vibration isolation systems.

  13. Nuclear resonance apparatus including means for rotating a magnetic field

    International Nuclear Information System (INIS)

    Sugimoto, H.

    1983-01-01

    A nuclear magnetic resonance apparatus including magnet apparatus for generating a homogeneous static magnetic field between its magnetic poles, shims of a magnetic substance mounted on the magnetic poles to apply a first gradient magnetic field intensity distribution in a direction orthogonal as to the direction of line of magnetic force of the static magnetic field, gradient magnetic field generating electromagnetic apparatus for generating a second gradient magnetic field having a gradient magnetic field intensity distribution in superimposition with the static magnetic field and for changing the magnetic field gradient of the first gradient magnetic field, an oscillator for generating an oscillating output having a frequency corresponding to the nuclear magnetic resonance condition of an atomic nucleus to be measured, a coil wound around a body to be examined for applying the output of said oscillator as electromagnetic waves upon the body, a receiver for detecting the nuclear magnetic resonance signals received by the coil, a gradient magnetic field controller making a magnetic field line equivalent to the combined gradient magnetic fields and for rotating the line along the section of the body to be examined by controlling said gradient magnetic field generating electromagnetic apparatus and devices for recording the nuclear magnetic resonance signals, for reconstructing the concentration distribution of the specific atomic nuclei in the section of the body, and a display unit for depicting the result of reconstruction

  14. Directionality effects in percolation

    Science.gov (United States)

    Redner, Sidney

    The percolation properties of random networks containing resistors (two-way streets) and/or diodes (one-way streets) are considered. The directionality constraints of the diodes are found to lead to novel geometrical behavior. As a simple example, various random cluster models with a preferred direction, such as directed random walks or directed lattice animals, are shown to be anisotropic in character. The critical behavior of directed percolation is then treated and its connection with branching Markov processes is explained. A closely related "reverse" percolation problem, a transition from one-way percolation to isotropic percolation, is introduced. Finally, the geometrical properties of a network containing arbitrarily oriented diodes are treated. Symmetry and duality arguments are applied to yield exact results for certain aspects of its critical behavior.

  15. Catalyst support structure, catalyst including the structure, reactor including a catalyst, and methods of forming same

    Science.gov (United States)

    Van Norman, Staci A.; Aston, Victoria J.; Weimer, Alan W.

    2017-05-09

    Structures, catalysts, and reactors suitable for use for a variety of applications, including gas-to-liquid and coal-to-liquid processes and methods of forming the structures, catalysts, and reactors are disclosed. The catalyst material can be deposited onto an inner wall of a microtubular reactor and/or onto porous tungsten support structures using atomic layer deposition techniques.

  16. Supercapacitor to Provide Ancillary Services: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, Eduard [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Luo, Yusheng [Idaho National Laboratory; Mohanpurkar, M. [Idaho National Laboratory; Hovsapian, R. [Idaho National Laboratory; Koritarov, V. [Argonne National Laboratory

    2017-10-09

    Supercapacitor technology has reached a level of maturity as a viable energy storage option available to support a modern electric power system grid; however, its application is still limited because of its energy capacity and the cost of the commercial product. In this paper, we demonstrate transient models of supercapacitor energy storage plants operating in coordination with run-of-the-river (ROR), doubly-fed induction generator hydropower plants (HPP) using a system control concept and architecture developed. A detailed transient model of a supercapacitor energy storage device is coupled with the grid via a three-phase inverter/rectifier and bidirectional DC-DC converter. In addition, we use a version of a 14-bus IEEE test case that includes the models of the supercapacitor energy storage device, ROR HPPs, and synchronous condensers that use the rotating synchronous generators of retired coal-powered plants. The purpose of the synchronous condensers is to enhance the system stability by providing voltage and reactive power control, provide power system oscillations damping, and maintain system inertia at secure levels. The control layer provides coordinated, decentralized operation of distributed ROR HPPs and energy storage as aggregate support to power system operations.

  17. The omni-directional image assisted optical surveillance system

    Science.gov (United States)

    Chen, Yung-Hsiang; Hwang, Chi-Hung; Wang, Wei-Chung; Lin, Chun-Fu

    2015-05-01

    This paper presents a high resolution optical surveillance system which integrated an omni-directional imager as an event finder/ system trigger. The omni-directional optics, a fish-eye camera in this study, provides a wider field of view (FOV) which can monitor widely range continuously without scanning mechanism but offers sufficient information which includes sign of field event and direction and then drive high resolution surveillance camera for detail imaging. To archive an optical triggering surveillance system, the scale-invariant feature transform (SIFT) is implemented to detect features both from images taken by omni-directional imager and the high resolution surveillance camera. Considering the FOV of high resolution surveillance system is narrow, to ensure the pointing of high resolution surveillance system, feature matching is also implemented in this system to identify the images obtained by high resolution surveillance system are identical to the existing omni-directional image obtained from fish-eye camera. This provides a robust and accurate solution to the problem of optical radar surveillance system localization in unknown environments. An experiment is performed on outdoor image sequences with demonstrating the efficiency of our algorithm.

  18. Policies for including disabled people in education. obstacles and facilitating factors for their implementation: Bucaramanga, 2010

    Directory of Open Access Journals (Sweden)

    Claudia P. Serrano R

    2011-07-01

    Full Text Available Objective: to explore the factors enabling or hindering the implementation of inclusive education policies for the disabled population of Bucaramanga. Methodology: a descriptive study, involving representatives from governmental agencies (EG, members of the faculty boards of educational institutions (DIE and guardians of disabled individuals (APSD. Physical, social, and political obstacles and facilitating factors that could potentially determine the implementation of these policies were analyzed. Data was collected through interviews. Results: there was a total of 2, 32, and 34 participants from the EG, DIE, and APSD groups respectively. Identified obstacles included: lack of strategies to support educational institutions, poor or limited teacher training, high tuition fees, and negative attitude towards disability. The facilitating factors included: availability of places, inclusion of this issue in the political agenda, and desire of the disabled individuals’ families to provide them with education. Discussion: These findings provide useful information for further research on this issue and show how action has been taken, as well as how urgent it is to establish a direct relationship between academia and the public sector to propose strategies for assessing and modifying these policies.

  19. Direct conversion of algal biomass to biofuel

    Science.gov (United States)

    Deng, Shuguang; Patil, Prafulla D; Gude, Veera Gnaneswar

    2014-10-14

    A method and system for providing direct conversion of algal biomass. Optionally, the method and system can be used to directly convert dry algal biomass to biodiesels under microwave irradiation by combining the reaction and combining steps. Alternatively, wet algae can be directly processed and converted to fatty acid methyl esters, which have the major components of biodiesels, by reacting with methanol at predetermined pressure and temperature ranges.

  20. Direct conversion of fusion energy

    Energy Technology Data Exchange (ETDEWEB)

    Johansson, Markus

    2003-03-01

    Deuterium and tritium are expected to be used as fuel in the first fusion reactors. Energy is released as kinetic energy of ions and neutrons, when deuterium reacts with tritium. One way to convert the kinetic energy to electrical energy, is to let the ions and neutrons hit the reactor wall and convert the heat that is caused by the particle bombardment to electrical energy with ordinary thermal conversion. If the kinetic energy of the ions instead is converted directly to electrical energy, a higher efficiency of the energy conversion is possible. The majority of the fusion energy is released as kinetic energy of neutrons, when deuterium reacts with tritium. Fusion reactions such as the D-D reactions, the D-{sup 3}He reaction and the p-{sup 11}B reaction, where a larger part of the fusion energy becomes kinetic energy of charged particles, appears therefore more suitable for direct conversion. Since they have lower reactivity than the D-T reaction, they need a larger {beta}B{sup 2}{sub 0} to give sufficiently high fusion power density. Because of this, the fusion configurations spherical torus (ST) and field-reversed configuration (FRC), where high {beta} values are possible, appear interesting. Rosenbluth and Hinton come to the conclusion that efficient direct conversion isn't possible in closed field line systems and that open geometries, which facilitate direct conversion, provide inadequate confinement for D-{sup 3}He. It is confirmed in this study that it doesn't seem possible to achieve as high direct conversion efficiency in closed systems as in open systems. ST and FRC fusion power plants that utilize direct conversion seem however interesting. Calculations with the help of Maple indicate that the reactor parameters needed for a D-D ST and a D{sub 3} He ST hopefully are possible to achieve. The best energy conversion option for a D-D or D{sub 3} He ST appears to be direct electrodynamic conversion (DEC) together with ordinary thermal conversion

  1. DIRECTIONS AND CHALLENGES IN GLOBAL AGRICULTURE

    Directory of Open Access Journals (Sweden)

    Daniela POPA

    2013-01-01

    Full Text Available The development of global agricultural market has been at the forefront of professional studies. Expert opinions have quite differing views as to whether the world’s food production will be able to supply the huge demand of growing population. This scientific paper provides a general overview of global agricultural directions, including views on whether agricultural productivity increases will be able to keep with food demand increases and price trends. The scientific paper has focused on the present state of the agricultural market and on the analysis of the key factors defining the tasks of the agricultural sector in the near future, with a special attention to the case of Republic of Moldova.

  2. Direct UV-writing of waveguides

    DEFF Research Database (Denmark)

    Færch, Kjartan Ullitz

    2003-01-01

    The research presented in this phd thesis is concerned about fabrication of waveguide structures in photosensitized germanosilica thin films by exposure to Ultra-violet (UV) radiation. Using a high pressure loading system and a waveguide fabrication setup, planar waveguiding structures with an UV...... induced refractive index change of more than 10-2 have been obtained. New insight, with respect to understanding the UV induced index change obtained by direct UV writing, has been provided, through experiments conducted with such high-pressure loaded germanosilica samples. This include measurements...... of the UV induced refractive index change, and spectroscopic measurements of the defect distribution, for various fabrication parameters. A method to measure the concentration of molecular hydrogen in thin film planar waveguide samples is established and validated for hydrogen loadign at up to 12 mole...

  3. EDM 1.0: electron direct methods.

    Science.gov (United States)

    Kilaas, R; Marks, L D; Own, C S

    2005-02-01

    A computer program designed to provide a number of quantitative analysis tools for high-resolution imaging and electron diffraction data is described. The program includes basic image manipulation, both real space and reciprocal space image processing, Wiener-filtering, symmetry averaging, methods for quantification of electron diffraction patterns and two-dimensional direct methods. The program consists of a number of sub-programs written in a combination of C++, C and Fortran. It can be downloaded either as GNU source code or as binaries and has been compiled and verified on a wide range of platforms, both Unix based and PC's. Elements of the design philosophy as well as future possible extensions are described.

  4. New Directions in Chronic Disease Management

    Directory of Open Access Journals (Sweden)

    Hun-Sung Kim

    2015-06-01

    Full Text Available A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions.

  5. Adiabatic equilibrium models for direct containment heating

    International Nuclear Information System (INIS)

    Pilch, M.; Allen, M.D.

    1991-01-01

    Probabilistic risk assessment (PRA) studies are being extended to include a wider spectrum of reactor plants than was considered in NUREG-1150. There is a need for simple direct containment heating (DCH) models that can be used for screening studies aimed at identifying potentially significant contributors to overall risk in individual nuclear power plants. This paper presents two adiabatic equilibrium models suitable for the task. The first, a single-cell model, places a true upper bound on DCH loads. This upper bound, however, often far exceeds reasonable expectations of containment loads based on CONTAIN calculations and experiment observations. In this paper, a two cell model is developed that captures the major mitigating feature of containment compartmentalization, thus providing more reasonable estimates of the containment load

  6. Providing Real Research Opoportunities to Undergraduates

    Science.gov (United States)

    Ragozzine, Darin

    2016-01-01

    The current approach to undergraduate education focuses on teaching classes which provide the foundational knowledge for more applied experiences such as scientific research. Like most programs, Florida Institute of Technology (Florida Tech or FIT) strongly encourages undergraduate research, but is dominated by content-focused courses (e.g., "Physical Mechanics"). Research-like experiences are generally offered through "lab" classes, but these are almost always reproductions of past experiments: contrived, formulaic, and lacking the "heart" of real (i.e., potentially publishable) scientific research. Real research opportunities 1) provide students with realistic insight into the actual scientific process; 2) excite students far more than end-of-chapter problems; 3) provide context for the importance of learning math, physics, and astrophysics concepts; and 4) allow unique research progress for well-chosen problems. I have provided real research opportunities as an "Exoplanet Lab" component of my Introduction to Space Science (SPS1020) class at Florida Tech, generally taken by first-year majors in our Physics, Astronomy & Astrophysics, Planetary Science, and Astrobiology degree programs. These labs are a hybrid between citizen science (e.g., PlanetHunters) and simultaneously mentoring ~60 undergraduates in similar small research projects. These projects focus on problems that can be understood in the context of the course, but which benefit from "crowdsourcing". Examples include: dividing up the known planetary systems and developing a classification scheme and organizing them into populations (Fall 2013); searching through folded light curves to discover new exoplanets missed by previous pipelines (Fall 2014); and fitting n-body models to all exoplanets with known Transit Timing Variations to estimate planet masses (Fall 2015). The students love the fact that they are doing real potentially publishable research: not many undergraduates can claim to have discovered

  7. Direction of time

    International Nuclear Information System (INIS)

    Mirman, R.

    1975-01-01

    The meaning of the phrase ''the direction of time'' and the physical problems involved are considered. These problems are discussed, and plausibility arguments are given to show that all clocks run in the same direction (almost always), that the most probable development of the universe during the early stages of the expansion would result in the introduction of some internal organization, and that the expansion of the universe and the increase in entropy define time directions that have the same sense. The question of what properties of the laws governing the universe lead to these results is studied

  8. Laser direct writing of micro- and nano-scale medical devices

    Science.gov (United States)

    Gittard, Shaun D; Narayan, Roger J

    2010-01-01

    Laser-based direct writing of materials has undergone significant development in recent years. The ability to modify a variety of materials at small length scales and using short production times provides laser direct writing with unique capabilities for fabrication of medical devices. In many laser-based rapid prototyping methods, microscale and submicroscale structuring of materials is controlled by computer-generated models. Various laser-based direct write methods, including selective laser sintering/melting, laser machining, matrix-assisted pulsed-laser evaporation direct write, stereolithography and two-photon polymerization, are described. Their use in fabrication of microstructured and nanostructured medical devices is discussed. Laser direct writing may be used for processing a wide variety of advanced medical devices, including patient-specific prostheses, drug delivery devices, biosensors, stents and tissue-engineering scaffolds. PMID:20420557

  9. Memoization in Type-Directed Partial Evaluation

    DEFF Research Database (Denmark)

    Balat, Vincent; Danvy, Olivier

    2002-01-01

    the functions and type-directed partial evaluation provides a convenient setting to obtain the normal form of their composition. However, off-the-shelf type-directed partial evaluation turns out to yield gigantic normal forms. We identify that this gigantism is due to redundancies, and that these redundancies...

  10. Is Neural Machine Translation Ready for Deployment? A Case Study on 30 Translation Directions

    OpenAIRE

    Junczys-Dowmunt, Marcin; Dwojak, Tomasz; Hoang, Hieu

    2016-01-01

    In this paper we provide the largest published comparison of translation quality for phrase-based SMT and neural machine translation across 30 translation directions. For ten directions we also include hierarchical phrase-based MT. Experiments are performed for the recently published United Nations Parallel Corpus v1.0 and its large six-way sentence-aligned subcorpus. In the second part of the paper we investigate aspects of translation speed, introducing AmuNMT, our efficient neural machine ...

  11. [Small scale direct oxide reduction (DOR) experiments

    International Nuclear Information System (INIS)

    1987-01-01

    Objectives were to provide process design information to the Plutonium Recovery Project and to produce DOR (direct oxide reduction) product which meets Foundry purity specifications and Oh-0 Foundry specifications

  12. Self-Directed Learning with Feedback

    Science.gov (United States)

    Choi, Youngeun; Anderson, William

    2016-01-01

    This article describes a weekly writing assignment named SelFeed (Self-Directed Learning with Feedback), in which students are asked to identify their own questions relevant to the lecture content and provide logical answers.

  13. Construction engineering inspection direct cost survey.

    Science.gov (United States)

    2014-07-01

    The objective of the study was to provide a rationale to Georgia Department of Transportation : (GDOT) for Direct Costs in terms of salary and wages charged by qualified independent : contractors performing Construction Engineering Inspection (CEI) s...

  14. Advance Directives - Multiple Languages

    Science.gov (United States)

    ... Expand Section Advance Directives - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Chinese, Traditional (Cantonese dialect) (繁體中文) Expand Section Advance ...

  15. Modeling of Pem Fuel Cell Systems Including Controls and Reforming Effects for Hybrid Automotive Applications

    National Research Council Canada - National Science Library

    Boettner, Daisie

    2001-01-01

    .... This study develops models for a stand-alone Proton Exchange Membrane (PEM) fuel cell stack, a direct-hydrogen fuel cell system including auxiliaries, and a methanol reforming fuel cell system for integration into a vehicle performance simulator...

  16. Directed GF-spaces

    Directory of Open Access Journals (Sweden)

    F.G. Arenas

    2001-10-01

    Full Text Available In this paper we introduce the concept of directed fractal structure, which is a generalization of the concept of fractal structure (introduced by the authors. We study the relation with transitive quasiuniformities and inverse limits of posets. We define the concept of GF-compactification and apply it to prove that the Stone-Cech compactification can be obtained as the GF-compactification of the directed fractal structure associated to the Pervin quasi-uniformity.

  17. Electrolyte solutions including a phosphoranimine compound, and energy storage devices including same

    Science.gov (United States)

    Klaehn, John R.; Dufek, Eric J.; Rollins, Harry W.; Harrup, Mason K.; Gering, Kevin L.

    2017-09-12

    An electrolyte solution comprising at least one phosphoranimine compound and a metal salt. The at least one phosphoranimine compound comprises a compound of the chemical structure ##STR00001## where X is an organosilyl group or a tert-butyl group and each of R.sup.1, R.sup.2, and R.sup.3 is independently selected from the group consisting of an alkyl group, an aryl group, an alkoxy group, or an aryloxy group. An energy storage device including the electrolyte solution is also disclosed.

  18. Head direction cell activity in mice: robust directional signal depends on intact otolith organs

    Science.gov (United States)

    Yoder, Ryan M.; Taube, Jeffrey S.

    2009-01-01

    The head direction (HD) cell signal is a representation of an animal's perceived directional heading with respect to its environment. This signal appears to originate in the vestibular system, which includes the semicircular canals and otolith organs. Preliminary studies indicate the semicircular canals provide a necessary component of the HD signal, but involvement of otolithic information in the HD signal has not been tested. The present study was designed to determine the otolithic contribution to the HD signal, as well as to compare HD cell activity of mice to that of rats. HD cell activity in the anterodorsal thalamus was assessed in wild-type C57BL/6J and otoconia-deficient tilted mice during locomotion within a cylinder containing a prominent visual landmark. HD cell firing properties in C57BL/6J mice were generally similar to those in rats. However, in C57BL/6J mice, landmark rotation failed to demonstrate dominant control of the HD signal in 36% of the sessions. In darkness, directional firing became unstable during 42% of the sessions, but landmark control was not associated with HD signal stability in darkness. HD cells were identified in tilted mice, but directional firing properties were not as robust as those of C57BL/6J mice. Most HD cells in tilted mice were controlled by landmark rotation, but showed substantial signal degradation across trials. These results support current models that suggest otolithic information is involved in the perception of directional heading. Furthermore, compared to rats, the HD signal in mice appears to be less reliably anchored to prominent environmental cues. PMID:19176815

  19. Directional gear ratio transmissions

    Science.gov (United States)

    Lafever, A. E. (Inventor)

    1984-01-01

    Epicyclic gear transmissions which transmit output at a gear ratio dependent only upon the input's direction are considered. A transmission housing envelops two epicyclic gear assemblies, and has shafts extending from it. One shaft is attached to a sun gear within the first epicyclic gear assembly. Planet gears are held symmetrically about the sun gear by a planet gear carrier and are in mesh with both the sun gear and a ring gear. Two unidirectional clutches restrict rotation of the first planet gear carrier and ring gear to one direction. A connecting shaft drives a second sun gear at the same speed and direction as the first planet gear carrier while a connecting portion drives a second planet gear carrier at the same speed and direction as the first ring gear. The transmission's output is then transmitted by the second ring gear to the second shaft. Input is transmitted at a higher gear ratio and lower speed for all inputs in the first direction than in the opposite direction.

  20. Optimage central organised image quality control including statistics and reporting

    International Nuclear Information System (INIS)

    Jahnen, A.; Schilz, C.; Shannoun, F.; Schreiner, A.; Hermen, J.; Moll, C.

    2008-01-01

    Quality control of medical imaging systems is performed using dedicated phantoms. As the imaging systems are more and more digital, adequate image processing methods might help to save evaluation time and to receive objective results. The developed software package OPTIMAGE is focusing on this with a central approach: On one hand, OPTIMAGE provides a framework, which includes functions like database integration, DICOM data sources, multilingual user interface and image processing functionality. On the other hand, the test methods are implemented using modules which are able to process the images automatically for the common imaging systems. The integration of statistics and reporting into this environment is paramount: This is the only way to provide these functions in an interactive, user-friendly way. These features enable the users to discover degradation in performance quickly and document performed measurements easily. (authors)

  1. Actuator assembly including a single axis of rotation locking member

    Science.gov (United States)

    Quitmeyer, James N.; Benson, Dwayne M.; Geck, Kellan P.

    2009-12-08

    An actuator assembly including an actuator housing assembly and a single axis of rotation locking member fixedly attached to a portion of the actuator housing assembly and an external mounting structure. The single axis of rotation locking member restricting rotational movement of the actuator housing assembly about at least one axis. The single axis of rotation locking member is coupled at a first end to the actuator housing assembly about a Y axis and at a 90.degree. angle to an X and Z axis providing rotation of the actuator housing assembly about the Y axis. The single axis of rotation locking member is coupled at a second end to a mounting structure, and more particularly a mounting pin, about an X axis and at a 90.degree. angle to a Y and Z axis providing rotation of the actuator housing assembly about the X axis. The actuator assembly is thereby restricted from rotation about the Z axis.

  2. Equal Angle Distribution of Polling Directions in Direct-Search Methods

    Directory of Open Access Journals (Sweden)

    Benjamin Van Dyke

    2014-01-01

    Full Text Available The purpose of this paper is twofold: first, to introduce deterministic strategies for directional direct-search methods, including new instances of the mesh adaptive direct-search (MADS and the generating set search (GSS class of algorithms, which utilize a nice distribution of PoLL directions when compared to other strategies, and second, to introduce variants of each algorithm which utilize a minimal positive basis at each step. The strategies base their PoLL directions on the use of the QR decomposition to obtain an orthogonal set of directions or on using the equal angular directions from a regular simplex centered at the origin with vertices on the unit sphere. Test results are presented on a set of smooth, nonsmooth, unconstrained, and constrained problems that give comparisons between the various implementations of these directional direct-search methods.

  3. Under what conditions are provided services in Czech municipalities?

    Directory of Open Access Journals (Sweden)

    Markéta Fantová Šumpíková

    2007-10-01

    Full Text Available The goal of our paper is to present a set of analytical data connected with local services and their delivery arrangements, focusing on contracting out. Brief theoretical part of this paper shortly highlights theoretical issues of local service delivery and new alternative service delivery arrangements. Analytical part provides selected data on forms of delivery and the ways of selection of an external supplier, including comparisons with similar research data from Slovakia. This study uses a positive approach to investigate the research issue. The study analyzes the original collected survey data from own research project No. 402/05/2644 supported by Czech Scientific Foundation. A survey was conducted for each of selected local service to collect data on the structure of forms of delivery of service; the decision-making processes, concerning the selection of the delivery form; and in case of external delivery, the way/system selecting the external supplier and some other selected aspects of the contracting-out. The delivery of local services by external supplier or municipal firm is frequent solution. However, the selection of supplier is realized in many cases without any competition, via the direct award, resulting in non-transparency and bringing inefficiency risks. The final part of our paper summarizes the outcomes and formulates recommendations.

  4. Energy storage device including a redox-enhanced electrolyte

    Science.gov (United States)

    Stucky, Galen; Evanko, Brian; Parker, Nicholas; Vonlanthen, David; Auston, David; Boettcher, Shannon; Chun, Sang-Eun; Ji, Xiulei; Wang, Bao; Wang, Xingfeng; Chandrabose, Raghu Subash

    2017-08-08

    An electrical double layer capacitor (EDLC) energy storage device is provided that includes at least two electrodes and a redox-enhanced electrolyte including two redox couples such that there is a different one of the redox couples for each of the electrodes. When charged, the charge is stored in Faradaic reactions with the at least two redox couples in the electrolyte and in a double-layer capacitance of a porous carbon material that comprises at least one of the electrodes, and a self-discharge of the energy storage device is mitigated by at least one of electrostatic attraction, adsorption, physisorption, and chemisorption of a redox couple onto the porous carbon material.

  5. 78 FR 32347 - Airworthiness Directives; Airbus Airplanes

    Science.gov (United States)

    2013-05-30

    ...-002-AD; Amendment 39-17459; AD 2013-10-06] RIN 2120-AA64 Airworthiness Directives; Airbus Airplanes.... SUMMARY: We are adopting a new airworthiness directive (AD) for all Airbus Model A330-200 Freighter, A330... information: Airbus Mandatory Service Bulletin A330-56-3009, Revision 02, including Appendix 01, dated...

  6. SDR (Systems Directed Reading): An Overview.

    Science.gov (United States)

    Baugo Community Schools, Elkhart, IN.

    The objective of this project for kindergarten through fifth grade is to interest public and private educational institutions in the systematization of elementary school reading programs. Facets of Systems Directed Reading (SDR) include the use of a differentiated staffing pattern; experienced language arts unit leaders guiding and directing all…

  7. Laboratory Directed Research and Development Program FY 2006 Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    Sjoreen, Terrence P [ORNL

    2007-04-01

    The Oak Ridge National Laboratory (ORNL) Laboratory Directed Research and Development (LDRD) Program reports its status to the US Departmental of Energy (DOE) in March of each year. The program operates under the authority of DOE Order 413.2B, 'Laboratory Directed Research and Development' (April 19, 2006), which establishes DOE's requirements for the program while providing the Laboratory Director broad flexibility for program implementation. LDRD funds are obtained through a charge to all Laboratory programs. This report includes summaries all ORNL LDRD research activities supported during FY 2006. The associated FY 2006 ORNL LDRD Self-Assessment (ORNL/PPA-2007/2) provides financial data about the FY 2006 projects and an internal evaluation of the program's management process.

  8. Providing informal care in a changing society.

    Science.gov (United States)

    Broese van Groenou, Marjolein I; De Boer, Alice

    The ageing of society is leading to significant reforms in long-term care policy and systems in many European countries. The cutbacks in professional care are increasing demand for informal care considerably, from both kin and non-kin. At the same time, demographic and societal developments such as changing family structures and later retirement may limit the supply of informal care. This raises the question as to whether the volume of informal care (in people) will increase in the years ahead. This paper aims to provide a theoretical answer to this question in two steps. First, based on different care models and empirical literature, we develop a behavioural model on individual caregiving, the Informal Care Model. The model states that, in response to the care recipient's need for care, the intention to provide care is based on general attitudes, quality of the relationship, normative beliefs, and perceived barriers. Whether one actually provides care also depends on the care potential of the social context, being the family, the social network, and the community. Second, we discuss how current policy and societal developments may negatively or positively impact on these mechanisms underlying the provision of informal care. Given the increased need for care among home-dwelling individuals, the model suggests that more people will take up the caregiver role in the years ahead contributing to larger and more diverse care networks. It is concluded that long-term informal care provision is a complex phenomenon including multiple actors in various contexts. More research is needed to test the Informal Care Model empirically, preferably using information on care recipients, informal caregivers and community care in a dynamic design and in different countries. Such information will increase insight in the developments in informal care provision in retrenching welfare states.

  9. A study of helicopter stability and control including blade dynamics

    Science.gov (United States)

    Zhao, Xin; Curtiss, H. C., Jr.

    1988-01-01

    A linearized model of rotorcraft dynamics has been developed through the use of symbolic automatic equation generating techniques. The dynamic model has been formulated in a unique way such that it can be used to analyze a variety of rotor/body coupling problems including a rotor mounted on a flexible shaft with a number of modes as well as free-flight stability and control characteristics. Direct comparison of the time response to longitudinal, lateral and directional control inputs at various trim conditions shows that the linear model yields good to very good correlation with flight test. In particular it is shown that a dynamic inflow model is essential to obtain good time response correlation, especially for the hover trim condition. It also is shown that the main rotor wake interaction with the tail rotor and fixed tail surfaces is a significant contributor to the response at translational flight trim conditions. A relatively simple model for the downwash and sidewash at the tail surfaces based on flat vortex wake theory is shown to produce good agreement. Then, the influence of rotor flap and lag dynamics on automatic control systems feedback gain limitations is investigated with the model. It is shown that the blade dynamics, especially lagging dynamics, can severly limit the useable values of the feedback gain for simple feedback control and that multivariable optimal control theory is a powerful tool to design high gain augmentation control system. The frequency-shaped optimal control design can offer much better flight dynamic characteristics and a stable margin for the feedback system without need to model the lagging dynamics.

  10. Monitoring of tritium-contaminated surfaces, including skin

    International Nuclear Information System (INIS)

    Surette, R.A.; Wood, M.J.

    1994-05-01

    We have examined various commercially available tritium surface contamination monitors along with different swipe media and techniques for direct and indirect (swipe) monitoring of contaminated surfaces, including skin. None of the methods or instruments evaluated were more sensitive than the swipe and liquid scintillation counting (LSC) method. Swipe measurements with open-window proportional counters were, in general, less than half as sensitive as LSC, but have the advantages of having the results available almost immediately, and no sample preparation is required. The Nuclear Measurement Corporation's PC-55 is the most suitable instrument we tested for the analysis of routine swipe measurement. The PC-55 was about one third as sensitive as LSC when used with Ontario Hydro filter paper swipe media. Surface contamination measurement results can be obtained within minutes using the PC-55, compared to hours using LSC. The selection of swipe media for use with proportional counter-based instruments is critical. A medium that is electrically insulating can develop an electrostatic charge on its surface; this may alter the field gradient in the detector and may adversely influence the results. Although the PC-55 is sufficiently sensitive and very convenient, operational experience with the instrument is needed before recommending that it replace current LSC methods. The PC-55's susceptibility to internal tritium contamination may limit its practical usefulness. Because of the complexity of using live animals to evaluate direct and indirect methods for assessing skin contamination, pig skin was investigated as a possible substitute. We concluded that, for the first few hours post-exposure, pig skin mimics the kinetics of animal skin that has contacted a tritium-contaminated surface. (author). 30 refs., 1 tab., 7 figs

  11. Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives.

    Science.gov (United States)

    Moradi, G; Mohraz, M; Gouya, M M; Dejman, M; Alinaghi, S S; Rahmani, K; Malekafzali-Ardakani, H

    2015-02-25

    This qualitative study aimed to identify the health-care problems of people living with HIV (PLHIV) in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers (policy-makers, managers, physicians and counsellors) and service recipients (PLHIV and their relatives) - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region.

  12. Statistics Report on TEQSA Registered Higher Education Providers

    Science.gov (United States)

    Australian Government Tertiary Education Quality and Standards Agency, 2015

    2015-01-01

    This statistics report provides a comprehensive snapshot of national statistics on all parts of the sector for the year 2013, by bringing together data collected directly by TEQSA with data sourced from the main higher education statistics collections managed by the Australian Government Department of Education and Training. The report provides…

  13. Statistics Report on TEQSA Registered Higher Education Providers, 2016

    Science.gov (United States)

    Australian Government Tertiary Education Quality and Standards Agency, 2016

    2016-01-01

    This Statistics Report is the third release of selected higher education sector data held by the Australian Government Tertiary Education Quality and Standards Agency (TEQSA) for its quality assurance activities. It provides a snapshot of national statistics on all parts of the sector by bringing together data collected directly by TEQSA with data…

  14. Iterative Adaptive Sampling For Accurate Direct Illumination

    National Research Council Canada - National Science Library

    Donikian, Michael

    2004-01-01

    This thesis introduces a new multipass algorithm, Iterative Adaptive Sampling, for efficiently computing the direct illumination in scenes with many lights, including area lights that cause realistic soft shadows...

  15. Reference book on geothermal direct use

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.J.; Lund, J.W.; Rafferty, K.; Culver, G.

    1994-08-01

    This report presents the direct uses of geothermal energy in the United States. Topics discussed include: low-temperature geothermal energy resources; energy reserves; geothermal heat pumps; geothermal energy for residential buildings; and geothermal energy for industrial usage.

  16. Extreme Events and Energy Providers: Science and Innovation

    Science.gov (United States)

    Yiou, P.; Vautard, R.

    2012-04-01

    Most socio-economic regulations related to the resilience to climate extremes, from infrastructure or network design to insurance premiums, are based on a present-day climate with an assumption of stationarity. Climate extremes (heat waves, cold spells, droughts, storms and wind stilling) affect in particular energy production, supply, demand and security in several ways. While national, European or international projects have generated vast amounts of climate projections for the 21st century, their practical use in long-term planning remains limited. Estimating probabilistic diagnostics of energy user relevant variables from those multi-model projections will help the energy sector to elaborate medium to long-term plans, and will allow the assessment of climate risks associated to those plans. The project "Extreme Events for Energy Providers" (E3P) aims at filling a gap between climate science and its practical use in the energy sector and creating in turn favourable conditions for new business opportunities. The value chain ranges from addressing research questions directly related to energy-significant climate extremes to providing innovative tools of information and decision making (including methodologies, best practices and software) and climate science training for the energy sector, with a focus on extreme events. Those tools will integrate the scientific knowledge that is developed by scientific communities, and translate it into a usable probabilistic framework. The project will deliver projection tools assessing the probabilities of future energy-relevant climate extremes at a range of spatial scales varying from pan-European to local scales. The E3P project is funded by the Knowledge and Innovation Community (KIC Climate). We will present the mechanisms of interactions between academic partners, SMEs and industrial partners for this project. Those mechanisms are elementary bricks of a climate service.

  17. Direct magnification radiography of the hand

    International Nuclear Information System (INIS)

    Presacco, D.; Pellegrini, A.; Di Maggio, C.

    1987-01-01

    The value of direct magnification radiography of the hand and the wrist has been studied in 128 patients affected by rheumatic diseases. Only in a small group (3.17%) magnification determined a higher percentage of correct diagnosis; in the 17.06% of cases direct magnification radiography provided useful increase in information but did not change the diagnisis correctly reached by conventional techniques. In most cases (79.76%) magnification provided only a better image quality but no more information helpful for the diagnosis, because of the high level achieved by convetional techniques. Therefore direct magnification radiography must be used only in selected cases and not as routine radiographyc technique

  18. Direct Numerical Simulations of Transient Dispersion

    Science.gov (United States)

    Porter, M.; Valdes-Parada, F.; Wood, B.

    2008-12-01

    Transient dispersion is important in many engineering applications, including transport in porous media. A common theoretical approach involves upscaling the micro-scale mass balance equations for convection- diffusion to macro-scale equations that contain effective medium quantities. However, there are a number of assumptions implicit in the various upscaling methods. For example, results obtained from volume averaging are often dependent on a given set of length and time scale constraints. Additionally, a number of the classical models for dispersion do not fully capture the early-time dispersive behavior of the solute for a general set of initial conditions. In this work, we present direct numerical simulations of micro-scale transient mass balance equations for convection-diffusion in both capillary tubes and porous media. Special attention is paid to analysis of the influence of a new time- decaying coefficient that filters the effects of the initial conditions. The direct numerical simulations were compared to results obtained from solving the closure problem associated with volume averaging. These comparisons provide a quantitative measure of the significance of (1) the assumptions implicit in the volume averaging method and (2) the importance of the early-time dispersive behavior of the solute due to various initial conditions.

  19. RF waveguide phase-directed power combiners

    Energy Technology Data Exchange (ETDEWEB)

    Nantista, Christopher D.; Dolgashev, Valery A.; Tantawi, Sami G.

    2017-05-02

    High power RF phase-directed power combiners include magic H hybrid and/or superhybrid circuits oriented in orthogonal H-planes and connected using E-plane bends and/or twists to produce compact 3D waveguide circuits, including 8.times.8 and 16.times.16 combiners. Using phase control at the input ports, RF power can be directed to a single output port, enabling fast switching between output ports for applications such as multi-angle radiation therapy.

  20. Determining wave direction using curvature parameters.

    Science.gov (United States)

    de Queiroz, Eduardo Vitarelli; de Carvalho, João Luiz Baptista

    2016-01-01

    The curvature of the sea wave was tested as a parameter for estimating wave direction in the search for better results in estimates of wave direction in shallow waters, where waves of different sizes, frequencies and directions intersect and it is difficult to characterize. We used numerical simulations of the sea surface to determine wave direction calculated from the curvature of the waves. Using 1000 numerical simulations, the statistical variability of the wave direction was determined. The results showed good performance by the curvature parameter for estimating wave direction. Accuracy in the estimates was improved by including wave slope parameters in addition to curvature. The results indicate that the curvature is a promising technique to estimate wave directions.•In this study, the accuracy and precision of curvature parameters to measure wave direction are analyzed using a model simulation that generates 1000 wave records with directional resolution.•The model allows the simultaneous simulation of time-series wave properties such as sea surface elevation, slope and curvature and they were used to analyze the variability of estimated directions.•The simultaneous acquisition of slope and curvature parameters can contribute to estimates wave direction, thus increasing accuracy and precision of results.

  1. Directed information measures in neuroscience

    CERN Document Server

    Vicente, Raul; Lizier, Joseph

    2014-01-01

    Analysis of information transfer has found rapid adoption in neuroscience, where a highly dynamic transfer of information continuously runs on top of the brain's slowly-changing anatomical connectivity. Measuring such transfer is crucial to understanding how flexible information routing and processing give rise to higher cognitive function. Directed Information Measures in Neuroscience reviews recent developments of concepts and tools for measuring information transfer, their application to neurophysiological recordings and analysis of interactions. Written by the most active researchers in the field the book discusses the state of the art, future prospects and challenges on the way to an efficient assessment of neuronal information transfer. Highlights include the theoretical quantification and practical estimation of information transfer, description of transfer locally in space and time, multivariate directed measures, information decomposition among a set of stimulus/responses variables, and the relation ...

  2. Direct reading dosimeter

    International Nuclear Information System (INIS)

    Thomson, I.

    1985-01-01

    This invention is a direct reading dosimeter which is light, small enough to be worn on a person, and measures both dose rates and total dose. It is based on a semiconductor sensor. The gate threshold voltage change rather than absolute value is measured and displayed as a direct reading of the dose rate. This is effected by continuously switching the gate of an MOS transistor from positive to negative bias. The output can directly drive a digital readout or trigger an audible alarm. The sensor device can be a MOSFET, bipolar transistor, or MOSFET capacitor which has its electrical characteristics change due to the trapped charge in the insulating layer of the device

  3. Application of Ethics for Providing Telemedicine Services and Information Technology.

    Science.gov (United States)

    Langarizadeh, Mostafa; Moghbeli, Fatemeh; Aliabadi, Ali

    2017-10-01

    Advanced technology has increased the use of telemedicine and Information Technology (IT) in treating or rehabilitating diseases. An increased use of technology increases the importance of the ethical issues involved. The need for keeping patients' information confidential and secure, controlling a number of therapists' inefficiency as well as raising the quality of healthcare services necessitates adequate heed to ethical issues in telemedicine provision. The goal of this review is gathering all articles that are published through 5 years until now (2012-2017) for detecting ethical issues for providing telemedicine services and Information technology. The reason of this time is improvement of telemedicine and technology through these years. This article is important for clinical practice and also to world, because of knowing ethical issues in telemedicine and technology are always important factors for physician and health providers. the required data in this research were derived from published electronic sources and credible academic articles published in such databases as PubMed, Scopus and Science Direct. The following key words were searched for in separation and combination: tele-health, telemedicine, ethical issues in telemedicine. A total of 503 articles were found. After excluding the duplicates (n= 93), the titles and abstracts of 410 articles were skimmed according to the inclusion criteria. Finally, 64 articles remained. They were reviewed in full text and 36 articles were excluded. At the end, 28 articles were chosen which met our eligibility criteria and were included in this study. Ethics has been of a great significance in IT and telemedicine especially the Internet since there are more chances provided for accessing information. It is, however, accompanied by a threat to patients' personal information. Therefore, suggestions are made to investigate ethics in technology, to offer standards and guidelines to therapists. Due to the advancement in

  4. DIRECT KICKS IN BOXING

    Directory of Open Access Journals (Sweden)

    Izet Kahrović

    2009-11-01

    Full Text Available Hit directly, giving any impact maximum muscle strength is skill, and it is neces- sary to the exercise and learning to make it perfect. Training begins with oral statement, so that students get to know with the techni- que that works. After oral exposure, it is necessary to create a good notion on technology that is adopted. The best way for the creation of good notion is a good demonstration. In direct training kicks in the box, you need patience and gradualness and there- fore uses a large number of additional exercises. In their work with beginners, in the first class, individual elements of technology, and also direct blow, it is necessary to separate the parts and run them on multiple commands, to later come to the confluence in one command. Direct wounds, with left and right hand, can be run from the towns, on the head and body, from the movement, to step forward, step back and step aside, the remedy to the left and right side. Left direct is taking out from a running protrusion hands, but kick, which is a pro- duct of the system, ankle-knee-pelvis and shoulder forward horizontaly. Set at the time of stripes, body weight over the left leg. Right direct from the place, starting ekscentrical reflecsive impuls of a extensor muscle in ankle, knee and joint of a hip.This kind of a sud- den movement is running simultaneously with the rotation of the body around vertical (longitudinal axis, with the transfer body weight on the left leg. Further movement to the hand which serves as a lever, which is transmitted through the power stroke

  5. Insure Kids Now (IKN) (Dental Care Providers)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Insure Kids Now (IKN) Dental Care Providers in Your State locator provides profile information for oral health providers participating in Medicaid and Children's...

  6. Directed flux motor

    Science.gov (United States)

    Wilson, Andrew (Inventor); Punnoose, Andrew (Inventor); Strausser, Katherine (Inventor); Parikh, Neil (Inventor)

    2011-01-01

    A directed flux motor described utilizes the directed magnetic flux of at least one magnet through ferrous material to drive different planetary gear sets to achieve capabilities in six actuated shafts that are grouped three to a side of the motor. The flux motor also utilizes an interwoven magnet configuration which reduces the overall size of the motor. The motor allows for simple changes to modify the torque to speed ratio of the gearing contained within the motor as well as simple configurations for any number of output shafts up to six. The changes allow for improved manufacturability and reliability within the design.

  7. Direct subdural scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Keren, G.; Barzilay, Z.; Czerniak, P.; Cohen, B.E.

    1980-06-01

    We report a case of pneumococcal meningitis in an 8 weeks old female infant followed by persistent subdural effusion successsfully treated by repeated subdural taps. The initial delineation of the subdural effusion, the decrease in size and the disappearance of the fluid were demonstrated by direct subdural scintigraphy (D.S.S.). The literature of pneumoccocal meningitis, its diagnosis, treatment and complications are reviewed, and it is suggested that direct subdural scintigraphy should be employed as a diagnostic aid in the evaluation and follow up of subdural effusions.

  8. Handedness of direct photons

    International Nuclear Information System (INIS)

    Kopeliovich, B.Z.; Rezaeian, A.H.; Schmidt, Ivan

    2008-01-01

    The azimuthal asymmetry of direct photons originating from primary hard scatterings between partons is calculated. This can be accounted for by the inclusion of the color dipole orientation, which is sensitive to the rapid variation of the nuclear profile. To this end we introduce the dipole orientation within the saturation model of Golec-Biernat and Wuesthoff, while preserving all its features at the cross-section level. We show that the direct photon elliptic anisotropy v2 coming from this mechanism changes sign and becomes negative for peripheral collisions, albeit it is quite small for nuclear collisions at the RHIC energy. (author)

  9. The direction of time

    CERN Document Server

    Reichenbach, Hans

    1999-01-01

    Ever a source of philosophical conjecture and debate, the concept of time represents the beating heart of physics. This final work by the distinguished physicist Hans Reichenbach represents the culmination and integration of a lifetime's philosophical contributions and inquiries into the analysis of time. The result is an outstanding overview of such qualitative, or topological, attributes of time as order and direction.Beginning with a discussion of the emotive significance of time, Reichenbach turns to an examination of the time order of mechanics, the time direction of thermodynamics and m

  10. Early Course in Obstetrics Increases Likelihood of Practice Including Obstetrics.

    Science.gov (United States)

    Pearson, Jennifer; Westra, Ruth

    2016-10-01

    The Department of Family Medicine and Community Health Duluth has offered the Obstetrical Longitudinal Course (OBLC) as an elective for first-year medical students since 1999. The objective of the OBLC Impact Survey was to assess the effectiveness of the course over the past 15 years. A Qualtrics survey was emailed to participants enrolled in the course from 1999-2014. Data was compiled for the respondent group as a whole as well as four cohorts based on current level of training/practice. Cross-tabulations with Fisher's exact test were applied and odds ratios calculated for factors affecting likelihood of eventual practice including obstetrics. Participation in the OBLC was successful in increasing exposure, awareness, and comfort in caring for obstetrical patients and feeling more prepared for the OB-GYN Clerkship. A total of 50.5% of course participants felt the OBLC influenced their choice of specialty. For participants who are currently physicians, 51% are practicing family medicine with obstetrics or OB-GYN. Of the cohort of family physicians, 65.2% made the decision whether to include obstetrics in practice during medical school. Odds ratios show the likelihood of practicing obstetrics is higher when participants have completed the OBLC and also are practicing in a rural community. Early exposure to obstetrics, as provided by the OBLC, appears to increase the likelihood of including obstetrics in practice, especially if eventual practice is in a rural community. This course may be a tool to help create a pipeline for future rural family physicians providing obstetrical care.

  11. Direct application of geothermal energy

    Energy Technology Data Exchange (ETDEWEB)

    Reistad, G.M.

    1980-01-01

    An overall treatment of direct geothermal applications is presented with an emphasis on the above-ground engineering. The types of geothermal resources and their general extent in the US are described. The potential market that may be served with geothermal energy is considered briefly. The evaluation considerations, special design aspects, and application approaches for geothermal energy use in each of the applications are considered. The present applications in the US are summarized and a bibliography of recent studies and applications is provided. (MHR)

  12. A Framework for Including Family Health Spillovers in Economic Evaluation

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-01-01

    Health care interventions may affect the health of patients’ family networks. It has been suggested that these “health spillovers” should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the “health care perspective”). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society. PMID:26377370

  13. A Framework for Including Family Health Spillovers in Economic Evaluation.

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-02-01

    Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society. © The Author(s) 2015.

  14. Modeling heart rate variability including the effect of sleep stages

    Science.gov (United States)

    Soliński, Mateusz; Gierałtowski, Jan; Żebrowski, Jan

    2016-02-01

    We propose a model for heart rate variability (HRV) of a healthy individual during sleep with the assumption that the heart rate variability is predominantly a random process. Autonomic nervous system activity has different properties during different sleep stages, and this affects many physiological systems including the cardiovascular system. Different properties of HRV can be observed during each particular sleep stage. We believe that taking into account the sleep architecture is crucial for modeling the human nighttime HRV. The stochastic model of HRV introduced by Kantelhardt et al. was used as the initial starting point. We studied the statistical properties of sleep in healthy adults, analyzing 30 polysomnographic recordings, which provided realistic information about sleep architecture. Next, we generated synthetic hypnograms and included them in the modeling of nighttime RR interval series. The results of standard HRV linear analysis and of nonlinear analysis (Shannon entropy, Poincaré plots, and multiscale multifractal analysis) show that—in comparison with real data—the HRV signals obtained from our model have very similar properties, in particular including the multifractal characteristics at different time scales. The model described in this paper is discussed in the context of normal sleep. However, its construction is such that it should allow to model heart rate variability in sleep disorders. This possibility is briefly discussed.

  15. Electrolytes including fluorinated solvents for use in electrochemical cells

    Science.gov (United States)

    Tikhonov, Konstantin; Yip, Ka Ki; Lin, Tzu-Yuan

    2015-07-07

    Provided are electrochemical cells and electrolytes used to build such cells. The electrolytes include ion-supplying salts and fluorinated solvents capable of maintaining single phase solutions with the salts at between about -30.degree. C. to about 80.degree. C. The fluorinated solvents, such as fluorinated carbonates, fluorinated esters, and fluorinated esters, are less flammable than their non-fluorinated counterparts and increase safety characteristics of cells containing these solvents. The amount of fluorinated solvents in electrolytes may be between about 30% and 80% by weight not accounting weight of the salts. Fluorinated salts, such as fluoroalkyl-substituted LiPF.sub.6, fluoroalkyl-substituted LiBF.sub.4 salts, linear and cyclic imide salts as well as methide salts including fluorinated alkyl groups, may be used due to their solubility in the fluorinated solvents. In some embodiments, the electrolyte may also include a flame retardant, such as a phosphazene or, more specifically, a cyclic phosphazene and/or one or more ionic liquids.

  16. Polymer Directed Protein Assemblies

    Directory of Open Access Journals (Sweden)

    Patrick van Rijn

    2013-05-01

    Full Text Available Protein aggregation and protein self-assembly is an important occurrence in natural systems, and is in some form or other dictated by biopolymers. Very obvious influences of biopolymers on protein assemblies are, e.g., virus particles. Viruses are a multi-protein assembly of which the morphology is dictated by poly-nucleotides namely RNA or DNA. This “biopolymer” directs the proteins and imposes limitations on the structure like the length or diameter of the particle. Not only do these bionanoparticles use polymer-directed self-assembly, also processes like amyloid formation are in a way a result of directed protein assembly by partial unfolded/misfolded biopolymers namely, polypeptides. The combination of proteins and synthetic polymers, inspired by the natural processes, are therefore regarded as a highly promising area of research. Directed protein assembly is versatile with respect to the possible interactions which brings together the protein and polymer, e.g., electrostatic, v.d. Waals forces or covalent conjugation, and possible combinations are numerous due to the large amounts of different polymers and proteins available. The protein-polymer interacting behavior and overall morphology is envisioned to aid in clarifying protein-protein interactions and are thought to entail some interesting new functions and properties which will ultimately lead to novel bio-hybrid materials.

  17. Direct vision internal urethrotomy

    DEFF Research Database (Denmark)

    Jakobsen, H; Willumsen, H; Søndergaard Jensen, L

    1984-01-01

    During a five-year period, direct vision internal urethrotomy was used for the treatment of urethral strictures in 34 men. After the primary operation the patients were followed for an average period of 29 months (range 3-73 months). During this period 53% of the patients were found to have one...

  18. CGH Future Directions

    Science.gov (United States)

    Looking ahead, we have three major future directions that we believe will help us push forward in achieving NCI’s goal of advancing global cancer research, building expertise, and leveraging resources across nations to address the challenges of cancer and reduce cancer deaths worldwide.

  19. Directional loudness perception

    DEFF Research Database (Denmark)

    Sivonen, Ville Pekka

    developed. The research and modeling of loudness have mainly been concerned with the temporal and spectral aspects of sounds, while the spatial aspects have mostly been overlooked. This PhD thesis investigates the spatial aspects of loudness perception, namely, how does the direction from which a sound...

  20. Direct Sulfation of Limestone

    DEFF Research Database (Denmark)

    Hu, Guilin; Dam-Johansen, Kim; Wedel, Stig

    2007-01-01

    The direct sulfation of limestone was studied in a laboratory fixed-bed reactor. It is found that the direct sulfation of limestone involves nucleation and crystal grain growth of the solid product (anhydrite). At 823 K and at low-conversions (less than about 0.5 %), the influences of SO2, O-2...... and CO2 on the direct sulfation of limestone corresponds to apparent reaction orders of about 0.2, 0.2 and -0.5, respectively. Water is observed to promote the sulfation reaction and increase the apparent reaction orders of SO2 and O-2. The influence of O-2 at high O-2 concentrations (> about 15...... %) becomes negligible. In the temperature interval from 723 K to 973 K, an apparent activation energy of about 104 kJ/mol is observed for the direct sulfation of limestone. At low temperatures and low conversions, the sulfation process is most likely under mixed control by chemical reaction and solid...

  1. Direct contamination - seasonality

    International Nuclear Information System (INIS)

    Aarkrog, A.

    1994-01-01

    Direct contamination is the primary pathway to terrestrial vegetation in the first period after an activity release to the atmosphere. All radionuclides are able to be transferred via this pathway. Deposition, interception and retention are the three processes involved in direct contamination of crops. Wet deposition is more important than dry deposition in temperature regions. Resuspension and rainsplash both belong to secondary direct deposition and became evident for e.g. radiocaesium after the Chernobyl accident. Seasonality is the varying response to radioactive contamination of crops according to the time of the year when the contamination occurs. Shortlived radionuclides (as 131 I) and those that mainly enter the foodchain by direct contamination (e.g. 137 Cs) are especially important in this connection. In particular, the contamination of cereal crops is influenced by seasonality. As a result of seasonality the impact of the Chernobyl accident on the radioactive contamination of human diet was for the same deposition density higher in southern than in northern Europe. (orig.)

  2. Direct fired heat exchanger

    Science.gov (United States)

    Reimann, Robert C.; Root, Richard A.

    1986-01-01

    A gas-to-liquid heat exchanger system which transfers heat from a gas, generally the combustion gas of a direct-fired generator of an absorption machine, to a liquid, generally an absorbent solution. The heat exchanger system is in a counterflow fluid arrangement which creates a more efficient heat transfer.

  3. Direction des Publications

    African Journals Online (AJOL)

    Synthese

    Experimental research of fluid flow and convection heat transfer in plate channels filled with glass or metallic particles, Experimental Thermal and Fluid. Science, Vol.20, Issue.1, 45-54. [7] Rahimian M.H., Pourshaghaghy A.,. 2002. Direct simulation of forced convection flow in a parallel plate channel filled with porous media, ...

  4. 75 FR 70863 - Airworthiness Directives; The Boeing Company Model 747 Airplanes

    Science.gov (United States)

    2010-11-19

    ... Federal Aviation Administration 14 CFR Part 39 RIN 2120-AA64 Airworthiness Directives; The Boeing Company... the electrical bond resistance between the motor operated valve (MOV) actuators and airplane structure..., without change, to http://www.regulations.gov , including any personal information you provide. We will...

  5. Apparatus including concave reflectors and a line of optical fibers

    International Nuclear Information System (INIS)

    Dolan, J.T.

    1992-01-01

    This patent describes an apparatus including a radiation source which emits in a multiplicity of directions for focusing radiation on an object which may receive radiation within a certain solid angle. It comprises a first reflector and a second reflector, the first reflector being elliptical in cross section and having a first focus and a second focus, the second reflector being circular in cross section and having a center, and a radius equal to the distance between the second reflector and the first focus, the first reflector and the second reflector being arranged so that a concave reflecting surface of the first reflector faces a concave reflecting surface of the second reflector, and so arranged that the first focus of the first reflector corresponds to the center of the second reflector, the radiation source being an elongated discharge bulb, the object being a group of two or more optical fibers defining at least one line of optical fibers which are located at the second focus of the first reflector

  6. Integration of medical imaging including ultrasound into a new clinical anatomy curriculum.

    Science.gov (United States)

    Moscova, Michelle; Bryce, Deborah A; Sindhusake, Doungkamol; Young, Noel

    2015-01-01

    In 2008 a new clinical anatomy curriculum with integrated medical imaging component was introduced into the University of Sydney Medical Program. Medical imaging used for teaching the new curriculum included normal radiography, MRI, CT scans, and ultrasound imaging. These techniques were incorporated into teaching over the first two years of the program as a part of anatomy practical sessions, in addition to dedicated lectures and tutorials given by imaging specialists. Surveys were conducted between 2009 and 2012 to evaluate the student acceptance of the integration. Students were asked to rate individual activities as well as provide open-ended comments. The number of students who responded to the surveys varied from 40% to 98%. Over 90% of the respondents were satisfied with the overall quality of teaching in the anatomy units. In summary, 48% to 63% of the responding students thought that the specialist imaging lectures helped them learn effectively; 72% to 77% of students thought that the cross-sectional practical sessions helped them to better understand the imaging modalities of CT, MRI, and ultrasound; 76% to 80% of students considered hands-on ultrasound session to be useful in understanding the application of ultrasound in abdominal imaging. The results also revealed key similarities and differences in student perceptions of the new integrated curriculum for students with both a high and low prior exposure to anatomy. Further evaluation will aid in refining the integrated medical imaging program and providing its future direction. © 2014 American Association of Anatomists.

  7. Direct Bonded Pontic (Laporan Kasus

    Directory of Open Access Journals (Sweden)

    Suhandi Sidjaja

    2015-10-01

    Full Text Available Advanced science and technology in dentistry enable dental practitioners to modified she bonding techniques in tooth replacement. A pontic made of composite resin bonded to etched enamel of the adjacent teeth can be used in the replacement of one missing anterior tooth with a virgin or sowed adpicent tooth. The advantages of this technique include a one visit treatment, cow cost, good esthetics, less side effects and easy repair or rebounding. Clinical evaluation showed a high success rate therefore with a proper diagnosis and a perfect skill of the direct bonded technique this treatment can be used as an alternative restoration.

  8. A perspective on direct conversion

    International Nuclear Information System (INIS)

    Lewis, W.B.

    1963-10-01

    As flowing energy, electricity is sought for its versatility. Its generation from some other flow or release of energy without mechanical power, or even sometimes heat, as intermediary is called direct conversion. The objective is high electrical output for minimum total cost and not always high conversion efficiency. The wide range of techniques embracing cryogenics and hot plasma derives from the special requirements of source, environment and application. Sources include solar and other radiation, nuclear fission and fusion, chemical energy and heat. Environments and applications range from space vehicles to submarines and from giant power networks to isolated buoys and pocket devices. (author)

  9. Provider deselection: "cause" or "no cause".

    Science.gov (United States)

    Hansen, E

    1996-09-01

    Termination of provider contracts by MCOs rankles most in the provider community. Oftentimes, no cause is given for the termination, as permitted in the contract between the MCO and the provider. Yet, there is always a cause for termination, and providers generally don't like the reason.

  10. Health provider networks, quality and costs

    NARCIS (Netherlands)

    Boone, Jan; Schottmuller, C.

    2015-01-01

    We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider

  11. Health Provider Networks, Quality and Costs

    NARCIS (Netherlands)

    Boone, J.; Schottmuller, C.

    2015-01-01

    We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider

  12. Laboratory Directed Research and Development Program FY98

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, T. [ed.; Chartock, M.

    1999-02-05

    The Ernest Orlando Lawrence Berkeley National Laboratory (LBNL or Berkeley Lab) Laboratory Directed Research and Development Program FY 1998 report is compiled from annual reports submitted by principal investigators following the close of the fiscal year. This report describes the supported projects and summarizes their accomplishments. It constitutes a part of the Laboratory Directed Research and Development (LDRD) program planning and documentation process that includes an annual planning cycle, projection selection, implementation, and review. The LBNL LDRD program is a critical tool for directing the Laboratory's forefront scientific research capabilities toward vital, excellent, and emerging scientific challenges. The program provides the resources for LBNL scientists to make rapid and significant contributions to critical national science and technology problems. The LDRD program also advances LBNL's core competencies, foundations, and scientific capability, and permits exploration of exciting new opportunities. All projects are work in forefront areas of science and technology. Areas eligible for support include the following: Advanced study of hypotheses, concepts, or innovative approaches to scientific or technical problems; Experiments and analyses directed toward ''proof of principle'' or early determination of the utility of new scientific ideas, technical concepts, or devices; and Conception and preliminary technical analyses of experimental facilities or devices.

  13. Laboratory directed research and development program, FY 1996

    International Nuclear Information System (INIS)

    1997-02-01

    The Ernest Orlando Lawrence Berkeley National Laboratory (Berkeley Lab) Laboratory Directed Research and Development Program FY 1996 report is compiled from annual reports submitted by principal investigators following the close of the fiscal year. This report describes the projects supported and summarizes their accomplishments. It constitutes a part of the Laboratory Directed Research and Development (LDRD) program planning and documentation process that includes an annual planning cycle, projection selection, implementation, and review. The Berkeley Lab LDRD program is a critical tool for directing the Laboratory's forefront scientific research capabilities toward vital, excellent, and emerging scientific challenges. The program provides the resources for Berkeley Lab scientists to make rapid and significant contributions to critical national science and technology problems. The LDRD program also advances the Laboratory's core competencies, foundations, and scientific capability, and permits exploration of exciting new opportunities. Areas eligible for support include: (1) Work in forefront areas of science and technology that enrich Laboratory research and development capability; (2) Advanced study of new hypotheses, new experiments, and innovative approaches to develop new concepts or knowledge; (3) Experiments directed toward proof of principle for initial hypothesis testing or verification; and (4) Conception and preliminary technical analysis to explore possible instrumentation, experimental facilities, or new devices

  14. Laboratory directed research and development program, FY 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-02-01

    The Ernest Orlando Lawrence Berkeley National Laboratory (Berkeley Lab) Laboratory Directed Research and Development Program FY 1996 report is compiled from annual reports submitted by principal investigators following the close of the fiscal year. This report describes the projects supported and summarizes their accomplishments. It constitutes a part of the Laboratory Directed Research and Development (LDRD) program planning and documentation process that includes an annual planning cycle, projection selection, implementation, and review. The Berkeley Lab LDRD program is a critical tool for directing the Laboratory`s forefront scientific research capabilities toward vital, excellent, and emerging scientific challenges. The program provides the resources for Berkeley Lab scientists to make rapid and significant contributions to critical national science and technology problems. The LDRD program also advances the Laboratory`s core competencies, foundations, and scientific capability, and permits exploration of exciting new opportunities. Areas eligible for support include: (1) Work in forefront areas of science and technology that enrich Laboratory research and development capability; (2) Advanced study of new hypotheses, new experiments, and innovative approaches to develop new concepts or knowledge; (3) Experiments directed toward proof of principle for initial hypothesis testing or verification; and (4) Conception and preliminary technical analysis to explore possible instrumentation, experimental facilities, or new devices.

  15. Geothermal direct heat applications program summary

    Energy Technology Data Exchange (ETDEWEB)

    None

    1982-08-01

    In 1978, the Department of Energy Division of Geothermal and Hydropower Technologies initiated a program to accelerate the direct use of geothermal energy, in which 23 projects were selected. The projects, all in the western part of the US, cover the use of geothermal energy for space conditioning (heating and cooling) and agriculture (aquaculture and greenhouses). Initially, two projects were slated for industrial processing; however, because of lack of geothermal resources, these projects were terminated. Of the 23 projects, seven were successfully completed, ten are scheduled for completion by the end of 1983, and six were terminated for lack of resources. Each of the projects is being documented from its inception through planning, drilling, and resource confirmation, design, construction, and one year of monitoring. The information is being collected, evaluated, and will be reported. Several reports will be produced, including detailed topical reports on economics, institutional and regulatory problems, engineering, and a summary final report. To monitor progress and provide a forum for exchange of information while the program is progressing, semiannual or annual review meetings have been held with all project directors and lead engineers for the past four years. This is the sixth meeting in that series. Several of the projects which have been terminated are not included this year. Overall, the program has been very successful. Valuable information has been gathered. problems have been encountered and resolved concerning technical, regulatory, and institutional constraints. Most projects have been proven to be economical with acceptable pay-back periods. Although some technical problems have emerged, they were resolved with existing off-the-shelf technologies and equipment. The risks involved in drilling for the resource, the regulatory constraints, the high cost of finance, and large front-end cost remain the key obstacles to the broad development of

  16. Provider collaboration: cohesion, constellations, and shared patients.

    Science.gov (United States)

    Mandl, Kenneth D; Olson, Karen L; Mines, Daniel; Liu, Chunfu; Tian, Fang

    2014-11-01

    There is a natural assumption that quality and efficiency are optimized when providers consistently work together and share patients. Diversity in composition and recurrence of groups that provide face-to-face care to the same patients has not previously been studied. Claims data enable identification of the constellation of providers caring for a single patient. To indirectly measure teamwork and provider collaboration, we measure recurrence of provider constellations and cohesion among providers. Retrospective analysis of commercial healthcare claims from a single insurer. Patients with claims for office visits and their outpatient providers. To maximize capture of provider panels, the cohort was drawn from the four regions with the highest plan coverage. Regional outpatient provider networks were constructed with providers as nodes and number of shared patients as links. Measures of cohesion and stability of provider constellations derived from the networks of providers to quantify patient sharing. For 10,325 providers and their 521,145 patients, there were 2,641,933 collaborative provider pairs sharing at least one patient. Fifty-four percent only shared a single patient, and 19 % shared two. Of 15,449,835 unique collaborative triads, 92 % shared one patient, 5 % shared two, and 0.2 % shared ten or more. Patient constellations had a median of four providers. Any precise constellation recurred rarely-89 % with exactly two providers shared just one patient and only 4 % shared over two; 97 % of constellations with exactly three providers shared just one patient. Four percent of constellations with 2+ providers were not at all cohesive, sharing only the hub patient. In the remaining constellations, a median of 93 % of provider pairs shared at least one additional patient beyond the hub patient. Stunning variability in the constellations of providers caring for patients may challenge underlying assumptions about the current state of teamwork in healthcare.

  17. Exoplanet Direct Imaging Project

    Data.gov (United States)

    National Aeronautics and Space Administration — "We propose to develop high contrast coronagraphic techniques for segmented telescopes, providing an integrated solution for wavefront control and starlight...

  18. The ethics of providing hope in psychotherapy.

    Science.gov (United States)

    Dembo, Justine Sarah; Clemens, Norman A

    2013-07-01

    The instillation of hope is a common factor in most psychotherapies. A considerable literature exists on the ethics of providing false or positively biased hope in non-psychiatric medical settings, and ethicists have generally concluded that this practice is unethical. However, the literature on the ethics of encouraging hope in psychotherapy, especially in the case of treatment-resistant mental illness, is sparse. The author explores two clinical cases with the intention of examining the nature of hope, false hope, positive illusions, and denial, as they relate to our definitions of mental health and psychotherapy. The cases highlight the ethics of balancing an acknowledgment of likely treatment futility with a desire to hope. Clinical psychological studies on depressive realism and optimistic bias indicate that some degree of positive bias, referred to by some authors as "the optimal margin of illusion," is in fact necessary to promote what we define as "good mental health;" conversely, stark realism is correlated with mild to moderate depression. An examination of the existential literature, including Ernest Becker's work, The Denial of Death, indicates that without the defense mechanism of denial, human beings tend to experience paralytic despair as a result of being fallible, mortal creatures in a frightening world. The combination of these diverse bodies of literature, along with the surprising outcomes of our case examples, leads to an unexpected conclusion: it may occasionally be ethical to encourage some degree of optimistic bias, and perhaps even positive illusion, when treating patients in psychotherapy.

  19. Providing effective supervision in clinical neuropsychology.

    Science.gov (United States)

    Stucky, Kirk J; Bush, Shane; Donders, Jacobus

    2010-01-01

    A specialty like clinical neuropsychology is shaped by its selection of trainees, educational standards, expected competencies, and the structure of its training programs. The development of individual competency in this specialty is dependent to a considerable degree on the provision of competent supervision to its trainees. In clinical neuropsychology, as in other areas of professional health-service psychology, supervision is the most frequently used method for teaching a variety of skills, including assessment, report writing, differential diagnosis, and treatment. Although much has been written about the provision of quality supervision in clinical and counseling psychology, very little published guidance is available regarding the teaching and provision of supervision in clinical neuropsychology. The primary focus of this article is to provide a framework and guidance for the development of suggested competency standards for training of neuropsychological supervisors, particularly at the residency level. In this paper we outline important components of supervision for neuropsychology trainees and suggest ways in which clinicians can prepare for supervisory roles. Similar to Falender and Shafranske (2004), we propose a competency-based approach to supervision that advocates for a science-informed, formalized, and objective process that clearly delineates the competencies required for good supervisory practice. As much as possible, supervisory competencies are related to foundational and functional competencies in professional psychology, as well as recent legislative initiatives mandating training in supervision. It is our hope that this article will foster further discussion regarding this complex topic, and eventually enhance training in clinical neuropsychology.

  20. Providing smoking cessation programs to homeless youth: the perspective of service providers.

    Science.gov (United States)

    Shadel, William G; Tucker, Joan S; Mullins, Leslie; Staplefoote, Lynette

    2014-10-01

    There is almost no information available on cigarette smoking among homeless youth, whether they are currently receiving services for smoking cessation, and how to best help them quit. This paper presents data collected from a series of semi-structured telephone interviews with service providers from 23 shelters and drop-in centers serving homeless youth in Los Angeles County about their current smoking cessation programming, interest in providing smoking cessation services to their clients, potential barriers to providing this service, and ways to overcome these barriers. Results indicated that 84% of facilities did not offer smoking cessation services, although nearly all (91%) were interested in doing so. Barriers to implementing formal smoking cessation programs on site included lack of resources (e.g., money, personnel) to support the programs, staff training, and concern that smoking cessation may not be a high priority for homeless youth themselves. Overall, service providers seemed to prefer a less intensive smoking cessation program that could be delivered at their site by existing staff. Data from this formative needs assessment will be useful for developing and evaluating a smoking cessation treatment that could be integrated into the busy, complex environment that characterizes agencies that serve homeless youth. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. The physics of semiconductors an introduction including nanophysics and applications

    CERN Document Server

    Grundmann, Marius

    2016-01-01

    The 3rd edition of this successful textbook contains ample material for a comprehensive upper-level undergraduate or beginning graduate course, guiding readers to the point where they can choose a special topic and begin supervised research. The textbook provides a balance between essential aspects of solid-state and semiconductor physics, on the one hand, and the principles of various semiconductor devices and their applications in electronic and photonic devices, on the other. It highlights many practical aspects of semiconductors such as alloys, strain, heterostructures, nanostructures, that are necessary in modern semiconductor research but typically omitted in textbooks. Coverage also includes additional advanced topics, such as Bragg mirrors, resonators, polarized and magnetic semiconductors, nanowires, quantum dots, multi-junction solar cells, thin film transistors, carbon-based nanostructures and transparent conductive oxides. The text derives explicit formulas for many results to support better under...

  2. The Physics of Semiconductors An Introduction Including Nanophysics and Applications

    CERN Document Server

    Grundmann, Marius

    2010-01-01

    The Physics of Semiconductors contains ample material for a comprehensive upper-level undergraduate or beginning graduate course, guiding readers to the point where they can choose a special topic and begin supervised research. The textbook provides a balance between essential aspects of solid-state and semiconductor physics, on the one hand, and the principles of various semiconductor devices and their applications in electronic and photonic devices, on the other. It highlights many practical aspects of semiconductors such as alloys, strain, heterostructures, nanostructures, that are necessary in modern semiconductor research but typically omitted in textbooks. Coverage also includes additional advanced topics, such as Bragg mirrors, resonators, polarized and magnetic semiconductors. The text derives explicit formulas for many results to support better understanding of the topics. The Physics of Semiconductors requires little or no prior knowledge of solid-state physics and evolved from a highly regarded two...

  3. Two-dimensional analysis of motion artifacts, including flow effects

    International Nuclear Information System (INIS)

    Litt, A.M.; Brody, A.S.; Spangler, R.A.; Scott, P.D.

    1990-01-01

    The effects of motion on magnetic resonance images have been theoretically analyzed for the case of a point-like object in simple harmonic motion and for other one-dimensional trajectories. The authors of this paper extend this analysis to a generalized two-dimensional magnetization with an arbitrary motion trajectory. The authors provide specific solutions for the clinically relevant cases of the cross-sections of cylindrical objects in the body, such as the aorta, which has a roughly one-dimensional, simple harmonic motion during respiration. By extending the solution to include inhomogeneous magnetizations, the authors present a model which allows the effects of motion artifacts and flow artifacts to be analyzed simultaneously

  4. A Case for Including Transactions in OpenMP

    Energy Technology Data Exchange (ETDEWEB)

    Wong, M; Bihari, B L; de Supinski, B R; Wu, P; Michael, M; Liu, Y; Chen, W

    2010-01-25

    Transactional Memory (TM) has received significant attention recently as a mechanism to reduce the complexity of shared memory programming. We explore the potential of TM to improve OpenMP applications. We combine a software TM (STM) system to support transactions with an OpenMP implementation to start thread teams and provide task and loop-level parallelization. We apply this system to two application scenarios that reflect realistic TM use cases. Our results with this system demonstrate that even with the relatively high overheads of STM, transactions can outperform OpenMP critical sections by 10%. Overall, our study demonstrates that extending OpenMP to include transactions would ease programming effort while allowing improved performance.

  5. Incorporating direct marketing activity into latent attrition models

    NARCIS (Netherlands)

    Schweidel, David A.; Knox, George

    2013-01-01

    When defection is unobserved, latent attrition models provide useful insights about customer behavior and accurate forecasts of customer value. Yet extant models ignore direct marketing efforts. Response models incorporate the effects of direct marketing, but because they ignore latent attrition,

  6. Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis.

    Science.gov (United States)

    Feely, Molly A; Hildebrandt, Daniel; Edakkanambeth Varayil, Jithinraj; Mueller, Paul S

    2016-12-07

    ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives. We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis. Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; Phydration (34.3%), and pain management (43.4%) than dialysis (10.6%). Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients. Copyright © 2016 by the American Society of Nephrology.

  7. Incretin secretion: direct mechanisms

    DEFF Research Database (Denmark)

    Balk-Møller, Emilie; Holst, Jens Juul; Kuhre, Rune Ehrenreich

    2014-01-01

    enzyme responsible for incretin degradation (dipeptidyl peptidase-4) is inhibited (drugs are already on the market) while the secretion of endogenous GLP-1 secretion is stimulated at the same time may prove particularly rewarding. In this section we review current knowledge on the mechanisms for direct......The incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) are secreted from gastro-intestinal K- and L-cells, respectively, and play an important role in post-prandial blood glucose regulation. They do this by direct stimulation of the pancreatic β....... This suggests that the therapeutic potential of GIP for the treatment for T2D is limited, whereas GLP-1 based treatments have been on the market since 2005. Research is now pursuing novel approaches to utilize the effects of GLP-1 for T2D treatment. A combinatorial approach by which the activity of the major...

  8. Incretin secretion: direct mechanisms

    DEFF Research Database (Denmark)

    Balk-Møller, Emilie; Holst, Jens Juul; Kuhre, Rune Ehrenreich

    2014-01-01

    The incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) are secreted from gastro-intestinal K- and L-cells, respectively, and play an important role in post-prandial blood glucose regulation. They do this by direct stimulation of the pancreatic β......-cell, accounting for some 25-70% of postprandial insulin secretion in healthy subjects. In patients with type 2 diabetes (T2D, however, this effect is greatly reduced or lost due to a combination of severely impaired or eliminated insulinotrophic effect of GIP and reduced meal stimulated GLP-1 secretion...... enzyme responsible for incretin degradation (dipeptidyl peptidase-4) is inhibited (drugs are already on the market) while the secretion of endogenous GLP-1 secretion is stimulated at the same time may prove particularly rewarding. In this section we review current knowledge on the mechanisms for direct...

  9. Direct use in Hawaii

    International Nuclear Information System (INIS)

    Beck, A.G.

    1990-01-01

    This paper reports on a public laboratory, Noi'i O Puna, that was established in Hawaii to support direct use research in 1985, tapping the previously unutilized heat in brines from the HGP-A well. Two rounds of small grants were offered to entrepreneurs. With the closure of the HGP-A power plant in late 1989, Noi'i O Puna is expanding its facilities. When the HGP-A well is back in service, Noi'i O Puna will be able to support additional research and development projects, as well as pre-commercial ventures. Direct use industries, which support existing agricultural activities in the region have good potential

  10. Direct hydrocarbon fuel cells

    Science.gov (United States)

    Barnett, Scott A.; Lai, Tammy; Liu, Jiang

    2010-05-04

    The direct electrochemical oxidation of hydrocarbons in solid oxide fuel cells, to generate greater power densities at lower temperatures without carbon deposition. The performance obtained is comparable to that of fuel cells used for hydrogen, and is achieved by using novel anode composites at low operating temperatures. Such solid oxide fuel cells, regardless of fuel source or operation, can be configured advantageously using the structural geometries of this invention.

  11. 30 CFR 285.906 - What must my decommissioning application include?

    Science.gov (United States)

    2010-07-01

    ... provide one paper copy and one electronic copy of the application. Include the following information in... discharge of pollutants, including marine trash and debris, into the offshore waters. (k) A statement of...

  12. Clustering and community detection in directed networks: A survey

    Science.gov (United States)

    Malliaros, Fragkiskos D.; Vazirgiannis, Michalis

    2013-12-01

    Networks (or graphs) appear as dominant structures in diverse domains, including sociology, biology, neuroscience and computer science. In most of the aforementioned cases graphs are directed - in the sense that there is directionality on the edges, making the semantics of the edges nonsymmetric as the source node transmits some property to the target one but not vice versa. An interesting feature that real networks present is the clustering or community structure property, under which the graph topology is organized into modules commonly called communities or clusters. The essence here is that nodes of the same community are highly similar while on the contrary, nodes across communities present low similarity. Revealing the underlying community structure of directed complex networks has become a crucial and interdisciplinary topic with a plethora of relevant application domains. Therefore, naturally there is a recent wealth of research production in the area of mining directed graphs - with clustering being the primary method sought and the primary tool for community detection and evaluation. The goal of this paper is to offer an in-depth comparative review of the methods presented so far for clustering directed networks along with the relevant necessary methodological background and also related applications. The survey commences by offering a concise review of the fundamental concepts and methodological base on which graph clustering algorithms capitalize on. Then we present the relevant work along two orthogonal classifications. The first one is mostly concerned with the methodological principles of the clustering algorithms, while the second one approaches the methods from the viewpoint regarding the properties of a good cluster in a directed network. Further, we present methods and metrics for evaluating graph clustering results, demonstrate interesting application domains and provide promising future research directions.

  13. Application of the linear-quadratic model with incomplete repair to radionuclide directed therapy

    International Nuclear Information System (INIS)

    Millar, W.T.; Glasgow Univ.

    1991-01-01

    The LQ model has now been extended to include a general time varying dose rate profile, and the equations can be readily evaluated if an exponential radiation damage repair process is assumed. These equations are applicable to radionuclide directed therapy, including brachytherapy. Kinetic uptake data obtained during radionuclide directed therapy may therefore be used to determine the radiobiological dosimetry of the target and non-target tissues. Also, preliminary tracer studies may be used to pre-plan the radionuclide directed therapy, provided that tracer and therapeutic amounts of the radionuclide carrier are identically processed by the tissues. It is also shown that continuous radionuclide therapy will induce less damage in late-responding tissues than 2 Gy/fraction external beam therapy if the ratio of the maximum dose rate and the sublethal damage repair half-life in the tissue is less than 1.0 Gy. Similar inequalities may be derived for β-particle radionuclide directed therapy. (author)

  14. Low contaminant formic acid fuel for direct liquid fuel cell

    Science.gov (United States)

    Masel, Richard I [Champaign, IL; Zhu, Yimin [Urbana, IL; Kahn, Zakia [Palatine, IL; Man, Malcolm [Vancouver, CA

    2009-11-17

    A low contaminant formic acid fuel is especially suited toward use in a direct organic liquid fuel cell. A fuel of the invention provides high power output that is maintained for a substantial time and the fuel is substantially non-flammable. Specific contaminants and contaminant levels have been identified as being deleterious to the performance of a formic acid fuel in a fuel cell, and embodiments of the invention provide low contaminant fuels that have improved performance compared to known commercial bulk grade and commercial purified grade formic acid fuels. Preferred embodiment fuels (and fuel cells containing such fuels) including low levels of a combination of key contaminants, including acetic acid, methyl formate, and methanol.

  15. Providing Policy Implication Based on the R and D Portfolio Analysis in Advanced Countries in the Nuclear Technology

    International Nuclear Information System (INIS)

    Moon, K. H.; Lee, M. K.; Won, B. C.; Kim, S. S.; Lee, J. H.; Yun, S. W.; Jeong, I. K.; Lee, Y. C.; Lee, Y. J.; Kim, Y. S.

    2013-08-01

    This study is to provide the investment direction of nuclear R and D, which is the most efficient and reasonable integrating the various aspects comprehensively. This study includes four parts. In the first part, we extracted Mega-trend and driving forces of nuclear R and D field by using various reports published by National Intelligence Council of US, UN, etc. Also, in this part we established the linkage between megatrend factors focussing on nuclear and the five aspects including society, technology, ecology, economics and politics. In the second part, we analyzed the nuclear R and D investment directions of major advanced countries including US, Japan, EU and China for comparing the investment portfolio in the specific research area. In the third part, domestic investment of nuclear R and D was reviewed by analyzing the investment trend of nuclear R and D in the past, with their connection to nuclear policy, and to the levels and capacities of national technologies of nuclear. In the final part, the desirable directions of nuclear R and D investment were suggested comprehensively taking into consideration various aspects including the Mega-trend associated with nuclear, nuclear R and D directions of major advanced countries, and the level and capacities of the domestic nuclear technologies

  16. Generalized fluid theory including non-Maxwellian kinetic effects

    Science.gov (United States)

    Izacard, Olivier

    2017-04-01

    The results obtained by the plasma physics community for the validation and the prediction of turbulence and transport in magnetized plasmas come mainly from the use of very central processing unit (CPU)-consuming particle-in-cell or (gyro)kinetic codes which naturally include non-Maxwellian kinetic effects. To date, fluid codes are not considered to be relevant for the description of these kinetic effects. Here, after revisiting the limitations of the current fluid theory developed in the 19th century, we generalize the fluid theory including kinetic effects such as non-Maxwellian super-thermal tails with as few fluid equations as possible. The collisionless and collisional fluid closures from the nonlinear Landau Fokker-Planck collision operator are shown for an arbitrary collisionality. Indeed, the first fluid models associated with two examples of collisionless fluid closures are obtained by assuming an analytic non-Maxwellian distribution function (e.g. the INMDF (Izacard, O. 2016b Kinetic corrections from analytic non-Maxwellian distribution functions in magnetized plasmas. Phys. Plasmas 23, 082504) that stands for interpreted non-Maxwellian distribution function). One of the main differences with the literature is our analytic representation of the distribution function in the velocity phase space with as few hidden variables as possible thanks to the use of non-orthogonal basis sets. These new non-Maxwellian fluid equations could initiate the next generation of fluid codes including kinetic effects and can be expanded to other scientific disciplines such as astrophysics, condensed matter or hydrodynamics. As a validation test, we perform a numerical simulation based on a minimal reduced INMDF fluid model. The result of this test is the discovery of the origin of particle and heat diffusion. The diffusion is due to the competition between a growing INMDF on short time scales due to spatial gradients and the thermalization on longer time scales. The results

  17. Medicare Provider Data - Part D Prescriber

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...

  18. How Do Health Care Providers Diagnose Endometriosis?

    Science.gov (United States)

    ... Share Facebook Twitter Pinterest Email Print How do health care providers diagnose endometriosis? Surgery is currently the only ... larger incision—is used to make a diagnosis. Health care providers may also use imaging methods to produce ...

  19. Discussing Diabetes with Your Healthcare Provider

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Diabetes Discussing Diabetes with Your Healthcare Provider Past Issues / Fall 2009 Table of Contents Diabetes Medicines—Always Discuss Them with Your Healthcare Provider ...

  20. Medicare Provider Payment Data - Skilled Nursing Facilities

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Skilled Nursing Facility Utilization and Payment Public Use File (Skilled Nursing Facility PUF) provides information on services provided to Medicare...

  1. Institutional Provider and Beneficiary Summary PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS IPBS PUFs are aggregated files in which each record summarizes information for a particular institutional provider. An institutional provider refers to a...

  2. Medicare Provider Data - Physician and Other Supplier

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare...

  3. Identifiable Data Files - Medicare Provider Analysis and ...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Provider Analysis and Review (MEDPAR) File contains data from claims for services provided to beneficiaries admitted to Medicare certified inpatient...

  4. The king is dead (warfarin): direct thrombin and factor Xa inhibitors: the next Diadochian War?

    Science.gov (United States)

    Diener, Hans-Christoph; Eikelboom, John; Granger, Christopher B; Hacke, Werner

    2012-02-01

    Atrial fibrillation is an important risk factor for stroke. New drugs for oral anticoagulation that do not exhibit the limitations of vitamin K antagonists like warfarin are under investigation. These include direct factor Xa inhibitors and direct thrombin-inhibitors. Recent studies provide promising results for apixaban, dabigatran, and rivaroxaban, including higher efficacy and significantly lower incidences of intracranial bleeds compared with warfarin. The new oral anticoagulants substances show similar results in secondary as in primary stroke prevention in patients with AF and will on the long run replace warfarin.

  5. Using Turnitin to Provide Feedback on L2 Writers' Texts

    Science.gov (United States)

    Kostka, Ilka; Maliborska, Veronika

    2016-01-01

    Second language (L2) writing instructors have varying tools at their disposal for providing feedback on students' writing, including ones that enable them to provide written and audio feedback in electronic form. One tool that has been underexplored is Turnitin, a widely used software program that matches electronic text to a wide range of…

  6. 20 CFR 670.640 - Are students provided with clothing?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Are students provided with clothing? 670.640... clothing? Yes, Job Corps students are provided cash clothing allowances and/or articles of clothing, including safety clothing, when needed for their participation in Job Corps and their successful entry into...

  7. Earthquake Preparedness: What Every Childcare Provider Should Know.

    Science.gov (United States)

    California State Office of Emergency Services, Sacramento.

    This brochure provides information to help child care providers reduce or avoid damage, injuries, or loss of life during earthquakes. It first discusses steps to implement before an earthquake strikes, including securing household contents, and practicing with children how to duck and cover. Next, the brochure describes what to do during an…

  8. Providing nuclear pharmacy education via the internet

    International Nuclear Information System (INIS)

    Hilliard, N.L.; Pickett, M.; Thaxton, P.; Norenberg, J.P.; Wittstrom, K.; Rhodes, B.

    2002-01-01

    Aim: (1) Increase the nuclear pharmacy education opportunities across the United States and the around the world. (2) Establish collaborative educational agreements between colleges of pharmacy and local nuclear pharmacy preceptors. (3) Decrease the shortage of radio pharmacists. 4) Provide nuclear education courses to supplement existing educational programs. Materials and Methods: Nuclear Education Online (www.nuclearonline.org) is an educational consortium between the University of Arkansas for Medical Sciences and the University of New Mexico. The faculty members from each institution have collaborated to design an online didactic curriculum and experiential training materials. The didactic portion is delivered via WebCT (www.webct.com) and involves interactive studies with faculty from UNM and UAMS. The student-centered curriculum is based on the APhA Syllabus for Nuclear Pharmacy Training and includes interactive web-based course materials, discussion groups, preceptor-led activities and problem-based learning (PBL) case studies based upon actual clinical studies and real-life pharmacy situations. Individual units of study include Nuclear Physics, Radiation Biology, Radiation Safety, Instrumentation, and Radiochemistry/Radiopharmacology. Students can begin the program at anytime. Once a cohort of students is established, the students proceed through the PBL cases, working interactively as a group. Results: Since June 2001, over 26 students have completed the 10-week certificate program. These students have been located across the U.S. and in Saudi Arabia. Fifteen students have completed individual courses in nuclear physics and instrumentation through colleges of pharmacy course offerings using the NEO faculty as instructors. Student evaluations revealed that 78% of the students thought that the NEO program was a 'great way to learn' (highest rating). When comparing PBL to a traditional classroom setting, two thirds of students preferred problem

  9. Co-providing: understanding the logistics.

    Science.gov (United States)

    Dickerson, Pamela S

    2011-11-01

    Continuing nursing education providers have sometimes said that they don't want to co-provide because "it's too much trouble" or they "won't be able to control what happens" or because they don't understand the process. This column clarifies the logistics of the co-provider relationship. Copyright 2011, SLACK Incorporated.

  10. Piezoelectric pump and pressurised circuit provided therewith

    NARCIS (Netherlands)

    Van Es, Johannes; Wits, Wessel Willems

    2015-01-01

    A piezoelectric pump for use in a pressurised circuit is provided, comprising a pump chamber (5) with an inlet (6) provided with a one way inlet valve (7), for connection to a feeding line (8) of the pressurised circuit and an outlet (9) provided with a one way outlet valve (10), for connection to a

  11. Provider-Independent Use of the Cloud

    Science.gov (United States)

    Harmer, Terence; Wright, Peter; Cunningham, Christina; Perrott, Ron

    Utility computing offers researchers and businesses the potential of significant cost-savings, making it possible for them to match the cost of their computing and storage to their demand for such resources. A utility compute provider enables the purchase of compute infrastructures on-demand; when a user requires computing resources a provider will provision a resource for them and charge them only for their period of use of that resource. There has been a significant growth in the number of cloud computing resource providers and each has a different resource usage model, application process and application programming interface (API)-developing generic multi-resource provider applications is thus difficult and time consuming. We have developed an abstraction layer that provides a single resource usage model, user authentication model and API for compute providers that enables cloud-provider neutral applications to be developed. In this paper we outline the issues in using external resource providers, give examples of using a number of the most popular cloud providers and provide examples of developing provider neutral applications. In addition, we discuss the development of the API to create a generic provisioning model based on a common architecture for cloud computing providers.

  12. 5 CFR 890.910 - Provider information.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Provider information. 890.910 Section 890.910 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS..., and FEHB Benefit Payments § 890.910 Provider information. The hospital provider information used to...

  13. Harmonizing Self-Directed and Teacher-Directed Approaches to Learning.

    Science.gov (United States)

    Bell, Deanne F.; Bell, Durward L.

    1983-01-01

    A combination of self-directed learning and teacher-directed learning provides a rich and flexible learning experience and accommodates various teaching styles. The key to a successful mixture is the appropriate use of criterion-referencing and normative-referencing for learner evaluation. (JOW)

  14. Human trafficking: Role of oral health care providers.

    Science.gov (United States)

    Nuzzolese, E

    2014-11-30

    Trafficking in human beings is a modern form of slavery and is a well-known phenomenon throughout the European Union and beyond. After drug dealing and the weapons industry, human trafficking is the second largest criminal activity in the world today and it is a growing crime. The aim of governmental and non-governmental agencies, which are either directly or indirectly involved in combating trafficking in human beings, is the identification and referral of victims of trafficking and also to encourage self-referrals. Identification is the most important step to provide protection and assistance to victims of trafficking. Victims often have a variety of physical and mental health needs, including psychological trauma, injuries from violence, head and neck trauma, sexually transmitted infections and other gynaecological problems, dental/oral problems and have poor nutrition. The author's experience in the field of community dentistry in presented within. Volunteer dental services are offered to non-European Union patients held in a centre for asylum seekers in Bari (Italy). Dental professionals can, in fact, contribute to the identification, assistance and protection of trafficked persons, as well as offering forensic services to assist the police investigation in order to identify crimes and find the criminal organizations behind them. As for domestic violence and child abuse cases, there are ethical concerns involved in the identification and protection of the trafficked persons, as well as the need for interdisciplinary work and awareness. Adequate training in behavioural science and intercultural learning is paramount in order to avoid misunderstandings and increase sensitivity.

  15. Determinants of Foreign Direct Investment Inflows in Kenya

    African Journals Online (AJOL)

    Nneka Umera-Okeke

    DISCIPLINARY ... Key Words: Foreign Direct Investments, Determinants, Inflows, Kenya. Introduction. Foreign Direct Investments .... Previous FDI inflows are also expected to influence current FDI inflows hence the need to include them in the model.

  16. Composite Structure Monitoring using Direct Write Sensors, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Direct Write (DW) sensors deposited directly and precisely on to complex (3D) components are proposed. Sensors proposed include strain gages and thermocouples,...

  17. Eliminating Direction Specificity in Visuomotor Learning.

    Science.gov (United States)

    Yin, Cong; Bi, Yuqing; Yu, Cong; Wei, Kunlin

    2016-03-30

    The generalization of learning offers a unique window for investigating the nature of motor learning. Error-based motor learning reportedly cannot generalize to distant directions because the aftereffects are direction specific. This direction specificity is often regarded as evidence that motor adaptation is model-based learning, and is constrained by neuronal tuning characteristics in the primary motor cortices and the cerebellum. However, recent evidence indicates that motor adaptation also involves model-free learning and explicit strategy learning. Using rotation paradigms, here we demonstrate that savings (faster relearning), which is closely related to model-free learning and explicit strategy learning, is also direction specific. However, this new direction specificity can be abolished when the participants receive exposure to the generalization directions via an irrelevant visuomotor gain-learning task. Control evidence indicates that this exposure effect is weakened when direction error signals are absent during gain learning. Therefore, the direction specificity in visuomotor learning is not solely related to model-based learning; it may also result from the impeded expression of model-free learning and explicit strategy learning with untrained directions. Our findings provide new insights into the mechanisms underlying motor learning, and may have important implications for practical applications such as motor rehabilitation. Motor learning is more useful if it generalizes to untrained scenarios when needed, especially for sports training and motor rehabilitation. However, as a form of motor learning, motor adaptation is typically direction specific. Here we first show that savings with motor adaptation, an index for model-free learning and explicit strategy learning in motor learning, is also direction specific. However, the participants' additional exposure to untrained directions via an irrelevant gain-learning task can enable the complete

  18. Semiquantum secure direct communication using EPR pairs

    Science.gov (United States)

    Zhang, Ming-Hui; Li, Hui-Fang; Xia, Zhao-Qiang; Feng, Xiao-Yi; Peng, Jin-Ye

    2017-05-01

    Quantum secure direct communication can transmit a secret message directly through quantum channels without first generating a shared secret key. In the most of the existing protocols, quantum secure direct communication is possible only when both communicating participants have quantum capabilities. So what happens if either party of two participants just has classical capabilities? In this paper, we propose a semiquantum secure direct communication protocol with Einstein-Podolsky-Rosen photon pairs in which the classical sender Bob transmits a secret message to quantum Alice directly. After checking the security of quantum channels, Bob encodes his secret message on Alice's code sequence. Then, quantum Alice extracts Bob's secret message by measuring her home qubits and the received code qubits, respectively. In addition, we demonstrate the security of the proposed protocol against some individual eavesdropping attacks. The efficiency analysis shows that our protocol can provide higher efficiency.

  19. The protean nature of Whipple's disease includes multiorgan arteriopathy.

    Science.gov (United States)

    James, T N

    2001-01-01

    Knowledge about the arterial abnormalities in Whipple's disease can be useful for our better understanding of both Whipple's disease and the more general question of pathogenesis of atherosclerosis. There are several notable morphological features of Whipple's arteriopathy. First, it appears to involve primarily arteries one millimeter or less in diameter. Second, there is very little evidence of inflammation accompanying invasion of any or all three layers of the walls of affected arteries, and there is almost no evidence of local attraction of platelets to these sites of arterial injury. Third, the nature of arterial injury appears to be one of slow progression. The few sites of actual arteritis are most likely attributable to some other coinciding microbial organism not yet identified. Although the arteriopathy in Whipple's disease is seen mainly in small arteries (the aorta is a notable exception), their significance can be illustrated by consideration of this fact as it applies to the coronary circulation (and probably the arteries of all other organs). In the heart these small arteries comprise almost the entire collateral circulation, the principal blood supply to each component of the conduction system, and most pragmatically, these small arteries represent the terminal distribution of every larger epicardial artery. Small arteries are important. The "cardiomyopathy" so often a feature of Whipple's disease (very much including his original case) is most logically attributable to recurring bouts of focal ischemia and subsequent focal fibrosis ending in myocardial incompetence. However, direct bacillary invasion of cardiac myocytes (22) also occurs. In lamina propria of jejunum, there is also arteriopathy, as there is in brain, lung, kidney, spleen, liver, gall bladder, rectum, stomach, lymph nodes and testis. It is likely that no organ in the body is spared. There is growing evidence that a wide variety of chronic infections (occurring concomitantly or

  20. A Shifting Shield Provides Protection Against Cosmic Rays

    Science.gov (United States)

    Kohler, Susanna

    2017-12-01

    The Sun plays an important role in protecting us from cosmic rays, energetic particles that pelt us from outside our solar system. But can we predict when and how it will provide the most protection, and use this to minimize the damage to both pilotedand roboticspace missions?The Challenge of Cosmic RaysSpacecraft outside of Earths atmosphere and magnetic field are at risk of damage from cosmic rays. [ESA]Galactic cosmic rays are high-energy, charged particles that originate from astrophysical processes like supernovae or even distant active galactic nuclei outside of our solar system.One reason to care about the cosmic rays arriving near Earth is because these particles can provide a significant challenge for space missions traveling above Earths protective atmosphere and magnetic field. Since impacts from cosmic rays can damage human DNA, this risk poses a major barrier to plans for interplanetary travel by crewed spacecraft. And roboticmissions arent safe either: cosmic rays can flip bits, wreaking havoc on spacecraft electronics as well.The magnetic field carried by the solar wind provides a protective shield, deflecting galactic cosmic rays from our solar system. [Walt Feimer/NASA GSFCs Conceptual Image Lab]Shielded by the SunConveniently, we do have some broader protection against galactic cosmic rays: a built-in shield provided by the Sun. The interplanetary magnetic field, which is embedded in the solar wind, deflects low-energy cosmic rays from us at the outer reaches of our solar system, decreasing the flux of these cosmic rays that reach us at Earth.This shield, however, isnt stationary; instead, it moves and changes as the strength and direction of the solar wind moves and changes. This results in a much lower cosmic-ray flux at Earth when solar activity is high i.e., at the peak of the 11-year solar cycle than when solar activity is low. This visible change in local cosmic-ray flux with solar activity is known as solar modulation of the cosmic ray flux