Dementia and serious coexisting medical conditions: a double whammy.

Science.gov (United States)

Maslow, Katie

2004-09-01

Research-based information about the prevalence of other serious medical conditions in people with dementia has become available only recently, and the true prevalence is not known, primarily because many people with dementia do not have a diagnosis. The existing information is sufficient, however, to show that these other conditions are common in people with dementia. It is also clear that coexisting medical conditions increase the use and cost of health care services for people with dementia, and conversely, dementia increases the use and cost of health care services for people with other serious medical conditions. Nurses and other healthcare professionals should expect to see these relationships in their elderly patients. They should know how to recognize possible dementia and assess, or obtain an assessment of, the patient's cognitive status. They should expect the worsening of cognitive and related symptoms in acutely ill people with dementia and try to eliminate factors that cause this worsening, to the extent possible, while assuring the family that the symptoms are likely to improve once the acute phase of illness or treatment is over. Families, nurses, and other health care professionals are challenged by the complex issues involved in caring for a person with both dementia and other serious medical conditions. Greater attention to these issues by informed and thoughtful clinicians will improve outcomes for the people and their family and professional caregivers.

Prevalence of self-reported medical conditions among dental patients

Directory of Open Access Journals (Sweden)

Mukhatar A Javali

2017-01-01

Conclusion: The results of our study found a high prevalence of medical conditions among patients seeking periodontal treatment, thereby highlighting the need to record patients' medical and dental care history in detail.

Sexual dysfunction among Ghanaian men presenting with various medical conditions

Directory of Open Access Journals (Sweden)

Quaye Lawrence

2010-10-01

Full Text Available Abstract Background Several medical conditions can affect and disrupt human sexuality. The alteration of sexuality in these medical conditions often hinder effective communication and empathy between the patients and their sexual partners because of cultural attitudes, social norms and negative feelings such as anxiety and guilt. Validated and standardized sexual inventories might therefore help resolve this problem. The objective of this cross-sectional study was to obtain data on the prevalence of male sexual dysfunction (SD among Ghanaians with various medical conditions residing in Kumasi. Methods The Golombok Rust Inventory of Sexual Satisfaction (GRISS was administered to 150 Ghanaian men with various medical conditions between 19 and 66 years old (mean ± standard deviation: 40.01 ± 12.32 years domiciled in the Kumasi metropolis. Results Out of the total 150 questionnaires administered, 105 (70.0% men returned the questionnaires. Questionnaires from 3 men were incomplete, leaving 102 complete and evaluable questionnaires, indicating a 68.0% response rate. Of the remaining 102 men, 88.2% were married, 70.6% had attained higher education, 88.2% were non-smokers. Whereas 54.9% were engaged in exercise, 61.8% indulged in alcoholic beverages. The prevalence of the various medical conditions include: diabetes (18%, hypertension (24.5%, migraine (11.8%, ulcer (7.8%, surgery (6.9%, STD (3.9 and others (26.5%. The prevalence of SD among the respondents in the study was 59.8%. The highest prevalence of SD was seen among ulcer patients (100%, followed by patients who have undergone surgery (75%, diabetes (70%, hypertension (50%, STD (50% and the lowest was seen among migraine patients (41.7%. Conclusions SD rate is high among Ghanaian men with medical conditions (about 60% and vary according to the condition and age.

Numerical tests of evolution systems, gauge conditions, and boundary conditions for 1D colliding gravitational plane waves

International Nuclear Information System (INIS)

Bardeen, J.M.; Buchman, L.T.

2002-01-01

We investigate how the accuracy and stability of numerical relativity simulations of 1D colliding plane waves depends on choices of equation formulations, gauge conditions, boundary conditions, and numerical methods, all in the context of a first-order 3+1 approach to the Einstein equations, with basic variables some combination of first derivatives of the spatial metric and components of the extrinsic curvature tensor. Hyperbolic schemes, specifically variations on schemes proposed by Bona and Masso and Anderson and York, are compared with variations of the Arnowitt-Deser-Misner formulation. Modifications of the three basic schemes include raising one index in the metric derivative and extrinsic curvature variables and adding a multiple of the energy constraint to the extrinsic curvature evolution equations. Redundant variables in the Bona-Masso formulation may be reset frequently or allowed to evolve freely. Gauge conditions which simplify the dynamical structure of the system are imposed during each time step, but the lapse and shift are reset periodically to control the evolution of the spacetime slicing and the longitudinal part of the metric. We show that physically correct boundary conditions, satisfying the energy and momentum constraint equations, generically require the presence of some ingoing eigenmodes of the characteristic matrix. Numerical methods are developed for the hyperbolic systems based on decomposing flux differences into linear combinations of eigenvectors of the characteristic matrix. These methods are shown to be second-order accurate, and in practice second-order convergent, for smooth solutions, even when the eigenvectors and eigenvalues of the characteristic matrix are spatially varying

Experimental and numerical investigation of centrifugal pumps with asymmetric inflow conditions

Science.gov (United States)

Mittag, Sten; Gabi, Martin

2015-11-01

Most of the times pumps operate off best point states. Reasons are changes of operating conditions, modifications, pollution and wearout or erosion. As consequences non-rotational symmetric flows, transient operational conditions, increased risk of cavitation, decrease of efficiency and unpredictable wearout can appear. Especially construction components of centrifugal pumps, in particular intake elbows, contribute to this matter. Intake elbows causes additional losses and secondary flows, hence non-rotational velocity distributions as intake profile to the centrifugal pump. As a result the impeller vanes experience permanent changes of the intake flow angle and with it transient flow conditions in the blade channels. This paper presents the first results of a project, experimentally and numerically investigating the consequences of non-rotational inflow to leading edge flow conditions of a centrifugal pump. Therefore two pumpintake- elbow systems are compared, by only altering the intake elbow geometry: a common single bended 90° elbow and a numerically optimized elbow (improved regarding rotational symmetric inflow conditions and friction coefficient). The experiments are carried out, using time resolved stereoscopic PIV on a full acrylic pump with refractions index matched (RIM) working fluid. This allows transient investigations of the flow field simultaneously for all blade leading edges. Additional CFD results are validated and used to further support the investigation i.e. for comparing an analog pump system with ideal inflow conditions.

Systematic screening for unsafe driving due to medical conditions: Still debatable

Directory of Open Access Journals (Sweden)

Lagarde Emmanuel

2008-01-01

Full Text Available Abstract Background Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective. Discussion Using criteria developed for screening for chronic diseases and published studies on driving with medical conditions, we specify six criteria to judge the opportunity of screening for unsafe driving due to medical conditions. This adaptation was needed because of the complexity of the natural history of medical conditions and their potential consequences on driving and road safety. We then illustrate that published studies pleading for or against screening for unsafe driving due to medical conditions fail to provide the needed documentation. Individual criteria were mentioned in 3 to 72% of 36 papers pleading for or against screening. Quantitative estimates of relevant indicators were provided in at most 42% of papers, and some data, such as the definition of an appropriate unsafe driving period were never provided. Summary The standardised framework described in this paper provides a template for assessing the effectiveness (or lack of effectiveness of proposed measures for screening for unsafe driving due to medical conditions. Even if most criteria were mentioned in the published literature pleading for or against such a screening, the failure to find quantitative and

Concurrent Medical Conditions and Health Care Use and Needs among Children with Learning and Behavioral Developmental Disabilities, National Health Interview Survey, 2006-2010

Science.gov (United States)

Schieve, Laura A.; Gonzalez, Vanessa; Boulet, Sheree L.; Visser, Susanna N.; Rice, Catherine E.; Braun, Kim Van Naarden; Boyle, Coleen A.

2012-01-01

Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006-2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a…

On the analytic and numeric optimisation of airplane trajectories under real atmospheric conditions

Science.gov (United States)

Gonzalo, J.; Domínguez, D.; López, D.

2014-12-01

From the beginning of aviation era, economic constraints have forced operators to continuously improve the planning of the flights. The revenue is proportional to the cost per flight and the airspace occupancy. Many methods, the first started in the middle of last century, have explore analytical, numerical and artificial intelligence resources to reach the optimal flight planning. In parallel, advances in meteorology and communications allow an almost real-time knowledge of the atmospheric conditions and a reliable, error-bounded forecast for the near future. Thus, apart from weather risks to be avoided, airplanes can dynamically adapt their trajectories to minimise their costs. International regulators are aware about these capabilities, so it is reasonable to envisage some changes to allow this dynamic planning negotiation to soon become operational. Moreover, current unmanned airplanes, very popular and often small, suffer the impact of winds and other weather conditions in form of dramatic changes in their performance. The present paper reviews analytic and numeric solutions for typical trajectory planning problems. Analytic methods are those trying to solve the problem using the Pontryagin principle, where influence parameters are added to state variables to form a split condition differential equation problem. The system can be solved numerically -indirect optimisation- or using parameterised functions -direct optimisation-. On the other hand, numerical methods are based on Bellman's dynamic programming (or Dijkstra algorithms), where the fact that two optimal trajectories can be concatenated to form a new optimal one if the joint point is demonstrated to belong to the final optimal solution. There is no a-priori conditions for the best method. Traditionally, analytic has been more employed for continuous problems whereas numeric for discrete ones. In the current problem, airplane behaviour is defined by continuous equations, while wind fields are given in a

Robust Machine Learning Variable Importance Analyses of Medical Conditions for Health Care Spending.

Science.gov (United States)

Rose, Sherri

2018-03-11

To propose nonparametric double robust machine learning in variable importance analyses of medical conditions for health spending. 2011-2012 Truven MarketScan database. I evaluate how much more, on average, commercially insured enrollees with each of 26 of the most prevalent medical conditions cost per year after controlling for demographics and other medical conditions. This is accomplished within the nonparametric targeted learning framework, which incorporates ensemble machine learning. Previous literature studying the impact of medical conditions on health care spending has almost exclusively focused on parametric risk adjustment; thus, I compare my approach to parametric regression. My results demonstrate that multiple sclerosis, congestive heart failure, severe cancers, major depression and bipolar disorders, and chronic hepatitis are the most costly medical conditions on average per individual. These findings differed from those obtained using parametric regression. The literature may be underestimating the spending contributions of several medical conditions, which is a potentially critical oversight. If current methods are not capturing the true incremental effect of medical conditions, undesirable incentives related to care may remain. Further work is needed to directly study these issues in the context of federal formulas. © Health Research and Educational Trust.

The "prudent layperson" definition of an emergency medical condition.

Science.gov (United States)

Li, James; Galvin, Hannah K; Johnson, Sandra C

2002-01-01

The study objectives, based on federal and state legislative language, were to objectively define symptoms and signs commonly agreed on by "prudent laypersons" as "emergency medical conditions." After comprehensive tabulation of symptom classifications from the International Classification of Diseases (ICD-9), we performed a survey of nonmedical laypersons. Data analysis included descriptive statistics, proportional calculations, and 95% confidence intervals. A minority of symptoms and signs (25/87, 29%) were considered emergency medical conditions by more than half of nonmedical survey respondents who were self-defined as prudent laypersons. The leading conditions deemed emergencies were loss of consciousness, seizure, no recognition of one side of the body, paralysis, shock, gangrene, coughing blood, trouble breathing, chest pain, and choking. Pain, except for renal colic or chest pain, was not considered an emergency. No symptoms or signs specifically related to gynecologic disorders were considered emergencies. Most symptoms and signs tabulated in the diagnostic coding manual, ICD-9, are not considered emergency medical conditions by self-designated prudent laypersons. These include many conditions that are commonly investigated and treated in the emergency department setting. Use of the prudent layperson standard for reimbursable emergency health services may not reflect the actual scope of symptoms necessitating emergency care.

Sleep-related problems in common medical conditions.

Science.gov (United States)

Parish, James M

2009-02-01

Common medical problems are often associated with abnormalities of sleep. Patients with chronic medical disorders often have fewer hours of sleep and less restorative sleep compared to healthy individuals, and this poor sleep may worsen the subjective symptoms of the disorder. Individuals with lung disease often have disturbed sleep related to oxygen desaturations, coughing, or dyspnea. Both obstructive lung disease and restrictive lung diseases are associated with poor quality sleep. Awakenings from sleep are common in untreated or undertreated asthma, and cause sleep disruption. Gastroesophageal reflux is a major cause of disrupted sleep due to awakenings from heartburn, dyspepsia, acid brash, coughing, or choking. Patients with chronic renal disease commonly have sleep complaints often due to insomnia, insufficient sleep, sleep apnea, or restless legs syndrome. Complaints related to sleep are very common in patients with fibromyalgia and other causes of chronic pain. Sleep disruption increases the sensation of pain and decreases quality of life. Patients with infectious diseases, including acute viral illnesses, HIV-related disease, and Lyme disease, may have significant problems with insomnia and hypersomnolence. Women with menopause have from insomnia, sleep-disordered breathing, restless legs syndrome, or fibromyalgia. Patients with cancer or receiving cancer therapy are often bothered by insomnia or other sleep disturbances that affect quality of life and daytime energy. The objective of this article is to review frequently encountered medical conditions and examine their impact on sleep, and to review frequent sleep-related problems associated with these common medical conditions.

Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations

International Nuclear Information System (INIS)

Isambert, Aurelie; Valero, Marc; Rousse, Carole; Blanchard, Vincent; Le Du, Dominique; Guilhem, Marie-Therese; Dieudonne, Arnaud; Pierrat, Noelle; Salvat, Cecile

2015-01-01

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. (authors)

Processing And Display Of Medical Three Dimensional Arrays Of Numerical Data Using Octree Encoding

Science.gov (United States)

Amans, Jean-Louis; Darier, Pierre

1986-05-01

imaging modalities such as X-Ray computerized Tomography (CT), Nuclear Medecine and Nuclear Magnetic Resonance can produce three-dimensional (3-D) arrays of numerical data of medical object internal structures. The analysis of 3-D data by synthetic generation of realistic images is an important area of computer graphics and imaging.

Numerical simulation of time-dependent deformations under hygral and thermal transient conditions

International Nuclear Information System (INIS)

Roelfstra, P.E.

1987-01-01

Some basic concepts of numerical simulation of the formation of the microstructure of HCP are outlined. The aim is to replace arbitrary terms like aging by more realistic terms like bond density in the xerogel and bonds between hydrating particles of HCP. Actual state parameters such as temperature, humidity and degree of hydration can be determined under transient hygral and thermal conditions by solving numerically a series of appropriate coupled differential equations with given boundary conditions. Shrinkage of a composite structure without crack formation, based on calculated moisture distributions, has been determined with numerical concrete codes. The influence of crack formation, tensile strain-hardening and softening on the total deformation of a quasi-homogeneous drying material has been studied by means of model based on FEM. The difference between shrinkage without crack formation and shrinkage with crack formation can be quantified. Drying shrinkage and creep of concrete cannot be separated. The total deformation depends on the superimposed stress fields. Transient hygral deformation can be realistically predicted if the concept of point properties is applied rigorously. Transient thermal deformation has to be dealt with in the same way. (orig./HP)

Assessment of the use of xerogenic medications for chronic medical and dental conditions among adult day health participants.

Science.gov (United States)

Lam, Annie; Kiyak, Asuman; Gossett, Allison M; McCormick, Lawrence

2009-10-01

To describe the health conditions, dental problems, and use of xerogenic medications among dental patients in adult day health (ADH) centers. Cross-sectional descriptive study. ADH centers in King County, Washington. ADH clients who were patients of a mobile dental service. Pharmacist-conducted chart reviews and in-person medication reviews with patients. Demographic description, mean numbers of medical and dental problems, medications, xerogenic medications used per subject, and identification of xerogenic medications by therapeutic class. At five sites, 97 patients were interviewed (average age 73.8 +/- 11.8 years, 61% female); ethnicities included: Asian-American (37.1%), Caucasian (30.9%), Russian (29%), and African-American (3%). Mean numbers of chronic health problems, medications, and xerogenic medications per patient were 5.2 +/- 2.7, 10.9 +/- 4.4, and 3.3 +/- 1.8, respectively. Antidepressants were the most commonly used xerogenic medication, followed by antipsychotics, antiemetics, analgesics, and antihistamines. Among 74 patients who received dental treatment, 33 (44.6%) wore dentures. Among 58 patients with teeth, a mean number of 2.8 dental problems per patient was identified. Dental caries (51.7%) was the most prevalent problem, followed by periodontitis (29.3%), soft tissue lesions (10.3%), gingivitis (5.2%), and candidiasis (3.4%). Multiple systemic diseases, use of multiple xerogenic medications, and poor oral health were prevalent among the ADH clients in this study. However, self-reports of dry mouth were unrelated to number of xerogenic medications or oral conditions. Further research is needed to determine the association between self-reported dry mouth, chronic health conditions, use of xerogenic medications, tooth loss, and/or denture use.

Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations.

Science.gov (United States)

Isambert, Aurélie; Le Du, Dominique; Valéro, Marc; Guilhem, Marie-Thérèse; Rousse, Carole; Dieudonné, Arnaud; Blanchard, Vincent; Pierrat, Noëlle; Salvat, Cécile

2015-04-01

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Numerical Analysis of Flood modeling of upper Citarum River under Extreme Flood Condition

Science.gov (United States)

Siregar, R. I.

2018-02-01

This paper focuses on how to approach the numerical method and computation to analyse flood parameters. Water level and flood discharge are the flood parameters solved by numerical methods approach. Numerical method performed on this paper for unsteady flow conditions have strengths and weaknesses, among others easily applied to the following cases in which the boundary irregular flow. The study area is in upper Citarum Watershed, Bandung, West Java. This paper uses computation approach with Force2 programming and HEC-RAS to solve the flow problem in upper Citarum River, to investigate and forecast extreme flood condition. Numerical analysis based on extreme flood events that have occurred in the upper Citarum watershed. The result of water level parameter modeling and extreme flood discharge compared with measurement data to analyse validation. The inundation area about flood that happened in 2010 is about 75.26 square kilometres. Comparing two-method show that the FEM analysis with Force2 programs has the best approach to validation data with Nash Index is 0.84 and HEC-RAS that is 0.76 for water level. For discharge data Nash Index obtained the result analysis use Force2 is 0.80 and with use HEC-RAS is 0.79.

Lithuanian medical tourism cluster: conditions and background for functioning

Directory of Open Access Journals (Sweden)

Korol A. N.

2017-10-01

Full Text Available as the global economy develops, more and more attention is paid to the creation of tourist clusters, which are extremely important for the economy and national competitiveness. This article analyzes the cluster of medical tourism in Lithuania, and explores the conditions for its successful functioning. The creation of the medical tourism cluster is highly influenced by a number of factors: the regulation of tourist and medical services, the level of entrepreneurial activity, human resources, the experience of partnership. In addition, the article analyzes the structure of the medical tourism cluster, determines the prerequisites for the functioning of the Lithuanian medical tourism cluster, including a wide range of services, European standards for the provision of medical services, high qualification of specialists, etc. When writing the article, the methods of systematic and logical analysis of scientific literature were used.

Acute Medical conditions in under five year old children at a Public ...

African Journals Online (AJOL)

Objective: To determine the prevalence of childhood preventable and treatable medical conditions and the parent's/guardian's knowledge about the conditions and their management. Design: A descriptive cross-sectional study. Setting: Paediatric medical wards at Kenyatta National hospital Subjects: All children aged 0-60 ...

Formulation and numerical implementation of micro-scale boundary conditions for particle aggregates

NARCIS (Netherlands)

Liu, J.; Bosco, E.; Suiker, A.S.J.

2017-01-01

Novel numerical algorithms are presented for the implementation of micro-scale boundary conditions of particle aggregates modelled with the discrete element method. The algorithms are based on a servo-control methodology, using a feedback principle comparable to that of algorithms commonly applied

Geometrically motivated hyperbolic coordinate conditions for numerical relativity: Analysis, issues and implementations

International Nuclear Information System (INIS)

Bona, Carles; Lehner, Luis; Palenzuela-Luque, Carlos

2005-01-01

We study the implications of adopting hyperbolic-driver coordinate conditions motivated by geometrical considerations. In particular, conditions that minimize the rate of change of the metric variables. We analyze the properties of the resulting system of equations and their effect when implementing excision techniques. We find that commonly used coordinate conditions lead to a characteristic structure at the excision surface where some modes are not of outflow type with respect to any excision boundary chosen inside the horizon. Thus, boundary conditions are required for these modes. Unfortunately, the specification of these conditions is a delicate issue as the outflow modes involve both gauge and main variables. As an alternative to these driver equations, we examine conditions derived from extremizing a scalar constructed from Killing's equation and present specific numerical examples

Gauge conditions for long-term numerical black hole evolutions without excision

International Nuclear Information System (INIS)

Alcubierre, Miguel; Bruegmann, Bernd; Diener, Peter; Koppitz, Michael; Pollney, Denis; Seidel, Edward; Takahashi, Ryoji

2003-01-01

Numerical relativity has faced the problem that standard 3+1 simulations of black hole spacetimes without singularity excision and with singularity avoiding lapse and vanishing shift fail early on due to the so-called slice stretching. We discuss lapse and shift conditions for the nonexcision case that effectively cure slice stretching and allow run times of 1000M and more

Effects of the bottom boundary condition in numerical investigations of dense water cascading on a slope

Science.gov (United States)

Berntsen, Jarle; Alendal, Guttorm; Avlesen, Helge; Thiem, Øyvind

2018-05-01

The flow of dense water along continental slopes is considered. There is a large literature on the topic based on observations and laboratory experiments. In addition, there are many analytical and numerical studies of dense water flows. In particular, there is a sequence of numerical investigations using the dynamics of overflow mixing and entrainment (DOME) setup. In these papers, the sensitivity of the solutions to numerical parameters such as grid size and numerical viscosity coefficients and to the choices of methods and models is investigated. In earlier DOME studies, three different bottom boundary conditions and a range of vertical grid sizes are applied. In other parts of the literature on numerical studies of oceanic gravity currents, there are statements that appear to contradict choices made on bottom boundary conditions in some of the DOME papers. In the present study, we therefore address the effects of the bottom boundary condition and vertical resolution in numerical investigations of dense water cascading on a slope. The main finding of the present paper is that it is feasible to capture the bottom Ekman layer dynamics adequately and cost efficiently by using a terrain-following model system using a quadratic drag law with a drag coefficient computed to give near-bottom velocity profiles in agreement with the logarithmic law of the wall. Many studies of dense water flows are performed with a quadratic bottom drag law and a constant drag coefficient. It is shown that when using this bottom boundary condition, Ekman drainage will not be adequately represented. In other studies of gravity flow, a no-slip bottom boundary condition is applied. With no-slip and a very fine resolution near the seabed, the solutions are essentially equal to the solutions obtained with a quadratic drag law and a drag coefficient computed to produce velocity profiles matching the logarithmic law of the wall. However, with coarser resolution near the seabed, there may be a

Factors Affecting the Readiness of Medical Doctors and Patients with Chronic Conditions toward the Usage of Smartphones in the Saudi Arabian Healthcare Sector

OpenAIRE

Bassam M Al-Mahadeen

2015-01-01

Numerous studies have reported the rapid increase in the number of individuals who use smartphones. However, smartphones appear to be increasingly used by healthcare workers, particularly physicians and nurses. Therefore, this study aims to investigate the readiness of medical doctors and patients with chronic conditions in using and adopting smartphones for communication. This study employs the Technology Acceptance Model to examine the behavior of people in using smartphones from the perspe...

28 CFR 79.26 - Proof of medical condition.

Science.gov (United States)

2010-07-01

... diagnosis, that authorizes the Program to contact the appropriate state cancer or tumor registry. The Program will accept as proof of medical condition verification from the state cancer or tumor registry... death. (5) Primary cancer of the esophagus. (i) Pathology report of tissue biopsy or surgical resection...

Numerical versus narrative: A comparison between methods to measure medical student performance during clinical clerkships.

Science.gov (United States)

Bartels, Josef; Mooney, Christopher John; Stone, Robert Thompson

2017-11-01

Medical school evaluations typically rely on both language-based narrative descriptions and psychometrically converted numeric scores to convey performance to the grading committee. We evaluated inter-rater reliability and correlation of numeric versus narrative evaluations for students on their Neurology Clerkship. 50 Neurology Clerkship in-training evaluation reports completed by their residents and faculty members at the University of Rochester School of Medicine were dissected into narrative and numeric components. 5 Clerkship grading committee members retrospectively gave new narrative scores (NNS) while blinded to original numeric scores (ONS). We calculated intra-class correlation coefficients (ICC) and their associated confidence intervals for the ONS and the NNS. In addition, we calculated the correlation between ONS and NNS. The ICC was greater for the NNS (ICC = .88 (95% CI = .70-.94)) than the ONS (ICC = .62 (95% CI = .40-.77)) Pearson correlation coefficient showed that the ONS and NNS were highly correlated (r = .81). Narrative evaluations converted by a small group of experienced graders are at least as reliable as numeric scoring by individual evaluators. We could allow evaluators to focus their efforts on creating richer narrative of greater value to trainees.

A study on the numerical instability of COBRA-series subchannel analysis codes at low-pressure and low-flow conditions

International Nuclear Information System (INIS)

Yoo, Y. J.; Hwnag, T. H.; Kim, K. K.; Ji, S. K.

2001-01-01

The numerical instability at low-pressure and low-flow conditions has been confirmed to be the common problem of the existing COBRA-series subchannel analysis codes. In addition, the range of operating conditions at which the analyses by the codes are impossible has been evaluated. To evaluate the MATRA's inapplicable range of operating conditions of the SMART core that is to be operated at the low flow condition, i.e. about 30% of the flow of the existing commercial pressurized water reactors at the steady-state condition, the analyses of various operating conditions were performed by using several representative COBRA-series subchannel analysis codes including MATRA. TORC of CE, COBRA3CP of Siemens/KWU, COBRA4I of PNL, and MATRA of KAERI were chosen as the subchannel analysis codes to be evaluated. The various operating conditions used in the CHF tests carried out at the Winfrith Establishment of UKAEA were chosen as the conditions to be analyzed. As the result, the numerical instabilities at low-pressure and low-flow conditions occurred in the analyses by all of the codes. It was revealed that the MATRA code, which numerically more stable thatn the other codes, was not able to analyze the conditions of the pressure not more than 100 bar and the mass velocity not more than 300 kg/sec-m 2 . Hereafter it is required to find out the exact reason for the numerical instability of the existing COBRA-series subchannel analysis codes at low-pressure and low-flow conditions and to devise the new method to get over that numerical problem

Medication Adherence in People Dually Treated for HIV Infection and Mental Health Conditions: Test of the Medications Beliefs Framework

OpenAIRE

Kalichman, Seth C.; Pellowski, Jennifer; Kegler, Christopher; Cherry, Chauncey; Kalichman, Moira O.

2015-01-01

Beliefs about medication necessity and concerns predict treatment adherence in people with a wide-array of medical conditions, including HIV infection. However, medication beliefs have not been examined in people dually treated with psychotropic medications and antiretroviral therapy. In the current study, we used a prospective design to investigate the factors associated with adherence to psychotropic medications and antiretrovirals among 123 dually treated persons living with HIV. We used u...

Effect of inlet conditions for numerical modelling of the urban boundary layer

Science.gov (United States)

Gnatowska, Renata

2018-01-01

The paper presents the numerical results obtained with the use of the ANSYS FLUENT commercial code for analysing the flow structure around two rectangular inline surface-mounted bluff bodies immersed in a boundary layer. The effects of the inflow boundary layer for the accuracy of the numerical modelling of the flow field around a simple system of objects are described. The analysis was performed for two concepts. In the former case, the inlet velocity profile was defined using the power law, whereas the kinetic and dissipation energy was defined from the equations according to Richards and Hoxey [1]. In the latter case, the inlet conditions were calculated for the flow over the rough area composed of the rectangular components.

Numerical Simulation of single-stage axial fan operation under dusty flow conditions

Science.gov (United States)

Minkov, L. L.; Pikushchak, E. V.

2017-11-01

Assessment of the aerodynamic efficiency of the single-stage axial flow fan under dusty flow conditions based on a numerical simulation using the computational package Ansys-Fluent is proposed. The influence of dust volume fraction on the dependences of the air volume flow rate and the pressure drop on the rotational speed of rotor is demonstrated. Matching functions for formulas describing a pressure drop and volume flow rate in dependence on the rotor speed and dust content are obtained by numerical simulation for the single-stage axial fan. It is shown that the aerodynamic efficiency of the single-stage axial flow fan decreases exponentially with increasing volume content of dust in the air.

Coupled numerical modeling of gas hydrates bearing sediments from laboratory to field-scale conditions

Science.gov (United States)

Sanchez, M. J.; Santamarina, C.; Gai, X., Sr.; Teymouri, M., Sr.

2017-12-01

Stability and behavior of Hydrate Bearing Sediments (HBS) are characterized by the metastable character of the gas hydrate structure which strongly depends on thermo-hydro-chemo-mechanical (THCM) actions. Hydrate formation, dissociation and methane production from hydrate bearing sediments are coupled THCM processes that involve, amongst other, exothermic formation and endothermic dissociation of hydrate and ice phases, mixed fluid flow and large changes in fluid pressure. The analysis of available data from past field and laboratory experiments, and the optimization of future field production studies require a formal and robust numerical framework able to capture the very complex behavior of this type of soil. A comprehensive fully coupled THCM formulation has been developed and implemented into a finite element code to tackle problems involving gas hydrates sediments. Special attention is paid to the geomechanical behavior of HBS, and particularly to their response upon hydrate dissociation under loading. The numerical framework has been validated against recent experiments conducted under controlled conditions in the laboratory that challenge the proposed approach and highlight the complex interaction among THCM processes in HBS. The performance of the models in these case studies is highly satisfactory. Finally, the numerical code is applied to analyze the behavior of gas hydrate soils under field-scale conditions exploring different features of material behavior under possible reservoir conditions.

Concurrent medical conditions among pregnant women - ignore at their peril: report from an antenatal anesthesia clinic.

Science.gov (United States)

Weiniger, Carolyn F; Einav, Sharon; Elchalal, Uriel; Ozerski, Vladislav; Shatalin, Daniel; Ioscovich, Alexander; Ginosar, Yehuda

2018-03-19

Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002-2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center. Each consultation focused on the concurrent medical condition. A written anesthesia strategy according to the medical condition and its anesthesia considerations was discussed and given to the patient. Data regarding clinic visits were recorded. A total of 451 clinic women attended the antenatal anesthesia clinic. Maternal age was 31.7 ± 6.0 years (mean ± SD), with gestational age of pregnancy 33.0 ± 5.4 weeks at the clinic visit. Musculoskeletal conditions (23% of all the women seen) were the most frequent concurrent conditions, followed by anesthesia related concerns 20%, neurologic conditions 19%, and cardiac conditions 15%. Women were provided plans that were deliberated carefully rather than being concocted during labor. A wide range of concurrent medical conditions was seen in the antenatal anesthesia clinic, however fewer women attended the clinic than expected according to known population frequencies of concurrent medical conditions. Women with concurrent medical conditions should have labor and anesthesia plans considered during the nine months of pregnancy, prior to delivery, and hospitals should have a means of obtaining this information in a timely manner. Finally, there is a need to develop additional antenatal anesthesia clinics.

Numerical tools to predict the environmental loads for offshore structures under extreme weather conditions

Science.gov (United States)

Wu, Yanling

2018-05-01

In this paper, the extreme waves were generated using the open source computational fluid dynamic (CFD) tools — OpenFOAM and Waves2FOAM — using linear and nonlinear NewWave input. They were used to conduct the numerical simulation of the wave impact process. Numerical tools based on first-order (with and without stretching) and second-order NewWave are investigated. The simulation to predict force loading for the offshore platform under the extreme weather condition is implemented and compared.

A simple and rational numerical method of two-phase flow with volume-junction model. 2. The numerical method for general condition of two-phase flow in non-equilibrium states

International Nuclear Information System (INIS)

Okazaki, Motoaki

1997-11-01

In the previous report, the usefulness of a new numerical method to achieve a rigorous numerical calculation using a simple explicit method with the volume-junction model was presented with the verification calculation for the depressurization of a saturated two-phase mixture. In this report, on the basis of solution method above, a numerical method for general condition of two-phase flow in non-equilibrium states is presented. In general condition of two-phase flow, the combinations of saturated and non-saturated conditions of each phase are considered in the each flow of volume and junction. Numerical evaluation programs are separately prepared for each combination of flow condition. Several numerical calculations of various kinds of non-equilibrium two-phase flow are made to examine the validity of the numerical method. Calculated results showed that the thermodynamic states obtained in different solution schemes were consistent with each other. In the first scheme, the states are determined by using the steam table as a function of pressure and specific enthalpy which are obtained as the solutions of simultaneous equations. In the second scheme, density and specific enthalpy of each phase are directly calculated by using conservation equations of mass and enthalpy of each phase, respectively. Further, no accumulation of error in mass and energy was found. As for the specific enthalpy, two cases of using energy equations for the volume are examined. The first case uses total energy conservation equation and the second case uses the type of the first law of thermodynamics. The results of both cases agreed well. (author)

When is it safe to fly? Addressing medical conditions in pilots.

Science.gov (United States)

Steinkraus, Lawrence

2011-06-01

Since World War I, the role of physicians who care for pilots has been to minimize the risks posed by the unique environment in airplanes and the demands of flying. Originally, that meant screening out those with any physical limitations that might affect their ability to fly such as vision or cardiac problems. Today, however, with the ability to better manage patients with multiple conditions, the physician's task is more nuanced and requires an estimation of risk based on the how well a pilot's condition can be managed and the type of flying he or she does. This article looks at how pilots are medically evaluated and how the standards for medical certification are evolving, allowing some pilots who have certain conditions to continue flying.

Review of U.S. Army Aviation Accident Reports: Prevalence of Environmental Stressors and Medical Conditions

Science.gov (United States)

2017-10-18

terminology related to an aforementioned stressor or medical condition. Table 1 presents the identified operational stressor with the keywords extracted...USAARL Report No. 2018-02 Review of U.S. Army Aviation Accident Reports: Prevalence of Environmental Stressors and Medical Conditions By Kathryn...Environmental Stressors and Medical Conditions N/A N/A N/A N/A N/A N/A Feltman, Kathryn A. Kelley, Amanda M. Curry, Ian P. Boudreaux, David A. Milam

[Medical and social condition of families of patients with multiple sclerosis].

Science.gov (United States)

Lugovtsova, Y A; Karnaukh, V N

2015-01-01

To analyze the medical and social condition of 70 families having a member with multiple sclerosis of working age. We used the classification of types and kinds of families of chronically ill patients of working-age that included two sections - grouping families by health and social status. By medical condition, most families are assessed as dysfunctional II degree, by welfare as at risk families. Both health and social status of the family depends on a number of social factors as well as the clinical characteristics of the disease, in particular, type of disease course and severity of neurological deficit.

Psychological factors affecting medical condition: a new proposal for DSM-V.

Science.gov (United States)

Fava, Giovanni A; Fabbri, Stefania; Sirri, Laura; Wise, Thomas N

2007-01-01

The DSM category of "psychological factors affecting medical condition" had virtually no impact on clinical practice. However, several clinically relevant psychosomatic syndromes have been described in the literature: disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, and irritable mood. These syndromes, in addition to the DSM definition of hypochondriasis, can yield clinical specification in the category of "psychological factors affecting medical condition" and eliminate the need for the highly criticized DSM classification of somatoform disorders. This new classification is supported by a growing body of research evidence and is in line with psychosomatic medicine as a recognized subspecialty.

Factors Associated with Parental Adaptation to Children with an Undiagnosed Medical Condition

Science.gov (United States)

Yanes, Tatiane; Humphreys, Linda; McInerney-Leo, Aideen; Biesecker, Barbara

2017-01-01

Little is known about the adaptive process and experiences of parents raising a child with an undiagnosed medical condition. The present study aims to assess how uncertainty, hope, social support, and coping efficacy contributes to adaptation among parents of children with an undiagnosed medical condition. Sixty-two parents of child affected by an undiagnosed medical condition for at least two years completed an electronically self-administered survey. Descriptive analysis suggested parents in this population had significantly lower adaptation scores when compared to other parents of children with undiagnosed medical conditions, and parents of children with a diagnosed intellectual and/or physical disability. Similarly, parents in this population had significantly lower hope, perceived social support and coping efficacy when compared to parents of children with a diagnosed medical condition. Multiple linear regression was used to identify relationships between independent variables and domains of adaptation. Positive stress response was negatively associated with emotional support (B = −0.045, p ≤ 0.05), and positively associated with coping efficacy (B = 0.009, p ≤ 0.05). Adaptive self-esteem was negatively associated with uncertainty towards one's social support (B = −0.248, p ≤ 0.05), and positively associated with coping efficacy (B = 0.007, p ≤ 0.05). Adaptive social integration was negatively associated with uncertainty towards one's social support (B-0.273, p ≤ 0.05), and positively associated with uncertainty towards child's health (B = 0.323, p ≤ 0.001), and affectionate support (B = 0.110, p ≤ 0.001). Finally, adaptive spiritual wellbeing was negatively associated with uncertainty towards one's family (B = −0.221, p ≤ 0.05). Findings from this study have highlighted the areas where parents believed additional support was required, and provided insight into factors that contribute to parental adaptation. PMID:28039658

Numerical simulation of hydrodynamic performance of ship under oblique conditions

Directory of Open Access Journals (Sweden)

CHEN Zhiming

2018-02-01

Full Text Available [Objectives] This paper is intended to study the viscous flow field around a ship under oblique conditions and provide a research basis for ship maneuverability. [Methods] Using commercial software STRA-CCM+, the SST k-ω turbulence model is selected to predict the hydrodynamic performance of the KVLCC2 model at different drift angles, and predict the hull flow field. The pressure distribution of the ship model at different drift angles is observed and the vortex shedding of the ship's hull and constraint streamlines on the hull's surface are also observed. [Results] The results show that numerical simulation can satisfy the demands of engineering application in the prediction of the lateral force, yaw moment and hull surface pressure distribution of a ship. [Conclusions] The research results of this paper can provide valuable references for the study of the flow separation phenomenon under oblique conditions.

Numerical study on lithium titanate battery thermal response under adiabatic condition

International Nuclear Information System (INIS)

Sun, Qiujuan; Wang, Qingsong; Zhao, Xuejuan; Sun, Jinhua; Lin, Zijing

2015-01-01

Highlights: • The thermal behavior of lithium titanate battery during cycling was investigated. • The temperature rate in charging was less than that of discharging in the cycling. • The temperature difference was less than 0.02 °C at 0.5 C in adiabatic condition. • The temperature distribution and thermal runaway of the battery were predicted. - Abstract: To analyze the thermal behavior of 945 mA h lithium titanate battery during charging and discharging processes, the experimental and numerical studies are performed in this work. The cathode and anode of the 945 mA h lithium titanate soft package battery are the lithium nickel–cobalt–manganese-oxide and lithium titanate, respectively. In the experiment, an Accelerating Rate Calorimeter combined with battery cycler is employed to investigate the electrochemical–thermal behavior during charge–discharge cycling under the adiabatic condition. In numerical simulation, one electrochemical-thermal model is adopted to predict the thermal response and validated with the experimental results. From both experimental and simulated results, the profile of potential and current, the heat generation, the temperature, the temperature changing rate and the temperature distribution in the cell are obtained and thermal runaway is predicted. The analysis of the electrochemical and thermal behavior is beneficial for the commercial application of lithium titanate battery in the fields of electric vehicles and hybrid electric vehicles

Experimental and numerical study of an evaporatively-cooled condenser of air-conditioning systems

International Nuclear Information System (INIS)

Islam, M.R.; Jahangeer, K.A.; Chua, K.J.

2015-01-01

The performance of an air-conditioning unit with evaporately-cooled condenser coil is studied experimentally and numerically. An experimental setup is fabricated by retrofitting a commercially available air-conditioning unit and installing comprehensive measuring sensors and controllers. Experimental result shows that the COP (Coefficient of Performance) of the evaporately-cooled air-conditioning unit increases by about 28% compared to the conventional air cooled air-conditioning unit. To analyze the heat and mass transfer processes involved in the evaporately-cooled condenser, a detailed theoretical model has been developed based on the fluid flow characteristics of the falling film and the thermodynamic aspect of the evaporation process. Simulated results agree well with experimental data. The numerical model provides new insights into the intrinsic links between operating variables and heat transfer characteristics of water film in evaluating the performance of evaporatively-cooled condenser system. Two heat transfer coefficients, namely, wall to bulk and bulk to interface are introduced and computed from the simulation results under different operating conditions. Finally, the overall heat transfer coefficient for the water film is computed and presented as a function of dimensionless variables which can conveniently be employed by engineers to design and analyze high performance evaporatively-cooled heat exchangers. - Highlights: • Performance of evaporatively-cooled condenser is investigated. • Local convective heat transfer coefficients of water film are determined. • Thermal resistance of water film is negligible. • Heat transfer with evaporated vapor plays significant role on performance. • Better condenser performance translates to an improvement in COP

Medical condition and care of undocumented migrants in ambulatory clinics in Tel Aviv, Israel: assessing unmet needs.

Science.gov (United States)

Mor, Zohar; Raveh, Yuval; Lurie, Ido; Leventhal, Alex; Gamzu, Roni; Davidovitch, Nadav; Benari, Orel; Grotto, Itamar

2017-07-14

Approximately 150,000 undocumented migrants (UM) who are medically uninsured reside in Israel, including ~50,000 originating from the horn of Africa (MHA). Free medical-care is provided by two walk-in clinics in Tel-Aviv. This study aims to compare the medical complaints of UM from different origins, define their community health needs and assess gaps between medical needs and available services. This cross-sectional study included a random sample of 610 UM aged 18-64 years, who were treated in these community clinics between 2008 and 2011. The study compared UM who had complex medical conditions which necessitated referral to more equipped medical settings with UM having mild/simple medical conditions, who were treated at the clinics. MHA were younger, unemployed and more commonly males compared with UM originating from other countries. MHA also had longer referral-delays and visited the clinics less frequently. UM with complex medical conditions were more commonly females, had chronic diseases and demonstrated longer referral-delays than those who had mild/simple medical conditions. The latter more commonly presented with complained of respiratory, muscular and skeletal discomfort. In multivariate analysis, the variables which predicted complex medical conditions included female gender, chronic illnes and self-referral to the clinics. The ambulatory clinics were capable of responding to mild/simple medical conditions. Yet, the health needs of women and migrants suffering from complex medical conditions and chronic diseases necessitated referrals to secondary/tertiary medical settings, while jeopardizing the continuity of care. The health gaps can be addressed by a more holistic social approach, which includes integration of UM in universal health insurance.

Numerical simulation of diurnally varying thermal environment in a street canyon under haze-fog conditions

Science.gov (United States)

Tan, Zijing; Dong, Jingliang; Xiao, Yimin; Tu, Jiyuan

2015-10-01

The impact of haze-fog on surface temperature, flow pattern, pollutant dispersion and pedestrian thermal comfort are investigated using computational fluid dynamics (CFD) approach based on a three-dimensional street canyon model under different haze-fog conditions. In this study, light extinction coefficient (Kex) is adopted to represent haze-fog pollution level. Numerical simulations are performed for different Kex values at four representative time events (1000 LST, 1300 LST, 1600 LST and 2000 LST). The numerical results suggest that the surface temperature is strongly affected by the haze-fog condition. Surface heating induced by the solar radiation is enhanced by haze-fog, as higher surface temperature is observed under thicker haze-fog condition. Moreover, the temperature difference between sunlit and shadow surfaces is reduced, while that for the two shadow surfaces is slightly increased. Therefore, the surface temperature among street canyon facets becomes more evenly distributed under heavy haze-fog conditions. In addition, flow patterns are considerably altered by different haze-fog conditions, especially for the afternoon (1600 LST) case, in which thermal-driven flow has opposite direction as that of the wind-driven flow direction. Consequently, pollutants such as vehicular emissions will accumulate at pedestrian level, and pedestrian thermal comfort may lower under thicker haze-fog condition.

Medical Comorbidity of Full and Partial Posttraumatic Stress Disorder in United States Adults: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

Science.gov (United States)

Pietrzak, Robert H.; Goldstein, Risë B.; Southwick, Steven M.; Grant, Bridget F.

2011-01-01

Objective This study examined associations between lifetime trauma exposures, PTSD and partial PTSD, and past-year medical conditions in a nationally representative sample of U.S. adults. Methods Face-to-face interviews were conducted with 34,653 participants in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression analyses evaluated associations of trauma exposure, PTSD and partial PTSD with respondent-reported medical diagnoses. Results After adjustment for sociodemographic characteristics and comorbid Axis I and II disorders, respondents with full PTSD were more likely than traumatized respondents without full or partial PTSD (comparison group) to report diagnoses of diabetes mellitus, noncirrhotic liver disease, angina pectoris, tachycardia, hypercholesterolemia, other heart disease, stomach ulcer, HIV seropositivity, gastritis, and arthritis (odds ratios [ORs]=1.2-2.5). Respondents with partial PTSD were more likely than the comparison group to report past-year diagnoses of stomach ulcer, angina pectoris, tachycardia, and arthritis (ORs=1.3-1.6). Men with full and partial PTSD were more likely than controls to report diagnoses of hypertension (both ORs=1.6), and both men and women with PTSD (ORs=1.8 and 1.6, respectively), and men with partial PTSD (OR=2.0) were more likely to report gastritis. Total number of lifetime traumatic event types was associated with many assessed medical conditions (ORs=1.04-1.16), reducing the magnitudes and rendering non-significant some of the associations between PTSD status and medical conditions. Conclusions Greater lifetime trauma exposure and PTSD are associated with numerous medical conditions, many of which are stress-related and chronic, in U.S. adults. Partial PTSD is associated with intermediate odds of some of these conditions. PMID:21949429

Conditions of radiation protection in medical stations

International Nuclear Information System (INIS)

Sa, L.R.B.S.; Tomaz Neto, A.; Pires, A.; Azevedo, H.; Boasquevisque, E.M.

1988-01-01

The purpose of this study is to clear up what safety procedures are normally' observed for occupational and environmental radiology. 30 Public Medical station in Rio de Janeiro were investigated. A questionaire of 13 questions was prepared to be filled up by the professionals directly involved with the radiologic work, intending to evaluate, the personal and environmental aspect of radioprotection, the individual responsability of each worker and of the whole institution. It was also verified that knowledge of safety norms is doubtful and precarious in the despite of the fact that a great number of the people in question declare to have specific graduation for the activity. Only 45% from the total really make use of the dosimeters, the periodical medical examinations are not frequent (65%), and fewer employes make use of this lead apron (23%). We come to the conclusion that there is a remarkable bewilderment as for the personal observences about the work conditions in controlled areas. (author) [pt

Numerical simulation of wave-current interaction under strong wind conditions

Science.gov (United States)

Larrañaga, Marco; Osuna, Pedro; Ocampo-Torres, Francisco Javier

2017-04-01

Although ocean surface waves are known to play an important role in the momentum and other scalar transfer between the atmosphere and the ocean, most operational numerical models do not explicitly include the terms of wave-current interaction. In this work, a numerical analysis about the relative importance of the processes associated with the wave-current interaction under strong off-shore wind conditions in Gulf of Tehuantepec (the southern Mexican Pacific) was carried out. The numerical system includes the spectral wave model WAM and the 3D hydrodynamic model POLCOMS, with the vertical turbulent mixing parametrized by the kappa-epsilon closure model. The coupling methodology is based on the vortex-force formalism. The hydrodynamic model was forced at the open boundaries using the HYCOM database and the wave model was forced at the open boundaries by remote waves from the southern Pacific. The atmospheric forcing for both models was provided by a local implementation of the WRF model, forced at the open boundaries using the CFSR database. The preliminary analysis of the model results indicates an effect of currents on the propagation of the swell throughout the study area. The Stokes-Coriolis term have an impact on the transient Ekman transport by modifying the Ekman spiral, while the Stokes drift has an effect on the momentum advection and the production of TKE, where the later induces a deepening of the mixing layer. This study is carried out in the framework of the project CONACYT CB-2015-01 255377 and RugDiSMar Project (CONACYT 155793).

Co-occurrence of medical conditions: Exposing patterns through probabilistic topic modeling of snomed codes.

Science.gov (United States)

Bhattacharya, Moumita; Jurkovitz, Claudine; Shatkay, Hagit

2018-04-12

Patients associated with multiple co-occurring health conditions often face aggravated complications and less favorable outcomes. Co-occurring conditions are especially prevalent among individuals suffering from kidney disease, an increasingly widespread condition affecting 13% of the general population in the US. This study aims to identify and characterize patterns of co-occurring medical conditions in patients employing a probabilistic framework. Specifically, we apply topic modeling in a non-traditional way to find associations across SNOMED-CT codes assigned and recorded in the EHRs of >13,000 patients diagnosed with kidney disease. Unlike most prior work on topic modeling, we apply the method to codes rather than to natural language. Moreover, we quantitatively evaluate the topics, assessing their tightness and distinctiveness, and also assess the medical validity of our results. Our experiments show that each topic is succinctly characterized by a few highly probable and unique disease codes, indicating that the topics are tight. Furthermore, inter-topic distance between each pair of topics is typically high, illustrating distinctiveness. Last, most coded conditions grouped together within a topic, are indeed reported to co-occur in the medical literature. Notably, our results uncover a few indirect associations among conditions that have hitherto not been reported as correlated in the medical literature. Copyright © 2018. Published by Elsevier Inc.

Investigations of actual conditions of medical radiation technologists

International Nuclear Information System (INIS)

2002-01-01

At 50 year after enactment of the law of medical radiation technologists, their actual conditions were investigated. The investigation was done in December 2001 by questionnaire to directors of 10,514 facilities and answers were obtained from 4,241 facilities (40.37%). Following 11 questions (major answers and their analysis in parenthesis) were made: Nature of the facility (Private hospitals 45.8%, public ones 20.8%); State of radiation department (Independent department of the technologists from medical one about 30%); Actual job of the technologists (X-ray about 81% of the facilities, angiography 34%, CT 78%, MRI 38% where 94% of technologists conduct, nuclear medicine 17%, ultrasound 51% where, 10%); Personnel of the radiation department (21,897 persons in total/male 85%); Fulfillment of the personnel number; Treatment of the personnel; Acknowledgement system of the Technologist Society; Management of radiation instruments like daily examination; Radiation control (Leak dose measurement by technologists by themselves about 50% facilities for X-ray and radio-therapy); Medical exposure (Measurement experience about 50%); and Possession of dose rate-meter/survey-meter (Possession in about 40% facilities). (N.I.)

Investigations of actual conditions of medical radiation technologists

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-12-01

At 50 year after enactment of the law of medical radiation technologists, their actual conditions were investigated. The investigation was done in December 2001 by questionnaire to directors of 10,514 facilities and answers were obtained from 4,241 facilities (40.37%). Following 11 questions (major answers and their analysis in parenthesis) were made: Nature of the facility (Private hospitals 45.8%, public ones 20.8%); State of radiation department (Independent department of the technologists from medical one about 30%); Actual job of the technologists (X-ray about 81% of the facilities, angiography 34%, CT 78%, MRI 38% where 94% of technologists conduct, nuclear medicine 17%, ultrasound 51% where, 10%); Personnel of the radiation department (21,897 persons in total/male 85%); Fulfillment of the personnel number; Treatment of the personnel; Acknowledgement system of the Technologist Society; Management of radiation instruments like daily examination; Radiation control (Leak dose measurement by technologists by themselves about 50% facilities for X-ray and radio-therapy); Medical exposure (Measurement experience about 50%); and Possession of dose rate-meter/survey-meter (Possession in about 40% facilities). (N.I.)

Prudent layperson definition of an emergent pediatric medical condition.

Science.gov (United States)

Huang, Craig J; Poirier, Michael P; Cantwell, John R; Ermis, Peter R; Isaacman, Daniel J

2006-03-01

This study was designed to assess how well parents rated pediatric medical conditions based on their perceived degree of urgency so as to determine if the "Prudent Layperson Standard'' is reasonable. A self-administered, supervised survey was given to a convenience sample of 340 caregivers in the emergency department of an urban children's hospital. Respondents were asked to rank the urgency of 15 scenarios. A caregiver response within 1 point of the physician score was considered concordant with medical opinion. A 2-week-old infant with a rectal temperature of 103.7 degrees F was the only emergent scenario underestimated by caregivers. A 1 1/2-yr-old child with an upper respiratory tract infection, a 7-year-old child with ringworm, an 8-month-old infant with a simple forehead contusion, and a 4-year-old child with conjunctivitis were the non-urgent scenarios overestimated by caregivers. Laypeople are able to identify cases constructed to represent obvious pediatric medical emergencies. Several patient subgroups frequently overestimate medical urgency.

Numerical modeling of the flow conditions in a closed-circuit low-speed wind tunnel

NARCIS (Netherlands)

Moonen, P.; Blocken, B.J.E.; Roels, S.; Carmeliet, J.E.

2006-01-01

A methodology for numerically simulating the flow conditions in closed-circuit wind tunnels is developed as a contribution to the general philosophy of incorporating Computational Fluid Dynamics (CFD) in wind tunnel design and testing and to CFD validation studies. The methodology is applied to the

Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy

DEFF Research Database (Denmark)

Lauridsen, M M; Poulsen, L; Rasmussen, C K

2016-01-01

Many chronic medical conditions are accompanied by cognitive disturbances but these have only to a very limited extent been psychometrically quantified. An exception is liver cirrhosis where hepatic encephalopathy is an inherent risk and mild forms are diagnosed by psychometric tests. The preferred...... diagnostic test battery in cirrhosis is often the Continuous Reaction Time (CRT) and the Portosystemic Encephalopathy (PSE) tests but the effect on these of other medical conditions is not known. We aimed to examine the effects of common chronic (non-cirrhosis) medical conditions on the CRT and PSE tests. We...

An Efficient Numerical Approach for Solving Nonlinear Coupled Hyperbolic Partial Differential Equations with Nonlocal Conditions

Directory of Open Access Journals (Sweden)

A. H. Bhrawy

2014-01-01

Full Text Available One of the most important advantages of collocation method is the possibility of dealing with nonlinear partial differential equations (PDEs as well as PDEs with variable coefficients. A numerical solution based on a Jacobi collocation method is extended to solve nonlinear coupled hyperbolic PDEs with variable coefficients subject to initial-boundary nonlocal conservation conditions. This approach, based on Jacobi polynomials and Gauss-Lobatto quadrature integration, reduces solving the nonlinear coupled hyperbolic PDEs with variable coefficients to a system of nonlinear ordinary differential equation which is far easier to solve. In fact, we deal with initial-boundary coupled hyperbolic PDEs with variable coefficients as well as initial-nonlocal conditions. Using triangular, soliton, and exponential-triangular solutions as exact solutions, the obtained results show that the proposed numerical algorithm is efficient and very accurate.

Drowning fatalities in childhood: the role of pre-existing medical conditions.

Science.gov (United States)

Franklin, Richard C; Pearn, John H; Peden, Amy E

2017-10-01

This study is an analysis of the contribution of pre-existing medical conditions to unintentional fatal child (0-14 years) drowning and a of critique prevention stratagems, with an exploration of issues of equity in recreation. This study is a total population, cross-sectional audit of all demographic, forensic and on-site situational details surrounding unintentional fatal drowning of children 0-14 years in Australia for the period of 1 July 2002 to 30 June 2012. Data were sourced from the National (Australia) Coronial Information System. Age-specific disease patterns in the general population were obtained from the Australian Institute of Health and Welfare. Four hundred and sixty-eight children drowned during the study period. Fifty-three (11.3%) had a pre-existing medical condition, of whom 19 suffered from epilepsy, 13 from autism and 5 with non-specific intellectual disabilities. Epilepsy is a risk factor in childhood drowning deaths, with a prevalence of 4.1% of drowning fatalities, compared with 0.7%-1.7% among the general 0-14 years population (relative risk: 2.4-5.8). Epilepsy was deemed to be contributory in 16 of 19 cases (84.2% of epilepsy cases) with a median age of 8 years. Asthma and intellectual disabilities were under-represented in the drowning cohort. Except for epilepsy, this research has indicated that the risks of drowning while undertaking aquatic activities are not increased in children with pre-existing medical conditions. Children with pre-existing medical conditions can enjoy aquatic activities when appropriately supervised. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Advancing medical-surgical nursing practice: improving management of the changing patient condition.

Science.gov (United States)

Monroe, Heidi; Plylar, Peggy; Krugman, Mary

2014-01-01

Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

Life Balance and Stress in Adults With Medical Conditions or Obesity.

Science.gov (United States)

Matuska, Kathleen; Bass, Julie

2016-04-01

This cross-sectional research examined differences in life balance and perceived stress by body mass index (BMI) levels and self-reported medical conditions that limited physical activity. The sample consisted of 2,338 participants between the ages of 18 and 49 years who took the Life Balance Inventory, the Perceived Stress Scale, and provided demographic information including height and weight. Findings showed that individuals who were obese (BMI > 30.0) reported significantly lower life balance scores and higher stress scores than participants without obesity (p life balance and more stress than individuals without medical conditions (p < .001). These findings highlight the importance of addressing activity participation as a means to promote health and wellness. © The Author(s) 2016.

Experimental and numerical study on inlet and outlet conditions of a bulb turbine with considering free surface

International Nuclear Information System (INIS)

Zhao, Y P; Liao, W L; Feng, H D; Ruan, H; Luo, X Q

2012-01-01

For a bulb turbine, it has a low head and a big runner diameter, and the free surface influences the flow at the inlet and outlet of the turbine, which bring many problems such as vibration, cracks and cavitation to the turbine. Therefore, it is difficult to get the precise internal flow characteristics through a numerical simulation with conventional ideal flow conditions. In this paper, both numerical and experimental methods are adopted to investigate the flow characteristics at the inlet and outlet of the bulb turbine with considering free surface. Firstly, experimental and numerical studies in a low head pressure pipeline are conducted, and the corresponding boundary condition according with reality is obtained through the comparison between the model test result and the CFD simulation result. Then, through an analysis of the velocity and pressure fields at the inlet of the bulb turbine at different heads, the flow characteristics and rules at the entrance of the bulb turbine have been revealed with considering free surface; Finally, the performance predictions for a bulb turbine have been conducted by using the obtained flow rules at the inlet as the boundary condition of a turbine, and the causes that lead to non-uniform forces on blades, cavitation and vibration have been illustrated in this paper, which also provide a theory basis for an accurate numerical simulation and optimization design of a bulb turbine.

Investigation of film boiling thermal hydraulics under FCI conditions. Results of a numerical study

Energy Technology Data Exchange (ETDEWEB)

Dinh, T.N.; Dinh, A.T.; Nourgaliev, R.R.; Sehgal, B.R. [Div. of Nuclear Power Safety Royal Inst. of Tech. (RIT), Brinellvaegen 60, 10044 Stockholm (Sweden)

1998-01-01

Film boiling on the surface of a high-temperature melt jet or of a melt particle is one of key phenomena governing the physics of fuel-coolant interactions (FCIs) which may occur during the course of a severe accident in a light water reactor (LWR). A number of experimental and analytical studies have been performed, in the past, to address film boiling heat transfer and the accompanying hydrodynamic aspects. Most of the experiments have, however, been performed for temperature and heat flux conditions, which are significantly lower than the prototypic conditions. For ex-vessel FCIs, high liquid subcooling can significantly affect the FCI thermal hydraulics. Presently, there are large uncertainties in predicting natural-convection film boiling of subcooled liquids on high-temperature surfaces. In this paper, research conducted at the Division of Nuclear Power Safety, Royal Institute of Technology (RIT/NPS), Stockholm, concerning film-boiling thermal hydraulics under FCI condition is presented. Notably, the focus is placed on the effects of (1) water subcooling, (2) high-temperature steam properties, (3) the radiation heat transfer and (4) mixing zone boiling dynamics, on the vapor film characteristics. Numerical investigations are performed using a novel CFD modeling concept named as the local-homogeneous-slip model (LHSM). Results of the analytical and numerical studies are discussed with respect to boiling dynamics under FCI conditions. (author)

Organizing of medical ensurance of human population under extreme conditions. Summaries of reports of scientific-practical conference

International Nuclear Information System (INIS)

1994-01-01

Summary of reports are presented of Scientific-Practical conference on the organizing of medical ensurance of human population under extreme conditions including radiation accidents. The conference held in Moscow in October, 1994. It covered problems of organizing medical ensurance of population, medical surveillance problems, sanitary-hygienic and epidemiological problems (including radiation protection), and medical provision problems under extreme conditions

Medical privacy and the disclosure of personal medical information: the beliefs and experiences of those with genetic and other clinical conditions.

Science.gov (United States)

Kass, Nancy E; Hull, Sara Chandros; Natowicz, Marvin R; Faden, Ruth R; Plantinga, Laura; Gostin, Lawrence O; Slutsman, Julia

2004-07-30

There has been heightened legislative attention to medical privacy and to protections from genetic discrimination, without large-scale studies to document privacy concerns or analysis of whether experiences differ by whether the condition is genetic (defined here as a single-gene disorder) or non-genetic. To determine whether experiences regarding privacy, disclosure, and consequences of disclosure differ by whether one's medical condition is genetic, we conducted a descriptive study with one-time, structured quantitative and qualitative interviews. We interviewed approximately 100 adults or parents of children with each of the following medical conditions: sickle cell disease, cystic fibrosis, diabetes, and HIV, and 200 adults with or at risk for breast cancer or colon cancer. The percentages of the total 597 respondents experiencing positive or negative consequences of disclosure and the degree to which experiences differed by whether the condition was genetic were the outcomes of interest. Seventy-four percent were glad and 13% regretted others knew about their condition; these findings did not differ significantly by genetic vs. non-genetic condition. Reports of job and health insurance discrimination were not uncommon for the overall study population (19 and 27%, respectively) but were more likely among those with genetic conditions (30 and 37%, respectively). Legislation and other policy-making should target the needs of persons with all conditions and not focus exclusively on genetic discrimination, given that experiences and concerns generally do not differ based on the genetic etiology of the condition. Copyright 2004 Wiley-Liss, Inc.

The analysis of the medical university students’ health condition and lifestyle

Directory of Open Access Journals (Sweden)

OLGA KHURS

2017-01-01

Full Text Available Introduction: Significant psychophysiological burdens and unhealthy lifestyle constitute the risk factors leading to students’ health deterioration. Purpose: The purpose of the research was the analysis of students’ health condition and lifestyle in medical university. Material and methods: The objects of the research were 100 third year students of the Faculties of General Medicine and Pediatrics of Grodno State Medical University. For the study of students’ orientation on healthy lifestyle, a special scale-type questionnaire was developed and used. Results: According to the respondents’ opinions it has been detected that the basic factors influencing the state of health are the lifestyle and the living conditions. The students activity is evaluated as very low as well as their rational nutrition. The majority of them smoke and drink alcohol. Conclusions: The peculiarities of studying at a medical university accompanied by imbalanced nutrition might lead to the deterioration of health in the students which are doctors to be. The results ought to lead to the optimization of prophylaxis programs and entire alteration of the students’ lifestyles.

The language of uncertainty in genetic risk communication: framing and verbal versus numerical information.

Science.gov (United States)

Welkenhuysen, M; Evers-Kiebooms, G; d'Ydewalle, G

2001-05-01

Within a group of 300 medical students, two characteristics of risk communication in the context of a decision regarding prenatal diagnosis for cystic fibrosis are manipulated: verbal versus numerical probabilities and the negative versus positive framing of the problem (having a child with versus without cystic fibrosis). Independently of the manipulations, most students were in favor of prenatal diagnosis. The effect of framing was only significant in the conditions with verbal information: negative framing produced a stronger choice in favor of prenatal diagnosis than positive framing. The framing effect in the verbal conditions and its absence in the numerical conditions are explained by the dominance of the problem-occurrence orientation in health matters as well as a recoding process which is more likely to occur in the numerical (the probability "1-P" switches to its counterpart "P") than in the verbal conditions. The implications for the practice of genetic counseling are discussed.

Medical Conditions in the First Years of Life Associated with Future Diagnosis of ASD in Children

Science.gov (United States)

Alexeeff, Stacey E.; Yau, Vincent; Qian, Yinge; Davignon, Meghan; Lynch, Frances; Crawford, Phillip; Davis, Robert; Croen, Lisa A.

2017-01-01

This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest…

Optimality conditions for the numerical solution of optimization problems with PDE constraints :

Energy Technology Data Exchange (ETDEWEB)

Aguilo Valentin, Miguel Alejandro; Ridzal, Denis

2014-03-01

A theoretical framework for the numerical solution of partial di erential equation (PDE) constrained optimization problems is presented in this report. This theoretical framework embodies the fundamental infrastructure required to e ciently implement and solve this class of problems. Detail derivations of the optimality conditions required to accurately solve several parameter identi cation and optimal control problems are also provided in this report. This will allow the reader to further understand how the theoretical abstraction presented in this report translates to the application.

Sociodemographic disparities in the occurrence of medical conditions among adolescent and young adult Hodgkin lymphoma survivors.

Science.gov (United States)

Keegan, Theresa H M; Li, Qian; Steele, Amy; Alvarez, Elysia M; Brunson, Ann; Flowers, Christopher R; Glaser, Sally L; Wun, Ted

2018-06-01

Hodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors. Data for 5,085 patients aged 15-39 when diagnosed with HL during 1996-2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (≥ 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression. Twenty-six percent of AYAs experienced at least one medical condition and 15% had ≥ 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.05-1.78] and circulatory system diseases (HR = 1.58, CI 1.17-2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04-1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death. Strategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.

Utilization of emergency medical transports and hospital admissions among persons with behavioral health conditions.

Science.gov (United States)

Cuddeback, Gary; Patterson, P Daniel; Moore, Charity Galena; Brice, Jane H

2010-04-01

Emergency medical services transport and emergency department misuse among persons with behavioral health conditions is a concern. Administrative data were used to examine medical transports and hospital admissions among persons with behavioral health conditions. Data on 70,126 medical transports to emergency departments in three southeastern counties were analyzed. Compared with general medical transports, fewer behavioral health transports resulted in a hospital admission. Among behavioral health transports, persons with schizophrenia were 2.62 times more likely than those with substance use disorders to be admitted, and persons with mood disorders were 4.36 times more likely than those with substance use disorders to be admitted. Also, among behavioral health transports, rural transports were less likely than more urban transports to result in a hospital admission. More training of emergency medical services personnel and more behavioral health crisis resources, especially targeting rural areas and substance use disorders, are needed.

Clinical studies on health conditions of medical diagnostic X-ray workers

International Nuclear Information System (INIS)

Liu Liqun

1984-01-01

The results of investigations on general health conditions of 2484 medical X-ray workers and 1718 controls were reported. It was shown that the incidences of neurasthenic syndrome, loss of appetite, baldness etc. in X-ray workers were statistically higher than those in controls. Chronic rhinitis, pharyngitis, and paranasal sinusitis also occurred more frequently in the former group. The blood pressure, pulse rate, capillary resistance and past medical history showed no significant difference between these two groups. (Author)

Clinical studies on health conditions of medical diagnostic X-ray workers

Energy Technology Data Exchange (ETDEWEB)

Liqun, Liu

1984-10-01

The results of investigations on general health conditions of 2484 medical X-ray workers and 1718 controls were reported. It was shown that the incidences of neurasthenic syndrome, loss of appetite, baldness etc. in X-ray workers were statistically higher than those in controls. Chronic rhinitis, pharyngitis, and paranasal sinusitis also occurred more frequently in the former group. The blood pressure, pulse rate, capillary resistance and past medical history showed no significant difference between these two groups. (Author).

The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions.

Science.gov (United States)

Moon, Sanghee; Ranchet, Maud; Akinwuntan, Abiodun Emmanuel; Tant, Mark; Carr, David Brian; Raji, Mukaila Ajiboye; Devos, Hannes

2018-01-01

Adults aged 85 and older, often referred to as the oldest-old, are the fastest-growing segment of the population. The rapidly increasing number of older adults with chronic and multiple medical conditions poses challenges regarding their driving safety. To investigate the effect of advanced age on driving safety in drivers with medical conditions. We categorized 3,425 drivers with preexisting medical conditions into four age groups: middle-aged (55-64 years, n = 1,386), young-old (65-74 years, n = 1,013), old-old (75-84 years, n = 803), or oldest-old (85 years and older, n = 223). All underwent a formal driving evaluation. The outcome measures included fitness to drive recommendation by the referring physician, comprehensive fitness to drive decision from an official driving evaluation center, history of motor vehicle crashes (MVCs), and history of traffic violations. The oldest-old reported more cardiopulmonary and visual conditions, but less neurological conditions than the old-old. Compared to the middle-aged, the oldest-old were more likely to be considered unfit to drive by the referring physicians (odds ratio [OR] = 4.47, 95% confidence interval [CI] 2.20-9.10) and by the official driving evaluation center (OR = 2.74, 95% CI 1.87-4.03). The oldest-old reported more MVCs (OR = 2.79, 95% CI 1.88-4.12) compared to the middle-aged. Advanced age adversely affected driving safety outcomes. The oldest-old are a unique age group with medical conditions known to interfere with safe driving. Driving safety strategies should particularly target the oldest-old since they are the fastest-growing group and their increased frailty is associated with severe or fatal injuries due to MVCs. © 2018 S. Karger AG, Basel.

Numerical model for mapping of complex hydrogeological conditions: the Chmielnik area (South Poland) case study

Science.gov (United States)

Buszta, Kamila; Szklarczyk, Tadeusz; Malina, Grzegorz

2017-04-01

Detailed analysis of hydrogeological conditions at a study area is the basis for characterising adjacent groundwater circulation systems. It is also an essential element during executing hydrogeological documentations. The goal of this work was to reconstruct on a numerical model natural groundwater circulation systems of the studied area located within the municipality of Chmielnik in the region of Kielce (South Poland). The area is characterized by a complex geological structure, which along with the existing hydrographic network, makes the scheme of groundwater circulation complicated and difficult to map on a numerical model. The studied area is situated at the border of three geological units: on the North - the extended portion of the Palaeozoic Swietokrzyskie Mountains (mainly Devonian and Permian), in the center - the S-W part of the Mesozoic Margin of the Swietokrzyskie Mountains, and on the South - a marginal zone of the Carpathian Foredeep. The whole area belongs to the Vistula river basin, and it includes catchments of its left tributaries: the Nida and Czarna Staszowska rivers. Based on the collected field and archival hydrogeological, hydrological and sozological data a conceptual model was built, under which a numerical model of groundwater flow was developed using the specialized software - Visual MODFLOW. The numerical model maps the five-layer groundwater circulation system in conjunction with surface watercourses. Such division reflects appropriately the variability of hydrogeological parameters within the geological structures. Two principal and exploited aquifers comprise: a fractured-porous Neogene and fractured Upper Jurassic formations. The external model borders are based primarily on surface watercourses and locally on watersheds. The modelled area of 130 km2 was divided into square grids of 50 m. The model consists of 275 rows and 277 columns. Each of five layers was simulated with the same number of active blocks. In the construction of

Medical Evaluation and Triage of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup

Science.gov (United States)

Nordstrom, Kimberly; Zun, Leslie S; Wilson, Michael P; MD, Victor Stiebel; Ng, Anthony T; Bregman, Benjamin; Anderson, Eric L

2012-01-01

Numerous medical and psychiatric conditions can cause agitation; some of these causes are life threatening. It is important to be able to differentiate between medical and nonmedical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in nonmedical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or when etiology is unclear. PMID:22461915

Numerical simulation of the shot peening process under previous loading conditions

International Nuclear Information System (INIS)

Romero-Ángeles, B; Urriolagoitia-Sosa, G; Torres-San Miguel, C R; Molina-Ballinas, A; Benítez-García, H A; Vargas-Bustos, J A; Urriolagoitia-Calderón, G

2015-01-01

This research presents a numerical simulation of the shot peening process and determines the residual stress field induced into a component with a previous loading history. The importance of this analysis is based on the fact that mechanical elements under shot peening are also subjected to manufacturing processes, which convert raw material into finished product. However, material is not provided in a virgin state, it has a previous loading history caused by the manner it is fabricated. This condition could alter some beneficial aspects of the residual stress induced by shot peening and could accelerate the crack nucleation and propagation progression. Studies were performed in beams subjected to strain hardening in tension (5ε y ) before shot peening was applied. Latter results were then compared in a numerical assessment of an induced residual stress field by shot peening carried out in a component (beam) without any previous loading history. In this paper, it is clearly shown the detrimental or beneficial effect that previous loading history can bring to the mechanical component and how it can be controlled to improve the mechanical behavior of the material

Medication therapy management and condition care services in a community-based employer setting.

Science.gov (United States)

Johannigman, Mark J; Leifheit, Michael; Bellman, Nick; Pierce, Tracey; Marriott, Angela; Bishop, Cheryl

2010-08-15

A program in which health-system pharmacists and pharmacy technicians provide medication therapy management (MTM), wellness, and condition care (disease management) services under contract with local businesses is described. The health-system pharmacy department's Center for Medication Management contracts directly with company benefits departments for defined services to participating employees. The services include an initial wellness and MTM session and, for certain patients identified during the initial session, ongoing condition care. The initial appointment includes a medication history, point-of-care testing for serum lipids and glucose, body composition analysis, and completion of a health risk assessment. The pharmacist conducts a structured MTM session, reviews the patient's test results and risk factors, provides health education, discusses opportunities for cost savings, and documents all activities on the patient's medication action plan. Eligibility for the condition care program is based on a diagnosis of diabetes, hypertension, asthma, heart failure, or hyperlipidemia or elevation of lipid or glucose levels. Findings are summarized for employers after the initial wellness screening and at six-month intervals. Patients receiving condition care sign a customized contract, establish goals, attend up to four MTM sessions per year, and track their information on a website; employers may offer incentives for participation. When pharmacists recommend adjustments to therapy or cost-saving changes, it is up to patients to discuss these with their physician. A survey completed by each patient after the initial wellness session has indicated high satisfaction. Direct cost savings related to medication changes have averaged $253 per patient per year. Total cost savings to companies in the first year of the program averaged $1011 per patient. For the health system, the program has been financially sustainable. Key laboratory values indicate positive clinical

Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients

Directory of Open Access Journals (Sweden)

Dhamane AD

2016-12-01

.78, all P<0.01. Conclusion: Adherence to mCOPD medications is low. Non-adherence (or adherence to mCOPD medications is positively related to non-adherence (or adherence to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to mCOPD medications. Keywords: COPD, comorbidities, adherence, PDC, database, Medicare

Medical Signal-Conditioning and Data-Interface System

Science.gov (United States)

Braun, Jeffrey; Jacobus, charles; Booth, Scott; Suarez, Michael; Smith, Derek; Hartnagle, Jeffrey; LePrell, Glenn

2006-01-01

A general-purpose portable, wearable electronic signal-conditioning and data-interface system is being developed for medical applications. The system can acquire multiple physiological signals (e.g., electrocardiographic, electroencephalographic, and electromyographic signals) from sensors on the wearer s body, digitize those signals that are received in analog form, preprocess the resulting data, and transmit the data to one or more remote location(s) via a radiocommunication link and/or the Internet. The system includes a computer running data-object-oriented software that can be programmed to configure the system to accept almost any analog or digital input signals from medical devices. The computing hardware and software implement a general-purpose data-routing-and-encapsulation architecture that supports tagging of input data and routing the data in a standardized way through the Internet and other modern packet-switching networks to one or more computer(s) for review by physicians. The architecture supports multiple-site buffering of data for redundancy and reliability, and supports both real-time and slower-than-real-time collection, routing, and viewing of signal data. Routing and viewing stations support insertion of automated analysis routines to aid in encoding, analysis, viewing, and diagnosis.

Price elasticity and medication use: cost sharing across multiple clinical conditions.

Science.gov (United States)

Gatwood, Justin; Gibson, Teresa B; Chernew, Michael E; Farr, Amanda M; Vogtmann, Emily; Fendrick, A Mark

2014-11-01

To address the impact that out-of-pocket prices may have on medication use, it is vital to understand how the demand for medications may be affected when patients are faced with changes in the price to acquire treatment and how price responsiveness differs across medication classes.  To examine the impact of cost-sharing changes on the demand for 8 classes of prescription medications. This was a retrospective database analysis of 11,550,363 commercially insured enrollees within the 2005-2009 MarketScan Database. Patient cost sharing, expressed as a price index for each medication class, was the main explanatory variable to examine the price elasticity of demand. Negative binomial fixed effect models were estimated to examine medication fills. The elasticity estimates reflect how use changes over time as a function of changes in copayments. Model estimates revealed that price elasticity of demand ranged from -0.015 to -0.157 within the 8 categories of medications (P  less than  0.01 for 7 of 8 categories). The price elasticity of demand for smoking deterrents was largest (-0.157, P  less than  0.0001), while demand for antiplatelet agents was not responsive to price (P  greater than 0.05). The price elasticity of demand varied considerably by medication class, suggesting that the influence of cost sharing on medication use may be related to characteristics inherent to each medication class or underlying condition.

Gorlin-Goltz syndrome--a medical condition requiring a multidisciplinary approach.

Science.gov (United States)

Kiwilsza, Małgorzata; Sporniak-Tutak, Katarzyna

2012-09-01

Gorlin-Goltz syndrome is a rare genetic condition showing a variable expressiveness. It is inherited in a dominant autosomal way. The strongest characteristic of the disease includes multiple basal cell carcinomas, jaw cysts, palmar and plantar pits, skeletal abnormalities and other developmental defects. Owing to the fact that the condition tends to be a multisystemic disorder, familiarity of various medical specialists with its manifestations may reduce the time necessary for providing a diagnosis. It will also enable them to apply adequate methods of treatment and secondary prevention. In this study, we present symptoms of the disease, its diagnostic methods and currently used treatments. We searched 2 scientific databases: Medline (EBSCO) and Science Direct, for the years 1996 to 2011. In our search of abstracts, key words included nevoid basal cell carcinoma syndrome and Gorlin-Goltz syndrome. We examined 287 studies from Medline and 80 from Science Direct, all published in English. Finally, we decided to use 60 papers, including clinical cases and literature reviews. Patients with Gorlin-Goltz syndrome need particular multidisciplinary medical care. Knowledge of multiple and difficult to diagnose symptoms of the syndrome among professionals of various medical specialties is crucial. The consequences of the disease pose a threat to the health and life of patients. Therefore, an early diagnosis creates an opportunity for effective prevention and treatment of the disorder. Prevention is better than cure.

New strategies in the assessment of psychological factors affecting medical conditions.

Science.gov (United States)

Sirri, Laura; Fabbri, Stefania; Fava, Giovanni A; Sonino, Nicoletta

2007-12-01

In this article, we examine research that may lead to a better assessment of psychological factors affecting medical conditions. We performed a review of the psychosomatic literature using both Medline and manual searches. We selected papers that were judged to be relevant to new strategies of assessment, with particular reference to the use of the Diagnostic Criteria for Psychosomatic Research. We assessed 8 areas concerned with the assessment of psychological factors in the setting of medical disease: hypochondriasis, disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, irritable mood, and Type A behavior. A new subclassification of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-V]; not yet published) category of psychological factors affecting physical conditions appears to be feasible and may provide the clinician with better tools for identifying psychological distress.

Numerical Approach for Goaf-Side Entry Layout and Yield Pillar Design in Fractured Ground Conditions

Science.gov (United States)

Jiang, Lishuai; Zhang, Peipeng; Chen, Lianjun; Hao, Zhen; Sainoki, Atsushi; Mitri, Hani S.; Wang, Qingbiao

2017-11-01

Entry driven along goaf-side (EDG), which is the development of an entry of the next longwall panel along the goaf-side and the isolation of the entry from the goaf with a small-width yield pillar, has been widely employed in China over the past several decades . The width of such a yield pillar has a crucial effect on EDG layout in terms of the ground control, isolation effect and resource recovery rate. Based on a case study, this paper presents an approach for evaluating, designing and optimizing EDG and yield pillar by considering the results from numerical simulations and field practice. To rigorously analyze the ground stability, the numerical study begins with the simulation of goaf-side stress and ground conditions. Four global models with identical conditions, except for the width of the yield pillar, are built, and the effect of pillar width on ground stability is investigated by comparing aspects of stress distribution, failure propagation, and displacement evolution during the entire service life of the entry. Based on simulation results, the isolation effect of the pillar acquired from field practice is also considered. The suggested optimal yield pillar design is validated using a field test in the same mine. Thus, the presented numerical approach provides references and can be utilized for the evaluation, design and optimization of EDG and yield pillars under similar geological and geotechnical circumstances.

Role of childhood adversity in the development of medical co-morbidities associated with bipolar disorder

NARCIS (Netherlands)

Post, Robert M.; Altshuler, Lori L.; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trisha; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

Objective: A role for childhood adversity in the development of numerous medical conditions in adults has been described in the general population, but has not been examined in patients with bipolar disorder who have multiple medical comorbidities which contribute to their premature mortality.

Co-morbid medical conditions and medical complications of prostate cancer in Southern Nigeria.

Science.gov (United States)

Sapira, Monday Komene; Onwuchekwa, Arthur Chukwubike; Onwuchekwa, Chinwe Regina

2012-08-01

Prostate cancer often co-exists with other diseases. It accounts for 11% of all cancers in Nigerian men, and it is the commonest cause of mortality due to cancer in elderly males in Nigeria. To present co-morbid medical conditions and medical complications of prostate cancer in patients with the disease in Southern Nigeria. The study was carried out prospectively (2002 to 2003) at University of Port Harcourt Teaching Hospital (UPTH), and Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi- both in Southern Nigeria. Using common proforma, patients who presented to the urology units of the two teaching hospitals were evaluated clinically and with relevant investigations for prostate cancer and other diseases. Those with histologically confirmed prostate cancer were included in this study. Data was also collected retrospectively by using the same proforma to obtain information from case files of 37 patients diagnosed with prostate cancer at UPTH. Data from the two institutions were collated and analysed. Of 189 cases analysed, 73.4% had significant medical co-morbid diseases/complications. These included anaemia (69.8%), urinary tract infection (56.1%), chronic renal failure (33.9%), hypertension (41.8%), diabetes mellitus (9.5%), paraplegia (9.5%), congestive cardiac failure (9.0%) and cerebrovascular disease (5.3%). These patients had high disease burden. Improved health education and well coordinated interdisciplinary team work are suggested in managing this malignancy.

Numerical investigation towards a HiTAC condition in a 9MW heavy fuel-oil boiler

NARCIS (Netherlands)

Zhu, Shanglong; Venneker, Bart; Roekaerts, Dirk; Pozarlik, Artur; van der Meer, Theo

2013-01-01

In this study, several conditions in a 9 MW heavy fuel-oil boiler were numerically studied in order to get a better understanding of the application of HiTAC in such a boiler. Simulations were done with an Euler- Lagrange approach. The Eddy Dissipation model was used for combustion. Simulation

Medical Evaluation and Triage of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup

Directory of Open Access Journals (Sweden)

Kimberly Nordstrom

2012-04-01

Full Text Available Numerous medical and psychiatric conditions can cause agitation, some of these causes are life threatening. It is important to be able to differentiate between medical and non-medical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in non-medical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or when etiology is unclear. [West J Emerg Med. 2012;13(1:3–10.

CHRONIC MEDICAL CONDITIONS AND REPRODUCIBILITY OF SELF-REPORTED AGE AT MENOPAUSE AMONG COMMUNITY DWELLING WOMEN

Science.gov (United States)

de Vries, Heather F.; Northington, Gina M.; Kaye, Elise M.; Bogner, Hillary R.

2011-01-01

OBJECTIVE To examine the association between chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women. METHOD Age at menopause was assessed in a population-based longitudinal survey of 240 women twice, in 1993 and 2004. Women who recalled age at menopause in 2004 within one year or less of the age at menopause recalled in 1993 (concordant) were compared with women who did not recall of age at menopause in 2004 within 1 year of age at menopause recalled in 1993 (discordant). Type of menopause (surgical or natural) and chronic medical conditions were assessed by self-report. RESULTS One hundred and forty three women (59.6%) reported surgical menopause and 97 (40.4%) reported natural menopause. In all, 130 (54.2%) of women recalled age at menopause in 2004 within one year or less of recalled age at menopause in 1994 while 110 (45.8%) women did not recall age at menopause in 2004 within one year or less of recalled age at menopause in 1994. Among women with surgical menopause, women with three or more medical conditions were less likely to have concordant recall of age at menopause than women with less than three chronic medical conditions (adjusted odds ratio (OR) = 0.36, 95% confidence interval (CI) [0.15, 0.91]) in multivariate models controlling for potentially influential characteristics including cognition and years from menopause. CONCLUSIONS Among women who underwent surgical menopause, the presence of three or more medical conditions is associated with decreased reproducibility of self-reported age at menopause. PMID:21971208

Chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women.

Science.gov (United States)

de Vries, Heather F; Northington, Gina M; Kaye, Elise M; Bogner, Hillary R

2011-12-01

The aim of this study was to examine the association between chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women. Age at menopause was assessed in a population-based longitudinal survey of 240 women twice, in 1993 and 2004. Women who recalled age at menopause in 2004 within 1 year or less of age at menopause recalled in 1993 (concordant) were compared with women who did not recall age at menopause in 2004 within 1 year of age at menopause recalled in 1993 (discordant). Type of menopause (surgical or natural) and chronic medical conditions were assessed by self-report. One hundred forty-three women (59.6%) reported surgical menopause, and 97 (40.4%) reported natural menopause. In all, 130 (54.2%) women recalled age at menopause in 2004 within 1 year or less of recalled age at menopause in 1994, whereas 110 (45.8%) women did not recall age at menopause in 2004 within 1 year or less of recalled age at menopause in 1994. Among the women with surgical menopause, the women with three or more medical conditions were less likely to have concordant recall of age at menopause than the women with less than three chronic medical conditions (adjusted odds ratio, 0.36; 95% CI, 0.15-0.91) in multivariate models controlling for potentially influential characteristics including cognition and years since menopause. Among women who underwent surgical menopause, the presence of three or more medical conditions is associated with decreased reproducibility of self-reported age at menopause.

[Modern approaches to the planning of the medical material support in conditions of daily activities].

Science.gov (United States)

Miroshnichenko, Iu V; Goriachev, A B; Krasavin, K D; Tikhonov, A V

2012-07-01

There are requirements producing to the planning in modem social and economic conditions: solidarity, participation, continuity, flexibility, accuracy. The authors made a conclusion that the main target of the planning of the medical material support is creating of conditions for highly effective function of the system of medical material support on the basis of long-time forecast of status and development of inner and outer factors.

Development status of the experimental and numerical load analysis of package units CASTOR registered under drop test conditions

International Nuclear Information System (INIS)

Voelzer, Walter; Schaefer, Marc; Rumanus, Erkan; Liedtke, Ralph; Brehmer, Frank

2012-01-01

The mechanical integrity of package units CASTOR registered for a 9-m drop test under accident conditions has to be demonstrated according the requirements of IAEA among others. For reduction of the loads the containers have to be equipped with shock absorbers on the bottom and top sides. The determination of loads under drop test conditions can be performed with experimental or numerical methods. Due to the complexity of the load state and the verification of results both methods are usually used for integrity demonstration. The numerical codes have to model the short-term dynamic behavior of the whole container for different drop orientations and temperatures, local stress states have to be quantifiable for assessment. One of the problems is the modeling of the material behavior of wood that is used in the shock absorbers. The so far used energetic calculation approach will be replaced by a dynamic approach, the numerical models will have to be verified by experimental drop tests.

An evidence-based approach to the creation of normative data: base rates of impaired scores within a brief neuropsychological battery argue for age corrections, but against corrections for medical conditions.

Science.gov (United States)

O'Connell, Megan E; Tuokko, Holly; Voll, Stacey; Simard, Martine; Griffith, Lauren E; Taler, Vanessa; Wolfson, Christina; Kirkland, Susan; Raina, Parminder

We detail a new approach to the creation of normative data for neuropsychological tests. The traditional approach to normative data creation is to make demographic adjustments based on observations of correlations between single neuropsychological tests and selected demographic variables. We argue, however, that this does not describe the implications for clinical practice, such as increased likelihood of misclassification of cognitive impairment, nor does it elucidate the impact on decision-making with a neuropsychological battery. We propose base rate analyses; specifically, differential base rates of impaired scores between theoretical and actual base rates as the basis for decisions to create demographic adjustments within normative data. Differential base rates empirically describe the potential clinical implications of failing to create an appropriate normative group. We demonstrate this approach with data from a short telephone-administered neuropsychological battery given to a large, neurologically healthy sample aged 45-85 years old. We explored whether adjustments for age and medical conditions were warranted based on differential base rates of spuriously impaired scores. Theoretical base rates underestimated the frequency of impaired scores in older adults and overestimated the frequency of impaired scores in younger adults, providing an evidence base for the creation of age-corrected normative data. In contrast, the number of medical conditions (numerous cardiovascular, hormonal, and metabolic conditions) was not related to differential base rates of impaired scores. Despite a small correlation between number of medical conditions and each neuropsychological variable, normative adjustments for number of medical conditions does not appear warranted. Implications for creation of normative data are discussed.

SEAFLOOR MORPHOLOGY INFLUENCES ON CURRENT CONDITION IN A SUNDA STRAIT BRIDGE PROJECT USING NUMERICAL MODEL

Directory of Open Access Journals (Sweden)

Franto Novico

2017-07-01

Full Text Available It has been more than 50 years since the idea to construct the bridge of Sunda Strait was inspirited by Prof. Sedyatmo. This issued is very important due to accelerate the economic growth between Sumatera Island and Java Island which is known as the densest population in the Indonesia. However, until today the bridge is still not construct yet because the high budget and the lack of technical data are still being problems. One of the most important data is current condition along the Sunda Strait. Unfortunately, no one has been clearly studied about current condition along Sunda Strait. Therefore, the information about current condition would be completed to fulfil the lack of data and information. The RV Geomarine I, as a research vessel conducted the survey in October 2012 that one of the objectives is to get the impression about the current condition around the bridge plan. Attaching echo sounder of bathy 1500 to get the depth profile and applied the RD Instrument ADCP Mobile Workhorse Monitor 300 kHz to collect the real current data and analyze the current using numerical model by Mike 21 were carried out to describe the condition of the current around the bridge proposed. In addition, the detail flexible mesh of hydrodynamic model is applied along bridge plan to analyse the current condition that caused by seafloor morphology. Based on the ADCP data it would be seen that the highest velocity record of the current occurs at October 18th 2012 at line 19 with the value 2.63 m/sec. Nevertheless, the numerical model shown the highest current velocity occurs around the northwest of Sangiang Island where the speed attains more than 4.59 m/sec.

Tolerance of centrifuge-simulated suborbital spaceflight by medical condition.

Science.gov (United States)

Blue, Rebecca S; Pattarini, James M; Reyes, David P; Mulcahy, Robert A; Garbino, Alejandro; Mathers, Charles H; Vardiman, Johnené L; Castleberry, Tarah L; Vanderploeg, James M

2014-07-01

We examined responses of volunteers with known medical disease to G forces in a centrifuge to evaluate how potential commercial spaceflight participants (SFPs) might tolerate the forces of spaceflight despite significant medical history. Volunteers were recruited based upon suitability for each of five disease categories (hypertension, cardiovascular disease, diabetes, lung disease, back or neck problems) or a control group. Subjects underwent seven centrifuge runs over 2 d. Day 1 consisted of two +G(z) runs (peak = +3.5 G(z), Run 2) and two +G(x), runs (peak = +6.0 G(x), Run 4). Day 2 consisted of three runs approximating suborbital spaceflight profiles (combined +G(x) and +G(z), peak = +6.0 G(x)/+4.0 G(z)). Data collected included blood pressure, electrocardiogram, pulse oximetry, neurovestibular exams, and post-run questionnaires regarding motion sickness, disorientation, grayout, and other symptoms. A total of 335 subjects registered for participation, of which 86 (63 men, 23 women, age 20-78 yr) participated in centrifuge trials. The most common causes for disqualification were weight and severe and uncontrolled medical or psychiatric disease. Five subjects voluntarily withdrew from the second day of testing: three for anxiety reasons, one for back strain, and one for time constraints. Maximum hemodynamic values recorded included HR of 192 bpm, systolic BP of 217 mmHg, and diastolic BP of 144 mmHg. Common subjective complaints included grayout (69%), nausea (20%), and chest discomfort (6%). Despite their medical history, no subject experienced significant adverse physiological responses to centrifuge profiles. These results suggest that most individuals with well-controlled medical conditions can withstand acceleration forces of launch and re-entry profiles of current commercial spaceflight vehicles.

Gorlin-Goltz syndrome – a medical condition requiring a multidisciplinary approach

Science.gov (United States)

Kiwilsza, Małgorzata; Sporniak-Tutak, Katarzyna

2012-01-01

Summary Gorlin-Goltz syndrome is a rare genetic condition showing a variable expressiveness. It is inherited in a dominant autosomal way. The strongest characteristic of the disease includes multiple basal cell carcinomas, jaw cysts, palmar and plantar pits, skeletal abnormalities and other developmental defects. Owing to the fact that the condition tends to be a multisystemic disorder, familiarity of various medical specialists with its manifestations may reduce the time necessary for providing a diagnosis. It will also enable them to apply adequate methods of treatment and secondary prevention. In this study, we present symptoms of the disease, its diagnostic methods and currently used treatments. We searched 2 scientific databases: Medline (EBSCO) and Science Direct, for the years 1996 to 2011. In our search of abstracts, key words included nevoid basal cell carcinoma syndrome and Gorlin-Goltz syndrome. We examined 287 studies from Medline and 80 from Science Direct, all published in English. Finally, we decided to use 60 papers, including clinical cases and literature reviews. Patients with Gorlin-Goltz syndrome need particular multidisciplinary medical care. Knowledge of multiple and difficult to diagnose symptoms of the syndrome among professionals of various medical specialties is crucial. The consequences of the disease pose a threat to the health and life of patients. Therefore, an early diagnosis creates an opportunity for effective prevention and treatment of the disorder. Prevention is better than cure. PMID:22936202

Does Coordinated, Multidisciplinary Treatment Limit Medical Disability and Attrition Related to Spine Conditions in the US Navy?

Science.gov (United States)

Ziemke, Gregg; Campello, Marco; Hiebert, Rudi; Weiner, Shira Schecter; Rennix, Chris; Nordin, Margareta

2015-09-01

Musculoskeletal conditions account for the largest proportion of cases resulting in early separation from the US Navy. This study evaluates the impact of the Spine Team, a multidisciplinary care group that included physicians, physical therapists, and a clinical psychologist, for the treatment of active-duty service members with work-disabling, nonspecific low back pain at the Naval Medical Center, Portsmouth, VA, USA. We compared the impact of the introduction of the Spine Team in limiting disability and attrition from work-disabling spine conditions with the experience of the Naval Medical Center, San Diego, CA, USA, where there is no comparable spine team. Is a multidisciplinary spine team effective in limiting disability and attrition related to work-disabling spine conditions as compared with the current standard of care for US military active-duty service members? This is a retrospective, pre-/post-study with a separate, concurrent control group using administratively collected data from two large military medical centers during the period 2007 to 2009. In this study, disability is expressed as the proportion of active-duty service members seeking treatment for a work-disabling spine condition that results in the assignment of a first-career limited-duty status. Attrition is expressed as the proportion of individuals assigned a first-career limited-duty status for a work-disabling spine condition who were referred to a Physical Evaluation Board. We analyzed 667 individuals assigned a first-career limited-duty for a work-disabling spine condition between 2007 and 2009 who received care at the Naval Medical Center Portsmouth or Naval Medical Center San Diego. Rates of first-career limited-duty assignments for spine conditions decreased from 2007 to 2009 at both sites, but limited-duty rates decreased to a greater extent at the intervention site (Naval Medical Center Portsmouth; from 8.5 per 100 spine cases in 2007 to 5.1 per 100 cases in 2009, p Team was

A Numerical Model for the Thermomechanical Conditions During Hydration of Early-age Concrete

DEFF Research Database (Denmark)

Hattel, Jesper; Thorborg, Jesper

2003-01-01

In the present study, a macroscopic numerical model for the thermomechanical conditions during hydration of early-age concrete is presented. The formulation is based on a semi-coupled, incremental thermomechanical model where the heat production from the hydration process is expressed in terms...... of the maturity and the thermal activation is expressed by the Arrhenius principle. The material properties are assumed to depend on the hydration process via the maturity. The discretization of the governing equations is accomplished by a control volume formulation involving a time-splitting scheme for the heat...

Numerical ductile tearing simulation of circumferential cracked pipe tests under dynamic loading conditions

Energy Technology Data Exchange (ETDEWEB)

Nam, Hyun Suk; Kim, Ji Soo; Ryu, Ho Wan; Kim, Yun Jae [Dept. of Mechanical Engineering, Korea University, Seoul (Korea, Republic of); Kim, Jin Weon [Dept. of Nuclear Engineering, Chosun University, Gwangju (Korea, Republic of)

2016-10-15

This paper presents a numerical method to simulate ductile tearing in cracked components under high strain rates using finite element damage analysis. The strain rate dependence on tensile properties and multiaxial fracture strain is characterized by the model developed by Johnson and Cook. The damage model is then defined based on the ductility exhaustion concept using the strain rate dependent multiaxial fracture strain concept. The proposed model is applied to simulate previously published three cracked pipe bending test results under two different test speed conditions. Simulated results show overall good agreement with experimental results.

Experimental verification of boundary conditions for numerical simulation of airflow in a benchmark ventilation channel

Directory of Open Access Journals (Sweden)

Lizal Frantisek

2016-01-01

Full Text Available Correct definition of boundary conditions is crucial for the appropriate simulation of a flow. It is a common practice that simulation of sufficiently long upstream entrance section is performed instead of experimental investigation of the actual conditions at the boundary of the examined area, in the case that the measurement is either impossible or extremely demanding. We focused on the case of a benchmark channel with ventilation outlet, which models a regular automotive ventilation system. At first, measurements of air velocity and turbulence intensity were performed at the boundary of the examined area, i.e. in the rectangular channel 272.5 mm upstream the ventilation outlet. Then, the experimentally acquired results were compared with results obtained by numerical simulation of further upstream entrance section defined according to generally approved theoretical suggestions. The comparison showed that despite the simple geometry and general agreement of average axial velocity, certain difference was found in the shape of the velocity profile. The difference was attributed to the simplifications of the numerical model and the isotropic turbulence assumption of the used turbulence model. The appropriate recommendations were stated for the future work.

Numerical simulations of unsteady flows past two-bladed rotors in forward-flight conditions

Energy Technology Data Exchange (ETDEWEB)

Xu, H.; Mamou, M.; Khalid, M. [National Research Council, Inst. for Aerospace Research, Ottawa, Ontario (Canada)]. E-mail: Hongyi.Xu@nrc.ca

2004-07-01

The current paper presents time-accurate numerical simulations of compressible flows past two-bladed rotor configurations using a Chimera moving grid approach. The simulations are performed for a variety of flow conditions and various blade aspect ratios. The rotor blades are rectangular, untapered and untwisted planforms. Their cross-sections are built using the NACA 0012 airfoil profile. The aerodynamic performance of the rotor is investigated using the Euler equations. The CFD-FASTRAN code was used for the computations. The pressure distributions are benchmarked against the experimental data from Caradonna and Tung and a number of previous Euler calculations by Agarwal and Deese and Chen et al. The comparisons indicate that the current simulations for the forward flight conditions can reproduce the pressure distributions on the blade surfaces and the prediction of shockwave locations with reasonably good accuracy. (author)

Numerical simulations of unsteady flows past two-bladed rotors in forward-flight conditions

International Nuclear Information System (INIS)

Xu, H.; Mamou, M.; Khalid, M.

2004-01-01

The current paper presents time-accurate numerical simulations of compressible flows past two-bladed rotor configurations using a Chimera moving grid approach. The simulations are performed for a variety of flow conditions and various blade aspect ratios. The rotor blades are rectangular, untapered and untwisted planforms. Their cross-sections are built using the NACA 0012 airfoil profile. The aerodynamic performance of the rotor is investigated using the Euler equations. The CFD-FASTRAN code was used for the computations. The pressure distributions are benchmarked against the experimental data from Caradonna and Tung and a number of previous Euler calculations by Agarwal and Deese and Chen et al. The comparisons indicate that the current simulations for the forward flight conditions can reproduce the pressure distributions on the blade surfaces and the prediction of shockwave locations with reasonably good accuracy. (author)

Medical Image Segmentation for Mobile Electronic Patient Charts Using Numerical Modeling of IoT

Directory of Open Access Journals (Sweden)

Seung-Hoon Chae

2014-01-01

Full Text Available Internet of Things (IoT brings telemedicine a new chance. This enables the specialist to consult the patient’s condition despite the fact that they are in different places. Medical image segmentation is needed for analysis, storage, and protection of medical image in telemedicine. Therefore, a variety of methods have been researched for fast and accurate medical image segmentation. Performing segmentation in various organs, the accurate judgment of the region is needed in medical image. However, the removal of region occurs by the lack of information to determine the region in a small region. In this paper, we researched how to reconstruct segmentation region in a small region in order to improve the segmentation results. We generated predicted segmentation of slices using volume data with linear equation and proposed improvement method for small regions using the predicted segmentation. In order to verify the performance of the proposed method, lung region by chest CT images was segmented. As a result of experiments, volume data segmentation accuracy rose from 0.978 to 0.981 and from 0.281 to 0.187 with a standard deviation improvement confirmed.

Mediators for internalizing problems in adolescents of parents with chronic medical condition

NARCIS (Netherlands)

Sieh, D.S.; Oort, F.J.; Visser-Meily, J.M.A.; Meijer, A.M.

2014-01-01

Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is

Theoretical and numerical investigations of TAP experiments. New approaches for variable pressure conditions

Energy Technology Data Exchange (ETDEWEB)

Senechal, U.; Breitkopf, C. [Technische Univ. Dresden (Germany). Inst. fuer Energietechnik

2011-07-01

Temporal analysis of products (TAP) is a valuable tool for characterization of porous catalytic structures. Established TAP-modeling requires a spatially constant diffusion coefficient and neglect convective flows, which is only valid in Knudsen diffusion regime. Therefore in experiments, the number of molecules per pulse must be chosen accordingly. New approaches for variable process conditions are highly required. Thus, a new theoretical model is developed for estimating the number of molecules per pulse to meet these requirements under any conditions and at any time. The void volume is calculated as the biggest sphere fitting between three pellets. The total number of pulsed molecules is assumed to fill the first void volume at the inlet immediately. Molecule numbers from these calculations can be understood as maximum possible molecules at any time in the reactor to be in Knudsen diffusion regime, i.e., above the Knudsen number of 2. Moreover, a new methodology for generating a full three-dimensional geometrical representation of beds is presented and used for numerical simulations to investigate spatial effects. Based on a freely available open-source game physics engine library (BULLET), beds of arbitrary-sized pellets can be generated and transformed to CFD-usable geometry. In CFD-software (ANSYS CFX registered) a transient diffusive transport equation with time-dependent inlet boundary conditions is solved. Three different pellet diameters were investigated with 1e18 molecules per pulse, which is higher than the limit from the theoretical calculation. Spatial and temporal distributions of transported species show regions inside the reactor, where non-Knudsen conditions exist. From this results, the distance from inlet can be calculated where the theoretical pressure limit (Knudsen number equals 2) is obtained, i.e., from this point to the end of the reactor Knudsen regime can be assumed. Due to linear dependency of pressure and concentration (assuming ideal

Numerical simulation of flow in centrifugal pump under cavitation and sediment condition

International Nuclear Information System (INIS)

Lu, J L; Guo, P C; Zheng, X B; Zhao, Q; Luo, X Q

2012-01-01

The sediment concentration is very high in many rivers in the world, especially in China. The pumps that designed for the clear water are usually seriously abraded. The probability of pump cavitation is greatly enhanced due to the existence of sand. Under the joint action and mutual promotion of sand erosion and cavitation, serious abrasion could occurred, and the hydraulic performance of the pump may be greatly descended, meanwhile the safety and stability of the whole pump are greatly threatened. Therefore, it is significant to investigate the cavitation characteristic of pump under sediment flow condition. In this paper, the flow in a single stage centrifugal pump under cleat water and sediment flow conditions was numerically simulated. The cavitation performance under clear water was firstly analyzed. Then, The pressure, velocity and solid particle distribution in centrifugal pump under different particle diameter and different particle concentration was investigated by using the two-fluid model; The area and extent of erosion was illustrated by using the particle track model. Finally, the influence of mixed sand on centrifugal pump performance was investigated.

Numerical prediction of a draft tube flow taking into account uncertain inlet conditions

International Nuclear Information System (INIS)

Brugiere, O; Balarac, G; Corre, C; Metais, O; Flores, E; Pleroy

2012-01-01

The swirling turbulent flow in a hydroturbine draft tube is computed with a non-intrusive uncertainty quantification (UQ) method coupled to Reynolds-Averaged Navier-Stokes (RANS) modelling in order to take into account in the numerical prediction the physical uncertainties existing on the inlet flow conditions. The proposed approach yields not only mean velocity fields to be compared with measured profiles, as is customary in Computational Fluid Dynamics (CFD) practice, but also variance of these quantities from which error bars can be deduced on the computed profiles, thus making more significant the comparison between experiment and computation.

Numerical prediction of a draft tube flow taking into account uncertain inlet conditions

Science.gov (United States)

Brugiere, O.; Balarac, G.; Corre, C.; Metais, O.; Flores, E.; Pleroy

2012-11-01

The swirling turbulent flow in a hydroturbine draft tube is computed with a non-intrusive uncertainty quantification (UQ) method coupled to Reynolds-Averaged Navier-Stokes (RANS) modelling in order to take into account in the numerical prediction the physical uncertainties existing on the inlet flow conditions. The proposed approach yields not only mean velocity fields to be compared with measured profiles, as is customary in Computational Fluid Dynamics (CFD) practice, but also variance of these quantities from which error bars can be deduced on the computed profiles, thus making more significant the comparison between experiment and computation.

Guide to Geriatric Syndromes: Common and Often Related Medical Conditions in Older Adults

Science.gov (United States)

... and Often Related Medical Conditions in Older Adults Font size A A A Print Share Glossary previous ... provider so he or she can identify the type of sleep problem you have. Delirium : Many older ...

Numerical problems in physics

CERN Document Server

Singh, Devraj

2015-01-01

Numerical Problems in Physics, Volume 1 is intended to serve the need of the students pursuing graduate and post graduate courses in universities with Physics and Materials Science as subject including those appearing in engineering, medical, and civil services entrance examinations. KEY FEATURES: * 29 chapters on Optics, Wave & Oscillations, Electromagnetic Field Theory, Solid State Physics & Modern Physics * 540 solved numerical problems of various universities and ompetitive examinations * 523 multiple choice questions for quick and clear understanding of subject matter * 567 unsolved numerical problems for grasping concepts of the various topic in Physics * 49 Figures for understanding problems and concept

Treatment Effect in Earlier Trials of Patients With Chronic Medical Conditions: A Meta-Epidemiologic Study.

Science.gov (United States)

Alahdab, Fares; Farah, Wigdan; Almasri, Jehad; Barrionuevo, Patricia; Zaiem, Feras; Benkhadra, Raed; Asi, Noor; Alsawas, Mouaz; Pang, Yifan; Ahmed, Ahmed T; Rajjo, Tamim; Kanwar, Amrit; Benkhadra, Khalid; Razouki, Zayd; Murad, M Hassan; Wang, Zhen

2018-03-01

To determine whether the early trials in chronic medical conditions demonstrate an effect size that is larger than that in subsequent trials. We identified randomized controlled trials (RCTs) evaluating a drug or device in patients with chronic medical conditions through meta-analyses (MAs) published between January 1, 2007, and June 23, 2015, in the 10 general medical journals with highest impact factor. We estimated the prevalence of having the largest effect size or heterogeneity in the first 2 published trials. We evaluated the association of the exaggerated early effect with several a priori hypothesized explanatory variables. We included 70 MAs that had included a total of 930 trials (average of 13 [range, 5-48] RCTs per MA) with average follow-up of 24 (range, 1-168) months. The prevalence of the exaggerated early effect (ie, proportion of MAs with largest effect or heterogeneity in the first 2 trials) was 37%. These early trials had an effect size that was on average 2.67 times larger than the overall pooled effect size (ratio of relative effects, 2.67; 95% CI, 2.12-3.37). The presence of exaggerated effect was not significantly associated with trial size; number of events; length of follow-up; intervention duration; number of study sites; inpatient versus outpatient setting; funding source; stopping a trial early; adequacy of random sequence generation, allocation concealment, or blinding; loss to follow-up or the test for publication bias. Trials evaluating treatments of chronic medical conditions published early in the chain of evidence commonly demonstrate an exaggerated treatment effect compared with subsequent trials. At the present time, this phenomenon remains unpredictable. Considering the increasing morbidity and mortality of chronic medical conditions, decision makers should act on early evidence with caution. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Numerical simulation of pressure fluctuation of a pump-turbine with MGV at no-load condition

International Nuclear Information System (INIS)

Liu, J T; Wang, L Q; Liu, S H; Sun, Y K; Wu, Y L

2012-01-01

In order to analyse the pressure fluctuation caused by misaligned guide vanes (MGV) during starting period at no-load condition, 3-D (three dimensional), unsteady flows in a pump-turbine were numerically studied. Pressure fluctuations of different points at no-load condition are obtained. Fast Fourier Transform(FFT) was used to analyse the frequency spectrum of pressure fluctuations. The amplitude and dominant frequency of pressure fluctuation at vaneless space between the runner and guide vane, as well as the inlet of draft tube, was investigated. The amplitude of pressure fluctuation of the pump-turbine with MGV device is twice that of synchronous vanes. This might be caused by the non-uniform flow in the pump-turbine due to the pre-opened guide vanes. The pump-turbine with synchronous vanes has a low frequency which is 0.33f n , while the low frequency changes into 0.63f n when the MGV device is used. The vortex rope in the draft tube is large than that of synchronize vanes. Resultsof pressure fluctuations with synchronous vanes agree with each other between computational and testing results. The numerical study of pressure fluctuations with MGV can provide a basic understanding for the improvement of the instability of a pump-turbine.

Evaluation of accelerated stability test conditions for medicated chewing gums.

Science.gov (United States)

Maggi, Lauretta; Conte, Ubaldo; Nhamias, Alain; Grenier, Pascal; Vergnault, Guy

2013-10-01

The overall stability of medicated chewing gums is investigated under different storage conditions. Active substances with different chemical stabilities in solid state are chosen as model drugs. The dosage form is a three layer tablet obtained by direct compression. The gum core contains the active ingredient while the external layers are formulated to prevent gum adhesion to the punches of the tableting machine. Two accelerated test conditions (40°C/75% RH and 30°C/65% RH) are performed for 6 months. Furthermore, a long-term stability test at room conditions is conducted to verify the predictability of the results obtained from the stress tests. Some drugs are stable in all the conditions tested, but other drugs, generally considered stable in solid dosage forms, have shown relevant stability problems particularly when stress test conditions are applied to this particular semi-solid dosage forms. For less stable drugs, the stress conditions of 40°C/75% RH are not always predictable of chewing gum stability at room temperature and may produce false negative; intermediate conditions, 30°C/65% RH, are more predictive for this purpose, the results of drug content found after 6 months at intermediate stress conditions and 12 months at room conditions are generally comparable. But the results obtained show that only long-term conditions stability tests gave consistent results. During aging, the semi solid nature of the gum base itself, may also influence the drug delivery rate during chewing and great attention should be given also to the dissolution stability.

Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users.

Science.gov (United States)

Lankenau, Stephen E; Ataiants, Janna; Mohanty, Salini; Schrager, Sheree; Iverson, Ellen; Wong, Carolyn F

2018-02-01

While marijuana has been legal for medical purposes in California since 1996, little is known about the health histories of young adult medical marijuana patients who are a significant proportion of medical marijuana patients. We examined whether young adult medical marijuana patients reported health conditions and motivations for use that were consistent with medical use of marijuana in California. Young adults (N = 366) aged 18 to 26 years were sampled in Los Angeles in 2014-2015 and segmented into medical marijuana 'patients' (n = 210), marijuana users with a current recommendation, and non-patient users or 'non-patients' (n = 156), marijuana users who never had a medical marijuana recommendation. Differences between patients and non-patients regarding self-reported health histories and past/current motivations for marijuana use were expressed as unadjusted risk ratios. Compared with non-patients, patients were significantly more likely to report a range of lifetime health problems, such as psychological, physical pain and gastrointestinal. In the past 90 days, patients were significantly more likely to report motivations for marijuana use than non-patients concerning sleep, anxiety, physical pain and focusing. Psychological and pain problems were the most common health conditions reported to receive a medical marijuana recommendation. Patients were significantly less likely than non-patients to report any privacy concerns about obtaining a medical marijuana recommendation. Patients were significantly more likely to report a range of health conditions and motivations associated with medical use than non-patients. A great majority of patients reported obtaining a medical marijuana recommendation for health problems in accordance with the California law. [Lankenau SE, Ataiants J,Mohanty S, Schrager S, Iverson E, Wong CF.Health conditions and motivations for marijuana use among young adultmedical marijuana patients and non-patient marijuana users. Drug

Rare medical conditions and suggestive past-life memories: a case report and literature review.

Science.gov (United States)

Lucchetti, Giancarlo; dos Santos Camargo, Luizete; Lucchetti, Alessandra L G; Schwartz, Gary E; Nasri, Fabio

2013-01-01

We aim to report the case of a 38-year-old male with suggestive past-life memories during a regression session and to show how these memories were related to unusual medical conditions: (1) isolated obstruction of the right coronary artery in a young patient, (2) omental infarction, and (3) right aortic arch with isolation of the left subclavian artery. These conditions were related to the following suggestive past-life memories: (1) a priest who committed suicide with a crucifix nailed to his chest and (2) a medieval weapon (skull flail) hitting his cervical and left back region. There was an intriguing relation between the patient's suggestive past-life memories and rare medical conditions. In this article, the authors highlight possible explanations, rarity of findings, and similarities/differences from previous cases and potential pitfalls in this area. © 2013 Elsevier Inc. All rights reserved.

Numerical study for peristalsis of Carreau-Yasuda nanomaterial with convective and zero mass flux condition

Science.gov (United States)

Hayat, T.; Ahmed, Bilal; Alsaedi, A.; Abbasi, F. M.

2018-03-01

The present communication investigates flow of Carreau-Yasuda nanofluid in presence of mixed convection and Hall current. Effects of viscous dissipation, Ohmic heating and convective conditions are addressed. In addition zero nanoparticle mass flux condition is imposed. Wave frame analysis is carried out. Coupled differential systems after long wavelength and low Reynolds number are numerically solved. Effects of different parameters on velocity, temperature and concentration are studied. Heat and mass transfer rates are analyzed through tabular values. It is observed that concentration for thermophoresis and Brownian motion parameters has opposite effect. Further heat and mass transfer rates at the upper wall enhances significantly when Hartman number increases and reverse situation is noticed for Hall parameter.

Needs, conditions of intervention and staff in medical physics for medical imagery

International Nuclear Information System (INIS)

Salvat, Cecile; Dieudonne, Arnaud; Guilhem, Marie-Therese; Le Du, Dominique; Pierrat, Noelle; Isambert, Aurelie; Valero, Marc; Blanchard, Vincent

2013-04-01

This guide proposes information on the types and quantification of medical physics tasks to be performed when performing medical imagery using ionizing radiations. It gives recommendations about the commitment of medical physicists (with or without support staff) and the required staff in nuclear medicine and, more generally in imagery (interventional radiology, scanography, conventional radiology). It first gives an overview of the situation in France in 2012 in terms of observations made by the ASN during inspections, and of results of a survey conducted among medical physicists involved in medical imagery. It indicates the current regulatory requirements, and international and national recommendations, and describes the commitment in imagery of medical physicists in three countries (Spain, Belgium and Germany). It analyses and describes the fields of intervention of medical physicists in imagery and identifies associated tasks in France (in equipment purchasing, equipment installation, equipment routine usage, patient care, nuclear medicine or internal vectorized radiotherapy, or staff training). Recommendations of a work-group about sizing criteria are proposed

Trends, productivity losses, and associated medical conditions among toxoplasmosis deaths in the United States, 2000-2010.

Science.gov (United States)

Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank

2014-11-01

Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000-2010. A matched case-control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups. © The American Society of Tropical Medicine and Hygiene.

Medical tourism: the trend toward outsourcing medical procedures to foreign countries.

Science.gov (United States)

York, Diane

2008-01-01

The rising costs of medical treatment in the United States are fueling a movement to outsource medical treatment. Estimates of the number of Americans traveling overseas for treatment range from 50,000 to 500,000. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee replacement in the United States can cost $40,000 compared to $13,000 in Singapore.A new industry, medical tourism, has been created to advise patients on the appropriate facility in the right country for their condition, handle all travel arrangements, teleconference with physicians, and send medical records. To respond to the growth in medical travel, the Joint Commission (formerly the Joint Commission on Accreditation of Health Care Organizations) initiated the Joint Commission International (JCI) to accredit hospitals worldwide. Although outcome statistics from hospitals outside the United States are rare, first-person reports on quality are numerous. Making surgery possible for uninsured and underinsured individuals or self-insured state, municipal, and private entities is a major benefit of medical tourism. Mitigating against medical travel are the lack of legal remedies in place for malpractice and the possibility that travel itself can impose risk to patients. For example, lengthy air flights where the patient is in a fixed position for hours at a time can cause embolisms. If the trend toward medical tourism continues, continuing education, credentialing, and certification services may be required to help assure patient safety.

14 CFR 67.213 - General medical condition.

Science.gov (United States)

2010-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... unable to perform those duties or exercise those privileges. (c) No medication or other treatment that... relating to the medication or other treatment involved, finds— (1) Makes the person unable to safely...

14 CFR 67.113 - General medical condition.

Science.gov (United States)

2010-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... unable to perform those duties or exercise those privileges. (c) No medication or other treatment that... relating to the medication or other treatment involved, finds— (1) Makes the person unable to safely...

14 CFR 67.313 - General medical condition.

Science.gov (United States)

2010-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... unable to perform those duties or exercise those privileges. (c) No medication or other treatment that... relating to the medication or other treatment involved, finds— (1) Makes the person unable to safely...

Numerical Study of Pollutant Emissions in a Jet Stirred Reactor under Elevated Pressure Lean Premixed Conditions

Directory of Open Access Journals (Sweden)

Karim Mazaheri

2016-01-01

Full Text Available Numerical study of pollutant emissions (NO and CO in a Jet Stirred Reactor (JSR combustor for methane oxidation under Elevated Pressure Lean Premixed (EPLP conditions is presented. A Detailed Flow-field Simplified Chemistry (DFSC method, a low computational cost method, is employed for predicting NO and CO concentrations. Reynolds Averaged Navier Stokes (RANS equations with species transport equations are solved. Improved-coefficient five-step global mechanisms derived from a new evolutionary-based approach were taken as combustion kinetics. For modeling turbulent flow field, Reynolds Stress Model (RSM, and for turbulence chemistry interactions, finite rate-Eddy dissipation model are employed. Effects of pressure (3, 6.5 bars and inlet temperature (408–573 K over a range of residence time (1.49–3.97 ms are numerically examined. A good agreement between the numerical and experimental distribution of NO and CO was found. The effect of decreasing the operating pressure on NO generation is much more than the effect of increase in the inlet temperature.

Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial.

Science.gov (United States)

Druss, Benjamin G; Singh, Manasvini; von Esenwein, Silke A; Glick, Gretl E; Tapscott, Stephanie; Tucker, Sherry Jenkins; Lally, Cathy A; Sterling, Evelina W

2018-02-01

Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.

Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital

Directory of Open Access Journals (Sweden)

Nkokone S Z Tema

2015-05-01

Full Text Available Background. Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient. Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP service at the Helen Joseph Hospital (HJH in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition. Methods. A retrospective record review of all patients referred to the HJH CLP team over a 6-month period. Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357 between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%, which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only. The medical wards admitted the majority (n=37; 67.3% mostly for delirium (n=28; 50.9%. HIV was identified as the most common systemic aetiological factor (n=23; 67.7%. Conclusion. In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and

Numerical and Experimental Investigation on the Spray Coating Process Using a Pneumatic Atomizer: Influences of Operating Conditions and Target Geometries

Directory of Open Access Journals (Sweden)

Qiaoyan Ye

2017-01-01

Full Text Available This paper presents a numerical simulation of the spray painting process using a pneumatic atomizer with the help of a computational fluid dynamics code. The droplet characteristics that are necessary for the droplet trajectory calculation were experimentally investigated using different shaping air flow rates. It was found that the droplet size distribution depends on both the atomizing and the shaping air flow rate. An injection model for creating the initial droplet conditions is necessary for the spray painting simulation. An approach for creating these initial conditions has been proposed, which takes different operating conditions into account and is suitable for practical applications of spray coating simulation using spray guns. Further, tests on complicated targets and complex alignments of the atomizer have been carried out to verify this numerical approach. The results confirm the applicability and reliability of the chosen method for the painting process.

Factors Affecting the Readiness of Medical Doctors and Patients with Chronic Conditions toward the Usage of Smartphones in the Saudi Arabian Healthcare Sector

Directory of Open Access Journals (Sweden)

Bassam M Al-Mahadeen

2015-01-01

Full Text Available Numerous studies have reported the rapid increase in the number of individuals who use smartphones. However, smartphones appear to be increasingly used by healthcare workers, particularly physicians and nurses. Therefore, this study aims to investigate the readiness of medical doctors and patients with chronic conditions in using and adopting smartphones for communication. This study employs the Technology Acceptance Model to examine the behavior of people in using smartphones from the perspectives of trust and rural areas. To realize our objective, we conducted a questionnaire survey that involved medical doctors and patients with chronic conditions. Our particular focus was Al Qunfudhah City in Saudi Arabia. More than 200 questionnaires were distributed to people belonging to different healthcare sectors in the rural areas of Al Qunfudhah City. Our aim was to include every possible scenario and to obtain excellent perspectives. The results that we eventually analyzed indicated that trust factor and rural areas significantly influence the readiness of people belonging to the healthcare sector toward using smartphones. The results of our study concur with the findings of other studies. Our results indicate that smartphones and other high-technology gadgets are now necessary and accepted devices in the different healthcare fields. However, further studies should explore the challenges and effects of smartphone use in the healthcare sector.

Constipation--prevalence and incidence among medical patients acutely admitted to hospital with a medical condition.

Science.gov (United States)

Noiesen, Eline; Trosborg, Ingelise; Bager, Louise; Herning, Margrethe; Lyngby, Christel; Konradsen, Hanne

2014-08-01

To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients. Constipation is a common medical problem with severe consequences, and most people suffer from constipation at some point in their lives. In the general population, constipation is one of the most common complaints and is a significant personal and public health burden. Alteration in patients' patterns of elimination while in hospital has long been identified as either a potential or an actual problem that requires attention. Knowledge of the prevalence and incidence of constipation during hospitalisation is only sporadic. The study was descriptive and a prospective cohort design was chosen. The Constipation Assessment Scale was translated into Danish and was used for the assessment of patient-reported bowel function. Five nurses made the assessments at admission to the acute medical ward and three days after admission. Three hundred and seventy-three patients participated in this study. Thirty-nine percent of the patients showed symptoms of constipation at admission. Of the patients who did not have the symptoms at admission, 43% developed the symptoms during the first three days of their stay in hospital. Significantly more of the older patients developed symptoms of moderate constipation. The incidence rate was 143 new cases per 1000 patient days. In this study, symptoms of constipation were common among patients acutely admitted to hospital due to different medical conditions. Symptoms of constipation were also developed during the first three days of the stay in hospital. The study highlights the need to develop both clinical guidelines towards treating constipation, and preventive measures to ensure that patients do not become constipated while staying in hospital. © 2013 John Wiley & Sons Ltd.

42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

Science.gov (United States)

2010-10-01

..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in the... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Acceptance of patients...

An 8-year Retrospective Review of Gastrointestinal Medical Emergency Conditions at a Tertiary Health Facility in Nigeria

Directory of Open Access Journals (Sweden)

Oguntoye Oluwatosin Oluwagbenga

2018-03-01

Conclusion: Gastrointestinal medical conditions are common indications for emergency admission. Measures should be taken to avoid these preventable conditions in a bid to reduce their morbidity and mortality.

Disclosure of personal medical information: differences among parents and affected adults for genetic and nongenetic conditions.

Science.gov (United States)

Johnson, Summer; Kass, Nancy E; Natowicz, Marvin

2005-01-01

Protecting the confidentiality of medical information has been an issue of great interest in the fields of bioethics, public policy, and law. Few empirical studies have addressed patient experiences and attitudes toward disclosure of private medical information in multiple contexts such as health insurance, employment, and the family. Furthermore, it is unclear whether differences exist in experiences and attitudes about privacy between those living with a serious medical condition versus those who have a child with a medical condition. The study sought to determine whether attitudes and experiences related to medical privacy and confidentiality differ between affected adults and parents of affected children. Interviews were conducted with 296 adults and parents of children with sickle cell disease (SCD), cystic fibrosis (CF), or diabetes mellitus (DM). This cross-sectional study collected data regarding their experiences, attitudes, and beliefs concerning medical privacy and confidentiality. Multinomial logistic regression analysis was conducted on quantitative data. Qualitative analysis was conducted on data from open-ended response items. Parents disclose their child's diagnosis to others more often than affected adults disclose their own disease status. Parents are less likely than affected adults to regret their disclosure, to hope others do not find out, to have been pressured to share information, and to be asked about their disease by employers. Affected adults express greater concern about disclosure, a greater prevalence and greater fear of discrimination, and experience greater pressure from family members to disclose. Clinicians and researchers working with these populations should consider these differences in privacy and disclosure. Further study is necessary to examine the implications of these differences in attitudes and experiences concerning insurance, employment, and social interactions among persons with these conditions.

Numerical investigation on cryogenic liquid jet under transcritical and supercritical conditions

Science.gov (United States)

Li, Liang; Xie, Maozhao; Wei, Wu; Jia, Ming; Liu, Hongsheng

2018-01-01

Cryogenic fluid injection and mixing under transcritical and supercritical conditions is numerically investigated with emphasis on the difference of the mechanism and characteristics between the two injections. A new solver is developed which is capable of handling the nonideality of the equation of state and the anomalies in fluid transport properties and is incorporated into the CFD software OpenFOAM. The new solver has been validated against available experimental data and exhibits a good performance. Computational results indicates that the differences between transcritical and supercritical injections are mainly induced by the pseudo-boiling phenomenon, resulting in that the transcritical jet has a longer cold liquid core and an isothermal expansion occurs at the surface of the cold core. The thickness of the supercritical mixing layer and its increase value along the jet direction are greater than its transcritical counterpart. The high-temperature jet whose initial temperature is above the pseudo-boiling temperature has the ability of enhancing the mixing of the jet with the surrounding gas.

Validity of self-reported periodontal measures, demographic characteristics and systemic medical conditions.

Science.gov (United States)

Chatzopoulos, Georgios S; Cisneros, Alejandro; Sanchez, Miguel; Lunos, Scott; Wolff, Larry F

2018-04-06

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic. In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were utilized to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self-reported periodontal screening questions were included with the range of answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors. The sample mean age was 54.1 years and included 52.6% males and 14.9% smokers with a mean number of missing teeth of 3.5. Self-reported tooth mobility, history of "gum treatment" and the importance to keep the teeth as well as age, tobacco use and cancer were statistically significant (p brushing", gender, diabetes, anxiety and arthritis. Self-reported periodontal screening questions as well as demographic characteristics, smoking and systemic medical conditions were significant predictors of periodontal disease and they could be used as valid, economical and practical measures. This article is protected by copyright. All rights reserved. © 2018 American Academy of Periodontology.

Mothers of children diagnosed with attention-deficit/hyperactivity disorder: health conditions and medical care utilization in periods before and after birth of the child.

Science.gov (United States)

Ray, G Thomas; Croen, Lisa A; Habel, Laurel A

2009-01-01

Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biologic, environmental, and psychosocial factors relating to ADHD. To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers' diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared with mothers of children without ADHD and, separately, to mothers of children with asthma. Compared with mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the 2 years after birth of their child, including depression [odds ratio (OR): 1.88], anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1,003) and the 2 years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child's diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination.

Psychological Stressors and Burden of Medical Conditions in Older Adults: A Psychosomatic Approach

Directory of Open Access Journals (Sweden)

Arash Mani

2009-12-01

Full Text Available "n  "n  "nObjective: "nIn geriatric practice, the impact of psychological distress on health status has been undermined due to ageism, atypical presentation and less tendency to report negative affect among elderly people. Few studies have examined the impact of psychological stressors on medical burden in older adults. The current study has investigated the correlation of psychological distress and burden of medical conditions in a sample of older people .     "n  "n  "nMethod: A convenient study sample of 120 elderly subjects was recruited from the places where there was greater chance for the elderly people to attend. Data were collected by a trained research assistant using perceived stress scale, cumulative illness rating scale, geriatric depressive scale and a demographic questionnaire.     "n  "n  "nResults: "nOur participants perceived more level of stress than the average for their age. In the current study, the burden of medical condition was significantly correlated with the level of perceived stress(r = .197, p = .044. Moreover, in regression analysis, perceived stress was the strongest predictor for physical health morbidity (R2 =.049, significant f= .03.     "n  "n  "nConclusions: "nThe result of this study suggested that the psychological stressors contribute to poor health outcome in older adults ; the area that is usually overlooked due to ageism and its physiological related changes. The medical practitioners should consider the psychological distress as a part of etiological factors implicating in health morbidity among their aged patients.

Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient.

Science.gov (United States)

Cartwright, Martina M

2004-12-01

Eating disorders are maladaptive eating behaviors that typically develop in adolescence and early adulthood. Psychiatric maladies and comorbid conditions, especially insulin-dependent diabetes mellitus, frequently co-exist with eating disorders. Serious medical complications affecting all organs and tissues can develop and result in numerous emergent hospitalizations. This article reviews the pathophysiologies of anorexia nervosa, bulimia nervosa, and orthorexia nervosa and discusses the complexities associated with the treatment of medical complications seen in these patients.

Selected medical conditions and risk of pancreatic cancer.

Science.gov (United States)

Olson, Sara H

2012-01-01

We review the current evidence for associations of several medical conditions with risk of pancreatic cancer, including allergies, pancreatitis, gall bladder disease, cholecystectomy, ulcers, gastrectomy, appendectomy, and tonsillectomy. There are consistent findings of reduced risk associated with presence of self-reported allergies, particularly hay fever but not asthma; data on other allergies are limited and inconclusive. Several studies provide evidence that patients with pancreatic cancer are more likely than comparison groups to report pancreatitis. Those studies that investigated the time between onset of pancreatitis and diagnosis of pancreatic cancer found that risk estimates declined with longer periods of time; however, increased risks were noted for long-term pancreatitis, indicating that this condition is both a risk factor and a sign of early disease. Increased risk was reported in association with cholelithiasis, but the few studies that considered time before diagnosis of cancer did not find increased risk for cholelithiasis diagnosed in the more distant past. There is weak evidence that cholecystectomy 2 or more years before cancer diagnosis is related to risk, but this is based on only a few studies. There is no consistent association between ulcers and risk, while gastrectomy may increase risk. Overall, study of these conditions, particularly those that are rare, presents methodologic challenges. Time between diagnoses is likely to be important but is not considered in most studies. Lack of adequate control in several studies for risk factors such as smoking and heavy alcohol use also makes it difficult to draw firm conclusions about these results. Copyright © 2011 Wiley Periodicals, Inc.

Trends, Productivity Losses, and Associated Medical Conditions Among Toxoplasmosis Deaths in the United States, 2000–2010

Science.gov (United States)

Cummings, Patricia L.; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank

2014-01-01

Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000–2010. A matched case–control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups. PMID:25200264

A numerical study of magnetohydrodynamics flow in Casson nanofluid combined with Joule heating and slip boundary conditions

Directory of Open Access Journals (Sweden)

A. Kamran

Full Text Available A numerical study of Casson nanofluid past horizontal stretching surface with magnetic effect and Joule heating are presented. Slip and thermal convective boundary conditions are considered in the study. A numerical technique of Keller box is applied to the nonlinear ODEs which are obtained by applying the similarity transformation to the nonlinear partial differential equations. The magnetic field and Joule heating effects are observed graphically. Also the strength of convective heat exchange (Nusselt number and the strength of mass exchange (Sherwood number are analyzed. It is noted that Nusselt number declines whereas Sherwood number rises by increasing Eckert number. The impact of increasing Hartman number resulted in the decrease of both Sherwood and Nusselt number. Keywords: Casson nanofluid, Magnetohydrodynamic, Joule heating, Keller box method

The association of an inability to form and maintain close relationships due to a medical condition with anxiety and depressive disorders.

Science.gov (United States)

Simning, Adam; Seplaki, Christopher L; Conwell, Yeates

2016-03-15

While low social support is a risk factor for mental illness, anxiety and depression's relationship with social impairment specifically resulting from a medical condition is poorly understood. We hypothesize that when a medical illness makes it difficult for people to form and maintain close relationships with others, they will be at increased risk for anxiety and depression. Two nationally representative surveys, the National Comorbidity Survey-Replication and National Latino and Asian American Study, included 6805 adults with at least one medical illness and information on social impairment attributed to a medical condition. The Composite International Diagnostic Interview evaluated a 12-month history of anxiety and depressive disorders. 8.2% of our sample had at least moderate difficulty in forming and maintaining close relationships due to a medical condition. In bivariate analyses, younger age, Latino ethnicity, less education, worse financial status, more chronic illnesses, physical health and discomfort, and problems with mobility, home management, and self-care were associated with this social impairment. In multivariable analyses accounting for possible confounders, there was a dose-dependent relationship between social impairment and the prevalence of anxiety and depression. Data are cross-sectional and our analyses are therefore unable to determine cause-and-effect relationships. Among adults with one or more medical conditions, social impairment attributed to medical illness was associated with a significantly greater odds of anxiety and depression. Further clarification of this relationship could inform more targeted, personalized interventions to prevent and/or alleviate mental illness in those with chronic medical conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

Examining the effect of adverse geological conditions on jamming of a single shielded TBM in Uluabat tunnel using numerical modeling

Directory of Open Access Journals (Sweden)

Rohola Hasanpour

2017-12-01

Full Text Available Severe shield jamming events have been reported during excavation of Uluabat tunnel through adverse geological conditions, which resulted in several stoppages at advancing a single shielded tunnel boring machine (TBM. To study the jamming mechanism, three-dimensional (3D simulation of the machine and surrounding ground was implemented using the finite difference code FLAC3D. Numerical analyses were performed for three sections along the tunnel with a higher risk for entrapment due to the combination of overburden and geological conditions. The computational results including longitudinal displacement contours and ground pressure profiles around the shield allow a better understanding of ground behavior within the excavation. Furthermore, they allow realistically assessing the impact of adverse geological conditions on shield jamming. The calculated thrust forces, which are required to move the machine forward, are in good agreement with field observations and measurements. It also proves that the numerical analysis can effectively be used for evaluating the effect of adverse geological environment on TBM entrapments and can be applied to prediction of loads on the shield and pre-estimating of the required thrust force during excavation through adverse ground conditions.

Evaluating sociodemographic and medical conditions of patients under home care service

Directory of Open Access Journals (Sweden)

Tolga Önder

2015-09-01

Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

Experimental and numerical study on frost heave of saturated rock under uniform freezing conditions

Science.gov (United States)

Lv, Zhitao; Xia, Caichu; Li, Qiang

2018-04-01

A series of freezing experiments are conducted on saturated sandstone and mortar specimens to investigate the frost heave of saturated rock under uniform freezing conditions. The experimental results show that the frost heave of saturated rock is isotropic under uniform freezing conditions. During the freezing process, three stages are observed in the curves of variation of total frost heaving strain versus time: the thermal contraction stage, the frost heaving stage and the steady stage. Moreover, the amount of final stable frost heave first increases and then decreases with decrease in freezing temperature, and the maximum final stable frost heave occurs at different freezing temperature in saturated sandstone and mortar. Furthermore, a coupled thermal-mechanical (TM) model of frost heave of saturated rock is proposed in which a constraint coefficient \\zeta is used to consider the susceptibility of the internal rock grain structure to the expansion of pore ice. Then, numerical simulations are implemented with COMSOL to solve the governing equations of the TM model. Comparisons of the numerical results with the experimental results are performed to demonstrate the reliability of the model. The influences of elastic modulus and porosity on frost heave are also investigated, and the results show that the total frost heaving strain decreases non-linearly with increasing elastic modulus, and the decrease is significant when the elastic modulus is less than 3000 MPa, or approximately five times the elastic modulus of ice. In addition, the total frost heaving strain increases linearly with increasing porosity. Finally, an empirical equation between total frost heaving strain and freezing temperature is proposed and the equation well describes the variation of total frost heaving strain with freezing temperature.

Experimental and numerical study of plastic shear instability under high-speed loading conditions

International Nuclear Information System (INIS)

Sokovikov, Mikhail; Chudinov, Vasiliy; Bilalov, Dmitry; Oborin, Vladimir; Uvarov, Sergey; Plekhov, Oleg; Terekhina, Alena; Naimark, Oleg

2014-01-01

The behavior of specimens dynamically loaded during the split Hopkinson (Kolsky) bar tests in a regime close to simple shear conditions was studied. The lateral surface of the specimens was investigated in a real-time mode with the aid of a high-speed infra-red camera CEDIP Silver 450M. The temperature field distribution obtained at different time made it possible to trace the evolution of plastic strain localization. The process of target perforation involving plug formation and ejection was examined using a high-speed infra-red camera and a VISAR velocity measurement system. The microstructure of tested specimens was analyzed using an optical interferometer-profilometer and a scanning electron microscope. The development of plastic shear instability regions has been simulated numerically

Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions.

Science.gov (United States)

Fattori, A; Neri, L; Aguglia, E; Bellomo, A; Bisogno, A; Camerino, D; Carpiniello, B; Cassin, A; Costa, G; De Fazio, P; Di Sciascio, G; Favaretto, G; Fraticelli, C; Giannelli, R; Leone, S; Maniscalco, T; Marchesi, C; Mauri, M; Mencacci, C; Polselli, G; Quartesan, R; Risso, F; Sciaretta, A; Vaggi, M; Vender, S; Viora, U

2015-01-01

Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182-5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

Science.gov (United States)

Fattori, A.; Neri, L.; Aguglia, E.; Bellomo, A.; Bisogno, A.; Camerino, D.; Carpiniello, B.; Cassin, A.; Costa, G.; De Fazio, P.; Di Sciascio, G.; Favaretto, G.; Fraticelli, C.; Giannelli, R.; Leone, S.; Maniscalco, T.; Marchesi, C.; Mauri, M.; Mencacci, C.; Polselli, G.; Quartesan, R.; Risso, F.; Sciaretta, A.; Vaggi, M.; Vender, S.; Viora, U.

2015-01-01

Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions. PMID:26557692

An experimental and numerical study of diffusion flames in cross-flow and quiescent environment at smoke point condition

Science.gov (United States)

Goh, Sien Fong

An experimental and numerical study of a turbulent smoke point diffusion flame in a quiescent and cross-flow condition was performed. The fuel mass flow rate of a turbulent smoke point flame was determined at a quiescent condition and in cross-flow with velocity ranging from 2 to 4 m/s. This fuel mass flow rate is defined as the Critical Fuel Mass Flow Rate (CFMFR). At a fuel mass flow rate below the CFMFR the flame produces smoke. In the dilution study, an amount of inert gas (nitrogen) was added to the fuel stream to achieve the smoke point condition for ten different fractions of CFMFR. From this dilution study, three regions were defined, the chemically-dominated region, transition region, and momentum-dominated region. The first objective of this study was to determine the factors behind the distinction of these three regions. The second objective was to understand the effect of cross-flow velocity on the smoke point flame structure. The flame temperature, radiation, geometrical dimension of flame, velocity, and global emissions and in-flame species concentration were measured. The third objective was to study a numerical model that can simulate the turbulent smoke point flame structure. The dilution study showed that the flames in quiescent condition and in the 3.5 and 4 m/s cross-flow condition had the chemically-dominated region at 5% to 20% CFMFR, the transition region at 20% to 40% CFMFR, and the momentum-dominated region at 40% to 100% CFMFR. On the other hand, the flame in cross-flow of 2 to 3 m/s showed the chemically-dominated region at 5% to 10% CFMFR, the transition region at 10% to 30% CFMFR, and the momentum-dominated region at 30% to 100% CFMFR. The chemically-dominated flame had a sharp dual-peak structure for the flame temperature, CO2 and NO concentration profiles at 25% and 50% flame length. However, the momentum-dominated region flame exhibited a dual peak structure only at 25% flame length. The decrease of flow rate from 30% to 10% CFMFR

The Relationship Between Aerobic Activity Health Conditions and Medical Visits Among Men and Women Serving Aboard Navy Ships

National Research Council Canada - National Science Library

Hughes, Linda

2002-01-01

.... Contingency tables were computed for amount of self-reported aerobic activity and prevalence rate of adverse health conditions, number of adverse health conditions, number of medical visits, and gender...

Age and Sex Variation In Prevalence Of Chronic Medical Conditions In Older Residents of U.S. Nursing Homes

Science.gov (United States)

Moore, Kelly L.; Boscardin, W. John; Steinman, Michael A.; Schwartz, Janice B.

2012-01-01

OBJECTIVES To investigate patterns in prevalences of chronic medical conditions over the agespan of long-term stay nursing home residents and between the sexes with data from the 2004 National Nursing Home Survey (NNHS). DESIGN Retrospective, cross-sectional study. SETTING U.S. nursing homes. PARTICIPANTS Nationally representative sample comprising 11,788 long-term stay residents (3003 (25%) men and 8785 women) aged 65 years or older. MEASUREMENTS Clinical Classifications Software (CCS) was used to group ICD-9 codes to identify the 20 most prevalent chronic medical conditions. SAS survey procedures were used to account for design effects of stratification and clustering to generate nationally representative estimates of prevalences of medical conditions. RESULTS Average age was 84 y, with women older than men (85 vs. 81, p=0.02) with 67% of women ages 80–95. Women required more ADL assistance. The most frequent chronic medical conditions were hypertension (53, 56%: men, women), dementia (45, 52%), depression (31, 37%), arthritis (26, 35%), diabetes mellitus (26, 23%), gastrointestinal reflux -GERD (23, 23%), atherosclerosis (24, 20%), congestive heart failure -CHF (18, 21%), cerebrovascular disease (24, 19%) and anemia (17, 20%). Sex differences in prevalences existed for all but constipation, GERD, and hypertension. Diabetes, cerebrovascular disease, and lipid disorders decreased with age in men and women. Atrial fibrillation, anemia, arthritis, CHF, and dementia, and thyroid disease increased with age in both men and women. Age-related patterns differed between the sexes for diabetes, hypertension, and Parkinson’s disease. CONCLUSION The profile of chronic medical conditions varies over the agespan of nursing home residents and differs between men and women. This knowledge should guide educational and care efforts in long-term care. PMID:22463062

Palliative Care Medical Education in European Universities: A Descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development.

Science.gov (United States)

Carrasco, José Miguel; Lynch, Thomas J; Garralda, Eduardo; Woitha, Kathrin; Elsner, Frank; Filbet, Marilène; Ellershaw, John E; Clark, David; Centeno, Carlos

2015-10-01

The lack of palliative medicine (PM) education has been identified as a barrier to the development of the discipline. A number of international institutions have called for its implementation within undergraduate medical curricula. The objectives are to describe the situation of undergraduate PM education in Europe and to propose a scoring system to evaluate its status. This descriptive study was conducted with data provided by key experts from countries of the World Health Organization European Region (n = 53). A numerical scoring system was developed through consensus techniques. Forty-three countries (81%) provided the requested information. In 13 countries (30%), a PM course is taught in all medical schools, being compulsory in six of them (14%). In 15 countries (35%), PM is taught in at least one university. In 14 countries (33%), PM is not taught within medical curricula. A full professor of PM was identified in 40% of countries. Three indicators were developed to construct a scale (rank 0-100) of educational development: 1) proportion of medical schools that teach PM (weight = 32%); 2) proportion of medical schools that offer PM as a compulsory subject (weight = 40%); 3) total number of PM professors (weight = 28%). The highest level of PM educational development was found in Israel, Norway, the U.K., Belgium, France, Austria, Germany, and Ireland. PM is taught in a substantial number of undergraduate medical programs at European universities, and a qualified teaching structure is emerging; however, there is a wide variation in the level of PM educational development between individual countries. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Prenatal and Postnatal Medical Conditions and the Risk of Brain Tumors in Children and Adolescents

DEFF Research Database (Denmark)

Tettamanti, Giorgio; Shu, Xiaochen; Adel Fahmideh, Maral

2017-01-01

BACKGROUND: Previous studies have evaluated the effect of medical diagnostic radiation on brain tumors. Recent cohort studies have reported an increased risk associated with exposure to head CT scans. METHODS: Information regarding medical conditions, including prenatal and postnatal exposure...... to medical diagnostic radiation, was obtained from CEFALO, a multicenter case-control study performed in Denmark, Norway, Sweden, and Switzerland through face-to-face interview. Eligible cases of childhood and adolescent brain tumors (CABT) were ages 7 to 19 years, diagnosed between January 1, 2004...... and August 31, 2008, and living in the participating countries (n = 352). The cases were matched by age, sex, and region to 646 population-based controls. RESULTS: Prenatal exposure to medical diagnostic radiation and postnatal exposure to X-rays were not associated with CABTs. A higher risk estimate...

Hybrid heating systems optimization of residential environment to have thermal comfort conditions by numerical simulation.

Science.gov (United States)

Jahantigh, Nabi; Keshavarz, Ali; Mirzaei, Masoud

2015-01-01

The aim of this study is to determine optimum hybrid heating systems parameters, such as temperature, surface area of a radiant heater and vent area to have thermal comfort conditions. DOE, Factorial design method is used to determine the optimum values for input parameters. A 3D model of a virtual standing thermal manikin with real dimensions is considered in this study. Continuity, momentum, energy, species equations for turbulent flow and physiological equation for thermal comfort are numerically solved to study heat, moisture and flow field. K - ɛRNG Model is used for turbulence modeling and DO method is used for radiation effects. Numerical results have a good agreement with the experimental data reported in the literature. The effect of various combinations of inlet parameters on thermal comfort is considered. According to Pareto graph, some of these combinations that have significant effect on the thermal comfort require no more energy can be used as useful tools. A better symmetrical velocity distribution around the manikin is also presented in the hybrid system.

Evaluation of treatment effects in obese children with co-morbid medical or psychiatric conditions

Science.gov (United States)

The need for effective treatments for pediatric overweight is well known. We evaluated the applicability of an evidence-based treatment in an applied clinic setting that includes children with severe obesity and comorbid medical or psychiatric conditions. Forty-eight overweight children and their fa...

Evaluation of conditions of radiation protection of medical personnel in intracavitary neutron therapy of cervical cancer

International Nuclear Information System (INIS)

Kostromina, K.N.; Korenkov, I.P.; Bocharov, A.L.; Gladkikh, N.N.

1991-01-01

Combined radiation therapy was provided to cervical cancer patients. Working conditions of personnel were examined, the rate of exposure doses and flows of neutrons at working places were measured, dose exposures of the personnel were evaluated. It has been concluded that occupational conditions for the medical personnel are considered to be relatively safe

Extensive medical absenteeism among secondary school students : An observational study on their health condition from a biopsychosocial perspective

NARCIS (Netherlands)

Vanneste-van Zandvoort, Y.T.M.; Mathijssen, J.J.P.; van de Goor, L.A.M.; Rots, M.C.; Feron, F.

2015-01-01

An adequate approach to reducing school absenteeism should focus on medical absenteeism as this is the most prevalent form of school absenteeism. The objective of this study is to explore the health condition of pre-vocational secondary students with extensive medical absenteeism from a

Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

Directory of Open Access Journals (Sweden)

A. Fattori

2015-01-01

Full Text Available Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N=1717 with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p<0.01; SF-12 MCS: 59.4% versus 74.3%, p<0.01. The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers’ quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

Framing effect debiasing in medical decision making.

Science.gov (United States)

Almashat, Sammy; Ayotte, Brian; Edelstein, Barry; Margrett, Jennifer

2008-04-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts. The present study investigated the effects of a debiasing procedure designed to prevent the framing effect for young adults who made decisions based on hypothetical medical decision-making vignettes. The debiasing technique involved participants listing advantages and disadvantages of each treatment prior to making a choice. One hundred and two undergraduate students read a set of three medical treatment vignettes that presented information in terms of different outcome probabilities under either debiasing or control conditions. The framing effect was demonstrated by the control group in two of the three vignettes. The debiasing group successfully avoided the framing effect for both of these vignettes. These results further support previous findings of the framing effect as well as an effective debiasing technique. This study improved upon previous framing debiasing studies by including a control group and personal medical scenarios, as well as demonstrating debiasing in a framing condition in which the framing effect was demonstrated without a debiasing procedure. The findings suggest a relatively simple manipulation may circumvent the use of decision-making heuristics in patients.

Influence of the initial conditions for the numerical simulation of two-phase slug flow

Energy Technology Data Exchange (ETDEWEB)

Pachas Napa, Alex A.; Morales, Rigoberto E.M.; Medina, Cesar D. Perea

2010-07-01

Multiphase flows in pipelines commonly show several patterns depending on the flow rate, geometry and physical properties of the phases. In oil production, the slug flow pattern is the most common among the others. This flow pattern is characterized by an intermittent succession in space and time of an aerated liquid slug and an elongated gas bubble with a liquid film. Slug flow is studied through the slug tracking model described as one-dimensional and Lagrangian frame referenced. In the model, the mass and the momentum balance equations are applied in control volumes constituted by the gas bubble and the liquid slug. Initial conditions must be determined, which need to reproduce the intermittence of the flow pattern. These initial conditions are given by a sequence of flow properties for each unit cell. Properties of the unit cell in initial conditions should reflect the intermittence, for which they can be analyzed in statistical terms. Therefore, statistical distributions should be obtained for the slug flow variables. Distributions are complemented with the mass balance and the bubble design model. The objective of the present work is to obtain initial conditions for the slug tracking model that reproduce a better adjustment of the fluctuating properties for different pipe inclinations (horizontal, vertical or inclined). The numerical results are compared with experimental data obtained by PFG/FEM/UNICAMP for air-water flow at 0 deg, 45 deg and 90 deg and good agreement is observed. (author)

Living conditions, ability to seek medical treatment, and awareness of health conditions and healthcare options among homeless persons in Tokyo, Japan.

Science.gov (United States)

Ohtsu, Tadahiro; Toda, Ryouhei; Shiraishi, Tomonobu; Toyoda, Hirokuni; Toyozawa, Hideyasu; Kamioka, Yasuaki; Ochiai, Hirotaka; Shimada, Naoki; Shirasawa, Takako; Hoshino, Hiromi; Kokaze, Akatsuki

2011-12-01

Empirical data indicative of the health conditions and medical needs of homeless persons are scarce in Japan. In this study, with the aim of contributing to the formulation of future healthcare strategies for the homeless, we conducted a self-administered questionnaire survey and interviews at a park in Shinjuku Ward, Tokyo, to clarify the living conditions of homeless persons and their health conditions and awareness about the availability of medical treatment. Responses from 55 homeless men were recorded (response rate: 36.7%). With the exception of one person, none of them possessed a health insurance certificate. Half of the respondents reported having a current income source, although their modal monthly income was 30,000 yen($1 was approximately 90 yen). The number of individuals who responded "yes" to the questions regarding "Consulting a doctor on the basis of someone's recommendation" and "Being aware of the location of the nearest hospital or clinic" was significantly higher among those who had someone to consult when they were ill than among those who did not (the odds ratios [95% confidence intervals] were 15.00 [3.05-93.57] and 11.45 [1.42-510.68], respectively). This showed that whether or not a homeless person had a person to consult might influence his healthcare-seeking behavior. When queried about the entity they consulted (multiple responses acceptable), respondents mentioned "life support organizations" (61.1%) and "public offices" (33.3%). Overall, 94.5% of the respondents were aware of swine flu (novel influenza A (H1N1)). Their main sources of information were newspapers and magazines. On the basis of these findings, with regard to the aim of formulating healthcare strategies for homeless persons, while life support organizations and public offices play significant roles as conduits to medical institutions, print media should be considered useful for communicating messages to homeless persons.

American Academy of Allergy, Asthma & Immunology membership experience with allergen immunotherapy safety in patients with specific medical conditions.

Science.gov (United States)

Larenas-Linnemann, Désirée E S; Hauswirth, David W; Calabria, Christopher W; Sher, Lawrence D; Rank, Matthew A

2016-09-01

Little data in the literature exist concerning patients with certain underlying medical conditions who receive allergen subcutaneous immunotherapy (SCIT). To survey allergists' experience with SCIT in patients with medical conditions considered to impose an elevated risk for untoward outcomes. A Web-based survey was conducted among members of the American Academy of Allergy, Asthma & Immunology to query about their experience with SCIT in patients with certain medical conditions. There were 1085 replies (21% response), of whom, 86% were U.S. based, 51% were suburban, 31% were academic, 42% were medium-sized practices, and 54% had >15 years' experience. In responders' opinion, SCIT was "contraindicated" in patients with the following: acquired immune deficiency syndrome (AIDS) (48%), cancer (and still receiving active treatment) (33%), severe asthma (32%), and a history of transplantation (30%). Even so, survey responders collectively gave SCIT to >2400 patients for each of these conditions: severe asthma, coronary artery disease, cancer in remission, and autoimmune disorders; and to ≥5400 patients with hypertension and ≥4100 women who became pregnant. The experience of colleagues with these patients rarely resulted in major problems (i.e., activation of underlying disease, systemic reactions to SCIT, or SCIT discontinuation), with the exception of severe asthma (12.5%), initiation of SCIT during pregnancy (5.4%), and AIDS (4.2%). For most other conditions, it was ≤1.5% (e.g., continue during pregnancy, cancer in remission, history of transplantation, positive human immunodeficiency virus and no AIDS). According to the experience of a large group of practicing allergists, the American Academy of Allergy, Asthma & Immunology members, few medical conditions seemed to pose an elevated risk for untoward outcomes from SCIT. Because these are survey results, prospective research might yield even more solid data.

Use of exact albedo conditions in numerical methods for one-dimensional one-speed discrete ordinates eigenvalue problems

International Nuclear Information System (INIS)

Abreu, M.P. de

1994-01-01

The use of exact albedo boundary conditions in numerical methods applied to one-dimensional one-speed discrete ordinates (S n ) eigenvalue problems for nuclear reactor global calculations is described. An albedo operator that treats the reflector region around a nuclear reactor core implicitly is described and exactly was derived. To illustrate the method's efficiency and accuracy, it was used conventional linear diamond method with the albedo option to solve typical model problems. (author)

Is medical marijuana legalisation possible in Poland?

Science.gov (United States)

Rogowska-Szadkowska, Dorota; Strumiło, Julia; Chlabicz, Sławomir

2018-03-01

In some countries of the world it is legal to use plant-based marijuana for therapeutic purposes. When we had learned that 7,000 petitioners (including doctors) signed the petition to enable access to marijuana for patients in the Czech Republic, we decided to examine the knowledge about marijuana's medical properties among Polish medical students. Anonymous questionnaire study was conducted on a group of 181 of students of the last (sixth) year of medical school. It was demonstrated that students are not provided with sufficient information about therapeutic administration of plant-based marijuana during medical studies. The majority of interviewees mentioned only one indication for medical marijuana use. All students did not interchange medical conditions for which marijuana is used in 30 USA states or Canada. Marijuana smoking for medical purposes differs from recreational smoking, and its effect does not depend on occurrence of symptoms from the central nervous system. Few studies, that were carried out along with numerous previously unreported cases of patients, demonstrated that plant-derived marijuana had therapeutic effect on many diseases where conventional medicine was of no help. All doctors, including medical students, should receive more information about the therapeutic properties of marijuana. Copyright© by the National Institute of Public Health, Prague 2018.

[Medical tourism: a new kind of traveler?].

Science.gov (United States)

Bovier, Patrick A

2008-05-14

In an era of globalisation, an increasing number of patients are seeking medical care abroad, for a fraction of the price in their home country The reasons are numerous. Some countries face an increasing demand, either because of inappropriate health insurance coverage (e.g. United States) or long waiting lists (e.g. United-Kingdom, Canada). In parallel, medical care facilities and infrastructures of many countries of Asia and latin America offer now high quality care, if not better, than their European or North American counterparts. In theses conditions, more and more patients decide now to travel abroad for cardiovascular and orthopedic surgery that they cannot readily have in their home country. In Switzerland, this phenomenon is still marginal but changes could occur in a near future.

Patient-centered medical homes improve care for adults with chronic conditions.

Science.gov (United States)

Pourat, Nadereh; Lavarreda, Shana Alex; Snyder, Sophie

2013-05-01

The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

Numerical analysis of an entire ceramic kiln under actual operating conditions for the energy efficiency improvement.

Science.gov (United States)

Milani, Massimo; Montorsi, Luca; Stefani, Matteo; Saponelli, Roberto; Lizzano, Maurizio

2017-12-01

The paper focuses on the analysis of an industrial ceramic kiln in order to improve the energy efficiency and thus the fuel consumption and the corresponding carbon dioxide emissions. A lumped and distributed parameter model of the entire system is constructed to simulate the performance of the kiln under actual operating conditions. The model is able to predict accurately the temperature distribution along the different modules of the kiln and the operation of the many natural gas burners employed to provide the required thermal power. Furthermore, the temperature of the tiles is also simulated so that the quality of the final product can be addressed by the modelling. Numerical results are validated against experimental measurements carried out on a real ceramic kiln during regular production operations. The developed numerical model demonstrates to be an efficient tool for the investigation of different design solutions for the kiln's components. In addition, a number of control strategies for the system working conditions can be simulated and compared in order to define the best trade off in terms of fuel consumption and product quality. In particular, the paper analyzes the effect of a new burner type characterized by internal heat recovery capability aimed at improving the energy efficiency of the ceramic kiln. The fuel saving and the relating reduction of carbon dioxide emissions resulted in the order of 10% when compared to the standard burner. Copyright © 2017 Elsevier Ltd. All rights reserved.

Numerical modeling of materials under extreme conditions

CERN Document Server

Brown, Eric

2014-01-01

The book presents twelve state of the art contributions in the field of numerical modeling of materials subjected to large strain, high strain rates, large pressure and high stress triaxialities, organized into two sections. The first part is focused on high strain rate-high pressures such as those occurring in impact dynamics and shock compression related phenomena, dealing with material response identification, advanced modeling incorporating microstructure and damage, stress waves propagation in solids and structures response under impact. The latter part is focused on large strain-low strain rates applications such as those occurring in technological material processing, dealing with microstructure and texture evolution, material response at elevated temperatures, structural behavior under large strain and multi axial state of stress.

Numerical methods for image registration

CERN Document Server

Modersitzki, Jan

2003-01-01

Based on the author's lecture notes and research, this well-illustrated and comprehensive text is one of the first to provide an introduction to image registration with particular emphasis on numerical methods in medical imaging. Ideal for researchers in industry and academia, it is also a suitable study guide for graduate mathematicians, computer scientists, engineers, medical physicists, and radiologists.Image registration is utilised whenever information obtained from different viewpoints needs to be combined or compared and unwanted distortion needs to be eliminated. For example, CCTV imag

A survey of medical exposure during X-ray diagnosis in Aomori

International Nuclear Information System (INIS)

Kon, Masanori; Fukushi, Shouji; Oota, Fumio; Kawamura, Kouji; Shinohe, Tetsuo; Suwa, Kouki; Fujii, Kiyosuke; Yamagami, Hirofumi

2000-01-01

The purpose of this project was to survey medical exposure doses in Aomori Prefecture and compare them with guidance levels for X-ray diagnosis. A questionnaire survey on X-ray diagnosis was conducted at the main medical institutions in the prefecture. The questionnaire asked about technical conditions, and replies were obtained from 72.2% of the 79 institutions. The medical exposure doses (entrance surface doses) were calculated from the results of the questionnaires by the modified numerical dose determination (NDD) method. The distribution of the entrance surface doses at each site was calculated as the 1st quartile, median, 3rd quartile, average, standard deviation, maximum value and minimum value, by the quartile method. The distribution of exposed doses at each site showed a similar pattern with that of the national distribution. Some institutions used higher doses than the Japanese proposed guidance levels and International Atomic Energy Agency (IAEA) guidance levels. Re-assessment of radiographic conditions and photosensitive materials is needed to reduce exposure doses. (K.H.)

Direct numerical simulation of turbulent flows over superhydrophobic surfaces with gas pockets using linearized boundary conditions

Science.gov (United States)

Seo, Jongmin; Bose, Sanjeeb; Garcia-Mayoral, Ricardo; Mani, Ali

2012-11-01

Superhydrophobic surfaces are shown to be effective for surface drag reduction under laminar regime by both experiments and simulations (see for example, Ou and Rothstein, Phys. Fluids 17:103606, 2005). However, such drag reduction for fully developed turbulent flow maintaining the Cassie-Baxter state remains an open problem due to high shear rates and flow unsteadiness of turbulent boundary layer. Our work aims to develop an understanding of mechanisms leading to interface breaking and loss of gas pockets due to interactions with turbulent boundary layers. We take advantage of direct numerical simulation of turbulence with slip and no-slip patterned boundary conditions mimicking the superhydrophobic surface. In addition, we capture the dynamics of gas-water interface, by deriving a proper linearized boundary condition taking into account the surface tension of the interface and kinematic matching of interface deformation and normal velocity conditions on the wall. We will show results from our simulations predicting the dynamical behavior of gas pocket interfaces over a wide range of dimensionless surface tensions. Supported by the Office of Naval Research and the Kwanjeong Educational Scholarship Foundation.

Constraining the thermal conditions of impact environments through integrated low-temperature thermochronometry and numerical modeling

Science.gov (United States)

Kelly, N. M.; Marchi, S.; Mojzsis, S. J.; Flowers, R. M.; Metcalf, J. R.; Bottke, W. F., Jr.

2017-12-01

Impacts have a significant physical and chemical influence on the surface conditions of a planet. The cratering record is used to understand a wide array of impact processes, such as the evolution of the impact flux through time. However, the relationship between impactor size and a resulting impact crater remains controversial (e.g., Bottke et al., 2016). Likewise, small variations in the impact velocity are known to significantly affect the thermal-mechanical disturbances in the aftermath of a collision. Development of more robust numerical models for impact cratering has implications for how we evaluate the disruptive capabilities of impact events, including the extent and duration of thermal anomalies, the volume of ejected material, and the resulting landscape of impacted environments. To address uncertainties in crater scaling relationships, we present an approach and methodology that integrates numerical modeling of the thermal evolution of terrestrial impact craters with low-temperature, (U-Th)/He thermochronometry. The approach uses time-temperature (t-T) paths of crust within an impact crater, generated from numerical simulations of an impact. These t-T paths are then used in forward models to predict the resetting behavior of (U-Th)/He ages in the mineral chronometers apatite and zircon. Differences between the predicted and measured (U-Th)/He ages from a modeled terrestrial impact crater can then be used to evaluate parameters in the original numerical simulations, and refine the crater scaling relationships. We expect our methodology to additionally inform our interpretation of impact products, such as lunar impact breccias and meteorites, providing robust constraints on their thermal histories. In addition, the method is ideal for sample return mission planning - robust "prediction" of ages we expect from a given impact environment enhances our ability to target sampling sites on the Moon, Mars or other solar system bodies where impacts have strongly

Direct Numerical Simulation of Turbulent Multi-Stage Autoignition Relevant to Engine Conditions

Science.gov (United States)

Chen, Jacqueline

2017-11-01

Due to the unrivaled energy density of liquid hydrocarbon fuels combustion will continue to provide over 80% of the world's energy for at least the next fifty years. Hence, combustion needs to be understood and controlled to optimize combustion systems for efficiency to prevent further climate change, to reduce emissions and to ensure U.S. energy security. In this talk I will discuss recent progress in direct numerical simulations of turbulent combustion focused on providing fundamental insights into key `turbulence-chemistry' interactions that underpin the development of next generation fuel efficient, fuel flexible engines for transportation and power generation. Petascale direct numerical simulation (DNS) of multi-stage mixed-mode turbulent combustion in canonical configurations have elucidated key physics that govern autoignition and flame stabilization in engines and provide benchmark data for combustion model development under the conditions of advanced engines which operate near combustion limits to maximize efficiency and minimize emissions. Mixed-mode combustion refers to premixed or partially-premixed flames propagating into stratified autoignitive mixtures. Multi-stage ignition refers to hydrocarbon fuels with negative temperature coefficient behavior that undergo sequential low- and high-temperature autoignition. Key issues that will be discussed include: 1) the role of mixing in shear driven turbulence on the dynamics of multi-stage autoignition and cool flame propagation in diesel environments, 2) the role of thermal and composition stratification on the evolution of the balance of mixed combustion modes - flame propagation versus spontaneous ignition - which determines the overall combustion rate in autoignition processes, and 3) the role of cool flames on lifted flame stabilization. Finally prospects for DNS of turbulent combustion at the exascale will be discussed in the context of anticipated heterogeneous machine architectures. sponsored by DOE

Fictitious domain methods for elliptic problems with general boundary conditions with an application to the numerical simulation of two phase flows

International Nuclear Information System (INIS)

Ramiere, I.

2006-09-01

This work is dedicated to the introduction of two original fictitious domain methods for the resolution of elliptic problems (mainly convection-diffusion problems) with general and eventually mixed boundary conditions: Dirichlet, Robin or Neumann. The originality lies in the approximation of the immersed boundary by an approximate interface derived from the fictitious domain Cartesian mesh, which is generally not boundary-fitted to the physical domain. The same generic numerical scheme is used to impose the embedded boundary conditions. Hence, these methods require neither a surface mesh of the immersed boundary nor the local modification of the numerical scheme. We study two modelling of the immersed boundary. In the first one, called spread interface, the approximate immersed boundary is the union of the cells crossed by the physical immersed boundary. In the second one, called thin interface, the approximate immersed boundary lies on sides of mesh cells. Additional algebraic transmission conditions linking both flux and solution jumps through the thin approximate interface are introduced. The fictitious problem to solve as well as the treatment of the embedded boundary conditions are detailed for the two methods. A Q1 finite element scheme is implemented for the numerical validation of the spread interface approach while a new cell-centered finite volume scheme is derived for the thin interface approach with immersed jumps. Each method is then combined to multilevel local mesh refinement algorithms (with solution or flux residual) to increase the precision of the solution in the vicinity of the immersed interface. A convergence analysis of a Q1 finite element method with non-boundary fitted meshes is also presented. This study proves the convergence rates of the present methods. Among the various industrial applications, the simulation on a model of heat exchanger in french nuclear power plants enables us to appreciate the performances of the fictitious domain

Risk of Adverse Health Outcomes and Decrements in Performance Due to In-flight Medical Conditions

Science.gov (United States)

Antonsen,Erik

2017-01-01

The drive to undertake long-duration space exploration missions at greater distances from Earth gives rise to many challenges concerning human performance under extreme conditions. At NASA, the Human Research Program (HRP) has been established to investigate the specific risks to astronaut health and performance presented by space exploration, in addition to developing necessary countermeasures and technology to reduce risk and facilitate safer, more productive missions in space (NASA Human Research Program 2009). The HRP is divided into five subsections, covering behavioral health, space radiation, habitability, and other areas of interest. Within this structure is the ExMC Element, whose research contributes to the overall development of new technologies to overcome the challenges of expanding human exploration and habitation of space. The risk statement provided by the HRP to the ExMC Element states: "Given that medical conditions/events will occur during human spaceflight missions, there is a possibility of adverse health outcomes and decrements in performance in mission and for long term health" (NASA Human Research Program 2016). Within this risk context, the Exploration Medical Capabilities (ExMC) Element is specifically concerned with establishing evidenced-based methods of monitoring and maintaining astronaut health. Essential to completing this task is the advancement in techniques that identify, prevent, and treat any health threats that may occur during space missions. The ultimate goal of the ExMC Element is to develop and demonstrate a pathway for medical system integration into vehicle and mission design to mitigate the risk of medical issues. Integral to this effort is inclusion of an evidence-based medical and data handling system appropriate for long-duration, exploration-class missions. This requires a clear Concept of Operations, quantitative risk metrics or other tools to address changing risk throughout a mission, and system scoping and system

Resolving embarrassing medical conditions with online health information.

Science.gov (United States)

Redston, Sarah; de Botte, Sharon; Smith, Carl

2018-06-01

Reliance on online health information is proliferating and the Internet has the potential to revolutionize the provision of public health information. The anonymity of online health information may be particularly appealing to people seeking advice on 'embarrassing' health problems. The purpose of this study was to investigate (1) whether data generated by the embarrassingproblems.com health information site showed any temporal patterns in problem resolution, and (2) whether successful resolution of a medical problem using online information varied with the type of medical problem. We analyzed the responses of visitors to the embarrassingproblems.com website on the resolution of their problems. The dataset comprised 100,561 responses to information provided on 77 different embarrassing problems grouped into 9 classes of medical problem over an 82-month period. Data were analyzed with a Bernoulli Generalized Linear Model using Bayesian inference. We detected a statistically important interaction between embarrassing problem type and the time period in which data were collected, with an improvement in problem resolution over time for all of the classes of medical problem on the website but with a lower rate of increase in resolution for urinary health problems and medical problems associated with the mouth and face. As far as we are aware, this is the first analysis of data of this nature. Findings support the growing recognition that online health information can contribute to the resolution of embarrassing medical problems, but demonstrate that outcomes may vary with medical problem type. The results indicate that building data collection into online information provision can help to refine and focus health information for online users. Copyright © 2018 Elsevier B.V. All rights reserved.

Numerical investigations of buoyancy-driven natural ventilation in a simple atrium building and its effect on the thermal comfort conditions

International Nuclear Information System (INIS)

Hussain, Shafqat; Oosthuizen, Patrick H.

2012-01-01

In the present study use of solar-assisted buoyancy-driven natural ventilation in a simple atrium building is explored numerically with particular emphasis on the thermal comfort conditions in the building. Initially various geometric configurations of the atrium space were considered in order to investigate airflows and temperature distributions in the building using a validated computational fluid dynamics (CFD) model. The Reynolds Averaged Navier–Stokes (RANS) modelling approach with the SST-k–ω turbulence model and the Discrete Transfer Radiation Model (DTRM) was used for the investigations. The steady-state governing equations were solved using a commercial CFD solver FLUENT © . From the numerical results obtained, it was noted that an atrium space integrated with a solar chimney would be a relatively better option to be used in an atrium building. In the geometry selected, the performance of the building in response to various changes in design parameters was investigated. The produced airflows and temperature distributions were then used to evaluate indoor thermal comfort conditions in terms of the thermal comfort indices, i.e. the well-known predicted mean vote (PMV) index, its modifications especially for natural ventilation, predicted percent dissatisfied (PPD) index and Percent dissatisfied (PD) factor due to draft. It was found that the thermal conditions in the occupied areas of the building developed as a result of the use of solar-assisted buoyancy-driven ventilation for the particular values of the design parameters selected are mostly in the comfortable zone. Finally, it is demonstrated that the proposed methodology leads to reliable thermal comfort predictions, while the effect of various design variables on the performance of the building is easily recognized. - Highlights: ► Numerical investigations were carried for the use of buoyancy-driven displacement ventilation in a simple atrium building. ► Effect of various atrium

Sparse grid spectral methods for the numerical solution of partial differential equations with periodic boundary conditions

International Nuclear Information System (INIS)

Kupka, F.

1997-11-01

This thesis deals with the extension of sparse grid techniques to spectral methods for the solution of partial differential equations with periodic boundary conditions. A review on boundary and initial-boundary value problems and a discussion on numerical resolution is used to motivate this research. Spectral methods are introduced by projection techniques, and by three model problems: the stationary and the transient Helmholtz equations, and the linear advection equation. The approximation theory on the hyperbolic cross is reviewed and its close relation to sparse grids is demonstrated. This approach extends to non-periodic problems. Various Sobolev spaces with dominant mixed derivative are introduced to provide error estimates for Fourier approximation and interpolation on the hyperbolic cross and on sparse grids by means of Sobolev norms. The theorems are immediately applicable to the stability and convergence analysis of sparse grid spectral methods. This is explicitly demonstrated for the three model problems. A variant of the von Neumann condition is introduced to simplify the stability analysis of the time-dependent model problems. The discrete Fourier transformation on sparse grids is discussed together with its software implementation. Results on numerical experiments are used to illustrate the performance of the new method with respect to the smoothness properties of each example. The potential of the method in mathematical modelling is estimated and generalizations to other sparse grid methods are suggested. The appendix includes a complete Fortran90 program to solve the linear advection equation by the sparse grid Fourier collocation method and a third-order Runge-Kutta routine for integration in time. (author)

Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the U.S.A.

Science.gov (United States)

Walker, Elizabeth Reisinger; Druss, Benjamin G

2017-07-01

The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity. We examined the patterns of co-occurrence of mental illness, substance abuse/dependence, and chronic medical conditions and the cumulative burden of these conditions and living in poverty on self-rated health. We conducted a secondary data analysis using publically-available data from the National Survey on Drug Use and Health (NSDUH), which is an annual nationally-representative survey. Pooled data from the 2010-2012 NSDUH surveys included 115,921 adults 18 years of age or older. The majority of adults (52.2%) had at least one type of condition (mental illness, substance abuse/dependence, or chronic medical conditions), with substantial overlap across the conditions. 1.2%, or 2.2 million people, reported all three conditions. Generally, as the number of conditions increased, the odds of reporting worse health also increased. The likelihood of reporting fair/poor health was greatest for people who reported AMI, chronic medical conditions, and poverty (AOR = 9.41; 95% CI: 7.53-11.76), followed by all three conditions and poverty (AOR = 9.32; 95% CI: 6.67-13.02). For each combination of conditions, the addition of poverty increased the likelihood of reporting fair/poor health. Traditional conceptualizations of multimorbidity should be expanded to take into account the complexities of co-occurrence between mental illnesses, chronic medical conditions, and socioeconomic factors.

Numerical investigations of solute transport in bimodal porous media under dynamic boundary conditions

Science.gov (United States)

Cremer, Clemens; Neuweiler, Insa; Bechtold, Michel; Vanderborght, Jan

2016-04-01

Quantification of flow and solute transport in the shallow subsurface adjacent to the atmosphere is decisive to prevent groundwater pollution and conserve groundwater quality, to develop successful remediation strategies and to understand nutrient cycling. In nature, due to erratic precipitation-evaporation patterns, soil moisture content and related hydraulic conductivity in the vadose zone are not only variable in space but also in time. Flow directions and flow paths locally change between precipitation and evaporation periods. This makes the identification and description of solute transport processes in the vadose zone a complex problem. Recent studies (Lehmann and Or, 2009; Bechtold et al., 2011a) focused on the investigation of upward transport of solutes during evaporation in heterogeneous soil columns, where heterogeneity was introduced by a sharp vertical material interface between two types of sand. Lateral solute transport through the interface in both (lateral) directions was observed at different depths of the investigated soil columns. Following recent approaches, we conduct two-dimensional numerical simulations in a similar setup which is composed of two sands with a sharp vertical material interface. The investigation is broadened from the sole evaporation to combined precipitation-evaporation cycles in order to quantify transport processes resulting from the combined effects of heterogeneous soil structure and dynamic flow conditions. Simulations are performed with a coupled finite volume and random walk particle tracking algorithm (Ippisch et al., 2006; Bechtold et al., 2011b). By comparing scenarios with cyclic boundary conditions and stationary counterparts with the same net flow rate, we found that duration and intensity of precipitation and evaporation periods potentially have an influence on lateral redistribution of solutes and thus leaching rates. Whether or not dynamic boundary conditions lead to significant deviations in the transport

Pedagogical Conditions of Shaping Motor Competence in Physical Education of Students of Special Medical Groups

Directory of Open Access Journals (Sweden)

В. М. Корягін

2016-09-01

Full Text Available Study objective. To define the pedagogical conditions of shaping motor competence in students of special medical groups during physical education at higher educational institutions. Study methods: theoretical analysis, systematization, comparison of different views on the issue under study, methodological and special literature collation, general scientific methods of theoretical level: analogy, analysis, synthesis, abstraction, induction. Study results. The study addresses the issues of indicating the pedagogical conditions necessary for the effective shaping of the motor competence in students of special medical groups during their physical education at higher educational institutions. The data analysis and collation of the data collected from the scientific, methodological and special literature helped outline and organize their index, which is a pre-requisite for ensuring the process effectiveness. We recommend using the study results as a major foundation for re-organization of the scientific and methodological aspects of physical education of students with health problems to ensure their motor competence effectively shaped.

Kinetics of UO2(s) dissolution under reducing conditions: Numerical modelling

International Nuclear Information System (INIS)

Puigdomenech, I.; Casas, I.; Bruno, J.

1990-05-01

A numerical model is presented that describes the dissolution and precipitation of UO 2 (s) under reducing conditions. For aqueous solutions with pH>4, main reaction is: UO 2 (s)+2H 2 O↔U(OH) 4 (aq). The rate constant for the precipitation reaction is found to be log(k p )=-1.2±0.2 h -1 m -2 , while the value for the rate constant of the dissolution reaction is log(k d )=-9.0±0.2 mol/(1 h m 2 ). Most of the experiments reported in the literature show a fast initial dissolution of a surface film of hexavalent uranium oxide. Making the assumption that the chemical composition of the surface coating is U 3 O 7 (s), we have derived a mechanism for this process, and its rate constants have been obtained. The influence of HCO 3 - and CO 3 2- on the mechanism of dissolution and precipitation of UO 2 (s) is still unclear. From the solubility measurements reported, one may conclude that the identity of the aqueous complexes in solution is not well known. Therefore it is not possible to make a mechanistic interpretation of the kinetic data in carbonate medium. (orig.)

Computerized medical convocations

International Nuclear Information System (INIS)

Roche, Annie; Gilbert, Jean-Francois; Chiadot, Pierre; Vanzetto, Rene; Darnault, Jean

1969-06-01

Thanks to a close collaboration between the Medical and Social department and the Numerical Calculation Laboratory, a computerized convocation system has been implemented to reduce the administrative workload and to introduce more rigor in medical management, patient historical background and statistics. This work comprises: - a preliminary study of the data generating medical convocations and the related practical requirements; - the programming work according to these data; - the realisation of the mechano-graphical file covering the overall personnel [fr

Risk of Adverse Health Outcomes & Decrements in Performance due to Inflight Medical Conditions: ExMC Pharmacy Research Plan

Science.gov (United States)

Antonsen, Erik

2016-01-01

The Exploration Medical Capabilities (ExMC) Element of NASA's Human Research Program is charged with identifying medical capabilities that can address the challenges of prevention, diagnosis, and treatment of disease and injuries that could occur during exploration missions beyond Earth's orbit. Faced with the obstacle of access to in-flight medical care, and limitations of vehicle space, time, and communications; it is necessary to prioritize what medical consumables are manifested for the flight, and which medical conditions are addressed. Studies of astronaut health establish the incidence of common and high risk medical conditions that require medical intervention during long-duration exploration missions. In 2000, the Institute of Medicine (IOM) convened a committee of experts, Committee on Creating a Vision for Space Medicine during Travel beyond Earth Orbit, to examine the issues surrounding astronaut health and safety for long duration space missions. Two themes run throughout the committee's final report: (1) that not enough is known about the risks to human health during long-duration missions beyond Earth's orbit or about what can effectively mitigate those risks to enable humans to travel and work safely in the environment of deep space and (2) that everything reasonable should be done to gain the necessary information before humans are sent on missions of space exploration (IOM, 2001). Although several spaceflight focused pharmaceutical research studies have been conducted, few have provided sufficient data regarding medication usage or potency changes during spaceflight. The Du pharmaceutical stability study assessed medications flown on space shuttles to and from the International Space Station (ISS) from 2006 until 2008; of which some medications were still viable beyond their expiration dates (Du et al, 2011). However, as with many spaceflight studies, the small 'n' associated with this study limits the ability to draw strong conclusions from it

Narrative descriptions should replace grades and numerical ratings for clinical performance in medical education in the United States

Directory of Open Access Journals (Sweden)

Janice Lynn Hanson

2013-11-01

Full Text Available Background: In medical education, evaluation of clinical performance is based almost universally on rating scales for defined aspects of performance and scores on examinations and checklists. Unfortunately, scores and grades do not capture progress and competence among learners in the complex tasks and roles required to practice medicine. While the literature suggests serious problems with the validity and reliability of ratings of clinical performance based on numerical scores, the critical issue is not that judgments about what is observed vary from rater to rater but that these judgments are lost when translated into numbers on a scale. As the Next Accreditation System of the Accreditation Council on Graduate Medical Education (ACGME takes effect, medical educators have an opportunity to create new processes of evaluation to document and facilitate progress of medical learners in the required areas of competence.Proposal and initial experience: Narrative descriptions of learner performance in the clinical environment, gathered using a framework for observation that builds a shared understanding of competence among the faculty, promise to provide meaningful qualitative data closely linked to the work of physicians. With descriptions grouped in categories and matched to milestones, core faculty can place each learner along the milestones’ continua of progress. This provides the foundation for meaningful feedback to facilitate the progress of each learner as well as documentation of progress toward competence.Implications: This narrative evaluation system addresses educational needs as well as the goals of the Next Accreditation System for explicitly documented progress. Educators at other levels of education and in other professions experience similar needs for authentic assessment and, with meaningful frameworks that describe roles and tasks, may also find useful a system built on descriptions of learner performance in actual work settings

Health Care Use, Health Behaviors, and Medical Conditions Among Individuals in Same-Sex and Opposite-Sex Partnerships: A Cross-Sectional Observational Analysis of the Medical Expenditures Panel Survey (MEPS), 2003-2011.

Science.gov (United States)

Blosnich, John R; Hanmer, Janel; Yu, Lan; Matthews, Derrick D; Kavalieratos, Dio

2016-06-01

Prior research documents disparities between sexual minority and nonsexual minority individuals regarding health behaviors and health services utilization. However, little is known regarding differences in the prevalence of medical conditions. To examine associations between sexual minority status and medical conditions. We conducted multiple logistic regression analyses of the Medical Expenditure Panel Survey (2003-2011). We identified individuals who reported being partnered with an individual of the same sex, and constructed a matched cohort of individuals in opposite-sex partnerships. A total of 494 individuals in same-sex partnerships and 494 individuals in opposite-sex partnerships. Measures of health risk (eg, smoking status), health services utilization (eg, physician office visits), and presence of 15 medical conditions (eg, cancer, diabetes, arthritis, HIV, alcohol disorders). Same-sex partnered men had nearly 4 times the odds of reporting a mood disorder than did opposite-sex partnered men [adjusted odds ratio (aOR)=3.96; 95% confidence interval (CI), 1.85-8.48]. Compared with opposite-sex partnered women, same-sex partnered women had greater odds of heart disease (aOR=2.59; 95% CI, 1.19-5.62), diabetes (aOR=2.75; 95% CI, 1.10-6.90), obesity (aOR=1.92; 95% CI, 1.26-2.94), high cholesterol (aOR=1.89; 95% CI, 1.03-3.50), and asthma (aOR=1.90; 95% CI, 1.02-1.19). Even after adjusting for sociodemographics, health risk behaviors, and health conditions, individuals in same-sex partnerships had 67% increased odds of past-year emergency department utilization and 51% greater odds of ≥3 physician visits in the last year compared with opposite-sex partnered individuals. A combination of individual-level, provider-level, and system-level approaches are needed to reduce disparities in medical conditions and health care utilization among sexual minority individuals.

Performance investigation of low – Concentration photovoltaic systems under hot and arid conditions: Experimental and numerical results

International Nuclear Information System (INIS)

Yousef, Mohamed S.; Abdel Rahman, Ali K.; Ookawara, S.

2016-01-01

Highlights: • Influence of cooling on the performance of photovoltaic systems. • A comprehensive model (optical, thermal, and electrical) was developed. • Experimental measurements were conducted under hot climate conditions. • For conventional photovoltaic with cooling, about 11% more power was obtained. • For concentrated photovoltaic with cooling, about 15% more power was obtained. - Abstract: In this study, a comparative performance analysis was performed between a conventional photovoltaic system and a low-concentration photovoltaic system. Two typical photovoltaic modules and two compound parabolic concentrating photovoltaic systems were examined. A Cooling system was employed to lower the temperature of the solar cells in each of the two configurations. Experimental and numerical investigations of the performance of the two arrangements with and without cooling were presented. Experiments were conducted outdoors at the Egypt-Japan University of Science and Technology, subjected to the hot climate conditions of New Borg El-Arab City, Alexandria, Egypt (Longitude/Latitude: E 029°42′/N 30°55′). A comprehensive system model was established, which comprises an optical model, coupled with thermal and electrical models. The coupled model was developed analytically and solved numerically, using MATLAB software, to assess the overall performance of the two configurations, considering the concentration ratio of the concentrated photovoltaic system to be 2.4X. The results indicated that cooling the solar panels considerably improved the electrical power yield of the photovoltaic systems. By employing cooling, the temperatures of the conventional photovoltaic system and the concentrated photovoltaic system were effectively lowered by approximately 25% and 30%, respectively, resulting in a significant enhancement in the electrical power output of the photovoltaic system by 11% and that of the concentrated photovoltaic system by 15%. Furthermore, the

Ménière's Disease and Underlying Medical and Mental Conditions: Towards Factors Contributing to the Disease.

Science.gov (United States)

Mohamed, Shwan; Khan, Imran; Iliodromiti, Stamatina; Gaggini, Margaret; Kontorinis, Georgios

2016-01-01

To investigate the relation of Ménière's disease (MD) with medical comorbidity or mental conditions. Demographic data, medical and mental comorbidities were retrospectively collected and compared from 3 groups of 30 patients each: a group with patients with definite MD, a second one with patients with vestibulopathies other than MD (non-Ménière's vertigo, NMV) and a third one with patients without any vestibular symptoms (control). The level of significance was set at 0.05. The prevalence of mental conditions was 26.7, 23.3 and 6.7% for the MD, the NMV and the control group, respectively. Medical comorbidity was found in 80% of patients in the MD, 63% in the NMV and 20% in the control group. Arthritis was encountered in 8 patients with MD, 3 with NMV and none from the control group. The differences in prevalence of mental disease, comorbidities and arthritis between the MD and the control group were statistically significant (p = 0.02, p disease. © 2016 S. Karger AG, Basel.

Impact of socioeconomic status and medical conditions on health and healthcare utilization among aging Ghanaians.

Science.gov (United States)

Saeed, Bashiru Ii; Xicang, Zhao; Yawson, Alfred Edwin; Nguah, Samuel Blay; Nsowah-Nuamah, Nicholas N N

2015-03-20

This study attempts to examine the impact of socioeconomic and medical conditions in health and healthcare utilization among older adults in Ghana. Five separate models with varying input variables were estimated for each response variable. Data (Wave 1 data) were drawn from the World Health Organization Global Ageing and Adult Health (SAGE) conducted during 2007-2008 and included a total of 4770 respondents aged 50+ and 803 aged 18-49 in Ghana. Ordered logits was estimated for self-rated health, and binary logits for functional limitation and healthcare utilization. Our results show that the study provides enough grounds for further research on the interplay between socioeconomic and medical conditions on one hand and the health of the aged on the other. Controlling for socioeconomic status substantially contributes significantly to utilization. Also, aged women experience worse health than men, as shown by functioning assessment, self-rated health, chronic conditions and functional limitations. Women have higher rates of healthcare utilization, as shown by significantly higher rates of hospitalization and outpatient encounters. Expansion of the national health insurance scheme to cover the entire older population--for those in both formal and informal employments--is likely to garner increased access and improved health states for the older population.

Numerical Transducer Modeling

DEFF Research Database (Denmark)

Henriquez, Vicente Cutanda

This thesis describes the development of a numerical model of the propagation of sound waves in fluids with viscous and thermal losses, with application to the simulation of acoustic transducers, in particular condenser microphones for measurement. The theoretical basis is presented, numerical...... manipulations are developed to satisfy the more complicated boundary conditions, and a model of a condenser microphone with a coupled membrane is developed. The model is tested against measurements of ¼ inch condenser microphones and analytical calculations. A detailed discussion of the results is given....

Perceptions of the impact of depression and anxiety and the medication for these conditions on safety in the workplace.

Science.gov (United States)

Haslam, C; Atkinson, S; Brown, S; Haslam, R A

2005-08-01

The number of people taking prescribed medication for anxiety and depression has increased greatly, but little is known of how this medication impacts on safety at work. To examine the relation between anxiety and depression, prescribed medication, performance, and safety in the workplace. The research involved nine focus groups with sufferers of anxiety and depression to investigate experiences of mental health problems and the impact of psychotropic drugs. A further three focus groups were conducted with staff in human resources, personnel, occupational health, and health and safety departments, to explore organisational perspectives. The sample comprised 74 individuals drawn from a wide range of occupational sectors. Finally, the results were presented to a panel of experts from occupational medicine, general practice, psychology, health and safety, and psychiatry, to consider the implications for practice. Workers reported that both the symptoms and the medication impaired work performance. Participants described accidents which they attributed to their condition or to the medication. Workers with responsibilities for others, such as teachers, healthcare workers, and managers appeared to present a particular safety risk. Healthcare workers believed that they placed themselves and their patients at risk when carrying out medical procedures. Respondents in this study felt that their symptoms of anxiety and depression and the medication they took to treat these conditions placed them at risk with respect to safety in the workplace. Drawing on the results, the authors outline areas for improvement in the management of mental health problems at work.

Changes in psychosocial and physical working conditions and psychotropic medication in ageing public sector employees: a record-linkage follow-up study.

Science.gov (United States)

Kouvonen, Anne; Mänty, Minna; Lallukka, Tea; Pietiläinen, Olli; Lahelma, Eero; Rahkonen, Ossi

2017-07-12

To investigate whether changes in psychosocial and physical working conditions are associated with subsequent psychotropic medication in ageing employees. Data were from the Helsinki Health Study, a cohort study of Finnish municipal employees, aged 40-60 years at phase 1 (2000-2002). Changes in psychosocial and physical working conditions were measured between phase 1 and phase 2 (2007). Survey data were longitudinally linked to data on prescribed, reimbursed psychotropic medication purchases (Anatomical Therapeutic Chemical) obtained from the registers of the Social Insurance Institution of Finland between the phase 2 survey and December 2013 (N=3587; 80% women). Outcomes were any psychotropic medication; antidepressants (N06A); anxiolytics (N05B); and sedatives and hypnotics (N05C). Cox regression analyses were performed. During the follow-up, 28% of the participants were prescribed psychotropic medication. Repeated exposures to low job control, high job demands and high physical work load were associated with an increased risk of subsequent antidepressant and anxiolytic medication. Increased and repeated exposure to high physical work load, increased job control and repeated high job demands were associated with subsequent sedative and hypnotic medication. Age and sex-adjusted HR varied from 1.18 to 1.66. Improvement in job control was associated with a lower risk of anxiolytic, but with a higher risk of sedatives and hypnotic medication. Decreased physical work load was associated with a lower risk of antidepressant and anxiolytic medications. Improvement in working conditions could lower the risk of mental ill-health indicated by psychotropic medication. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Making choices about medical interventions: the experience of disabled young people with degenerative conditions.

Science.gov (United States)

Mitchell, Wendy A

2014-04-01

Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children's role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents' perspectives. To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision-making processes. Findings from a longitudinal qualitative study of 10 young people (13-22 years) with degenerative conditions are reported. Individual semi-structured interviews were conducted with participants over 3 years (2007-2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Young people's experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as 'irreversible' and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working. © 2012 John Wiley & Sons Ltd.

Numerical model simulations of boundary-layer dynamics during winter conditions

DEFF Research Database (Denmark)

Melas, D.; Persson, T.; Bruin, H. de

2001-01-01

A mesoscale numerical model, incorporating a land-surface scheme based on Deardorffs' approach, is used to study the diurnal variation of the boundary layer structure and surface fluxes during four consecutive days with air temperatures well below zero, snow covered ground and changing synoptic f...

Analytical expressions for conditional averages: A numerical test

DEFF Research Database (Denmark)

Pécseli, H.L.; Trulsen, J.

1991-01-01

Conditionally averaged random potential fluctuations are an important quantity for analyzing turbulent electrostatic plasma fluctuations. Experimentally, this averaging can be readily performed by sampling the fluctuations only when a certain condition is fulfilled at a reference position...

Proposed Industry Best Practices in Development and Marketing of Medical Foods for the Management of Chronic Conditions and Diseases while Awaiting Regulation.

Science.gov (United States)

Burnett, Bruce; Levy, Robert M

Ideal therapeutics have low toxicity and can effectively manage condition(s) or disease(s). The Food & Drug Administration (FDA) marketing category of therapeutics called “medical foods” (MFs) meets such a definition. Medical foods have existed in Federal law since passage the Orphan Drug Act in 1988, which created a category of nutritional therapeutics separate from drugs. Unfortunately, MFs are not widely understood by the medical community or utilized in all patients who need them due to lack of a FDA-approval process, unclear and contradictory guidance especially with regard for need for an investigational new drug (IND) application, and no clear regulations regarding their development and marketing. The goals of this article are to propose “Best Practices” to guide the medical food industry in the development and marketing of products as well as to serve as a starting point for suggestions regarding further FDA regulation so that therapeutics which are shown to be generally recognized as safe (GRAS), provide food ingredients to meet a distinctive nutritional requirement for a specific condition/disease and are proven effective for the management for that condition/disease can be used to benefit patients who need them.

Numerical Simulation of the Application of Solar Radiant Systems, Internal Airflow and Occupants’ Presence in the Improvement of Comfort in Winter Conditions

Directory of Open Access Journals (Sweden)

Eusébio Z. E. Conceição

2016-09-01

Full Text Available In this work, the use of numerical simulation in the application of solar radiant systems, internal airflow and occupants’ presence in the improvement of comfort in winter conditions is made. The thermal comfort, the local thermal discomfort and the air quality in an occupied chamber space are evaluated. In the experimental measurements, a wood chamber, a desk, two seats, two seated hygro-thermal manikins, a warm radiant floor, a solar radiation simulator and a water solar collector are used. The air velocity and the air temperature fluctuation are experimentally evaluated around 15 human body sections. The chamber surface temperature is experimentally measured. In the numerical simulation, a coupling human thermal comfort (HTC integral model, a computational fluids dynamics (CFD differential model and a building thermal response (BTR integral model are applied. The human thermal comfort level is evaluated by the HTC numerical model. The airflow inside the virtual chamber, using the k-epsilon and RNG turbulence models, is evaluated by the CFD numerical model. The chamber surface and the collector temperatures are evaluated by the BTR numerical model. In the human thermal comfort level, in non-uniform environments, the predicted mean vote (PMV and the predicted percentage of dissatisfied (PPD people are numerically evaluated; in the local thermal discomfort level the draught risk (DR is experimentally and numerically analyzed; and in the air quality, the carbon dioxide CO2 concentration is numerically calculated. In the validation tests, the experimental and numerical values of the chamber surface temperature, the air temperature, the air velocity, the air turbulence intensity and the DR are presented.

Association between patient unconscious or not alert conditions and cardiac arrest or high-acuity outcomes within the Medical Priority Dispatch System "Falls" protocol.

Science.gov (United States)

Clawson, Jeff; Olola, Christopher; Scott, Greg; Schultz, Bryon; Pertgen, Richard; Robinson, Don; Bagwell, Barry; Patterson, Brett

2010-01-01

Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though "not alert" falls patients with severe outcomes mostly are "hot" transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing. The objective of this study was to characterize the risk of cardiac arrest and "hot-transport" outcomes in patients with "not alert" condition, within the Medical Priority Dispatch System (MPDS®) Falls protocol descriptors. This retrospective study used 129 months of de-identified, aggregate, dispatch datasets from three US emergency communication centers. The communication centers used the Medical Priority Dispatch System version 11.3-OMEGA type (released in 2006) to interrogate Emergency Medical System callers, select dispatch codes assigned to various response configurations, and provide pre-arrival instructions. The distribution of cases and percentages of cardiac arrest and hot-transport outcomes, categorized by MPDS® code, was profiled. Assessment of the association between MPDS® Delta-level 3 (D-3) "not alert" condition and cardiac arrest and hot-transport outcomes then followed. Overall, patients within the D-3 and D-2 "long fall" conditions had the highest proportions (compared to the other determinants in the "falls" protocol) of cardiac arrest and hot-transport outcomes, respectively. "Not alert" condition was associated significantly with cardiac arrest and hot-transport outcomes (pdeterminant within the MPDS® "fall" protocol was associated significantly with severe outcomes for short falls (falls. As reported to 9-1-1, the complaint of a "fall" may include the presence of underlying conditions that go beyond the obvious traumatic injuries caused by the fall itself.

An introduction to medical statistics

International Nuclear Information System (INIS)

Hilgers, R.D.; Bauer, P.; Scheiber, V.; Heitmann, K.U.

2002-01-01

This textbook teaches all aspects and methods of biometrics as a field of concentration in medical education. Instrumental interpretations of the theory, concepts and terminology of medical statistics are enhanced by numerous illustrations and examples. With problems, questions and answers. (orig./CB) [de

Influence of surface conditions on fatigue strength through the numerical simulation of microstructure

International Nuclear Information System (INIS)

Le Pecheur, A.; Clavel, M.; Rey, C.; Bompard, P.; Le Pecheur, A.; Curtit, F.; Stephan, J.M.

2010-01-01

A thermal fatigue test (INTHERPOL) was developed by EDF in order to study the initiation of cracks. These tests are carried out on tubular specimens under various thermal loadings and surface finish qualities in order to give an account of these parameters on crack initiation. The main topic of this study is to test the sensitivity of different fatigue criteria to surface conditions using a micro/macro modelling approach. Therefore a 304L polycrystalline aggregate, used for cyclic plasticity based FE modelling, have been considered as a Representative Volume Element located at the surface and subsurface of the test tube. This aggregate has been cyclically strained according to the results issued from FE simulation of INTHERPOL thermal fatigue experiment. Different surface parameters have been numerically simulated: effects of local microstructure and of grains orientation, effects of machining: metallurgical prehardening, residual stress gradient, and surface roughness. Three different fatigue criteria (Manson Coffin, Fatemi Socie and dissipated energy types), previously fitted at a macro-scale for thermal fatigue of 304L, have been computed at a meso scale, in order to show the surface 'hot spots' features and test the sensitivity of these three criteria to different surface conditions. Results show that grain orientation and neighbouring play an important role on the location of hot spots, and also that the positive effect of pre-straining and the negative effect of roughness on fatigue life are not all similarly predicted by these different fatigue criteria. (authors)

Numerical discrepancy between serial and MPI parallel computations

Directory of Open Access Journals (Sweden)

Sang Bong Lee

2016-09-01

Full Text Available Numerical simulations of 1D Burgers equation and 2D sloshing problem were carried out to study numerical discrepancy between serial and parallel computations. The numerical domain was decomposed into 2 and 4 subdomains for parallel computations with message passing interface. The numerical solution of Burgers equation disclosed that fully explicit boundary conditions used on subdomains of parallel computation was responsible for the numerical discrepancy of transient solution between serial and parallel computations. Two dimensional sloshing problems in a rectangular domain were solved using OpenFOAM. After a lapse of initial transient time sloshing patterns of water were significantly different in serial and parallel computations although the same numerical conditions were given. Based on the histograms of pressure measured at two points near the wall the statistical characteristics of numerical solution was not affected by the number of subdomains as much as the transient solution was dependent on the number of subdomains.

Numerical simulation of hydrodynamics in a pump-turbine at off-design operating conditions in turbine mode

International Nuclear Information System (INIS)

Yan, J P; Seidel, U; Koutnik, J

2012-01-01

The hydrodynamics of a reduced-scaled model of a radial pump-turbine is investigated under off-design operating conditions, involving runaway and 'S-shape' turbine brake curve at low positive discharge. It is a low specific speed pump-turbine machine of Francis type with 9 impeller blades and 20 stay vanes as well as 20 guide vanes. The computational domain includes the entire water passage from the spiral casing inlet to the draft tube outlet. Completely structured hexahedral meshes generated by the commercial software ANSYS-ICEM are employed. The unsteady incompressible simulations are performed using the commercial code ANSYS-CFX13. For turbulence modeling the standard k-ε model is applied. The numerical results at different operating points are compared to the experimental results. The predicted pressure amplitude is in good agreement with the experimental data and the amplitude of normal force on impeller is in reasonable range. The detailed analysis reveals the onset of the flow instabilities when the machine is brought from a regular operating condition to runaway and turbine break mode. Furthermore, the rotating stall phenomena are well captured at runaway condition as well as low discharge operating condition with one stall cell rotating inside and around the impeller with about 70% of its frequency. Moreover, the rotating stall is found to be the effect of rotating flow separations developed in several consecutive impeller channels which lead to their blockage. The reliable simulation of S-curve characteristics in pump-turbines is a basic requirement for design and optimization at off-design operating conditions.

Numerical tool development of fluid-structure interactions for investigation of obstructive sleep apnea

Science.gov (United States)

Huang, Chien-Jung; White, Susan; Huang, Shao-Ching; Mallya, Sanjay; Eldredge, Jeff

2016-11-01

Obstructive sleep apnea (OSA) is a medical condition characterized by repetitive partial or complete occlusion of the airway during sleep. The soft tissues in the upper airway of OSA patients are prone to collapse under the low pressure loads incurred during breathing. The ultimate goal of this research is the development of a versatile numerical tool for simulation of air-tissue interactions in the patient specific upper airway geometry. This tool is expected to capture several phenomena, including flow-induced vibration (snoring) and large deformations during airway collapse of the complex airway geometry in respiratory flow conditions. Here, we present our ongoing progress toward this goal. To avoid mesh regeneration, for flow model, a sharp-interface embedded boundary method is used on Cartesian grids for resolving the fluid-structure interface, while for the structural model, a cut-cell finite element method is used. Also, to properly resolve large displacements, non-linear elasticity model is used. The fluid and structure solvers are connected with the strongly coupled iterative algorithm. The parallel computation is achieved with the numerical library PETSc. Some two- and three- dimensional preliminary results are shown to demonstrate the ability of this tool.

Numerical doubly-periodic solution of the (2+1)-dimensional Boussinesq equation with initial conditions by the variational iteration method

International Nuclear Information System (INIS)

Inc, Mustafa

2007-01-01

In this Letter, a scheme is developed to study numerical doubly-periodic solutions of the (2+1)-dimensional Boussinesq equation with initial condition by the variational iteration method. As a result, the approximate and exact doubly-periodic solutions are obtained. For different modulus m, comparison between the approximate solution and the exact solution is made graphically, revealing that the variational iteration method is a powerful and effective tool to non-linear problems

Dioxins from medical waste incineration: Normal operation and transient conditions.

Science.gov (United States)

Chen, Tong; Zhan, Ming-xiu; Yan, Mi; Fu, Jian-ying; Lu, Sheng-yong; Li, Xiao-dong; Yan, Jian-hua; Buekens, Alfons

2015-07-01

Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) are key pollutants in waste incineration. At present, incinerator managers and official supervisors focus only on emissions evolving during steady-state operation. Yet, these emissions may considerably be raised during periods of poor combustion, plant shutdown, and especially when starting-up from cold. Until now there were no data on transient emissions from medical (or hospital) waste incineration (MWI). However, MWI is reputed to engender higher emissions than those from municipal solid waste incineration (MSWI). The emission levels in this study recorded for shutdown and start-up, however, were significantly higher: 483 ± 184 ng Nm(-3) (1.47 ± 0.17 ng I-TEQ Nm(-3)) for shutdown and 735 ng Nm(-3) (7.73 ng I-TEQ Nm(-3)) for start-up conditions, respectively. Thus, the average (I-TEQ) concentration during shutdown is 2.6 (3.8) times higher than the average concentration during normal operation, and the average (I-TEQ) concentration during start-up is 4.0 (almost 20) times higher. So monitoring should cover the entire incineration cycle, including start-up, operation and shutdown, rather than optimised operation only. This suggestion is important for medical waste incinerators, as these facilities frequently start up and shut down, because of their small size, or of lacking waste supply. Forthcoming operation should shift towards much longer operating cycles, i.e., a single weekly start-up and shutdown. © The Author(s) 2015.

Issues of medical necessity: a medical director's guide to good faith adjudication.

Science.gov (United States)

Quinn, C

1997-06-01

The term medical necessity is difficult to define, a problem for insurers who need to clearly describe what is and is not covered in their contracts with subscribers. An unclear, vague definition of medical necessity leaves insurers vulnerable to litigation by subscribers denied care deemed medically unnecessary. To avoid lawsuits, insurers must make every effort to educate their subscribers about their medical coverage, going beyond merely providing a lengthy subscriber handbook. In decisions on medical necessity, medical directors at insurance companies play a key role. They can bolster the insurer's position in denial-of-care cases in numerous ways, including keeping meticulous records, eliminating unreasonable financial incentives, maintaining a claims denial database, and consulting with other insurers to achieve a consensus on medical necessity.

MedMinify: An Advice-giving System for Simplifying the Schedules of Daily Home Medication Regimens Used to Treat Chronic Conditions.

Science.gov (United States)

Flynn, Allen J; Klasnja, Predrag; Friedman, Charles P

2014-01-01

For those with high blood pressure, diabetes, or high cholesterol, adherence to a home medication regimen is important for health. Reductions in the number of daily medication-taking events or daily pill burden improve adherence. A novel advice-giving computer application was developed using the SMART platform to generate advice on how to potentially simplify home medication regimens. MedMinify generated advice for 41.3% of 1,500 home medication regimens for adults age 60 years and older with chronic medical conditions. If the advice given by MedMinify were implemented, 320 regimen changes would have reduced daily medication-taking events while an additional 295 changes would have decreased the daily pill burden. The application identified four serious drug-drug interactions and so advised against taking two pairs of medications simultaneously. MedMinify can give advice to change home medication regimens that could result in simpler home medication-taking schedules.

Empathetic attitudes of undergraduate paramedic and nursing students towards four medical conditions: a three-year longitudinal study.

Science.gov (United States)

Williams, Brett; Boyle, Malcolm; Fielder, Chris

2015-02-01

In the healthcare context empathy is the cognitive ability to understand a patient's perspectives and experiences and to convey that understanding back to the patient. Some medical conditions are frequently stigmatised or otherwise detrimentally stereotyped with patients often describing healthcare practitioners as intolerant, prejudiced and discriminatory. The purpose of this study was to find how a group of paramedic students and nursing/paramedic double-degree students regard these types of patients and to note any changes that may occur as those students continued through their education. The 11-questions, 6-point Likert scale version of the Medical Condition Regard Scale was used in this prospective cross-sectional longitudinal study. This study included paramedic students enrolled in first, second, third and fourth year of an undergraduate paramedic or paramedic/nursing program from Monash University. A total of 554 students participated. Statistically significant differences were found between double-degree and single-degree students (pintellectual disability and attempted suicide. No statistically significant results were found for acute mental illness. This study has demonstrated significant differences in empathy between paramedic and nursing/paramedic double-degree students in regard to patients with these complex medical conditions. Paramedic/nursing students generally showed a positive change in empathy towards these complex patients by their third year of study; however, they also showed some alarming drops in empathy between second and third year. Copyright © 2014 Elsevier Ltd. All rights reserved.

Care coordination, medical complexity, and unmet need for prescription medications among children with special health care needs.

Science.gov (United States)

Aboneh, Ephrem A; Chui, Michelle A

Children with special health care needs (CSHCN) have multiple unmet health care needs including that of prescription medications. The objectives of this study were twofold: 1) to quantify and compare unmet needs for prescription medications for subgroups of CSHCN without and with medical complexity (CMC)-those who have multiple, chronic, and complex medical conditions associated with severe functional limitations and high utilization of health care resources, and 2) to describe its association with receipt of effective care coordination services and level of medical complexity. A secondary data analysis of the 2009/2010 National Survey of CSHCN, a nationally representative telephone survey of parents of CSHCN, was conducted. Logistic regression models were constructed to determine associations between unmet need for prescription medications and medical complexity and care coordination for families of CSHCN, while controlling for demographic variables such as race, insurance, education level, and household income. Analyses accounted for the complex survey design and sampling weights. CMC represented about 3% of CSHCN. CMC parents reported significantly more unmet need for prescription medications and care coordination (4%, 68%), compared to Non-CMC parents (2%, 40%). Greater unmet need for prescription medications was associated with unmet care coordination (adjusted OR 3.81; 95% CI: 2.70-5.40) and greater medical complexity (adjusted OR 2.01; 95% CI: 1.00-4.03). Traditional care coordination is primarily facilitated by nurses and nurse practitioners with little formal training in medication management. However, pharmacists are rarely part of the CSHCN care coordination model. As care delivery models for these children evolve, and given the complexity of and numerous transitions of care for these patients, pharmacists can play an integral role to improve unmet needs for prescription medications. Copyright © 2016 Elsevier Inc. All rights reserved.

Impaired driving from medical conditions: A 70-year-old man trying to decide if he should continue driving

Science.gov (United States)

Rizzo, Matthew

2012-01-01

Some medical disorders can impair performance, increasing the risk of driving safety errors that can lead to vehicle crashes. The causal pathway often involves a concatenation of factors or events, some of which can be prevented or controlled. Effective interventions can operate before, during, or after a crash occurs at the levels of driver capacity, vehicle and road design, and public policy. A variety of systemic, neurological, psychiatric, and developmental disorders put drivers at potential increased risk of a car crash in the short or long term. Medical diagnosis and age alone are usually insufficient criteria for determining fitness to drive. Strategies are needed for determining what types and levels of reduced function provide a threshold for disqualification in drivers with medical disorders. Evidence of decreased mileage, self-restriction to driving in certain situations, collisions, moving violations, aggressive driving, sleepiness, alcohol abuse, metabolic disorders, and multiple medications may trigger considerations of driver safety. A general framework for evaluating driver fitness relies on a functional evaluation of multiple domains (cognitive, motor, perceptual, and psychiatric) that are important for safe driving and can be applied across many disorders, including conditions that have rarely been studied with respect to driving, and in patients with multiple conditions and medications. Neurocognitive tests, driving simulation, and road tests provide complementary sources of evidence to evaluate driver safety. No single test is sufficient to determine who should drive and who should not. PMID:21364126

Impaired driving from medical conditions: a 70-year-old man trying to decide if he should continue driving.

Science.gov (United States)

Rizzo, Matthew

2011-03-09

Some medical disorders can impair performance, increasing the risk of driving safety errors that can lead to vehicle crashes. The causal pathway often involves a concatenation of factors or events, some of which can be prevented or controlled. Effective interventions can operate before, during, or after a crash occurs at the levels of driver capacity, vehicle and road design, and public policy. A variety of systemic, neurological, psychiatric, and developmental disorders put drivers at potential increased risk of a car crash in the short or long term. Medical diagnosis and age alone are usually insufficient criteria for determining fitness to drive. Strategies are needed for determining what types and levels of reduced function provide a threshold for disqualification in drivers with medical disorders. Evidence of decreased mileage, self-restriction to driving in certain situations, collisions, moving violations, aggressive driving, sleepiness, alcohol abuse, metabolic disorders, and multiple medications may trigger considerations of driver safety. A general framework for evaluating driver fitness relies on a functional evaluation of multiple domains (cognitive, motor, perceptual, and psychiatric) that are important for safe driving and can be applied across many disorders, including conditions that have rarely been studied with respect to driving, and in patients with multiple conditions and medications. Neurocognitive tests, driving simulation, and road tests provide complementary sources of evidence to evaluate driver safety. No single test is sufficient to determine who should drive and who should not.

Integration of numerical analysis tools for automated numerical optimization of a transportation package design

International Nuclear Information System (INIS)

Witkowski, W.R.; Eldred, M.S.; Harding, D.C.

1994-01-01

The use of state-of-the-art numerical analysis tools to determine the optimal design of a radioactive material (RAM) transportation container is investigated. The design of a RAM package's components involves a complex coupling of structural, thermal, and radioactive shielding analyses. The final design must adhere to very strict design constraints. The current technique used by cask designers is uncoupled and involves designing each component separately with respect to its driving constraint. With the use of numerical optimization schemes, the complex couplings can be considered directly, and the performance of the integrated package can be maximized with respect to the analysis conditions. This can lead to more efficient package designs. Thermal and structural accident conditions are analyzed in the shape optimization of a simplified cask design. In this paper, details of the integration of numerical analysis tools, development of a process model, nonsmoothness difficulties with the optimization of the cask, and preliminary results are discussed

Academic and Family Conditions Associated with Intrinsic Academic Motivation in Japanese Medical Students: A Pilot Study

Science.gov (United States)

Tanaka, Masaaki; Watanabea, Yasuyoshi

2012-01-01

Objective: Intrinsic academic motivation is one of the most important psychological concepts in education, and it is related to academic outcomes in medical students. This study examined the relationships between academic and family conditions and intrinsic academic motivation. Design: Cross-sectional design. Setting: The study group consisted of…

Conditions and consequences of medical futility--from a literature review to a clinical model.

Science.gov (United States)

Löfmark, R; Nilstun, T

2002-04-01

To present an analysis of "futility" that is useful in the clinical setting. Literature review. According to Medline more than 750 articles have been published about medical futility. Three criteria (language, time period, and the authors expressed their own opinions) singled out 43 of them. The authors' opinions about futility were analysed using the scheme: "If certain conditions are satisfied, then a particular measure is futile" and "If a particular measure is futile, then certain moral consequences are implied". Regarding conditions, most authors stated that judgments about futility should be made by physicians. The measure was usually some kind of medical treatment, and the goals related to quality of life, physiological improvement, or prolongation of life. The probability of success in reaching the goal was in most cases described in semiquantitative terms. Regarding consequences, the authors stated that health care professionals may (sometimes ought or should) withhold or withdraw a futile measure, most often after a dialogue with the patient (29 articles), but sometimes without informing the patient (nine articles), or with one-way information (four articles). Over time more and more articles recommend that the patient should be involved in joint decision making. Based on this literature review a clinical model was developed. The model, requiring that conditions and consequences should be made explicit, may, in "futility situations", facilitate both the collection of the necessary information and make the moral implications visible. It also makes communication about measures considered to be futile possible without using such ambiguous terms as "futile".

Combined Racial and Gender Differences in the Long-Term Predictive Role of Education on Depressive Symptoms and Chronic Medical Conditions.

Science.gov (United States)

Assari, Shervin

2017-06-01

Despite a well-established literature on the protective effect of education on health, less is known about group differences in the mechanisms underlying this association. Using a life course approach and cumulative advantage theory, this study compared Black men, Black women, White men, and White women to assess the long-term gradient (education as a continuous measure) and threshold (>12 years) effects of baseline education on change in chronic medical conditions (CMC) and depressive symptoms (DS) from baseline to 25 years later. Data came from the Americans' Changing Lives Study, 1986-2011. The study followed Black and White respondents for up to 25 years, among whom 1271 individuals who had survived and were under follow-up were interviewed in 2011 and reported their number of chronic medical conditions and depressive symptoms (Center for Epidemiological Studies-Depression; CES-D 11). Multi-group structural equation modeling was used to compare gradient and threshold effects of education on change in chronic medical conditions and depressive symptoms from baseline (1986) to 25 years later (2011) among Black men, Black women, White men, and White women. There were group differences in the long-term association between education measured as a gradient and the change in depressive symptoms and chronic medical conditions during the follow-up, and in the association between education measured at the threshold of 12 years on change in depressive symptoms from baseline to follow-up. However, the association between education measured at this threshold and change in chronic medical conditions did not differ across race-gender groups. With the exception of Black men, who showed a gradient protective effect for baseline education against increase in the number of chronic medical associations (threshold or gradient) with change in chronic medical conditions. Among White men and White women, education had a threshold protective effect against increase in depressive

University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

Directory of Open Access Journals (Sweden)

Mokgobadibe V. Ntsiea

2017-06-01

Conclusion: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

Numerical Simulation of PAHs Formation and Effect of Operating Conditions in DI-Diesel Engines Based on a Comprehensive Chemical Mechanism

Directory of Open Access Journals (Sweden)

Bei-Jing Zhong

2013-01-01

Full Text Available Three-dimensional numerical simulations of polycyclic aromatic hydrocarbon (PAH formation in a Chaochai 6102bzl direct injection diesel engine are performed. n-Heptane is chosen as the fuel. A detailed mechanism, which includes 108 species and 572 elementary reactions that describe n-heptane oxidation and PAH formation, is proposed. A reduced kinetic mechanism, with only 86 reactions and 57 species, is developed and incorporated into computational fluid dynamics (CFD software for the numerical simulations. Results show that PAHs, which were mostly deposited at the bottom of the diesel combustion chamber wall, first increased and then decreased with the increase in diesel crank angle. Furthermore, the diesel engine operating conditions (intake vortex intensity, intake air pressure, fuel injection advance angle, diesel load, and engine speed had a significant effect on PAH formation.

Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

Science.gov (United States)

Gagnon, Marie-Pierre; Duplantie, Julie; Fortin, Jean-Paul; Landry, Réjean

2006-08-24

Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering

Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

Directory of Open Access Journals (Sweden)

Duplantie Julie

2006-08-01

Full Text Available Abstract Background Telehealth, as other information and communication technologies (ICTs introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. Methods A qualitative field study was conducted in four remote regions of Quebec (Canada to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. Results According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and

Coping and Depressive Symptoms in Adolescents with a Chronic Medical Condition: A Search for Intervention Targets

Science.gov (United States)

Kraaij, Vivian; Garnefski, Nadia

2012-01-01

The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for adolescents with a chronic medical condition. A wide range of coping techniques were studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 176 adolescents participated. They were…

Determination of the ejector dimensions of a bus air-conditioning system using analytical and numerical methods

International Nuclear Information System (INIS)

Ünal, Şaban

2015-01-01

Comfortable journey with commercial buses is an essential goal of transportation companies. An air-conditioning system can play an important role for this comfortable journey but it can put extra load on the engine and extra cost in the fuel consumption. The purpose of this work is to increase the performance of air-conditioning system of the buses by reducing the load on the engine and fuel consumption. Using a two-phase ejector as an expansion valve can increase the coefficient of performance (COP) of the air-conditioning system. An improvement in the COP can reduce the empty vehicle weight and fuel consumption of buses. Two-phase ejector dimensions can be determined using the empirical methods available in the literature. In this paper, the two-phase ejector dimensions of air conditioning system for a bus are calculated using the analytical and numerical methods. First of all, the thermodynamic analysis of the vapor-compression refrigeration cycle with a two-phase ejector is performed, and then the ejector dimensions are subsequently determined. The cooling loads of the midibus and bus with R134a as a refrigerant are assumed to be 14 kW and 32 kW, respectively. The total length of the two-phase ejector for the midibuses and buses due to these cooling loads, are computed to be 480.8 mm and 793.1 mm, respectively. Also, an experimental setup is installed on a midibus air conditioner to turn it into the ejector air conditioning system to validate theoretical results with the experimental study. - Highlights: • Determination of two-phase ejector dimensions of a bus air-conditioning system. • Thermodynamic analysis of the two-phase ejector cooling system. • Experimental study on a midibus air conditioner using two-phase ejector.

Numerical study of the inlet conditions on a turbulent plane two dimensional wall jet

Energy Technology Data Exchange (ETDEWEB)

Kechiche, Jamel; Mhiri, Hatem [Ecole Nationale d' Ingenieurs de Monastir, Lab. de Mecanique des Fluides et de Transferts Thermiques, Monastir (Tunisia); Le Palec, Georges; Bournot, Philippe [Institut de Mecanique de Marseille, Marseille, 13 (France)

2004-11-01

The low Reynolds number turbulence model of Herrero et al. [Int J Heat Mass Trans 34 (1991) 711] is used in this work to study turbulent isothermal or non-isothermal plane two dimensional wall jets in stagnant surroundings. In this model, the empirical constant C{sub {mu}} = 0.09 appearing in the Kolmogorov-Prandtl relation was replaced by the function proposed by Ljuboja and Rodi [J Fluids Eng 102 (1980) 350] to take account of the damping effect of the wall on the lateral fluctuations. The system of equations governing the studied configuration is solved with a finite difference scheme using a staggered grid for numerical stability, not uniform in the two directions of the flow. In the present work, we are interested particularly in the influence of the inlet conditions at the nozzle exit on the jet characteristic parameters. The obtained results show that the inlet conditions affect the flow in the vicinity of the region of the nozzle. Starting from a certain distance, the established region is reached (auto-similar region), and the results become independent of the flow characteristics at the nozzle exit. The results are also compared to those suggested in the literature. The agreement with the experimental data is satisfactory for all studied flow configurations, which provides validation of our results. (Author)

[Towards the problem of necessity to reduce the medical evacuation stages in conditions of local wars and armed conflicts].

Science.gov (United States)

Gaĭdar, B V; Ivantsov, V A; Sidel'nikov, V O; Rusev, I T; Madaĭ, D Iu; Kokoev, V G; Zinov'ev, E V; Mutalibov, M M

2004-06-01

The article is devoted to the review of modern opinions concerning the experience of military operation medical support in conditions of local wars and military conflicts. On the base of analysis of medical assistance rendered to the wounded and casualties in Republic of Chechnya the advantages and defects of different approaches are discussed. The experience in rendering assistance to the casualties in the Armed Forces of NATO countries during the local wars for the last decades is discussed. It is shown that the optimal variant of organization of treatment-and-evacuation measures during the local armed conflicts and wars is the two-stage scheme of evacuation: the first medical aid--the qualified (specialized) medical aid.

A randomised crossover trial of minimising medical terminology in secondary care correspondence in patients with chronic health conditions: impact on understanding and patient reported outcomes.

Science.gov (United States)

Wernick, M; Hale, P; Anticich, N; Busch, S; Merriman, L; King, B; Pegg, T

2016-05-01

There is little existing research on the role that secondary care letters have in ensuring patient understanding of chronic health conditions. To determine whether minimising the use of medical terminology in medical correspondence improved patient understanding and anxiety/depression scores. A single-centre, non-blinded, randomised crossover design assessed health literacy, EQ-5D scores and the impact of the 'translated' letter on the doctor's professionalism, the patient's relationship with their general practitioner (GP) and their perceived impact on chronic disease management. Patients were crossed over between their 'translated' and original letter. Sixty patients were recruited. Use of a 'translated' letter reduced mean terms not understood from 7.78 to 1.76 (t(58) = 4.706, P medical terminology in medical correspondence significantly improved patient understanding and perception of their ability to manage their chronic health condition. Although there was no impact on EQ-5D depression/anxiety scores, overwhelming patient preference for the 'translated' letter indicates a need for minimisation of medical terminology in medical correspondence for patients with chronic health conditions. © 2016 Royal Australasian College of Physicians.

The boundary condition at the valve for numerical modelling of transient pipe flow with fluid structure interaction

Science.gov (United States)

Henclik, S.

2014-08-01

Transient flows in pipes (water hammer = WH) do appear in various situations and the accompanying pressure waves may involve serious perturbations in system functioning. To model these effects properly in the case of elastic pipe the dynamic fluid-structure interaction (FSI) should be taken into account. Fluid-structure couplings appear in various manners and the junction coupling is considered to be the strongest. This effect can be especially significant if the pipe can move as a whole body, which is possible when all its supports are not rigid. In the current paper a similar effect is numerically modelled. The pipe is fixed rigidly, but the valve at the end has a spring-dashpot mounting system, thus its motion is possible when WH is excited by the valve closuring. The boundary condition at the moving valve is modelled as a differential equation of motion. The valve hydraulic characteristics during closuring period are assumed by a time dependence of its loss factor. Preliminary numerical tests of that algorithm were done with an own computer program and it was found that the proper valve fixing system may produce significant lowering of WH pressures.

Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning

Directory of Open Access Journals (Sweden)

Angelos P. Kassianos

2017-10-01

Full Text Available Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth applications (“apps” to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions.Method: Three platform descriptions (Apple, Google, and Microsoft were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis.Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor.Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to

Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning.

Science.gov (United States)

Kassianos, Angelos P; Georgiou, Giorgos; Papaconstantinou, Electra P; Detzortzi, Angeliki; Horne, Rob

2017-01-01

Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications ("apps") to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions. Method: Three platform descriptions (Apple, Google, and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis. Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor. Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non

Towards standard testbeds for numerical relativity

International Nuclear Information System (INIS)

Alcubierre, Miguel; Allen, Gabrielle; Bona, Carles; Fiske, David; Goodale, Tom; Guzman, F Siddhartha; Hawke, Ian; Hawley, Scott H; Husa, Sascha; Koppitz, Michael; Lechner, Christiane; Pollney, Denis; Rideout, David; Salgado, Marcelo; Schnetter, Erik; Seidel, Edward; Shinkai, Hisa-aki; Shoemaker, Deirdre; Szilagyi, Bela; Takahashi, Ryoji; Winicour, Jeff

2004-01-01

In recent years, many different numerical evolution schemes for Einstein's equations have been proposed to address stability and accuracy problems that have plagued the numerical relativity community for decades. Some of these approaches have been tested on different spacetimes, and conclusions have been drawn based on these tests. However, differences in results originate from many sources, including not only formulations of the equations, but also gauges, boundary conditions, numerical methods and so on. We propose to build up a suite of standardized testbeds for comparing approaches to the numerical evolution of Einstein's equations that are designed to both probe their strengths and weaknesses and to separate out different effects, and their causes, seen in the results. We discuss general design principles of suitable testbeds, and we present an initial round of simple tests with periodic boundary conditions. This is a pivotal first step towards building a suite of testbeds to serve the numerical relativists and researchers from related fields who wish to assess the capabilities of numerical relativity codes. We present some examples of how these tests can be quite effective in revealing various limitations of different approaches, and illustrating their differences. The tests are presently limited to vacuum spacetimes, can be run on modest computational resources and can be used with many different approaches used in the relativity community

Towards standard testbeds for numerical relativity

Energy Technology Data Exchange (ETDEWEB)

Alcubierre, Miguel [Inst. de Ciencias Nucleares, Univ. Nacional Autonoma de Mexico, Apartado Postal 70-543, Mexico Distrito Federal 04510 (Mexico); Allen, Gabrielle; Goodale, Tom; Guzman, F Siddhartha; Hawke, Ian; Husa, Sascha; Koppitz, Michael; Lechner, Christiane; Pollney, Denis; Rideout, David [Max-Planck-Inst. fuer Gravitationsphysik, Albert-Einstein-Institut, 14476 Golm (Germany); Bona, Carles [Departament de Fisica, Universitat de les Illes Balears, Ctra de Valldemossa km 7.5, 07122 Palma de Mallorca (Spain); Fiske, David [Dept. of Physics, Univ. of Maryland, College Park, MD 20742-4111 (United States); Hawley, Scott H [Center for Relativity, Univ. of Texas at Austin, Austin, Texas 78712 (United States); Salgado, Marcelo [Inst. de Ciencias Nucleares, Univ. Nacional Autonoma de Mexico, Apartado Postal 70-543, Mexico Distrito Federal 04510 (Mexico); Schnetter, Erik [Inst. fuer Astronomie und Astrophysik, Universitaet Tuebingen, 72076 Tuebingen (Germany); Seidel, Edward [Max-Planck-Inst. fuer Gravitationsphysik, Albert-Einstein-Inst., 14476 Golm (Germany); Shinkai, Hisa-aki [Computational Science Div., Inst. of Physical and Chemical Research (RIKEN), Hirosawa 2-1, Wako, Saitama 351-0198 (Japan); Shoemaker, Deirdre [Center for Radiophysics and Space Research, Cornell Univ., Ithaca, NY 14853 (United States); Szilagyi, Bela [Dept. of Physics and Astronomy, Univ. of Pittsburgh, Pittsburgh, PA 15260 (United States); Takahashi, Ryoji [Theoretical Astrophysics Center, Juliane Maries Vej 30, 2100 Copenhagen, (Denmark); Winicour, Jeff [Max-Planck-Inst. fuer Gravitationsphysik, Albert-Einstein-Institut, 14476 Golm (Germany)

2004-01-21

In recent years, many different numerical evolution schemes for Einstein's equations have been proposed to address stability and accuracy problems that have plagued the numerical relativity community for decades. Some of these approaches have been tested on different spacetimes, and conclusions have been drawn based on these tests. However, differences in results originate from many sources, including not only formulations of the equations, but also gauges, boundary conditions, numerical methods and so on. We propose to build up a suite of standardized testbeds for comparing approaches to the numerical evolution of Einstein's equations that are designed to both probe their strengths and weaknesses and to separate out different effects, and their causes, seen in the results. We discuss general design principles of suitable testbeds, and we present an initial round of simple tests with periodic boundary conditions. This is a pivotal first step towards building a suite of testbeds to serve the numerical relativists and researchers from related fields who wish to assess the capabilities of numerical relativity codes. We present some examples of how these tests can be quite effective in revealing various limitations of different approaches, and illustrating their differences. The tests are presently limited to vacuum spacetimes, can be run on modest computational resources and can be used with many different approaches used in the relativity community.

Psychiatric disorders and general medical conditions: implications ...

African Journals Online (AJOL)

African Journal of Psychiatry ... They are also at increased risk of contracting HIV. ... As medical practice becomes more specialized and arguably compartmentalized it may increasingly fail to integrate health care for patients with severe mental ...

Constipation - prevalence and incidence among medical patients acutely admitted to hospital with a medical condition

DEFF Research Database (Denmark)

Noiesen, Eline; Trosborg, Ingelise; Bager, Louise

2014-01-01

To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients.......To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients....

42 CFR 416.47 - Condition for coverage-Medical records.

Science.gov (United States)

2010-10-01

... accurate medical records to ensure adequate patient care. (a) Standard: Organization. The ASC must develop and maintain a system for the proper collection, storage, and use of patient records. (b) Standard...) Patient identification. (2) Significant medical history and results of physical examination. (3) Pre...

Numerical simulation of hypersonic flight experiment vehicle

OpenAIRE

Yamamoto, Yukimitsu; Yoshioka, Minako; 山本　行光; 吉岡　美菜子

1994-01-01

Hypersonic aerodynamic characteristics of Hypersonic FLight EXperiment (HYFLEX vehicle were investigated by numerical simulations using Navier-Stokes CFD (Computational Fluid Dynamics) code of NAL. Numerical results were compared with experimental data obtained at Hypersonic Wind Tunnel at NAL. In order to investigate real flight aerodynamic characteristics. numerical calculations corresponding to the flight conditions suffering from maximum aero thermodynamic heating were also made and the d...

Numerical Feedback Stabilization with Applications to Networks

Directory of Open Access Journals (Sweden)

Simone Göttlich

2017-01-01

Full Text Available The focus is on the numerical consideration of feedback boundary control problems for linear systems of conservation laws including source terms. We explain under which conditions the numerical discretization can be used to design feedback boundary values for network applications such as electric transmission lines or traffic flow systems. Several numerical examples illustrate the properties of the results for different types of networks.

Chronic medical conditions and mental health in older people : disability and psychosocial resources mediate specific mental health effects

NARCIS (Netherlands)

Ormel, J; Kempen, GIJM; Penninx, BWJH; Brilman, EI; Beekman, ATF; VanSonderen, E

Background. This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental

Monotone numerical methods for finite-state mean-field games

KAUST Repository

Gomes, Diogo A.; Saude, Joao

2017-01-01

Here, we develop numerical methods for finite-state mean-field games (MFGs) that satisfy a monotonicity condition. MFGs are determined by a system of differential equations with initial and terminal boundary conditions. These non-standard conditions are the main difficulty in the numerical approximation of solutions. Using the monotonicity condition, we build a flow that is a contraction and whose fixed points solve the MFG, both for stationary and time-dependent problems. We illustrate our methods in a MFG modeling the paradigm-shift problem.

Monotone numerical methods for finite-state mean-field games

KAUST Repository

Gomes, Diogo A.

2017-04-29

Here, we develop numerical methods for finite-state mean-field games (MFGs) that satisfy a monotonicity condition. MFGs are determined by a system of differential equations with initial and terminal boundary conditions. These non-standard conditions are the main difficulty in the numerical approximation of solutions. Using the monotonicity condition, we build a flow that is a contraction and whose fixed points solve the MFG, both for stationary and time-dependent problems. We illustrate our methods in a MFG modeling the paradigm-shift problem.

Optimization of working conditions of medical staff of isotopic diagnostic departments. Optimizatsiya uslovij truda meditsinskogo personala radiodiagnosticheskikh otdelenij

Energy Technology Data Exchange (ETDEWEB)

Ovsyannikov, A S [Akademiya Meditsinskikh Nauk SSSR, Moscow (USSR). Inst. Gigieny Truda i Professional' nykh Zabolevanij

1989-01-01

The study was undertaken to analyze the characteristics of the work of medical staff of isotopic diagnostic departments during use of {sup 99m}Tc isotope generators. The data on the functional load of physicians and paramedical staff were given along with the description of radiation doses and dose rates at various stages of work. The measures on optimization of labour conditions by means of the appropriate department's design, improvement of the regime of nurses' work and adequate allocation and utilization of medical equipment were developed.

Simulation of Intra-Aneurysmal Blood Flow by Different Numerical Methods

Directory of Open Access Journals (Sweden)

Frank Weichert

2013-01-01

Full Text Available The occlusional performance of sole endoluminal stenting of intracranial aneurysms is controversially discussed in the literature. Simulation of blood flow has been studied to shed light on possible causal attributions. The outcome, however, largely depends on the numerical method and various free parameters. The present study is therefore conducted to find ways to define parameters and efficiently explore the huge parameter space with finite element methods (FEMs and lattice Boltzmann methods (LBMs. The goal is to identify both the impact of different parameters on the results of computational fluid dynamics (CFD and their advantages and disadvantages. CFD is applied to assess flow and aneurysmal vorticity in 2D and 3D models. To assess and compare initial simulation results, simplified 2D and 3D models based on key features of real geometries and medical expert knowledge were used. A result obtained from this analysis indicates that a combined use of the different numerical methods, LBM for fast exploration and FEM for a more in-depth look, may result in a better understanding of blood flow and may also lead to more accurate information about factors that influence conditions for stenting of intracranial aneurysms.

Medical Services at an International Summer Camp Event Under Hot and Humid Conditions: Experiences From the 23rd World Scout Jamboree, Japan.

Science.gov (United States)

Watanabe, Takemasa; Mizutani, Keiji; Iwai, Toshiyasu; Nakashima, Hiroshi

2018-06-01

The 23rd World Scout Jamboree (WSJ) was a 10-day summer camp held in Japan in 2015 under hot and humid conditions. The attendees comprised 33,628 people from 155 countries and territories. The aim of this study was to examine the provision of medical services under such conditions and to identify preventive factors for major diseases among long-term campers. Data were obtained from WSJ medical center records and examined to clarify the effects of age, sex, and period on visit frequencies and rates. Medical records from 3215 patients were examined. Daytime temperatures were 31.5±3.2°C and relative humidity was 61±13% (mean±SD). The initial visit rates among scouts and adults were 72.2 and 77.2 per 1000 persons, respectively. No significant age difference was observed in the initial visit rate; however, it was significantly higher among female patients than male patients. Significant differences were also seen in the adjusted odds ratios by age, sex, and period for disease distributions of initial visit frequencies. In addition, a higher initial visit frequency for heat strain-related diseases was seen among the scouts. Initial visit frequencies for heatstroke and/or dehydration increased just after opening day and persisted until closing day. Our findings suggest the importance of taking effective countermeasures against heat strain, fatigue, and unsanitary conditions at the WSJ. Medical services staff should take attendees' age, sex, and period into consideration to prevent heat strain-related diseases during such camps under hot and humid conditions. Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

MIMS - MEDICAL INFORMATION MANAGEMENT SYSTEM

Science.gov (United States)

Frankowski, J. W.

1994-01-01

MIMS, Medical Information Management System is an interactive, general purpose information storage and retrieval system. It was first designed to be used in medical data management, and can be used to handle all aspects of data related to patient care. Other areas of application for MIMS include: managing occupational safety data in the public and private sectors; handling judicial information where speed and accuracy are high priorities; systemizing purchasing and procurement systems; and analyzing organizational cost structures. Because of its free format design, MIMS can offer immediate assistance where manipulation of large data bases is required. File structures, data categories, field lengths and formats, including alphabetic and/or numeric, are all user defined. The user can quickly and efficiently extract, display, and analyze the data. Three means of extracting data are provided: certain short items of information, such as social security numbers, can be used to uniquely identify each record for quick access; records can be selected which match conditions defined by the user; and specific categories of data can be selected. Data may be displayed and analyzed in several ways which include: generating tabular information assembled from comparison of all the records on the system; generating statistical information on numeric data such as means, standard deviations and standard errors; and displaying formatted listings of output data. The MIMS program is written in Microsoft FORTRAN-77. It was designed to operate on IBM Personal Computers and compatibles running under PC or MS DOS 2.00 or higher. MIMS was developed in 1987.

NUMERICAL ANALYSIS OF THE STRESS-STRAIN STATE OF A ROPE STRAND WITH LINEAR CONTACT UNDER TENSION AND TORSION LOADING CONDITIONS

Directory of Open Access Journals (Sweden)

Evgenij Kalentev

2017-06-01

Full Text Available The paper presents the results of a numerical analysis of the stress-strain state of a rope strand with linear contact under tension and torsion loading conditions. Calculations are done using the ANSYS software package. Different approaches to calculation of the stress-strain state of ropes are reviewed, and their advantages and deficiencies are considered. The analysis of the obtained results leads us to the conclusion that the proposed method can be used in engineering calculations.

Interactive effect between depression and chronic medical conditions on fall risk in community-dwelling elders.

Science.gov (United States)

Kao, Senyeong; Wang, Yun-Chang; Tzeng, Ya-Mei; Liang, Chang-Kuo; Lin, Fu-Gong

2012-09-01

It is well documented that fall risk among elderly people is associated with poor health and depression. In this study, we set out to examine the combined effects of medical condition and depression status on fall incidents among community-dwelling elderly people. A cross-sectional study was carried out to investigate the fall history of community-dwelling elders involving 360 participants. Those who had experienced at least two falls over the previous year, or one injurious fall, were defined as "fallers." The Geriatric Depression Scale-15 was used as a screening instrument for depression status. Based on a multivariate logistic regression and stratification analysis, depression was found to interact with various medical conditions on fall risk. In comparison with the non-depressive reference group, a six-fold fall risk was discernible among depressed elders with polypharmacy, while a five-fold risk was found among depressive elders using ancillary devices, along with a four-fold risk among depressive elders with diabetes or cardiovascular disease. Finally, arthritis was found to produce a nine-fold risk of falls among such populations. These findings suggest that greater emphasis should be placed on the integration of depression screening as an element of fall risk assessment in elderly people.

Numerical prediction of the natural frequency of an Oscillating Water Column operating under resonant conditions

Directory of Open Access Journals (Sweden)

Marco Torresi

2016-12-01

Full Text Available Among the different technologies developed in order to harness wave energy, the Oscillating Water Column devices are the most accredited for an actual diffusion. Recently, Boccotti has patented the REWEC1 (REsonant sea Wave Energy Converter solution 1, a submerged breakwater that performs an active coast protection, embedding an Oscillating Water Column device, which is capable of operating under resonant conditions with that sea state, which gives the highest yearly energy contribution. The REWEC1 dynamic behavior can be approximated by means of a mass-spring-damper system. According to this approximation, a criterion for evaluating the oscillating natural frequency of the REWEC1 has been derived. This criterion has been validated against both experimental results and computational fluid dynamics simulations, performed on a REWEC1 laboratory-scale model. The numerical simulations have shown a good agreement between measurements and predictions.

Predictive Analytics In Healthcare: Medications as a Predictor of Medical Complexity.

Science.gov (United States)

Higdon, Roger; Stewart, Elizabeth; Roach, Jared C; Dombrowski, Caroline; Stanberry, Larissa; Clifton, Holly; Kolker, Natali; van Belle, Gerald; Del Beccaro, Mark A; Kolker, Eugene

2013-12-01

Children with special healthcare needs (CSHCN) require health and related services that exceed those required by most hospitalized children. A small but growing and important subset of the CSHCN group includes medically complex children (MCCs). MCCs typically have comorbidities and disproportionately consume healthcare resources. To enable strategic planning for the needs of MCCs, simple screens to identify potential MCCs rapidly in a hospital setting are needed. We assessed whether the number of medications used and the class of those medications correlated with MCC status. Retrospective analysis of medication data from the inpatients at Seattle Children's Hospital found that the numbers of inpatient and outpatient medications significantly correlated with MCC status. Numerous variables based on counts of medications, use of individual medications, and use of combinations of medications were considered, resulting in a simple model based on three different counts of medications: outpatient and inpatient drug classes and individual inpatient drug names. The combined model was used to rank the patient population for medical complexity. As a result, simple, objective admission screens for predicting the complexity of patients based on the number and type of medications were implemented.

Marijuana: modern medical chimaera.

Science.gov (United States)

Lamarine, Roland J

2012-01-01

Marijuana has been used medically since antiquity. In recent years there has been a resurgence of interest in medical applications of various cannabis preparations. These drugs have been cited in the medical literature as potential secondary treatment agents for severe pain, muscle spasticity, anorexia, nausea, sleep disturbances, and numerous other uses. This article reviews the research literature related to medical applications of various forms of cannabis. Benefits related to medical use of cannabinoids are examined and a number of potential risks associated with cannabis use, both medical and recreational, are considered. There is a clearly identified need for further research to isolate significant benefits from the medical application of cannabinoids and to establish dosage levels, appropriate delivery mechanisms and formulations, and to determine what role, if any, cannabinoids might play in legitimate medical applications. It is also imperative to determine if reported dangers pose a significant health risks to users.

Determining risk factors for internalizing problem behavior: the Screening Instrument for Adolescents of Parents with Chronic Medical Condition

NARCIS (Netherlands)

Sieh, D.S.; Oort, F.J.; Visser-Meily, J.M.A.; Meijer, A.M.

2013-01-01

A large body of evidence suggests that the risk for adjustment difficulties in children of parents with a chronic medical condition (CMC) depend on a number of demographic, illness-related, child adaptational, and family characteristics. In particular, internalizing problems are common in children

Direct Time Domain Numerical Analysis of Transient Behavior of a VLFS during Unsteady External Loads in Wave Condition

Directory of Open Access Journals (Sweden)

Yong Cheng

2014-01-01

Full Text Available The transient response of the VLFS subjected to arbitrary external load is systematically investigated by a direct time domain modal expansion method, in which the BEM solutions based on time domain Kelvin sources are used for hydrodynamic forces. In the analysis, the time domain free-surface Green functions with sufficient accuracy are rapidly evaluated in finite water depth by the interpolation-tabulation method, and the boundary integral equation with a quarter VLFS model is established taking advantage of symmetry of flow field and structure. The validity of the present method is verified by comparing with the time histories of vertical displacements of the VLFS during a mass drop and airplane landing and takeoff in still water conditions, respectively. Then the developed numerical scheme is used in wave conditions to study the combined action taking into account the mass drop/airplane landing/takeoff loads as well as incident wave action. It is found that the elevation of structural waves due to mass drop load can be significantly changed near the impact region, while the vertical motion of runway in wave conditions is dominant as compared with that only generated by airplane.

Medical judgement analogue studies with applications to spaceflight crew medical officer.

Science.gov (United States)

McCarroll, Michele L; Ahmed, Rami A; Schwartz, Alan; Gothard, Michael David; Atkinson, Steven Scott; Hughes, Patrick; Brito, Jose Cepeda; Assad, Lori; Myers, Jerry; George, Richard L

2017-10-01

The National Aeronautics and Space Administration (NASA) developed plans for potential emergency conditions from the Exploration Medical Conditions List. In an effort to mitigate conditions on the Exploration Medical Conditions List, NASA implemented a crew medical officer (CMO) designation for eligible astronauts. This pilot study aims to add knowledge that could be used in the Integrated Medical Model. An analogue population was recruited for two categories: administrative physicians (AP) representing the physician CMOs and technical professionals (TP) representing the non-physician CMOs. Participants completed four medical simulations focused on abdominal pain: cholecystitis (CH) and renal colic (RC) and chest pain: cardiac ischaemia (STEMI; ST-segment elevation myocardial infarction) and pneumothorax (PX). The Medical Judgment Metric (MJM) was used to evaluate medical decision making. There were no significant differences between the AP and TP groups in age, gender, race, ethnicity, education and baseline heart rate. Significant differences were noted in MJM average rater scores in AP versus TP in CH: 13.0 (±2.25), 4.5 (±0.48), p=<0.001; RC: 12.3 (±2.66), 4.8 (±0.94); STEMI: 12.1 (±3.33), 4.9 (±0.56); and PX: 13.5 (±2.53), 5.3 (±1.01), respectively. There could be a positive effect on crew health risk by having a physician CMO. The MJM demonstrated the ability to quantify medical judgement between the two analogue groups of spaceflight CMOs. Future studies should incorporate the MJM in a larger analogue population study to assess the medical risk for spaceflight crewmembers.

Numerical simulation of a semi-indirect evaporative cooler

Energy Technology Data Exchange (ETDEWEB)

Martin, R. Herrero [Departamento de Ingenieria Termica y de Fluidos, Universidad Politecnica de Cartagena, C/Dr. Fleming, s/n (Campus Muralla), 30202 Cartagena, Murcia (Spain)

2009-11-15

This paper presents the experimental study and numerical simulation of a semi-indirect evaporative cooler (SIEC), which acts as an energy recovery device in air conditioning systems. The numerical simulation was conducted by applying the CFD software FLUENT implementing a UDF to model evaporation/condensation. The numerical model was validated by comparing the simulation results with experimental data. Experimental data and numerical results agree for the lower relative humidity series but not for higher relative humidity values. (author)

Numerical analysis of fractional MHD Maxwell fluid with the effects of convection heat transfer condition and viscous dissipation

Directory of Open Access Journals (Sweden)

Yu Bai

2017-12-01

Full Text Available This paper investigates the incompressible fractional MHD Maxwell fluid due to a power function accelerating plate with the first order slip, and the numerical analysis on the flow and heat transfer of fractional Maxwell fluid has been done. Moreover the deformation motion of fluid micelle is simply analyzed. Nonlinear velocity equation are formulated with multi-term time fractional derivatives in the boundary layer governing equations, and convective heat transfer boundary condition and viscous dissipation are both taken into consideration. A newly finite difference scheme with L1-algorithm of governing equations are constructed, whose convergence is confirmed by the comparison with analytical solution. Numerical solutions for velocity and temperature show the effects of pertinent parameters on flow and heat transfer of fractional Maxwell fluid. It reveals that the fractional derivative weakens the effects of motion and heat conduction. The larger the Nusselt number is, the greater the heat transfer capacity of fluid becomes, and the temperature gradient at the wall becomes more significantly. The lower Reynolds number enhances the viscosity of the fluid because it is the ratio of the viscous force and the inertia force, which resists the flow and heat transfer.

Numerical analysis of fractional MHD Maxwell fluid with the effects of convection heat transfer condition and viscous dissipation

Science.gov (United States)

Bai, Yu; Jiang, Yuehua; Liu, Fawang; Zhang, Yan

2017-12-01

This paper investigates the incompressible fractional MHD Maxwell fluid due to a power function accelerating plate with the first order slip, and the numerical analysis on the flow and heat transfer of fractional Maxwell fluid has been done. Moreover the deformation motion of fluid micelle is simply analyzed. Nonlinear velocity equation are formulated with multi-term time fractional derivatives in the boundary layer governing equations, and convective heat transfer boundary condition and viscous dissipation are both taken into consideration. A newly finite difference scheme with L1-algorithm of governing equations are constructed, whose convergence is confirmed by the comparison with analytical solution. Numerical solutions for velocity and temperature show the effects of pertinent parameters on flow and heat transfer of fractional Maxwell fluid. It reveals that the fractional derivative weakens the effects of motion and heat conduction. The larger the Nusselt number is, the greater the heat transfer capacity of fluid becomes, and the temperature gradient at the wall becomes more significantly. The lower Reynolds number enhances the viscosity of the fluid because it is the ratio of the viscous force and the inertia force, which resists the flow and heat transfer.

Numerical

Directory of Open Access Journals (Sweden)

M. Boumaza

2015-07-01

Full Text Available Transient convection heat transfer is of fundamental interest in many industrial and environmental situations, as well as in electronic devices and security of energy systems. Transient fluid flow problems are among the more difficult to analyze and yet are very often encountered in modern day technology. The main objective of this research project is to carry out a theoretical and numerical analysis of transient convective heat transfer in vertical flows, when the thermal field is due to different kinds of variation, in time and space of some boundary conditions, such as wall temperature or wall heat flux. This is achieved by the development of a mathematical model and its resolution by suitable numerical methods, as well as performing various sensitivity analyses. These objectives are achieved through a theoretical investigation of the effects of wall and fluid axial conduction, physical properties and heat capacity of the pipe wall on the transient downward mixed convection in a circular duct experiencing a sudden change in the applied heat flux on the outside surface of a central zone.

Numerical Verification Of Equilibrium Chemistry

International Nuclear Information System (INIS)

Piro, Markus; Lewis, Brent; Thompson, William T.; Simunovic, Srdjan; Besmann, Theodore M.

2010-01-01

A numerical tool is in an advanced state of development to compute the equilibrium compositions of phases and their proportions in multi-component systems of importance to the nuclear industry. The resulting software is being conceived for direct integration into large multi-physics fuel performance codes, particularly for providing boundary conditions in heat and mass transport modules. However, any numerical errors produced in equilibrium chemistry computations will be propagated in subsequent heat and mass transport calculations, thus falsely predicting nuclear fuel behaviour. The necessity for a reliable method to numerically verify chemical equilibrium computations is emphasized by the requirement to handle the very large number of elements necessary to capture the entire fission product inventory. A simple, reliable and comprehensive numerical verification method is presented which can be invoked by any equilibrium chemistry solver for quality assurance purposes.

Motivating medical students to learn teamwork skills.

Science.gov (United States)

Aarnio, Matti; Nieminen, Juha; Pyörälä, Eeva; Lindblom-Ylänne, Sari

2010-01-01

This study examined teaching teamwork skills to first-year medical students. Teamwork skills focused on verbal communication in PBL-tutorial sessions and in healthcare teams. The aim was to find out how to teach teamwork skills to first-year medical students and how to motivate them to learn these skills. Three consecutive classes of first-year medical students (N = 342) participated in teamwork skills module in the years 2006, 2007 and 2008. After the first year, the introduction to the topic was revised in order to be more motivating to medical students. After each module data were collected with a feedback questionnaire containing numerical and open questions. By analyzing the students' numerical answers and the content of students' open answers regarding the module, we examined how the revised introduction affected students' perceptions of the usefulness of the module. Medical students' feedback in the years 1 (n = 81), 2 (n = 99) and 3 (n = 95) showed that the students found the module in the second and third years significantly more useful than in the first year. These results support earlier findings that clearly stated clinical relevance motivates medical students. When introducing multidisciplinary subjects to medical students, it is important to think through the clinical relevance of the topic and how it is introduced to medical students.

A numerical investigation of electrohydrodynamic (EHD) effects on bubble deformation under pseudo-nucleate boiling conditions

International Nuclear Information System (INIS)

Zu, Y.Q.; Yan, Y.Y.

2009-01-01

In this article, the electrohydrodynamic (EHD) effects on nucleate boiling are studied by developing a numerical modelling of EHD effect on bubble deformation in pseudo-nucleate boiling conditions. The volume of fluid (VOF) method is employed to track the interface between the gas-liquid two phases; the user-defined code is written and added to the commercial software FLUENT to solve the electric field and the corresponding electric body force. On this basis, the model is applied to study the EHD effects on heat transfer and fluid flows. An initial air bubble surrounded by liquid CCl 4 and attached to a horizontal superheated wall under the action of electric field is studied. The results of the EHD effect on bubble shape evolution are compared with those of available experiments showing good agreement. The mechanism of EHD enhancement of heat transfer and the EHD induced phenomena including bubble elongation and detachment are analyzed in detail.

Artificial boundary conditions for the numerical simulation of unsteady acoustic waves

International Nuclear Information System (INIS)

Tsynkov, S.V.

2003-01-01

We construct non-local artificial boundary conditions (ABCs) for the numerical simulation of genuinely time-dependent acoustic waves that propagate from a compact source in an unbounded unobstructed space. The key property used for obtaining the ABCs is the presence of lacunae, i.e., sharp aft fronts of the waves, in wave-type solutions in odd-dimension spaces. This property can be considered a manifestation of the Huygens' principle. The ABCs are obtained directly for the discrete formulation of the problem. They truncate the original unbounded domain and guarantee the complete transparency of the new outer boundary for all the outgoing waves. A central feature of the proposed ABCs is that the extent of their temporal non-locality is fixed and limited, and it does not come at the expense of simplifying the original model. It is rather a natural consequence of the existence of lacunae, which is a fundamental property of the corresponding solutions. The proposed ABCs can be built for any consistent and stable finite-difference scheme. Their accuracy can always be made as high as that of the interior approximation, and it will not deteriorate even when integrating over long time intervals. Besides, the ABCs are most flexible from the standpoint of geometry and can handle irregular boundaries on regular grids with no fitting/adaptation needed and no accuracy loss induced. Finally, they allow for a wide range of model settings. In particular, not only one can analyze the simplest advective acoustics case with the uniform background flow, but also the case when the waves' source (or scatterer) is engaged in an accelerated motion

Numerical simulation of pore pressure changes in levee under flood conditions

Science.gov (United States)

Stanisz, Jacek; Borecka, Aleksandra; Pilecki, Zenon; Kaczmarczyk, Robert

2017-11-01

The article discusses the potential for using numerical simulation to assess the development of deformation and pore pressure changes in a levee as a result of the increase and decrease of the flood wave. The simulation made in FLAC 2D did not take into account the filter-erosion deformation associated with seepage in the levee. The simulations were carried out for a field experimental storage consisting of two combined levees, which was constructed with the help of homogeneous cohesive materials with different filtration coefficients. Calculated and measured pore pressure changes were analysed at 4 monitoring points. The water level was increased to 4 m in 96 hours and decreased in 120 hours. The characteristics of the calculated and measured pore pressure changes over time were similar. The maximum values of the calculated and measured pore pressure were almost identical. The only differences were the greater delay of the experimental levee response to changes in water level increase compared to the response of the numerical model. These differences were probably related to filtering-erosion effects during seepage in the levee.

Zdeněk Kopal: Numerical Analyst

Science.gov (United States)

Křížek, M.

2015-07-01

We give a brief overview of Zdeněk Kopal's life, his activities in the Czech Astronomical Society, his collaboration with Vladimír Vand, and his studies at Charles University, Cambridge, Harvard, and MIT. Then we survey Kopal's professional life. He published 26 monographs and 20 conference proceedings. We will concentrate on Kopal's extensive monograph Numerical Analysis (1955, 1961) that is widely accepted to be the first comprehensive textbook on numerical methods. It describes, for instance, methods for polynomial interpolation, numerical differentiation and integration, numerical solution of ordinary differential equations with initial or boundary conditions, and numerical solution of integral and integro-differential equations. Special emphasis will be laid on error analysis. Kopal himself applied numerical methods to celestial mechanics, in particular to the N-body problem. He also used Fourier analysis to investigate light curves of close binaries to discover their properties. This is, in fact, a problem from mathematical analysis.

Medication/Drug Allergy

Science.gov (United States)

... Training Home Conditions Medication/Drug Allergy Medication/Drug Allergy Make an Appointment Find a Doctor Ask a ... risk for adverse reactions to medications. Facts about Allergies The tendency to develop allergies may be inherited. ...

Survey of Preventable Disaster Deaths at Medical Institutions in Areas Affected by the Great East Japan Earthquake: Retrospective Survey of Medical Institutions in Miyagi Prefecture.

Science.gov (United States)

Yamanouchi, Satoshi; Sasaki, Hiroyuki; Kondo, Hisayoshi; Mase, Tomohiko; Otomo, Yasuhiro; Koido, Yuichi; Kushimoto, Shigeki

2017-10-01

Introduction In 2015, the authors reported the results of a preliminary investigation of preventable disaster deaths (PDDs) at medical institutions in areas affected by the Great East Japan Earthquake (2011). This initial survey considered only disaster base hospitals (DBHs) and hospitals that had experienced at least 20 patient deaths in Miyagi Prefecture (Japan); therefore, hospitals that experienced fewer than 20 patient deaths were not investigated. This was an additional study to the previous survey to better reflect PDD at hospitals across the entire prefecture. Of the 147 hospitals in Miyagi Prefecture, the 14 DBHs and 82 non-DBHs that agreed to participate were included in an on-site survey. A database was created based on the medical records of 1,243 patient deaths that occurred between March 11, 2011 and April 1, 2011, followed by determination of their status as PDDs. A total of 125 cases of PDD were identified among the patients surveyed. The rate of PDD was significantly higher at coastal hospitals than inland hospitals (17.3% versus 6.3%; Pdisaster deaths in non-DBHs were most numerous in facilities with few general beds, especially among patients hospitalized before the disaster in hospitals with fewer than 100 beds. Categorized by area, the most frequent causes of PDD were: insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters in coastal areas; and were delayed medical intervention and disrupted lifelines in inland areas. Categorized by hospital function, the most frequent causes were: delayed medical intervention, deteriorated environmental conditions in homes and emergency shelters, and insufficient medical resources at DBHs; while those at non-DBHs were disrupted lifelines, insufficient medical resources, delayed medical intervention, and lack of capacity for transport within the area. Preventable disaster death at medical institutions in areas

Temporal direct numerical simulation of transitional natural-convection boundary layer under conditions of considerable external turbulence effects

International Nuclear Information System (INIS)

Abramov, Alexey G; Smirnov, Evgueni M; Goryachev, Valery D

2014-01-01

Results of direct numerical simulations for time-developing air natural-convection boundary layer are presented. Computations have been performed assuming periodicity conditions in both the directions parallel to the vertical isothermal hot plate. The contribution is mainly focused on understanding of laminar–turbulent transition peculiarities in the case of perturbation action of external turbulence that is modeled by isotropic disturbances initially introduced into the computational domain. Special attention is paid to identification and analysis of evolving three-dimensional vortices that clearly manifest themselves through the whole stages of laminar–turbulent transition in the boundary layer. A comparison of computed profiles of mean velocity, mean temperature and fluctuation characteristics for turbulent regimes of convection with experimental data is performed as well. (paper)

A numerical performance assessment of a commercial cardiopulmonary by-pass blood heat exchanger.

Science.gov (United States)

Consolo, Filippo; Fiore, Gianfranco B; Pelosi, Alessandra; Reggiani, Stefano; Redaelli, Alberto

2015-06-01

We developed a numerical model, based on multi-physics computational fluid dynamics (CFD) simulations, to assist the design process of a plastic hollow-fiber bundle blood heat exchanger (BHE) integrated within the INSPIRE(TM), a blood oxygenator (OXY) for cardiopulmonary by-pass procedures, recently released by Sorin Group Italia. In a comparative study, we analyzed five different geometrical design solutions of the BHE module. Quantitative geometrical-dependent parameters providing a comprehensive evaluation of both the hemo- and thermo-dynamics performance of the device were extracted to identify the best-performing prototypical solution. A convenient design configuration was identified, characterized by (i) a uniform blood flow pattern within the fiber bundle, preventing blood flow shunting and the onset of stagnation/recirculation areas and/or high velocity pathways, (ii) an enhanced blood heating efficiency, and (iii) a reduced blood pressure drop. The selected design configuration was then prototyped and tested to experimentally characterize the device performance. Experimental results confirmed numerical predictions, proving the effectiveness of CFD modeling as a reliable tool for in silico identification of suitable working conditions of blood handling medical devices. Notably, the numerical approach limited the need for extensive prototyping, thus reducing the corresponding machinery costs and time-to-market. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Experimental and numerical study on single-phase flow characteristics of natural circulation system with heated narrow rectangular channel under rolling motion condition

International Nuclear Information System (INIS)

Yu, Shengzhi; Wang, Jianjun; Yan, Ming; Yan, Changqi; Cao, Xiaxin

2017-01-01

Highlights: • The phasic difference between flow rate and frictional pressure drop is negligible. • Effect mechanism of rolling motion on flow behaviors of NC is interpreted. • The startup model is proposed and verified. • Steady-state correlations are feasible to predict transient resistance. • The in-house code can simulate instantaneous flow behaviors of NC correctly. - Abstract: Effects of rolling motion on flow characteristics in a natural circulation system were investigated experimentally and numerically. The numerical results from validated code were mainly used to provide detailed information for the discussion and analysis of experimental results. The results indicate that under rolling motion condition, the phasic difference between flow rate and frictional pressure drop of narrow rectangular channel is negligible. Angular acceleration is the eigenvalue for the effects of rolling motion on flow rate under single-phase natural circulation condition. When angular acceleration is approximately equal, even though either the angle or the period of rolling motion is different, peak, trough and time-averaged values of flow rate are approximately equal. Under rolling motion and single-phase natural circulation conditions, the phenomenon that dimensionless time-averaged mass flow rate is smaller than that under steady state condition is controlled by the nonlinear relationship between mass flow rate and the resistance of loop. The factor also causes the result that the absolute difference of dimensionless flow rate between peak and steady state is smaller than that between trough and steady state. The startup model which is proposed in present paper can be used to predict the flow characteristics of single-phase natural circulation system at startup stage of rolling motion favorably. The self-developed code can simulate instantaneous flow characteristics of single-phase natural circulation system under rolling motion and steady state conditions

Do people with and without medical conditions respond similarly to the short health anxiety inventory? An assessment of differential item functioning using item response theory.

Science.gov (United States)

LeBouthillier, Daniel M; Thibodeau, Michel A; Alberts, Nicole M; Hadjistavropoulos, Heather D; Asmundson, Gordon J G

2015-04-01

Individuals with medical conditions are likely to have elevated health anxiety; however, research has not demonstrated how medical status impacts response patterns on health anxiety measures. Measurement bias can undermine the validity of a questionnaire by overestimating or underestimating scores in groups of individuals. We investigated whether the Short Health Anxiety Inventory (SHAI), a widely-used measure of health anxiety, exhibits medical condition-based bias on item and subscale levels, and whether the SHAI subscales adequately assess the health anxiety continuum. Data were from 963 individuals with diabetes, breast cancer, or multiple sclerosis, and 372 healthy individuals. Mantel-Haenszel tests and item characteristic curves were used to classify the severity of item-level differential item functioning in all three medical groups compared to the healthy group. Test characteristic curves were used to assess scale-level differential item functioning and whether the SHAI subscales adequately assess the health anxiety continuum. Nine out of 14 items exhibited differential item functioning. Two items exhibited differential item functioning in all medical groups compared to the healthy group. In both Thought Intrusion and Fear of Illness subscales, differential item functioning was associated with mildly deflated scores in medical groups with very high levels of the latent traits. Fear of Illness items poorly discriminated between individuals with low and very low levels of the latent trait. While individuals with medical conditions may respond differentially to some items, clinicians and researchers can confidently use the SHAI with a variety of medical populations without concern of significant bias. Copyright © 2015 Elsevier Inc. All rights reserved.

Experimental and Numerical Studies on Wave Breaking Characteristics over a Fringing Reef under Monochromatic Wave Conditions

Directory of Open Access Journals (Sweden)

Jong-In Lee

2014-01-01

Full Text Available Fringing reefs play an important role in protecting the coastal area by inducing wave breaking and wave energy dissipation. However, modeling of wave transformation and energy dissipation on this topography is still difficult due to the unique structure. In the present study, two-dimensional laboratory experiments were conducted to investigate the cross-shore variations of wave transformation, setup, and breaking phenomena over an idealized fringing reef with the 1/40 reef slope and to verify the Boussinesq model under monochromatic wave conditions. One-layer and two-layer model configurations of the Boussinesq model were used to figure out the model capability. Both models predicted well (r2>0.8 the cross-shore variation of the wave heights, crests, troughs, and setups when the nonlinearity is not too high (A0/h0<0.07 in this study. However, as the wave nonlinearity and steepness increase, the one-layer model showed problems in prediction and stability due to the error on the vertical profile of fluid velocity. The results in this study revealed that one-layer model is not suitable in the highly nonlinear wave condition over a fringing reef bathymetry. This data set can contribute to the numerical model verification.

Application of numerical modeling of selective NOx reduction by hydrocarbon under diesel transient conditions in consideration of hydrocarbon adsorption and desorption process

International Nuclear Information System (INIS)

Watanabe, Y.; Asano, A.; Banno, K.; Yokota, K.; Sugiura, M.

2001-01-01

A model of NO x selective reduction by hydrocarbon (HC) was developed, which takes into account the adsorption and desorption of HC. The model was applied for predicting the performance of a De-NO x catalytic reactor, working under transient conditions such as a legislative driving cycle. Diesel fuel was used as a supplemental reductant. The behavior of HC and NO x reactions and HC adsorption and desorption has been simulated successfully by our numerical approach under the transient conditions of the simulated Japanese 10-15 driving cycle. Our model is expected to optimize the design of selective diesel NO x reduction systems using a diesel fuel as a supplemental reductant

The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

Science.gov (United States)

Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G., Jr.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

Force-controlled absorption in a fully-nonlinear numerical wave tank

International Nuclear Information System (INIS)

Spinneken, Johannes; Christou, Marios; Swan, Chris

2014-01-01

An active control methodology for the absorption of water waves in a numerical wave tank is introduced. This methodology is based upon a force-feedback technique which has previously been shown to be very effective in physical wave tanks. Unlike other methods, an a-priori knowledge of the wave conditions in the tank is not required; the absorption controller being designed to automatically respond to a wide range of wave conditions. In comparison to numerical sponge layers, effective wave absorption is achieved on the boundary, thereby minimising the spatial extent of the numerical wave tank. In contrast to the imposition of radiation conditions, the scheme is inherently capable of absorbing irregular waves. Most importantly, simultaneous generation and absorption can be achieved. This is an important advance when considering inclusion of reflective bodies within the numerical wave tank. In designing the absorption controller, an infinite impulse response filter is adopted, thereby eliminating the problem of non-causality in the controller optimisation. Two alternative controllers are considered, both implemented in a fully-nonlinear wave tank based on a multiple-flux boundary element scheme. To simplify the problem under consideration, the present analysis is limited to water waves propagating in a two-dimensional domain. The paper presents an extensive numerical validation which demonstrates the success of the method for a wide range of wave conditions including regular, focused and random waves. The numerical investigation also highlights some of the limitations of the method, particularly in simultaneously generating and absorbing large amplitude or highly-nonlinear waves. The findings of the present numerical study are directly applicable to related fields where optimum absorption is sought; these include physical wavemaking, wave power absorption and a wide range of numerical wave tank schemes

Remote Ischemic Conditioning and Renal Protection.

Science.gov (United States)

Giannopoulos, Georgios; Vrachatis, Dimitrios A; Panagopoulou, Vasiliki; Vavuranakis, Manolis; Cleman, Michael W; Deftereos, Spyridon

2017-07-01

Over the course of the last 2 decades, the concept of remote ischemic conditioning (RIC) has attracted considerable research interest, because RIC, in most of its embodiments offers an inexpensive way of protecting tissues against ischemic damage inflicted by a number of medical conditions or procedures. Acute kidney injury (AKI) is a common side effect in the context of various medical procedures, and RIC has been suggested as a means of reducing its incidence. Outcomes regarding kidney function have been reported in numerous studies that evaluated the effects of RIC in a variety of settings (eg, cardiac surgery, interventions requiring intravenous administration of contrast media). Although several individual studies have implied a beneficial effect of RIC in preserving kidney function, 3 recently published randomized controlled trials evaluating more than 1000 patients each (Effect of Remote Ischemic Preconditioning in the Cardiac Surgery, Remote Ischaemic Preconditioning for Heart Surgery, and ERICCA) were negative. However, AKI or any other index of renal function was not a stand-alone primary end point in any of these trials. On the other hand, a range of meta-analyses (each including thousands of participants) have reported mixed results, with the most recent among them showing benefit from RIC, pinpointing at the same time a number of shortcomings in published studies, adversely affecting the quality of available data. The present review provides a critical appraisal of the current state of this field of research. It is the opinion of the authors of this review that there is a clear need for a common clinical trial framework for ischemic conditioning studies. If the current babel of definitions, procedures, outcomes, and goals persists, it is most likely that soon ischemic conditioning will be "yesterday's news" with no definitive conclusions having been reached in terms of its real clinical utility.

Elements of calculation of reactivity by numerical processing

International Nuclear Information System (INIS)

Hedde, J.

1968-01-01

In order to explore the new opportunities provided by numerical techniques, the author describes the theoretical optimal conditions of a calculation in real time of reactivity from counting samples produced by a nuclear reactor. These optimal conditions can be the better approached if a more complex processing is adopted. A compromise is to be searched between the desired precision and simplicity of the numerical processing hardware. An example is reported to assess result accuracy on a wide power evolution range with a structure of reduced complexity [fr

Medicalization of HIV and the African Response

African Journals Online (AJOL)

AJRH Managing Editor

disorder, and having it treated to improve the experience and quality of life of the affected individual, is a key benefit of medicalization. Numerous examples exist where medicalization of certain problems previously confined to socio- cultural circles has helped in finding solutions. For example, Alzheimer's, a previously ...

A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study

Science.gov (United States)

Damschroder, Laura J; Fetters, Michael D; Zikmund-Fisher, Brian J; Crabtree, Benjamin F; Hudson, Shawna V; Ruffin IV, Mack T; Fucinari, Juliana; Kang, Minji; Taichman, L Susan; Creswell, John W

2018-01-01

Background Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling. Objective The overall goal of the MiHealth, MiChoice project is to design and implement a theory-driven, Web-based tool that incorporates the US MEC (provider-level intervention) within the vehicle of a contraceptive decision tool for women with chronic medical conditions (patient-level intervention) in community-based primary care settings (practice-level intervention). This will be a 3-phase study that includes a predesign phase, a design phase, and a testing phase in a randomized controlled trial. This study protocol describes phase 1 and aim 1, which is to determine patient-, provider-, and practice-level factors that are relevant to the design and implementation of the contraceptive decision tool. Methods This is a mixed methods implementation study. To customize the delivery of the US MEC in the decision tool, we selected high-priority constructs from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to drive data collection and analysis at the practice and provider level, respectively. A conceptual model that incorporates constructs from the transtheoretical model and the health beliefs model undergirds patient-level data collection and analysis and will inform customization of the decision tool for this population. We will recruit 6 community-based primary care practices and conduct quantitative surveys and semistructured qualitative

Hopf Bifurcation of a Delayed Epidemic Model with Information Variable and Limited Medical Resources

Directory of Open Access Journals (Sweden)

Caijuan Yan

2014-01-01

Full Text Available We consider SIR epidemic model in which population growth is subject to logistic growth in absence of disease. We get the condition for Hopf bifurcation of a delayed epidemic model with information variable and limited medical resources. By analyzing the corresponding characteristic equations, the local stability of an endemic equilibrium and a disease-free equilibrium is discussed. If the basic reproduction ratio ℛ01, we obtain sufficient conditions under which the endemic equilibrium E* of system is locally asymptotically stable. And we also have discussed the stability and direction of Hopf bifurcations. Numerical simulations are carried out to explain the mathematical conclusions.

Determinants of self-medication with NSAIDs in a Portuguese community pharmacy

Directory of Open Access Journals (Sweden)

Nunes AP

2016-03-01

Full Text Available Background: Non-steroid anti-inflammatory drugs (NSAIDs are a widely used therapeutic group in the world, and particularly in the Portuguese population. Objective: To compare NSAID’s use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients’ safety. Methods: A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved. Results: A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%, actively employed (n=77; 59.2% and presenting a mean age of 49.5 years old (SD=20.49. An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%. Over 4/5 of patients (n=57; 87.7% acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7 had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%, regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%. One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects. Conclusion: Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident confirm the need for a more rational use of NSAIDs and ongoing

Review of determinants of national medical leadership development

NARCIS (Netherlands)

Keijser, Wouter Alexander; Poorthuis, Max Bastiaan; Tweedie, Judith; Wilderom, Celeste P.M.

2017-01-01

Increasingly, physician engagement in management, quality and innovation is being recognised as vital, requiring ’medical leadership’ (ML) competencies. Besides numerous local institutional efforts and despite the high level of autonomy of the medical profession and the education of its members, in

Evaluation of wave runup predictions from numerical and parametric models

Science.gov (United States)

Stockdon, Hilary F.; Thompson, David M.; Plant, Nathaniel G.; Long, Joseph W.

2014-01-01

Wave runup during storms is a primary driver of coastal evolution, including shoreline and dune erosion and barrier island overwash. Runup and its components, setup and swash, can be predicted from a parameterized model that was developed by comparing runup observations to offshore wave height, wave period, and local beach slope. Because observations during extreme storms are often unavailable, a numerical model is used to simulate the storm-driven runup to compare to the parameterized model and then develop an approach to improve the accuracy of the parameterization. Numerically simulated and parameterized runup were compared to observations to evaluate model accuracies. The analysis demonstrated that setup was accurately predicted by both the parameterized model and numerical simulations. Infragravity swash heights were most accurately predicted by the parameterized model. The numerical model suffered from bias and gain errors that depended on whether a one-dimensional or two-dimensional spatial domain was used. Nonetheless, all of the predictions were significantly correlated to the observations, implying that the systematic errors can be corrected. The numerical simulations did not resolve the incident-band swash motions, as expected, and the parameterized model performed best at predicting incident-band swash heights. An assimilated prediction using a weighted average of the parameterized model and the numerical simulations resulted in a reduction in prediction error variance. Finally, the numerical simulations were extended to include storm conditions that have not been previously observed. These results indicated that the parameterized predictions of setup may need modification for extreme conditions; numerical simulations can be used to extend the validity of the parameterized predictions of infragravity swash; and numerical simulations systematically underpredict incident swash, which is relatively unimportant under extreme conditions.

The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

Science.gov (United States)

Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

2009-01-01

The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

Root water extraction and limiting soil hydraulic conditions estimated by numerical simulation

NARCIS (Netherlands)

Jong van Lier, de Q.; Metselaar, K.; Dam, van J.C.

2006-01-01

Root density, soil hydraulic functions, and hydraulic head gradients play an important role in the determination of transpiration-rate-limiting soil water contents. We developed an implicit numerical root water extraction model to solve the Richards equation for the modeling of radial root water

A numerical investigation into the effect of windvent dampers on operating conditions

Energy Technology Data Exchange (ETDEWEB)

Hughes, Ben Richard; Abdul Ghani, S.A.A. [Faculty of Arts, Computing, Engineering and Sciences, Materials and Engineering Institute, Sheffield Hallam University, Sheffield, South Yorkshire S1 1WB (United Kingdom)

2009-02-15

The United Kingdom has made a commitment to reduce buildings carbon emissions, placing a greater onus on sustainable energy sources. Therefore, an anticipated increase of usage of zero carbon technologies in new and existing building has led to the emergence of passive ventilation devices as an alternative to mechanical ventilation and air conditioning. The windvent is a commercially available passive ventilation device. The device is constructed from sheet metal and works on the principle of pressure differential. Whereby air rises, creating a low pressure in the receiving room, which then draws in the fresh air. The ensuing air delivery velocity is controlled by the dampers, installed at the room entry interface. The dampers are actuator operated, and form the basis of the control system for the device. The purpose of this paper is to investigate the control mechanism for the device and ascertain an optimum operating range. Numerical analysis is carried out using a commercial computational fluid dynamics (CFD) code, to investigate the effect of various damper angles (range 0-90 ). The results show that optimum operating occurs at a damper angle range of 45-55 , at the UK average 4.5 m/s external wind speed. The operating range when considered in tandem with macro climatic influences is central to determining the overall control strategy for the fresh air supply. The results provide useful information for both engineers and architects when examining ways to reduce new and existing buildings running costs, and conform to new legislation. (author)

The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

Science.gov (United States)

Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

A Viewpoint on Medical Education in Iran

Directory of Open Access Journals (Sweden)

Mozafar Khazaei

2013-08-01

Full Text Available One of the unique characteristics of medical universities compared to other higher education centers in Iran is existence of medical education development centers. These centers have made an attempt to enhance the quality of medical education by regular and constant activity in various domains of educational planning and policymaking, and empowerment of the faculty members, students and personnel. Numerous studies published in Persian and English journals are one of the achievements of these centers. Also, several Persian and English scientific journals are being published by these centers among which the role of the few English languages journals of these centers is remarkably significant. Since these journals attract more audience, especially from abroad, it is necessary to pay special heed to the quality of their published articles. Avoiding the publication of such articles as “analysis of awareness and attitude” and turning to innovative intervention studies in medical education (1 have been highlighted by the authorities of medical education. During the past 30 years, the planners and medical sciences teachers have made to keep up with global developments in medicine. However, medical education in Iran has encountered numerous challenges, some of which have been referred to in the literature such as incompatibility of education with the real needs of the society, necessity of revising the syllabi and scientific resources, and weakness of clinical education (2, 3. One of the challenges highlighted in the recent years is the decreasing trend in medical students’ motivation and their academic failure. Various studies have investigated the factors affecting the students’ academic failure (4, 5, but few studies have analyzed the practical and scientific solutions to decrease and prevent it. Accepting undergraduate students in Iranian universities is state-based and the fact that universities have no role in the selection and acceptance

Dental Erosion and Medical Conditions: An Overview of Aetiology, Diagnosis and Management.

Science.gov (United States)

Paryag, A; Rafeek, R

2014-09-01

Tooth wear or tooth surface loss is a normal physiological process and occurs throughout life but is considered pathological when the degree of destruction is excessive or the rate of loss is rapid, causing functional, aesthetic or sensitivity problems. The importance of tooth wear as a dental problem has been increasingly recognized. The findings of a study in Trinidad indicate that the prevalence of tooth wear in a Trinidadian population is comparable to the United Kingdom (UK) and, indeed, that the level of moderate and severe wear is in fact nearly twice as high. The aetiology of tooth wear is attributed to four causes: erosion, attrition, abrasion and abfraction. Erosion is generally considered to be the most prevalent cause of tooth wear in the UK and Europe. Acids that cause dental erosion originate mainly from the diet or the stomach and to a lesser extent, the environment. Underlying medical problems can contribute to the progress of tooth wear due to erosion and the patient may not be aware of these conditions. Moderate to severe tooth wear poses a significant clinical challenge to dental practitioners and may result in treatment that is more complex and costly to the patient both in terms of finances and time spent in the dental chair. This paper provides an overview of aetiology and diagnosis of tooth wear, in particular tooth wear due to erosion, so that medical and dental practitioners may recognize tooth wear early, institute preventive measures and manage patients appropriately.

Catatonia in the medically ill: Etiology, diagnosis, and treatment. The Academy of Consultation-Liaison Psychiatry Evidence-Based Medicine Subcommittee Monograph.

Science.gov (United States)

Denysenko, Lex; Sica, Nicole; Penders, Thomas M; Philbrick, Kemuel L; Walker, Audrey; Shaffer, Scott; Zimbrean, Paula; Freudenreich, Oliver; Rex, Nicole; Carroll, Brendan T; Francis, Andrew

2018-05-01

Catatonia in medically ill patients is rare but often unrecognized. This monograph summarizes current knowledge on the diagnosis, epidemiology, etiology, and management of catatonia occurring in the medical setting. PubMed searches were used to identify relevant articles from 1962 to present. More than 3,000 articles were obtained and reviewed for relevance, including references of articles identified by the initial search. Several areas were identified as important, including: (1) catatonia and delirium; (2) malignant catatonia; (3) pediatric catatonia; (4) catatonia associated with another medical condition (CAMC); (5) drug exposure and withdrawal syndromes associated with catatonia; and (6) treatment of catatonia in the medical setting. Catatonia in the medically ill appears to have numerous etiologies, although etiology does not seem to modify the general treatment approach of prompt administration of lorazepam. Delirium and catatonia are commonly comorbid in the medical setting and should not be viewed as mutually exclusive. Electroconvulsive therapy should be offered to patients who do not respond to benzodiazepines or have malignant features. Removing offending agents and treating the underlying medical condition is paramount when treating CAMC. Memantine or amantadine may be helpful adjunctive agents. There is not enough evidence to support the use of antipsychotics or stimulants in treating CAMC.

AsMA Medical Guidelines for Air Travel: Fitness to Fly and Medical Clearances.

Science.gov (United States)

Thibeault, Claude; Evans, Anthony D; Dowdall, Nigel P

2015-07-01

Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Not everyone is fit to travel by air and physicians should advise their patients accordingly. They should review the passenger's medical condition, giving special consideration to the dosage and timing of any medications, contagiousness, and the need for special assistance during travel. In general, an individual with an unstable medical condition should not fly; cabin altitude, duration of exposure, and altitude of the destination airport are all considerations when recommending a passenger for flight.

Numerical simulation of fire vortex

Science.gov (United States)

Barannikova, D. D.; Borzykh, V. E.; Obukhov, A. G.

2018-05-01

The article considers the numerical simulation of the swirling flow of air around the smoothly heated vertical cylindrical domain in the conditions of gravity and Coriolis forces action. The solutions of the complete system of Navie-Stocks equations are numerically solved at constant viscosity and heat conductivity factors. Along with the proposed initial and boundary conditions, these solutions describe the complex non-stationary 3D flows of viscous compressible heat conducting gas. For various instants of time of the initial flow formation stage using the explicit finite-difference scheme the calculations of all gas dynamics parameters, that is density, temperature, pressure and three velocity components of gas particles, have been run. The current instant lines corresponding to the trajectories of the particles movement in the emerging flow have been constructed. A negative direction of the air flow swirling occurred in the vertical cylindrical domain heating has been defined.

The Mathematics of Medical Imaging in the Classroom.

Science.gov (United States)

Funkhouser, Charles P.; Jafari, Farhad; Eubank, William B.

2002-01-01

Presents an integrated exposition of aspects of secondary school mathematics and a medical science specialty. Reviews clinical medical practice and theoretical and empirical literature in mathematics education and radiology to develop and pilot model integrative classroom topics and activities. Suggests mathematical applications in numeration and…

Experiments and numerical modeling of fast flowing liquid metal thin films under spatially varying magnetic field conditions

Science.gov (United States)

Narula, Manmeet Singh

Innovative concepts using fast flowing thin films of liquid metals (like lithium) have been proposed for the protection of the divertor surface in magnetic fusion devices. However, concerns exist about the possibility of establishing the required flow of liquid metal thin films because of the presence of strong magnetic fields which can cause flow disrupting MHD effects. A plan is underway to design liquid lithium based divertor protection concepts for NSTX, a small spherical torus experiment at Princeton. Of these, a promising concept is the use of modularized fast flowing liquid lithium film zones, as the divertor (called the NSTX liquid surface module concept or NSTX LSM). The dynamic response of the liquid metal film flow in a spatially varying magnetic field configuration is still unknown and it is suspected that some unpredicted effects might be lurking. The primary goal of the research work being reported in this dissertation is to provide qualitative and quantitative information on the liquid metal film flow dynamics under spatially varying magnetic field conditions, typical of the divertor region of a magnetic fusion device. The liquid metal film flow dynamics have been studied through a synergic experimental and numerical modeling effort. The Magneto Thermofluid Omnibus Research (MTOR) facility at UCLA has been used to design several experiments to study the MHD interaction of liquid gallium films under a scaled NSTX outboard divertor magnetic field environment. A 3D multi-material, free surface MHD modeling capability is under development in collaboration with HyPerComp Inc., an SBIR vendor. This numerical code called HIMAG provides a unique capability to model the equations of incompressible MHD with a free surface. Some parts of this modeling capability have been developed in this research work, in the form of subroutines for HIMAG. Extensive code debugging and benchmarking exercise has also been carried out. Finally, HIMAG has been used to study the

Comparison of numerical simulations to experiments for atomization in a jet nebulizer.

Science.gov (United States)

Lelong, Nicolas; Vecellio, Laurent; Sommer de Gélicourt, Yann; Tanguy, Christian; Diot, Patrice; Junqua-Moullet, Alexandra

2013-01-01

The development of jet nebulizers for medical purposes is an important challenge of aerosol therapy. The performance of a nebulizer is characterized by its output rate of droplets with a diameter under 5 µm. However the optimization of this parameter through experiments has reached a plateau. The purpose of this study is to design a numerical model simulating the nebulization process and to compare it with experimental data. Such a model could provide a better understanding of the atomization process and the parameters influencing the nebulizer output. A model based on the Updraft nebulizer (Hudson) was designed with ANSYS Workbench. Boundary conditions were set with experimental data then transient 3D calculations were run on a 4 µm mesh with ANSYS Fluent. Two air flow rate (2 L/min and 8 L/min, limits of the operating range) were considered to account for different turbulence regimes. Numerical and experimental results were compared according to phenomenology and droplet size. The behavior of the liquid was compared to images acquired through shadowgraphy with a CCD Camera. Three experimental methods, laser diffractometry, phase Doppler anemometry (PDA) and shadowgraphy were used to characterize the droplet size distributions. Camera images showed similar patterns as numerical results. Droplet sizes obtained numerically are overestimated in relation to PDA and diffractometry, which only consider spherical droplets. However, at both flow rates, size distributions extracted from numerical image processing were similar to distributions obtained from shadowgraphy image processing. The simulation then provides a good understanding and prediction of the phenomena involved in the fragmentation of droplets over 10 µm. The laws of dynamics apply to droplets down to 1 µm, so we can assume the continuity of the distribution and extrapolate the results for droplets between 1 and 10 µm. So, this model could help predicting nebulizer output with defined geometrical and

Comparison of numerical simulations to experiments for atomization in a jet nebulizer.

Directory of Open Access Journals (Sweden)

Nicolas Lelong

Full Text Available The development of jet nebulizers for medical purposes is an important challenge of aerosol therapy. The performance of a nebulizer is characterized by its output rate of droplets with a diameter under 5 µm. However the optimization of this parameter through experiments has reached a plateau. The purpose of this study is to design a numerical model simulating the nebulization process and to compare it with experimental data. Such a model could provide a better understanding of the atomization process and the parameters influencing the nebulizer output. A model based on the Updraft nebulizer (Hudson was designed with ANSYS Workbench. Boundary conditions were set with experimental data then transient 3D calculations were run on a 4 µm mesh with ANSYS Fluent. Two air flow rate (2 L/min and 8 L/min, limits of the operating range were considered to account for different turbulence regimes. Numerical and experimental results were compared according to phenomenology and droplet size. The behavior of the liquid was compared to images acquired through shadowgraphy with a CCD Camera. Three experimental methods, laser diffractometry, phase Doppler anemometry (PDA and shadowgraphy were used to characterize the droplet size distributions. Camera images showed similar patterns as numerical results. Droplet sizes obtained numerically are overestimated in relation to PDA and diffractometry, which only consider spherical droplets. However, at both flow rates, size distributions extracted from numerical image processing were similar to distributions obtained from shadowgraphy image processing. The simulation then provides a good understanding and prediction of the phenomena involved in the fragmentation of droplets over 10 µm. The laws of dynamics apply to droplets down to 1 µm, so we can assume the continuity of the distribution and extrapolate the results for droplets between 1 and 10 µm. So, this model could help predicting nebulizer output with defined

Numerical Calculation of Transport Based on the Drift-Kinetic Equation for Plasmas in General Toroidal Magnetic Geometry: Numerical Methods

International Nuclear Information System (INIS)

Reynolds, J. M.; Lopez-Bruna, D.

2009-01-01

In this report we continue with the description of a newly developed numerical method to solve the drift kinetic equation for ions and electrons in toroidal plasmas. Several numerical aspects, already outlined in a previous report [Informes Tecnicos Ciemat 1165, mayo 2009], will be treated now in more detail. Aside from discussing the method in the context of other existing codes, various aspects will be now explained from the viewpoint of numerical methods: the way to solve convection equations, the adopted boundary conditions, the real-space meshing procedures along with a new software developed to build them, and some additional questions related with the parallelization and the numerical integration. (Author) 16 refs

Does medical education erode medical trainees' ethical attitude and behavior?

Science.gov (United States)

Yavari, Neda

2016-01-01

In the last few years, medical education policy makers have expressed concern about changes in the ethical attitude and behavior of medical trainees during the course of their education. They claim that newly graduated physicians (MDs) are entering residency years with inappropriate habits and attitudes earned during their education. This allegation has been supported by numerous research on the changes in the attitude and morality of medical trainees. The aim of this paper was to investigate ethical erosion among medical trainees as a serious universal problem, and to urge the authorities to take urgent preventive and corrective action. A comparison with the course of moral development in ordinary people from Kohlberg’s and Gilligan's points of view reveals that the growth of ethical attitudes and behaviors in medical students is stunted or even degraded in many medical schools. In the end, the article examines the feasibility of teaching ethics in medical schools and the best approach for this purpose. It concludes that there is considerable controversy among ethicists on whether teaching ethical virtues is plausible at all. Virtue-based ethics, principle-based ethics and ethics of care are approaches that have been considered as most applicable in this regard. PMID:28050246

Experimental-numerical study of heat flow in deep low-enthalpy geothermal conditions

NARCIS (Netherlands)

Saeid, S.; Al-Khoury, R.; Nick, H.M.; Barends, F.

2014-01-01

This paper presents an intensive experimental-numerical study of heat flow in a saturated porous domain. A temperature and a flow rate range compared to that existing in a typical deep low-enthalpy hydrothermal system is studied. Two main issues are examined: the effect of fluid density and

Numerical investigation of sixth order Boussinesq equation

Science.gov (United States)

Kolkovska, N.; Vucheva, V.

2017-10-01

We propose a family of conservative finite difference schemes for the Boussinesq equation with sixth order dispersion terms. The schemes are of second order of approximation. The method is conditionally stable with a mild restriction τ = O(h) on the step sizes. Numerical tests are performed for quadratic and cubic nonlinearities. The numerical experiments show second order of convergence of the discrete solution to the exact one.

Understanding the types of fraud in claims to South African medical schemes.

Science.gov (United States)

Legotlo, T G; Mutezo, A

2018-03-28

Medical schemes play a significant role in funding private healthcare in South Africa (SA). However, the sector is negatively affected by the high rate of fraudulent claims. To identify the types of fraudulent activities committed in SA medical scheme claims. A cross-sectional qualitative study was conducted, adopting a case study strategy. A sample of 15 employees was purposively selected from a single medical scheme administration company in SA. Semi-structured interviews were conducted to collect data from study participants. A thematic analysis of the data was done using ATLAS.ti software (ATLAS.ti Scientific Software Development, Germany). The study population comprised the 17 companies that administer medical schemes in SA. Data were collected from 15 study participants, who were selected from the medical scheme administrator chosen as a case study. The study found that medical schemes were defrauded in numerous ways. The perpetrators of this type of fraud include healthcare service providers, medical scheme members, employees, brokers and syndicates. Medical schemes are mostly defrauded by the submission of false claims by service providers and syndicates. Fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage. The study concluded that perpetrators of fraud have found several ways of defrauding SA medical schemes regarding claims. Understanding and identifying the types of fraud events facing medical schemes is the initial step towards establishing methods to mitigate this risk. Future studies should examine strategies to manage fraudulent medical scheme claims.

The Influence of Safety, Efficacy, and Medical Condition Severity on Natural versus Synthetic Drug Preference.

Science.gov (United States)

Meier, Brian P; Lappas, Courtney M

2016-11-01

Research indicates that there is a preference for natural v. synthetic products, but the influence of this preference on drug choice in the medical domain is largely unknown. We present 5 studies in which participants were asked to consider a hypothetical situation in which they had a medical issue requiring pharmacological therapy. Participants ( N = 1223) were asked to select a natural, plant-derived, or synthetic drug. In studies 1a and 1b, approximately 79% of participants selected the natural v. synthetic drug, even though the safety and efficacy of the drugs were identical. Furthermore, participants rated the natural drug as safer than the synthetic drug, and as that difference increased, the odds of choosing the natural over synthetic drug increased. In studies 2 and 3, approximately 20% of participants selected the natural drug even when they were informed that it was less safe (study 2) or less effective (study 3) than the synthetic drug. Finally, in study 4, approximately 65% of participants chose a natural over synthetic drug regardless of the severity of a specific medical condition (mild v. severe hypertension), and this choice was predicted by perceived safety and efficacy differences. Overall, these data indicate that there is a bias for natural over synthetic drugs. This bias could have implications for drug choice and usage. © The Author(s) 2015.

Numerical simulation of the effect of wind removing the corona space charge over grounded structures under thunderstorm conditions

DEFF Research Database (Denmark)

Vogel, Stephan; Lopez, Javier; Holbøll, Joachim

2015-01-01

agrounded object under thunderstorm conditions. The electric fieldcreated by the charge distribution in the thundercloud above theobject, which is in first place enhanced by its geometry, leadsto the generation and secondly upward propagation of chargefrom the object. Recent investigations underline......Different types of tall structures are severely exposed to lightning discharges, including power lines, communicationtowers, buildings and wind turbines all over the world. Thepresent paper focuses on the numerical modelling and simulationof the effect of wind on the electric field developed over...... quantifies thedifference between static towers and rotating wind turbines whichare influenced by different resultant wind velocities. The voltagedistribution and ion drift velocities in the vicinity of the groundedstructures are illustrated. The results show a higher voltagegradient at the side of the object...

Numerical modelling of structure and mechanical properties for medical tools

OpenAIRE

L. Jeziorski; J. Jasinski; M. Lubas; M. Szota; P. Lacki; B. Stodolnika

2007-01-01

Purpose: In order to design forceps and bowl cutter property, it is necessary to optimise many parameters and consider the functions, which these medical tools should fulfil. Of course, some simplifications are necessary in respect of calculation methodology. In the paper a solution procedure concerning this problem has been presented. The presented solution allows for precise determination of the geometrical dimensions according to the functional requirements that forceps should fulfil. The ...

A direct numerical simulation of cool-flame affected autoignition in diesel engine-relevant conditions

Energy Technology Data Exchange (ETDEWEB)

Krisman, Alexander; Hawkes, Evatt Robert.; Talei, Mohsen; Bhagatwala, Ankit; Chen, Jacqueline H.

2016-11-11

In diesel engines, combustion is initiated by a two-staged autoignition that includes both low- and high-temperature chemistry. The location and timing of both stages of autoignition are important parameters that influence the development and stabilisation of the flame. In this study, a two-dimensional direct numerical simulation (DNS) is conducted to provide a fully resolved description of ignition at diesel engine-relevant conditions. The DNS is performed at a pressure of 40 atmospheres and at an ambient temperature of 900 K using dimethyl ether (DME) as the fuel, with a 30 species reduced chemical mechanism. At these conditions, similar to diesel fuel, DME exhibits two-stage ignition. The focus of this study is on the behaviour of the low-temperature chemistry (LTC) and the way in which it influences the high-temperature ignition. The results show that the LTC develops as a “spotty” first-stage autoignition in lean regions which transitions to a diffusively supported cool-flame and then propagates up the local mixture fraction gradient towards richer regions. The cool-flame speed is much faster than can be attributed to spatial gradients in first-stage ignition delay time in homogeneous reactors. The cool-flame causes a shortening of the second-stage ignition delay times compared to a homogeneous reactor and the shortening becomes more pronounced at richer mixtures. Multiple high-temperature ignition kernels are observed over a range of rich mixtures that are much richer than the homogeneous most reactive mixture and most kernels form much earlier than suggested by the homogeneous ignition delay time of the corresponding local mixture. Altogether, the results suggest that LTC can strongly influence both the timing and location in composition space of the high-temperature ignition.

Medication Related Cutaneous Disorders in End Stage Renal ...

African Journals Online (AJOL)

TNHJOURNALPH

BACKGROUND. In End Stage Renal Disease (ESRD) patients, a wide range of cutaneous manifestations are present which may be due to the medications prescribed. Most patients' with ESRD are on numerous medications for their primary ailment, with transplant patients needing long term steroids and cytotoxics for ...

A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study.

Science.gov (United States)

Wu, Justine P; Damschroder, Laura J; Fetters, Michael D; Zikmund-Fisher, Brian J; Crabtree, Benjamin F; Hudson, Shawna V; Ruffin, Mack T; Fucinari, Juliana; Kang, Minji; Taichman, L Susan; Creswell, John W

2018-04-18

Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling. The overall goal of the MiHealth, MiChoice project is to design and implement a theory-driven, Web-based tool that incorporates the US MEC (provider-level intervention) within the vehicle of a contraceptive decision tool for women with chronic medical conditions (patient-level intervention) in community-based primary care settings (practice-level intervention). This will be a 3-phase study that includes a predesign phase, a design phase, and a testing phase in a randomized controlled trial. This study protocol describes phase 1 and aim 1, which is to determine patient-, provider-, and practice-level factors that are relevant to the design and implementation of the contraceptive decision tool. This is a mixed methods implementation study. To customize the delivery of the US MEC in the decision tool, we selected high-priority constructs from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to drive data collection and analysis at the practice and provider level, respectively. A conceptual model that incorporates constructs from the transtheoretical model and the health beliefs model undergirds patient-level data collection and analysis and will inform customization of the decision tool for this population. We will recruit 6 community-based primary care practices and conduct quantitative surveys and semistructured qualitative interviews with women who

Medical conditions among Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System

Science.gov (United States)

Carone, Marco; Al-Saedy, Huda; Nyce, Sayre; Ghosn, Jad; Mutuerandu, Timothy; Black, Robert E

2012-01-01

Abstract Objective To determine the range and burden of health services utilization among Iraqi refugees receiving health assistance in Jordan, a country of first asylum. Methods Medical conditions, diagnosed in accordance with the tenth revision of the International classification of diseases, were actively monitored from 1January to 31December 2010 using a pilot centralized database in Jordan called the Refugee Assistance Information System. Findings There were 27 166 medical visits by 7642 Iraqi refugees (mean age: 37.4 years; 49% male; 70% from Baghdad; 6% disabled; 3% with a history of torture). Chronic diseases were common, including essential hypertension (22% of refugees), visual disturbances (12%), joint disorders (11%) and type II diabetes mellitus (11%). The most common reasons for seeking acute care were upper respiratory tract infection (11%), supervision of normal pregnancy (4%) and urinary disorders (3%). The conditions requiring the highest number of visits per refugee were cerebrovascular disease (1.46 visits), senile cataract (1.46) and glaucoma (1.44). Sponsored care included 31 747 referrals or consultations to a specialty service, 18 432 drug dispensations, 2307 laboratory studies and 1090 X-rays. The specialties most commonly required were ophthalmology, dentistry, gynaecology and orthopaedic surgery. Conclusion Iraqi refugees in countries of first asylum and resettlement require targeted health services, health education and sustainable prevention and control strategies for predominantly chronic diseases. PMID:22690034

Medical conditions among Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System.

Science.gov (United States)

Mateen, Farrah J; Carone, Marco; Al-Saedy, Huda; Nyce, Sayre; Ghosn, Jad; Mutuerandu, Timothy; Black, Robert E

2012-06-01

To determine the range and burden of health services utilization among Iraqi refugees receiving health assistance in Jordan, a country of first asylum. Medical conditions, diagnosed in accordance with the tenth revision of the International classification of diseases, were actively monitored from 1 January to 31 December 2010 using a pilot centralized database in Jordan called the Refugee Assistance Information System. There were 27 166 medical visits by 7642 Iraqi refugees (mean age: 37.4 years; 49% male; 70% from Baghdad; 6% disabled; 3% with a history of torture). Chronic diseases were common, including essential hypertension (22% of refugees), visual disturbances (12%), joint disorders (11%) and type II diabetes mellitus (11%). The most common reasons for seeking acute care were upper respiratory tract infection (11%), supervision of normal pregnancy (4%) and urinary disorders (3%). The conditions requiring the highest number of visits per refugee were cerebrovascular disease (1.46 visits), senile cataract (1.46) and glaucoma (1.44). Sponsored care included 31 747 referrals or consultations to a specialty service, 18 432 drug dispensations, 2307 laboratory studies and 1090 X-rays. The specialties most commonly required were ophthalmology, dentistry, gynaecology and orthopaedic surgery. Iraqi refugees in countries of first asylum and resettlement require targeted health services, health education and sustainable prevention and control strategies for predominantly chronic diseases.

Asthma Medications and Pregnancy

Science.gov (United States)

... Asthma Associated Conditions Asthma & Pregnancy Asthma & Pregnancy: Medications Asthma & Pregnancy: Medications Make an Appointment Refer a Patient ... make sure you are using it correctly. Other Asthma Related Medication Treatment Annual influenza vaccine (flu shot) ...

American Academy of Asthma, Allergy & Immunology membership experience with venom immunotherapy in chronic medical conditions and pregnancy, and in young children.

Science.gov (United States)

Calabria, Christopher W; Hauswirth, David W; Rank, Matthew; Sher, Lawrence; Larenas-Linnemann, Desiree

2017-03-01

Few data exist regarding the use of venom immunotherapy (VIT) in specific high-risk chronic medical conditions and pregnancy, and in young children. A Web-based survey was sent to American Academy of Asthma Allergy & Immunology members to explore their VIT experience in potential high-risk medical conditions and pregnancy, and in young children. Major problems were defined as "activation of underlying disease and/or VIT not well tolerated (systemic adverse events) and/or VIT discontinued for medical reasons." Results were expressed descriptively. A total of 697 of 5123 surveys (14%) were completed: 87% of the respondents were based in the United States, and 28% worked in an academic setting. Most respondents (71%) believed that pregnancy was a contraindication for starting VIT. Most were comfortable continuing VIT (51%) if the woman became pregnant after starting therapy. Of the allergists who treated children, many would give VIT down to age 5 years (42%) or younger, ages 1-4 years (35%). The following list is of the specific medical condition, the number of allergists who used VIT in patients with this condition, and the percentage who reported major problems: severe asthma, 212 (4.2%); hypertension, 287 (1.1%); coronary artery disease, 222 (3.6%); arrhythmias, 136 (3.4%); cerebrovascular disease, 104 (5.1%); cancer in remission, 166 (0%); cancer stable but still under treatment, 44 (7.2%); a history of bone marrow transplantation, 15 (4.9%); a history of solid organ transplantation, 29 (3.6%); human immunodeficiency virus, 53 (1.4%); acquired immunodeficiency syndrome, 24 (6.2%); stable autoimmune disease, 164 (2.8%); mastocytosis, 66 (18.4%); elevated serum tryptase, 101 (10.8%); immunodeficiency 59 (2.5%). Many allergists were comfortable using VIT in young children and continuing but not starting pregnant women on VIT. VIT was commonly used in patients with hypertension, coronary artery disease, arrhythmias, cancer in remission, and stable autoimmune disease

Relationships between beliefs about medications and nonadherence to prescribed chronic medications.

Science.gov (United States)

Phatak, Hemant M; Thomas, Joseph

2006-10-01

Medication beliefs of patients with a specific medical condition have been associated with nonadherence to drugs used to treat that condition. However, associations between medication beliefs and nonadherence of individuals on chronic, multiple medications have not been studied. To investigate associations between patients' medication beliefs and nonadherence to chronic drug therapy. A cross-sectional, self-administered survey of patients waiting to see pharmacists at an outpatient pharmacy in a primary care clinic was conducted. Participants' medication beliefs were assessed using the Beliefs about Medicines Questionnaire, and nonadherence was assessed using the Morisky Medication Adherence Scale. Pearson correlation analysis was used to assess bivariate associations between medication beliefs and nonadherence. Regression was used to assess relative strength of associations between various medication beliefs and nonadherence and also to assess the significance of the interactions between those beliefs and nonadherence. There were positive bivariate associations between specific concerns about medications (p harmful effects of medications (p belief and nonadherence was assessed, while controlling for other medication beliefs, specific-necessity (p = 0.02) and specific-concerns (p = 0.01) exhibited significant negative and positive associations with nonadherence, respectively. All two-way interactions between variables in the model were insignificant. A model consisting of age, total number of drugs used, and medication beliefs, that is, specific-necessity, specific-concerns, general-overuse, and general-harm, accounted for 26.5% of variance. Medication beliefs alone explained 22.4% of variation in nonadherence to chronic drug therapy. Patients' medication beliefs explained a significant portion of variation in medication nonadherence.

Initial condition effects on large scale structure in numerical simulations of plane mixing layers

Science.gov (United States)

McMullan, W. A.; Garrett, S. J.

2016-01-01

In this paper, Large Eddy Simulations are performed on the spatially developing plane turbulent mixing layer. The simulated mixing layers originate from initially laminar conditions. The focus of this research is on the effect of the nature of the imposed fluctuations on the large-scale spanwise and streamwise structures in the flow. Two simulations are performed; one with low-level three-dimensional inflow fluctuations obtained from pseudo-random numbers, the other with physically correlated fluctuations of the same magnitude obtained from an inflow generation technique. Where white-noise fluctuations provide the inflow disturbances, no spatially stationary streamwise vortex structure is observed, and the large-scale spanwise turbulent vortical structures grow continuously and linearly. These structures are observed to have a three-dimensional internal geometry with branches and dislocations. Where physically correlated provide the inflow disturbances a "streaky" streamwise structure that is spatially stationary is observed, with the large-scale turbulent vortical structures growing with the square-root of time. These large-scale structures are quasi-two-dimensional, on top of which the secondary structure rides. The simulation results are discussed in the context of the varying interpretations of mixing layer growth that have been postulated. Recommendations are made concerning the data required from experiments in order to produce accurate numerical simulation recreations of real flows.

Influence of framing on medical decision making

OpenAIRE

Feng, Jun; Gong, Jingjing; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei; Zhang, Yan

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience.

Influence of framing on medical decision making.

Science.gov (United States)

Gong, Jingjing; Zhang, Yan; Feng, Jun; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience.

Numerical study of magnetohydrodynamics (MHD boundary layer slip flow of a Maxwell nanofluid over an exponentially stretching surface with convective boundary condition

Directory of Open Access Journals (Sweden)

P.BalaAnki Reddy

2017-12-01

Full Text Available This paper focuses on a theoretical analysis of a steady two-dimensional magnetohydrodynamic boundary layer flow of a Maxwell fluid over an exponentially stretching surface in the presence of velocity slip and convective boundary condition. This model is used for a nanofluid, which incorporates the effects of Brownian motion and thermophoresis. The resulting non-linear partial differential equations of the governing flow field are converted into a system of coupled non-linear ordinary differential equations by using suitable similarity transformations, and the resultant equations are then solved numerically by using Runge-Kutta fourth order method along with shooting technique. A parametric study is conducted to illustrate the behavior of the velocity, temperature and concentration. The influence of significant parameters on velocity, temperature, concentration, skin friction coefficient and Nusselt number has been studied and numerical results are presented graphically and in tabular form. The reported numerical results are compared with previously published works on various special cases and are found to be an in excellent agreement. It is found that momentum boundary layer thickness decreases with the increase of magnetic parameter. It can also be found that the thermal boundary layer thickness increases with Brownian motion and thermophoresis parameters.

On the effects of assembly compression on the performance of liquid-feed DMFCs under methanol-limiting conditions: A 2D numerical study

Science.gov (United States)

García-Salaberri, P. A.; Vera, M.

2015-07-01

The influence of assembly compression on the performance of liquid-feed DMFCs under methanol-limiting conditions is explored by means of a 2D/1D multiphysics across-the-channel model. The numerical formulation incorporates a comprehensive 2D description of the anode GDL, including two-phase phenomena, non-uniform anisotropic transport properties, and electrical contact resistances at the GDL/BPP interface. GDL effective properties are evaluated using empirical data corresponding to Toray® carbon paper. A simplified but physically sound 1D description, locally coupled to the 2D anode GDL model, is adopted to describe transport processes in the MPLs, membrane and cathode GDL, whereas the catalyst layers are treated as infinitely thin surfaces. Good agreement is found between the numerical results and previous experimental data. The interplay between assembly compression, bipolar plate material, and channel configuration is also investigated. The results show that there is an optimum GDL compression ratio in terms of overall power density, the optimal compression level being strongly dependent on bipolar plate material. Beyond the optimum, the detrimental effect of compression is larger in non-parallel flow fields due to the additional reduction of methanol transported by under-rib convection. The results suggest that, under certain conditions, this transport mechanism could be more important than diffusion in the anode of liquid-feed DMFCs.

The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: Is the whole greater than the sum of its parts?

Directory of Open Access Journals (Sweden)

Fong Kok-Yong

2005-01-01

Full Text Available Abstract Background Diabetes mellitus (DM is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1 evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL (which could be additive, synergistic or subtractive; (2 to determine the extent to which the SF-6D (a single-index preference measure captures the multidimensional information provided by the SF-36 (a profile measure. Methods Using data from a cross-sectional, population-based survey of Chinese, Malay and Indians in Singapore, we developed 9 separate multiple linear regression models, with each SF-36 scale or SF-6D index score being the dependent variable for one model. The influence of DM and a second chronic medical condition (hypertension (HTN, heart disease (HD, musculoskeletal illnesses (MS and their interactions were studied after adjusting for the influence of potential confounding variables. Results Among 5,224 subjects, the prevalence of DM, HTN, HD and MS were 5.9%, 10.7%, 2.4% and 26.6% respectively. DM lowered SF-36 scores by more than 2 points on 3 SF-36 scales and lowered SF-6D scores by 0.03 points. Subjects with DM and HTN, DM and HD or DM and MS experienced further lowering of SF-36 scores exceeding 2 points on at least 6 scales and further lowering of SF-6D scores by 0.05, 0.08 and 0.10 points respectively. Generally, DM and co-existing medical conditions exerted additive effects on HRQoL, with the exception of DM and heart disease, where a subtractive effect was noted. SF-6D index scores generally reflected the patterns of influence of DM and chronic medical conditions on SF-36 scores. Conclusion DM and chronic medical conditions generally reduced HRQoL in this multiethnic general population in an additive, rather than synergistic or subtractive fashion. In this study, the SF

Polypharmacy and Potentially Inappropriate Medication in People with Dementia

DEFF Research Database (Denmark)

Kristensen, Rachel Underlien; Nørgaard, Ane; Jensen-Dahm, Christina

2018-01-01

BACKGROUND: Polypharmacy (use of ≥5 different medications) and potentially inappropriate medication (PIM) are well-known risk factors for numerous negative health outcomes. However, the use of polypharmacy and PIM in people with dementia is not well-described. OBJECTIVE: To examine the prevalence...

The impact of cannabis and cannabinoids for medical conditions on health-related quality of life: A systematic review and meta-analysis.

Science.gov (United States)

Goldenberg, Matthew; Reid, Mark William; IsHak, Waguih William; Danovitch, Itai

2017-05-01

The use of cannabis or cannabinoids to treat medical conditions and/or alleviate symptoms is increasingly common. However, the impact of this use on patient reported outcomes, such as health-related quality of life (HRQoL), remains unclear. We conducted a systematic review and meta-analysis, employing guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We categorized studies based on design, targeted disease condition, and type of cannabis or cannabinoid used. We scored studies based on quality and risk of bias. After eliminating some studies because of poor quality or insufficient data, we conducted meta-analyses of remaining studies based on design. Twenty studies met our pre-defined selection criteria. Eleven studies were randomized controlled trials (RCTs; 2322 participants); the remaining studies were of cohort and cross-sectional design. Studies of cannabinoids were mostly RCTs of higher design quality than studies of cannabis, which utilized smaller self-selected samples in observational studies. Although we did not uncover a significant association between cannabis and cannabinoids for medical conditions and HRQoL, some patients who used them to treat pain, multiple sclerosis, and inflammatory bower disorders have reported small improvements in HRQoL, whereas some HIV patients have reported reduced HRQoL. The relationship between HRQoL and the use of cannabis or cannabinoids for medical conditions is inconclusive. Some patient populations report improvements whereas others report reductions in HRQoL. In order to inform users, practitioners, and policymakers more clearly, future studies should adhere to stricter research quality guidelines and more clearly report patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

Transportation package design using numerical optimization

International Nuclear Information System (INIS)

Harding, D.C.; Witkowski, W.R.

1992-01-01

The design of structures and engineering systems has always been an iterative process whose complexity was dependent upon the boundary conditions, constraints and available analytical tools. Transportation packaging design is no exception with structural, thermal and radiation shielding constraints based on regulatory hypothetical accident conditions. Transportation packaging design is often accomplished by a group of specialists, each designing a single component based on one or more simple criteria, pooling results with the group, evaluating the open-quotes pooledclose quotes design, and then reiterating the entire process until a satisfactory design is reached. The manual iterative methods used by the designer/analyst can be summarized in the following steps: design the part, analyze the part, interpret the analysis results, modify the part, and re-analyze the part. The inefficiency of this design practice and the frequently conservative result suggests the need for a more structured design methodology, which can simultaneously consider all of the design constraints. Numerical optimization is a structured design methodology whose maturity in development has allowed it to become a primary design tool in many industries. The purpose of this overview is twofold: first, to outline the theory and basic elements of numerical optimization; and second, to show how numerical optimization can be applied to the transportation packaging industry and used to increase efficiency and safety of radioactive and hazardous material transportation packages. A more extensive review of numerical optimization and its applications to radioactive material transportation package design was performed previously by the authors (Witkowski and Harding 1992). A proof-of-concept Type B package design is also presented as a simplified example of potential improvements achievable using numerical optimization in the design process

Strategy for a numerical Rock Mechanics Site Descriptive Model. Further development of the theoretical/numerical approach

International Nuclear Information System (INIS)

Olofsson, Isabelle; Fredriksson, Anders

2005-05-01

The Swedish Nuclear and Fuel Management Company (SKB) is conducting Preliminary Site Investigations at two different locations in Sweden in order to study the possibility of a Deep Repository for spent fuel. In the frame of these Site Investigations, Site Descriptive Models are achieved. These products are the result of an interaction of several disciplines such as geology, hydrogeology, and meteorology. The Rock Mechanics Site Descriptive Model constitutes one of these models. Before the start of the Site Investigations a numerical method using Discrete Fracture Network (DFN) models and the 2D numerical software UDEC was developed. Numerical simulations were the tool chosen for applying the theoretical approach for characterising the mechanical rock mass properties. Some shortcomings were identified when developing the methodology. Their impacts on the modelling (in term of time and quality assurance of results) were estimated to be so important that the improvement of the methodology with another numerical tool was investigated. The theoretical approach is still based on DFN models but the numerical software used is 3DEC. The main assets of the programme compared to UDEC are an optimised algorithm for the generation of fractures in the model and for the assignment of mechanical fracture properties. Due to some numerical constraints the test conditions were set-up in order to simulate 2D plane strain tests. Numerical simulations were conducted on the same data set as used previously for the UDEC modelling in order to estimate and validate the results from the new methodology. A real 3D simulation was also conducted in order to assess the effect of the '2D' conditions in the 3DEC model. Based on the quality of the results it was decided to update the theoretical model and introduce the new methodology based on DFN models and 3DEC simulations for the establishment of the Rock Mechanics Site Descriptive Model. By separating the spatial variability into two parts, one

Factors associated with geographic variation in cost per episode of care for three medical conditions

Science.gov (United States)

2014-01-01

Objective To identify associations between market factors, especially relative reimbursement rates, and the probability of surgery and cost per episode for three medical conditions (cataract, benign prostatic neoplasm, and knee degeneration) with multiple treatment options. Methods We use 2004–2006 Medicare claims data for elderly beneficiaries from sixty nationally representative communities to estimate multivariate models for the probability of surgery and cost per episode of care as a function local market factors, including Medicare physician reimbursement for surgical versus non-surgical treatment and the availability of primary care and specialty physicians. We used Symmetry’s Episode Treatment Groups (ETG) software to group claims into episodes for the three conditions (n = 540,874 episodes). Results Higher Medicare reimbursement for surgical episodes and greater availability of the relevant specialists are significantly associated with more surgery and higher cost per episode for all three conditions, while greater availability of primary care physicians is significantly associated with less frequent surgery and lower cost per episode. Conclusion Relative Medicare reimbursement rates for surgical vs. non-surgical treatments and the availability of both primary care physicians and relevant specialists are associated with the likelihood of surgery and cost per episode. PMID:24949281

Comparison of Pilot Medical History and Medications Found In Postmortem Specimens

National Research Council Canada - National Science Library

Canfield, Dennis V; Salazar, Guillermo J; Lewis, Russell J; Whinnery, James E

2006-01-01

Pilots are required by FAA regulations to report all medications and medical conditions to the FAA Office of Aerospace Medicine for review as to the overall suitability of the pilot for flight activities...

Military Medical Care: Questions and Answers

Science.gov (United States)

2013-07-24

conditions. Qualifying conditions include: • Diagnosis in an infant or toddler of a neuromuscular developmental condition or other condition expected to...TRICARE and Medicare Payments to Providers and the Sustainable Growth Rate ......... 19 Medicare and TRICARE for Life...training, medical research and development , health information technology, facility planning, public health, medical logistics, acquisition, budget, and

Using Electronic Health Record Data to Measure Care Quality for Individuals with Multiple Chronic Medical Conditions.

Science.gov (United States)

Bayliss, Elizabeth A; McQuillan, Deanna B; Ellis, Jennifer L; Maciejewski, Matthew L; Zeng, Chan; Barton, Mary B; Boyd, Cynthia M; Fortin, Martin; Ling, Shari M; Tai-Seale, Ming; Ralston, James D; Ritchie, Christine S; Zulman, Donna M

2016-09-01

To inform the development of a data-driven measure of quality care for individuals with multiple chronic conditions (MCCs) derived from an electronic health record (EHR). Qualitative study using focus groups, interactive webinars, and a modified Delphi process. Research department within an integrated delivery system. The webinars and Delphi process included 17 experts in clinical geriatrics and primary care, health policy, quality assessment, health technology, and health system operations. The focus group included 10 individuals aged 70-87 with three to six chronic conditions selected from a random sample of individuals aged 65 and older with three or more chronic medical conditions. Through webinars and the focus group, input was solicited on constructs representing high-quality care for individuals with MCCs. A working list was created of potential measures representing these constructs. Using a modified Delphi process, experts rated the importance of each possible measure and the feasibility of implementing each measure using EHR data. High-priority constructs reflected processes rather than outcomes of care. High-priority constructs that were potentially feasible to measure included assessing physical function, depression screening, medication reconciliation, annual influenza vaccination, outreach after hospital admission, and documented advance directives. High-priority constructs that were less feasible to measure included goal setting and shared decision-making, identifying drug-drug interactions, assessing social support, timely communication with patients, and other aspects of good customer service. Lower-priority domains included pain assessment, continuity of care, and overuse of screening or laboratory testing. High-quality MCC care should be measured using meaningful process measures rather than outcomes. Although some care processes are currently extractable from electronic data, capturing others will require adapting and applying technology to

Miscellaneous conditions

International Nuclear Information System (INIS)

Berquist, T.H.; Hoffman, A.D.

1989-01-01

This paper reports on numerous conditions (systemic diseases, metabolic diseases, etc.) that may also affect the foot and ankle. In many cases, imaging of the foot and ankle is not performed for primary diagnostic purposes. However, radiographic changes do occur with these conditions. Therefore, it is important to be aware of radiographic abnormalities that these diseases may cause in the foot and ankle

Medical marijuana.

OpenAIRE

Marmor, J B

1998-01-01

Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several...

Numerical simulation of meteorological conditions for peak pollution in Paris

Energy Technology Data Exchange (ETDEWEB)

Carissimo, B. [Electricite de France (EDF), 78 - Chatou (France). Direction des Etudes et Recherches

1997-06-01

Results obtained on the simulation of meteorological conditions during two episodes of peak pollution in Paris are presented, one in the winter, the other in the summer. The A3UR air quality modelling system is first described followed by the MERCURE mesoscale meteorological model. The conditions of simulation are described. The results obtained on these two causes show satisfactory agreement, for example on the magnitude of the urban heat island which is correctly reproduced. In this study, several areas of progress have been identified: improvement of the altitude measurement network around cities, the simulation of light wind conditions and the simulation of formation and dissipation of fog. (author) 24 refs.

Numerical simulation of nanosecond pulsed DBD in lean methane–air mixture for typical conditions in internal engines

International Nuclear Information System (INIS)

Takana, Hidemasa; Nishiyama, Hideya

2014-01-01

Detailed two-dimensional numerical simulations of a high energy loading nanosecond dc pulse DBD in a lean methane–air mixture were conducted for plasma-assisted combustion by integrating individual models of plasma chemistry, photoionization and energy loading. The DBD streamer propagation process with radical productions was clarified at 10 atm and 600 K as under the condition of actual internal engines at ignition. Energy is loaded to the streamer first by the formation of plasma channel and then ceased due to the self-shielding effect. Because of the inversed electric field in a discharge space during decrease in applied voltage, energy is loaded to the discharge again. It was found that higher energy is loaded to the DBD streamer for larger dielectric constant even at lower applied voltage, and higher number density of oxygen radical is produced at almost the same radical production efficiency. (paper)

PubMed search strategies for the identification of etiologic associations between hypothalamic-pituitary disorders and other medical conditions.

Science.gov (United States)

Guaraldi, Federica; Grottoli, Silvia; Arvat, Emanuela; Mattioli, Stefano; Ghigo, Ezio; Gori, Davide

2013-12-01

Biomedical literature has enormously grown in the last decades and become broadly available through online databases. Ad-hoc search methods, created on the basis of research field and goals, are required to enhance the quality of searching. Aim of this study was to formulate efficient, evidence-based PubMed search strategies to retrieve articles assessing etiologic associations between a condition of interest and hypothalamic-pituitary disorders (HPD). Based on expert knowledge, 17 MeSH (Medical Subjects Headings) and 79 free terms related to HPD were identified to search PubMed. Using random samples of abstracts retrieved by each term, we estimated the proportion of articles containing pertinent information and formulated two strings (one more specific, one more sensitive) for the detection of articles focusing on the etiology of HPD, that were then applied to retrieve articles identifying possible etiologic associations between HPD and three diseases (malaria, LHON and celiac disease) considered not associated to HPD, and define the number of abstracts needed to read (NNR) to find one potentially pertinent article. We propose two strings: one sensitive string derived from the combination of articles providing the largest literature coverage in the field and one specific including combined terms retrieving ≥40% of potentially pertinent articles. NNR were 2.1 and 1.6 for malaria, 3.36 and 2.29 for celiac disease, 2.8 and 2.2 for LHON, respectively. For the first time, two reliable, readily applicable strings are proposed for the retrieval of medical literature assessing putative etiologic associations between HPD and other medical conditions of interest.

Medical Device Safety

Science.gov (United States)

A medical device is any product used to diagnose, cure, or treat a condition, or to prevent disease. They ... may need one in a hospital. To use medical devices safely Know how your device works. Keep ...

Influence of framing on medical decision making

Science.gov (United States)

Gong, Jingjing; Zhang, Yan; Feng, Jun; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience. PMID:27034630

Medical Optimization Network for Space Telemedicine Resources

Science.gov (United States)

Shah, R. V.; Mulcahy, R.; Rubin, D.; Antonsen, E. L.; Kerstman, E. L.; Reyes, D.

2017-01-01

INTRODUCTION: Long-duration missions beyond low Earth orbit introduce new constraints to the space medical system such as the inability to evacuate to Earth, communication delays, and limitations in clinical skillsets. NASA recognizes the need to improve capabilities for autonomous care on such missions. As the medical system is developed, it is important to have an ability to evaluate the trade space of what resources will be most important. The Medical Optimization Network for Space Telemedicine Resources was developed for this reason, and is now a system to gauge the relative importance of medical resources in addressing medical conditions. METHODS: A list of medical conditions of potential concern for an exploration mission was referenced from the Integrated Medical Model, a probabilistic model designed to quantify in-flight medical risk. The diagnostic and treatment modalities required to address best and worst-case scenarios of each medical condition, at the terrestrial standard of care, were entered into a database. This list included tangible assets (e.g. medications) and intangible assets (e.g. clinical skills to perform a procedure). A team of physicians working within the Exploration Medical Capability Element of NASA's Human Research Program ranked each of the items listed according to its criticality. Data was then obtained from the IMM for the probability of occurrence of the medical conditions, including a breakdown of best case and worst case, during a Mars reference mission. The probability of occurrence information and criticality for each resource were taken into account during analytics performed using Tableau software. RESULTS: A database and weighting system to evaluate all the diagnostic and treatment modalities was created by combining the probability of condition occurrence data with the criticalities assigned by the physician team. DISCUSSION: Exploration Medical Capabilities research at NASA is focused on providing a medical system to

Introduction to 3+1 numerical relativity

CERN Document Server

Alcubierre, Miguel

2008-01-01

This book introduces the modern field of 3+1 numerical relativity. The book has been written in a way as to be as self-contained as possible, and only assumes a basic knowledge of special relativity. Starting from a brief introduction to general relativity, it discusses the different concepts and tools necessary for the fully consistent numerical simulation of relativistic astrophysical systems, with strong and dynamical gravitational fields. Among the topics discussed in detail arethe following: the initial data problem, hyperbolic reductions of the field equations, gauge conditions, the evol

Numerical modelling approach for mine backfill

Indian Academy of Sciences (India)

Muhammad Zaka Emad

2017-07-24

Jul 24, 2017 ... conditions. This paper discusses a numerical modelling strategy for modelling mine backfill material. The .... placed in an ore pass that leads the ore to the ore bin and crusher, from ... 1 year, depending on the mine plan.

Softening behaviour of concrete : numerical research

NARCIS (Netherlands)

Bongers, J.P.W.; Rutten, H.S.; Fijneman, H.J.

1994-01-01

Experimental research shows, apart from the influence of multiaxial loading conditions, that softening of concrete loaded in compression is accompanied by localization of deformations. Therefore, numerical modelling of concrete material behaviour has to take this effect into account. This implies

A numerical method for complex structural dynamics in nuclear plant facilities

International Nuclear Information System (INIS)

Zeitner, W.

1979-01-01

The solution of dynamic problems is often connected with difficulties in setting up a system of equations of motion because of the constraint conditions of the system. Such constraint conditions may be of geometric nature as for example gaps or slidelines, they may be compatibility conditions or thermodynamic criteria for the energy balance of a system. The numerical method proposed in this paper for the treatment of a dynamic problem with constraint conditions requires only to set up the equations of motion without considering the constraints. This always leads to a relatively simple formulation. The constraint conditions themselves are included in the integration procedure by a numerical application of Gauss' principle. (orig.)

Experimental and numerical analyses of different extended surfaces

International Nuclear Information System (INIS)

Diani, A; Mancin, S; Zilio, C; Rossetto, L

2012-01-01

Air is a cheap and safe fluid, widely used in electronic, aerospace and air conditioning applications. Because of its poor heat transfer properties, it always flows through extended surfaces, such as finned surfaces, to enhance the convective heat transfer. In this paper, experimental results are reviewed and numerical studies during air forced convection through extended surfaces are presented. The thermal and hydraulic behaviours of a reference trapezoidal finned surface, experimentally evaluated by present authors in an open-circuit wind tunnel, has been compared with numerical simulations carried out by using the commercial CFD software COMSOL Multiphysics. Once the model has been validated, numerical simulations have been extended to other rectangular finned configurations, in order to study the effects of the fin thickness, fin pitch and fin height on the thermo-hydraulic behaviour of the extended surfaces. Moreover, several pin fin surfaces have been simulated in the same range of operating conditions previously analyzed. Numerical results about heat transfer and pressure drop, for both plain finned and pin fin surfaces, have been compared with empirical correlations from the open literature, and more accurate equations have been developed, proposed, and validated.

A numerical study of thermal conditions in the THM growth of HgTe

Science.gov (United States)

Martínez-Tomás, M. C.; Muñoz-Sanjosé, V.; Reig, C.

2002-09-01

A numerical simulation of the travelling heater method (THM) process in the growth of HgTe is carried out. The whole system (furnace, ampoule and charge) is taken into account in the frame of a quasi-steady-state model. The mass conservation condition for the solute in the liquid zone permits the determination of the rate of advance of the crystallisation isotherm as a function of the heater position. We claim to study the evolution of different magnitudes along the growth process, searching for the physical reasons which could be at the origin of defects in the form of thin layers observed in some growing experiences. To solve the governing equations of fluid flow, heat transfer and mass transport we have made use of a commercial code which can run in a PC. The simulation is made by using a three-level strategy, which allows the reduction of the computational effort. In the first level, heat transport is assumed to be by conduction, convection and radiation between the furnace and the ampoule, and by conduction through the ampoule wall, coating, solid and liquid zones. The temperature calculated at this level in the air/ampoule boundary is used as boundary condition for the second and third level. In these two levels the ampoule and its content are studied in detail. Convection in the liquid zone is considered at the second level and thermosolutal convection is finally included at the third level. The analysis of the incoming/outcoming heat flux per second through the ampoule for the whole system shows that the lower part of the ampoule exhibits some ineffectiveness for the heat evacuation at certain positions of the growth run, depending on thermal properties of the whole system and the particular material to be grown. As a consequence, the growth rate suffers a significant variation just for these positions of the heater. From these considerations a plausible interpretation has been proposed to understand the apparition of solvent inclusions in the form of thin

Transport of radionuclides in the atmosphere during complex meteorological conditions

International Nuclear Information System (INIS)

Antic, D.; Telenta, B.

1991-01-01

Radionuclides from various sources (nuclear and fossil fuel power plants, nuclear facilities, medical facilities, etc.) are being released to the atmosphere. The meteorological conditions determine the atmospheric turbulence, dispersion, and removal processes of the radionuclides. A two-dimensional version of the cloud model based on the Klemp-Wilhelmson dynamic and Lin et al.'s microphysics and thermodynamics has been adapted and used to simulate the transport of radionuclides emitted from a power plant or other source to the atmosphere. Calculations of the trajectories and radii for a few puffs are included in this paper. These numerical investigations show that the presented model can be used for the transport simulation of radionuclides and for the assessment of the radiological impact of power plants and other sources in safety assessments and comparative studies. Because it can simulate puff trajectories, this model is especially valuable in the presence of complex meteorological conditions

Medical Tourism and Its Implication on Malaysia's Economic Growth

OpenAIRE

Tang, Chor Foon

2015-01-01

Policymakers in the developed and developing countries already heading toward medical tourism to stimulate economic growth. Nonetheless, the actual impact of medical tourism on economic growth remains ambiguous. Although medical tourism may spur economic growth via its impact on foreign currency earnings, investments, tax revenue, and employment opportunities, it may also leave numerous negative externalities that either direct or indirectly harmful the process of economic growth. Undeniably,...

Medical students' note-taking in a medical biochemistry course: an initial exploration.

Science.gov (United States)

Morrison, Elizabeth H; McLaughlin, Calvin; Rucker, Lloyd

2002-04-01

Beginning medical students spend numerous hours every week attending basic science lectures and taking notes. Medical faculty often wonder whether they should give students pre-printed instructors' notes before lectures. Proponents of this strategy argue that provided notes enhance learning by facilitating the accurate transmission of information, while opponents counter that provided notes inhibit students' cognitive processing or even discourage students from attending lectures. Little if any research has directly addressed medical students' note-taking or the value of providing instructors' notes. The educational literature does suggest that taking lecture notes enhances university students' learning. University students perform best on post-lecture testing if they review a combination of provided notes and their own personal notes, particularly if the provided notes follow a 'skeletal' format that encourages active note-taking.

Numerical simulation of electro-osmotic consolidation coupling non-linear variation of soil parameters

Science.gov (United States)

Wu, Hui; Hu, Liming; Wen, Qingbo

2017-06-01

Electro-osmotic consolidation is an effective method for soft ground improvement. A main limitation of previous numerical models on this technique is the ignorance of the non-linear variation of soil parameters. In the present study, a multi-field numerical model is developed with the consideration of the non-linear variation of soil parameters during electro-osmotic consolidation process. The numerical simulations on an axisymmetric model indicated that the non-linear variation of soil parameters showed remarkable impact on the development of the excess pore water pressure and degree of consolidation. A field experiment with complex geometry, boundary conditions, electrode configuration and voltage application was further simulated with the developed numerical model. The comparison between field and numerical data indicated that the numerical model coupling of the non-linear variation of soil parameters gave more reasonable results. The developed numerical model is capable to analyze engineering cases with complex operating conditions.

Numerical abilities in fish: A methodological review.

Science.gov (United States)

Agrillo, Christian; Miletto Petrazzini, Maria Elena; Bisazza, Angelo

2017-08-01

The ability to utilize numerical information can be adaptive in a number of ecological contexts including foraging, mating, parental care, and anti-predator strategies. Numerical abilities of mammals and birds have been studied both in natural conditions and in controlled laboratory conditions using a variety of approaches. During the last decade this ability was also investigated in some fish species. Here we reviewed the main methods used to study this group, highlighting the strengths and weaknesses of each of the methods used. Fish have only been studied under laboratory conditions and among the methods used with other species, only two have been systematically used in fish-spontaneous choice tests and discrimination learning procedures. In the former case, the choice between two options is observed in a biologically relevant situation and the degree of preference for the larger/smaller group is taken as a measure of the capacity to discriminate the two quantities (e.g., two shoals differing in number). In discrimination learning tasks, fish are trained to select the larger or the smaller of two sets of abstract objects, typically two-dimensional geometric figures, using food or social companions as reward. Beyond methodological differences, what emerges from the literature is a substantial similarity of the numerical abilities of fish with those of other vertebrates studied. Copyright © 2017 Elsevier B.V. All rights reserved.

Numerical investigation of diffuse ceiling ventilation in an office under different operating conditions

DEFF Research Database (Denmark)

Hviid, Christian Anker; Petersen, Steffen

2014-01-01

is a numerical study of the performance of a six person office equipped with diffuse ventilation ceiling. In total six extreme, yet realistic, operation scenarios were simulated to study the performance including different occupancy, ventilation rates and supply air temperatures. The performance was studied...

The Perceived Medical Condition Self-Management Scale can be applied to patients with chronic kidney disease.

Science.gov (United States)

Wild, Marcus G; Wallston, Kenneth A; Green, Jamie A; Beach, Lauren B; Umeukeje, Ebele; Wright Nunes, Julie A; Ikizler, T Alp; Steed, Julia; Cavanaugh, Kerri L

2017-10-01

Chronic Kidney Disease (CKD) is a major burden on patients and the health care system. Treatment of CKD requires dedicated involvement from both caretakers and patients. Self-efficacy, also known as perceived competence, contributes to successful maintenance of patient's CKD self-management behaviors such as medication adherence and dietary regulations. Despite a clear association between self-efficacy and improved CKD outcomes, there remains a lack of validated self-report measures of CKD self-efficacy. To address this gap, the Perceived Kidney/Dialysis Self-Management Scale (PKDSMS) was adapted from the previously validated Perceived Medical Condition Self-Management Scale. We then sought to validate this using data from two separate cohorts: a cross-sectional investigation of 146 patients with end-stage renal disease receiving maintenance hemodialysis and a longitudinal study of 237 patients with CKD not receiving dialysis. The PKDSMS was found to be positively and significantly correlated with self-management behaviors and medication adherence in both patient cohorts. The PKDSMS had acceptable reliability, was internally consistent, and exhibited predictive validity between baseline PKDSMS scores and self-management behaviors across multiple time points. Thus, the PKDSMS is a valid and reliable measure of CKD patient self-efficacy and supports the development of interventions enhancing perceived competence to improve CKD self-management. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Numerical simulation of spatter formation during fiber laser welding of 5083 aluminum alloy at full penetration condition

Science.gov (United States)

Wu, Dongsheng; Hua, Xueming; Huang, Lijin; Zhao, Jiang

2018-03-01

The droplet escape condition in laser welding is established in this paper. A three-dimensional numerical model is developed to study the weld pool convection and spatter formation at full penetration during the fiber laser welding of 5083 aluminum alloy. It is found that when laser power is 9 kW, the bottom of the keyhole is dynamically opened and closed. When the bottom of the keyhole is closed, the molten metal at the bottom of the back keyhole wall flows upwards along the fusion line. When the bottom of the keyhole is opened, few spatters can be seen around the keyhole at the top surface, two flow patterns exists in the rear part of the keyhole: a portion of molten metal flows upwards along the fusion line, other portion of molten metal flows to the bottom of the keyhole, which promote the spatter formation at the bottom of the keyhole rear wall.

An introduction to medical physics

CERN Document Server

2017-01-01

This book begins with the basic terms and definitions and takes a student, step by step, through all areas of medical physics. The book covers radiation therapy, diagnostic radiology, dosimetry, radiation shielding, and nuclear medicine, all at a level suitable for undergraduates. This title not only describes the basics concepts of the field, but also emphasizes numerical and mathematical problems and examples.Students will find An Introduction to Medical Physics to be an indispensible resource in preparations for further graduate studies in the field.

Numerical Investigation of the Thermal Regime of Underground Channel Heat Pipelines Under Flooding Conditions with the Use of a Conductive-Convective Heat Transfer Model

Science.gov (United States)

Polovnikov, V. Yu.

2018-05-01

This paper presents the results of numerical analysis of thermal regimes and heat losses of underground channel heating systems under flooding conditions with the use of a convective-conductive heat transfer model with the example of the configuration of the heat pipeline widely used in the Russian Federation — a nonpassage ferroconcrete channel (crawlway) and pipelines insulated with mineral wool and a protective covering layer. It has been shown that convective motion of water in the channel cavity of the heat pipeline under flooding conditions has no marked effect on the intensification of heat losses. It has been established that for the case under consideration, heat losses of the heat pipeline under flooding conditions increase from 0.75 to 52.39% due to the sharp increase in the effective thermal characteristics of the covering layer and the heat insulator caused by their moistening.

Conditions for excellence in teaching in medical education: The Frankfurt Model to ensure quality in teaching and learning

Directory of Open Access Journals (Sweden)

Giesler, Marianne

2017-10-01

Full Text Available Background: There is general consensus that the organizational and administrative aspects of academic study programs exert an important influence on teaching and learning. Despite this, no comprehensive framework currently exists to describe the conditions that affect the quality of teaching and learning in medical education. The aim of this paper is to systematically and comprehensively identify these factors to offer academic administrators and decision makers interested in improving teaching a theory-based and, to an extent, empirically founded framework on the basis of which improvements in teaching quality can be identified and implemented.Method: Primarily, the issue was addressed by combining a theory-driven deductive approach with an experience based, “best evidence” one during the course of two workshops held by the GMA Committee on Personnel and Organizational Development in Academic Teaching (POiL in Munich (2013 and Frankfurt (2014. Two models describing the conditions relevant to teaching and learning (Euler/Hahn and Rindermann were critically appraised and synthesized into a new third model. Practical examples of teaching strategies that promote or hinder learning were compiled and added to the categories of this model and, to the extent possible, supported with empirical evidence.Based on this, a checklist with recommendations for optimizing general academic conditions was formulated.Results: The covers six categories: and These categories have been supplemented by the interests, motives and abilities of the actual teachers and students in this particular setting. The categories of this model provide the structure for a checklist in which recommendations for optimizing teaching are given.Conclusions: The checklist derived from the Frankfurt Model for ensuring quality in teaching and learning can be used for quality assurance and to improve the conditions under which teaching and learning take place in medical schools.

Acute Care Use for Ambulatory Care-Sensitive Conditions in High-Cost Users of Medical Care with Mental Illness and Addictions.

Science.gov (United States)

Hensel, Jennifer M; Taylor, Valerie H; Fung, Kinwah; Yang, Rebecca; Vigod, Simone N

2018-01-01

The role of mental illness and addiction in acute care use for chronic medical conditions that are sensitive to ambulatory care management requires focussed attention. This study examines how mental illness or addiction affects risk for repeat hospitalization and/or emergency department use for ambulatory care-sensitive conditions (ACSCs) among high-cost users of medical care. A retrospective, population-based cohort study using data from Ontario, Canada. Among the top 10% of medical care users ranked by cost, we determined rates of any and repeat care use (hospitalizations and emergency department [ED] visits) between April 1, 2011, and March 31, 2012, for 14 consensus established ACSCs and compared them between those with and without diagnosed mental illness or addiction during the 2 years prior. Risk ratios were adjusted (aRR) for age, sex, residence, and income quintile. Among 314,936 high-cost users, 35.9% had a mental illness or addiction. Compared to those without, individuals with mental illness or addiction were more likely to have an ED visit or hospitalization for any ACSC (22.8% vs. 19.6%; aRR, 1.21; 95% confidence interval [CI], 1.20-1.23). They were also more likely to have repeat ED visits or hospitalizations for the same ACSC (6.2% vs. 4.4% of those without; aRR, 1.48; 95% CI, 1.44-1.53). These associations were stronger in stratifications by mental illness diagnostic subgroup, particularly for those with a major mental illness. The presence of mental illness and addiction among high-cost users of medical services may represent an unmet need for quality ambulatory and primary care.

Assessment of Medical Risks and Optimization of their Management using Integrated Medical Model

Science.gov (United States)

Fitts, Mary A.; Madurai, Siram; Butler, Doug; Kerstman, Eric; Risin, Diana

2008-01-01

The Integrated Medical Model (IMM) Project is a software-based technique that will identify and quantify the medical needs and health risks of exploration crew members during space flight and evaluate the effectiveness of potential mitigation strategies. The IMM Project employs an evidence-based approach that will quantify probability and consequences of defined in-flight medical risks, mitigation strategies, and tactics to optimize crew member health. Using stochastic techniques, the IMM will ultimately inform decision makers at both programmatic and institutional levels and will enable objective assessment of crew health and optimization of mission success using data from relevant cohort populations and from the astronaut population. The objectives of the project include: 1) identification and documentation of conditions that may occur during exploration missions (Baseline Medical Conditions List [BMCL), 2) assessment of the likelihood of conditions in the BMCL occurring during exploration missions (incidence rate), 3) determination of the risk associated with these conditions and quantify in terms of end states (Loss of Crew, Loss of Mission, Evacuation), 4) optimization of in-flight hardware mass, volume, power, bandwidth and cost for a given level of risk or uncertainty, and .. validation of the methodologies used.

Energy functionals for medical image segmentation: choices and consequences

OpenAIRE

McIntosh, Christopher

2011-01-01

Medical imaging continues to permeate the practice of medicine, but automated yet accurate segmentation and labeling of anatomical structures continues to be a major obstacle to computerized medical image analysis. Though there exists numerous approaches for medical image segmentation, one in particular has gained increasing popularity: energy minimization-based techniques, and the large set of methods encompassed therein. With these techniques an energy function must be chosen, segmentations...

Visiting Holocaust-Related Sites with Medical Students as an Aid in Teaching Medical Ethics.

Science.gov (United States)

González-López, Esteban; Ríos-Cortés, Rosa

2016-05-01

During the Nazi period numerous doctors and nurses played a nefarious role. In Germany they were responsible for the sterilization and killing of disabled persons. Furthermore, the Nazi doctors used concentration camp inmates as guinea pigs in medical experiments for military or racial purposes. A study of the collaboration of doctors with National Socialism exemplifies behavior that must be avoided. Combining medical teaching with lessons from the Holocaust could be a way to transmit Medical Ethics to doctors, nurses and students. The authors describe a study tour with medical students to Poland, to the largest Nazi extermination camp, Auschwitz, and to the city of Krakow. The tour is the final component of a formal course entitled: "The Holocaust, a Reflection from Medicine" at the Autónoma University of Madrid, Spain. Visiting sites related to the Holocaust, the killing centers and the sites where medical experiments were conducted has a singular meaning for medical students. Tolerance, non-discrimination, and the value of human life can be both learnt and taught at the very place where such values were utterly absent.

Beyond "medical tourism": Canadian companies marketing medical travel.

Science.gov (United States)

Turner, Leigh

2012-06-15

Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, "Liberation therapy" for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross

Health locus of control: Its relationship with medication adherence and medication wastage.

Science.gov (United States)

West, Lorna Marie; Borg Theuma, Ruth; Cordina, Maria

2017-12-09

Non-adherence is a significant factor contributing to medication wastage. Whilst there is some evidence on the influence of patients' health locus of control in relation to adherence, there has been little inquiry into its relationship with mediation wastage. To determine the relationship between medication adherence and health locus of control as well as medication wastage and health locus of control in patients with chronic conditions. Outpatients having a diagnosis of asthma, cardiovascular conditions, or diabetes participated in a cross-sectional study employing a self-administered questionnaire. The questionnaire determined presence of unused medication (wastage), adherence using 'Tool for Adherence Behaviour Screening' (TABS), and health locus of control using 'Multidimensional Health Locus of Control' (MHLC) scale Form C. Logistic regression was performed to ascertain the effects of MHLC and demographics in relation to adherence and wastage. MHLC beliefs were divided into 8 types of health locus of control. One-Way ANOVA was used to assess differences between conditions and belief types. P-values ≤ .05 were considered significant. There were 330 patients recruited (58% male; age, mean±(SD): 61 ± 15 years; 110 asthma, 110 cardiovascular, 110 diabetes). In terms of health locus of control, females had higher 'doctors' beliefs (p = .054) and significantly lower 'other people' beliefs (p = control. 'Yea-sayers' had the least presence of unused medication, followed by 'pure internal' believers. 'Pure powerful others external' had the highest presence of unused medication. Healthcare professionals should take into account patients' health locus of control beliefs whilst conducting an intervention with patients; this can impact positively medication adherence and minimisation of medication wastage. Copyright © 2017 Elsevier Inc. All rights reserved.

Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review

Science.gov (United States)

McGinty, Emma E.; Baller, Julia; Azrin, Susan T.; Juliano-Bult, Denise; Daumit, Gail L.

2016-01-01

People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings. PMID:26221050

Exploration Medical System Demonstration Project

Science.gov (United States)

Chin, D. A.; McGrath, T. L.; Reyna, B.; Watkins, S. D.

2011-01-01

A near-Earth Asteroid (NEA) mission will present significant new challenges including hazards to crew health created by exploring a beyond low earth orbit destination, traversing the terrain of asteroid surfaces, and the effects of variable gravity environments. Limited communications with ground-based personnel for diagnosis and consultation of medical events require increased crew autonomy when diagnosing conditions, creating treatment plans, and executing procedures. Scope: The Exploration Medical System Demonstration (EMSD) project will be a test bed on the International Space Station (ISS) to show an end-to-end medical system assisting the Crew Medical Officers (CMO) in optimizing medical care delivery and medical data management during a mission. NEA medical care challenges include resource and resupply constraints limiting the extent to which medical conditions can be treated, inability to evacuate to Earth during many mission phases, and rendering of medical care by a non-clinician. The system demonstrates the integration of medical technologies and medical informatics tools for managing evidence and decision making. Project Objectives: The objectives of the EMSD project are to: a) Reduce and possibly eliminate the time required for a crewmember and ground personnel to manage medical data from one application to another. b) Demonstrate crewmember's ability to access medical data/information via a software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities. d) Develop a common data management architecture that allows for scalability, extensibility, and interoperability of data sources and data users. e) Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management f) Provide

Adolf Hitler's medical care.

Science.gov (United States)

Doyle, D

2005-02-01

For the last nine years of his life Adolf Hitler, a lifelong hypochondriac had as his physician Dr Theodor Morell. Hitler's mood swings, Parkinson's disease, gastro-intestinal symptoms, skin problems and steady decline until his suicide in 1945 are documented by reliable observers and historians, and in Morell's diaries. The bizarre and unorthodox medications given to Hitler, often for undisclosed reasons, include topical cocaine, injected amphetamines, glucose, testosterone, estradiol, and corticosteroids. In addition, he was given a preparation made from a gun cleaner, a compound of strychnine and atropine, an extract of seminal vesicles, and numerous vitamins and 'tonics'. It seems possible that some of Hitler's behaviour, illnesses and suffering can be attributed to his medical care. Whether he blindly accepted such unorthodox medications or demanded them is unclear.

Defining Medical Capabilities for Exploration Missions

Science.gov (United States)

Hailey, M.; Antonsen, E.; Blue, R.; Reyes, D.; Mulcahy, R.; Kerstman, E.; Bayuse, T.

2018-01-01

Exploration-class missions to the moon, Mars and beyond will require a significant change in medical capability from today's low earth orbit centric paradigm. Significant increases in autonomy will be required due to differences in duration, distance and orbital mechanics. Aerospace medicine and systems engineering teams are working together within ExMC to meet these challenges. Identifying exploration medical system needs requires accounting for planned and unplanned medical care as defined in the concept of operations. In 2017, the ExMC Clinicians group identified medical capabilities to feed into the Systems Engineering process, including: determining what and how to address planned and preventive medical care; defining an Accepted Medical Condition List (AMCL) of conditions that may occur and a subset of those that can be treated effectively within the exploration environment; and listing the medical capabilities needed to treat those conditions in the AMCL. This presentation will discuss the team's approach to addressing these issues, as well as how the outputs of the clinical process impact the systems engineering effort.

Numerical study of inflow conditions on a turbulent isothermal or heated plane jet; Etude numerique des conditions d'emission sur un ecoulement de type jet plan turbulent isotherme ou chauffe

Energy Technology Data Exchange (ETDEWEB)

Mhiri, H.; Habli, S.; El Golli, S. [Ecole Nationale d' Ingenieurs de Monastir (Tunisia); Le Palec, G.; Bournot, Ph. [Institut de Mecanique de Marseille (France)

1999-11-01

We intend to solve equations governing turbulent plane-vertical isotherm and non isotherm jets by taking into account inflow conditions at the exit of the nozzle. The analysis is focused on the influence of these conditions on this type of flow. Two cases are considered (uniform and parabolic velocity and temperature profiles). A finite difference scheme is developed to solve the governing equations. This numeric model allows us to show that the region of fully developed regime begins much nearer the nozzle for the turbulent case than for the laminar flow case. Indeed, the turbulence increases the mixing between the incoming gas from the nozzle and the ambient fluid, and consequently the size of the potential core zone decreases. The results are compared to other works introducing mathematical variables based on the energy conservation for the case of the mixed convection and the momentum conservation for the forced convection, which allows the validation of our results. (authors)

Numerical simulation of the regularized long wave equation by He's homotopy perturbation method

International Nuclear Information System (INIS)

Inc, Mustafa; Ugurlu, Yavuz

2007-01-01

In this Letter, we present the homotopy perturbation method (shortly HPM) for obtaining the numerical solution of the RLW equation. We obtain the exact and numerical solutions of the Regularized Long Wave (RLW) equation for certain initial condition. The initial approximation can be freely chosen with possible unknown constants which can be determined by imposing the boundary and initial conditions. Comparison of the results with those of other methods have led us to significant consequences. The numerical solutions are compared with the known analytical solutions

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

Science.gov (United States)

Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

Numerical Modeling and Mechanical Analysis of Flexible Risers

Directory of Open Access Journals (Sweden)

J. Y. Li

2015-01-01

Full Text Available ABAQUS is used to create a detailed finite element model for a 10-layer unbonded flexible riser to simulate the riser’s mechanical behavior under three load conditions: tension force and internal and external pressure. It presents a technique to create detailed finite element model and to analyze flexible risers. In FEM model, all layers are modeled separately with contact interfaces; interaction between steel trips in certain layers has been considered as well. FEM model considering contact interaction, geometric nonlinearity, and friction has been employed to accurately simulate the structural behavior of riser. The model includes the main features of the riser geometry with very little simplifying assumptions. The model was solved using a fully explicit time-integration scheme implemented in a parallel environment on an eight-processor cluster and 24 G memory computer. There is a very good agreement obtained from numerical and analytical comparisons, which validates the use of numerical model here. The results from the numerical simulation show that the numerical model takes into account various details of the riser. It has been shown that the detailed finite element model can be used to predict riser’s mechanics behavior under various load cases and bound conditions.

Hand Surgery – Postoperative Recovery and Medical Tourism

Directory of Open Access Journals (Sweden)

Ruxandra Diana Sinescu

2014-11-01

Full Text Available Medical tourism is a growing industry worldwide. Romania has spa treatment facilities that can ensure the development of medical tourism. This article presents a statistical analysis of hand surgery in Romania in 2012. Using adequate quantitative methods we highlight significant differences between age groups and differences regarding procedures that have gender particularities. Recovery after such surgery can be achieved through spa treatment Romania, taking advantage of lower prices compared to other developed countries and numerous medical tourism facilities.

Assessment of the viscoelastic mechanical properties of polycarbonate urethane for medical devices.

Science.gov (United States)

Beckmann, Agnes; Heider, Yousef; Stoffel, Marcus; Markert, Bernd

2018-06-01

The underlying research work introduces a study of the mechanical properties of polycarbonate urethane (PCU), used in the construction of various medical devices. This comprises the discussion of a suitable material model, the application of elemental experiments to identify the related parameters and the numerical simulation of the applied experiments in order to calibrate and validate the mathematical model. In particular, the model of choice for the simulation of PCU response is the non-linear viscoelastic Bergström-Boyce material model, applied in the finite-element (FE) package Abaqus®. For the parameter identification, uniaxial tension and unconfined compression tests under in-laboratory physiological conditions were carried out. The geometry of the samples together with the applied loadings were simulated in Abaqus®, to insure the suitability of the modelling approach. The obtained parameters show a very good agreement between the numerical and the experimental results. Copyright © 2018 Elsevier Ltd. All rights reserved.

The use of an exclusion-based risk-assessment model for venous thrombosis improves uptake of appropriate thromboprophylaxis in hospitalized medical patients.

Science.gov (United States)

Bagot, C; Gohil, S; Perrott, R; Barsam, S; Patel, R K; Arya, R

2010-08-01

Venous thromboembolism is a common condition in hospitalized medical patients. Numerous studies have demonstrated that low molecular weight heparin significantly reduces this risk but, despite this, the use of thromboprophylaxis remains poor. To evaluate the use of an exclusion based risk-assessment model (RAM) for venous thrombosis in improving the uptake of appropriate thromboprophylaxis in hospitalized medical patients. A survey with a subsequent audit cycle of three separate audits over 36 months. 497 hospitalized patients with acute medical conditions on general medical wards were audited at a secondary care centre in London, UK. The survey and subsequent audits were performed by reviewing the notes and medication charts of medical patients, prior to the launch of the RAM and at 12, 28 and 36 months following its introduction. Prior to launching the RAM, 49% of hospitalized medical patients received appropriate thromboprophylaxis. This did not change 12 months after the RAM was introduced but increased significantly to 71% following formal education of the health care professionals involved in thromboprophylaxis prescription. This improvement was maintained as demonstrated by a subsequent audit 8 months later (75.9%). The introduction of a simple exclusion-based RAM for venous thrombosis in medical patients significantly improved delivery of thromboprophylaxis. The successful uptake of the RAM appears to have been dependent on direct education of those health carers involved in its use. A similar exclusion-based model used nationally could have a significant impact on the burden of VTE currently experienced in the UK.

Numerical modelling of multicomponent LNAPL dissolution kinetics ...

Indian Academy of Sciences (India)

subsequent removal of free phase liquid, still the organic compounds are present .... Since the flow through porous media is mainly restricted to the pore space ..... initial and boundary conditions for the numerical scheme are given in table 2.

Medical student attitudes about mental illness: does medical-school education reduce stigma?

Science.gov (United States)

Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

2012-05-01

Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Authors examined medical students' attitudes to mental illness, as compared with attitudes toward other medical illness, and the influence of the number of years spent in medical school, as well as of several key socio-demographic, ethnic, and cultural variables. A group of 760 U.K. medical students completed a nationwide on-line survey examining their attitudes toward patients with five conditions (pneumonia, depression, psychotic symptoms, intravenous drug use, long-standing unexplained abdominal complaints), using the Medical Condition Regard Scale (MCRS). Students were also asked whether they had completed the psychiatry rotation or had personal experience of mental disorders themselves or among their friends or family members. They were also asked about their ethnic group (using U.K. national census categories), religious affiliation, and how important religion was in their lives. Independent-samples t-tests and one-way ANOVA were used to compare differences between groups on the MCRS. Students showed the highest regard for patients with pneumonia and lowest regard for patients with long-standing, unexplained abdominal complaints. Although attitudes toward pneumonia were more positive in fifth-year students than in first-year students, attitudes toward unexplained chronic abdominal pain were worse in fifth-year students than in first-year students. Personal experience of mental health treatment, or that among family and friends, were associated with less stigmatizing attitudes. Men showed more stigmatization than women for nearly all conditions; Chinese and South Asian students showed more stigmatizing attitudes toward delusions and hallucinations than their white British counterparts. Medical students in this survey

Allergic Contact Dermatitis to Ophthalmic Medications: Relevant Allergens and Alternative Testing Methods.

Science.gov (United States)

Grey, Katherine R; Warshaw, Erin M

Allergic contact dermatitis is an important cause of periorbital dermatitis. Topical ophthalmic agents are relevant sensitizers. Contact dermatitis to ophthalmic medications can be challenging to diagnose and manage given the numerous possible offending agents, including both active and inactive ingredients. Furthermore, a substantial body of literature reports false-negative patch test results to ophthalmic agents. Subsequently, numerous alternative testing methods have been described. This review outlines the periorbital manifestations, causative agents, and alternative testing methods of allergic contact dermatitis to ophthalmic medications.

Jump conditions in transonic equilibria

International Nuclear Information System (INIS)

Guazzotto, L.; Betti, R.; Jardin, S. C.

2013-01-01

In the present paper, the numerical calculation of transonic equilibria, first introduced with the FLOW code in Guazzotto et al.[Phys. Plasmas 11, 604 (2004)], is critically reviewed. In particular, the necessity and effect of imposing explicit jump conditions at the transonic discontinuity are investigated. It is found that “standard” (low-β, large aspect ratio) transonic equilibria satisfy the correct jump condition with very good approximation even if the jump condition is not explicitly imposed. On the other hand, it is also found that high-β, low aspect ratio equilibria require the correct jump condition to be explicitly imposed. Various numerical approaches are described to modify FLOW to include the jump condition. It is proved that the new methods converge to the correct solution even in extreme cases of very large β, while they agree with the results obtained with the old implementation of FLOW in lower-β equilibria.

Numerical Analysis of Dusty-Gas Flows

Science.gov (United States)

Saito, T.

2002-02-01

This paper presents the development of a numerical code for simulating unsteady dusty-gas flows including shock and rarefaction waves. The numerical results obtained for a shock tube problem are used for validating the accuracy and performance of the code. The code is then extended for simulating two-dimensional problems. Since the interactions between the gas and particle phases are calculated with the operator splitting technique, we can choose numerical schemes independently for the different phases. A semi-analytical method is developed for the dust phase, while the TVD scheme of Harten and Yee is chosen for the gas phase. Throughout this study, computations are carried out on SGI Origin2000, a parallel computer with multiple of RISC based processors. The efficient use of the parallel computer system is an important issue and the code implementation on Origin2000 is also described. Flow profiles of both the gas and solid particles behind the steady shock wave are calculated by integrating the steady conservation equations. The good agreement between the pseudo-stationary solutions and those from the current numerical code validates the numerical approach and the actual coding. The pseudo-stationary shock profiles can also be used as initial conditions of unsteady multidimensional simulations.

Coherent Structures in Numerically Simulated Plasma Turbulence

DEFF Research Database (Denmark)

Kofoed-Hansen, O.; Pécseli, H.L.; Trulsen, J.

1989-01-01

Low level electrostatic ion acoustic turbulence generated by the ion-ion beam instability was investigated numerically. The fluctuations in potential were investigated by a conditional statistical analysis revealing propagating coherent structures having the form of negative potential wells which...

Numerical experiments on the atmospheric response to cold Equatorial Pacific conditions ('La Nina') during northern summer

International Nuclear Information System (INIS)

Storch, H. von; Schriever, D.; Arpe, K.; Branstator, G.W.; Legnani, R.; Ulbrich, U.

1993-01-01

The effect of cold conditions in the central and eastern Equatorial Pacific during Northern Summer is examined in a series of numerical experiments with the low resolution (T21) atmospheric general circulation model ECHAM2. Anomalous sea surface temperatures (SST) as observed in June 1988 were prescribed and the effect on the global circulation is examined. In the model atmosphere, the anomalous cold water in the Equatorial Pacific excites a strong and stable response over the tropical Central and East Pacific. From here stationary Rossby waves radiate into both hemispheres. The Northern Hemisphere wave train is weak and affects only the Northeast Pacific area; the Southern Hemisphere wave train arches from the Central Pacific over the southern tip of South America to the South Atlantic. This response is not only present in the basic anomaly experiment with the T21 GCM but also in experiments with SST anomalies confined to the tropics and with an envelope-formulation of the SST anomalies, in experiments with a linear model, and in high resolution (T42) model experiments. The model output is also compared to the actually observed atmospheric state in June 1988. (orig./KW)

Numerical simulation of heat transfer in metal foams

Science.gov (United States)

Gangapatnam, Priyatham; Kurian, Renju; Venkateshan, S. P.

2018-02-01

This paper reports a numerical study of forced convection heat transfer in high porosity aluminum foams. Numerical modeling is done considering both local thermal equilibrium and non local thermal equilibrium conditions in ANSYS-Fluent. The results of the numerical model were validated with experimental results, where air was forced through aluminum foams in a vertical duct at different heat fluxes and velocities. It is observed that while the LTE model highly under predicts the heat transfer in these foams, LTNE model predicts the Nusselt number accurately. The novelty of this study is that once hydrodynamic experiments are conducted the permeability and porosity values obtained experimentally can be used to numerically simulate heat transfer in metal foams. The simulation of heat transfer in foams is further extended to find the effect of foam thickness on heat transfer in metal foams. The numerical results indicate that though larger foam thicknesses resulted in higher heat transfer coefficient, this effect weakens with thickness and is negligible in thick foams.

Medical cyber-physical systems: A survey.

Science.gov (United States)

Dey, Nilanjan; Ashour, Amira S; Shi, Fuqian; Fong, Simon James; Tavares, João Manuel R S

2018-03-10

Medical cyber-physical systems (MCPS) are healthcare critical integration of a network of medical devices. These systems are progressively used in hospitals to achieve a continuous high-quality healthcare. The MCPS design faces numerous challenges, including inoperability, security/privacy, and high assurance in the system software. In the current work, the infrastructure of the cyber-physical systems (CPS) are reviewed and discussed. This article enriched the researches of the networked Medical Device (MD) systems to increase the efficiency and safety of the healthcare. It also can assist the specialists of medical device to overcome crucial issues related to medical devices, and the challenges facing the design of the medical device's network. The concept of the social networking and its security along with the concept of the wireless sensor networks (WSNs) are addressed. Afterward, the CPS systems and platforms have been established, where more focus was directed toward CPS-based healthcare. The big data framework of CPSs is also included.

Direct Numerical Simulation and Visualization of Subcooled Pool Boiling

Directory of Open Access Journals (Sweden)

Tomoaki Kunugi

2014-01-01

Full Text Available A direct numerical simulation of the boiling phenomena is one of the promising approaches in order to clarify their heat transfer characteristics and discuss the mechanism. During these decades, many DNS procedures have been developed according to the recent high performance computers and computational technologies. In this paper, the state of the art of direct numerical simulation of the pool boiling phenomena during mostly two decades is briefly summarized at first, and then the nonempirical boiling and condensation model proposed by the authors is introduced into the MARS (MultiInterface Advection and Reconstruction Solver developed by the authors. On the other hand, in order to clarify the boiling bubble behaviors under the subcooled conditions, the subcooled pool boiling experiments are also performed by using a high speed and high spatial resolution camera with a highly magnified telescope. Resulting from the numerical simulations of the subcooled pool boiling phenomena, the numerical results obtained by the MARS are validated by being compared to the experimental ones and the existing analytical solutions. The numerical results regarding the time evolution of the boiling bubble departure process under the subcooled conditions show a very good agreement with the experimental results. In conclusion, it can be said that the proposed nonempirical boiling and condensation model combined with the MARS has been validated.

Beyond "medical tourism": Canadian companies marketing medical travel

Science.gov (United States)

2012-01-01

Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other

The medicalization of society: on the transformation of human conditions into treatable disorders

National Research Council Canada - National Science Library

Conrad, Peter

2007-01-01

... 197This page intentionally left blank PrefacePreface I have been interested in the medicalization of society for a long time. My Ph.D. dissertation was a participant observation study of the medicalization of hyperactivity in children (Conrad, 1976). This was followed by a more historical account of the medicalization of deviance, coau...

Experimental and numerical investigations of a plasma reactor for the thermal destruction of medical waste using a model substance

International Nuclear Information System (INIS)

Fiedler, J; Lietz, E; Bendix, D; Hebecker, D

2004-01-01

A demonstration plant for the thermal destruction of medical waste using dc plasma torches as the energy source has been developed and tested in several set-ups and under different conditions. Three-dimensional CFD modelling of the gaseous phase in the thermal plasma reactor has been carried out to investigate the experimentally observed phenomena, with the objective of improving the process with respect to conversion rate and power consumption per unit weight. Several models for energy release, and additional parameter studies required to approach the real process as closely as possible, will be discussed. Results for velocity, temperature, and residence time distribution are presented and qualitatively compared with images taken from the running process

The Structure of Medical Decisions

DEFF Research Database (Denmark)

Austin, Laurel C.; Reventlow, Susanne; Sandøe, Peter

2013-01-01

) an individual for a population-based intervention. Analysis of these situations facilitates examination of intuitive probabilistic reasoning. Drawing on evidence in related literature, we discuss some implications of decision-makers imposing the wrong structure or probabilistic reasoning when making medical......Increasingly, medical choices involve deciding whether to look for evidence of undetected, asymptomatic conditions, or increased risk of future conditions (i.e. screening). Those who screen at sufficiently high risk face decisions about interventions to prevent or postpone the onset of possible......, but not certain, future symptomatic conditions. Other preventive decisions include whether or not to accept population-based intervention, such as vaccination. Using decision trees, we model the normative structures and associated uncertainties that underlie five medical decision situations, each of which...

Numerical investigation of beam-driven PWFA in quasi-nonlinear regime

International Nuclear Information System (INIS)

Londrillo, P.; Gatti, C.; Ferrario, M.

2014-01-01

In beam-driven Plasma Based Wakefield Acceleration (PWFA), the quasi-nonlinear model has been designed to combine high efficient ‘blowout’ regimes, where cold and overdense driving electron beams form a totally rarefied plasma channel, with low charge beam distribution assuring the excited wakefield preserves relevant linear properties. This scheme can have applications in experimental facilities, like SPARC 150 MeV linac at LNF-INFN laboratories, where low-emittance, low-charge narrow electron beams can be produced to be injected on a preformed plasma channel. Here we present a preliminary numerical investigation of this configuration, using the fully 3D ALaDyn PIC code, as a preparatory work to design optimal conditions for the COMB experimental set-up. Specific numerical tools, having computational and diagnostic advantages in PWFA conditions and checks of the numerical outcomes with analytical results, are also presented and discussed

Multidimensional Inventory of Hypochondriacal Traits: An Examination of a Bifactor Model and Measurement Invariance Between Those With and Without a Self-Reported Medical Condition.

Science.gov (United States)

Bardeen, Joseph R; Fergus, Thomas A

2017-08-01

The Multidimensional Inventory of Hypochondriacal Traits (MIHT) is a self-report measure that assesses four interrelated domains of health anxiety (i.e., Cognitive, Behavioral, Perceptual, Affective). Prior research has supported a correlated four-factor model, as well as a hierarchical model, in which each of the four factors load onto the higher order health anxiety construct. However, a bifactor modeling approach has yet to be used to examine the factor structure of the MIHT. Results supported a bifactor model of the MIHT in three different samples (i.e., unselected based on current medical status [ n = 824], and those with [ n = 348] and without [ n = 354] a self-reported medical condition). The MIHT appears to be strongly multidimensional, with three of the four subscales providing substantive value. Confirmatory factor analysis supported the configural and metric/scalar invariance of the bifactor model between those with and without a self-reported medical condition. Results provide support for a bifactor conceptualization of the MIHT and the invariance of that model across levels of current health status.

Medical Individualism or Medical Familism? A Critical Analysis of China's New Guidelines for Informed Consent: The Basic Norms of the Documentation of the Medical Record.

Science.gov (United States)

Bian, Lin

2015-08-01

Modern Western medical individualism has had a significant impact on health care in China. This essay demonstrates the ways in which such Western-style individualism has been explicitly endorsed in China's 2010 directive: The Basic Norms of the Documentation of the Medical Record. The Norms require that the patient himself, rather than a member of his family, sign each informed consent form. This change in clinical practice indicates a shift toward medical individualism in Chinese healthcare legislation. Such individualism, however, is incompatible with the character of Chinese familism that is deeply rooted in the Chinese ethical tradition. It also contradicts family-based patterns of health care in China. Moreover, the requirement for individual informed consent is incompatible with numerous medical regulations promulgated in the past two decades. This essay argues that while Chinese medical legislation should learn from relevant Western ideas, it should not simply copy such practices by importing medical individualism into Chinese health care. Chinese healthcare policy is properly based on Chinese medical familist resources. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.

Science.gov (United States)

Fried, Terri R; Niehoff, Kristina M; Street, Richard L; Charpentier, Peter A; Rajeevan, Nallakkandi; Miller, Perry L; Goldstein, Mary K; O'Leary, John R; Fenton, Brenda T

2017-10-01

To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial. Primary care clinics at a Veterans Affairs Medical Center. Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The

42 CFR 482.24 - Condition of participation: Medical record services.

Science.gov (United States)

2010-10-01

... anesthesia services. (B) An updated examination of the patient, including any changes in the patient's... practitioners' orders, nursing notes, reports of treatment, medication records, radiology, and laboratory...

Modeling and numerical simulation of a novel solar-powered absorption air conditioning system driven by a bubble pump with energy storage

Institute of Scientific and Technical Information of China (English)

QIU Jia; LIANG Jian; CHEN GuangMing; DU RuXu

2009-01-01

This paper presents a novel solar-powered absorption air conditioning system driven by a bubble pump with energy storage. It solves the problem of unreliable solar energy supply by storing the working fluids and hence, functions 24 h per day. First, the working principles are described and the dynamic models for the primary energy storage components are developed. Then, the system is evaluated based on a numerical simulation. Based on the meteorological data of a typical day in a subtropical area, with the area of a solar collector being set at 19.15 m2, whilst the initial charging mass, mass fraction and temperature of the solution are respectively set at 379.5 kg, 54.16% and 34.5 ℃, it is found that the respective coefficients of performance (COP) of the air conditioning system and the en-tire system (including the solar panel) are 0.7771 and 0.4372. In particular, the energy storage density of the system is 206.69 MJ/m3 which is much greater than those of chilled water or hot water storage systems under comparable conditions. This makes the new system much more compact and efficient. Finally, an automatic control strategy is given to achieve the highest COP when solar energy fluctuates.

Shared decision making among parents of children with mental health conditions compared to children with chronic physical conditions.

Science.gov (United States)

Butler, Ashley M; Elkins, Sara; Kowalkowski, Marc; Raphael, Jean L

2015-02-01

High quality care in pediatrics involves shared decision making (SDM) between families and providers. The extent to which children with common mental health disorders experience SDM is not well known. The objectives of this study were to examine how parent-reported SDM varies by child health (physical illness, mental health condition, and comorbid mental and physical conditions) and to examine whether medical home care attenuates any differences. We analyzed data on children (2-17 years) collected through the 2009/2010 National Survey of Children with Special Health Care Needs. The sample consisted of parents of children in one of three child health categories: (1) children with a chronic physical illness but no mental health condition; (2) children with a common mental health condition but no chronic physical condition; and (3) children with comorbid mental and chronic physical conditions. The primary dependent variable was parent-report of provider SDM. The primary independent variable was health condition category. Multivariate linear regression analyses were conducted. Multivariate analyses controlling for sociodemographic variables and parent-reported health condition impact indicated lower SDM among children with a common mental health condition-only (B = -0.40; p mental health condition-only were no longer significant in the model adjusting for medical home care. However, differences in SDM for children with comorbid conditions persisted after adjusting for medical home care. Increasing medical home care may help mitigate differences in SDM for children with mental health conditions-only. Other interventions may be needed to improve SDM among children with comorbid mental and physical conditions.

Teaching medical ethics and law.

Science.gov (United States)

Parker, Malcolm

2012-03-01

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.

Boundary conditions for the numerical solution of elliptic equations in exterior regions

International Nuclear Information System (INIS)

Bayliss, A.; Gunzburger, M.; Turkel, E.

1982-01-01

Elliptic equations in exterior regions frequently require a boundary condition at infinity to ensure the well-posedness of the problem. Examples of practical applications include the Helmholtz equation and Laplace's equation. Computational procedures based on a direct discretization of the elliptic problem require the replacement of the condition at infinity by a boundary condition on a finite artificial surface. Direct imposition of the condition at infinity along the finite boundary results in large errors. A sequence of boundary conditions is developed which provides increasingly accurate approximations to the problem in the infinite domain. Estimates of the error due to the finite boundary are obtained for several cases. Computations are presented which demonstrate the increased accuracy that can be obtained by the use of the higher order boundary conditions. The examples are based on a finite element formulation but finite difference methods can also be used

Supporting medical education research quality: the Association of American Medical Colleges' Medical Education Research Certificate program.

Science.gov (United States)

Gruppen, Larry D; Yoder, Ernie; Frye, Ann; Perkowski, Linda C; Mavis, Brian

2011-01-01

The quality of the medical education research (MER) reported in the literature has been frequently criticized. Numerous reasons have been provided for these shortcomings, including the level of research training and experience of many medical school faculty. The faculty development required to improve MER can take various forms. This article describes the Medical Education Research Certificate (MERC) program, a national faculty development program that focuses exclusively on MER. Sponsored by the Association of American Medical Colleges and led by a committee of established medical education researchers from across the United States, the MERC program is built on a set of 11 interactive workshops offered at various times and places across the United States. MERC participants can customize the program by selecting six workshops from this set to fulfill requirements for certification. This article describes the history, operations, current organization, and evaluation of the program. Key elements of the program's success include alignment of program content and focus with needs identified by prospective users, flexibility in program organization and logistics to fit participant schedules, an emphasis on practical application of MER principles in the context of the participants' activities and interests, consistency in program content and format to ensure standards of quality, and a sustainable financial model. The relationship between the national MERC program and local faculty development initiatives is also described. The success of the MERC program suggests that it may be a possible model for nationally disseminated faculty development programs in other domains.

Numerical optimization of composite hip endoprostheses under different loading conditions

Science.gov (United States)

Blake, T. A.; Davy, D. T.; Saravanos, D. A.; Hopkins, D. A.

1992-01-01

The optimization of composite hip implants was investigated. Emphasis was placed on the effect of shape and material tailoring of the implant to improve the implant-bone interaction. A variety of loading conditions were investigated to better understand the relationship between loading and optimization outcome. Comparisons of the initial and optimal models with more complex 3D finite element models were performed. The results indicate that design improvements made using this method result in similar improvements in the 3D models. Although the optimization outcomes were significantly affected by the choice of loading conditions, certain trends were observed that were independent of the applied loading.

Fictitious domain methods for elliptic problems with general boundary conditions with an application to the numerical simulation of two phase flows; Methodes de domaine fictif pour des problemes elliptiques avec conditions aux limites generales en vue de la simulation numerique d'ecoulements diphasiques

Energy Technology Data Exchange (ETDEWEB)

Ramiere, I

2006-09-15

This work is dedicated to the introduction of two original fictitious domain methods for the resolution of elliptic problems (mainly convection-diffusion problems) with general and eventually mixed boundary conditions: Dirichlet, Robin or Neumann. The originality lies in the approximation of the immersed boundary by an approximate interface derived from the fictitious domain Cartesian mesh, which is generally not boundary-fitted to the physical domain. The same generic numerical scheme is used to impose the embedded boundary conditions. Hence, these methods require neither a surface mesh of the immersed boundary nor the local modification of the numerical scheme. We study two modelling of the immersed boundary. In the first one, called spread interface, the approximate immersed boundary is the union of the cells crossed by the physical immersed boundary. In the second one, called thin interface, the approximate immersed boundary lies on sides of mesh cells. Additional algebraic transmission conditions linking both flux and solution jumps through the thin approximate interface are introduced. The fictitious problem to solve as well as the treatment of the embedded boundary conditions are detailed for the two methods. A Q1 finite element scheme is implemented for the numerical validation of the spread interface approach while a new cell-centered finite volume scheme is derived for the thin interface approach with immersed jumps. Each method is then combined to multilevel local mesh refinement algorithms (with solution or flux residual) to increase the precision of the solution in the vicinity of the immersed interface. A convergence analysis of a Q1 finite element method with non-boundary fitted meshes is also presented. This study proves the convergence rates of the present methods. Among the various industrial applications, the simulation on a model of heat exchanger in french nuclear power plants enables us to appreciate the performances of the fictitious domain

Medical Robotic and Telesurgical Simulation and Education Research

Science.gov (United States)

2012-09-01

an expert - Gladwell “There is no excuse for the surgeon to learn on the patient.” – William Mayo, 1927 32 Outliers l"n r: · oRY or l l E s MALCOLM ...10,000 hours to become an expert - Gladwell “There is no excuse for the surgeon to learn on the patient.” – William Mayo, 1927 100 Outliers l"n r...oRY or l l E s MALCOLM GLADW Medical Education – Explosion of Information • Medical procedures are becoming more numerous and more complex – medical

Numerical analysis for the conjugate heat transfer of skin under various temperature conditions of contrast therapy

Energy Technology Data Exchange (ETDEWEB)

Park, Da Ae; Oh, Han Nah; Choi, Hyoung Gwon [Dept. of Mechanical and Automotive Engineering, Seoul National University of Science and Technology, Seoul (Korea, Republic of); Jeon, Byoung Jin; Kim, Eun Jeoung; Lee, Seung Deok [Yonsei University, Seoul (Korea, Republic of)

2015-11-15

In this paper, the contrast therapy of skin was numerically investigated by solving the conjugate heat transfer problem. A finite volume method based on the SIMPLE algorithm was adopted to solve the axisymmetric incompressible Navier-Stokes equations, coupled with an energy equation. These equations are strongly coupled with the Pennes bio-heat equation in order to consider the effect of blood perfusion rate. We investigated the thermal response of skin at some selected depths for various input temperature profiles of a stimulator for contrast therapy. From the numerical simulations, the regions with cold/hot threshold temperatures were found for five input temperature profiles. It was shown that the temperature varies mildly for different input profiles as the depth increases, owing to the Pennes effect. The input temperatures for effective hot/cold stimulation of dermis layer were found to be 47 degrees C and 7 degrees C, respectively. The present numerical results will be used for finding an optimal temperature profile of a stimulator for contrast therapy.

Mathematical properties of numerical inversion for jet calibrations

Energy Technology Data Exchange (ETDEWEB)

Cukierman, Aviv [Physics Department, Stanford University, Stanford, CA 94305 (United States); SLAC National Accelerator Laboratory, Stanford University, Menlo Park, CA 94025 (United States); Nachman, Benjamin, E-mail: bnachman@cern.ch [Physics Department, Stanford University, Stanford, CA 94305 (United States); SLAC National Accelerator Laboratory, Stanford University, Menlo Park, CA 94025 (United States); Physics Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94704 (United States)

2017-06-21

Numerical inversion is a general detector calibration technique that is independent of the underlying spectrum. This procedure is formalized and important statistical properties are presented, using high energy jets at the Large Hadron Collider as an example setting. In particular, numerical inversion is inherently biased and common approximations to the calibrated jet energy tend to over-estimate the resolution. Analytic approximations to the closure and calibrated resolutions are demonstrated to effectively predict the full forms under realistic conditions. Finally, extensions of numerical inversion are presented which can reduce the inherent biases. These methods will be increasingly important to consider with degraded resolution at low jet energies due to a much higher instantaneous luminosity in the near future.

Flow in air conditioned rooms

DEFF Research Database (Denmark)

Nielsen, Peter V.

1974-01-01

Flow in air conditioned r ooms is examined by means of model experiments . The different gearnetries giving unsteady, steady three- dimensional and steady twodimensional flow are determined . Velacity profiles and temperature profiles are measured in some of the geometries. A numerical solution...... of the flow equations is demonstrated and the flow in air conditioned rooms in case of steady two dimensional flow is predi cted. Compari son with measured results is shown i n the case of small Archimedes numbers, and predictions are shown at high Archimedes numbers. A numerical prediction of f low and heat...

Comments on numerical simulations

International Nuclear Information System (INIS)

Sato, T.

1984-01-01

The author comments on a couple of things about numerical simulation. One is just about the philosophical discussion that is, spontaneous or driven. The other thing is the numerical or technical one. Frankly, the author didn't want to touch on the technical matter because this should be a common sense one for those who are working at numerical simulation. But since many people take numerical simulation results at their face value, he would like to remind you of the reality hidden behind them. First, he would point out that the meaning of ''driven'' in driven reconnection is different from that defined by Schindler or Akasofu. The author's definition is closer to Axford's definition. In the spontaneous case, for some unpredicted reason an excess energy of the system is suddenly released at a certain point. However, one does not answer how such an unstable state far beyond a stable limit is realized in the magnetotail. In the driven case, there is a definite energy buildup phase starting from a stable state; namely, energy in the black box increases from a stable level subject to an external source. When the state has reached a certain position, the energy is released suddenly. The difference between driven and spontaneous is whether the cause (plasma flow) to trigger reconnection is specified or reconnection is triggered unpredictably. Another difference is that in driven reconnection the reconnection rate is dependent on the speed of the external plasma flow, but in spontaneous reconnection the rate is dependent on the internal condition such as the resistivity

Numerical simulation and physical aspects of supersonic vortex breakdown

Science.gov (United States)

Liu, C. H.; Kandil, O. A.; Kandil, H. A.

1993-01-01

Existing numerical simulations and physical aspects of subsonic and supersonic vortex-breakdown modes are reviewed. The solution to the problem of supersonic vortex breakdown is emphasized in this paper and carried out with the full Navier-Stokes equations for compressible flows. Numerical simulations of vortex-breakdown modes are presented in bounded and unbounded domains. The effects of different types of downstream-exit boundary conditions are studied and discussed.

The Liquid Film Flow with Evaporation: Numerical Modelling

Directory of Open Access Journals (Sweden)

Rezanova Ekaterina

2016-01-01

Full Text Available The flow of thin liquid layer on an inclined substrate is investigated numerically. The mathematical modelling is based on the Oberbeck-Boussinesq equations and the generalized conditions on the thermocapillary boundary simplified during the parametrical analysis. In the framework of the long-wave approximation the evolution equation which determines the thickness of the liquid layer in the case of moderate Reynolds numbers is derived. The results of numerical modelling of the liquid flow with evaporation at the interface are obtained.

Parametrical Numerical Study on Breakwater SSG Application

DEFF Research Database (Denmark)

Margheritini, Lucia; Kofoed, Jens Peter

The report presents numerical investigations on the performance of the SSG concept for different tide and wave conditions towards different levels of discretization to an optimal solution. Benefit of extra reservoir utilization and reservoir length has also been investigated. The report must be c...

Numerical relativity

International Nuclear Information System (INIS)

Piran, T.

1982-01-01

There are many recent developments in numerical relativity, but there remain important unsolved theoretical and practical problems. The author reviews existing numerical approaches to solution of the exact Einstein equations. A framework for classification and comparison of different numerical schemes is presented. Recent numerical codes are compared using this framework. The discussion focuses on new developments and on currently open questions, excluding a review of numerical techniques. (Auth.)

Use of a medication quantification scale for comparison of pain medication usage in patients with complex regional pain syndrome (CRPS).

Science.gov (United States)

Gallizzi, Michael A; Khazai, Ravand S; Gagnon, Christine M; Bruehl, Stephen; Harden, R Norman

2015-03-01

To correlate the amount and types of pain medications prescribed to CRPS patients, using the Medication Quantification Scale, and patients' subjective pain levels. An international, multisite, retrospective review. University medical centers in the United States, Israel, Germany, and the Netherlands. A total of 89 subjects were enrolled from four different countries: 27 from the United States, 20 Germany, 18 Netherlands, and 24 Israel. The main outcome measures used were the Medication Quantification Scale III and numerical analog pain scale. There was no statistically significant correlation noted between the medication quantification scale and the visual analog scale for any site except for a moderate positive correlation at German sites. The medication quantification scale mean differences between the United States and Germany, the Netherlands, and Israel were 9.793 (P CRPS patients and would be useful in further prospective studies of pain medication prescription practices in the CRPS population worldwide. Wiley Periodicals, Inc.

Numerical investigation of a high head Francis turbine under steady operating conditions using foam-extend

International Nuclear Information System (INIS)

Lenarcic, M; Eichhorn, M; Schoder, S J; Bauer, Ch

2015-01-01

In this work the incompressible turbulent flow in a high head Francis turbine under steady operating conditions is investigated using the open source CFD software package FOAM-extend- 3.1. By varying computational domains (cyclic model, full model), coupling methods between stationary and rotating frames (mixing-plane, frozen-rotor) and turbulence models (kω-SST, κε), numerical flow simulations are performed at the best efficiency point as well as at operating points in part load and high load. The discretization is adjusted according the y + -criterion with y + mean > 30. A grid independence study quantifies the discretization error and the corresponding computational costs for the appropriate simulations, reaching a GCI < 1% for the chosen grid. Specific quantities such as efficiency, head, runner shaft torque as well as static pressure and velocity components are computed and compared with experimental data and commercial code. Focusing on the computed results of integral quantities and static pressures, the highest level of accuracy is obtained using FOAM in combination with the full model discretization, the mixing-plane coupling method and the κω-SST turbulence model. The corresponding relative deviations regarding the efficiency reach values of Δη rel ∼ 7% at part load, Δη rel ∼ 0.5% at best efficiency point and Δη rel ∼ 5.6% at high load. The computed static pressures deviate from the measurements by a maximum of Δp rel = 9.3% at part load, Δp rel = 4.3% at best efficiency point and Δp rel = 6.7% at high load. Commercial code in turn yields slightly better predictions for the velocity components in the draft tube cone, reaching a good accordance with the measurements at part load. Although FOAM also shows an adequate correspondence to the experimental data at part load, local effects near the runner hub are captured less accurate at best efficiency point and high load. Nevertheless, FOAM is a reasonable alternative to commercial code

The lifesaving potential of specialized on-scene medical support for urban tactical operations.

Science.gov (United States)

Metzger, Jeffery C; Eastman, Alexander L; Benitez, Fernando L; Pepe, Paul E

2009-01-01

Since the 1980s, the specialized field of tactical medicine has evolved with growing support from numerous law-enforcement and medical organizations. On-scene backup from tactical emergency medical support (TEMS) providers has not only permitted more immediate advanced medical aid to injured officers, victims, bystanders, and suspects, but also allows for rapid after-incident medical screening or minor treatments that can obviate an unnecessary transport to an emergency department. The purpose of this report is to document one very explicit benefit of TEMS deployment, namely, a situation in which a police officer's life was saved by the routine on-scene presence of specialized TEMS physicians. In this specific case, a police officer was shot in the anterior neck during a law-enforcement operation and became moribund with massive hemorrhage and compromised airway. Two TEMS physicians, who had been integrated into the tactical law-enforcement team, were on scene, controlled the hemorrhage, and provided a surgical airway. By the time of arrival at the hospital, the patient had begun purposeful movements and, within 12 hours, was alert and oriented. Considering the rapid decline in the patient's condition, it was later deemed by quality assurance reviewers that the on-scene presence of these TEMS providers was lifesaving.

Numerical and experimental investigation of the melt casting of explosives

Energy Technology Data Exchange (ETDEWEB)

Sun, Dawei; Garimella, Suresh V. [School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907-2088 (United States); Singh, Sanjeev; Naik, Neelam [US Army Armaments Research, Development and Engineering Center, Picatinny Arsenal, NJ 07806 (United States)

2005-10-01

Melt casting of energetic materials is investigated, and a numerical model is formulated for the analysis of the coupled fluid flow, heat transfer, and stress fields involved in this phase-change process. The numerical model is based on a conservative multi block control volume method. The SIMPLE algorithm is employed along with an enthalpy method approach to model the solidification process. Results from the model are verified against analytical solutions, experimental results, and published numerical results for simplified cases. In the melt casting of RDX-binder mixtures, the very high viscosity of the melt limits the influence of melt convection. The impacts of different cooling conditions on the velocity, temperature and stress distributions, as well as on the solidification time, are discussed. The present model can be used to improve the quality of cast explosives, by optimizing and controlling the processing conditions. (Abstract Copyright [2005], Wiley Periodicals, Inc.)

Numerical Leak Detection in a Pipeline Network of Complex Structure with Unsteady Flow

Science.gov (United States)

Aida-zade, K. R.; Ashrafova, E. R.

2017-12-01

An inverse problem for a pipeline network of complex loopback structure is solved numerically. The problem is to determine the locations and amounts of leaks from unsteady flow characteristics measured at some pipeline points. The features of the problem include impulse functions involved in a system of hyperbolic differential equations, the absence of classical initial conditions, and boundary conditions specified as nonseparated relations between the states at the endpoints of adjacent pipeline segments. The problem is reduced to a parametric optimal control problem without initial conditions, but with nonseparated boundary conditions. The latter problem is solved by applying first-order optimization methods. Results of numerical experiments are presented.

32 CFR 564.37 - Medical care.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care; policies outlining the manner, conditions, procedures, and eligibility for care; and the sources from which...

Numerical investigation of solid-liquid two phase flow in a non-clogging centrifugal pump at off-design conditions

International Nuclear Information System (INIS)

Zhao, B J; Chen, H L; Hou, D H; Huang, Z F

2012-01-01

The solid-liquid two-phase flow fields in the non-clogging centrifugal pump with a double-channel impeller have been investigated numerically for the design condition and also off-design conditions, in order to study the solid-liquid two-phase flow pattern and non-clogging mechanism in non-clogging centrifugal pumps. The main conclusions include: The sand volume fraction distribution is extremely inhomogeneous in the whole flow channel of the pump at off-design conditions. In the impeller, particles mainly flow along the pressure surface and hub; In the volute, particles mainly accumulate in the region near to the exit of volute, the largest sand volume fraction is observed at the tongue, and a large number of particles collide with volute wall and exit the volute after circling around the volute for several times. When the particle diameter increases, particles tend to accumulate on the pressure side of the impeller, and more particles crash with the pressure side of the blade. And larger sand volume fraction gratitude is also observed in the whole flow channel of the pump. With the decrease of the inlet sand volume fraction, particles tend to accumulate on the suction side of the blade. Compared with the particle diameter, the inlet sand volume fraction has less influence on the sand volume fraction gratitude in the whole channel of the pump. At the large flow rate, the minimum and maximum sand volume fraction in the whole flow channel of the model pump tends to be smaller than that at the small flow rate. Thus, it is concluded that the water transportation capacity increases with the flow rate. This research will strengthen people's understanding of the multiphase flow pattern in non-clogging centrifugal pumps, thus provides a theoretical basis for the optimal design of non-clogging centrifugal pumps.

Simple Numerical Simulation of Strain Measurement

Science.gov (United States)

Tai, H.

2002-01-01

By adopting the basic principle of the reflection (and transmission) of a plane polarized electromagnetic wave incident normal to a stack of films of alternating refractive index, a simple numerical code was written to simulate the maximum reflectivity (transmittivity) of a fiber optic Bragg grating corresponding to various non-uniform strain conditions including photo-elastic effect in certain cases.

A Numerical Framework for Self-Similar Problems in Plasticity: Indentation in Single Crystals

DEFF Research Database (Denmark)

Juul, Kristian Jørgensen; Niordson, Christian Frithiof; Nielsen, Kim Lau

A new numerical framework specialized for analyzing self-similar problems in plasticity is developed. Self-similarity in plasticity is encountered in a number of different problems such as stationary cracks, void growth, indentation etc. To date, such problems are handled by traditional Lagrangian...... procedures that may be associated with severe numerical difficulties relating to sufficient discretization, moving contact points, etc. In the present work, self-similarity is exploited to construct the numerical framework that offers a simple and efficient method to handle self-similar problems in history...... numerical simulations [3] when possible. To mimic the condition for the analytical predictions, the wedge indenter is considered nearly flat and the material is perfectly plastic with a very low yield strain. Under these conditions, [1][2] proved analytically the existence of discontinuities in the slip...

Invitation to medical image processing

International Nuclear Information System (INIS)

Kitasaka, Takayuki; Suenaga, Yasuhito; Mori, Kensaku

2010-01-01

This medical essay explains the present state of CT image processing technology about its recognition, acquisition and visualization for computer-assisted diagnosis (CAD) and surgery (CAS), and future view. Medical image processing has a series of history of its original start from the discovery of X-ray to its application to diagnostic radiography, its combination with the computer for CT, multi-detector raw CT, leading to 3D/4D images for CAD and CAS. CAD is performed based on the recognition of normal anatomical structure of human body, detection of possible abnormal lesion and visualization of its numerical figure into image. Actual instances of CAD images are presented here for chest (lung cancer), abdomen (colorectal cancer) and future body atlas (models of organs and diseases for imaging), a recent national project: computer anatomy. CAS involves the surgical planning technology based on 3D images, navigation of the actual procedure and of endoscopy. As guidance to beginning technological image processing, described are the national and international community like related academic societies, regularly conducting congresses, textbooks and workshops, and topics in the field like computed anatomy of an individual patient for CAD and CAS, its data security and standardization. In future, protective medicine is in authors' view based on the imaging technology, e.g., daily life CAD of individuals ultimately, as exemplified in the present body thermometer and home sphygmometer, to monitor one's routine physical conditions. (T.T.)

Performance Analysis of IEEE 802.15.6 CSMA/CA Protocol for WBAN Medical Scenario through DTMC Model.

Science.gov (United States)

Kumar, Vivek; Gupta, Bharat

2016-12-01

The newly drafted IEEE 802.15.6 standard for Wireless Body Area Networks (WBAN) has been concentrating on a numerous medical and non-medical applications. Such short range wireless communication standard offers ultra-low power consumption with variable data rates from few Kbps to Mbps in, on or around the proximity of the human body. In this paper, the performance analysis of carrier sense multiple access with collision avoidance (CSMA/CA) scheme based on IEEE 802.15.6 standard in terms of throughput, reliability, clear channel assessment (CCA) failure probability, packet drop probability, and end-to-end delay has been presented. We have developed a discrete-time Markov chain (DTMC) to significantly evaluate the performances of IEEE 802.15.6 CSMA/CA under non-ideal channel condition having saturated traffic condition including node wait time and service time. We also visualize that, as soon as the payload length increases the CCA failure probability increases, which results in lower node's reliability. Also, we have calculated the end-to-end delay in order to prioritize the node wait time cause by backoff and retransmission. The user priority (UP) wise DTMC analysis has been performed to show the importance of the standard especially for medical scenario.

Numerical study of interfacial flows with immersed solids

International Nuclear Information System (INIS)

Kim, Sung Il; Son, Gi Hun

2003-01-01

A numerical method is presented for computing unsteady incompressible two-phase flows with immersed solids. The method is based on a level set technique for capturing the phase interface, which is modified to satisfy a contact angle condition at the solid-fluid interface as well as to achieve mass conservation during the whole calculation procedure. The modified level set method is applied for numerical simulation of bubble deformation in a micro channel with a cylindrical solid block and liquid jet from a micro nozzle

A round robin on numerical analyses for impact problems

International Nuclear Information System (INIS)

Yagawa, G.; Ohtsubo, H.; Toi, Y.; Aizawa, T.; Ikushima, T.

1984-01-01

In this paper, two types of numerical tests are performed using several general- and special-purpose computer codes to understand dynamic behaviors of CASK for nuclear fuel shipping under the impact onto rigid floor due to the accidental fall from the height of 9 m. Discussed are the efficiency and the validity of direct time integration schemes and the effects of material and geometric nonlinearities and contact conditions on the numerical data. (orig.)

Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers.

Science.gov (United States)

Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G

2016-08-01

A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance. Project HOPE—The People-to-People Health Foundation, Inc.

Numerical Simulation and Validation of a High Head Model Francis Turbine at Part Load Operating Condition

Science.gov (United States)

Goyal, Rahul; Trivedi, Chirag; Kumar Gandhi, Bhupendra; Cervantes, Michel J.

2017-07-01

Hydraulic turbines are operated over an extended operating range to meet the real time electricity demand. Turbines operated at part load have flow parameters not matching the designed ones. This results in unstable flow conditions in the runner and draft tube developing low frequency and high amplitude pressure pulsations. The unsteady pressure pulsations affect the dynamic stability of the turbine and cause additional fatigue. The work presented in this paper discusses the flow field investigation of a high head model Francis turbine at part load: 50% of the rated load. Numerical simulation of the complete turbine has been performed. Unsteady pressure pulsations in the vaneless space, runner, and draft tube are investigated and validated with available experimental data. Detailed analysis of the rotor stator interaction and draft tube flow field are performed and discussed. The analysis shows the presence of a rotating vortex rope in the draft tube at the frequency of 0.3 times of the runner rotational frequency. The frequency of the vortex rope precession, which causes severe fluctuations and vibrations in the draft tube, is predicted within 3.9% of the experimental measured value. The vortex rope results pressure pulsations propagating in the system whose frequency is also perceive in the runner and upstream the runner.

Guide of good practices in medical physics - French Society of Medical Physics

International Nuclear Information System (INIS)

Rosenwald, Jean-Claude; Aventin, Christophe; Coste, Frederic; Francois, Pascal; Ginestet, Chantal; Perrin, Benedicte; Salvat, Cecile; Caselles, Olivier; Dedieu, Veronique; Dejean, Catherine; Batalla, Alain; Guillaume, Bonniaud; Le Du, Dominique; Lisbona, Albert; Marchesi, Vincent; Sarrazin, Thierry; Mazeron, Jean-Jacques; Lipinski, Francis; Vera, Pierre; Vermandel, Maximilien; Ducou le Pointe, Hubert; Vidal, Vincent; Henry, Cecile; Mazeau-Woynar, Valerie; Prot, Camille; Valero, Marc; Aubert, Bernard; Etard, Cecile; Jimonet, Christine; Roue, Amelie; Sage, Julie; Bardies, Manuel; Beauvais, Helene; Bey, Pierre; Costa, Andre; Desblancs, Claire; Eudaldo, Teresa; Farman, Bardia; Ferrand, Regis; Garcia, Robin; Giraud, Jean-Yves; Husson, Francois; Koulibaly, Malick; Carlan, Loic de; Manens, Jean-Pierre; Naudy, Suzanne; Noel, Alain; Pilette, Pierre; Verdun, Francis; Bouette, Aurelien; Breen, Stephen; Bridier, Andre; Chauvenet, Bruno; Chavaudra, Jean; Gardin, Isabelle; Herlevin, Karine

2012-01-01

After a presentation of the methodological approach used to write this book, the first chapter addresses the profession of medical physicist: medical physics in France (history, evolution of the profession, of the education and of regulation), legal framework (related to the medical use of ionizing radiations, legal texts directly concerning medical physics, regulations impacting the professional practice of medical physicists), scopes of intervention of the medical physicist (context, missions, dose management, image quality, quality management and safety, relationship with the patient, education, training and research, relationships with industry, cost management), operating conditions, and good professional practices. The second chapter addresses the principles of management of quality and safety: quality management in medical physics, safety management, quality and safety in health care facilities. The third part addresses good practices in medical physics: general principles of working methods, equipment management, participation to clinic activities