WorldWideScience

Sample records for permissible limits set

  1. HEDIS Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of Americas health plans to measure performance on important...

  2. NASA Space Radiation Protection Strategies: Risk Assessment and Permissible Exposure Limits

    Science.gov (United States)

    Huff, J. L.; Patel, Z. S.; Simonsen, L. C.

    2017-01-01

    Permissible exposure limits (PELs) for short-term and career astronaut exposures to space radiation have been set and approved by NASA with the goal of protecting astronauts against health risks associated with ionizing radiation exposure. Short term PELs are intended to prevent clinically significant deterministic health effects, including performance decrements, which could threaten astronaut health and jeopardize mission success. Career PELs are implemented to control late occurring health effects, including a 3% risk of exposure induced death (REID) from cancer, and dose limits are used to prevent cardiovascular and central nervous system diseases. For radiation protection, meeting the cancer PEL is currently the design driver for galactic cosmic ray and solar particle event shielding, mission duration, and crew certification (e.g., 1-year ISS missions). The risk of cancer development is the largest known long-term health consequence following radiation exposure, and current estimates for long-term health risks due to cardiovascular diseases are approximately 30% to 40% of the cancer risk for exposures above an estimated threshold (Deep Space one-year and Mars missions). Large uncertainties currently exist in estimating the health risks of space radiation exposure. Improved understanding through radiobiology and physics research allows increased accuracy in risk estimation and is essential for ensuring astronaut health as well as for controlling mission costs, optimization of mission operations, vehicle design, and countermeasure assessment. We will review the Space Radiation Program Element's research strategies to increase accuracy in risk models and to inform development and validation of the permissible exposure limits.

  3. 42 CFR 433.67 - Limitations on level of FFP for permissible provider-related donations.

    Science.gov (United States)

    2010-10-01

    ... provider-related donations. 433.67 Section 433.67 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... permissible provider-related donations. (a)(1) Limitations on bona fide donations. There are no limitations on the amount of bona fide provider-related donations that a State may receive without a reduction in FFP...

  4. Guidelines for setting speed limits

    CSIR Research Space (South Africa)

    Wium, DJW

    1986-02-01

    Full Text Available , parking and loading manoeuvres, access to bounding properties, intersections, width of road without central median and clear roadside area. The method should result in greater uniformity in speed limits for similar circumstances as set by different...

  5. Threshold limit values, permissible exposure limits, and feasibility: The bases for exposure limits in the United States

    International Nuclear Information System (INIS)

    Rappaport, S.M.

    1993-01-01

    The development of exposure limits in the United States has always relied heavily upon the threshold limit values (TLVs) developed by the American Conference of Governmental Industrial Hygienists (ACGIH). In fact, the TLVs were adopted as official exposure limits by the Occupational Safety and Health Administration (OSHA) in 1972 and 1989. Given the continuing importance of the ACGIH limits, this paper compares the basis of the TLVs with that employed by OSHA de novo in its 12 new permissible exposure limits (PELs). Using benzene as an example, it is shown that OSHA's new PELs have been established following a rigorous assessment of the inherent risks and the feasibility of instituting the limit. The TLVs, on the other hand, have been developed by ad hoc procedures and appear to have traditionally reflected levels thought to be achievable at the time. However, this might be changing. Analysis of the historical reductions of TLVs, for 27 substances on the 1991-1992 list of intended changes, indicates smaller reductions in the past (median reduction of 2.0-2.5-fold between 1946 and 1988) compared to those currently being observed (median reduction of 7.5-fold between 1989 and 1991). Further analysis suggests a more aggressive policy of the ACGIH regarding TLVs for carcinogens but not for substances that produce effects other than cancer. Regardless of whether the basis of the TLVs has changed recently, it would take a relatively long time for the impact of any change to be felt, since the median age of the 1991-1992 TLVs is 16.5 years, and 75% of these limits are more than 10 years old. The implications of OSHA's continued reliance on the TLVs as a means of updating its PELs are discussed, and four alternatives are presented to the ACGIH regarding the future of its activities related to exposure limits. It is concluded that new mechanisms are needed for OSHA to update its PELs in a timely fashion so that the TLVs will not be adopted by default in the future

  6. The Impact of Different Permissible Exposure Limits on Hearing Threshold Levels Beyond 25 dBA.

    Science.gov (United States)

    Sayapathi, Balachandar S; Su, Anselm Ting; Koh, David

    2014-10-01

    Development of noise-induced hearing loss is reliant on a few factors such as frequency, intensity, and duration of noise exposure. The occurrence of this occupational malady has doubled from 120 million to 250 million in a decade. Countries such as Malaysia, India, and the US have adopted 90 dBA as the permissible exposure limit. According to the US Occupational Safety and Health Administration (OSHA), the exposure limit for noise is 90 dBA, while that of the US National Institute of Occupational Safety and Health (NIOSH) is 85 dBA for 8 hours of noise exposure. This study aimed to assess the development of hearing threshold levels beyond 25 dBA on adoption of 85 dBA as the permissible exposure limit compared to 90 dBA. This is an intervention study done on two automobile factories. There were 203 employees exposed to noise levels beyond the action level. Hearing protection devices were distributed to reduce noise levels to a level between the permissible exposure limit and action level. The permissible exposure limits were 90 and 85 dBA in factories 1 and 2, respectively, while the action levels were 85 and 80 dBA, respectively. The hearing threshold levels of participants were measured at baseline and at first month of postshift exposure of noise. The outcome was measured by a manual audiometer. McNemar and chi-square tests were used in the statistical analysis. We found that hearing threshold levels of more than 25 dBA has changed significantly from pre-intervention to post-intervention among participants from both factories (3000 Hz for the right ear and 2000 Hz for the left ear). There was a statistically significant association between participants at 3000 Hz on the right ear at 'deteriorated' level ( χ² (1) = 4.08, φ = - 0.142, P = 0.043), whereas there was worsening of hearing threshold beyond 25 dBA among those embraced 90 dBA. The adoption of 85 dBA as the permissible exposure limit has preserved hearing threshold level among participants at 3000 Hz

  7. The Impact of Different Permissible Exposure Limits on Hearing Threshold Levels Beyond 25 dBA

    OpenAIRE

    Sayapathi, Balachandar S; Su, Anselm Ting; Koh, David

    2014-01-01

    Background: Development of noise-induced hearing loss is reliant on a few factors such as frequency, intensity, and duration of noise exposure. The occurrence of this occupational malady has doubled from 120 million to 250 million in a decade. Countries such as Malaysia, India, and the US have adopted 90 dBA as the permissible exposure limit. According to the US Occupational Safety and Health Administration (OSHA), the exposure limit for noise is 90 dBA, while that of the US National Institut...

  8. Setting limits on supersymmetry using simplified models

    CERN Document Server

    Gutschow, C.

    2012-01-01

    Experimental limits on supersymmetry and similar theories are difficult to set because of the enormous available parameter space and difficult to generalize because of the complexity of single points. Therefore, more phenomenological, simplified models are becoming popular for setting experimental limits, as they have clearer physical implications. The use of these simplified model limits to set a real limit on a concrete theory has not, however, been demonstrated. This paper recasts simplified model limits into limits on a specific and complete supersymmetry model, minimal supergravity. Limits obtained under various physical assumptions are comparable to those produced by directed searches. A prescription is provided for calculating conservative and aggressive limits on additional theories. Using acceptance and efficiency tables along with the expected and observed numbers of events in various signal regions, LHC experimental results can be re-cast in this manner into almost any theoretical framework, includ...

  9. Health Outcomes Survey - Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Health Outcomes Survey (HOS) limited data sets (LDS) are comprised of the entire national sample for a given 2-year cohort (including both respondents...

  10. Maximum permissible dose

    International Nuclear Information System (INIS)

    Anon.

    1979-01-01

    This chapter presents a historic overview of the establishment of radiation guidelines by various national and international agencies. The use of maximum permissible dose and maximum permissible body burden limits to derive working standards is discussed

  11. Advantages and limitations of the SETS method

    International Nuclear Information System (INIS)

    Mahaffy, J.H.

    1983-01-01

    The stability-enchancing two-step (SETS) method has been used successfully in the Transient Reactor Analysis Code (TRAC) for several years. The method consists of a basic semi-implicit step combined with a stabilizer step that, taken together, eliminate the material Courant stability limit associated with standard semi-implicit numerical methods. This approach toward stability requires significantly fewer computational operations than a fully implicit method, but currently maintains the first-order accuracy in space and time of its semi-implicit predecessors

  12. Limited parameter set IMRT for carcinoma breast

    International Nuclear Information System (INIS)

    Gopinath, M.; Sharma, Sanjiv; Vivek, T.R.; Suparna; Deka, Preeti; Manikandan; Giriraj

    2008-01-01

    Post operative radiotherapy after breast conservation surgery is an effective and widely accepted treatment modality in early stage breast cancer. The treatment is usually performed using two wedged tangential photon beams. The disadvantage of this technique is significant dose inhomogeneity as large as 15-20% in the superior and inferior regions of the breast due to lesser transmission thickness and in the medial and lateral aspect of the breast due to lower attenuation of lung tissue in the field. The aim of the study is to modify the conventional wedged tangential pair to achieve a more homogeneous dose distribution and a reduction in acute toxicity and improved cosmetic result. A comparative study is done between the conventional wedged technique and limited parameter set IMRT

  13. Establishing Medical Schools in Limited Resource Settings.

    Science.gov (United States)

    Tsinuel, Girma; Tsedeke, Asaminew; Matthias, Siebeck; Fischer, Martin R; Jacobs, Fabian; Sebsibe, Desalegn; Yoseph, Mamo; Abraham, Haileamlak

    2016-05-01

    One urgent goal of countries in sub-Saharan Africa is to dynamically scale up the education and work force of medical doctors in the training institutions and health facilities, respectively. These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical education done in the context of limited resources is thus compromising the quality of graduates. In the future, a collaborative and need-based approach involving major stakeholders such as medical educators concerned, ministries, planners and policy makers is needed. This article identifies the challenges of establishing medical schools and sustaining the quality of education through rapid scale-up in Sub-Saharan Africa in the settings of limited resources. It also outlines the minimum requirements for establishing medical schools. A consensus building workshop was conducted in Bishoftu, Ethiopia, from Nov 8-12, 2013. Participants were professionals from 13 Ethiopian medical schools, and representatives of medical schools from South Sudan, Somaliland, Somalia, and Mozambique. Participants are listed in Appendix 1. The governments and stakeholders should jointly develop strategic plans and a roadmaps for opening or expanding medical schools to scale up educational resources. It is advisable that medical schools have autonomy regarding the number of student-intake, student selection, curriculum ownership, resource allocation including for infrastructure and staff development. Health science and medical curricula should be integrated within and harmonized nationally. An educational evaluation framework needs to be embedded in the curricula, and all medical schools should have Health Science Education Development Centers.

  14. Providing anesthesia in resource-limited settings.

    Science.gov (United States)

    Dohlman, Lena E

    2017-08-01

    The article reviews the reality of anesthetic resource constraints in low and middle-income countries (LMICs). Understanding these limitations is important to volunteers from high-income countries who desire to teach or safely provide anesthesia services in these countries. Recently published information on the state of anesthetic resources in LMICs is helping to guide humanitarian outreach efforts from high-income countries. The importance of using context-appropriate anesthesia standards and equipment is now emphasized. Global health experts are encouraging equal partnerships between anesthesia health care providers working together from different countries. The key roles that ketamine and regional anesthesia play in providing well tolerated anesthesia for cesarean sections and other common procedures is increasingly recognized. Anesthesia can be safely given in LMICs with basic supplies and equipment, if the anesthesia provider is trained and vigilant. Neuraxial and regional anesthesia and the use of ketamine as a general anesthetic appear to be the safest alternatives in low-resource countries. Environmentally appropriate equipment should be encouraged and pulse oximeters should be in every anesthetizing location. LMICs will continue to need support from outside sources until capacity building has made more progress.

  15. Natural penetrating radiation inside silicate dwellings in Chengdu and recommendation on permissible limits for radioactivity of building material made of silicate cinders

    International Nuclear Information System (INIS)

    Li Guangzao

    1984-01-01

    This paper reports the results of external exposure rate of penetrating radiation inside silicate dwellings in Chengdu. The average exposure rate was 24.3+-3.5 R/h. It was evidently higher than of red brick dwellings. The average effective equivalent of the population in silicate dwellings was 123.4+-10.4 mrem/y and the average additional dose was 29.5+-12.5 mrem/y. The permissible limits recommended for silicate building material would be 6 pCi/g, 7 pCi/g and 102 pCi/g for 226 Ra, 232 Th and 40 K, respectively. The total activity must fulfill the formula of Csub(Ra)/6 + Csub(Th)/7 + Csub(k)/102 1. Under ordinary condition the exposure rate (10+background) R/h of penetrating radiation from the surface of dry building material might be taken as the permissible limit for dwellings and other public buildings

  16. Suggested Safeguards and Limitations for Effective and Permissible Parenting Coordination (Facilitation or Case Management in South Africa

    Directory of Open Access Journals (Sweden)

    Madelene (Leentjie de Jong

    2015-07-01

    arbitration in respect of matrimonial matters. Lastly, the cost of parenting coordination is indicated as an area of contention. To properly address these problems, various safeguards for and limitations on parenting coordination practice are considered. It is proposed that the internationally accepted term "parenting coordination" is also consistently used in South Africa. It is further proposed that adequate qualifications, proper training and sufficient experience for parenting coordinators are set. To counter the argument that parenting coordination is an unlawful delegation of judicial power, the necessary authority for courts to refer parties for parenting coordination is sought, firstly in the inherent power of the High Court as upper guardian to ensure the best interests of children, and secondly in the Children's Act and the Constitution of the Republic of South Africa, 1996 as far as the children's court and divorce courts are concerned. In addition, various limitations regarding the conditions under which and the stage at which a parenting coordinator should be appointed, the scope of a parenting coordinator's decision-making powers and the finality of his or her directives are suggested. Lastly, the issue of the affordability of parenting coordination is addressed and suggestions are made on ways to provide fair access to this new intervention

  17. Exploring nurses' and patients' perspectives of limit setting in a forensic mental health setting.

    Science.gov (United States)

    Maguire, Tessa; Daffern, Michael; Martin, Trish

    2014-04-01

    Limit setting is an intervention that is frequently used by mental health nurses. However, limit setting is poorly conceptualized, its purpose is unclear, and there are few evidence-based guidelines to assist nurses to set limits in a safe and effective manner. What is known is that the manner in which nurses set limits influences patients' perceptions of the interactions and their emotional and behavioural responses. In this qualitative study, 12 nurses and 12 patients participated in personal, semistructured interviews that aimed to explore limit setting and to propose principles to guide practice. The findings suggested that: (i) limit setting is important to safety in mental health hospitals; (ii) engaging patients in an empathic manner is necessary when setting limits (when nurses engage in an empathic manner, the therapeutic relationship is more likely to be preserved and the risk of aggressive responses is reduced); and (iii) an authoritative (fair, respectful, consistent, and knowledgeable), rather than authoritarian (controlling and indifferent), limit-setting style enhances positive outcomes with regards to adherence, reduced likelihood of aggression, and preservation of the therapeutic relationship. In conclusion, a limit-setting style characterized by empathic responding and an authoritative, rather than authoritarian interpersonal, style is recommended. Elucidating the components of this style is critical for effective training and best practice of mental health nurses, and to reduce aggressive responses from limit setting. © 2013 Australian College of Mental Health Nurses Inc.

  18. The Limits of Fair Use in Military Scholarship: When, How, and From Whom to Request Permission to Use Copyrighted Works

    Science.gov (United States)

    2010-01-01

    69 J. AIR L. & COM. 743 (2004) (citing a popular song performed by the Beatles ). 152 E.g., Emily Kathryn Taylor, Note, Infringicus Maximus! An...16 JANUARY 2010 • THE ARMY LAWYER • DA PAM 27-50-440 The Limits of Fair Use in Military Scholarship: When, How, and From Whom to Request...throughout the military.1 Specialty journals, such as The Army Lawyer, and the Military, Naval, and Air Force Law Reviews (combined military publications

  19. The levels of heavy metals in water and all aquatic in Ismailia canal, (Egypt) compared with the international permissible limits and accumulative studies for these metals in biota

    International Nuclear Information System (INIS)

    Saleh, H.M.; Moloukhia, H.; Belacy, N.; Abd El-Rahman, G.A.

    2011-01-01

    The concentration of Pb, Cd, Cu, Zu, Ni, Fe and Mn were determined in water, and in different organs of fishes, bivalves, snails and plants in Ismailia canal, Egypt. Moreover, accumulation of the investigated heavy metals by aquatic biota in Ismailia canal and the concentration factor values for this accumulation were calculated to qualify the degree of pollution and compare these levels with the international permissible limits. Results showed that Pb, Cd, Cu and Zn were exceeded the permissible limits especially in the industrial area of Abu- Zaabal, Kalubia governorate. The relative order of heavy metal levels in the canal water was: Fe>Mn>Pb>Zn>Ni>Cd>Cu.Accumulation of heavy metals by the aquatic biota was determined. The accumulation of heavy metals by common snails, namely physa acuta and biomphalaria alexandrina and the bivalve oyster Caelatura (caelatura) companyoi was found mainly in the edible parts (soft parts), whereas, the accumulation by their shells, which are mainly formed of calcium carbonate was via adsorption and surface complexation, since all the accumulated heavy metals were released by adding 0.1 M HCl for few minutes . Moreover, accumulation of heavy metals by common plants namely water hyacinth plant (Eichhornia crassipes) and freshwater weeds were determined. It was found that the accumulation of heavy metals was higher in roots than in leaves. On the other hand, the accumulation of heavy metals by common fish namely, Oreochromis niloticus (Nile Tilapia) was measured in its organs : muscles, liver, gills and gonads. It was found that there is variation of distribution of heavy metals among fish organs. Since the high accumulation of heavy metals among the investigated biota, they can be used as biological indicator for pollution of heavy metals in aquatic ecosystem . The average values and standard deviation for all measurements were determined. Data obtained were compared with the permissible concentrations of the environmental protection

  20. Rethinking Permissioned Blockchains

    OpenAIRE

    Vukolic, Marko

    2017-01-01

    Current blockchain platforms, especially the recent permissioned systems, have architectural limitations: smart contracts run sequentially, all node executes all smart contracts, consensus protocols are hard-coded, the trust model is static and not exible, and non-determinism in smart-contract execution poses serious problems. Overcoming these limitations is critical for improving both functional properties of blockchains, such as con dentiality and consistency, as well as their non-functiona...

  1. Gene set analysis: limitations in popular existing methods and proposed improvements.

    Science.gov (United States)

    Mishra, Pashupati; Törönen, Petri; Leino, Yrjö; Holm, Liisa

    2014-10-01

    Gene set analysis is the analysis of a set of genes that collectively contribute to a biological process. Most popular gene set analysis methods are based on empirical P-value that requires large number of permutations. Despite numerous gene set analysis methods developed in the past decade, the most popular methods still suffer from serious limitations. We present a gene set analysis method (mGSZ) based on Gene Set Z-scoring function (GSZ) and asymptotic P-values. Asymptotic P-value calculation requires fewer permutations, and thus speeds up the gene set analysis process. We compare the GSZ-scoring function with seven popular gene set scoring functions and show that GSZ stands out as the best scoring function. In addition, we show improved performance of the GSA method when the max-mean statistics is replaced by the GSZ scoring function. We demonstrate the importance of both gene and sample permutations by showing the consequences in the absence of one or the other. A comparison of asymptotic and empirical methods of P-value estimation demonstrates a clear advantage of asymptotic P-value over empirical P-value. We show that mGSZ outperforms the state-of-the-art methods based on two different evaluations. We compared mGSZ results with permutation and rotation tests and show that rotation does not improve our asymptotic P-values. We also propose well-known asymptotic distribution models for three of the compared methods. mGSZ is available as R package from cran.r-project.org. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  2. Take control of permissions in Leopard

    CERN Document Server

    Tanaka, Brian

    2009-01-01

    Permissions problems got you down? Turn to Unix expert Brian Tanaka's unique guide to the permissions in Mac OS X 10.5 Leopard that control access to your files, folders, and disks. You'll learn how to keep files private, when to set Ignore Permissions, what happens when you repair permissions, how to delete stuck files, and the best ways to solve permissions-related problems. Advanced concepts include the sticky bit, Leopard's more-important access control lists, bit masks, and symbolic versus absolute ways to set permissions. The book covers how to take control of permissions via the Finder

  3. Permissible Delay in Payments

    Directory of Open Access Journals (Sweden)

    Yung-Fu Huang

    2007-01-01

    Full Text Available The main purpose of this paper wants to investigate the optimal retailer's lot-sizing policy with two warehouses under partially permissible delay in payments within the economic order quantity (EOQ framework. In this paper, we want to extend that fully permissible delay in payments to the supplier would offer the retailer partially permissible delay in payments. That is, the retailer must make a partial payment to the supplier when the order is received. Then the retailer must pay off the remaining balance at the end of the permissible delay period. In addition, we want to add the assumption that the retailer's storage space is limited. That is, the retailer will rent the warehouse to store these exceeding items when the order quantity is larger than retailer's storage space. Under these conditions, we model the retailer's inventory system as a cost minimization problem to determine the retailer's optimal cycle time and optimal order quantity. Three theorems are developed to efficiently determine the optimal replenishment policy for the retailer. Finally, numerical examples are given to illustrate these theorems and obtained a lot of managerial insights.

  4. Therapeutic drug monitoring of nevirapine in resource-limited settings.

    NARCIS (Netherlands)

    L'homme, R.F.A.; Muro, E.P.; Droste, J.A.H.; Wolters, L.R.; Ewijk-Beneken Kolmer, E.W.J. van; Schimana, W.; Burger, D.M.

    2008-01-01

    BACKGROUND: We developed a simple and inexpensive thin-layer chromatography (TLC) assay for semiquantitative detection of saliva concentrations of nevirapine in resource-limited settings. The method was validated in an African target population. METHODS: Paired plasma and saliva nevirapine

  5. Establishing Medical Schools in Limited Resource Settings | Girma ...

    African Journals Online (AJOL)

    Establishing Medical Schools in Limited Resource Settings. ... These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical ...

  6. Tuberculosis diagnosis in resource-limited settings: Clinical use of ...

    African Journals Online (AJOL)

    EB

    GeneXpert in the diagnosis of smear-negative PTB: a case report ... Background: The Xpert MTB/RIF test (GeneXpert) has recently been endorsed for use in resource-limited settings for the ... normochromic anemia (9.2g/dl), hypoalbuminemia.

  7. Limited Effects of Set Shifting Training in Healthy Older Adults

    Directory of Open Access Journals (Sweden)

    Petra Grönholm-Nyman

    2017-03-01

    Full Text Available Our ability to flexibly shift between tasks or task sets declines in older age. As this decline may have adverse effects on everyday life of elderly people, it is of interest to study whether set shifting ability can be trained, and if training effects generalize to other cognitive tasks. Here, we report a randomized controlled trial where healthy older adults trained set shifting with three different set shifting tasks. The training group (n = 17 performed adaptive set shifting training for 5 weeks with three training sessions a week (45 min/session, while the active control group (n = 16 played three different computer games for the same period. Both groups underwent extensive pre- and post-testing and a 1-year follow-up. Compared to the controls, the training group showed significant improvements on the trained tasks. Evidence for near transfer in the training group was very limited, as it was seen only on overall accuracy on an untrained computerized set shifting task. No far transfer to other cognitive functions was observed. One year later, the training group was still better on the trained tasks but the single near transfer effect had vanished. The results suggest that computerized set shifting training in the elderly shows long-lasting effects on the trained tasks but very little benefit in terms of generalization.

  8. Crossing the quality chasm in resource-limited settings.

    Science.gov (United States)

    Maru, Duncan Smith-Rohrberg; Andrews, Jason; Schwarz, Dan; Schwarz, Ryan; Acharya, Bibhav; Ramaiya, Astha; Karelas, Gregory; Rajbhandari, Ruma; Mate, Kedar; Shilpakar, Sona

    2012-11-30

    Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm"--the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

  9. Sulfonylurea herbicides – methodological challenges in setting aquatic limit values

    DEFF Research Database (Denmark)

    Rosenkrantz, Rikke Tjørnhøj; Baun, Anders; Kusk, Kresten Ole

    according to the EU Water Framework Directive, the resulting Water Quality Standards (WQSs) are below the analytical quantification limit, making it difficult to verify compliance with the limit values. However, several methodological concerns may be raised in relation to the very low effect concentrations...... and rimsulfuron. The following parameters were varied during testing: pH, exposure duration, temperature and light/dark cycle. Preliminary results show that a decrease in pH causes an increase in toxicity for all compounds. Exposure to a high concentration for 24 hours caused a reduction in growth rate, from...... for setting limit values for SUs or if more detailed information should be gained by taking methodological considerations into account....

  10. Estimating the CCSD basis-set limit energy from small basis sets: basis-set extrapolations vs additivity schemes

    Energy Technology Data Exchange (ETDEWEB)

    Spackman, Peter R.; Karton, Amir, E-mail: amir.karton@uwa.edu.au [School of Chemistry and Biochemistry, The University of Western Australia, Perth, WA 6009 (Australia)

    2015-05-15

    Coupled cluster calculations with all single and double excitations (CCSD) converge exceedingly slowly with the size of the one-particle basis set. We assess the performance of a number of approaches for obtaining CCSD correlation energies close to the complete basis-set limit in conjunction with relatively small DZ and TZ basis sets. These include global and system-dependent extrapolations based on the A + B/L{sup α} two-point extrapolation formula, and the well-known additivity approach that uses an MP2-based basis-set-correction term. We show that the basis set convergence rate can change dramatically between different systems(e.g.it is slower for molecules with polar bonds and/or second-row elements). The system-dependent basis-set extrapolation scheme, in which unique basis-set extrapolation exponents for each system are obtained from lower-cost MP2 calculations, significantly accelerates the basis-set convergence relative to the global extrapolations. Nevertheless, we find that the simple MP2-based basis-set additivity scheme outperforms the extrapolation approaches. For example, the following root-mean-squared deviations are obtained for the 140 basis-set limit CCSD atomization energies in the W4-11 database: 9.1 (global extrapolation), 3.7 (system-dependent extrapolation), and 2.4 (additivity scheme) kJ mol{sup –1}. The CCSD energy in these approximations is obtained from basis sets of up to TZ quality and the latter two approaches require additional MP2 calculations with basis sets of up to QZ quality. We also assess the performance of the basis-set extrapolations and additivity schemes for a set of 20 basis-set limit CCSD atomization energies of larger molecules including amino acids, DNA/RNA bases, aromatic compounds, and platonic hydrocarbon cages. We obtain the following RMSDs for the above methods: 10.2 (global extrapolation), 5.7 (system-dependent extrapolation), and 2.9 (additivity scheme) kJ mol{sup –1}.

  11. Estimating the CCSD basis-set limit energy from small basis sets: basis-set extrapolations vs additivity schemes

    International Nuclear Information System (INIS)

    Spackman, Peter R.; Karton, Amir

    2015-01-01

    Coupled cluster calculations with all single and double excitations (CCSD) converge exceedingly slowly with the size of the one-particle basis set. We assess the performance of a number of approaches for obtaining CCSD correlation energies close to the complete basis-set limit in conjunction with relatively small DZ and TZ basis sets. These include global and system-dependent extrapolations based on the A + B/L α two-point extrapolation formula, and the well-known additivity approach that uses an MP2-based basis-set-correction term. We show that the basis set convergence rate can change dramatically between different systems(e.g.it is slower for molecules with polar bonds and/or second-row elements). The system-dependent basis-set extrapolation scheme, in which unique basis-set extrapolation exponents for each system are obtained from lower-cost MP2 calculations, significantly accelerates the basis-set convergence relative to the global extrapolations. Nevertheless, we find that the simple MP2-based basis-set additivity scheme outperforms the extrapolation approaches. For example, the following root-mean-squared deviations are obtained for the 140 basis-set limit CCSD atomization energies in the W4-11 database: 9.1 (global extrapolation), 3.7 (system-dependent extrapolation), and 2.4 (additivity scheme) kJ mol –1 . The CCSD energy in these approximations is obtained from basis sets of up to TZ quality and the latter two approaches require additional MP2 calculations with basis sets of up to QZ quality. We also assess the performance of the basis-set extrapolations and additivity schemes for a set of 20 basis-set limit CCSD atomization energies of larger molecules including amino acids, DNA/RNA bases, aromatic compounds, and platonic hydrocarbon cages. We obtain the following RMSDs for the above methods: 10.2 (global extrapolation), 5.7 (system-dependent extrapolation), and 2.9 (additivity scheme) kJ mol –1

  12. Optimising Mycobacterium tuberculosis detection in resource limited settings.

    Science.gov (United States)

    Alfred, Nwofor; Lovette, Lawson; Aliyu, Gambo; Olusegun, Obasanya; Meshak, Panwal; Jilang, Tunkat; Iwakun, Mosunmola; Nnamdi, Emenyonu; Olubunmi, Onuoha; Dakum, Patrick; Abimiku, Alash'le

    2014-03-03

    The light-emitting diode (LED) fluorescence microscopy has made acid-fast bacilli (AFB) detection faster and efficient although its optimal performance in resource-limited settings is still being studied. We assessed the optimal performances of light and fluorescence microscopy in routine conditions of a resource-limited setting and evaluated the digestion time for sputum samples for maximum yield of positive cultures. Cross-sectional study. Facility-based involving samples of routine patients receiving tuberculosis treatment and care from the main tuberculosis case referral centre in northern Nigeria. The study included 450 sputum samples from 150 new patients with clinical diagnosis of pulmonary tuberculosis. The 450 samples were pooled into 150 specimens, examined independently with mercury vapour lamp (FM), LED CysCope (CY) and Primo Star iLED (PiLED) fluorescence microscopies, and with the Ziehl-Neelsen (ZN) microscopy to assess the performance of each technique compared with liquid culture. The cultured specimens were decontaminated with BD Mycoprep (4% NaOH-1% NLAC and 2.9% sodium citrate) for 10, 15 and 20 min before incubation in Mycobacterium growth incubator tube (MGIT) system and growth examined for acid-fast bacilli (AFB). Of the 150 specimens examined by direct microscopy: 44 (29%), 60 (40%), 49 (33%) and 64 (43%) were AFB positive by ZN, FM, CY and iLED microscopy, respectively. Digestion of sputum samples for 10, 15 and 20 min yielded mycobacterial growth in 72 (48%), 81 (54%) and 68 (45%) of the digested samples, respectively, after incubation in the MGIT system. In routine laboratory conditions of a resource-limited setting, our study has demonstrated the superiority of fluorescence microscopy over the conventional ZN technique. Digestion of sputum samples for 15 min yielded more positive cultures.

  13. Electromagnetic field limits set by the V-Curve.

    Energy Technology Data Exchange (ETDEWEB)

    Warne, Larry Kevin [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jorgenson, Roy Eberhardt [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hudson, Howard Gerald [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2014-07-01

    When emitters of electromagnetic energy are operated in the vicinity of sensitive components, the electric field at the component location must be kept below a certain level in order to prevent the component from being damaged, or in the case of electro-explosive devices, initiating. The V-Curve is a convenient way to set the electric field limit because it requires minimal information about the problem configuration. In this report we will discuss the basis for the V-Curve. We also consider deviations from the original V-Curve resulting from inductive versus capacitive antennas, increases in directivity gain for long antennas, decreases in input impedance when operating in a bounded region, and mismatches dictated by transmission line losses. In addition, we consider mitigating effects resulting from limited antenna sizes.

  14. Strengthening laboratory systems in resource-limited settings.

    Science.gov (United States)

    Olmsted, Stuart S; Moore, Melinda; Meili, Robin C; Duber, Herbert C; Wasserman, Jeffrey; Sama, Preethi; Mundell, Ben; Hilborne, Lee H

    2010-09-01

    Considerable resources have been invested in recent years to improve laboratory systems in resource-limited settings. We reviewed published reports, interviewed major donor organizations, and conducted case studies of laboratory systems in 3 countries to assess how countries and donors have worked together to improve laboratory services. While infrastructure and the provision of services have seen improvement, important opportunities remain for further advancement. Implementation of national laboratory plans is inconsistent, human resources are limited, and quality laboratory services rarely extend to lower tier laboratories (eg, health clinics, district hospitals). Coordination within, between, and among governments and donor organizations is also frequently problematic. Laboratory standardization and quality control are improving but remain challenging, making accreditation a difficult goal. Host country governments and their external funding partners should coordinate their efforts effectively around a host country's own national laboratory plan to advance sustainable capacity development throughout a country's laboratory system.

  15. Characterizing omega-limit sets which are closed orbits

    Science.gov (United States)

    Bautista, S.; Morales, C.

    Let X be a vector field in a compact n-manifold M, n⩾2. Given Σ⊂M we say that q∈M satisfies (P) Σ if the closure of the positive orbit of X through q does not intersect Σ, but, however, there is an open interval I with q as a boundary point such that every positive orbit through I intersects Σ. Among those q having saddle-type hyperbolic omega-limit set ω(q) the ones with ω(q) being a closed orbit satisfy (P) Σ for some closed subset Σ. The converse is true for n=2 but not for n⩾4. Here we prove the converse for n=3. Moreover, we prove for n=3 that if ω(q) is a singular-hyperbolic set [C. Morales, M. Pacifico, E. Pujals, On C robust singular transitive sets for three-dimensional flows, C. R. Acad. Sci. Paris Sér. I 26 (1998) 81-86], [C. Morales, M. Pacifico, E. Pujals, Robust transitive singular sets for 3-flows are partially hyperbolic attractors or repellers, Ann. of Math. (2) 160 (2) (2004) 375-432], then ω(q) is a closed orbit if and only if q satisfies (P) Σ for some Σ closed. This result improves [S. Bautista, Sobre conjuntos hiperbólicos-singulares (On singular-hyperbolic sets), thesis Uiversidade Federal do Rio de Janeiro, 2005 (in Portuguese)] and [C. Morales, M. Pacifico, Mixing attractors for 3-flows, Nonlinearity 14 (2001) 359-378].

  16. Perspectives on setting limits for RF contact currents: a commentary.

    Science.gov (United States)

    Tell, Richard A; Tell, Christopher A

    2018-01-15

    Limits for exposure to radiofrequency (RF) contact currents are specified in the two dominant RF safety standards and guidelines developed by the Institute of Electrical and Electronics Engineers (IEEE) and the International Commission on Non-Ionizing Radiation Protection (ICNIRP). These limits are intended to prevent RF burns when contacting RF energized objects caused by high local tissue current densities. We explain what contact currents are and review some history of the relevant limits with an emphasis on so-called "touch" contacts, i.e., contact between a person and a contact current source during touch via a very small contact area. Contact current limits were originally set on the basis of controlling the specific absorption rate resulting from the current flowing through regions of small conductive cross section within the body, such as the wrist or ankle. More recently, contact currents have been based on thresholds of perceived heating. In the latest standard from the IEEE developed for NATO, contact currents have been based on two research studies in which thresholds for perception of thermal warmth or thermal pain have been measured. Importantly, these studies maximized conductive contact between the subject and the contact current source. This factor was found to dominate the response to heating wherein high resistance contact, such as from dry skin, can result in local heating many times that from a highly conductive contact. Other factors such as electrode size and shape, frequency of the current and the physical force associated with contact are found to introduce uncertainty in threshold values when comparing data across multiple studies. Relying on studies in which the contact current is minimized for a given threshold does not result in conservative protection limits. Future efforts to develop limits on contact currents should include consideration of (1) the basis for the limits (perception, pain, tissue damage); (2) understanding of the

  17. Global Health: Preparation for Working in Resource-Limited Settings.

    Science.gov (United States)

    St Clair, Nicole E; Pitt, Michael B; Bakeera-Kitaka, Sabrina; McCall, Natalie; Lukolyo, Heather; Arnold, Linda D; Audcent, Tobey; Batra, Maneesh; Chan, Kevin; Jacquet, Gabrielle A; Schutze, Gordon E; Butteris, Sabrina

    2017-11-01

    Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships. Copyright © 2017 by the American Academy of Pediatrics.

  18. Caring for the injured child in settings of limited resource.

    Science.gov (United States)

    Stephenson, Jacob

    2016-02-01

    Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. Published by Elsevier Inc.

  19. Perinatal pathology: practice suggestions for limited-resource settings.

    Science.gov (United States)

    Roberts, Drucilla J

    2013-06-01

    The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

  20. Setting limits and application to Higgs boson search

    International Nuclear Information System (INIS)

    Lista, L.

    2013-01-01

    This lecture summarizes the basic concept of hypothesis testing, will introduce the concepts of significance and upper limit under the frequentist and Bayesian approaches, and will discuss the benefits and limitations of the most popular approaches. Special attention will be devoted to the so-called modified frequentist approach, which is a popular method in High Energy Physics, and some application to real physics cases will be discussed. (authors)

  1. Exploring Permission-Induced Risk in Android Applications for Malicious Application Detection

    KAUST Repository

    Wang, Wei

    2014-10-07

    Android has been a major target of malicious applications (malapps). How to detect and keep the malapps out of the app markets is an ongoing challenge. One of the central design points of Android security mechanism is permission control that restricts the access of apps to core facilities of devices. However, it imparts a significant responsibility to the app developers with regard to accurately specifying the requested permissions and to the users with regard to fully understanding the risk of granting certain combinations of permissions. Android permissions requested by an app depict the app\\'s behavioral patterns. In order to help understanding Android permissions, in this paper, we explore the permission-induced risk in Android apps on three levels in a systematic manner. First, we thoroughly analyze the risk of an individual permission and the risk of a group of collaborative permissions. We employ three feature ranking methods, namely, mutual information, correlation coefficient, and T-test to rank Android individual permissions with respect to their risk. We then use sequential forward selection as well as principal component analysis to identify risky permission subsets. Second, we evaluate the usefulness of risky permissions for malapp detection with support vector machine, decision trees, as well as random forest. Third, we in depth analyze the detection results and discuss the feasibility as well as the limitations of malapp detection based on permission requests. We evaluate our methods on a very large official app set consisting of 310 926 benign apps and 4868 real-world malapps and on a third-party app sets. The empirical results show that our malapp detectors built on risky permissions give satisfied performance (a detection rate as 94.62% with a false positive rate as 0.6%), catch the malapps\\' essential patterns on violating permission access regulations, and are universally applicable to unknown malapps (detection rate as 74.03%).

  2. Projective limits of state spaces IV. Fractal label sets

    Science.gov (United States)

    Lanéry, Suzanne; Thiemann, Thomas

    2018-01-01

    Instead of formulating the state space of a quantum field theory over one big Hilbert space, it has been proposed by Kijowski (1977) to represent quantum states as projective families of density matrices over a collection of smaller, simpler Hilbert spaces (see Lanéry (2016) [1] for a concise introduction to this formalism). One can thus bypass the need to select a vacuum state for the theory, and still be provided with an explicit and constructive description of the quantum state space, at least as long as the label set indexing the projective structure is countable. Because uncountable label sets are much less practical in this context, we develop in the present article a general procedure to trim an originally uncountable label set down to countable cardinality. In particular, we investigate how to perform this tightening of the label set in a way that preserves both the physical content of the algebra of observables and its symmetries. This work is notably motivated by applications to the holonomy-flux algebra underlying Loop Quantum Gravity. Building on earlier work by Okołów (2013), a projective state space was introduced for this algebra in Lanéry and Thiemann (2016). However, the non-trivial structure of the holonomy-flux algebra prevents the construction of satisfactory semi-classical states (Lanéry and Thiemann, 2017). Implementing the general procedure just mentioned in the case of a one-dimensional version of this algebra, we show how a discrete subalgebra can be extracted without destroying universality nor diffeomorphism invariance. On this subalgebra, quantum states can then be constructed which are more regular than was possible on the original algebra. In particular, this allows the design of semi-classical states whose semi-classicality is enforced step by step, starting from collective, macroscopic degrees of freedom and going down progressively toward smaller and smaller scales.

  3. Limit sets for the discrete spectrum of complex Jacobi matrices

    International Nuclear Information System (INIS)

    Golinskii, L B; Egorova, I E

    2005-01-01

    The discrete spectrum of complex Jacobi matrices that are compact perturbations of the discrete Laplacian is studied. The precise stabilization rate (in the sense of order) of the matrix elements ensuring the finiteness of the discrete spectrum is found. An example of a Jacobi matrix with discrete spectrum having a unique limit point is constructed. These results are discrete analogues of Pavlov's well-known results on Schroedinger operators with complex potential on a half-axis.

  4. Upper limit set for level of lightning activity on Titan

    Science.gov (United States)

    Desch, M. D.; Kaiser, M. L.

    1990-01-01

    Because optically thick cloud and haze layers prevent lightning detection at optical wavelength on Titan, a search was conducted for lightning-radiated signals (spherics) at radio wavelengths using the planetary radioastronomy instrument aboard Voyager 1. Given the maximum ionosphere density of about 3000/cu cm, lightning spherics should be detectable above an observing frequency of 500 kHz. Since no evidence for spherics is found, an upper limit to the total energy per flash in Titan lightning of about 10 to the 6th J, or about 1000 times weaker than that of typical terrestrial lightning, is inferred.

  5. Priority setting of strategies and mechanisms for limiting global warming

    International Nuclear Information System (INIS)

    Lewis, S.J.L.

    1994-01-01

    Scientific communities have reached a consensus that increases of greenhouse gas emission will result in climatic warming and sea level rises despite existing uncertainties. Major uncertainties include the sensitivities of climate changes in terms of timing, magnitude, and scales of regional changes. Socioeconomic uncertainties encompass population and economic growth, changes in technology, future reliance on fossil fuel, and policies compiled to stabilize the global warming. Moreover, increase in world population coupled with limited resources will increase the vulnerability of ecosystems and social systems. Global warming has become an international concern since the destinies of all nations are closely interwoven by this issue and how nations deal with it. Appropriate strategies and mechanisms are need to slow down the buildup of CO 2 and other greenhouse gases. Questionnaires were sent to 150 experts in 30 countries to evaluate such strategies and mechanisms for dealing with global warming, from both the domestic and international perspectives. This paper will focus primarily on strategy selection

  6. Limits to ductility set by plastic flow localization

    International Nuclear Information System (INIS)

    Needleman, A.; Rice, J.R.

    1977-11-01

    The theory of strain localization is reviewed with reference both to local necking in sheet metal forming processes and to more general three dimensional shear band localizations that sometimes mark the onset of ductile rupture. Both bifurcation behavior and the growth of initial imperfections are considered. In addition to analyses based on classical Mises-like constitutive laws, approaches to localization based on constitutive models that may more accurately model processes of slip and progressive rupturing on the microscale in structural alloys are discussed. Among these non-classical constitutive features are the destabilizing roles of yield surface vertices and of non-normality effects, arising, for example, from slight pressure sensitivity of yield. Analyses based on a constitutive model of a progressively cavitating dilational plastic material which is intended to model the process of ductile void growth in metals are also discussed. A variety of numerical results are presented. In the context of the three dimensional theory of localization, it is shown that a simple vertex model predicts ratios of ductility in plane strain tension to ductility in axisymmetric tension qualitatively consistent with experiment, and the destabilizing influence of a hydrostatic stress dependent void nucleation criterion is illustrated. In the sheet necking context, and focussing on positive biaxial stretching, it is shown that forming limit curves based on a simple vertex model and those based on a simple void growth model are qualitatively in accord, although attributing instability to very different physical mechanisms. These forming limit curves are compared with those obtained from the Mises material model and employing various material and geometric imperfections

  7. Childhood epilepsy: Management in resource-limited setting

    Directory of Open Access Journals (Sweden)

    Valvi Chhaya

    2008-01-01

    Full Text Available Objective: To optimize the use of phenobarbital and/or phenytoin as frontline drugs for treatment of childhood epilepsy. Design: Before-and -after study. Setting: Epilepsy clinic at paediatric OPD, Sassoon General Hospital, Pune. Materials and Methods: Epilepsy is a condition in which seizures are triggered recurrently from within the brain. For epidemiological classification purpose epilepsy is considered to be present when two or more unprovoked seizures occur at an interval greater than twenty four hours apart. Seizures were classified as generalized and partial seizures, with underlying etiology investigated with EEG, CT scan in majority of the patients. Follow - up rate, seizure - control and antiepileptic drugs used among 151 children enrolled as on 31 March 2005 were compared with 106 children with new onset epilepsy enrolled as on February 2006. Eight children with breakthrough convulsion after a seizure free period of five to eighteen months were followed up after injection vitamin D. Nineteen children with poor control of seizures receiving polytherapy with newer antiepileptic drugs were assessed with frontline antiepileptic medication of phenobarbital and/or phenytoin. Serum calcium, phosphorus, alkaline phosphatase were done in seventy two consecutive children with seizure disorder. Results: During post protocol period good seizure control was achieved in 84.8% as against 80.7% and use of phenobarbital and/or phenytoin increased to 65.11% from 22.87%. Of the 8 cases with breakthrough seizures seven remained seizure free after vitamin D administration and with no dose enhancement of AED medications of the nineteen. Children receiving polytherapy thirteen children could be successfully switched to phenobarbital and/or phenytoin. Forty four (61% children had hypocalcemia (less than 9 mg%, fifty seven (79% children had raised alkaline phosphatase levels (more than 270 IU. Comments: Phenobarbital and/or phenytoin have been found to be

  8. Maximum permissible voltage of YBCO coated conductors

    Energy Technology Data Exchange (ETDEWEB)

    Wen, J.; Lin, B.; Sheng, J.; Xu, J.; Jin, Z. [Department of Electrical Engineering, Shanghai Jiao Tong University, Shanghai (China); Hong, Z., E-mail: zhiyong.hong@sjtu.edu.cn [Department of Electrical Engineering, Shanghai Jiao Tong University, Shanghai (China); Wang, D.; Zhou, H.; Shen, X.; Shen, C. [Qingpu Power Supply Company, State Grid Shanghai Municipal Electric Power Company, Shanghai (China)

    2014-06-15

    Highlights: • We examine three kinds of tapes’ maximum permissible voltage. • We examine the relationship between quenching duration and maximum permissible voltage. • Continuous I{sub c} degradations under repetitive quenching where tapes reaching maximum permissible voltage. • The relationship between maximum permissible voltage and resistance, temperature. - Abstract: Superconducting fault current limiter (SFCL) could reduce short circuit currents in electrical power system. One of the most important thing in developing SFCL is to find out the maximum permissible voltage of each limiting element. The maximum permissible voltage is defined as the maximum voltage per unit length at which the YBCO coated conductors (CC) do not suffer from critical current (I{sub c}) degradation or burnout. In this research, the time of quenching process is changed and voltage is raised until the I{sub c} degradation or burnout happens. YBCO coated conductors test in the experiment are from American superconductor (AMSC) and Shanghai Jiao Tong University (SJTU). Along with the quenching duration increasing, the maximum permissible voltage of CC decreases. When quenching duration is 100 ms, the maximum permissible of SJTU CC, 12 mm AMSC CC and 4 mm AMSC CC are 0.72 V/cm, 0.52 V/cm and 1.2 V/cm respectively. Based on the results of samples, the whole length of CCs used in the design of a SFCL can be determined.

  9. A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting.

    Science.gov (United States)

    Flood, David; Douglas, Kate; Goldberg, Vera; Martinez, Boris; Garcia, Pablo; Arbour, MaryCatherine; Rohloff, Peter

    2017-08-01

    Quality improvement (QI) is a key strategy for improving diabetes care in low- and middle-income countries (LMICs). This study reports on a diabetes QI project in rural Guatemala whose primary aim was to improve glycemic control of a panel of adult diabetes patients. Formative research suggested multiple areas for programmatic improvement in ambulatory diabetes care. This project utilized the Model for Improvement and Agile Global Health, our organization's complementary healthcare implementation framework. A bundle of improvement activities were implemented at the home, clinic and institutional level. Control charts of mean hemoglobin A1C (HbA1C) and proportion of patients meeting target HbA1C showed improvement as special cause variation was identified 3 months after the intervention began. Control charts for secondary process measures offered insights into the value of different components of the intervention. Intensity of home-based diabetes education emerged as an important driver of panel glycemic control. Diabetes QI work is feasible in resource-limited settings in LMICs and can improve glycemic control. Statistical process control charts are a promising methodology for use with panels or registries of diabetes patients. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  10. Android Permission Model

    OpenAIRE

    Birendra, Chalise

    2016-01-01

    The recent evolution on the smart phone technology has made its application market huge and less secure. Every single day large number of apps introduced in the android market (mostly on google play store) without any particular inspections which creates a lot of security issues and they remain unresolved. There are a lot of recent and increasing security issues which are mostly caused by the android apps. Mainly, the access of user data through the apps relied on the users given permission t...

  11. The calculation of maximum permissible exposure levels for laser radiation

    International Nuclear Information System (INIS)

    Tozer, B.A.

    1979-01-01

    The maximum permissible exposure data of the revised standard BS 4803 are presented as a set of decision charts which ensure that the user automatically takes into account such details as pulse length and pulse pattern, limiting angular subtense, combinations of multiple wavelength and/or multiple pulse lengths, etc. The two decision charts given are for the calculation of radiation hazards to skin and eye respectively. (author)

  12. The Intermediate Set and Limiting Superdi erential for Coalition Games: Between the Core and the Weber Set

    Czech Academy of Sciences Publication Activity Database

    Adam, Lukáš; Kroupa, T.

    2017-01-01

    Roč. 46, č. 4 (2017), s. 891-918 ISSN 0020-7276 R&D Projects: GA ČR GA15-00735S Institutional support: RVO:67985556 Keywords : coalition game * limiting superdi erential * intermediate set * core * Weber set Subject RIV: BA - General Mathematics OBOR OECD: Statistics and probability Impact factor: 0.713, year: 2016 http://library.utia.cas.cz/separaty/2016/MTR/adam-0467365.pdf

  13. A method of setting limits for the purpose of quality assurance

    International Nuclear Information System (INIS)

    Sanghangthum, Taweap; Suriyapee, Sivalee; Kim, Gwe-Ya; Pawlicki, Todd

    2013-01-01

    The result from any assurance measurement needs to be checked against some limits for acceptability. There are two types of limits; those that define clinical acceptability (action limits) and those that are meant to serve as a warning that the measurement is close to the action limits (tolerance limits). Currently, there is no standard procedure to set these limits. In this work, we propose an operational procedure to set tolerance limits and action limits. The approach to establish the limits is based on techniques of quality engineering using control charts and a process capability index. The method is different for tolerance limits and action limits with action limits being categorized into those that are specified and unspecified. The procedure is to first ensure process control using the I-MR control charts. Then, the tolerance limits are set equal to the control chart limits on the I chart. Action limits are determined using the C pm process capability index with the requirements that the process must be in-control. The limits from the proposed procedure are compared to an existing or conventional method. Four examples are investigated: two of volumetric modulated arc therapy (VMAT) point dose quality assurance (QA) and two of routine linear accelerator output QA. The tolerance limits range from about 6% larger to 9% smaller than conventional action limits for VMAT QA cases. For the linac output QA, tolerance limits are about 60% smaller than conventional action limits. The operational procedure describe in this work is based on established quality management tools and will provide a systematic guide to set up tolerance and action limits for different equipment and processes. (paper)

  14. 77 FR 69548 - Price for the 2012 Limited Edition Silver Proof SetTM

    Science.gov (United States)

    2012-11-19

    ... DEPARTMENT OF THE TREASURY United States Mint Price for the 2012 Limited Edition Silver Proof Set TM AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing a price of $149.95 for the 2012 Limited Edition Silver Proof Set TM . FOR FURTHER...

  15. On compactoid and limited sets in non-Archimedean locally convex ...

    African Journals Online (AJOL)

    In [2] and [3] spaces in which every bounded subset is a compactoid was studied. Every compactoid set is limited but the converse is not true [3]. In this paper, we shall study some spaces in which every limited set is compactoid. Journal of the Nigerian Association of Mathematical Physics Vol. 10 2006: pp. 571-574.

  16. Relay protection coordination with generator capability curve, excitation system limiters and power system relay protections settings

    OpenAIRE

    Buha Danilo; Buha Boško; Jačić Dušan; Gligorov Saša; Božilov Marko; Marinković Savo; Milosavljević Srđan

    2016-01-01

    The relay protection settings performed in the largest thermal powerplant (TE "Nikola Tesla B") are reffered and explained in this paper. The first calculation step is related to the coordination of the maximum stator current limiter settings, the overcurrent protection with inverse characteristics settings and the permitted overload of the generator stator B1. In the second calculation step the settings of impedance generator protection are determined, and the methods and criteria according ...

  17. The ω-limit sets of a flow and periodic orbits

    International Nuclear Information System (INIS)

    Wang Xiaoxia; Blackmore, Denis; Wang Chengwen

    2009-01-01

    In this paper we discuss the ω-limit sets of a flow using the Conley theory, chain recurrence and Morse decompositions. Our results generalize and improve the related result in [Schropp J. A reduction principle for ω-limit sets. Z Angew Math Meth 1996;76(6):349-56], and we also show how they can be used as a basis for some new criteria for the existence of periodic orbits.

  18. Contribution of modifiable risk factors for hypertension and type-2 diabetes in Peruvian resource-limited settings.

    Science.gov (United States)

    Bernabé-Ortiz, Antonio; Carrillo-Larco, Rodrigo M; Gilman, Robert H; Checkley, William; Smeeth, Liam; Miranda, J Jaime

    2016-01-01

    It is important to understand the local burden of non-communicable diseases including within-country heterogeneity. The aim of this study was to characterise hypertension and type-2 diabetes profiles across different Peruvian geographical settings emphasising the assessment of modifiable risk factors. Analysis of the CRONICAS Cohort Study baseline assessment was conducted. Cardiometabolic outcomes were blood pressure categories (hypertension, prehypertension, normal) and glucose metabolism disorder status (diabetes, prediabetes, normal). Exposures were study setting and six modifiable factors (smoking, alcohol drinking, leisure time and transport-related physical activity levels, TV watching, fruit/vegetables intake and obesity). Poisson regression models were used to report prevalence ratios (PR). Population attributable risks (PAR) were also estimated. Data from 3238 participants, 48.3% male, mean age 45.3 years, were analysed. Age-standardised (WHO population) prevalence of prehypertension and hypertension was 24% and 16%, whereas for prediabetes and type-2 diabetes it was 18% and 6%, respectively. Outcomes varied according to study setting (pdiabetes. PAR showed that obesity was an important determinant for hypertension (15.7%) and type-2 diabetes (23.9%). There is an evident heterogeneity in the prevalence of and risk factors for hypertension and diabetes within Peru. Prehypertension and prediabetes are highly prevalent across settings. Our results emphasise the need of understanding the epidemiology of cardiometabolic conditions to appropriately implement interventions to tackle the burden of non-communicable diseases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. The NANOGrav Nine-year Data Set: Limits on the Isotropic Stochastic Gravitational Wave Background

    OpenAIRE

    Arzoumanian, Zaven; Brazier, Adam; Burke-Spolaor, Sarah; Chamberlin, Sydney; Chatterjee, Shami; Christy, Brian; Cordes, Jim; Cornish, Neil; Demorest, Paul; Deng, Xihao; Dolch, Tim; Ellis, Justin; Ferdman, Rob; Fonseca, Emmanuel; Garver-Daniels, Nate

    2015-01-01

    We compute upper limits on the nanohertz-frequency isotropic stochastic gravitational wave background (GWB) using the 9-year data release from the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) collaboration. We set upper limits for a GWB from supermassive black hole binaries under power law, broken power law, and free spectral coefficient GW spectrum models. We place a 95\\% upper limit on the strain amplitude (at a frequency of yr$^{-1}$) in the power law model of $A...

  20. Defining the anesthesia gap for reproductive health procedures in resource-limited settings.

    Science.gov (United States)

    Anderson, R Eleanor; Ahn, Roy; Nelson, Brett D; Chavez, Jean; de Redon, Emily; Burke, Thomas

    2014-12-01

    In resource-limited settings, severe shortages of anesthetists and anesthesiologists lead to surgical delays that increase maternal and neonatal mortality and morbidity. To more clearly understand the individual components of the anesthesia gap pertaining to reproductive health surgeries and procedures in resource-limited settings. Medline, the Cochrane Library, CINAHL, Embase, and POPLINE were systematically searched for reports published before December 31, 2013. Search terms were related to obstetric surgery, resource-limited settings, and anesthesia. Studies that addressed the use of anesthesia in reproductive procedures in resource-limited settings were included. Reviewers independently evaluated the full text of identified studies, extracted information related to study objectives and conclusions, and identified the anesthesia gap. Overall, 14 publications met the inclusion criteria. A significant lack of infrastructure, equipment and supplies, and trained personnel were identified as key factors responsible for a lack of anesthesia services. A shortage of trained anesthesia providers, equipment, supplies, medications, and infrastructure, along with limitations in transportation in resource-limited settings have produced a wide gap between available anesthesia services and the demand for them for reproductive health surgeries and procedures. Safe, affordable, and scalable solutions to address the anesthesia gap are urgently needed. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Permissive Subsorted Partial Logic in CASL

    DEFF Research Database (Denmark)

    Cerioli, Maura; Haxthausen, Anne Elisabeth; Krieg-Brückner, Bernd

    1997-01-01

    This paper presents a permissive subsorted partial logic used in the CoFI Algebraic Specification Language. In contrast to other order-sorted logics, subsorting is not modeled by set inclusions, but by injective embeddings allowing for more general models in which subtypes can have different data...

  2. A limit set trichotomy for order-preserving systems on time scales

    Directory of Open Access Journals (Sweden)

    Christian Poetzsche

    2004-04-01

    Full Text Available In this paper we derive a limit set trichotomy for abstract order-preserving 2-parameter semiflows in normal cones of strongly ordered Banach spaces. Additionally, to provide an example, Muller's theorem is generalized to dynamic equations on arbitrary time scales and applied to a model from population dynamics.

  3. Adjusting Limit Setting in Play Therapy with First-Generation Mexican-American Children

    Science.gov (United States)

    Perez, Roxanna; Ramirez, Sylvia Z.; Kranz, Peter L.

    2007-01-01

    This paper focuses on limit setting in play therapy with first-generation Mexican-American children in two important therapeutic environments that include the traditional indoor playroom and a proposed outdoor play area. The paper is based on a review of the literature and the authors' clinical experiences with this population. They concluded…

  4. Global patient safety and antiretroviral drug-drug interactions in the resource-limited setting.

    Science.gov (United States)

    Seden, Kay; Khoo, Saye H; Back, David; Byakika-Kibwika, Pauline; Lamorde, Mohammed; Ryan, Mairin; Merry, Concepta

    2013-01-01

    Scale-up of HIV treatment services may have contributed to an increase in functional health facilities available in resource-limited settings and an increase in patient use of facilities and retention in care. As more patients are reached with medicines, monitoring patient safety is increasingly important. Limited data from resource-limited settings suggest that medication error and antiretroviral drug-drug interactions may pose a significant risk to patient safety. Commonly cited causes of medication error in the developed world include the speed and complexity of the medication use cycle combined with inadequate systems and processes. In resource-limited settings, specific factors may contribute, such as inadequate human resources and high disease burden. Management of drug-drug interactions may be complicated by limited access to alternative medicines or laboratory monitoring. Improving patient safety by addressing the issue of antiretroviral drug-drug interactions has the potential not just to improve healthcare for individuals, but also to strengthen health systems and improve vital communication among healthcare providers and with regulatory agencies.

  5. Can Oxygen Set Thermal Limits in an Insect and Drive Gigantism?

    Science.gov (United States)

    Verberk, Wilco C. E. P.; Bilton, David T.

    2011-01-01

    Background Thermal limits may arise through a mismatch between oxygen supply and demand in a range of animal taxa. Whilst this oxygen limitation hypothesis is supported by data from a range of marine fish and invertebrates, its generality remains contentious. In particular, it is unclear whether oxygen limitation determines thermal extremes in tracheated arthropods, where oxygen limitation may be unlikely due to the efficiency and plasticity of tracheal systems in supplying oxygen directly to metabolically active tissues. Although terrestrial taxa with open tracheal systems may not be prone to oxygen limitation, species may be affected during other life-history stages, particularly if these rely on diffusion into closed tracheal systems. Furthermore, a central role for oxygen limitation in insects is envisaged within a parallel line of research focussing on insect gigantism in the late Palaeozoic. Methodology/Principal Findings Here we examine thermal maxima in the aquatic life stages of an insect at normoxia, hypoxia (14 kPa) and hyperoxia (36 kPa). We demonstrate that upper thermal limits do indeed respond to external oxygen supply in the aquatic life stages of the stonefly Dinocras cephalotes, suggesting that the critical thermal limits of such aquatic larvae are set by oxygen limitation. This could result from impeded oxygen delivery, or limited oxygen regulatory capacity, both of which have implications for our understanding of the limits to insect body size and how these are influenced by atmospheric oxygen levels. Conclusions/Significance These findings extend the generality of the hypothesis of oxygen limitation of thermal tolerance, suggest that oxygen constraints on body size may be stronger in aquatic environments, and that oxygen toxicity may have actively selected for gigantism in the aquatic stages of Carboniferous arthropods. PMID:21818347

  6. Can oxygen set thermal limits in an insect and drive gigantism?

    Directory of Open Access Journals (Sweden)

    Wilco C E P Verberk

    Full Text Available BACKGROUND: Thermal limits may arise through a mismatch between oxygen supply and demand in a range of animal taxa. Whilst this oxygen limitation hypothesis is supported by data from a range of marine fish and invertebrates, its generality remains contentious. In particular, it is unclear whether oxygen limitation determines thermal extremes in tracheated arthropods, where oxygen limitation may be unlikely due to the efficiency and plasticity of tracheal systems in supplying oxygen directly to metabolically active tissues. Although terrestrial taxa with open tracheal systems may not be prone to oxygen limitation, species may be affected during other life-history stages, particularly if these rely on diffusion into closed tracheal systems. Furthermore, a central role for oxygen limitation in insects is envisaged within a parallel line of research focussing on insect gigantism in the late Palaeozoic. METHODOLOGY/PRINCIPAL FINDINGS: Here we examine thermal maxima in the aquatic life stages of an insect at normoxia, hypoxia (14 kPa and hyperoxia (36 kPa. We demonstrate that upper thermal limits do indeed respond to external oxygen supply in the aquatic life stages of the stonefly Dinocras cephalotes, suggesting that the critical thermal limits of such aquatic larvae are set by oxygen limitation. This could result from impeded oxygen delivery, or limited oxygen regulatory capacity, both of which have implications for our understanding of the limits to insect body size and how these are influenced by atmospheric oxygen levels. CONCLUSIONS/SIGNIFICANCE: These findings extend the generality of the hypothesis of oxygen limitation of thermal tolerance, suggest that oxygen constraints on body size may be stronger in aquatic environments, and that oxygen toxicity may have actively selected for gigantism in the aquatic stages of Carboniferous arthropods.

  7. Relay protection coordination with generator capability curve, excitation system limiters and power system relay protections settings

    Directory of Open Access Journals (Sweden)

    Buha Danilo

    2016-01-01

    Full Text Available The relay protection settings performed in the largest thermal powerplant (TE "Nikola Tesla B" are reffered and explained in this paper. The first calculation step is related to the coordination of the maximum stator current limiter settings, the overcurrent protection with inverse characteristics settings and the permitted overload of the generator stator B1. In the second calculation step the settings of impedance generator protection are determined, and the methods and criteria according to which the calculations are done are described. Criteria used to provide the protection to fulfill the backup protection role in the event of malfunction of the main protection of the transmission system. are clarified. The calculation of all protection functions (32 functions of generator B1 were performed in the project "Coordination of relay protection blocks B1 and B2 with the system of excitation and power system protections -TENT B".

  8. ESTABLISHMENT OF THE PERMISSIBLE TRAIN SPEED ON THE CURVED TURNOUTS

    Directory of Open Access Journals (Sweden)

    O. M. Patlasov

    2016-04-01

    Full Text Available Purpose. Turnouts play a key role in the railway transportation process. One-sided and many-sided curved turnouts were railed over the last 20 years in difficult conditions (curved sections, yard necks. They have a number of geometric features, unlike the conventional one-sided turnouts. Today the normative documents prohibit laying such turnouts in curved track sections and only partially regulate the assessment procedure of their real condition. The question of establishment the permissible train speed within the curved turnouts is still open. In this regard, authors propose to set the train speed according to the driving comfort criterion using the results of field measurements of ordinates from the baseline for the particular curved turnout. Methodology. The article considers the criteria using which one can set the permissible speed on the turnouts. It defines the complexity of their application, advantages and disadvantages. Findings. The work analyzes the speed distribution along the length of the real curved turnout for the forward and lateral directions. It establishes the change rate values of unbalanced accelerations for the existing norms of the curved track sections maintenance according to the difference in the adjacent bend versine at speeds up to 160 km/h. Originality. A method for establishing the trains’ speed limit within the curved turnouts was developed. It takes into account the actual geometric position in the plan of forward and lateral turnout directions. This approach makes it possible to establish a barrier places in plan on the turnouts limiting the train speed. Practical value. The proposed method makes it possible to objectively assess and set the trains’ permissible speed on the basis of the ordinate measurement of the forward and lateral directions of the curved turnouts from the baseline using the driving comfort criteria. The method was tested using real turnouts, which are located within the Pridneprovsk

  9. Experiences from occupational exposure limits set on aerosols containing allergenic proteins

    DEFF Research Database (Denmark)

    Nielsen, Gunnar; Larsen, Søren; Hansen, Jitka S

    2012-01-01

    Occupational exposure limits (OELs) together with determined airborne exposures are used in risk assessment based managements of occupational exposures to prevent occupational diseases. In most countries, OELs have only been set for few protein-containing aerosols causing IgE-mediated allergies. ...... is available for setting OELs for proteins and protein-containing aerosols where the critical effect is IgE sensitization and IgE-mediated airway diseases.......Occupational exposure limits (OELs) together with determined airborne exposures are used in risk assessment based managements of occupational exposures to prevent occupational diseases. In most countries, OELs have only been set for few protein-containing aerosols causing IgE-mediated allergies...... for setting OELs. Our aim is to analyse prerequisites for setting OELs for the allergenic protein-containing aerosols. Opposite to the key effect of toxicological reactions, two thresholds, one for the sensitization phase and one for elicitation of IgE-mediated symptoms in sensitized individuals, are used...

  10. Ecotoxicological assessments and the setting of limit values for chemicals in the environment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The Committee on the Setting of Limit Values for Chemicals held its first open conference in Denmark in March 1992 at Mogenstrup Kro, Zealand. The conference proceedings were entitled `Risk Management and Risk Assessment in Different Sectors in Denmark`. The conference focused on risk assessment and the setting of limit values for chemicals in connection with human exposure to chemicals. The conference held in January 1996, which is covered by the present proceedings, dealt with the exposure of the environment to chemicals and the state-of-the-art as well as perspectives of ecotoxicological research. Special emphasis was placed on the illustration and discussion of the problems that have to be solved in order to secure satisfactory levels of protection of soil and aquatic environments in connection with exposure to chemicals. Also, problems connected with exposure through the atmosphere were discussed and exemplified by the work on the setting of limit values for tropospheric ozone. Furthermore, the global problems pertaining to what is believed to be the greenhouse effect and the degradation of the stratospheric ozone layer as well as the damage to crops caused by ozone were mentioned. (au)

  11. Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Scanlon ML

    2013-01-01

    Full Text Available Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART significantly reduced human immunodeficiency virus (HIV-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a

  12. Identifying finite-time coherent sets from limited quantities of Lagrangian data

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Matthew O. [Program in Applied and Computational Mathematics, Princeton University, New Jersey 08544 (United States); Rypina, Irina I. [Department of Physical Oceanography, Woods Hole Oceanographic Institute, Massachusetts 02543 (United States); Rowley, Clarence W. [Department of Mechanical and Aerospace Engineering, Princeton University, New Jersey 08544 (United States)

    2015-08-15

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that “leak” from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, “data rich” test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or “mesh-free” methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea.

  13. Identifying finite-time coherent sets from limited quantities of Lagrangian data

    International Nuclear Information System (INIS)

    Williams, Matthew O.; Rypina, Irina I.; Rowley, Clarence W.

    2015-01-01

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that “leak” from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, “data rich” test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or “mesh-free” methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea

  14. Identifying finite-time coherent sets from limited quantities of Lagrangian data.

    Science.gov (United States)

    Williams, Matthew O; Rypina, Irina I; Rowley, Clarence W

    2015-08-01

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that "leak" from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, "data rich" test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or "mesh-free" methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea.

  15. Setting limits on Effective Field Theories: the case of Dark Matter

    Science.gov (United States)

    Pobbe, Federico; Wulzer, Andrea; Zanetti, Marco

    2017-08-01

    The usage of Effective Field Theories (EFT) for LHC new physics searches is receiving increasing attention. It is thus important to clarify all the aspects related with the applicability of the EFT formalism in the LHC environment, where the large available energy can produce reactions that overcome the maximal range of validity, i.e. the cutoff, of the theory. We show that this does not forbid to set rigorous limits on the EFT parameter space through a modified version of the ordinary binned likelihood hypothesis test, which we design and validate. Our limit-setting strategy can be carried on in its full-fledged form by the LHC experimental collaborations, or performed externally to the collaborations, through the Simplified Likelihood approach, by relying on certain approximations. We apply it to the recent CMS mono-jet analysis and derive limits on a Dark Matter (DM) EFT model. DM is selected as a case study because the limited reach on the DM production EFT Wilson coefficient and the structure of the theory suggests that the cutoff might be dangerously low, well within the LHC reach. However our strategy can also be applied, if needed, to EFT's parametrising the indirect effects of heavy new physics in the Electroweak and Higgs sectors.

  16. An evolutionary algorithm for tomographic reconstructions in limited data sets problems

    International Nuclear Information System (INIS)

    Turcanu, Catrinel; Craciunescu, Teddy

    2000-01-01

    The paper proposes a new method for tomographic reconstructions. Unlike nuclear medicine applications, in physical science problems we are often confronted with limited data sets: constraints in the number of projections or limited angle views. The problem of image reconstruction from projections may be considered as a problem of finding an image (solution) having projections that match the experimental ones. In our approach, we choose a statistical correlation coefficient to evaluate the fitness of any potential solution. The optimization process is carried out by an evolutionary algorithm. Our algorithm has some problem-oriented characteristics. One of them is that a chromosome, representing a potential solution, is not linear but coded as a matrix of pixels corresponding to a two-dimensional image. This kind of internal representation reflects the genuine manifestation and slight differences between two points situated in the original problem space give rise to similar differences once they become coded. Another particular feature is a newly built crossover operator: the grid-based crossover, suitable for high dimension two-dimensional chromosomes. Except for the population size and the dimension of the cutting grid for the grid-based crossover, all the other parameters of the algorithm are independent of the geometry of the tomographic reconstruction. The performances of the method are evaluated in comparison with a traditional tomographic method, based on the maximization of the entropy of the image, that proved to work well with limited data sets. The test phantom is typical for an application with limited data sets: the determination of the neutron energy spectra with time resolution in case of short-pulsed neutron emission. The qualitative judgement and also the quantitative one, based on some figures of merit, point out that the proposed method ensures an improved reconstruction of shapes, sizes and resolution in the image, even in the presence of noise

  17. A systematic review of portable electronic technology for health education in resource-limited settings.

    Science.gov (United States)

    McHenry, Megan S; Fischer, Lydia J; Chun, Yeona; Vreeman, Rachel C

    2017-08-01

    The objective of this study is to conduct a systematic review of the literature of how portable electronic technologies with offline functionality are perceived and used to provide health education in resource-limited settings. Three reviewers evaluated articles and performed a bibliography search to identify studies describing health education delivered by portable electronic device with offline functionality in low- or middle-income countries. Data extracted included: study population; study design and type of analysis; type of technology used; method of use; setting of technology use; impact on caregivers, patients, or overall health outcomes; and reported limitations. Searches yielded 5514 unique titles. Out of 75 critically reviewed full-text articles, 10 met inclusion criteria. Study locations included Botswana, Peru, Kenya, Thailand, Nigeria, India, Ghana, and Tanzania. Topics addressed included: development of healthcare worker training modules, clinical decision support tools, patient education tools, perceptions and usability of portable electronic technology, and comparisons of technologies and/or mobile applications. Studies primarily looked at the assessment of developed educational modules on trainee health knowledge, perceptions and usability of technology, and comparisons of technologies. Overall, studies reported positive results for portable electronic device-based health education, frequently reporting increased provider/patient knowledge, improved patient outcomes in both quality of care and management, increased provider comfort level with technology, and an environment characterized by increased levels of technology-based, informal learning situations. Negative assessments included high investment costs, lack of technical support, and fear of device theft. While the research is limited, portable electronic educational resources present promising avenues to increase access to effective health education in resource-limited settings, contingent

  18. UNIVERSAL REGULAR AUTONOMOUS ASYNCHRONOUS SYSTEMS: ω-LIMIT SETS, INVARIANCE AND BASINS OF ATTRACTION

    Directory of Open Access Journals (Sweden)

    Serban Vlad

    2011-07-01

    Full Text Available The asynchronous systems are the non-deterministic real timebinarymodels of the asynchronous circuits from electrical engineering.Autonomy means that the circuits and their models have no input.Regularity means analogies with the dynamical systems, thus such systems may be considered to be real time dynamical systems with a’vector field’, Universality refers to the case when the state space of the system is the greatest possible in the sense of theinclusion. The purpose of this paper is that of defining, by analogy with the dynamical systems theory, the omega-limit sets, the invariance and the basins of attraction of the universal regular autonomous asynchronous systems.

  19. Evaluating Diagnostic Point-of-Care Tests in Resource-Limited Settings

    Science.gov (United States)

    Drain, Paul K; Hyle, Emily P; Noubary, Farzad; Freedberg, Kenneth A; Wilson, Douglas; Bishai, William; Rodriguez, William; Bassett, Ingrid V

    2014-01-01

    Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs. PMID:24332389

  20. Bush animal attacks: management of complex injuries in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Mitchell Katrina B

    2011-12-01

    Full Text Available Abstract Introduction Though animal-related injuries and fatalities have been documented throughout the world, the variety of attacks by wild animals native to rural East Africa are less commonly described. Given the proximity of our northwestern Tanzania hospital to Lake Victoria, Lake Tanganyika, and the Serengeti National Park, and presentation of several patients attacked by bush animals and suffering a variety of complex injuries, we sought to report the pattern of attacks and surgical management in a resource-limited setting. Materials and methods Four patients who were admitted to the northwestern Tanzania tertiary referral hospital, Bugando Medical Centre (BMC, in 2010-2011 suffered attacks by different bush animals: hyena, elephant, crocodile, and vervet monkey. These patients were triaged as trauma patients in the Casualty Ward, then admitted for inpatient monitoring and treatment. Their outcomes were followed to discharge. Results The age and gender of the patients attacked was variable, though all but the pediatric patient were participating in food gathering or guarding activities in rural locations at the time of the attacks. All patients required surgical management of their injuries, which included debridement and closure of wounds, chest tube insertion, amputation, and external fixation of an extremity fracture. All patients survived and were discharged home. Discussion Though human injuries secondary to encounters with undomesticated animals such as cows, moose, and camel are reported, they often are indirect traumas resulting from road traffic collisions. Snake attacks are well documented and common. However, this series of unique bush animal attacks describes the initial and surgical management of human injuries in the resource-limited setting of the developing world. Conclusion Animal attacks are common throughout the world, but their pattern may vary in Africa throughout jungle and bush environmental settings. It is

  1. A concept of dynamic permission mechanism on android

    Science.gov (United States)

    Aron, Lukas; Hanacek, Petr

    2016-02-01

    This paper discuss the main security topic in mobile security area and this topic is protect user against the leakage of data. This work primarily contains the proposal of concept of dynamic permission mechanism for Android operating system. This mechanism deals with assignment or enforcement permissions to the application according to files that the application works with. Application has set of permissions that can use, but if the user opens confident files the application permissions should change its permission set and there should not be possible leakage of this secret data. The permissions set should be stricter according to opened confidential file or more open (without restriction) if the file is not secret file. The concept proposes the solution for protecting this data leakage. Idea covers rule that user should be avoided of change this permissions himself, but this behavior should be dynamic, automatic and independent. This proposal is mainly aimed to Android operating system, but the concept can be applied to other mobile platforms with some implementation changes.

  2. 12 CFR 714.9 - Are indirect leasing arrangements subject to the purchase of eligible obligation limit set forth...

    Science.gov (United States)

    2010-01-01

    ... the purchase of eligible obligation limit set forth in § 701.23 of this chapter? 714.9 Section 714.9....9 Are indirect leasing arrangements subject to the purchase of eligible obligation limit set forth... underwriting decision and that the lease contract is assigned to you very soon after it is signed by the member...

  3. Emerging technologies in point-of-care molecular diagnostics for resource-limited settings.

    Science.gov (United States)

    Peeling, Rosanna W; McNerney, Ruth

    2014-06-01

    Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.

  4. Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Zolfo Maria

    2010-09-01

    Full Text Available Abstract Background We present an innovative approach to healthcare worker (HCW training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones (Nokia N95 and iPhone, each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation's HIV patients in need are on treatment. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress. A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module. Methods In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction. It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning. Results With a response rate of 90% (18/20 questionnaires returned, the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone. Conclusions Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs. Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.

  5. Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Leski Tomasz A

    2012-07-01

    Full Text Available Abstract Background Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a “cold chain” and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires “leapfrogging” to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries. Methods A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays. Results The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae. Conclusions This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting.

  6. Kangaroo mother care in resource-limited settings: implementation, health benefits, and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-06-01

    Full Text Available Samuel N Uwaezuoke Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria Abstract: Kangaroo mother care (KMC represents an intervention in low birth weight infants for resource-limited settings which aims to reduce mortality rates by thermoregulation, supporting breastfeeding, and promoting early hospital discharge. In terms of cost and impact on neonatal survival, it has comparative advantages over the conventional method of care (CMC. This paper aimed to review the evidence concerning the progress of KMC implementation, its health benefits, and its cost-effectiveness, especially in developing countries. From the synthesized evidence, KMC was shown to be a useful adjunct to CMC particularly with respect to improving neonatal survival, supporting breastfeeding, and promoting early discharge from the hospital. Substantial progress has been made in its implementation in many developing countries where facility-based KMC has been institutionalized. Despite the cost-effectiveness of KMC in neonatal care, its global implementation is bedeviled with country-specific, multifaceted challenges. In developed countries, there is an implementation gap due to easy accessibility to technology-based CMC. Nevertheless, many developing countries have initiated national policies to scale up KMC services in their domain. Given the major constraints to program implementation peculiar to these resource-limited countries, it has become imperative to boost caregiver confidence and experience using dedicated spaces in the hospital, as well as dedicated staff meant for adequate ambulatory follow-up and continuous health education. Capacity training for health professionals and provision of space infrastructure thus constitute the basic needs which could be funded by International Aid Agencies in order to scale up the program in these settings. Keywords: neonatal care, low birth weight infants, thermoregulation, breastfeeding

  7. Prediction of Severe Disease in Children with Diarrhea in a Resource-Limited Setting

    Science.gov (United States)

    Levine, Adam C.; Munyaneza, Richard M.; Glavis-Bloom, Justin; Redditt, Vanessa; Cockrell, Hannah C.; Kalimba, Bantu; Kabemba, Valentin; Musavuli, Juvenal; Gakwerere, Mathias; Umurungi, Jean Paul de Charles; Shah, Sachita P.; Drobac, Peter C.

    2013-01-01

    Objective To investigate the accuracy of three clinical scales for predicting severe disease (severe dehydration or death) in children with diarrhea in a resource-limited setting. Methods Participants included 178 children admitted to three Rwandan hospitals with diarrhea. A local physician or nurse assessed each child on arrival using the World Health Organization (WHO) severe dehydration scale and the Centers for Disease Control (CDC) scale. Children were weighed on arrival and daily until they achieved a stable weight, with a 10% increase between admission weight and stable weight considered severe dehydration. The Clinical Dehydration Scale was then constructed post-hoc using the data collected for the other two scales. Receiver Operator Characteristic (ROC) curves were constructed for each scale compared to the composite outcome of severe dehydration or death. Results The WHO severe dehydration scale, CDC scale, and Clinical Dehydration Scale had areas under the ROC curves (AUCs) of 0.72 (95% CI 0.60, 0.85), 0.73 (95% CI 0.62, 0.84), and 0.80 (95% CI 0.71, 0.89), respectively, in the full cohort. Only the Clinical Dehydration Scale was a significant predictor of severe disease when used in infants, with an AUC of 0.77 (95% CI 0.61, 0.93), and when used by nurses, with an AUC of 0.78 (95% CI 0.63, 0.93). Conclusions While all three scales were moderate predictors of severe disease in children with diarrhea, scale accuracy varied based on provider training and age of the child. Future research should focus on developing or validating clinical tools that can be used accurately by nurses and other less-skilled providers to assess all children with diarrhea in resource-limited settings. PMID:24349271

  8. Ethical considerations in HIV prevention and vaccine research in resource-limited settings.

    Science.gov (United States)

    Garner, Samual A; Anude, Chuka J; Adams, Elizabeth; Dawson, Liza

    2014-09-01

    HIV prevention research has been facing increasing ethical and operational challenges. Factors influencing the design and conduct of HIV prevention trials include a rapidly changing evidence base, new biomedical prevention methods and modalities being tested, a large diversity of countries, sites and populations affected by HIV and participating in trials, and challenges of developing and making available products that will be feasible and affordable for at-risk populations. To discuss these challenges, a meeting, Ethical considerations around novel combination prevention modalities in HIV prevention and vaccine trials in resource-limited settings, was convened by NIH/NIAID/Division of AIDS on April 22-23, 2013. Several themes emerged from the meeting: (1) because of both trial design and ethical complexities, choosing prevention packages and designing combination prevention research trials will need to be evaluated on a case by case basis in different clinical trials, countries, and health systems; (2) multilevel stakeholder engagement from the beginning is vital to a fair and transparent process and also to designing ethical and relevant trials; (3) research should generally be responsive to a host country's needs, and sponsors and stakeholders should work together to address potential barriers to future access; and finally, (4) another meeting including a broader group of stakeholders is needed to address many of the outstanding ethical issues raised by this meeting. We offer an overview of the meeting and the key discussion points and recommendations to help guide the design and conduct of future HIV prevention and vaccine research in resource-limited settings.

  9. Diagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.

    Science.gov (United States)

    Riviello, Elisabeth D; Buregeya, Egide; Twagirumugabe, Theogene

    2017-02-01

    The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification. In the last 18 months, the need for a universally applicable ARDS definition was reinforced by advances in supportive care that can be implemented in resource poor settings. Research demonstrating the variable impact of positive end expiratory pressure on hypoxemia, the validity of using pulse oximetry rather than arterial blood gas to categorize hypoxemia, and the accuracy of lung ultrasound support the use of the Kigali modification of the Berlin definition. Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.

  10. Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study.

    Science.gov (United States)

    Scott, John W; Lin, Yihan; Ntakiyiruta, Georges; Mutabazi, Zeta A; Davis, William Austin; Morris, Megan A; Smink, Douglas S; Riviello, Robert; Yule, Steven

    2018-03-01

    Safe surgery should be available to all patients, no matter the setting. The purpose of this study was to explore the contextual-specific challenges to safe surgical care encountered by surgeons and surgical teams in many in low- and middle-income countries (LMICs), and to understand the ways in which surgical teams overcome them. Optimal surgical performance is highly complex and requires providers to integrate and communicate information regarding the patient, task, team, and environment to coordinate team-based care that is timely, effective, and safe. Resource limitations common to many LMICs present unique challenges to surgeons operating in these environments, but have never been formally described. Using a grounded theory approach, we interviewed 34 experienced providers (surgeons, anesthetists, and nurses) at the 4 tertiary referral centers in Rwanda, to understand the challenges to safe surgical care and strategies to overcome them. Interview transcripts were coded line-by-line and iteratively analyzed for emerging themes until thematic saturation was reached. Rwandan-described challenges related to 4 domains: physical resources, human resources, overall systems support, and communication/language. The majority of these challenges arose from significant variability in either the quantity or quality of these domains. Surgical providers exhibited examples of resilient strategies to anticipate, monitor, respond to, and learn from these challenges. Resource variability rather than lack of resources underlies many contextual challenges to safe surgical care in a LMIC setting. Understanding these challenges and resilient strategies to overcome them is critical for both LMIC surgical providers and surgeons from HICs working in similar settings.

  11. The limits of the nuclear chart set by fission and alpha decay

    Directory of Open Access Journals (Sweden)

    Möller Peter

    2016-01-01

    Full Text Available I will review how our picture of heavy-element nuclear structure has evolved through remarkably simple ideas and related models. It is well known that the Bethe-Weizsäcker semi-empirical mass model had an important role in unraveling radioactive decay and element transmutation in the heavy-element region in the 1930s. A remarkable aspect is that this model could immediately after the discovery of fission be generalized to explain this phenomenon through the consideration of deformation of a charged liquid drop. Bethe and Bacher already raised the possibility that shell structure (by them calculated in terms of a single-particle oscillator potential could give rise to noticeable deviations between results of the macroscopic mass model and experiment but limited data prevented firm conclusions. In the 1950s the single-particle models took a realistic form and also included deformation. The possibility of the existence of a relatively stable “island” of superheavy elements was raised already then. But it was not until the work by Strutinsky in the mid 1960s that a quantitative model for the nuclear potential-energy emerged in the form of the macroscopic-microscopic model. Although new elements have been discovered at an almost steady pace since 1940, theory indicates that we are close to the end of this era: repulsive Coulomb effects will set the limit of observable elements to near Z = 120.

  12. Implications for paediatric shock management in resource-limited settings: a perspective from the FEAST trial.

    Science.gov (United States)

    Houston, Kirsty Anne; George, Elizabeth C; Maitland, Kathryn

    2018-05-04

    Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty. We re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings. We established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%). The updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group

  13. Heat transfer calculations for the High Flux Isotope Reactor (HFIR). Technical specifications: bases for safety limits and limiting safety system settings

    International Nuclear Information System (INIS)

    Sims, T.M.; Swanks, J.H.

    1977-09-01

    Heat transfer analyses, in support of the preparation of the HFIR technical specifications, were made to establish the bases for the safety limits and limiting safety system settings applicable to the HFIR. The results of these analyses, along with the detailed bases, are presented

  14. Weight Estimation Tool for Children Aged 6 to 59 Months in Limited-Resource Settings.

    Science.gov (United States)

    Ralston, Mark E; Myatt, Mark A

    2016-01-01

    A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers. To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries. This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992-2006 using a modified Expanded Program of Immunization two-stage cluster sample design. Locations with high prevalence of acute and chronic malnutrition. A total of 453,990 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values). Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined. Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision. Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and

  15. Experiencing a probabilistic approach to clarify and disclose uncertainties when setting occupational exposure limits.

    Science.gov (United States)

    Vernez, David; Fraize-Frontier, Sandrine; Vincent, Raymond; Binet, Stéphane; Rousselle, Christophe

    2018-03-15

    Assessment factors (AFs) are commonly used for deriving reference concentrations for chemicals. These factors take into account variabilities as well as uncertainties in the dataset, such as inter-species and intra-species variabilities or exposure duration extrapolation or extrapolation from the lowest-observed-adverse-effect level (LOAEL) to the noobserved- adverse-effect level (NOAEL). In a deterministic approach, the value of an AF is the result of a debate among experts and, often a conservative value is used as a default choice. A probabilistic framework to better take into account uncertainties and/or variability when setting occupational exposure limits (OELs) is presented and discussed in this paper. Each AF is considered as a random variable with a probabilistic distribution. A short literature was conducted before setting default distributions ranges and shapes for each AF commonly used. A random sampling, using Monte Carlo techniques, is then used for propagating the identified uncertainties and computing the final OEL distribution. Starting from the broad default distributions obtained, experts narrow it to its most likely range, according to the scientific knowledge available for a specific chemical. Introducing distribution rather than single deterministic values allows disclosing and clarifying variability and/or uncertainties inherent to the OEL construction process. This probabilistic approach yields quantitative insight into both the possible range and the relative likelihood of values for model outputs. It thereby provides a better support in decision-making and improves transparency. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  16. Vaccination program in a resource-limited setting: A case study in the Philippines.

    Science.gov (United States)

    Chootipongchaivat, Sarocha; Chantarastapornchit, Varit; Kulpeng, Wantanee; Ceria, Joyce Anne; Tolentino, Niña Isabelle; Teerawattananon, Yot

    2016-09-14

    Implementing national-level vaccination programs involves long-term investment, which can be a significant financial burden, particularly in resource-limited settings. Although many studies have assessed the economic impacts of providing vaccinations, evidence on the positive and negative implications of human resources for health (HRH) is still lacking. Therefore, this study aims to estimate the HRH impact of introducing pneumococcal conjugate vaccine (PCV) using a model-based economic evaluation. This study adapted a Markov model from a prior study that was conducted in the Philippines for assessing the cost-effectiveness of 10-valent and 13-valent PCV compared to no vaccination. The Markov model was used for estimating the number of cases of pneumococcal-related diseases, categorized by policy options. HRH-related parameters were obtained from document reviews and interviews using the quantity, task, and productivity model (QTP model). The number of full-time equivalent (FTE) of general practitioners, nurses, and midwives increases significantly if the universal vaccine coverage policy is implemented. A universal coverage of PCV13 - which is considered to be the best value for money compared to other vaccination strategies - requires an additional 380 FTEs for general practitioners, 602 FTEs for nurses, and 205 FTEs for midwives; it can reduce the number of FTEs for medical social workers, paediatricians, infectious disease specialists, neurologists, anaesthesiologists, radiologists, ultrasonologists, medical technologists, radiologic technologists, and pharmacists by 7, 17.9, 9.7, 0.4, 0.1, 0.7, 0.1, 12.3, 2, and 9.7, respectively, when compared to the no vaccination policy. This is the first attempt to estimate the impact of HRH alongside a model-based economic evaluation study, which can be eventually applied to other vaccine studies, especially those which inform resource allocation in developing settings where not only financial resources but also HRH are

  17. Is the maximum permissible radiation burden for the population indeed permissible

    International Nuclear Information System (INIS)

    Renesse, R.L. van.

    1975-01-01

    It is argued that legislation based on the ICRP doses will, under economical influences, lead to a situation where the population is exposed to radiation doses near the maximum permissible dose. Due to cumulative radiation effects, this will introduce unacceptable health risks. Therefore, it will be necessary to lower the legal dose limit of 170 millrem per year per person by a factor 10 to 20

  18. Estimating health workforce needs for antiretroviral therapy in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Fullem Andrew

    2006-01-01

    Full Text Available Abstract Background Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART, for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. Methods We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. Results We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1–2 physicians, 2–7 nurses, Discussion These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

  19. Strong Migration Limit for Games in Structured Populations: Applications to Dominance Hierarchy and Set Structure

    Directory of Open Access Journals (Sweden)

    Dhaker Kroumi

    2015-09-01

    Full Text Available In this paper, we deduce a condition for a strategy S1 to be more abundant on average at equilibrium under weak selection than another strategy S2 in a population structured into a finite number of colonies of fixed proportions as the population size tends to infinity. It is assumed that one individual reproduces at a time with some probability depending on the payoff received in pairwise interactions within colonies and between colonies and that the offspring replaces one individual chosen at random in the colony into which the offspring migrates. It is shown that an expected weighted average equilibrium frequency of S1 under weak symmetric strategy mutation between S1 and S2 is increased by weak selection if an expected weighted payoff of S1 near neutrality exceeds the corresponding expected weighted payoff of S2. The weights are given in terms of reproductive values of individuals in the different colonies in the neutral model. This condition for S1 to be favoured by weak selection is obtained from a strong migration limit of the genealogical process under neutrality for a sample of individuals, which is proven using a two-time scale argument. The condition is applied to games between individuals in colonies with linear or cyclic dominance and between individuals belonging to groups represented by subsets of a given set.

  20. The introduction of syphilis point of care tests in resource limited settings.

    Science.gov (United States)

    Marks, Michael; Mabey, David Cw

    2017-04-01

    Syphilis remains an important and preventable cause of stillbirth and neonatal mortality. About 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby and 33% a low birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks' gestation. Areas covered: This manuscript covers the impact of syphilis on pregnancy outcome, the diagnosis of syphilis, with a special focus on point of care (POC) tests, and challenges to the introduction of POC tests, and their potential impact on the control and prevention of syphilis in resource limited settings. Expert commentary: POC tests for syphilis are available which meet the ASSURED criteria, and could make syphilis screening accessible to all women anywhere in the world who attend an antenatal clinic. High quality dual POC tests for HIV and syphilis could ensure that well-funded programmes for the prevention of mother to child transmission of HIV can contribute towards increased coverage of antenatal syphilis screening, and prevent more than 300,000 adverse pregnancy outcomes due to syphilis annually. Alongside investment to increase availability of syphilis POC tests, operational research is needed to understand how best to improve screening of pregnant women and to translate test availability into improved pregnancy outcomes.

  1. Voluntary limit setting and player choice in most intense online gamblers: an empirical study of gambling behaviour.

    Science.gov (United States)

    Auer, Michael; Griffiths, Mark D

    2013-12-01

    Social responsibility in gambling has become a major issue for the gaming industry. The possibility for online gamblers to set voluntary time and money limits are a social responsibility practice that is now widespread among online gaming operators. The main issue concerns whether the voluntary setting of such limits has any positive impact on subsequent gambling behaviour and whether such measures are of help to problem gamblers. In this paper, this issue is examined through data collected from a representative random sample of 100,000 players who gambled on the win2day gambling website. When opening an account at the win2day site, there is a mandatory requirement for all players to set time and cash-in limits (that cannot exceed 800 per week). During a 3-month period, all voluntary time and/or money limit setting behaviour by a subsample of online gamblers (n = 5,000) within this mandatory framework was tracked and recorded for subsequent data analysis. From the 5,000 gamblers, the 10 % most intense players (as measured by theoretical loss) were further investigated. Voluntary spending limits had the highest significant effect on subsequent monetary spending among casino and lottery gamblers. Monetary spending among poker players significantly decreased after setting a voluntary time limit. The highest significant decrease in playing duration was among poker players after setting a voluntary playing duration limit. The results of the study demonstrated that voluntary limit setting had a specific and significant effect on the studied gamblers. Therefore, voluntary limits appear to show an appropriate effect in the desired target group (i.e., the most gaming intense players).

  2. Strategic establishment of an International Pharmacology Specialty Laboratory in a resource-limited setting.

    Science.gov (United States)

    Mtisi, Takudzwa J; Maponga, Charles; Monera-Penduka, Tsitsi G; Mudzviti, Tinashe; Chagwena, Dexter; Makita-Chingombe, Faithful; DiFranchesco, Robin; Morse, Gene D

    2018-01-01

    A growing number of drug development studies that include pharmacokinetic evaluations are conducted in regions lacking a specialised pharmacology laboratory. This necessitated the development of an International Pharmacology Specialty Laboratory (IPSL) in Zimbabwe. The aim of this article is to describe the development of an IPSL in Zimbabwe. The IPSL was developed collaboratively by the University of Zimbabwe and the University at Buffalo Center for Integrated Global Biomedical Sciences. Key stages included infrastructure development, establishment of quality management systems and collaborative mentorship in clinical pharmacology study design and chromatographic assay development and validation. Two high performance liquid chromatography instruments were donated by an instrument manufacturer and a contract research organisation. Laboratory space was acquired through association with the Zimbabwe national drug regulatory authority. Operational policies, standard operating procedures and a document control system were established. Scientists and technicians were trained in aspects relevant to IPSL operations. A high-performance liquid chromatography method for nevirapine was developed with the guidance of the Clinical Pharmacology Quality Assurance programme and approved by the assay method review programme. The University of Zimbabwe IPSL is engaged with the United States National Institute of Allergy and Infectious Diseases Division of AIDS research networks and is poised to begin drug assays and pharmacokinetic analyses. An IPSL has been successfully established in a resource-limited setting through the efforts of an external partnership providing technical guidance and motivated internal faculty and staff. Strategic partnerships were beneficial in navigating challenges leading to laboratory development and training new investigators. The IPSL is now engaged in clinical pharmacology research.

  3. Setting Authorized Limits for Radioactive Discharges: Practical Issues to Consider. Report for Discussion

    International Nuclear Information System (INIS)

    2010-03-01

    Application of the principles of radioactive waste management requires the implementation of measures that afford protection of human health and of the environment, now and in the future. The IAEA has issued safety standards and other publications that provide a framework for the control of releases of radionuclides to the environment. This framework is relevant for regulatory bodies that issue authorizations and for organizations that (i) use radionuclides for medical or research purposes, (ii) operate nuclear reactors or (iii) reprocess nuclear material. An IAEA Safety Guide on Regulatory Control of Radioactive Discharges to the Environment was issued in 2000 that outlines the roles and responsibilities of regulatory bodies, licensees and registrants and provides guidance on the authorization procedure. However, there have been significant developments in radiological protection policy since the publication of this Safety Guide, most notably the issue of ICRP Publications No. 101 on Assessing Dose of the Representative Person for the Purpose of Radiation Protection of the Public and the Optimisation of Radiological Protection and No. 103 on The 2007 Recommendations of the ICRP. The objective of this IAEA-TECDOC is to stimulate discussion on the practical implementation of the control of radioactive releases in order to inform the review and revision of IAEA guidance on this subject. This IAEA-TECDOC is based on the practical experience of Member States and on information provided at Technical Committee Meetings held in 2003 and 2008 and gained by means of a questionnaire. It summarizes international experience on the optimization of discharges and the setting by the regulatory body of authorized limits on discharges for nuclear installations and non-nuclear facilities. Its issue at this stage is intended for consultation as a preparatory step pending the current process of revision of the IAEA's International Basic Safety Standards for Protection against Ionizing

  4. 78 FR 70414 - Pricing for the 2013 United States Mint Limited Edition Silver Proof SetTM

    Science.gov (United States)

    2013-11-25

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2013 United States Mint Limited Edition Silver Proof Set TM AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing a price of $139.95 for the 2013 United States Mint Limited...

  5. The accountability for reasonableness approach to guide priority setting in health systems within limited resources

    DEFF Research Database (Denmark)

    Byskov, Jens; Marchal, Bruno; Maluka, Stephen

    2014-01-01

    : relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). METHODS...... of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications....

  6. Pollen limitation and its influence on natural selection through seed set.

    Science.gov (United States)

    Bartkowska, M P; Johnston, M O

    2015-11-01

    Stronger pollen limitation should increase competition among plants, leading to stronger selection on traits important for pollen receipt. The few explicit tests of this hypothesis, however, have provided conflicting support. Using the arithmetic relationship between these two quantities, we show that increased pollen limitation will automatically result in stronger selection (all else equal) although other factors can alter selection independently of pollen limitation. We then tested the hypothesis using two approaches. First, we analysed the published studies containing information on both pollen limitation and selection. Second, we explored how natural selection measured in one Ontario population of Lobelia cardinalis over 3 years and two Michigan populations in 1 year relates to pollen limitation. For the Ontario population, we also explored whether pollinator-mediated selection is related to pollen limitation. Consistent with the hypothesis, we found an overall positive relationship between selection strength and pollen limitation both among species and within L. cardinalis. Unexpectedly, this relationship was found even for vegetative traits among species, and was not found in L. cardinalis for pollinator-mediated selection on nearly all trait types. © 2015 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2015 European Society For Evolutionary Biology.

  7. Creating Online Training for Procedures in Global Health with PEARLS (Procedural Education for Adaptation to Resource-Limited Settings).

    Science.gov (United States)

    Bensman, Rachel S; Slusher, Tina M; Butteris, Sabrina M; Pitt, Michael B; On Behalf Of The Sugar Pearls Investigators; Becker, Amanda; Desai, Brinda; George, Alisha; Hagen, Scott; Kiragu, Andrew; Johannsen, Ron; Miller, Kathleen; Rule, Amy; Webber, Sarah

    2017-11-01

    The authors describe a multiinstitutional collaborative project to address a gap in global health training by creating a free online platform to share a curriculum for performing procedures in resource-limited settings. This curriculum called PEARLS (Procedural Education for Adaptation to Resource-Limited Settings) consists of peer-reviewed instructional and demonstration videos describing modifications for performing common pediatric procedures in resource-limited settings. Adaptations range from the creation of a low-cost spacer for inhaled medications to a suction chamber for continued evacuation of a chest tube. By describing the collaborative process, we provide a model for educators in other fields to collate and disseminate procedural modifications adapted for their own specialty and location, ideally expanding this crowd-sourced curriculum to reach a wide audience of trainees and providers in global health.

  8. Prehospital care practices for venomous snakebites in resource-limited settings: A narrative review

    Directory of Open Access Journals (Sweden)

    Godpower Chinedu Michael

    2017-01-01

    Full Text Available Venomous snakebite is a medical emergency encountered worldwide, especially in resource-limited communities. It usually leaves victims at the mercy of traditional care, whose effectiveness have come under scrutiny over time. Several of these traditional/ first aid practices have also been reported over time. Controversies over their efficacy often result in confusion among snakebite victims, their caregivers, and sometimes, among health-care providers. This narrative review describes reported prehospital interventions for venomous snakebites highlighting their usefulness, dangers, and/or limitations associated with their use and the currently widely recommended prehospital activities for venomous snakebite.

  9. 17 CFR 150.5 - Exchange-set speculative position limits.

    Science.gov (United States)

    2010-04-01

    ..., straddles, or arbitrage,” of from fixing limits which apply to such positions which are different from... opportunity for arbitrage between the futures market and the cash market in the commodity underlying the... pursuant to this section shall apply to bona fide hedging positions as defined by a contract market in...

  10. ROBUST ESTIMATION OF MEAN AND VARIANCE USING ENVIRONMENTAL DATA SETS WITH BELOW DETECTION LIMIT OBSERVATIONS

    Science.gov (United States)

    Scientists, especially environmental scientists often encounter trace level concentrations that are typically reported as less than a certain limit of detection, L. Type 1, left-censored data arise when certain low values lying below L are ignored or unknown as they cannot be mea...

  11. Control-free control: Manipulating a quantum system using only a limited set of measurements

    International Nuclear Information System (INIS)

    Ashhab, S.; Nori, Franco

    2010-01-01

    We present and discuss different protocols for preparing an arbitrary quantum state of a qubit using only a restricted set of measurements, with no unitary operations at all. We show that an arbitrary state can indeed be prepared, provided that the available measurements satisfy certain requirements. Our results shed light on the role that measurement-induced back-action plays in quantum feedback control and the extent to which this back-action can be exploited in quantum-control protocols.

  12. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings

    OpenAIRE

    Raghubanshi, Bijendra Raj; Sapkota, Supriya; Adhikari, Arjab; Dutta, Aman; Bhattarai, Utsuk; Bhandari, Rastriyata

    2017-01-01

    Abstract Background In developing countries like Nepal, 90% ethanol is cheap and is available in most hospitals. The unavailability of isopropyl alcohol (IPA) in these settings led us to compare the efficacy between 90% ethanol and isopropyl alcohol pads in reducing the bacterial contamination of diaphragm of stethoscope. Methods A randomized blinded experimental study was carried out to determine the difference between cleaning stethoscopes with 90% ethanol and IPA. Cultures of diaphragm wer...

  13. Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings.

    Science.gov (United States)

    Bennett, Desmond J; Carroll, Ryan W; Kacmarek, Robert M

    2018-04-01

    Respiratory compromise is a leading contributor to global neonatal death. CPAP is a method of treatment that helps maintain lung volume during expiration, promotes comfortable breathing, and improves oxygenation. Bubble CPAP is an effective alternative to standard CPAP. We sought to determine the reliability and functionality of a low-cost bubble CPAP device designed for low-resource settings. The low-cost bubble CPAP device was compared to a commercially available bubble CPAP system. The devices were connected to a lung simulator that simulated neonates of 4 different weights with compromised respiratory mechanics (∼1, ∼3, ∼5, and ∼10 kg). The devices' abilities to establish and maintain pressure and flow under normal conditions as well as under conditions of leak were compared. Multiple combinations of pressure levels (5, 8, and 10 cm H 2 O) and flow levels (3, 6, and 10 L/min) were tested. The endurance of both devices was also tested by running the systems continuously for 8 h and measuring the changes in pressure and flow. Both devices performed equivalently during the no-leak and leak trials. While our testing revealed individual differences that were statistically significant and clinically important (>10% difference) within specific CPAP and flow-level settings, no overall comparisons of CPAP or flow were both statistically significant and clinically important. Each device delivered pressures similar to the desired pressures, although the flows delivered by both machines were lower than the set flows in most trials. During the endurance trials, the low-cost device was marginally better at maintaining pressure, while the commercially available device was better at maintaining flow. The low-cost bubble CPAP device evaluated in this study is comparable to a bubble CPAP system used in developed settings. Extensive clinical trials, however, are necessary to confirm its effectiveness. Copyright © 2018 by Daedalus Enterprises.

  14. Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings.

    Science.gov (United States)

    Graham, Stephen M; English, Mike; Hazir, Tabish; Enarson, Penny; Duke, Trevor

    2008-05-01

    Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

  15. Maximum Permissible Concentrations and Negligible Concentrations for pesticides

    NARCIS (Netherlands)

    Crommentuijn T; Kalf DF; Polder MD; Posthumus R; Plassche EJ van de; CSR

    1997-01-01

    Maximum Permissible Concentrations (MPCs) and Negligible Concentrations (NCs) derived for a series of pesticides are presented in this report. These MPCs and NCs are used by the Ministry of Housing, Spatial Planning and the Environment (VROM) to set Environmental Quality Objectives. For some of the

  16. Regulatory challenges associated with conducting multicountry clinical trials in resource-limited settings.

    Science.gov (United States)

    Ndebele, Paul; Blanchard-Horan, Christina; Shahkolahi, Akbar; Sanne, Ian

    2014-01-01

    International public health and infectious diseases research has expanded to become a global enterprise transcending national and continental borders in organized networks addressing high-impact diseases. In conducting multicountry clinical trials, sponsors and investigators have to ensure that they meet regulatory requirements in all countries in which the clinical trials will be conducted. Some of these requirements include review and approval by national drug regulatory authorities and recognized research ethics committees. A limiting factor to the efficient conduct of multicountry clinical trials is the regulatory environment in each collaborating country, with significant differences determined by various factors including the laws and the procedures used in each country. The long regulatory processes in resource-limited countries may hinder the efficient implementation of multisite clinical trials, delaying research important to the health of populations in these countries and costing millions of dollars a year.

  17. A Program to Provide Vocational Training to Limited English Speaking Adults in a Correctional Setting. Final Report.

    Science.gov (United States)

    Murray, Lane

    The Windham School System implemented a pilot project designed to provide bilingual vocational training to limited English-speaking adults in a correctional setting. Inmate students enrolled in Windham bilingual academic classes on the Eastham Unit of the Texas Department of Corrections were interviewed, and procedures for student screening and…

  18. Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting

    NARCIS (Netherlands)

    van Zyl, Gert Uves; van Mens, Thijs E.; McIlleron, Helen; Zeier, Michele; Nachega, Jean B.; Decloedt, Eric; Malavazzi, Carolina; Smith, Peter; Huang, Yong; van der Merwe, Lize; Gandhi, Monica; Maartens, Gary

    2011-01-01

    In resource-limited settings, many patients, with no prior protease inhibitor (PI) treatment on a second-line, high genetic barrier, ritonavir-boosted PI-containing regimen have virologic failure. We conducted a cross-sectional survey to investigate the aetiology of virologic failure in 2 public

  19. Acceptability of donated breast milk in a resource limited South African setting

    OpenAIRE

    Coutsoudis Anna; Petrites Alissa; Coutsoudis Irene

    2011-01-01

    Abstract Background The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of th...

  20. Social construction and materiality: the limits of indeterminacy in therapeutic settings.

    Science.gov (United States)

    Lannamann, J W

    1998-01-01

    By drawing parallels between the courtroom testimony of a Christian Science practitioner and an intersession conversation between systemic family therapists, I critique the abstract idealism of language-centered social constructionism. I argue that social constructionist inquiry that highlights the indeterminacy of meaning without a corresponding emphasis on the responsive embodied practices of family members glosses over the material conditions shaping the politics of interaction. The implications of this problem are discussed as they relate to the setting of family therapy, where social construction theory is often used to guide practical interventions.

  1. Optimal allocation of the limited oral cholera vaccine supply between endemic and epidemic settings.

    Science.gov (United States)

    Moore, Sean M; Lessler, Justin

    2015-10-06

    The World Health Organization (WHO) recently established a global stockpile of oral cholera vaccine (OCV) to be preferentially used in epidemic response (reactive campaigns) with any vaccine remaining after 1 year allocated to endemic settings. Hence, the number of cholera cases or deaths prevented in an endemic setting represents the minimum utility of these doses, and the optimal risk-averse response to any reactive vaccination request (i.e. the minimax strategy) is one that allocates the remaining doses between the requested epidemic response and endemic use in order to ensure that at least this minimum utility is achieved. Using mathematical models, we find that the best minimax strategy is to allocate the majority of doses to reactive campaigns, unless the request came late in the targeted epidemic. As vaccine supplies dwindle, the case for reactive use of the remaining doses grows stronger. Our analysis provides a lower bound for the amount of OCV to keep in reserve when responding to any request. These results provide a strategic context for the fulfilment of requests to the stockpile, and define allocation strategies that minimize the number of OCV doses that are allocated to suboptimal situations. © 2015 The Authors.

  2. MMPI-2 Symptom Validity (FBS) Scale: psychometric characteristics and limitations in a Veterans Affairs neuropsychological setting.

    Science.gov (United States)

    Gass, Carlton S; Odland, Anthony P

    2014-01-01

    The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

  3. Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

    Science.gov (United States)

    Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

    2018-01-01

    Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  4. Lumbar Radiculopathy in the Setting of Degenerative Scoliosis: MIS Decompression and Limited Correction are Better Options.

    Science.gov (United States)

    Fontes, Ricardo B; Fessler, Richard G

    2017-07-01

    Surgery for adult spinal deformity (ASD) has emerged as an efficient treatment alternative, but it is fraught with potential perioperative morbidity, incompletely mitigated by emerging minimally invasive surgical techniques. In mild-to-moderate ASD balanced in the sagittal plane, there are situations in which the counterintuitive simple decompression through a foraminotomy or laminectomy, or even a short-segment fusion may be an attractive treatment. This article presents a case example and the authors' treatment rationale and reviews the limited available literature supporting it. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. 12 CFR 703.14 - Permissible investments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Permissible investments. 703.14 Section 703.14 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS INVESTMENT AND DEPOSIT ACTIVITIES § 703.14 Permissible investments. (a) Variable rate investment. A Federal...

  6. Modelling of Split Condenser Heat Pump with Limited Set of Plate Heat Exchanger Dimensions

    DEFF Research Database (Denmark)

    Christensen, Stefan Wuust; Elmegaard, Brian; Markussen, Wiebke Brix

    2017-01-01

    in parallel to different temperature levels, whereas only one stream is heated in a THP. The length/width ratio of the plate heat exchangers on the high pressure side of a SCHP was investigated to find the optimal plate dimensions with respect to minimum area of the heat exchangers. The total heat exchanger...... area was found to decrease with an increasing length/width ratio of the plates. The marginal change in heat exchanger area was shown to be less significant for heat exchangers with high length/width ratios. In practice only a limited number of plate dimensions are available and feasible...... in the production. This was investigated to find the practical potential of a SCHP compared to a THP. Using plates optimized for a SCHP in a THP, the total required heat exchanger area increased by approximately 100% for the conditions investigated in this study, indicating that available plate dimensions influence...

  7. Rules and recent trends for setting health-based occupational exposure limits for chemicals

    Directory of Open Access Journals (Sweden)

    Jolanta Skowroń

    2015-04-01

    Full Text Available The working environment is the special case of the non-natural environment created by man in which the increased production activity brings about the concentration of stimulators particularly aggressive to the human organism, such as chemical hazards, noise, vibration, extreme temperatures, and finally, intensified psychological and emotional stress. Depending on the nature and intensity, working environment factors have been classified into dangerous, harmful and annoying. The workers are more and more frequently exposed to dangerous chemicals in the working environment. The chemicals cause many diseases including, in the 1st place, respiratory insufficiency, inflammatory skin conditions, psychoneurological disorders and neoplastic diseases. Occupational exposure limit values (OELs, the main criteria for occupational exposure assessment, constitute an important factor for the safe use of chemicals in the working environment. In Poland, to date there are 524 chemical substances and 19 dusts for which maximum admissible concentrations (MAC have been established.

  8. Setting limits: Using air pollution thresholds to protect and restore US ecosystems

    Science.gov (United States)

    Fenn, Mark E.; Lambert, Kathleen F.; Blett, Tamara F.; Burns, Douglas A.; Pardo, Linda H.; Lovett, Gary M.; Haeuber, Richard A.; Evers, David C.; Driscoll, Charles T.; Jeffries, Dean S.

    2011-01-01

    More than four decades of research provide unequivocal evidence that sulfur, nitrogen, and mercury pollution have altered, and will continue to alter, our nation's lands and waters. The emission and deposition of air pollutants harm native plants and animals, degrade water quality, affect forest productivity, and are damaging to human health. Many air quality policies limit emissions at the source but these control measures do not always consider ecosystem impacts. Air pollution thresholds at which ecological effects are observed, such as critical loads, are effective tools for assessing the impacts of air pollution on essential ecosystem services and for informing public policy. U.S. ecosystems can be more effectively protected and restored by using a combination of emissions-based approaches and science-based thresholds of ecosystem damage.

  9. Setting Up a Limited Liability Company with Sole Shareholder in the European Union Countries

    Directory of Open Access Journals (Sweden)

    Simona Petrina GAVRILA

    2011-11-01

    Full Text Available Given the importance of legal rules as closely as possible to the legal systems of the European Union Member States in respect of the companies, several directives have been adopted, of which twelve present the essence of the operational mechanisms harmonization . The consecration of single-member company in positive law is determined by multiple motivations, and the relevance of its objectives is complex, for the reason of the diverse role it plays in the economic and social life, from which the existence of different single-member business derives:limited liability company, joint stock company, simplified joint stock company, dedicated assets, subjected to a personal legal system, difficult to compare, each of them to be therefore studied in the legal, economic, social and tax context of each country.

  10. Implications for Firms with Limited Information to Take Advantage of Reference Price Effect in Competitive Settings

    Directory of Open Access Journals (Sweden)

    Junhai Ma

    2017-01-01

    Full Text Available This paper studies internal reference price effects when competitive firms face reference price effects and make decisions based on partial information, where their decision-making mechanism is modeled by a dynamic adjustment process. It is shown that the evolution of this dynamic adjustment goes to stabilization if both adjustment speeds are small and the complexity of this evolution increases in adjustment speeds. It is proved that the necessary condition for flip bifurcation or Neimark-Sacker bifurcation will occur with the increase of adjustment speed in two special cases. What is more, numerical simulations show that these bifurcations do occur. Then, the impacts of parameters on stability and profits are investigated and some management insights for firms with limited information to take advantage of reference price effects are provided.

  11. Internal Dosimetry Monitoring- Detection Limits for a Selected Set of Radionuclides and Their Translation Into Committed Effective Dose

    International Nuclear Information System (INIS)

    Brandl, A.; Hrnecek, E.; Steger, F.

    2004-01-01

    To harmonize the practice of internal dosimetry monitoring across the country, the Austrian Standards Institute is currently drafting a new set of standards which are concerned with occupational incorporation monitoring of individuals handling non-sealed radioactive material. This set of standards is expected to consist of three parts discussing the general necessity and frequency, the requirements for monitoring institutions, and the determination and rigorous calculation of committed effective dose after incorporation of radioactive material, respectively. Considerations of the requirements for routine monitoring laboratories have led to an evaluation of the detection limits for routine monitoring equipment. For a selected set of radionuclides, these detection limits are investigated in detail. The main emphasis is placed on the decay chains of naturally occurring radionuclides showing some significant potential for being out of equilibrium due to chemical processes in certain mining industries. The radionuclides considered in this paper are 226Ra, 228Ra, 228Th, 232Th, 234U, 235U, and 238U. Given the routine monitoring intervals of the Austrian Standard, these detection limits are translated into information on committed effective dose. This paper investigates whether routine monitoring equipment is sufficient to ensure compliance with EC directive 96/29/Euratom for this selected set of radionuclides. (Author) 9 refs

  12. A Within-Group Analysis of African American Mothers’ Authoritarian Attitudes, Limit-Setting and Children's Self-Regulation

    Science.gov (United States)

    LeCuyer, Elizabeth A.; Swanson, Dena Phillips

    2016-01-01

    Research suggests that higher levels of authoritarian parenting exist in African American (AA) families than in European American (EA) families, and that authoritarian attitudes may be associated with more positive outcomes in AA families than EA families. However, less is known about authoritarian attitudes and children's development within AA families. This within-group study of 50 African American mothers and their 3-year-old children examined associations between maternal authoritarian attitudes, observed maternal limit-setting strategies, and children's self-regulation during a limit-setting interaction. The findings indicate that while AA families may hold more authoritarian attitudes than EA families, the direction of effect of authoritarian attitudes on children's outcomes appears to be the same in both ethnic groups. In this sample, when examining AA authoritarian attitudes relative to those of other AA mothers, less or lower authoritarian attitudes were associated with authoritative limit-setting behavior (firm limits within the context of overall warmth and responsiveness) and better children's self-regulation. PMID:28408794

  13. A Within-Group Analysis of African American Mothers' Authoritarian Attitudes, Limit-Setting and Children's Self-Regulation.

    Science.gov (United States)

    LeCuyer, Elizabeth A; Swanson, Dena Phillips

    2017-03-01

    Research suggests that higher levels of authoritarian parenting exist in African American (AA) families than in European American (EA) families, and that authoritarian attitudes may be associated with more positive outcomes in AA families than EA families. However, less is known about authoritarian attitudes and children's development within AA families. This within-group study of 50 African American mothers and their 3-year-old children examined associations between maternal authoritarian attitudes, observed maternal limit-setting strategies, and children's self-regulation during a limit-setting interaction. The findings indicate that while AA families may hold more authoritarian attitudes than EA families, the direction of effect of authoritarian attitudes on children's outcomes appears to be the same in both ethnic groups. In this sample, when examining AA authoritarian attitudes relative to those of other AA mothers, less or lower authoritarian attitudes were associated with authoritative limit-setting behavior (firm limits within the context of overall warmth and responsiveness) and better children's self-regulation.

  14. Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Campbell Timothy C

    2012-09-01

    Full Text Available Abstract Background Emerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness. Methods As components of its Suite for Automated Global bioSurveillance (SAGES program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies. Results ESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system. Conclusions OpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations.

  15. Setting an Upper Limit on Gas Exchange Through Sea-Spray

    Science.gov (United States)

    Vlahos, P.; Monahan, E. C.; Andreas, E. L.

    2016-02-01

    Air-sea gas exchange parameterization is critical to understanding both climate forcing and feedbacks and is key in biogeochemistry cycles. Models based on wind speed have provided empirical estimates of gas exchange that are useful though it is likely that at high wind speeds of over 10 m/s there are important gas exchange parameters including bubbles and sea spray that have not been well constrained. Here we address the sea-spray component of gas exchange at these high wind speeds to set sn upper boundary condition for the gas exchange of the six model gases including; nobel gases helium, neon and argon, diatomic gases nitrogen and oxygen and finally, the more complex gas carbon dioxide. Estimates are based on the spray generation function of Andreas and Monahan and the gases are tested under three scenarios including 100 percent saturation and complete droplet evaporation, 100 percent saturation and a more realistic scenario in which a fraction of droplets evaporate completely, a fraction evaporate to some degree and a fraction returns to the water side without significant evaporation. Finally the latter scenario is applied to representative under saturated concentrations of the gases.

  16. Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities.

    Science.gov (United States)

    Drummond, Jennifer L; Were, Martin C; Arrossi, Silvina; Wools-Kaloustian, Kara

    2017-07-01

    Appropriate collection and use of health information is critical to the planning, scaling up, and improvement of cervical cancer programs. The health information systems implementation landscape is unique to each country; however, systems serving cervical cancer programs in low-resource settings share characteristics that present common challenges. In response, many programs have taken innovative approaches to generating the quality information needed for decision making. Recent advances in health information technology also provide feasible solutions to challenges. This article draws from the experiences of the authors and from current literature to describe outstanding challenges and promising practices in the implementation of cervical cancer data systems, and to make recommendations for next steps. Recommendations include engaging all stakeholders-including providers, program managers, implementing partners, and donors-in promoting national, district, and community information systems; building on existing systems and processes, as well as introducing new technologies; and evolving data collection and data systems as programs advance. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  17. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings

    Directory of Open Access Journals (Sweden)

    Bijendra Raj Raghubanshi

    2017-06-01

    Full Text Available Abstract Background In developing countries like Nepal, 90% ethanol is cheap and is available in most hospitals. The unavailability of isopropyl alcohol (IPA in these settings led us to compare the efficacy between 90% ethanol and isopropyl alcohol pads in reducing the bacterial contamination of diaphragm of stethoscope. Methods A randomized blinded experimental study was carried out to determine the difference between cleaning stethoscopes with 90% ethanol and IPA. Cultures of diaphragm were taken before and after cleaning with one of the cleaning agent. Colony forming units (CFU count and organism identification was done by a blinded investigator. CFU before and after cleaning were compared using Wilcoxon signed–rank test. Mann Whitney U test was used to compare the decrease in CFU count between the cleaning agents. Results About 30% of the stethoscopes harbored potential pathogens. Significant reduction in CFU was observed with both IPA (Wilcoxon signed–rank test, P value 0.05. Conclusions Both 90% ethanol and IPA are equally effective in decontaminating the diaphragm of stethoscope. Selection of agent should be done on the basis of cost and availability.

  18. [Development of a software standardizing optical density with operation settings related to several limitations].

    Science.gov (United States)

    Tu, Xiao-Ming; Zhang, Zuo-Heng; Wan, Cheng; Zheng, Yu; Xu, Jin-Mei; Zhang, Yuan-Yuan; Luo, Jian-Ping; Wu, Hai-Wei

    2012-12-01

    To develop a software that can be used to standardize optical density to normalize the procedures and results of standardization in order to effectively solve several problems generated during standardization of in-direct ELISA results. The software was designed based on the I-STOD method with operation settings to solve the problems that one might encounter during the standardization. Matlab GUI was used as a tool for the development. The software was tested with the results of the detection of sera of persons from schistosomiasis japonica endemic areas. I-STOD V1.0 (WINDOWS XP/WIN 7, 0.5 GB) was successfully developed to standardize optical density. A serial of serum samples from schistosomiasis japonica endemic areas were used to examine the operational effects of I-STOD V1.0 software. The results indicated that the software successfully overcame several problems including reliability of standard curve, applicable scope of samples and determination of dilution for samples outside the scope, so that I-STOD was performed more conveniently and the results of standardization were more consistent. I-STOD V1.0 is a professional software based on I-STOD. It can be easily operated and can effectively standardize the testing results of in-direct ELISA.

  19. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings.

    Science.gov (United States)

    Raghubanshi, Bijendra Raj; Sapkota, Supriya; Adhikari, Arjab; Dutta, Aman; Bhattarai, Utsuk; Bhandari, Rastriyata

    2017-01-01

    In developing countries like Nepal, 90% ethanol is cheap and is available in most hospitals. The unavailability of isopropyl alcohol (IPA) in these settings led us to compare the efficacy between 90% ethanol and isopropyl alcohol pads in reducing the bacterial contamination of diaphragm of stethoscope. A randomized blinded experimental study was carried out to determine the difference between cleaning stethoscopes with 90% ethanol and IPA. Cultures of diaphragm were taken before and after cleaning with one of the cleaning agent. Colony forming units (CFU) count and organism identification was done by a blinded investigator. CFU before and after cleaning were compared using Wilcoxon signed-rank test. Mann Whitney U test was used to compare the decrease in CFU count between the cleaning agents. About 30% of the stethoscopes harbored potential pathogens. Significant reduction in CFU was observed with both IPA (Wilcoxon signed-rank test, P value Wilcoxon signed-rank test, P value test; U = 1357, P value >0.05). Both 90% ethanol and IPA are equally effective in decontaminating the diaphragm of stethoscope. Selection of agent should be done on the basis of cost and availability.

  20. Rules and recent trends for setting health-based occupational exposure limits for chemicals.

    Science.gov (United States)

    Skowroń, Jolanta; Czerczak, Sławomir

    2015-01-01

    The working environment is the special case of the non-natural environment created by man in which the increased production activity brings about the concentration of stimulators particularly aggressive to the human organism, such as chemical hazards, noise, vibration, extreme temperatures, and finally, intensified psychological and emotional stress. Depending on the nature and intensity, working environment factors have been classified into dangerous, harmful and annoying. The workers are more and more frequently exposed to dangerous chemicals in the working environment. The chemicals cause many diseases including, in the 1st place, respiratory insufficiency, inflammatory skin conditions, psychoneurological disorders and neoplastic diseases. Occupational exposure limit values (OELs), the main criteria for occupational exposure assessment, constitute an important factor for the safe use of chemicals in the working environment. In Poland, to date there are 524 chemical substances and 19 dusts for which maximum admissible concentrations (MAC) have been established. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  1. Emergency Sonography Aids Diagnostic Accuracy of Torso Injuries: A Study in a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Charles Edward Tunuka

    2014-01-01

    Full Text Available Introduction. Clinical evaluation of patients with torso trauma is often a diagnostic challenge. Extended focused assessment with sonography for trauma (EFAST is an emergency ultrasound scan that adds to the evaluation of intrathoracic abdominal and pericardial cavities done in FAST (focused assessment with sonography for trauma. Objective. This study compares EFAST (the index test with the routine standard of care (SoC investigations (the standard reference test for torso trauma injuries. Methods. A cross-sectional descriptive study was conducted over a 3-month period. Eligible patients underwent EFAST scanning and the SoC assessment. The diagnostic accuracy of EFAST was calculated using sensitivity and specificity scores. Results. We recruited 197 patients; the M : F ratio was 5 : 1, with mean age of 27 years (SD 11. The sensitivity of EFAST was 100%, the specificity was 97%, the PPV was 87%, and the NPV was 100%. It took 5 minutes on average to complete an EFAST scan. 168 (85% patients were EFAST-scanned. Most patients (82 (48% were discharged on the same day of hospitalization, while 7 (4% were still at the hospital after two weeks. The mortality rate was 18 (9%. Conclusion. EFAST is a reliable method of diagnosing torso injuries in a resource limited context.

  2. Suggested safeguards and limitations for effective and permissible ...

    African Journals Online (AJOL)

    Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad ... offers will be elucidated in the following pages.1 As parenting coordination has been implemented in haste and in an unsystematic and uncoordinated fashion, it has given rise to considerable confusion and both ethical and practice dilemmas.

  3. A pharmacology guided approach for setting limits on product-related impurities for bispecific antibody manufacturing.

    Science.gov (United States)

    Rajan, Sharmila; Sonoda, Junichiro; Tully, Timothy; Williams, Ambrose J; Yang, Feng; Macchi, Frank; Hudson, Terry; Chen, Mark Z; Liu, Shannon; Valle, Nicole; Cowan, Kyra; Gelzleichter, Thomas

    2018-04-13

    bFKB1 is a humanized bispecific IgG1 antibody, created by conjoining an anti-Fibroblast Growth Factor Receptor 1 (FGFR1) half-antibody to an anti-Klothoβ (KLB) half-antibody, using the knobs-into-holes strategy. bFKB1 acts as a highly selective agonist for the FGFR1/KLB receptor complex and is intended to ameliorate obesity-associated metabolic defects by mimicking the activity of the hormone FGF21. An important aspect of the biologics product manufacturing process is to establish meaningful product specifications regarding the tolerable levels of impurities that copurify with the drug product. The aim of the current study was to determine acceptable levels of product-related impurities for bFKB1. To determine the tolerable levels of these impurities, we dosed obese mice with bFKB1 enriched with various levels of either HMW impurities or anti-FGFR1-related impurities, and measured biomarkers for KLB-independent FGFR1 signaling. Here, we show that product-related impurities of bFKB1, in particular, high molecular weight (HMW) impurities and anti-FGFR1-related impurities, when purposefully enriched, stimulate FGFR1 in a KLB-independent manner. By taking this approach, the tolerable levels of product-related impurities were successfully determined. Our study demonstrates a general pharmacology-guided approach to setting a product specification for a bispecific antibody whose homomultimer-related impurities could lead to undesired biological effects. Copyright © 2018. Published by Elsevier Inc.

  4. A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting.

    Science.gov (United States)

    Mazmanyan, P; Mellor, K; Doré, C J; Modi, N

    2016-01-01

    The variable-flow flow driver (FD; EME) and continuous-flow bubble (Fisher-Paykel) continuous positive airway pressure (CPAP) systems are widely used. As these differ in cost and technical requirements, determining comparative efficacy is important particularly where resources are limited. We performed a randomised, controlled, equivalence trial of CPAP systems. We specified the margin of equivalence as 2 days. We analysed binary variables by logistical regression adjusted for gestation, and log transformed continuous variables by multiple linear regression adjusted for gestation, sex and antenatal steroids. A neonatal unit with no blood gas analyser or surfactant availability and limited X-ray and laboratory facilities Neonates CPAP at delivery followed by randomisation to FD or bubble (B). Primary outcome included total days receiving CPAP; secondary outcomes included days receiving CPAP, supplemental oxygen, ventilation, death, pneumothorax and nasal excoriation. We randomised 125 infants (B 66, FD 59). Differences in infant outcomes on B and FD were not statistically significant. The median (range) for CPAP days for survivors was B 0.8 (0.04 to 17.5), FD 0.5 (0.04 to 5.3). B:FD (95% CI) ratios were CPAP days 1.3 (0.9 to 2.1), CPAP plus supplementary oxygen days 1.2 (0.7 to 1.9). B:FD (95% CI) ORs were death 2.3 (0.2 to 28), ventilation 2.1 (0.5 to 9), nasal excoriation 1.2 (0.2 to 8) and pneumothorax 2.4 (0.2 to 26). In a resource-limited setting we found B CPAP equivalent to FD CPAP in the total number of days receiving CPAP within a margin of 2 days. ISRCTN22578364. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Gastroenterology training in a resource-limited setting: Zambia, Southern Africa.

    Science.gov (United States)

    Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul

    2013-07-07

    awareness in areas where resources are limited.

  6. New nucleic acid testing devices to diagnose infectious diseases in resource-limited settings.

    Science.gov (United States)

    Maffert, P; Reverchon, S; Nasser, W; Rozand, C; Abaibou, H

    2017-10-01

    Point-of-care diagnosis based on nucleic acid testing aims to incorporate all the analytical steps, from sample preparation to nucleic acid amplification and detection, in a single device. This device needs to provide a low-cost, robust, sensitive, specific, and easily readable analysis. Microfluidics has great potential for handling small volumes of fluids on a single platform. Microfluidic technology has recently been applied to paper, which is already used in low-cost lateral flow tests. Nucleic acid extraction from a biological specimen usually requires cell filtration and lysis on specific membranes, while affinity matrices, such as chitosan or polydiacetylene, are well suited to concentrating nucleic acids for subsequent amplification. Access to electricity is often difficult in resource-limited areas, so the amplification step needs to be equipment-free. Consequently, the reaction has to be isothermal to alleviate the need for a thermocycler. LAMP, NASBA, HDA, and RPA are examples of the technologies available. Nucleic acid detection techniques are currently based on fluorescence, colorimetry, or chemiluminescence. For point-of-care diagnostics, the results should be readable with the naked eye. Nowadays, interpretation and communication of results to health professionals could rely on a smartphone, used as a telemedicine device. The major challenge of creating an "all-in-one" diagnostic test involves the design of an optimal solution and a sequence for each analytical step, as well as combining the execution of all these steps on a single device. This review provides an overview of available materials and technologies which seem to be adapted to point-of-care nucleic acid-based diagnosis, in low-resource areas.

  7. Effect of African- and European-American maternal attitudes and limit-setting strategies on children's self-regulation.

    Science.gov (United States)

    LeCuyer, Elizabeth A; Swanson, Dena P; Cole, Robert; Kitzman, Harriet

    2011-12-01

    The effect of maternal attitudes and limit-setting strategies on children's self-regulation (measured as committed compliance) was compared in 151 African-American (AA) and 108 European-American (EA) mothers and their 3-year-old children. There were no ethnic differences in children's compliance, however ethnicity moderated the relationship between maternal authoritarian attitudes and children's compliance. Higher authoritarian attitudes predicted less children's compliance in the EA sample, but greater compliance in the AA sample. Observational limit-setting data revealed that in both ethnic groups, maternal authoritarian attitudes influenced children's self-regulation through maternal use of lower-power (gentle) verbal strategies, fewer physical strategies, and judicious use of higher-power verbal strategies. The findings indicate that the meaning and purpose of authoritarian attitudes varies across these mothers' socio-cultural contexts. Copyright © 2011 Wiley Periodicals, Inc.

  8. Acceptability of donated breast milk in a resource limited South African setting.

    Science.gov (United States)

    Coutsoudis, Irene; Petrites, Alissa; Coutsoudis, Anna

    2011-02-22

    The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants. The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability. This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily

  9. Acceptability of donated breast milk in a resource limited South African setting

    Directory of Open Access Journals (Sweden)

    Coutsoudis Anna

    2011-02-01

    Full Text Available Abstract Background The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants. Methods The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. Results Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability. Conclusions This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the

  10. Setting limits: Using air pollution thresholds to protect and restore U.S. ecosystems

    Science.gov (United States)

    Fenn, M.E.; Lambert, K.F.; Blett, T.F.; Burns, Douglas A.; Pardo, L.H.; Lovett, Gary M.; Haeuber, R. A.; Evers, D.C.; Driscoll, C.T.; Jeffries, D.S.

    2011-01-01

    More than four decades of research provide unequivocal evidence that sulfur, nitrogen, and mercury pollution have altered, and will continue to alter, our nation's lands and waters. The emission and deposition of air pollutants harm native plants and animals, degrade water quality, affect forest productivity, and are damaging to human health. Many air quality policies limit emissions at the source but these control measures do not always consider ecosystem impacts. Air pollution thresholds at which ecological effects are observed, such as critical loads, are effective tools for assessing the impacts of air pollution on essential ecosystem services and for informing public policy. U.S. ecosystems can be more effectively protected and restored by using a combination of emissions-based approaches and science-based thresholds of ecosystem damage. Based on the results of a comprehensive review of air pollution thresholds, we conclude: ??? Ecosystem services such as air and water purification, decomposition and detoxification of waste materials, climate regulation, regeneration of soil fertility, production and biodiversity maintenance, as well as crop, timber and fish supplies are impacted by deposition of nitrogen, sulfur, mercury and other pollutants. The consequences of these changes may be difficult or impossible to reverse as impacts cascade throughout affected ecosystems. ??? The effects of too much nitrogen are common across the U.S. and include altered plant and lichen communities, enhanced growth of invasive species, eutrophication and acidification of lands and waters, and habitat deterioration for native species, including endangered species. ??? Lake, stream and soil acidification is widespread across the eastern United States. Up to 65% of lakes within sensitive areas receive acid deposition that exceeds critical loads. ??? Mercury contamination adversely affects fish in many inland and coastal waters. Fish consumption advisories for mercury exist in all 50

  11. Results on neutrinoless double beta decay search in GERDA. Background modeling and limit setting

    Energy Technology Data Exchange (ETDEWEB)

    Becerici Schmidt, Neslihan

    2014-07-22

    The search for the neutrinoless double beta decay (0νββ) process is primarily motivated by its potential of revealing the possible Majorana nature of the neutrino, in which the neutrino is identical to its antiparticle. It has also the potential to yield information on the intrinsic properties of neutrinos, if the underlying mechanism is the exchange of a light Majorana neutrino. The Gerda experiment is searching for 0νββ decay of {sup 76}Ge by operating high purity germanium (HPGe) detectors enriched in the isotope {sup 76}Ge (∝ 87%), directly in ultra-pure liquid argon (LAr). The first phase of physics data taking (Phase I) was completed in 2013 and has yielded 21.6 kg.yr of data. A background index of B∼10{sup -2} cts/(keV.kg.yr) at Q{sub ββ}=2039 keV has been achieved. A comprehensive background model of the Phase I energy spectrum is presented as the major topic of this dissertation. Decomposition of the background energy spectrum into the individual contributions from different processes provides many interesting physics results. The specific activity of {sup 39}Ar has been determined. The obtained result, A=(1.15±0.11) Bq/kg, is in good agreement with the values reported in literature. The contribution from {sup 42}K decays in LAr to the background spectrum has yielded a {sup 42}K({sup 42}Ar) specific activity of A=(106.2{sub -19.2}{sup +12.7}) μBq/kg, for which only upper limits exist in literature. The analysis of high energy events induced by α decays in the {sup 226}Ra chain indicated a total {sup 226}Ra activity of (3.0±0.9) μBq and a total initial {sup 210}Po activity of (0.18±0.01) mBq on the p{sup +} surfaces of the enriched semi-coaxial HPGe detectors. The half life of the two-neutrino double beta (2νββ) decay of {sup 76}Ge has been determined as T{sub 1/2}{sup 2ν}=(1.926±0.094).10{sup 21} yr, which is in good agreement with the result that was obtained with lower exposure and has been published by the Gerda collaboration

  12. Results on neutrinoless double beta decay search in GERDA. Background modeling and limit setting

    International Nuclear Information System (INIS)

    Becerici Schmidt, Neslihan

    2014-01-01

    The search for the neutrinoless double beta decay (0νββ) process is primarily motivated by its potential of revealing the possible Majorana nature of the neutrino, in which the neutrino is identical to its antiparticle. It has also the potential to yield information on the intrinsic properties of neutrinos, if the underlying mechanism is the exchange of a light Majorana neutrino. The Gerda experiment is searching for 0νββ decay of 76 Ge by operating high purity germanium (HPGe) detectors enriched in the isotope 76 Ge (∝ 87%), directly in ultra-pure liquid argon (LAr). The first phase of physics data taking (Phase I) was completed in 2013 and has yielded 21.6 kg.yr of data. A background index of B∼10 -2 cts/(keV.kg.yr) at Q ββ =2039 keV has been achieved. A comprehensive background model of the Phase I energy spectrum is presented as the major topic of this dissertation. Decomposition of the background energy spectrum into the individual contributions from different processes provides many interesting physics results. The specific activity of 39 Ar has been determined. The obtained result, A=(1.15±0.11) Bq/kg, is in good agreement with the values reported in literature. The contribution from 42 K decays in LAr to the background spectrum has yielded a 42 K( 42 Ar) specific activity of A=(106.2 -19.2 +12.7 ) μBq/kg, for which only upper limits exist in literature. The analysis of high energy events induced by α decays in the 226 Ra chain indicated a total 226 Ra activity of (3.0±0.9) μBq and a total initial 210 Po activity of (0.18±0.01) mBq on the p + surfaces of the enriched semi-coaxial HPGe detectors. The half life of the two-neutrino double beta (2νββ) decay of 76 Ge has been determined as T 1/2 2ν =(1.926±0.094).10 21 yr, which is in good agreement with the result that was obtained with lower exposure and has been published by the Gerda collaboration. According to the model, the background in Q ββ ±5 keV window is resulting from close

  13. Compiled data set of exact NOE distance limits, residual dipolar couplings and scalar couplings for the protein GB3

    Directory of Open Access Journals (Sweden)

    Beat Vögeli

    2015-12-01

    Full Text Available We compiled an NMR data set consisting of exact nuclear Overhauser enhancement (eNOE distance limits, residual dipolar couplings (RDCs and scalar (J couplings for GB3, which forms one of the largest and most diverse data set for structural characterization of a protein to date. All data have small experimental errors, which are carefully estimated. We use the data in the research article Vogeli et al., 2015, Complementarity and congruence between exact NOEs and traditional NMR probes for spatial decoding of protein dynamics, J. Struct. Biol., 191, 3, 306–317, doi:10.1016/j.jsb.2015.07.008 [1] for cross-validation in multiple-state structural ensemble calculation. We advocate this set to be an ideal test case for molecular dynamics simulations and structure calculations.

  14. SAGES: a suite of freely-available software tools for electronic disease surveillance in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Sheri L Lewis

    Full Text Available Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations.

  15. Challenges in the implementation of an electronic surveillance system in a resource-limited setting: Alerta, in Peru

    Directory of Open Access Journals (Sweden)

    Soto Giselle

    2008-11-01

    Full Text Available Abstract Background Infectious disease surveillance is a primary public health function in resource-limited settings. In 2003, an electronic disease surveillance system (Alerta was established in the Peruvian Navy with support from the U.S. Naval Medical Research Center Detachment (NMRCD. Many challenges arose during the implementation process, and a variety of solutions were applied. The purpose of this paper is to identify and discuss these issues. Methods This is a retrospective description of the Alerta implementation. After a thoughtful evaluation according to the Centers for Disease Control and Prevention (CDC guidelines, the main challenges to implementation were identified and solutions were devised in the context of a resource-limited setting, Peru. Results After four years of operation, we have identified a number of challenges in implementing and operating this electronic disease surveillance system. These can be divided into the following categories: (1 issues with personnel and stakeholders; (2 issues with resources in a developing setting; (3 issues with processes involved in the collection of data and operation of the system; and (4 issues with organization at the central hub. Some of the challenges are unique to resource-limited settings, but many are applicable for any surveillance system. For each of these challenges, we developed feasible solutions that are discussed. Conclusion There are many challenges to overcome when implementing an electronic disease surveillance system, not only related to technology issues. A comprehensive approach is required for success, including: technical support, personnel management, effective training, and cultural sensitivity in order to assure the effective deployment of an electronic disease surveillance system.

  16. The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings.

    Science.gov (United States)

    Campbell, Jeffrey I; Aturinda, Isaac; Mwesigwa, Evans; Burns, Bridget; Santorino, Data; Haberer, Jessica E; Bangsberg, David R; Holden, Richard J; Ware, Norma C; Siedner, Mark J

    2017-11-01

    Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention's acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability. Interviews guided development of a proposed conceptual framework, the technology acceptance model for resource-limited settings (TAM-RLS). This framework incorporates both classic technology acceptance model categories as well as novel factors affecting use in this setting. Participants described how SMS message language, phone characteristics, and experience with similar technologies contributed to the system's ease of use. Perceived usefulness was shaped by the perception that the system led to augmented HIV care services and improved access to social support from family and colleagues. Emergent themes specifically related to mHealth acceptance among PLWH in Uganda included (1) the importance of confidentiality, disclosure, and stigma, and (2) the barriers and facilitators downstream from the intervention that impacted achievement of the system's target outcome. The TAM-RLS is a proposed model of mHealth technology acceptance based upon end-user experiences in rural Uganda. Although the proposed model requires validation, the TAM

  17. Commentary Considerations for Recommending Extended Use and Limited Reuse of Filtering Facepiece Respirators in Health Care Settings

    Science.gov (United States)

    Fisher, Edward M.; Shaffer, Ronald E.

    2015-01-01

    Public health organizations, such as the Centers for Disease Control and Prevention (CDC), are increasingly recommending the use of N95 filtering facepiece respirators (FFRs) in health care settings. For infection control purposes, the usual practice is to discard FFRs after close contact with a patient (“single use”). However, in some situations, such as during contact with tuberculosis patients, limited FFR reuse (i.e., repeated donning and doffing of the same FFR by the same person) is practiced. A related practice, extended use, involves wearing the same FFR for multiple patient encounters without doffing. Extended use and limited FFR reuse have been recommended during infectious disease outbreaks and pandemics to conserve FFR supplies. This commentary examines CDC recommendations related to FFR extended use and limited reuse and analyzes available data from the literature to provide a relative estimate of the risks of these practices compared to single use. Analysis of the available data and the use of disease transmission models indicate that decisions regarding whether FFR extended use or reuse should be recommended should continue to be pathogen- and event-specific. Factors to be included in developing the recommendations are the potential for the pathogen to spread via contact transmission, the potential that the event could result in or is currently causing a FFR shortage, the protection provided by FFR use, human factors, potential for self-inoculation, the potential for secondary exposures, and government policies and regulations. While recent findings largely support the previous recommendations for extended use and limited reuse in certain situations, some new cautions and limitations should be considered before issuing recommendations in the future. In general, extended use of FFRs is preferred over limited FFR reuse. Limited FFR reuse would allow the user a brief respite from extended wear times, but increases the risk of self-inoculation and

  18. Android Apps and Permissions: Security and Privacy Risks

    OpenAIRE

    Boksasp, Trond; Utnes, Eivind

    2012-01-01

    This thesis investigates the permissions requested by Android applications, and the possibility of identifying suspicious applications based only on information presented to the user before an application is downloaded. During the course of this project, a large data set consisting of applications published on Google Play and three different third-party Android application markets was collected over a two-month period. These applications are analysed using manual pattern recognition and k-mea...

  19. Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases.

    Science.gov (United States)

    Schwartz, Noah G; Rattner, Adi; Schwartz, Alan R; Mokhlesi, Babak; Gilman, Robert H; Bernabe-Ortiz, Antonio; Miranda, J Jaime; Checkley, William

    2015-09-01

    Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. There were 2,682 adults aged 35 to 92 y. Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms. Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong

  20. A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings.

    Science.gov (United States)

    Olusanya, B O; Iskander, I F; Slusher, T M; Wennberg, R P

    2016-05-01

    Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many low- and middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical priority-setting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

  1. A set of nutrient limitations trigger yeast cell death in a nitrogen-dependent manner during wine alcoholic fermentation.

    Directory of Open Access Journals (Sweden)

    Camille Duc

    Full Text Available Yeast cell death can occur during wine alcoholic fermentation. It is generally considered to result from ethanol stress that impacts membrane integrity. This cell death mainly occurs when grape musts processing reduces lipid availability, resulting in weaker membrane resistance to ethanol. However the mechanisms underlying cell death in these conditions remain unclear. We examined cell death occurrence considering yeast cells ability to elicit an appropriate response to a given nutrient limitation and thus survive starvation. We show here that a set of micronutrients (oleic acid, ergosterol, pantothenic acid and nicotinic acid in low, growth-restricting concentrations trigger cell death in alcoholic fermentation when nitrogen level is high. We provide evidence that nitrogen signaling is involved in cell death and that either SCH9 deletion or Tor inhibition prevent cell death in several types of micronutrient limitation. Under such limitations, yeast cells fail to acquire any stress resistance and are unable to store glycogen. Unexpectedly, transcriptome analyses did not reveal any major changes in stress genes expression, suggesting that post-transcriptional events critical for stress response were not triggered by micronutrient starvation. Our data point to the fact that yeast cell death results from yeast inability to trigger an appropriate stress response under some conditions of nutrient limitations most likely not encountered by yeast in the wild. Our conclusions provide a novel frame for considering both cell death and the management of nutrients during alcoholic fermentation.

  2. Thermodynamic limits set relevant constraints to the soil-plant-atmosphere system and to optimality in terrestrial vegetation

    Science.gov (United States)

    Kleidon, Axel; Renner, Maik

    2016-04-01

    The soil-plant-atmosphere system is a complex system that is strongly shaped by interactions between the physical environment and vegetation. This complexity appears to demand equally as complex models to fully capture the dynamics of the coupled system. What we describe here is an alternative approach that is based on thermodynamics and which allows for comparatively simple formulations free of empirical parameters by assuming that the system is so complex that its emergent dynamics are only constrained by the thermodynamics of the system. This approach specifically makes use of the second law of thermodynamics, a fundamental physical law that is typically not being considered in Earth system science. Its relevance to land surface processes is that it fundamentally sets a direction as well as limits to energy conversions and associated rates of mass exchange, but it requires us to formulate land surface processes as thermodynamic processes that are driven by energy conversions. We describe an application of this approach to the surface energy balance partitioning at the diurnal scale. In this application the turbulent heat fluxes of sensible and latent heat are described as the result of a convective heat engine that is driven by solar radiative heating of the surface and that operates at its thermodynamic limit. The predicted fluxes from this approach compare very well to observations at several sites. This suggests that the turbulent exchange fluxes between the surface and the atmosphere operate at their thermodynamic limit, so that thermodynamics imposes a relevant constraint to the land surface-atmosphere system. Yet, thermodynamic limits do not entirely determine the soil-plant-atmosphere system because vegetation affects these limits, for instance by affecting the magnitude of surface heating by absorption of solar radiation in the canopy layer. These effects are likely to make the conditions at the land surface more favorable for photosynthetic activity

  3. Level-set reconstruction algorithm for ultrafast limited-angle X-ray computed tomography of two-phase flows.

    Science.gov (United States)

    Bieberle, M; Hampel, U

    2015-06-13

    Tomographic image reconstruction is based on recovering an object distribution from its projections, which have been acquired from all angular views around the object. If the angular range is limited to less than 180° of parallel projections, typical reconstruction artefacts arise when using standard algorithms. To compensate for this, specialized algorithms using a priori information about the object need to be applied. The application behind this work is ultrafast limited-angle X-ray computed tomography of two-phase flows. Here, only a binary distribution of the two phases needs to be reconstructed, which reduces the complexity of the inverse problem. To solve it, a new reconstruction algorithm (LSR) based on the level-set method is proposed. It includes one force function term accounting for matching the projection data and one incorporating a curvature-dependent smoothing of the phase boundary. The algorithm has been validated using simulated as well as measured projections of known structures, and its performance has been compared to the algebraic reconstruction technique and a binary derivative of it. The validation as well as the application of the level-set reconstruction on a dynamic two-phase flow demonstrated its applicability and its advantages over other reconstruction algorithms. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

  4. Evaluating the Auto-MODS Assay, a Novel Tool for Tuberculosis Diagnosis for Use in Resource-Limited Settings

    Science.gov (United States)

    Wang, Linwei; Mohammad, Sohaib H.; Li, Qiaozhi; Rienthong, Somsak; Rienthong, Dhanida; Nedsuwan, Supalert; Mahasirimongkol, Surakameth; Yasui, Yutaka

    2014-01-01

    There is an urgent need for simple, rapid, and affordable diagnostic tests for tuberculosis (TB) to combat the great burden of the disease in developing countries. The microscopic observation drug susceptibility assay (MODS) is a promising tool to fill this need, but it is not widely used due to concerns regarding its biosafety and efficiency. This study evaluated the automated MODS (Auto-MODS), which operates on principles similar to those of MODS but with several key modifications, making it an appealing alternative to MODS in resource-limited settings. In the operational setting of Chiang Rai, Thailand, we compared the performance of Auto-MODS with the gold standard liquid culture method in Thailand, mycobacterial growth indicator tube (MGIT) 960 plus the SD Bioline TB Ag MPT64 test, in terms of accuracy and efficiency in differentiating TB and non-TB samples as well as distinguishing TB and multidrug-resistant (MDR) TB samples. Sputum samples from clinically diagnosed TB and non-TB subjects across 17 hospitals in Chiang Rai were consecutively collected from May 2011 to September 2012. A total of 360 samples were available for evaluation, of which 221 (61.4%) were positive and 139 (38.6%) were negative for mycobacterial cultures according to MGIT 960. Of the 221 true-positive samples, Auto-MODS identified 212 as positive and 9 as negative (sensitivity, 95.9%; 95% confidence interval [CI], 92.4% to 98.1%). Of the 139 true-negative samples, Auto-MODS identified 135 as negative and 4 as positive (specificity, 97.1%; 95% CI, 92.8% to 99.2%). The median time to culture positivity was 10 days, with an interquartile range of 8 to 13 days for Auto-MODS. Auto-MODS is an effective and cost-sensitive alternative diagnostic tool for TB diagnosis in resource-limited settings. PMID:25378569

  5. Parental influences on adolescent video game play: a study of accessibility, rules, limit setting, monitoring, and cybersafety.

    Science.gov (United States)

    Smith, Lisa J; Gradisar, Michael; King, Daniel L

    2015-05-01

    Adolescents' video gaming is increasing at a rapid rate. Yet, little is known about what factors contribute toward more hours of gaming per week, as well as what factors may limit or protect adolescents from excessive gaming. The aim of the present study was to examine associations between adolescents' accessibility to video gaming devices, the locations played (i.e., bedroom, shared rooms), parental regulation of technology use, and the amount of hours spent video gaming during the week (weekdays vs. weekends). Adolescents (N=422; age 16.3±2.0 years, 41% male) completed an online questionnaire battery, including demographics, video gaming behaviors (e.g., hours played weekdays/weekends, time of day played, devices owned, locations played, etc.), and a questionnaire measuring aspects of parents' regulation of game playing (e.g., rules, limit setting, co-gaming). Accessibility to the adolescents' own devices, but not shared devices or device portability, was predictive of hours gaming on weekdays and weekends. Location (i.e., bedroom) was associated with increased gaming across the week. Parents discussing cybersafety was predictive of lower hours of gaming (weekdays and weekends). However, limit setting, monitoring, and co-gaming showed no significant effects. Adolescents' access to their own gaming equipped devices, as well as gaming in their bedrooms, were linked to increased hours of gaming. The findings suggest that in order to curb the increase in hours gaming, parents are advised to delay the ownership of adolescents' devices, encourage use in shared rooms, and discuss aspects of cybersafety with their teenage children.

  6. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Nana Ama Amissah

    2017-10-01

    Full Text Available Objectives:Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa.Methods:Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana.Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA. Notably, 25 (81% of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%, aminoglycosides (33%, oxacillin (33%, chloramphenicol (50%, tetracycline (59% and fluoroquinolones (100%.Conclusion: Population genomics uncovered multiple transmission events of S. aureus, especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  7. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings.

    Science.gov (United States)

    Amissah, Nana Ama; Buultjens, Andrew H; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L; Bulach, Dieter; Tetteh, Caitlin S; Prah, Isaac; van der Werf, Tjip S; Friedrich, Alexander W; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P; Rossen, John W

    2017-01-01

    Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa. Methods: Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana. Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical) were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA). Notably, 25 (81%) of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%), aminoglycosides (33%), oxacillin (33%), chloramphenicol (50%), tetracycline (59%) and fluoroquinolones (100%). Conclusion: Population genomics uncovered multiple transmission events of S. aureus , especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  8. Validation of a pediatric early warning system for hospitalized pediatric oncology patients in a resource-limited setting.

    Science.gov (United States)

    Agulnik, Asya; Méndez Aceituno, Alejandra; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

    2017-12-15

    Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital

  9. Evaluation of a four-item DSM-5 Limited Prosocial Emotions specifier scale within and across settings with Spanish children.

    Science.gov (United States)

    Seijas, Raquel; Servera, Mateu; García-Banda, Gloria; Barry, Christopher T; Burns, G Leonard

    2018-04-01

    The objective was to evaluate a 4-item measure of the DSM-5 Limited Prosocial Emotions (LPE) specifier (a 4-item measure of prosocial emotions). Mothers, fathers, primary teachers, and ancillary teachers completed measures of prosocial emotions (PE), oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity/impulsivity (HI), academic and social impairment on 811 Spanish first-grade children (46% girls). Confirmatory factor and structural regression analyses showed PE symptom scores to have (a) good reliability for the 4 sources (80% to 89% true score variance), (b) invariance of like-symptom loadings and intercepts across the 4 sources, (c) strong convergent and discriminant validity within home and school settings, (d) no convergent validity across settings, and (e) associations with academic and social impairment independent of the ODD dimension (the unique effects of PE also remained significant after controlling for ODD, ADHD-IN, and ADHD-HI for mothers and ancillary teachers). A graded response item response theory analysis indicated that PE scores provided an accurate measure of the PE trait across a wide trait range and especially at low PE trait levels (i.e., scores in the clinical range). Findings also supported the DSM-5 diagnostic criteria of 2 or more LPE symptoms in 2 or more settings (e.g., high levels of the LPE trait were associated with the occurrence of 2 or more symptoms with 4% of the sample showing 2 or more symptoms in both settings). Although additional studies are still required, the PE measure appears useful as a brief measure of the LPE specifier. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  10. International Neurocognitive Normative Study: Neurocognitive Comparison Data in Diverse Resource Limited Settings: AIDS Clinical Trials Group A5271

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, SR; Marra, CM; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, TB; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S.; Kumarasamy, N; La Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L.; Amod, F; Walawander, A

    2016-01-01

    Summary ACTG A5271 collected neurocognitive normative comparison test data in 2400 at-risk HIV seronegative participants from Brazil, India, Malawi, Peru, South Africa, Thailand and Zimbabwe. The participants were enrolled in strata by site (10 levels), age (2 levels), education (2 levels), and gender (2 levels). These data provide necessary normative data infrastructure for future clinical research and care in these diverse resource limited settings. Infrastructure for conducting neurological research in resource limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment, and normative data needed for clinical interpretation impede research and clinical care. Here we report on ACTG 5271, which provided neurological training of clinical site personnel, and collected neurocognitive normative comparison data in diverse settings. At 10 sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n=240), India (n=480), Malawi (n=481), Peru (n=239), South Africa (480), Thailand (n=240) and Zimbabwe (n=240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline, and 770 at six-months. Participants were enrolled in 8 strata, gender (female and male), education (<10 years and ≥ 10 years), and age (<35 years and ≥35 years). Of 2400 enrolled, 770 completed the six-month follow up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p<.0001). There was variation between the age, gender and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the

  11. Optical Frequency Comb Fourier Transform Spectroscopy with Resolution Exceeding the Limit Set by the Optical Path Difference

    Science.gov (United States)

    Foltynowicz, Aleksandra; Rutkowski, Lucile; Johanssson, Alexandra C.; Khodabakhsh, Amir; Maslowski, Piotr; Kowzan, Grzegorz; Lee, Kevin; Fermann, Martin

    2015-06-01

    Fourier transform spectrometers (FTS) based on optical frequency combs (OFC) allow detection of broadband molecular spectra with high signal-to-noise ratios within acquisition times orders of magnitude shorter than traditional FTIRs based on thermal sources. Due to the pulsed nature of OFCs the interferogram consists of a series of bursts rather than a single burst at zero optical path difference (OPD). The comb mode structure can be resolved by acquiring multiple bursts, in both mechanical FTS systems and dual-comb spectroscopy. However, in all existing demonstrations the resolution was ultimately limited either by the maximum available OPD between the interferometer arms or by the total acquisition time enabled by the storage memory. We present a method that provides spectral resolution exceeding the limit set by the maximum OPD using an interferogram containing only a single burst. The method allows measurements of absorption lines narrower than the OPD-limited resolution without any influence of the instrumental lineshape function. We demonstrate this by measuring undistorted CO2 and CO absorption lines with linewidth narrower than the OPD-limited resolution using OFC-based mechanical FTS in the near- and mid-infrared wavelength ranges. The near-infrared system is based on an Er:fiber femtosecond laser locked to a high finesse cavity, while the mid-infrared system is based on a Tm:fiber-laser-pumped optical parametric oscillator coupled to a multi-pass cell. We show that the method allows acquisition of high-resolution molecular spectra with interferometer length orders of magnitude shorter than traditional FTIR. Mandon, J., G. Guelachvili, and N. Picque, Nat. Phot., 2009. 3(2): p. 99-102. Zeitouny, M., et al., Ann. Phys., 2013. 525(6): p. 437-442. Zolot, A.M., et al., Opt. Lett., 2012. 37(4): p. 638-640.

  12. Permission Marketing and Privacy Concerns - Why Do Customers (Not) Grant Permissions?

    NARCIS (Netherlands)

    Krafft, Manfred; Arden, Christine M.; Verhoef, Peter C.

    Little is known about the influence of motivators that drive consumers to grant permission to be contacted via personalized communication. In this study, a framework is developed to investigate the effect of select drivers of consumers granting permission to receive personalized messages. The

  13. User-centric android flexible permissions

    NARCIS (Netherlands)

    Scoccia, Gian Luca; Malavolta, Ivano; Autili, Marco; Di Salle, Amleto; Inverardi, Paola

    2017-01-01

    Privacy in mobile apps is a fundamental aspect to be considered, particularly with regard to meeting end user expectations. Due to the rigidities of the Android permission model, desirable trade-offs are not allowed. End users are confined into a secondary role, having the only option of choosing

  14. Gender Differences In Premarital Sexual Permissiveness Among ...

    African Journals Online (AJOL)

    This paper examined the concept of premariatal sexual permissiveness among selected University undergraduates in a state owned university in Nigeria, believing that the policy of non-residential status of the University will facilitate premarital sexual activity among the students. Using a total of 400 purposively selected ...

  15. Relationship between Perceived Limit-Setting Abilities, Autism Spectrum Disorder Severity, Behaviour Problems and Parenting Stress in Mothers of Children with Autism Spectrum Disorder

    Science.gov (United States)

    Reed, Phil; Howse, Jessie; Ho, Ben; Osborne, Lisa A.

    2017-01-01

    Parenting stress in mothers of children with autism spectrum disorder (ASD) is high and impacts perceptions about parenting. This study examined the relationship between parenting stress and observer-perceived limit-setting ability. Participants' perceptions of other parents' limit-setting ability were assessed by showing participants video clips…

  16. Low-cost matched sibling bone marrow transplant for standard-risk thalassemia in a limited-resource setting

    Directory of Open Access Journals (Sweden)

    Stalin Ramprakash

    2017-12-01

    Full Text Available Thalassemias are the most common inherited genetic disorder in India and a major public health burden with bone marrow transplant (BMT considered the only established curative therapy. We describe outcomes for patients (n = 71 with standard-risk thalassemia (liver size 80 at the last follow up. 5 patients (7% died, mortality related to transplant. Enough data existed for 2 centers in India (36/71 transplants to analyze overall costs from admission up to one-year post-BMT which revealed a median cost of Rs 7,30,445 ($11519 [Range Rs 4,52,821–10,32,842 ($ 7079–16147]. In conclusion, children with thalassemia in resource limited settings can achieve good outcomes with BMT at a reasonable cost.

  17. Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

    Directory of Open Access Journals (Sweden)

    Mahalu William

    2011-09-01

    Full Text Available Abstract Background Oesophageal perforation is a condition associated with a high mortality. Its management is still controversial with operative treatment being favoured but a shift to conservative management is occurring. Very little exists in medical literature about its management in Sub-Saharan Africa, where the paucity of thoracic surgeons is compounded by limited diagnostic and therapeutic facilities. Case Presentation We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy, nil by mouth with feeding gastrostomy, intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia. Conclusion In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations.

  18. Dry Blood Spots a Reliable Method for Measurement of Hepatitis B Viral Load in Resource-Limited Settings.

    Directory of Open Access Journals (Sweden)

    Kathrine Stene-Johansen

    Full Text Available Hepatitis B virus (HBV quantification is essential in the management of chronic hepatitis B, both to determine treatment eligibility and in the monitoring of treatment effect. This test, however, is rarely available in resource-limited settings due to high costs and stringent requirements for shipment and storage of plasma. Dried Blood Spots (DBS can be a convenient alternative to plasma, but its use for HBV monitoring has not been investigated under real-life conditions in Africa.The performance of DBS in HBV quantification was investigated using a modified commercial test (Abbott RealTime HBV assay. Paired DBS and plasma samples were collected from an HBV positive cohort in Addis Ababa, Ethiopia. DBS were stored at ambient temperature for 4-39 days before shipment to the laboratory.Twenty-six paired samples were selected covering the total range of quantification, from 2.14 log IU/ml to >7 log IU/ml. HBV was detected in 21 of 21 (100% DBS from patients with a corresponding plasma viral load above 2.70 log IU/ml. The mean difference between plasma and DBS was 0.59 log IU/ml, and the correlation was strong (R2 = 0.92. In stability studies there was no significant change in DBS viral load after storage at room temperature for up to 12 weeks.This study suggests that DBS can be a feasible and reliable alternative to plasma for quantification of HBV in resource-limited settings. DBS can expand access to antiviral treatment for patients in low- and middle-income countries.

  19. Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk pasteurization in resource-limited settings.

    Science.gov (United States)

    Naicker, Mageshree; Coutsoudis, Anna; Israel-Ballard, Kiersten; Chaudhri, Rohit; Perin, Noah; Mlisana, Koleka

    2015-03-01

    Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa. For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated. In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth. Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives.

  20. The 'My five moments for hand hygiene' concept for the overcrowded setting in resource-limited healthcare systems.

    Science.gov (United States)

    Salmon, S; Pittet, D; Sax, H; McLaws, M L

    2015-10-01

    Hand hygiene is a core activity of patient safety for the prevention of healthcare-associated infections (HCAIs). To standardize hand hygiene practices globally the World Health Organization (WHO) released Guidelines on Hand Hygiene in Health Care and introduced the 'My five moments for hand hygiene' concept to define indications for hand hygiene rooted in an evidence-based model for transmission of micro-organisms by healthcare workers' (HCWs) hands. Central to the concept is the division of the healthcare environment into two geographical care zones, the patient zone and the healthcare zone, that requires the HCW to comply with specific hand hygiene moments. In resource-limited, overcrowded healthcare settings inadequate or no spatial separation between beds occurs frequently. These conditions challenge the HCW's ability to visualize and delineate patient zones. The 'My five moments for hand hygiene' concept has been adapted for these conditions with the aim of assisting hand hygiene educators, auditors, and HCWs to minimize ambiguity regarding shared patient zones and achieve the ultimate goal set by the WHO Guidelines--the reduction of infectious risks. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  1. Epidemiology, Diagnosis, and Treatment of HIV-Associated Non-Hodgkin Lymphoma in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Matthew Ulrickson

    2012-01-01

    Full Text Available Lymphoma was a common complication of HIV infection in the pre-antiretroviral era, and the incidence of HIV-associated lymphoma has dropped dramatically since the introduction of combination antiretroviral therapy (cART in resource-rich regions. Conversely, lymphoma is an increasingly common complication of HIV infection in resource-limited settings where the prevalence of HIV infection is high. Relatively little is known, however, about the true incidence and optimal treatment regimens for HIV-associated lymphoma in resource-poor regions. We review the epidemiology, diagnosis, and treatment of HIV-associated non-Hodgkin lymphoma in developing nations and highlight areas for further research that may benefit care in both settings. Examples include risk modification and dose modification of chemotherapy based on HIV risk factors, improving our understanding of the current burden of disease through national cancer registries, and developing cost-effective hematopathological diagnostic strategies to optimize care delivery and maximize use of available chemotherapy.

  2. Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings

    Science.gov (United States)

    Lam, Christopher T.; Krieger, Marlee S.; Gallagher, Jennifer E.; Asma, Betsy; Muasher, Lisa C.; Schmitt, John W.; Ramanujam, Nimmi

    2015-01-01

    Introduction Current guidelines by WHO for cervical cancer screening in low- and middle-income countries involves visual inspection with acetic acid (VIA) of the cervix, followed by treatment during the same visit or a subsequent visit with cryotherapy if a suspicious lesion is found. Implementation of these guidelines is hampered by a lack of: trained health workers, reliable technology, and access to screening facilities. A low cost ultra-portable Point of Care Tampon based digital colposcope (POCkeT Colposcope) for use at the community level setting, which has the unique form factor of a tampon, can be inserted into the vagina to capture images of the cervix, which are on par with that of a state of the art colposcope, at a fraction of the cost. A repository of images to be compiled that can be used to empower front line workers to become more effective through virtual dynamic training. By task shifting to the community setting, this technology could potentially provide significantly greater cervical screening access to where the most vulnerable women live. The POCkeT Colposcope’s concentric LED ring provides comparable white and green field illumination at a fraction of the electrical power required in commercial colposcopes. Evaluation with standard optical imaging targets to assess the POCkeT Colposcope against the state of the art digital colposcope and other VIAM technologies. Results Our POCkeT Colposcope has comparable resolving power, color reproduction accuracy, minimal lens distortion, and illumination when compared to commercially available colposcopes. In vitro and pilot in vivo imaging results are promising with our POCkeT Colposcope capturing comparable quality images to commercial systems. Conclusion The POCkeT Colposcope is capable of capturing images suitable for cervical lesion analysis. Our portable low cost system could potentially increase access to cervical cancer screening in limited resource settings through task shifting to community

  3. TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.

    Science.gov (United States)

    Pathmanathan, I; Ahmedov, S; Pevzner, E; Anyalechi, G; Modi, S; Kirking, H; Cavanaugh, J S

    2018-06-01

    Tuberculosis (TB) is the leading cause of death for persons living with the human immunodeficiency virus (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children and has been recommended as an international standard of care for over a decade, it remains highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of tuberculous infection, especially in those, such as PLHIV, who are most likely to progress to TB disease. To do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. Here we review available evidence to address several commonly stated obstacles to TPT scale-up, including the need for the tuberculin skin test, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to monitor for and prevent adverse events, a 'one size fits all' option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how best to tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.

  4. Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study.

    Science.gov (United States)

    Abubakar, Amina; Van de Vijver, Fons; Van Baar, Anneloes; Mbonani, Leonard; Kalu, Raphael; Newton, Charles; Holding, Penny

    2008-09-01

    Sub-optimal physical growth has been suggested as a key pathway between the effect of environmental risk and developmental outcome. To determine if anthropometric status mediates the relation between socioeconomic status and psychomotor development of young children in resource-limited settings. A cross-sectional study design was used. A total of 204 (105 girls) children from two resource-limited communities in the Coast Province, Kenya. The mean age of these children was 29 months (SD = 3.43; range: 24-35 months). Psychomotor functioning was assessed using a locally developed and validated measure, the Kilifi Developmental Inventory. A significant association was found between anthropometric status (as measured by weight-for-age, height-for-age, mid-upper arm circumference, and head circumference) and psychomotor functioning and also between socioeconomic status and anthropometric status; no direct effects were found between socioeconomic status and developmental outcome. The models showed that weight, height and to a lesser extent mid-upper arm circumference mediate the relation between socioeconomic status and developmental outcome, while head circumference did not show the same effect. Among children under 3 years living in poverty, anthropometric status shows a clear association with psychomotor development while socioeconomic status may only have an indirect association.

  5. Large reptiles and cold temperatures: Do extreme cold spells set distributional limits for tropical reptiles in Florida?

    Science.gov (United States)

    Mazzotti, Frank J.; Cherkiss, Michael S.; Parry, Mark; Beauchamp, Jeff; Rochford, Mike; Smith, Brian J.; Hart, Kristen M.; Brandt, Laura A.

    2016-01-01

    Distributional limits of many tropical species in Florida are ultimately determined by tolerance to low temperature. An unprecedented cold spell during 2–11 January 2010, in South Florida provided an opportunity to compare the responses of tropical American crocodiles with warm-temperate American alligators and to compare the responses of nonnative Burmese pythons with native warm-temperate snakes exposed to prolonged cold temperatures. After the January 2010 cold spell, a record number of American crocodiles (n = 151) and Burmese pythons (n = 36) were found dead. In contrast, no American alligators and no native snakes were found dead. American alligators and American crocodiles behaved differently during the cold spell. American alligators stopped basking and retreated to warmer water. American crocodiles apparently continued to bask during extreme cold temperatures resulting in lethal body temperatures. The mortality of Burmese pythons compared to the absence of mortality for native snakes suggests that the current population of Burmese pythons in the Everglades is less tolerant of cold temperatures than native snakes. Burmese pythons introduced from other parts of their native range may be more tolerant of cold temperatures. We documented the direct effects of cold temperatures on crocodiles and pythons; however, evidence of long-term effects of cold temperature on their populations within their established ranges remains lacking. Mortality of crocodiles and pythons outside of their current established range may be more important in setting distributional limits.

  6. Study on the determination of permissible concentration in sea food

    International Nuclear Information System (INIS)

    Lee, C.M.; Lee, K.J.; Lee, W.K.

    2002-01-01

    Radioactive permissible concentration limit using the data which is suitable for Koreans is not established. In this paper, concentration limit is determined by using Korean food intake. Ministry of science of technology will adopt the new recommendation soon, so at this paper, dose limit of new value in ICRP 60 is used. Experts who have studied on this area worry about over-exposure by estimation of the case that intake contaminated a food by one radionuclide, therefore, complex intake limit is determined about all kinds of fishery products to solve this problem. Derived Food Concentration in single food divided by S(number of samples) and N(number of radionuclides) gives Complex intake limit (Derived Food Concentration in plural food). The value of N and S in this study is 3 and 12 respectively

  7. Rationalizing the Permissibility of Mosque Decoration

    Directory of Open Access Journals (Sweden)

    Spahic Omer

    2016-06-01

    Full Text Available This paper discusses the subject of mosque decoration and some of the criteria which determine its permissibility or otherwise. Some aspects of the matter are somewhat sensitive and double-edged. Thus, the paper presents an objective, balanced and scientific account of the theme, steering clear of the sentimental aspects of the evidences often put forth by both the proponents and opponents of mosque decoration. The main thrusts of the paper are the issues pertaining to the legitimacy of decoration in general, the subject of the function of mosques vis-à-vis their decoration, as well as the broad guidelines that regulate mosque decoration emphasizing the decoration of the mihrab (praying niche area and the qiblah wall. The paper concludes that in principle mosque decoration is permissible so long as it conforms to the requirements of the Islamic spirituality and the quintessence of genuine Islamic art and architecture.

  8. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings

    Science.gov (United States)

    Meyer, Ana-Claire L.; Dua, Tarun; Boscardin, John; Escarce, José J.; Saxena, Shekhar; Birbeck, Gretchen L.

    2013-01-01

    Purpose Epilepsy is one of the most common serious neurological disorders worldwide. Our objective was to determine which economic, healthcare, neurology and epilepsy specific resources were associated with untreated epilepsy in resource-constrained settings. Methods A systematic review of the literature identified community-based studies in resource-constrained settings that calculated the epilepsy treatment gap, the proportion with untreated epilepsy, from prevalent active epilepsy cases. Economic, healthcare, neurology and epilepsy specific resources were taken from existing datasets. Poisson regression models with jackknifed standard errors were used to create bivariate and multivariate models comparing the association between treatment status and economic and health resource indicators. Relative risks were reported. Key Findings Forty-seven studies of 8285 individuals from 24 countries met inclusion criteria. Bivariate analysis demonstrated that individuals residing in rural locations had significantly higher risks of untreated epilepsy [Relative Risk(RR)=1.63; 95% confidence interval(CI):1.26,2.11]. Significantly lower risks of untreated epilepsy were observed for higher physician density [RR=0.65, 95% CI:0.55,0.78], presence of a lay [RR=0.74, 95%CI:0.60,0.91] or professional association for epilepsy [RR=0.73, 95%CI:0.59,0.91], or post-graduate neurology training program [RR=0.67, 95%CI:0.55, 0.82]. In multivariate models, higher physician density maintained significant effects [RR=0.67; 95%CI:0.52,0.88]. Significance Even among resource-limited regions, people with epilepsy in countries with fewer economic, healthcare, neurology and epilepsy specific resources are more likely to have untreated epilepsy. Community-based epilepsy care programs have improved access to treatment but in order to decrease the epilepsy treatment gap, poverty and inequalities of healthcare, neurological and epilepsy resources must be dealt with at the local, national, and global

  9. Post procedural complications of cardiac implants done in a resource limited setting under 'C' arm: A single centre experience.

    Science.gov (United States)

    Jayachandra, A; Aggarwal, Vivek; Kumar, Sandeep; Nagesh, I V

    2018-04-01

    Cardiology interventions in peripheral hospitals is a challenging task where cardiologist have to fight against time and limited resources. Most of the sudden cardiac deaths occur due to arrhythmia and heart blocks/sinus node dysfunction. Our study is a single peripheral center experience of cardiac devices implantation using a 'C' Arm. The aim of this study was to post procedural complications of cardiac implants done in aresource limited setting under 'C' arm. This study is done at a peripheral cardiology center with no cardiac catheterization laboratory (CCL) facilities. Consecutive patients reporting to cardiology center, between Jan 2015 and Oct 2016, with a definite indication for cardiac device implant were included in the study. All the procedure of implantation was done in the operation theatre under 'C' arm under local anesthesia with continuous cardiac monitoring and critical care back up. Total 58 device implantations were done from Jan 2015 to Oct 2016. The mean age of the patients was 67.15 ± 10.85 years. Males constituted almost two third (68.9%) of patients. The commonest indication for device implantation was sinus node dysfunction in 60.34% followed by complete heart block in 25.86% and ventricular tachycardia in 12.06%. No post procedure infection was observed in our study. Device implantation constitute a major group of life saving interventions in cardiology practice. Our study has emphasised that when appropriate aseptic measures are taken during device implantation at peripheral centres, the complications rate are comparable to interventions done at advance cardiac centres.

  10. Characterization of HIV-1 antiretroviral drug resistance after second-line treatment failure in Mali, a limited-resources setting

    Science.gov (United States)

    Maiga, Almoustapha Issiaka; Fofana, Djeneba Bocar; Cisse, Mamadou; Diallo, Fodié; Maiga, Moussa Youssoufa; Traore, Hamar Alassane; Maiga, Issouf Alassane; Sylla, Aliou; Fofana, Dionke; Taiwo, Babafemi; Murphy, Robert; Katlama, Christine; Tounkara, Anatole; Calvez, Vincent; Marcelin, Anne-Geneviève

    2012-01-01

    Objectives We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) or resistance testing. Methods We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm. Results Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm3. Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P < 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P < 0.0001) and darunavir (P = 0.06). Conclusion Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings. PMID:22888273

  11. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

    Science.gov (United States)

    Modi, Payal; Glavis-Bloom, Justin; Nasrin, Sabiha; Guy, Allysia; Chowa, Erika P; Dvor, Nathan; Dworkis, Daniel A; Oh, Michael; Silvestri, David M; Strasberg, Stephen; Rege, Soham; Noble, Vicki E; Alam, Nur H; Levine, Adam C

    2016-01-01

    Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy. To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children. A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity. 850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor. Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

  12. Xpert MTB/RIF testing in a low tuberculosis incidence, high-resource setting: limitations in accuracy and clinical impact.

    Science.gov (United States)

    Sohn, Hojoon; Aero, Abebech D; Menzies, Dick; Behr, Marcel; Schwartzman, Kevin; Alvarez, Gonzalo G; Dan, Andrei; McIntosh, Fiona; Pai, Madhukar; Denkinger, Claudia M

    2014-04-01

    Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in low-income countries. However, little information is available on its performance in low-incidence, high-resource countries. We evaluated the accuracy of Xpert in a university hospital tuberculosis clinic in Montreal, Canada, for the detection of pulmonary tuberculosis on induced sputum samples, using mycobacterial cultures as the reference standard. We also assessed the potential reduction in time to diagnosis and treatment initiation. We enrolled 502 consecutive patients who presented for evaluation of possible active tuberculosis (most with abnormal chest radiographs, only 18% symptomatic). Twenty-five subjects were identified to have active tuberculosis by culture. Xpert had a sensitivity of 46% (95% confidence interval [CI], 26%-67%) and specificity of 100% (95% CI, 99%-100%) for detection of Mycobacterium tuberculosis. Sensitivity was 86% (95% CI, 42%-100%) in the 7 subjects with smear-positive results, and 28% (95% CI, 10%-56%) in the remaining subjects with smear-negative, culture-positive results; in this latter group, positive Xpert results were obtained a median 12 days before culture results. Subjects with positive cultures but negative Xpert results had minimal disease: 11 of 13 had no symptoms on presentation, and mean time to positive liquid culture results was 28 days (95% CI, 25-47 days) compared with 14 days (95% CI, 8-21 days) in Xpert/culture-positive cases. Our findings suggest limited potential impact of Xpert testing in high-resource, low-incidence ambulatory settings due to lower sensitivity in the context of less extensive disease, and limited potential to expedite diagnosis beyond what is achieved with the existing, well-performing diagnostic algorithm.

  13. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

    Directory of Open Access Journals (Sweden)

    Payal Modi

    Full Text Available Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b. Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60, sensitivity (67%, and specificity (49%, for predicting severe dehydration were all poor.Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

  14. Stroke mortality and its determinants in a resource-limited setting: A prospective cohort study in Yaounde, Cameroon.

    Science.gov (United States)

    Nkoke, Clovis; Lekoubou, Alain; Balti, Eric; Kengne, Andre Pascal

    2015-11-15

    About three quarters of stroke deaths occur in developing countries including those in sub-Saharan African. Short and long-term stroke fatality data are needed for health service and policy formulation. We prospectively followed up from stroke onset, 254 patients recruited from the largest reference hospitals in Yaounde (Cameroon). Mortality and determinants were investigated using the accelerated failure time regression analysis. Stroke mortality rates at one-, six- and 12 months were respectively 23.2% (Ischemic strokes: 20.4%, hemorrhagic strokes: 26.1%, and undetermined strokes: 34.8, p=0.219), 31.5% (ischemic strokes: 31.5%, hemorrhagic strokes: 30.4%, and undetermined strokes: 34.8%, p=0.927), and 32.7% (ischemic strokes: 32.1%, hemorrhagic strokes: 30.4%, undetermined strokes: 43.5%, p=0.496). Fever, swallowing difficulties, and admission NIHSS independently predicted mortality at one month, six and 12 months. Elevated systolic blood pressure (BP) predicted mortality at one month. Elevated diastolic blood pressure was a predictor of mortality at one month in participants with hemorrhagic stroke. Low hemoglobin level on admission only predicted long term mortality. In this resource-limited setting, post-stroke mortality was high with 1 out of 5 deaths occurring at one month and up to 30% deaths at six and twelve months after the index event. Fever, stroke severity, elevated BP and anemia increased the risk of death. Our findings add to the body of evidence for the poor outcome after stroke in resource limited environments. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Biomarkers to Stratify Risk Groups among Children with Malnutrition in Resource-Limited Settings and to Monitor Response to Intervention.

    Science.gov (United States)

    McGrath, Christine J; Arndt, Michael B; Walson, Judd L

    2017-01-01

    Despite global efforts to reduce childhood undernutrition, current interventions have had little impact on stunting and wasting, and the mechanisms underlying growth faltering are poorly understood. There is a clear need to distinguish populations of children most likely to benefit from any given intervention and to develop tools to monitor response to therapy prior to the development of morbid sequelae. In resource-limited settings, environmental enteric dysfunction (EED) is common among children, contributing to malnutrition and increasing childhood morbidity and mortality risk. In addition to EED, early alterations in the gut microbiota can adversely affect growth through nutrient malabsorption, altered metabolism, gut inflammation, and dysregulation of the growth hormone axis. We examined the evidence linking EED and the gut microbiome to growth faltering and explored novel biomarkers to identify subgroups of children at risk of malnutrition due to underlying pathology. These and other biomarkers could be used to identify specific groups of children at risk of malnutrition and monitor response to targeted interventions. © 2017 S. Karger AG, Basel.

  16. Systematic review of electronic surveillance of infectious diseases with emphasis on antimicrobial resistance surveillance in resource-limited settings.

    Science.gov (United States)

    Rattanaumpawan, Pinyo; Boonyasiri, Adhiratha; Vong, Sirenda; Thamlikitkul, Visanu

    2018-02-01

    Electronic surveillance of infectious diseases involves rapidly collecting, collating, and analyzing vast amounts of data from interrelated multiple databases. Although many developed countries have invested in electronic surveillance for infectious diseases, the system still presents a challenge for resource-limited health care settings. We conducted a systematic review by performing a comprehensive literature search on MEDLINE (January 2000-December 2015) to identify studies relevant to electronic surveillance of infectious diseases. Study characteristics and results were extracted and systematically reviewed by 3 infectious disease physicians. A total of 110 studies were included. Most surveillance systems were developed and implemented in high-income countries; less than one-quarter were conducted in low-or middle-income countries. Information technologies can be used to facilitate the process of obtaining laboratory, clinical, and pharmacologic data for the surveillance of infectious diseases, including antimicrobial resistance (AMR) infections. These novel systems require greater resources; however, we found that using electronic surveillance systems could result in shorter times to detect targeted infectious diseases and improvement of data collection. This study highlights a lack of resources in areas where an effective, rapid surveillance system is most needed. The availability of information technology for the electronic surveillance of infectious diseases, including AMR infections, will facilitate the prevention and containment of such emerging infectious diseases. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Christopher R. Stark

    2017-06-01

    Full Text Available Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda. Methods and Materials: Imaging the World Africa (ITWA is the registered non-governmental organization division of Imaging the World (ITW, a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits. Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD. Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.

  18. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings

    Science.gov (United States)

    Nadeem, Sayyada Ghufrana; Hakim, Shazia Tabassum; Kazmi, Shahana Urooj

    2010-01-01

    Introduction Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal–tween 80 agar and biochemical methods by using API 20 C AUX. Results The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients. PMID:21483597

  19. Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances.

    Science.gov (United States)

    Campbell, Jeffrey I; Haberer, Jessica E

    2015-12-01

    Numerous cell phone-based and adherence monitoring technologies have been developed to address barriers to effective HIV prevention, testing, and treatment. Because most people living with HIV and AIDS reside in resource-limited settings (RLS), it is important to understand the development and use of these technologies in RLS. Recent research on cell phone-based technologies has focused on HIV education, linkage to and retention in care, disease tracking, and antiretroviral therapy adherence reminders. Advances in adherence devices have focused on real-time adherence monitors, which have been used for both antiretroviral therapy and pre-exposure prophylaxis. Real-time monitoring has recently been combined with cell phone-based technologies to create real-time adherence interventions using short message service (SMS). New developments in adherence technologies are exploring ingestion monitoring and metabolite detection to confirm adherence. This article provides an overview of recent advances in these two families of technologies and includes research on their acceptability and cost-effectiveness when available. It additionally outlines key challenges and needed research as use of these technologies continues to expand and evolve.

  20. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Sayyada Ghufrana Nadeem

    2010-02-01

    Full Text Available Introduction: Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods: A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal–tween 80 agar and biochemical methods by using API 20 C AUX. Results: The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion: The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients.

  1. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings.

    Science.gov (United States)

    Nadeem, Sayyada Ghufrana; Hakim, Shazia Tabassum; Kazmi, Shahana Urooj

    2010-02-09

    Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal-tween 80 agar and biochemical methods by using API 20 C AUX. The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients.

  2. Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review.

    Science.gov (United States)

    Lawn, Stephen D; Meintjes, Graeme; McIlleron, Helen; Harries, Anthony D; Wood, Robin

    2013-12-02

    The HIV-associated tuberculosis (TB) epidemic remains a huge challenge to public health in resource-limited settings. Reducing the nearly 0.5 million deaths that result each year has been identified as a key priority. Major progress has been made over the past 10 years in defining appropriate strategies and policy guidelines for early diagnosis and effective case management. Ascertainment of cases has been improved through a twofold strategy of provider-initiated HIV testing and counseling in TB patients and intensified TB case finding among those living with HIV. Outcomes of rifampicin-based TB treatment are greatly enhanced by concurrent co-trimoxazole prophylaxis and antiretroviral therapy (ART). ART reduces mortality across a spectrum of CD4 counts and randomized controlled trials have defined the optimum time to start ART. Good outcomes can be achieved when combining TB treatment with first-line ART, but use with second-line ART remains challenging due to pharmacokinetic drug interactions and cotoxicity. We review the frequency and spectrum of adverse drug reactions and immune reconstitution inflammatory syndrome (IRIS) resulting from combined treatment, and highlight the challenges of managing HIV-associated drug-resistant TB.

  3. Maximizing the benefit of health workforce secondment in Botswana: an approach for strengthening health systems in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Grignon JS

    2014-05-01

    Full Text Available Jessica S Grignon,1,2 Jenny H Ledikwe,1,2 Ditsapelo Makati,2 Robert Nyangah,2 Baraedi W Sento,2 Bazghina-werq Semo1,2 1Department of Global Health, University of Washington, Seattle, WA, USA; 2International Training and Education Center for Health, Gaborone, Botswana Abstract: To address health systems challenges in limited-resource settings, global health initiatives, particularly the President's Emergency Plan for AIDS Relief, have seconded health workers to the public sector. Implementation considerations for secondment as a health workforce development strategy are not well documented. The purpose of this article is to present outcomes, best practices, and lessons learned from a President's Emergency Plan for AIDS Relief-funded secondment program in Botswana. Outcomes are documented across four World Health Organization health systems' building blocks. Best practices include documentation of joint stakeholder expectations, collaborative recruitment, and early identification of counterparts. Lessons learned include inadequate ownership, a two-tier employment system, and ill-defined position duration. These findings can inform program and policy development to maximize the benefit of health workforce secondment. Secondment requires substantial investment, and emphasis should be placed on high-level technical positions responsible for building systems, developing health workers, and strengthening government to translate policy into programs. Keywords: human resources, health policy, health worker, HIV/AIDS, PEPFAR

  4. Geometric Energy Derivatives at the Complete Basis Set Limit: Application to the Equilibrium Structure and Molecular Force Field of Formaldehyde.

    Science.gov (United States)

    Morgan, W James; Matthews, Devin A; Ringholm, Magnus; Agarwal, Jay; Gong, Justin Z; Ruud, Kenneth; Allen, Wesley D; Stanton, John F; Schaefer, Henry F

    2018-03-13

    Geometric energy derivatives which rely on core-corrected focal-point energies extrapolated to the complete basis set (CBS) limit of coupled cluster theory with iterative and noniterative quadruple excitations, CCSDTQ and CCSDT(Q), are used as elements of molecular gradients and, in the case of CCSDT(Q), expansion coefficients of an anharmonic force field. These gradients are used to determine the CCSDTQ/CBS and CCSDT(Q)/CBS equilibrium structure of the S 0 ground state of H 2 CO where excellent agreement is observed with previous work and experimentally derived results. A fourth-order expansion about this CCSDT(Q)/CBS reference geometry using the same level of theory produces an exceptional level of agreement to spectroscopically observed vibrational band origins with a MAE of 0.57 cm -1 . Second-order vibrational perturbation theory (VPT2) and variational discrete variable representation (DVR) results are contrasted and discussed. Vibration-rotation, anharmonicity, and centrifugal distortion constants from the VPT2 analysis are reported and compared to previous work. Additionally, an initial application of a sum-over-states fourth-order vibrational perturbation theory (VPT4) formalism is employed herein, utilizing quintic and sextic derivatives obtained with a recursive algorithmic approach for response theory.

  5. Generation of a suite of 3D computer-generated breast phantoms from a limited set of human subject data

    International Nuclear Information System (INIS)

    Hsu, Christina M. L.; Palmeri, Mark L.; Segars, W. Paul; Veress, Alexander I.; Dobbins, James T. III

    2013-01-01

    Purpose: The authors previously reported on a three-dimensional computer-generated breast phantom, based on empirical human image data, including a realistic finite-element based compression model that was capable of simulating multimodality imaging data. The computerized breast phantoms are a hybrid of two phantom generation techniques, combining empirical breast CT (bCT) data with flexible computer graphics techniques. However, to date, these phantoms have been based on single human subjects. In this paper, the authors report on a new method to generate multiple phantoms, simulating additional subjects from the limited set of original dedicated breast CT data. The authors developed an image morphing technique to construct new phantoms by gradually transitioning between two human subject datasets, with the potential to generate hundreds of additional pseudoindependent phantoms from the limited bCT cases. The authors conducted a preliminary subjective assessment with a limited number of observers (n= 4) to illustrate how realistic the simulated images generated with the pseudoindependent phantoms appeared. Methods: Several mesh-based geometric transformations were developed to generate distorted breast datasets from the original human subject data. Segmented bCT data from two different human subjects were used as the “base” and “target” for morphing. Several combinations of transformations were applied to morph between the “base’ and “target” datasets such as changing the breast shape, rotating the glandular data, and changing the distribution of the glandular tissue. Following the morphing, regions of skin and fat were assigned to the morphed dataset in order to appropriately assign mechanical properties during the compression simulation. The resulting morphed breast was compressed using a finite element algorithm and simulated mammograms were generated using techniques described previously. Sixty-two simulated mammograms, generated from morphing

  6. Scaling up the 2010 World Health Organization HIV Treatment Guidelines in resource-limited settings: a model-based analysis.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    2010-12-01

    Full Text Available The new 2010 World Health Organization (WHO HIV treatment guidelines recommend earlier antiretroviral therapy (ART initiation (CD4<350 cells/µl instead of CD4<200 cells/µl, multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible.We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl. For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line. We rank-in survival, cost-effectiveness, and equity terms-all 12 possible combinations of the following: (1 stavudine replacement with tenofovir, (2 ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl, and (3 one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival compared with stavudine/WHO/two-lines (66% and tenofovir/WHO/one-line (66%. The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo, stavudine/<350/µl/two-lines (177.6 mo, and tenofovir/<350/µl/two-lines (193.6 mo. Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS], tenofovir/<350/µl/one-line (US$1,140/YLS, and tenofovir/<350/µl/two-lines (US$2,370/YLS.In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long

  7. Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings.

    Directory of Open Access Journals (Sweden)

    Andrea J Curtis

    Full Text Available OBJECTIVES: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART in resource limited settings (RLS. DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41. OUTCOME MEASURES: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. RESULTS: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4. The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4. During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years and children aged 5-14 years (25.76 and oral candidiasis was the most common in children <5 years (25.79. Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001. Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia. CONCLUSIONS: The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly

  8. Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo.

    Science.gov (United States)

    Kalisya, Luc Malemo; Bake, Jacques Fadhili; Bigabwa, Richard; Rothstein, David H; Cairo, Sarah B

    2018-07-01

    faces a multitude of challenges. Access to surgical services for diagnosis and management as well as chemotherapeutic agents is prohibitively limited. Increased collaboration with local clinicians and remote specialist consultants is needed to deliver subspecialty care in resource-poor settings.

  9. A permissive graphical patcher for supercollider synths

    OpenAIRE

    Dufeu, Frédéric

    2016-01-01

    This article presents the first version of a permissive graphical patcher (referred to in the text as SCPGP) dedicated to fluid interconnection and control of SuperCollider Synths. With SCPGP, the user programs her/his SynthDefs normally as code in the SuperCollider environment, along with a minimal amount of additional information on these SynthDefs, and programs Patterns according to a simple SuperCollider-compliant syntax.\\ud From the execution of this SuperCollider session, the SCPGP inte...

  10. Assessing the quality of informed consent in a resource-limited setting: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kiguba Ronald

    2012-08-01

    Full Text Available Abstract Background The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University. Methods Data were collected using semi-structured interviewer-administered questionnaires on clinic days after initial or repeat informed consent procedures for the respective clinical studies had been administered to each study participant. Results Of the 600 participants interviewed, two thirds (64.2%, 385/600 were female. Overall mean age of study participants was 37.6 (SD = 7.7 years. Amongst all participants, less than a tenth (5.9%, 35/598 reported that they were not given enough information before making a decision to participate. A similar proportion (5.7%, 34/597 reported that they had not signed a consent form prior to making a decision to participate in the study. A third (33.7%, 201/596 of the participants were not aware that they could, at any time, voluntarily withdraw participation from these studies. Participants in clinical trials were 50% less likely than those in observational studies [clinical trial vs. observational; (odds ratio, OR = 0.5; 95% CI: 0.35-0.78] to perceive that refusal to participate in the parent research project would affect their regular medical care. Conclusions Most of the participants signed informed consent forms and a vast majority felt that they received enough information before deciding to participate. On the contrary, several were not aware that they could voluntarily withdraw their participation. Participants in observational studies were more likely than those in clinical trials to perceive that refusal to participate in the parent study would affect their regular medical care.

  11. Assessing the quality of informed consent in a resource-limited setting: a cross-sectional study.

    Science.gov (United States)

    Kiguba, Ronald; Kutyabami, Paul; Kiwuwa, Stephen; Katabira, Elly; Sewankambo, Nelson K

    2012-08-21

    The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University. Data were collected using semi-structured interviewer-administered questionnaires on clinic days after initial or repeat informed consent procedures for the respective clinical studies had been administered to each study participant. Of the 600 participants interviewed, two thirds (64.2%, 385/600) were female. Overall mean age of study participants was 37.6 (SD = 7.7) years. Amongst all participants, less than a tenth (5.9%, 35/598) reported that they were not given enough information before making a decision to participate. A similar proportion (5.7%, 34/597) reported that they had not signed a consent form prior to making a decision to participate in the study. A third (33.7%, 201/596) of the participants were not aware that they could, at any time, voluntarily withdraw participation from these studies. Participants in clinical trials were 50% less likely than those in observational studies [clinical trial vs. observational; (odds ratio, OR = 0.5; 95% CI: 0.35-0.78)] to perceive that refusal to participate in the parent research project would affect their regular medical care. Most of the participants signed informed consent forms and a vast majority felt that they received enough information before deciding to participate. On the contrary, several were not aware that they could voluntarily withdraw their participation. Participants in observational studies were more likely than those in clinical trials to perceive that refusal to participate in the parent study would affect their regular medical care.

  12. Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.

    Science.gov (United States)

    Ndayizigiye, M; Fawzi, M C Smith; Lively, C Thompson; Ware, N C

    2017-03-15

    Family planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere. We investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7). Contraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services. Where resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

  13. Approaching the theoretical limit in periodic local MP2 calculations with atomic-orbital basis sets: the case of LiH.

    Science.gov (United States)

    Usvyat, Denis; Civalleri, Bartolomeo; Maschio, Lorenzo; Dovesi, Roberto; Pisani, Cesare; Schütz, Martin

    2011-06-07

    The atomic orbital basis set limit is approached in periodic correlated calculations for solid LiH. The valence correlation energy is evaluated at the level of the local periodic second order Møller-Plesset perturbation theory (MP2), using basis sets of progressively increasing size, and also employing "bond"-centered basis functions in addition to the standard atom-centered ones. Extended basis sets, which contain linear dependencies, are processed only at the MP2 stage via a dual basis set scheme. The local approximation (domain) error has been consistently eliminated by expanding the orbital excitation domains. As a final result, it is demonstrated that the complete basis set limit can be reached for both HF and local MP2 periodic calculations, and a general scheme is outlined for the definition of high-quality atomic-orbital basis sets for solids. © 2011 American Institute of Physics

  14. On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings.

    Science.gov (United States)

    Rutstein, S E; Golin, C E; Wheeler, S B; Kamwendo, D; Hosseinipour, M C; Weinberger, M; Miller, W C; Biddle, A K; Soko, A; Mkandawire, M; Mwenda, R; Sarr, A; Gupta, S; Mataya, R

    2016-01-01

    Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider

  15. Minimal intervention for controlling nosocomial transmission of methicillin-resistant staphylococcus aureus in resource limited setting with high endemicity.

    Directory of Open Access Journals (Sweden)

    Vincent Chi-Chung Cheng

    Full Text Available OBJECTIVE: To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA in resource-limited healthcare setting with high endemicity. METHODS: Three phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model. Usage density of broad-spectrum antibiotics was monitored. RESULTS: During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3% were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001, 30.4% (p<0.001, and 19.6% (p = 0.040, while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001, 24.1% (p<0.001, and 21.9% (p = 0.041 respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1 to 168.99 per 1000 patient-days (phase 3. CONCLUSIONS: Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing

  16. Facilitating responsible gambling: the relative effectiveness of education-based animation and monetary limit setting pop-up messages among electronic gaming machine players.

    Science.gov (United States)

    Wohl, Michael J A; Gainsbury, Sally; Stewart, Melissa J; Sztainert, Travis

    2013-12-01

    Although most gamblers set a monetary limit on their play, many exceed this limit--an antecedent of problematic gambling. Responsible gambling tools may assist players to gamble within their means. Historically, however, the impact of such tools has been assessed in isolation. In the current research, two responsible gambling tools that target adherence to a monetary limit were assessed among 72 electronic gaming machine (EGM) players. Participants watched an educational animation explaining how EGMs work (or a neutral video) and then played an EGM in a virtual reality environment. All participants were asked to set a monetary limit on their play, but only half were reminded when that limit was reached. Results showed that both the animation and pop-up limit reminder helped gamblers stay within their preset monetary limit; however, an interaction qualified these main effects. Among participants who did not experience the pop-up reminder, those who watched the animation stayed within their preset monetary limits more than those who did not watch the animation. For those who were reminded of their limit, however, there was no difference in limit adherence between those who watched the animation and those who did not watch the animation. From a responsible gambling perspective, the current study suggests that there is no additive effect of exposure to both responsible gambling tools. Therefore, for minimal disruption in play, a pop-up message reminding gamblers of their preset monetary limit might be preferred over the lengthier educational animation.

  17. STATISTICAL METHODS FOR ENVIRONMENTAL APPLICATIONS USING DATA SETS WITH BELOW DETECTION LIMIT OBSERVATIONS AS INCORPORTED IN PROUCL 4.0

    Science.gov (United States)

    Nondetect (ND) or below detection limit (BDL) results cannot be measured accurately, and, therefore, are reported as less than certain detection limit (DL) values. However, since the presence of some contaminants (e.g., dioxin) in environmental media may pose a threat to human he...

  18. Limited evidence for intranasal fentanyl in the emergency department and the prehospital setting--a systematic review

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Dahl, Jørgen Berg

    2013-01-01

    The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management. Fentanyl demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of acute pain, and IN fentanyl may be of value in the prehospital setting. The aim...... of this systematic review was to evaluate the current evidence for the use of IN fentanyl in the emergency department (ED) and prehospital setting....

  19. Control over Permissible Short Emergency Overloads in Power Transformers

    Directory of Open Access Journals (Sweden)

    V. A. Anischenko

    2010-01-01

    Full Text Available The paper proposes a method for determination a permissible duration of short intermittent overloads of power transformers that permits to avoid non-permissible over-heating of winding insulation and fully utilize overloading transformer ability.

  20. Android Multi-Level System Permission Management Approach

    OpenAIRE

    Luo, Yang; Zhang, Qixun; Shen, Qingni; Liu, Hongzhi; Wu, Zhonghai

    2017-01-01

    With the expansion of the market share occupied by the Android platform, security issues (especially application security) have become attention focus of researchers. In fact, the existing methods lack the capabilities to manage application permissions without root privilege. This study proposes a dynamic management mechanism of Android application permissions based on security policies. The paper first describes the permissions by security policies, then implementes permission checking code ...

  1. 30 CFR 62.130 - Permissible exposure level.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Permissible exposure level. 62.130 Section 62... REGULATIONS OCCUPATIONAL NOISE EXPOSURE § 62.130 Permissible exposure level. (a) The mine operator must assure that no miner is exposed during any work shift to noise that exceeds the permissible exposure level. If...

  2. A Symbolic Approach to Permission Accounting for Concurrent Reasoning

    NARCIS (Netherlands)

    Huisman, Marieke; Mostowski, Wojciech

    2015-01-01

    Permission accounting is fundamental to modular, thread-local reasoning about concurrent programs. This paper presents a new, symbolic system for permission accounting. In existing systems, permissions are numeric value-based and refer to the current thread only. Our system is based on symbolic

  3. A risk modelling approach for setting microbiological limits using enterococci as indicator for growth potential of Salmonella in pork

    DEFF Research Database (Denmark)

    Bollerslev, Anne Mette; Nauta, Maarten; Hansen, Tina Beck

    2017-01-01

    Microbiological limits are widely used in food processing as an aid to reduce the exposure to hazardous microorganisms for the consumers. However, in pork, the prevalence and concentrations of Salmonella are generally low and microbiological limits are not considered an efficient tool to support...... for this purpose includes the dose-response relationship for Salmonella and a reduction factor to account for preparation of the fresh pork. By use of the risk model, it was estimated that the majority of salmonellosis cases, caused by the consumption of pork in Denmark, is caused by the small fraction of pork...... products that has enterococci concentrations above 5. log. CFU/g. This illustrates that our approach can be used to evaluate the potential effect of different microbiological limits and therefore, the perspective of this novel approach is that it can be used for definition of a risk-based microbiological...

  4. Legal Permissibility of Unilateral Humanitarian Interventions

    Directory of Open Access Journals (Sweden)

    Petra Perisic

    2013-03-01

    Full Text Available The paper explores the status of unilateral humanitarian interventions in international law. The United Nations Charter prohibits the use of force, except in case of self-defense and the collective action authorized by the Security Council. The question is whether the non-existence of unilateral humanitarian intervention among these exceptions means that they are not in conformity with the Charter and if so, whether the right to such interventions exists as the part of customary law. The issue has become even more controversial after the adoption of the “responsibility to protect” principle. Findings of legal scholars on this issue differ significantly. This paper analyzes and interprets the Charter provisions in order to answer the question of compatibility of humanitarian interventions with the Charter and examines the state practice in order to conclude whether the customary law rule allowing the humanitarian intervention exists. The conclusion of the paper is that there is no evidence to support the contentions that interventions without the Security Council authorization are permissible, although there are elements which point to the possibility of the creation of customary law allowing them.

  5. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit : The Importance of Active Surveillance in Resource-Limited Settings

    NARCIS (Netherlands)

    Amissah, Nana Ama; Buultjens, Andrew H.; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L.; Bulach, Dieter; Tetteh, Caitlin S.; Prah, Isaac; van der Werf, Tjip S.; Friedrich, Alexander W.; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P.; Rossen, John W.

    2017-01-01

    . Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low-and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the

  6. Basis Set Convergence of Indirect Spin-Spin Coupling Constants in the Kohn-Sham Limit for Several Small Molecules

    Czech Academy of Sciences Publication Activity Database

    Kupka, T.; Nieradka, M.; Stachów, M.; Pluta, T.; Nowak, P.; Kjaer, H.; Kongsted, J.; Kaminský, Jakub

    2012-01-01

    Roč. 116, č. 14 (2012), s. 3728-3738 ISSN 1089-5639 R&D Projects: GA ČR GPP208/10/P356 Institutional research plan: CEZ:AV0Z40550506 Keywords : consistent basis-sets * density-functional methods * ab-inition calculations * polarization propagator approximation Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 2.771, year: 2012

  7. Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia.

    Science.gov (United States)

    Devi, B C R; Tang, T S; Corbex, M

    2008-12-01

    The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from 1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

  8. On the Feasibility and Limitations of Just-in-Time Instruction Set Extension for FPGA-Based Reconfigurable Processors

    Directory of Open Access Journals (Sweden)

    Mariusz Grad

    2012-01-01

    Full Text Available Reconfigurable instruction set processors provide the possibility of tailor the instruction set of a CPU to a particular application. While this customization process could be performed during runtime in order to adapt the CPU to the currently executed workload, this use case has been hardly investigated. In this paper, we study the feasibility of moving the customization process to runtime and evaluate the relation of the expected speedups and the associated overheads. To this end, we present a tool flow that is tailored to the requirements of this just-in-time ASIP specialization scenario. We evaluate our methods by targeting our previously introduced Woolcano reconfigurable ASIP architecture for a set of applications from the SPEC2006, SPEC2000, MiBench, and SciMark2 benchmark suites. Our results show that just-in-time ASIP specialization is promising for embedded computing applications, where average speedups of 5x can be achieved by spending 50 minutes for custom instruction identification and hardware generation. These overheads will be compensated if the applications execute for more than 2 hours. For the scientific computing benchmarks, the achievable speedup is only 1.2x, which requires significant execution times in the order of days to amortize the overheads.

  9. Estimating permissible /sup 129/I-emission rates

    Energy Technology Data Exchange (ETDEWEB)

    Huebschmann, W G

    1976-06-01

    A mathematical method of iodine release limitation is presented which, in assessing the radiological effectiveness of /sup 129/I, takes advantage of the fact that the chemical behaviour of /sup 129/I resembles that of /sup 131/I and relies on the already extensive knowledge of the chemical and biological behaviour of /sup 131/I. If this method is used for calculating permissible /sup 129/I emission rates it is stated that no unnecessary restrictions need be imposed on a fuel reprocessing plant and that the grazing season for the pasture-cow-milk pathway can be taken into account. The concept is currently in use at the Karlsruhe Nuclear Research Center and seems to be appropriate for licensing of nuclear fuel reprocessing plants.

  10. Statistic method of research reactors maximum permissible power calculation

    International Nuclear Information System (INIS)

    Grosheva, N.A.; Kirsanov, G.A.; Konoplev, K.A.; Chmshkyan, D.V.

    1998-01-01

    The technique for calculating maximum permissible power of a research reactor at which the probability of the thermal-process accident does not exceed the specified value, is presented. The statistical method is used for the calculations. It is regarded that the determining function related to the reactor safety is the known function of the reactor power and many statistically independent values which list includes the reactor process parameters, geometrical characteristics of the reactor core and fuel elements, as well as random factors connected with the reactor specific features. Heat flux density or temperature is taken as a limiting factor. The program realization of the method discussed is briefly described. The results of calculating the PIK reactor margin coefficients for different probabilities of the thermal-process accident are considered as an example. It is shown that the probability of an accident with fuel element melting in hot zone is lower than 10 -8 1 per year for the reactor rated power [ru

  11. Robot Lies in Health Care: When Is Deception Morally Permissible?

    Science.gov (United States)

    Matthias, Andreas

    2015-06-01

    Autonomous robots are increasingly interacting with users who have limited knowledge of robotics and are likely to have an erroneous mental model of the robot's workings, capabilities, and internal structure. The robot's real capabilities may diverge from this mental model to the extent that one might accuse the robot's manufacturer of deceiving the user, especially in cases where the user naturally tends to ascribe exaggerated capabilities to the machine (e.g. conversational systems in elder-care contexts, or toy robots in child care). This poses the question, whether misleading or even actively deceiving the user of an autonomous artifact about the capabilities of the machine is morally bad and why. By analyzing trust, autonomy, and the erosion of trust in communicative acts as consequences of deceptive robot behavior, we formulate four criteria that must be fulfilled in order for robot deception to be morally permissible, and in some cases even morally indicated.

  12. A risk modelling approach for setting microbiological limits using enterococci as indicator for growth potential of Salmonella in pork.

    Science.gov (United States)

    Bollerslev, Anne Mette; Nauta, Maarten; Hansen, Tina Beck; Aabo, Søren

    2017-01-02

    Microbiological limits are widely used in food processing as an aid to reduce the exposure to hazardous microorganisms for the consumers. However, in pork, the prevalence and concentrations of Salmonella are generally low and microbiological limits are not considered an efficient tool to support hygiene interventions. The objective of the present study was to develop an approach which could make it possible to define potential risk-based microbiological limits for an indicator, enterococci, in order to evaluate the risk from potential growth of Salmonella. A positive correlation between the concentration of enterococci and the prevalence and concentration of Salmonella was shown for 6640 pork samples taken at Danish cutting plants and retail butchers. The samples were collected in five different studies in 2001, 2002, 2010, 2011 and 2013. The observations that both Salmonella and enterococci are carried in the intestinal tract, contaminate pork by the same mechanisms and share similar growth characteristics (lag phase and maximum specific growth rate) at temperatures around 5-10°C, suggest a potential of enterococci to be used as an indicator of potential growth of Salmonella in pork. Elevated temperatures during processing will lead to growth of both enterococci and, if present, also Salmonella. By combining the correlation between enterococci and Salmonella with risk modelling, it is possible to predict the risk of salmonellosis based on the level of enterococci. The risk model used for this purpose includes the dose-response relationship for Salmonella and a reduction factor to account for preparation of the fresh pork. By use of the risk model, it was estimated that the majority of salmonellosis cases, caused by the consumption of pork in Denmark, is caused by the small fraction of pork products that has enterococci concentrations above 5logCFU/g. This illustrates that our approach can be used to evaluate the potential effect of different microbiological

  13. Relationship between perceived limit-setting abilities, autism spectrum disorder severity, behaviour problems and parenting stress in mothers of children with autism spectrum disorder.

    Science.gov (United States)

    Reed, Phil; Howse, Jessie; Ho, Ben; Osborne, Lisa A

    2017-11-01

    Parenting stress in mothers of children with autism spectrum disorder (ASD) is high and impacts perceptions about parenting. This study examined the relationship between parenting stress and observer-perceived limit-setting ability. Participants' perceptions of other parents' limit-setting ability were assessed by showing participants video clips of parenting behaviours. Mothers of 93 children with autism spectrum disorder completed an online survey regarding the severity of their own child's autism spectrum disorder (Social Communication Questionnaire), their child's behaviour problems (Strengths and Difficulties Questionnaire) and their own levels of parenting stress (Questionnaire on Resources and Stress). They were shown five videos of other parents interacting with children with autism spectrum disorder and were asked to rate the limit-setting abilities observed in each video using the Parent-Child Relationship Inventory. Higher parenting stress negatively related to judgements about others' limit-setting skills. This mirrors the literature regarding the relationship between self-reported parenting stress and rating child behaviour more negatively. It suggests that stress negatively impacts a wide range of judgements and implies that caution may be required when interpreting the results of studies in which parenting skills are assessed by self-report.

  14. Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings

    NARCIS (Netherlands)

    Revell, A. D.; Wang, D.; Wood, R.; Morrow, C.; Tempelman, H.; Hamers, R. L.; Alvarez-Uria, G.; Streinu-Cercel, A.; Ene, L.; Wensing, A. M. J.; DeWolf, F.; Nelson, M.; Montaner, J. S.; Lane, H. C.; Larder, B. A.

    2013-01-01

    Genotypic HIV drug-resistance testing is typically 6065 predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART

  15. A reliable incremental method of computing the limit load in deformation plasticity based on compliance: Continuous and discrete setting

    Czech Academy of Sciences Publication Activity Database

    Haslinger, Jaroslav; Repin, S.; Sysala, Stanislav

    2016-01-01

    Roč. 303, September 2016 (2016), s. 156-170 ISSN 0377-0427 R&D Projects: GA MŠk LQ1602; GA ČR GA13-18652S Institutional support: RVO:68145535 Keywords : variational problems with linear growth energy * incremental limit analysis * elastic-perfectly plastic problems * finite element approximation Subject RIV: BA - General Mathematics Impact factor: 1.357, year: 2016 http://www.sciencedirect.com/science/article/pii/S0377042716300917

  16. Approaching the basis set limit for DFT calculations using an environment-adapted minimal basis with perturbation theory: Formulation, proof of concept, and a pilot implementation

    International Nuclear Information System (INIS)

    Mao, Yuezhi; Horn, Paul R.; Mardirossian, Narbe; Head-Gordon, Teresa; Skylaris, Chris-Kriton; Head-Gordon, Martin

    2016-01-01

    Recently developed density functionals have good accuracy for both thermochemistry (TC) and non-covalent interactions (NC) if very large atomic orbital basis sets are used. To approach the basis set limit with potentially lower computational cost, a new self-consistent field (SCF) scheme is presented that employs minimal adaptive basis (MAB) functions. The MAB functions are optimized on each atomic site by minimizing a surrogate function. High accuracy is obtained by applying a perturbative correction (PC) to the MAB calculation, similar to dual basis approaches. Compared to exact SCF results, using this MAB-SCF (PC) approach with the same large target basis set produces <0.15 kcal/mol root-mean-square deviations for most of the tested TC datasets, and <0.1 kcal/mol for most of the NC datasets. The performance of density functionals near the basis set limit can be even better reproduced. With further improvement to its implementation, MAB-SCF (PC) is a promising lower-cost substitute for conventional large-basis calculations as a method to approach the basis set limit of modern density functionals.

  17. Allocating limited resources in a time of fiscal constraints: a priority setting case study from Dalhousie University Faculty of Medicine.

    Science.gov (United States)

    Mitton, Craig; Levy, Adrian; Gorsky, Diane; MacNeil, Christina; Dionne, Francois; Marrie, Tom

    2013-07-01

    Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.

  18. Push it to the limit: Characterizing the convergence of common sequences of basis sets for intermolecular interactions as described by density functional theory

    Energy Technology Data Exchange (ETDEWEB)

    Witte, Jonathon [Department of Chemistry, University of California, Berkeley, California 94720 (United States); Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Neaton, Jeffrey B. [Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Department of Physics, University of California, Berkeley, California 94720 (United States); Kavli Energy Nanosciences Institute at Berkeley, Berkeley, California 94720 (United States); Head-Gordon, Martin, E-mail: mhg@cchem.berkeley.edu [Department of Chemistry, University of California, Berkeley, California 94720 (United States); Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States)

    2016-05-21

    With the aim of systematically characterizing the convergence of common families of basis sets such that general recommendations for basis sets can be made, we have tested a wide variety of basis sets against complete-basis binding energies across the S22 set of intermolecular interactions—noncovalent interactions of small and medium-sized molecules consisting of first- and second-row atoms—with three distinct density functional approximations: SPW92, a form of local-density approximation; B3LYP, a global hybrid generalized gradient approximation; and B97M-V, a meta-generalized gradient approximation with nonlocal correlation. We have found that it is remarkably difficult to reach the basis set limit; for the methods and systems examined, the most complete basis is Jensen’s pc-4. The Dunning correlation-consistent sequence of basis sets converges slowly relative to the Jensen sequence. The Karlsruhe basis sets are quite cost effective, particularly when a correction for basis set superposition error is applied: counterpoise-corrected def2-SVPD binding energies are better than corresponding energies computed in comparably sized Dunning and Jensen bases, and on par with uncorrected results in basis sets 3-4 times larger. These trends are exhibited regardless of the level of density functional approximation employed. A sense of the magnitude of the intrinsic incompleteness error of each basis set not only provides a foundation for guiding basis set choice in future studies but also facilitates quantitative comparison of existing studies on similar types of systems.

  19. Life, limb or off-label recombinant VIIa use in the setting of limited blood assets: a case study.

    Science.gov (United States)

    Carr, Marcus E; Vickaryous, Brian

    2013-06-01

    Due to the lack of adequate controlled trials, the off-label use of recombinant factor VIIa (rFVIIa) to control hemorrhage in trauma patients remains controversial. The decision regarding when to initiate rFVIIa therapy is particularly problematic. Whereas most reports and trials have delayed use until significant bleeding has occurred, there is some evidence that coagulopathy develops early in some trauma patients, raising the possibility that early rFVIIa use may be more clinically efficacious. Herein, we report the case of a hemodynamically unstable patient with massive blood loss from multiple gunshot wounds and who had a potentially salvageable upper extremity. Rapid hemorrhage despite efforts to surgically control the bleeding resulted in virtual exhaustion of the facilities' limited blood component supply. Hemorrhage was controlled when rFVIIa was added to hypotensive resuscitation allowing salvage of the arm and significant conservation of blood products. This case raises the question as to whether earlier off-label use of this agent should be considered when amputation for hemorrhage control is being considered and/or conservation of limited blood assets is needed.

  20. Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization.

    Science.gov (United States)

    Baumann, L M; Romero, K M; Robinson, C L; Hansel, N N; Gilman, R H; Hamilton, R G; Lima, J J; Wise, R A; Checkley, W

    2015-01-01

    Allergic rhinitis is a disease with a high global disease burden, but risk factors that contribute to this condition are not well understood. To assess the prevalence and risk factors of allergic rhinitis in two Peruvian populations with disparate degrees of urbanization. We conducted a population-based, cross-sectional study on 1441 children aged 13-15 years at enrollment (mean age 14.9 years, 51% boys) to investigate the prevalence of allergic disease. We used a standardized, Spanish validated questionnaire to determine the prevalence of allergic rhinitis and asked about sociodemographics and family history of allergies. Children also underwent spirometry, exhaled nitric oxide, allergy skin testing to 10 common household allergens and provided a blood sample for measurement of 25OH vitamin D and total serum IgE. Overall prevalence of allergic rhinitis was 18% (95% CI 16% to 20%). When stratified by site, the prevalence of allergic rhinitis was 23% Lima vs. 13% in Tumbes (P overweight (1.5, 1.0-2.3); exhaled nitric oxide ≥ 20 ppb (1.9, 1.3-2.7); and total serum IgE ≥ 95th percentile (2.4, 1.2-4.8). Population attributable risk of important factors for allergic rhinitis were 25% for high exhaled nitric oxide, 22% for allergic sensitization to common household aeroallergens, 22% for paternal rhinitis, 10% for being overweight and 7% for an elevated total serum IgE. Allergic rhinitis was prevalent in both settings, and important risk factors include elevated exhaled nitric oxide, allergic sensitization to common household aeroallergens, parental rhinitis, being overweight and high total serum IgE. When considering subject-specific factors, the difference in prevalence between the urban and rural settings became non-important. © 2014 John Wiley & Sons Ltd.

  1. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme

    Science.gov (United States)

    Brukner, Peter; Nealon, Andrew; Morgan, Christopher; Burgess, Darren; Dunn, Andrew

    2014-01-01

    Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme—biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence. PMID:23322894

  2. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme.

    Science.gov (United States)

    Brukner, Peter; Nealon, Andrew; Morgan, Christopher; Burgess, Darren; Dunn, Andrew

    2014-06-01

    Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme-biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence.

  3. Simplification of antiretroviral therapy: a necessary step in the public health response to HIV/AIDS in resource-limited settings.

    Science.gov (United States)

    Vitoria, Marco; Ford, Nathan; Doherty, Meg; Flexner, Charles

    2014-01-01

    The global scale-up of antiretroviral therapy (ART) over the past decade represents one of the great public health and human rights achievements of recent times. Moving from an individualized treatment approach to a simplified and standardized public health approach has been critical to ART scale-up, simplifying both prescribing practices and supply chain management. In terms of the latter, the risk of stock-outs can be reduced and simplified prescribing practices support task shifting of care to nursing and other non-physician clinicians; this strategy is critical to increase access to ART care in settings where physicians are limited in number. In order to support such simplification, successive World Health Organization guidelines for ART in resource-limited settings have aimed to reduce the number of recommended options for first-line ART in such settings. Future drug and regimen choices for resource-limited settings will likely be guided by the same principles that have led to the recommendation of a single preferred regimen and will favour drugs that have the following characteristics: minimal risk of failure, efficacy and tolerability, robustness and forgiveness, no overlapping resistance in treatment sequencing, convenience, affordability, and compatibility with anti-TB and anti-hepatitis treatments.

  4. Lessons learned developing a diagnostic tool for HIV-associated dementia feasible to implement in resource-limited settings: pilot testing in Kenya.

    Directory of Open Access Journals (Sweden)

    Judith Kwasa

    Full Text Available To conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD for use by primary health care workers (HCW which would be feasible to implement in resource-limited settings.In resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests. Thus, a simple diagnostic tool which is practical to implement in resource-limited settings is an urgent need.A convenience sample of 30 HIV-infected outpatients was enrolled in Western Kenya. We assessed the sensitivity and specificity of a diagnostic tool for HAD as administered by a primary HCW. This was compared to an expert clinical assessment which included examination by a physician, neuropsychological testing, and in selected cases, brain imaging. Agreement between HCW and an expert examiner on certain tool components was measured using Kappa statistic.The sample was 57% male, mean age was 38.6 years, mean CD4 T-cell count was 323 cells/µL, and 54% had less than a secondary school education. Six (20% of the subjects were diagnosed with HAD by expert clinical assessment. The diagnostic tool was 63% sensitive and 67% specific for HAD. Agreement between HCW and expert examiners was poor for many individual items of the diagnostic tool (K = .03-.65. This diagnostic tool had moderate sensitivity and specificity for HAD. However, reliability was poor, suggesting that substantial training and formal evaluations of training adequacy will be critical to enable HCW to reliably administer a brief diagnostic tool for HAD.

  5. Burden of chronic kidney disease in resource-limited settings from Peru: a population-based study.

    Science.gov (United States)

    Francis, Elizabeth R; Kuo, Chin-Chi; Bernabe-Ortiz, Antonio; Nessel, Lisa; Gilman, Robert H; Checkley, William; Miranda, J Jaime; Feldman, Harold I

    2015-07-24

    The silent progression of chronic kidney diseases (CKD) and its association with other chronic diseases, and high treatment costs make it a great public health concern worldwide. The population burden of CKD in Peru has yet to be fully described. We completed a cross sectional study of CKD prevalence among 404 participants (total study population median age 54.8 years, 50.2 % male) from two sites, highly-urbanized Lima and less urbanized Tumbes, who were enrolled in the population-based CRONICAS Cohort Study of cardiopulmonary health in Peru. Factors potentially associated with the presence of CKD were explored using Poisson regression, a statistical methodology used to determine prevalence ratios. In total, 68 participants (16.8 %, 95 % CI 13.5-20.9 %) met criteria for CKD: 60 (14.9%) with proteinuria, four (1%) with eGFR diabetes and hypertension was 19.1 % and 42.7 %, respectively. After multivariable adjustment, CKD was associated with older age, female sex, greater wealth tertile (although all wealth strata were below the poverty line), residence in Lima, and presence of diabetes and hypertension. The high prevalence rates of CKD identified in Lima and Tumbes are similar to estimates from high-income settings. These findings highlight the need to identify occult CKD and implement strategies to prevent disease progression and secondary morbidity.

  6. Quantitative Security Risk Assessment of Android Permissions and Applications

    OpenAIRE

    Wang , Yang; Zheng , Jun; Sun , Chen; Mukkamala , Srinivas

    2013-01-01

    Part 6: Mobile Computing; International audience; The booming of the Android platform in recent years has attracted the attention of malware developers. However, the permissions-based model used in Android system to prevent the spread of malware, has shown to be ineffective. In this paper, we propose DroidRisk, a framework for quantitative security risk assessment of both Android permissions and applications (apps) based on permission request patterns from benign apps and malware, which aims ...

  7. Study of boron detection limit using the in-air PIGE set-up at LAMFI-USP

    Energy Technology Data Exchange (ETDEWEB)

    Moro, M. V.; Silva, T. F.; Trindade, G. F.; Added, N.; Tabacniks, M. H. [Institute of Physics, University of São Paulo, SP (Brazil)

    2014-11-11

    The quantification of small amounts of boron in materials is of extreme importance in different areas of materials science. Boron is an important contaminant and also a silicon dopant in the semiconductor industry. Boron is also extensively used in nuclear power plants, either for neutron shielding or for safety control and boron is an essential nutrient for life, either vegetable or animal. The production of silicon solar cells, by refining metallurgical-grade silicon (MG-Si) requires the control and reduction of several silicon contaminants to very low concentration levels. Boron is one of the contaminants of solar-grade silicon (SG-Si) that must be controlled and quantified at sub-ppm levels. In the metallurgical purification, boron quantification is usually made by Inductive Coupled Plasma Mass Spectrometry, (ICP-MS) but the results need to be verified by an independent analytical method. In this work we present the results of the analysis of silicon samples by Particle Induced Gamma-Ray Emission (PIGE) aiming the quantification of low concentrations of boron. PIGE analysis was carried out using the in-air external beam line of the Laboratory for Materials Analysis with Ion Beams (LAMFI-USP) by the {sup 10}B(p,αγ({sup 7}Be nuclear reaction, and measuring the 429 keV γ-ray. The in-air PIGE measurements at LAMFI have a quantification limit of the order of 10{sup 16} at/cm{sup 2}.

  8. Could self-measured office blood pressure be a hypertension screening tool for limited-resources settings?

    Science.gov (United States)

    Salazar, Martin R; Espeche, Walter G; Stavile, Rodolfo N; Balbín, Eduardo; Leiva Sisnieguez, Betty C; Leiva Sisnieguez, Carlos E; March, Carlos E; Cor, Susana; Eugenio Acero, Irma; Carbajal, Horacio A

    2018-05-01

    Blood pressure (BP) was assessed by patients themselves in recently published trials. Self-measured office blood pressure (SMOBP) seems particularly interesting for limited health resources regions. The aim of our study was to evaluate the relationship between SMOBP values and those estimated by ambulatory blood pressure monitoring (ABPM). Six hundred seventy-seven patients were evaluated using both, SMOBP and ABPM. The differences between SMOBP and daytime ABPM were evaluated with paired "t" test. The correlations among SMOBP and ABPM were estimated using Pearson's r. The accuracy of SMOBP to identify abnormal ABPM was determined using area under ROC curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated for different SMOBP cut-points. Using the average of three readings, systolic SMOBP was higher (3.7 (14.2) mmHg, p 95%) to identify individuals with hypertension in the ABPM; SMOBP < 130/80 mmHg reasonably discarded abnormal ABPM. In conclusion, a high proportion of individuals could be classified adequately using SMOBP, reducing the necessity of healthcare resources and supporting its utility for screening purposes.

  9. Study of boron detection limit using the in-air PIGE set-up at LAMFI-USP

    Science.gov (United States)

    Moro, M. V.; Silva, T. F.; Trindade, G. F.; Added, N.; Tabacniks, M. H.

    2014-11-01

    The quantification of small amounts of boron in materials is of extreme importance in different areas of materials science. Boron is an important contaminant and also a silicon dopant in the semiconductor industry. Boron is also extensively used in nuclear power plants, either for neutron shielding or for safety control and boron is an essential nutrient for life, either vegetable or animal. The production of silicon solar cells, by refining metallurgical-grade silicon (MG-Si) requires the control and reduction of several silicon contaminants to very low concentration levels. Boron is one of the contaminants of solar-grade silicon (SG-Si) that must be controlled and quantified at sub-ppm levels. In the metallurgical purification, boron quantification is usually made by Inductive Coupled Plasma Mass Spectrometry, (ICP-MS) but the results need to be verified by an independent analytical method. In this work we present the results of the analysis of silicon samples by Particle Induced Gamma-Ray Emission (PIGE) aiming the quantification of low concentrations of boron. PIGE analysis was carried out using the in-air external beam line of the Laboratory for Materials Analysis with Ion Beans (LAMFI-USP) by the 10B ( p ,αγ(7Be nuclear reaction, and measuring the 429 keV γ-ray. The in-air PIGE measurements at LAMFI have a quantification limit of the order of 1016 at/cm2.

  10. Study of boron detection limit using the in-air PIGE set-up at LAMFI-USP

    International Nuclear Information System (INIS)

    Moro, M. V.; Silva, T. F.; Trindade, G. F.; Added, N.; Tabacniks, M. H.

    2014-01-01

    The quantification of small amounts of boron in materials is of extreme importance in different areas of materials science. Boron is an important contaminant and also a silicon dopant in the semiconductor industry. Boron is also extensively used in nuclear power plants, either for neutron shielding or for safety control and boron is an essential nutrient for life, either vegetable or animal. The production of silicon solar cells, by refining metallurgical-grade silicon (MG-Si) requires the control and reduction of several silicon contaminants to very low concentration levels. Boron is one of the contaminants of solar-grade silicon (SG-Si) that must be controlled and quantified at sub-ppm levels. In the metallurgical purification, boron quantification is usually made by Inductive Coupled Plasma Mass Spectrometry, (ICP-MS) but the results need to be verified by an independent analytical method. In this work we present the results of the analysis of silicon samples by Particle Induced Gamma-Ray Emission (PIGE) aiming the quantification of low concentrations of boron. PIGE analysis was carried out using the in-air external beam line of the Laboratory for Materials Analysis with Ion Beams (LAMFI-USP) by the 10 B(p,αγ( 7 Be nuclear reaction, and measuring the 429 keV γ-ray. The in-air PIGE measurements at LAMFI have a quantification limit of the order of 10 16 at/cm 2

  11. The use of Minilabs to improve the testing capacity of regulatory authorities in resource limited settings: Tanzanian experience.

    Science.gov (United States)

    Risha, Peter Gasper; Msuya, Zera; Clark, Malcolm; Johnson, Keith; Ndomondo-Sigonda, Margareth; Layloff, Thomas

    2008-08-01

    The Tanzania Food and Drugs Authority piloted the use of Minilab kits, a thin-layer-chromatographic based drug quality testing technique, in a two-tier quality assurance program. The program is intended to improve testing capacity with timely screening of the quality of medicines as they enter the market. After 1 week training of inspectors on Minilab screening techniques, they were stationed at key Ports-of-Entry (POE) to screen the quality of imported medicines. In addition, three non-Ports-of-Entry centres were established to screen samples collected during Post-Marketing-Surveillance. Standard operating procedures (SOPs) were developed to structure and standardize the implementation process. Over 1200 samples were tested using the Minilab outside the central quality control laboratory (QCL), almost doubling the previous testing capacity. The program contributed to increased regulatory reach and visibility of the Authority throughout the country, serving as a deterrent against entry of substandard medicines into market. The use of Minilab for quality screening was inexpensive and provided a high sample throughput. However, it suffers from the limitation that it can reliably detect only grossly substandard or wrong drug samples and therefore, it should not be used as an independent testing resource but in conjunction with a full-service quality control laboratory capable of auditing reported substandard results.

  12. Challenges in the use of the mental health information system in a resource-limited setting: lessons from Ghana.

    Science.gov (United States)

    Kpobi, Lily; Swartz, Leslie; Ofori-Atta, Angela L

    2018-02-08

    One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants' knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental

  13. Pathogen reduction and blood transfusion safety in Africa: strengths, limitations and challenges of implementation in low-resource settings.

    Science.gov (United States)

    Ware, A D; Jacquot, C; Tobian, A A R; Gehrie, E A; Ness, P M; Bloch, E M

    2018-01-01

    Transfusion-transmitted infection risk remains an enduring challenge to blood safety in Africa. A high background incidence and prevalence of the major transfusion-transmitted infections (TTIs), dependence on high-risk donors to meet demand, suboptimal testing and quality assurance collectively contribute to the increased risk. With few exceptions, donor testing is confined to serological evaluation of human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) and syphilis. Barriers to implementation of broader molecular methods include cost, limited infrastructure and lack of technical expertise. Pathogen reduction (PR), a term used to describe a variety of methods (e.g. solvent detergent treatment or photochemical activation) that may be applied to blood following collection, offers the means to diminish the infectious potential of multiple pathogens simultaneously. This is effective against different classes of pathogen, including the major TTIs where laboratory screening is already implemented (e.g. HIV, HBV and HCV) as well pathogens that are widely endemic yet remain unaddressed (e.g. malaria, bacterial contamination). We sought to review the available and emerging PR techniques and their potential application to resource-constrained parts of Africa, focusing on the advantages and disadvantages of such technologies. PR has been slow to be adopted even in high-income countries, primarily given the high costs of use. Logistical considerations, particularly in low-resourced parts of Africa, also raise concerns about practicality. Nonetheless, PR offers a rational, innovative strategy to contend with TTIs; technologies in development may well present a viable complement or even alternative to targeted screening in the future. © 2017 International Society of Blood Transfusion.

  14. The importance of inclusion of kinetic information in the extrapolation of high-to-low concentrations for human limit setting.

    Science.gov (United States)

    Geraets, Liesbeth; Zeilmaker, Marco J; Bos, Peter M J

    2018-01-05

    Human health risk assessment of inhalation exposures generally includes a high-to-low concentration extrapolation. Although this is a common step in human risk assessment, it introduces various uncertainties. One of these uncertainties is related to the toxicokinetics. Many kinetic processes such as absorption, metabolism or excretion can be subject to saturation at high concentration levels. In the presence of saturable kinetic processes of the parent compound or metabolites, disproportionate increases in internal blood or tissue concentration relative to the external concentration administered may occur resulting in nonlinear kinetics. The present paper critically reviews human health risk assessment of inhalation exposure. More specific, it emphasizes the importance of kinetic information for the determination of a safe exposure in human risk assessment of inhalation exposures assessed by conversion from a high animal exposure to a low exposure in humans. For two selected chemicals, i.e. methyl tert-butyl ether and 1,2-dichloroethane, PBTK-modelling was used, for illustrative purposes, to follow the extrapolation and conversion steps as performed in existing risk assessments for these chemicals. Human health-based limit values based on an external dose metric without sufficient knowledge on kinetics might be too high to be sufficiently protective. Insight in the actual internal exposure, the toxic agent, the appropriate dose metric, and whether an effect is related to internal concentration or dose is important. Without this, application of assessment factors on an external dose metric and the conversion to continuous exposure results in an uncertain human health risk assessment of inhalation exposures. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Mentorship needs at academic institutions in resource-limited settings: a survey at makerere university college of health sciences

    Directory of Open Access Journals (Sweden)

    Nakwagala Fred

    2011-07-01

    Full Text Available Abstract Background Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS. Methods Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees registered with the Uganda Society for Health Scientists (USHS. Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes. Results Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses. Up to 77% (17/22 of mentors had Master's-level training and only 18% (4/22 had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions. Conclusions

  16. Treatment of elephantiasis of the leg by fasciotomy and lymphangiectomy with skin preservation in a resource-limited setting: a case report and review.

    Science.gov (United States)

    Kibadi, K

    2018-02-01

    The author reports the surgical management of a patient with elephantiasis of the leg in the Democratic Republic of Congo. A fasciotomy and lymphangiectomy with skin preservation, combined with compression therapy, resulted in significant cosmetic, functional, and social improvement. Although challenging in a resource-limited setting, development of surgical management may make it possible to reduce beliefs that elephantiasis is incurable or due to witchcraft and may reduce time to consultation.

  17. Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti.

    Science.gov (United States)

    Rouhani, Shada A; Israel, Kerling; Leandre, Fernet; Pierre, Sosthène; Bollman, Brennan; Marsh, Regan H

    2018-04-06

    In many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists. In conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care. Fourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful. Key components to our program's success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels. Medium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings.

  18. A colorimetric sensor array for identification of toxic gases below permissible exposure limits†

    OpenAIRE

    Feng, Liang; Musto, Christopher J.; Kemling, Jonathan W.; Lim, Sung H.; Suslick, Kenneth S.

    2010-01-01

    A colorimetric sensor array has been developed for the rapid and sensitive detection of 20 toxic industrial chemicals (TICs) at their PELs (permissible exposure limits). The color changes in an array of chemically responsive nanoporous pigments provide facile identification of the TICs with an error rate below 0.7%.

  19. Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

    Directory of Open Access Journals (Sweden)

    Jane W. Muchiri

    2012-10-01

    Full Text Available Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary

  20. Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

    Directory of Open Access Journals (Sweden)

    Jane W. Muchiri

    2012-10-01

    Full Text Available Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary

  1. 46 CFR 115.700 - Permission for repairs and alterations.

    Science.gov (United States)

    2010-10-01

    ... replacement in kind, of electrical wiring, fuel lines, tanks, boilers and other pressure vessels, and steering... 46 Shipping 4 2010-10-01 2010-10-01 false Permission for repairs and alterations. 115.700 Section... AND CERTIFICATION Repairs and Alterations § 115.700 Permission for repairs and alterations. (a...

  2. 46 CFR 176.700 - Permission for repairs and alterations.

    Science.gov (United States)

    2010-10-01

    ... repair or replacement, other than replacement in kind, of electrical wiring, fuel lines, tanks, boilers... 46 Shipping 7 2010-10-01 2010-10-01 false Permission for repairs and alterations. 176.700 Section... (UNDER 100 GROSS TONS) INSPECTION AND CERTIFICATION Repairs and Alterations § 176.700 Permission for...

  3. 14 CFR 399.35 - Special tariff permission.

    Science.gov (United States)

    2010-01-01

    ... PROCEEDINGS) POLICY STATEMENTS STATEMENTS OF GENERAL POLICY Policies Relating to Rates and Tariffs § 399.35 Special tariff permission. (a) Definition. As used in this section, to grant STP means to approve a... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Special tariff permission. 399.35 Section...

  4. 42 CFR 433.66 - Permissible provider-related donations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Permissible provider-related donations. 433.66... Requirements State Financial Participation § 433.66 Permissible provider-related donations. (a) General rule... provider-related donations without a reduction in FFP, only in accordance with the requirements of this...

  5. 45 CFR 1639.4 - Permissible representation of eligible clients.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Permissible representation of eligible clients... CORPORATION WELFARE REFORM § 1639.4 Permissible representation of eligible clients. Recipients may represent an individual eligible client who is seeking specific relief from a welfare agency. [62 FR 30766...

  6. The ecological determination of the permissible concentrations for radioactive contamination

    International Nuclear Information System (INIS)

    Kononovich, A.L.

    1996-01-01

    It is supposed that all inhabitants of the ecosystem are enjoying equal rights. The report describes the approximate method of ecology normalizing of the permissible radionuclide concentrations. Definition of the permissible concentration is made by an indirect way, since the defining criterion is unknown

  7. May I sleep in your bed? Getting permission to book

    NARCIS (Netherlands)

    Karlsson, L.; Kemperman, A.D.A.M.; Dolnicar, S.

    2017-01-01

    Demand for tourist accommodation offered on peer-to-peer networks is skyrocketing. In such networks tourists can only book if the accommodation provider (host) gives their permission. Needing permission to book accommodation is radically new in tourism. No hotel, motel or B&B assesses a tourist

  8. Potential Impact of a Free Online HIV Treatment Response Prediction System for Reducing Virological Failures and Drug Costs after Antiretroviral Therapy Failure in a Resource-Limited Setting

    Directory of Open Access Journals (Sweden)

    Andrew D. Revell

    2013-01-01

    Full Text Available Objective. Antiretroviral drug selection in resource-limited settings is often dictated by strict protocols as part of a public health strategy. The objective of this retrospective study was to examine if the HIV-TRePS online treatment prediction tool could help reduce treatment failure and drug costs in such settings. Methods. The HIV-TRePS computational models were used to predict the probability of response to therapy for 206 cases of treatment change following failure in India. The models were used to identify alternative locally available 3-drug regimens, which were predicted to be effective. The costs of these regimens were compared to those actually used in the clinic. Results. The models predicted the responses to treatment of the cases with an accuracy of 0.64. The models identified alternative drug regimens that were predicted to result in improved virological response and lower costs than those used in the clinic in 85% of the cases. The average annual cost saving was $364 USD per year (41%. Conclusions. Computational models that do not require a genotype can predict and potentially avoid treatment failure and may reduce therapy costs. The use of such a system to guide therapeutic decision-making could confer health economic benefits in resource-limited settings.

  9. An accurate and affordable test for the rapid diagnosis of sickle cell disease could revolutionize the outlook for affected children born in resource-limited settings.

    Science.gov (United States)

    Williams, Thomas N

    2015-09-23

    Each year, at least 280,000 children are born with sickle cell disease (SCD) in resource-limited settings. For cost, logistic and political reasons, the availability of SCD testing is limited in such settings and consequently 50-90 % of affected children die undiagnosed before their fifth birthday. The recent development of a point of care method for the diagnosis of SCD - the Sickle SCAN™ device - could afford such children the prompt access to appropriate services that has transformed the outlook for affected children in resource-rich areas. In research published in BMC Medicine, Kanter and colleagues describe a small but carefully conducted study involving 208 children and adults, in which they found that by using Sickle SCAN™ it was possible to diagnose the common forms of SCD with 99 % sensitivity and 99 % specificity, in under 5 minutes. If repeatable both in newborn babies and under real-life conditions, and if marketed at an affordable price, Sickle SCAN™ could revolutionize the survival prospects for children born with SCD in resource-limited areas.Please see related article: http://dx.doi.org/10.1186/s12916-015-0473-6.

  10. Hazards and maximum permissible doses of radiation for man

    International Nuclear Information System (INIS)

    Walinder, G.

    1977-11-01

    Maximum permissible dose levels are primarely based on risks for genetic damage and cancer. The reason for this is the observation that such late effects of radiation seem to arise even after doses that are to low to give rise to acute effects. In contrast to the tumour incidence found in irradiated human populations no genetic effects of radiation have been observed in man. This does not mean that genetic effects have not been induced but that it has been impossible to find an increase or to discern them among all the congenital defects, that can not be ascribed to the irradiation. As a consequence, the radiological risk estimation has been concentrated on the hazard of malignant diseases. Tumour risks are generally expressed as excess rates of incidence and mortality per million persons per rem. These figures are, however, not obtained from direct epidemiological observations but have been calculated from such data under the assumption of a linear relationship between effect and radiation dose. This formal extrapolation of observed data involves an uncertainty which, of course, is proportionately greater for the calculated effects in the millirem range. However, although the calculated tumour risks can not be said to be founded on direct scientific evidence, there are scientific reasons to believe that the figures derived from the formal extrapolations constitute an upper limit of possible ri02050

  11. Characterization of potential mineralization in Afghanistan: four permissive areas identified using imaging spectroscopy data

    Science.gov (United States)

    King, Trude V.V.; Berger, Byron R.; Johnson, Michaela R.

    2014-01-01

    As part of the U.S. Geological Survey and Department of Defense Task Force for Business and Stability Operations natural resources revitalization activities in Afghanistan, four permissive areas for mineralization, Bamyan 1, Farah 1, Ghazni 1, and Ghazni 2, have been identified using imaging spectroscopy data. To support economic development, the areas of potential mineralization were selected on the occurrence of selected mineral assemblages mapped using the HyMap™ data (kaolinite, jarosite, hydrated silica, chlorite, epidote, iron-bearing carbonate, buddingtonite, dickite, and alunite) that may be indicative of past mineralization processes in areas with limited or no previous mineral resource studies. Approximately 30 sites were initially determined to be candidates for areas of potential mineralization. Additional criteria and material used to refine the selection and prioritization process included existing geologic maps, Landsat Thematic Mapper data, and published literature. The HyMapTM data were interpreted in the context of the regional geologic and tectonic setting and used the presence of alteration mineral assemblages to identify areas with the potential for undiscovered mineral resources. Further field-sampling, mapping, and supporting geochemical analyses are necessary to fully substantiate and verify the specific deposit types in the four areas of potential mineralization.

  12. Protocol for the systematic review of the prevention, treatment and public health management of impetigo, scabies and fungal skin infections in resource-limited settings.

    Science.gov (United States)

    May, Philippa; Bowen, Asha; Tong, Steven; Steer, Andrew; Prince, Sam; Andrews, Ross; Currie, Bart; Carapetis, Jonathan

    2016-09-23

    Impetigo, scabies, and fungal skin infections disproportionately affect populations in resource-limited settings. Evidence for standard treatment of skin infections predominantly stem from hospital-based studies in high-income countries. The evidence for treatment in resource-limited settings is less clear, as studies in these populations may lack randomisation and control groups for cultural, ethical or economic reasons. Likewise, a synthesis of the evidence for public health control within endemic populations is also lacking. We propose a systematic review of the evidence for the prevention, treatment and public health management of skin infections in resource-limited settings, to inform the development of guidelines for the standardised and streamlined clinical and public health management of skin infections in endemic populations. The protocol has been designed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. All trial designs and analytical observational study designs will be eligible for inclusion. A systematic search of the peer-reviewed literature will include PubMed, Excertpa Medica and Global Health. Grey literature databases will also be systematically searched, and clinical trials registries scanned for future relevant studies. The primary outcome of interest will be the clinical cure or decrease in prevalence of impetigo, scabies, crusted scabies, tinea capitis, tinea corporis or tinea unguium. Two independent reviewers will perform eligibility assessment and data extraction using standardised electronic forms. Risk of bias assessment will be undertaken by two independent reviewers according to the Cochrane Risk of Bias tool. Data will be tabulated and narratively synthesised. We expect there will be insufficient data to conduct meta-analysis. The final body of evidence will be reported against the Grades of Recommendation, Assessment, Development and Evaluation grading system. The evidence

  13. Human T Lymphocytes Are Permissive for Dengue Virus Replication.

    Science.gov (United States)

    Silveira, Guilherme F; Wowk, Pryscilla F; Cataneo, Allan H D; Dos Santos, Paula F; Delgobo, Murilo; Stimamiglio, Marco A; Lo Sarzi, Maria; Thomazelli, Ana Paula F S; Conchon-Costa, Ivete; Pavanelli, Wander R; Antonelli, Lis R V; Báfica, André; Mansur, Daniel S; Dos Santos, Claudia N Duarte; Bordignon, Juliano

    2018-05-15

    Dengue virus (DV) infection can cause either a self-limiting flu-like disease or a threatening hemorrhage that may evolve to shock and death. A variety of cell types, such as dendritic cells, monocytes, and B cells, can be infected by DV. However, despite the role of T lymphocytes in the control of DV replication, there remains a paucity of information on possible DV-T cell interactions during the disease course. In the present study, we have demonstrated that primary human naive CD4 + and CD8 + T cells are permissive for DV infection. Importantly, both T cell subtypes support viral replication and secrete viable virus particles. DV infection triggers the activation of both CD4 + and CD8 + T lymphocytes, but preactivation of T cells reduces the susceptibility of T cells to DV infection. Interestingly, the cytotoxicity-inducing protein granzyme A is highly secreted by human CD4 + but not CD8 + T cells after exposure to DV in vitro Additionally, using annexin V and polycaspase assays, we have demonstrated that T lymphocytes, in contrast to monocytes, are resistant to DV-induced apoptosis. Strikingly, both CD4 + and CD8 + T cells were found to be infected with DV in acutely infected dengue patients. Together, these results show that T cells are permissive for DV infection in vitro and in vivo , suggesting that this cell population may be a viral reservoir during the acute phase of the disease. IMPORTANCE Infection by dengue virus (DV) causes a flu-like disease that can evolve to severe hemorrhaging and death. T lymphocytes are important cells that regulate antibody secretion by B cells and trigger the death of infected cells. However, little is known about the direct interaction between DV and T lymphocytes. Here, we show that T lymphocytes from healthy donors are susceptible to infection by DV, leading to cell activation. Additionally, T cells seem to be resistant to DV-induced apoptosis, suggesting a potential role as a viral reservoir in humans. Finally, we show

  14. Reaching the end of the line: Operational issues with implementing phone-based unannounced pill counts in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Yael Hirsch-Moverman

    Full Text Available Accurate measurement of adherence is necessary to ensure that therapeutic outcomes can be attributed to the recommended treatment. Phone-based unannounced pill counts were shown to be feasible and reliable measures of adherence in developed settings; and have been further used as part of medication adherence interventions. However, it is not clear whether this method can be implemented successfully in resource-limited settings, where cellular network and mobile phone coverage may be low. Our objective is to describe operational issues surrounding the use of phone-based unannounced pill counts in Lesotho and Ethiopia.Phone-based monthly unannounced pill counts, using an adaptation of a standardized protocol from previous US-based studies, were utilized to measure anti-TB and antiretroviral medication adherence in two implementation science studies in resource-limited settings, START (Lesotho and ENRICH (Ethiopia.In START, 19.6% of calls were completed, with 71.9% of participants reached at least once; majority of failed call attempts were due to phones not being available (54.8% or because participants were away from the pills (32.7%. In ENRICH, 33.5% of calls were completed, with 86.7% of participants reached at least once; the main reasons for failed call attempts were phones being switched off (31.5%, participants not answering (27.3%, participants' discomfort speaking on the phone (15.4%, and network problems (13.2%. Structural, facility-level, participant-level, and data collection challenges were encountered in these settings.Phone-based unannounced pill counts were found to be challenging, and response rates suboptimal. While some of these challenges were specific to local contexts, most of them are generalizable to resource-limited settings. In a research study context, a possible solution to ease operational challenges may be to focus phone-based unannounced pill count efforts on a randomly selected sample from participants who are

  15. A New Zealand Scientific Perspective on 20+ Years of Efforts to Introduce Policies Setting Limits on Emissions: What's the Way Forward?

    Science.gov (United States)

    Baisden, T. W.

    2013-12-01

    Setting limits on pollution is an inherently political process negotiated between stakeholders within society. Science has a critical, but not dominant role in setting environmental limits. Over the past 20 years, nations have had the opportunity to build on a period of major international successes, limiting ozone-depleting chemicals and sulphur emissions causing acid rain. The science and politics of solutions attempted during this time has become vastly more complicated, and the outcome has been disappointing: global greenhouse gas emissions remain at business-as-usual trajectories. It seems logical and timely to examine the landscape before forging onward. In a brief review of lessons learned from the perspective of earth-system science within New Zealand, I highlight key examples and opportunities for creating more promising way forward. Among the lessons are that small-scale limit setting can host important innovation, while collapses can occur when systems that are too-big-to-fail but lack critical pre-requisites. In this sense, implementation of cap-and-trade for water quality may represent the former, while the collapse of C prices highlight the latter. Of critical importance is the simple observation that perceived uncertainties must be brought within bounds that make decisions possible. The way in which system are framed scientifically can be of overarching significance. Cap and trade for nutrients in New Zealand catchments has enabled small-scale illustrations of how the system frame can be vital in successful policy. For example, the N budget of Lake Taupo is simplified by focusing on inputs to the land, while 100-year forcing equivalence still raises questions about managing climate change. Relationships between emissions and activity must be distilled based on sound science, in a manner simple and certain enough for people and businesses to meaningfully consider in decisions that are made every day. With trust becoming a major limiting factor in the

  16. Is the publication of exit poll results morally permissible?

    DEFF Research Database (Denmark)

    Sønderholm, Jørn

    2016-01-01

    This article is about exit polls. It addresses the question of whether or not it is morally permissible to publish exit poll results. The conclusion of the article is that an affirmative answer should be given to this question. In section 2, the master argument in favor of the moral permissibility...... of the publication of exit poll results is introduced. This is a strong argument. It is, however, argued that it might be the case that the conclusion of this argument should be rejected if there are other, and weightier, arguments against the idea that the publication of exit poll results is morally permissible....... In section 3, the strongest arguments against the moral permissibility of the publication of exit poll results are outlined and discussed. The conclusion of this section is that all these arguments fail in their intended purpose. The conclusion of the article is therefore justified....

  17. A Standardized Needs Assessment Tool to Inform the Curriculum Development Process for Pediatric Resuscitation Simulation-Based Education in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Nicole Shilkofski

    2018-02-01

    Full Text Available IntroductionUnder five mortality rates (UFMR remain high for children in low- and middle-income countries (LMICs in the developing world. Education for practitioners in these environments is a key factor to improve outcomes that will address United Nations Sustainable Development Goals 3 and 10 (good health and well being and reduced inequalities. In order to appropriately contextualize a curriculum using simulation, it is necessary to first conduct a needs assessment of the target learner population. The World Health Organization (WHO has published a tool to assess capacity for emergency and surgical care in LMICs that is adaptable to this goal.Materials and methodsThe WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was modified to assess pediatric resuscitation capacity in clinical settings in two LMICs: Uganda and Myanmar. Modifications included assessment of self-identified learning needs, current practices, and perceived epidemiology of disease burden in each clinical setting, in addition to assessment of pediatric resuscitation capacity in regard to infrastructure, procedures, equipment, and supplies. The modified tool was administered to 94 respondents from the two settings who were target learners of a proposed simulation-based curriculum in pediatric and neonatal resuscitation.ResultsInfectious diseases (respiratory illnesses and diarrheal disease were cited as the most common causes of pediatric deaths in both countries. Self-identified learning needs included knowledge and skill development in pediatric airway/breathing topics, as well as general resuscitation topics such as CPR and fluid resuscitation in shock. Equipment and supply availability varied substantially between settings, and critical shortages were identified in each setting. Current practices and procedures were often limited by equipment availability or infrastructural considerations.Discussion and conclusionEpidemiology of disease

  18. Fundamental energy limits of SET-based Brownian NAND and half-adder circuits. Preliminary findings from a physical-information-theoretic methodology

    Science.gov (United States)

    Ercan, İlke; Suyabatmaz, Enes

    2018-06-01

    The saturation in the efficiency and performance scaling of conventional electronic technologies brings about the development of novel computational paradigms. Brownian circuits are among the promising alternatives that can exploit fluctuations to increase the efficiency of information processing in nanocomputing. A Brownian cellular automaton, where signals propagate randomly and are driven by local transition rules, can be made computationally universal by embedding arbitrary asynchronous circuits on it. One of the potential realizations of such circuits is via single electron tunneling (SET) devices since SET technology enable simulation of noise and fluctuations in a fashion similar to Brownian search. In this paper, we perform a physical-information-theoretic analysis on the efficiency limitations in a Brownian NAND and half-adder circuits implemented using SET technology. The method we employed here establishes a solid ground that enables studying computational and physical features of this emerging technology on an equal footing, and yield fundamental lower bounds that provide valuable insights into how far its efficiency can be improved in principle. In order to provide a basis for comparison, we also analyze a NAND gate and half-adder circuit implemented in complementary metal oxide semiconductor technology to show how the fundamental bound of the Brownian circuit compares against a conventional paradigm.

  19. Accurate Ionization Potentials and Electron Affinities of Acceptor Molecules I. Reference Data at the CCSD(T) Complete Basis Set Limit

    KAUST Repository

    Richard, Ryan M.

    2016-01-05

    © 2016 American Chemical Society. In designing organic materials for electronics applications, particularly for organic photovoltaics (OPV), the ionization potential (IP) of the donor and the electron affinity (EA) of the acceptor play key roles. This makes OPV design an appealing application for computational chemistry since IPs and EAs are readily calculable from most electronic structure methods. Unfortunately reliable, high-accuracy wave function methods, such as coupled cluster theory with single, double, and perturbative triples [CCSD(T)] in the complete basis set (CBS) limit are too expensive for routine applications to this problem for any but the smallest of systems. One solution is to calibrate approximate, less computationally expensive methods against a database of high-accuracy IP/EA values; however, to our knowledge, no such database exists for systems related to OPV design. The present work is the first of a multipart study whose overarching goal is to determine which computational methods can be used to reliably compute IPs and EAs of electron acceptors. This part introduces a database of 24 known organic electron acceptors and provides high-accuracy vertical IP and EA values expected to be within ±0.03 eV of the true non-relativistic, vertical CCSD(T)/CBS limit. Convergence of IP and EA values toward the CBS limit is studied systematically for the Hartree-Fock, MP2 correlation, and beyond-MP2 coupled cluster contributions to the focal point estimates.

  20. Providing Anesthesia Care in Resource-limited Settings: A 6-year Analysis of Anesthesia Services Provided at Médecins Sans Frontières Facilities.

    Science.gov (United States)

    Ariyo, Promise; Trelles, Miguel; Helmand, Rahmatullah; Amir, Yama; Hassani, Ghulam Haidar; Mftavyanka, Julien; Nzeyimana, Zenon; Akemani, Clemence; Ntawukiruwabo, Innocent Bagura; Charles, Adelin; Yana, Yanang; Moussa, Kalla; Kamal, Mustafa; Suma, Mohamed Lamin; Ahmed, Mowlid; Abdullahi, Mohamed; Wong, Evan G; Kushner, Adam; Latif, Asad

    2016-03-01

    Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed. Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively. A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.

  1. Contrasting amino acid profiles among permissive and non-permissive hosts of Candidatus Liberibacter asiaticus, putative causal agent of Huanglongbing.

    Directory of Open Access Journals (Sweden)

    Mamoudou Sétamou

    Full Text Available Huanglongbing is a devastating disease of citrus. In this study, a comprehensive profile of phloem sap amino acids (AA in four permissive host plants of Candidatus Liberibacter asiaticus (CLas and three non-permissive Rutaceae plants was conducted to gain a better understanding of host factors that may promote or suppress the bacterium. The AA profiles of Diaphorina citri nymphs and adults were similarly analyzed. A total of 38 unique AAs were detected in phloem sap of the various plants and D. citri samples, with phloem sap of young shoots containing more AAs and at higher concentrations than their mature counterparts. All AAs detected in phloem sap of non-permissive plants were also present in CLas -permissive hosts plus additional AAs in the latter class of plants. However, the relative composition of 18 commonly shared AAs varied between CLas -permissive hosts and non-permissive plants. Multivariate analysis with a partial least square discriminant methodology revealed a total of 12 AAs as major factors affecting CLas host status, of which seven were positively related to CLas tolerance/resistance and five positively associated with CLas susceptibility. Most of the AAs positively associated with CLas susceptibility were predominantly of the glutamate family, notably stressed-induced AAs such as arginine, GABA and proline. In contrast, AAs positively correlated with CLas tolerance/resistance were mainly of the serine family. Further analysis revealed that whereas the relative proportions of AAs positively associated with CLas susceptibility did not vary with host developmental stages, those associated with CLas tolerance/resistance increased with flush shoot maturity. Significantly, the proline-to-glycine ratio was determined to be an important discriminating factor for CLas permissivity with higher values characteristic of CLas -permissive hosts. This ratio could be exploited as a biomarker in HLB-resistance breeding programs.

  2. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yalda Jafari

    Full Text Available Rapid and point-of-care (POC tests for syphilis are an invaluable screening tool, yet inadequate evaluation of their diagnostic accuracy against best reference standards limits their widespread global uptake. To fill this gap, a systematic review and meta-analysis was conducted to evaluate the sensitivity and specificity of rapid and POC tests in blood and serum samples against Treponema pallidum (TP specific reference standards.Five electronic databases (1980-2012 were searched, data was extracted from 33 articles, and Bayesian hierarchical models were fit.In serum samples, against a TP specific reference standard point estimates with 95% credible intervals (CrI for the sensitivities of popular tests were: i Determine, 90.04% (80.45, 95.21, ii SD Bioline, 87.06% (75.67, 94.50, iii VisiTect, 85.13% (72.83, 92.57, and iv Syphicheck, 74.48% (56.85, 88.44, while specificities were: i Syphicheck, 99.14% (96.37, 100, ii Visitect, 96.45% (91.92, 99.29, iii SD Bioline, 95.85% (89.89, 99.53, and iv Determine, 94.15% (89.26, 97.66. In whole blood samples, sensitivities were: i Determine, 86.32% (77.26, 91.70, ii SD Bioline, 84.50% (78.81, 92.61, iii Syphicheck, 74.47% (63.94, 82.13, and iv VisiTect, 74.26% (53.62, 83.68, while specificities were: i Syphicheck, 99.58% (98.91, 99.96, ii VisiTect, 99.43% (98.22, 99.98, iii SD Bioline, 97.95%(92.54, 99.33, and iv Determine, 95.85% (92.42, 97.74.Rapid and POC treponemal tests reported sensitivity and specificity estimates comparable to laboratory-based treponemal tests. In resource limited settings, where access to screening is limited and where risk of patients lost to follow up is high, the introduction of these tests has already been shown to improve access to screening and treatment to prevent stillbirths and neonatal mortality due to congenital syphilis. Based on the evidence, it is concluded that rapid and POC tests are useful in resource limited settings with poor access to laboratories or screening

  3. The clinical and economic impact of point-of-care CD4 testing in mozambique and other resource-limited settings: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Emily P Hyle

    2014-09-01

    Full Text Available Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique.We use a validated model of HIV testing, linkage, and treatment (CEPAC-International to examine two strategies of immunological staging in Mozambique: (1 laboratory-based CD4 testing (LAB-CD4 and (2 point-of-care CD4 testing (POC-CD4. Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs. Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%, probability of correctly detecting antiretroviral therapy (ART eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90% or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%, and test cost (LAB-CD4, US$10; POC-CD4, US$24. In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570 to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%, increasing to 65.0% (95% CI, 64.9%-65.1% with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y and US$2,440 (95% CI, US$2,440-US$2,450 and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y and US$2,800 (95% CI, US$2,790-US$2,800; the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS (95% CI, US$480-US$520/YLS. POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published

  4. Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study

    Directory of Open Access Journals (Sweden)

    Keuky Lim

    2009-07-01

    Full Text Available Abstract Background Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008. Methods We calculated the mean and proportion of patients who met the recommended treatment targets, and the drop from baseline values for random blood glucose (RBG, hemoglobin A1c (HbA1c, blood pressure (BP, and body mass index (BMI at regular intervals. Analysis was restricted to patients not lost to follow-up. We used the t test to compare baseline and subsequent paired values. Results Of 4404 patients enrolled, 2,872 (65% were still in care at the time of the study, 24 (0.5% had died, and 1,508 (34% were lost tofollow-up. Median age was 53 years, 2,905 (66% were female and 4,350 (99% had type 2 diabetes. Median (interquartile range (IQR follow-up was 20 months (5 to 39.5 months. A total of 24% (51/210 of patients had a HbA1c concentration of P P P P 2 after 1 year. Factors associated with loss to follow-up were male sex, age >60 years, living outside the province, normal BMI on admission, high RBG on last visit, and coming late for the last consultation. Conclusion Significant and clinically important improvements in glycemia and BP were observed, but a relatively low proportion of diabetic patients reached treatment targets. These results and the high loss to follow-up rate highlight the challenges of delivering diabetic care in rural, resource-limited settings.

  5. Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

    Science.gov (United States)

    Zakumumpa, Henry; Taiwo, Modupe Oladunni; Muganzi, Alex; Ssengooba, Freddie

    2016-10-19

    Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009. A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis. The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment. Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.

  6. Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings.

    Science.gov (United States)

    Shrivastava, Rakesh; Sen, Sourav; Banerji, Debabrata; Praharaj, Ashok K; Chopra, Gurvinder Singh; Gill, Satyajit Singh

    2013-01-01

    A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. The aim of this study is to assess the utility of non-invasive mathematical models of liver fibrosis in chronic hepatitis B (CHB). Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. A cross-sectional study carried out at a tertiary care center. A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gama glutamyl transpeptidase (GGT), total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI), Fibrosis 4 (FIB-4) and Forn's index were calculated. Outcomes were compared for the assessment of best predictor of fibrosis by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each index. Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for significance. P value value of all 3 indices were significantly higher in patients group as compare with the controls (P model for excluding significant liver fibrosis while FIB-4 with a PPV of 61% showed fair correlation with significant fibrosis. Thus, these two non-invasive models for predicting of liver fibrosis, namely APRI and FIB-4, can be utilized in combination as screening tools in monitoring of CHB patients, especially in resource limiting settings.

  7. Improved Neuropsychological and Neurological Functioning Across Three Antiretroviral Regimens in Diverse Resource-Limited Settings: AIDS Clinical Trials Group Study A5199, the International Neurological Study

    Science.gov (United States)

    Robertson, K.; Jiang, H.; Kumwenda, J.; Supparatpinyo, K.; Evans, S.; Campbell, T. B.; Price, R.; Tripathy, S.; Kumarasamy, N.; La Rosa, A.; Santos, B.; Silva, M. T.; Montano, S.; Kanyama, C.; Faesen, S.; Murphy, R.; Hall, C.; Marra, C. M.; Marcus, C.; Berzins, B.; Allen, R.; Housseinipour, M.; Amod, F.; Sanne, I.; Hakim, J.; Walawander, A.; Nair, A.

    2012-01-01

    Background. AIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings. Methods. Participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations. Results. The median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P  .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01). Conclusions. The study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization –recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction. Clinical trials registration.  NCT00096824. PMID:22661489

  8. Particle size distributions of lead measured in battery manufacturing and secondary smelter facilities and implications in setting workplace lead exposure limits.

    Science.gov (United States)

    Petito Boyce, Catherine; Sax, Sonja N; Cohen, Joel M

    2017-08-01

    Inhalation plays an important role in exposures to lead in airborne particulate matter in occupational settings, and particle size determines where and how much of airborne lead is deposited in the respiratory tract and how much is subsequently absorbed into the body. Although some occupational airborne lead particle size data have been published, limited information is available reflecting current workplace conditions in the U.S. To address this data gap, the Battery Council International (BCI) conducted workplace monitoring studies at nine lead acid battery manufacturing facilities (BMFs) and five secondary smelter facilities (SSFs) across the U.S. This article presents the results of the BCI studies focusing on the particle size distributions calculated from Personal Marple Impactor sampling data and particle deposition estimates in each of the three major respiratory tract regions derived using the Multiple-Path Particle Dosimetry model. The BCI data showed the presence of predominantly larger-sized particles in the work environments evaluated, with average mass median aerodynamic diameters (MMADs) ranging from 21-32 µm for the three BMF job categories and from 15-25 µm for the five SSF job categories tested. The BCI data also indicated that the percentage of lead mass measured at the sampled facilities in the submicron range (i.e., lead) was generally small. The estimated average percentages of lead mass in the submicron range for the tested job categories ranged from 0.8-3.3% at the BMFs and from 0.44-6.1% at the SSFs. Variability was observed in the particle size distributions across job categories and facilities, and sensitivity analyses were conducted to explore this variability. The BCI results were compared with results reported in the scientific literature. Screening-level analyses were also conducted to explore the overall degree of lead absorption potentially associated with the observed particle size distributions and to identify key issues

  9. Translating vaccine policy into action: a report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings.

    Science.gov (United States)

    Ortiz, Justin R; Neuzil, Kathleen M; Ahonkhai, Vincent I; Gellin, Bruce G; Salisbury, David M; Read, Jennifer S; Adegbola, Richard A; Abramson, Jon S

    2012-11-26

    Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life. In April 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended revisions to the WHO position paper on influenza vaccines. For the first time, SAGE recommended pregnant women should be made the highest priority for inactivated seasonal influenza vaccination. However, the variable maternal influenza vaccination coverage in countries with pre-existing maternal influenza vaccine recommendations underscores the need to understand and to address the discrepancy between recommendations and implementation success. We present the outcome of a multi-stakeholder expert consultation on inactivated influenza vaccination in pregnancy. The creation and implementation of vaccine policies and regulations require substantial resources and capacity. As with all public health interventions, the existence of perceived and real risks of vaccination will necessitate effective and transparent risk communication. Potential risk allocation and sharing mechanisms should be addressed by governments, vaccine manufacturers, and other stakeholders. In resource-limited settings, vaccine-related issues concerning supply, formulation, regulation, evidence evaluation, distribution, cost-utility, and post-marketing safety surveillance need to be addressed. Lessons can be learned from the Maternal and Neonatal Tetanus Elimination Initiative as well as efforts to increase vaccine coverage among pregnant

  10. Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings

    Directory of Open Access Journals (Sweden)

    Rakesh Shrivastava

    2013-01-01

    Full Text Available Context: A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. Aim: The aim of this study is to assess the utility of non-invasive mathematical models of liver fibrosis in chronic hepatitis B (CHB. Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. Settings and Design: A cross-sectional study carried out at a tertiary care center. Subjects and Methods: A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST, Alanine aminotransferase (ALT, Gama glutamyl transpeptidase (GGT, total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI, Fibrosis 4 (FIB-4 and Forn′s index were calculated. Outcomes were compared for the assessment of best predictor of fibrosis by calculating the sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of each index. Statistical Analysis Used: Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for significance. P value < 0.05 was taken as significant. Results: While the serum levels of AST, ALT and GGT were significantly higher in patients group as compare with the healthy controls (P < 0.01, the platelet counts were significantly lower in patient group as compared to the control group (P < 0.01. Mean value of all 3 indices were significantly higher in patients group as compare with the controls (P < 0.01. Conclusions: Out of the three indices, APRI index with a NPV of 95% appeared to be a better model

  11. Dilution testing using rapid diagnostic tests in a HIV diagnostic algorithm: a novel alternative for confirmation testing in resource limited settings.

    Science.gov (United States)

    Shanks, Leslie; Siddiqui, M Ruby; Abebe, Almaz; Piriou, Erwan; Pearce, Neil; Ariti, Cono; Masiga, Johnson; Muluneh, Libsework; Wazome, Joseph; Ritmeijer, Koert; Klarkowski, Derryck

    2015-05-14

    Current WHO testing guidelines for resource limited settings diagnose HIV on the basis of screening tests without a confirmation test due to cost constraints. This leads to a potential risk of false positive HIV diagnosis. In this paper, we evaluate the dilution test, a novel method for confirmation testing, which is simple, rapid, and low cost. The principle of the dilution test is to alter the sensitivity of a rapid diagnostic test (RDT) by dilution of the sample, in order to screen out the cross reacting antibodies responsible for falsely positive RDT results. Participants were recruited from two testing centres in Ethiopia where a tiebreaker algorithm using 3 different RDTs in series is used to diagnose HIV. All samples positive on the initial screening RDT and every 10th negative sample underwent testing with the gold standard and dilution test. Dilution testing was performed using Determine™ rapid diagnostic test at 6 different dilutions. Results were compared to the gold standard of Western Blot; where Western Blot was indeterminate, PCR testing determined the final result. 2895 samples were recruited to the study. 247 were positive for a prevalence of 8.5 % (247/2895). A total of 495 samples underwent dilution testing. The RDT diagnostic algorithm misclassified 18 samples as positive. Dilution at the level of 1/160 was able to correctly identify all these 18 false positives, but at a cost of a single false negative result (sensitivity 99.6 %, 95 % CI 97.8-100; specificity 100 %, 95 % CI: 98.5-100). Concordance between the gold standard and the 1/160 dilution strength was 99.8 %. This study provides proof of concept for a new, low cost method of confirming HIV diagnosis in resource-limited settings. It has potential for use as a supplementary test in a confirmatory algorithm, whereby double positive RDT results undergo dilution testing, with positive results confirming HIV infection. Negative results require nucleic acid testing to rule out false

  12. Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study.

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    Sophie Janet

    Full Text Available Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable.Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU on the Thailand-Myanmar border.From 21,225 newbonrs delivered, 15,073 (71% met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU. Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06. Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442, and 6.32 (95%CI 3.01-13.26; p<0.001 respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001. Neurodevelopmental follow-up to one year was performed in 1,608 (10.5% of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565 versus 63 (n = 41; p = 0.732, while advanced resuscitation scores were significantly lower (56 (n = 5; p = 0.017.Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.

  13. Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh.

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    Teresa Bleakly Kortz

    Full Text Available Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay.This was a retrospective cohort study of children 1-59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation.404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72. The adjusted odds ratio (AOR for post-protocol mortality was 1.55 (95% CI, 0.88-2.71. The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04-5.85, as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43-14.29 and having a longer median length of stay (AOR 1.81, 95% CI 1.10-2.96. There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4 or antibiotic administration between the cohorts (pre- 16.08% vs

  14. Permissive hypercapnia and risk for brain injury and developmental impairment.

    Science.gov (United States)

    Hagen, Erika W; Sadek-Badawi, Mona; Carlton, David P; Palta, Mari

    2008-09-01

    Permissive hypercapnia is a respiratory-care strategy that is used to reduce the risk for lung injury. The goal of this study was to evaluate whether permissive hypercapnia is associated with higher risk for intraventricular hemorrhage and early childhood behavioral and functional problems than normocapnia among very low birth weight infants. Very low birth weight infants from a statewide cohort were eligible for this study when they were born at <32 weeks' gestational age and survived at least 24 hours. Infants were classified as receiving a permissive hypercapnia, normocapnia, or unclassifiable respiratory strategy during the first 24 hours after birth according to an algorithm based on Pco(2) values and respiratory-treatment decisions that were abstracted from medical charts. Intraventricular hemorrhage diagnosis was also abstracted from the medical chart. Behavioral and functional outcomes were assessed by parent interview at 2 to 3 years. Logistic regression was used to evaluate the relationship between intraventricular hemorrhage and respiratory strategy; ordinary linear regression was used to evaluate differences in behavior and function scores between children by respiratory strategy. Infants who received a permissive hypercapnia strategy were not more likely to have intraventricular hemorrhage than those with normocapnia. There were no differences in any of the behavioral or functional scores among children according to respiratory strategy. There was a significant interaction between care strategy and 1-minute Apgar score, indicating that infants with lower Apgar scores may be at higher risk for intraventricular hemorrhage with permissive hypercapnia. This study suggests that permissive hypercapnia does not increase risk for brain injury and impairment among very low birth weight children. The interaction between respiratory strategy and Apgar score is a potential worrisome exception to this conclusion. Future research should further evaluate the effect

  15. Permissible annual depositions and radionuclide concentrations in air

    International Nuclear Information System (INIS)

    Belyaev, V.A.; Golovko, M.Yu.

    1993-01-01

    It is established that it necessary to take into account the other ways of radionuclide intake apart from the inhalation one when determining the standards for radionuclide contamination of the atmospheric air. Whereby it is proposed to standardize annual depositions rather than permissible concentration in the atmospheric air for the ways related to radionuclide releases on the ground surface, which is explained by ambiguity of their dry deposition rate from the air. Formulae and results of calculation of standard characteristics are presented. The permissible radionuclide depositions, related to the intake through food chains are calculated with account for diet diversity, agroclimatic and phenological parameters in different regions of the country

  16. Tube temperature rise limits: Boiling considerations

    Energy Technology Data Exchange (ETDEWEB)

    Vanderwater, R.G.

    1952-03-26

    A revision of tube power limits based on boiling considerations was presented earlier. The limits were given on a basis of tube power versus header pressure. However, for convenience of operation, the limits have been converted from tube power to permissible water temperature rise. The permissible {triangle}t`s water are given in this document.

  17. Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting.

    Science.gov (United States)

    Swain, JaBaris D; Sinnott, Colleen; Breakey, Suellen; Hasson Charles, Rian; Mody, Gita; Nyirimanzi, Napthal; Patton-Bolman, Ceeya; Come, Patricia; Ganza, Gapira; Rusingiza, Emmanuel; Ruhamya, Nathan; Mucumbitsi, Joseph; Borges, Jorge; Zammert, Martin; Muehlschlegel, Jochen D; Oakes, Robert; Leavitt, Bruce; Bolman, R Morton

    2018-06-01

    Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease. Humanitarian surgical outreach in this region can improve the delivery of cardiovascular care by providing sustainability through mentorship, medical expertise, training, and knowledge transfer, and ultimately the creation of a cardiac center. We describe the experience of consecutive annual visits to Rwanda since 2008 and report the outcomes of a collaborative approach to enable sustainable cardiac surgery in the region. The Ferrans and Powers Quality of Life Index tool's Cardiac Version (http://www.uic.edu/orgs/qli/) was administered to assess the postoperative quality of life. Ten visits have been completed, performing 149 open procedures, including 200 valve implantations, New York Heart Association class III or IV, with 4.7% 30-day mortality. All procedures were performed with the participation of local Rwandan personnel, expatriate physicians, nurses, residents, and support staff. Early complications included cerebrovascular accident (n = 4), hemorrhage requiring reoperation (n = 6), and death (n = 7). Quality of life was assessed to further understand challenges encountered after cardiac surgery in this resource-limited setting. Four major domains were considered: health and functioning, social and economic, psychologic/spiritual, and family. The mean total quality of life index was 20.79 ± 4.07 on a scale from 0 to 30, for which higher scores indicated higher quality of life. Women had significantly lower "social and economic" subscores (16.81 ± 4.17) than men (18.64 ± 4

  18. The burden of presumed tuberculosis in hospitalized children in a resource-limited setting in Papua New Guinea: a prospective observational study.

    Science.gov (United States)

    Watch, Villa; Aipit, Jimmy; Kote-Yarong, Tina; Rero, Allanie; Bolnga, John W; Lufele, Elvin; Laman, Moses

    2017-11-01

    In Papua New Guinea, TB is considered to be a major public health problem, but little is known about the prevalence and prognosis of presumed TB in children. As part of a prospective hospital-based surveillance on the northern coast of mainland Papua New Guinea, the authors investigated the admission prevalence and case fatality rate associated with presumed TB over a 6-year period (2011-2016). All children admitted who were diagnosed with TB were followed-up until discharge or death. Of 8992 paediatric admissions, 734 patients (8.2%) were diagnosed with presumed TB and there were 825 deaths, with TB accounting for 102 (12.4%). Extrapulmonary TB was the final diagnosis in 384 admissions {prevalence 4.3% [384/8992 (95% CI 3.9-4.7)]} with a case fatality rate of 21.4% [82/384 (95% CI 17.4-25.9)]. TB meningitis, disseminated TB and pericardial TB had high case fatality rates of 29.0% (53/183), 28.9% (11/38) and 25% (4/16), respectively. Severe malnutrition was more common in patients with pulmonary compared with extrapulmonary TB (25.4% vs 15.6%; pPapua New Guinea. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Feasibility of establishing a biosafety level 3 tuberculosis culture laboratory of acceptable quality standards in a resource-limited setting: an experience from Uganda.

    Science.gov (United States)

    Ssengooba, Willy; Gelderbloem, Sebastian J; Mboowa, Gerald; Wajja, Anne; Namaganda, Carolyn; Musoke, Philippa; Mayanja-Kizza, Harriet; Joloba, Moses Lutaakome

    2015-01-15

    Despite the recent innovations in tuberculosis (TB) and multi-drug resistant TB (MDR-TB) diagnosis, culture remains vital for difficult-to-diagnose patients, baseline and end-point determination for novel vaccines and drug trials. Herein, we share our experience of establishing a BSL-3 culture facility in Uganda as well as 3-years performance indicators and post-TB vaccine trials (pioneer) and funding experience of sustaining such a facility. Between September 2008 and April 2009, the laboratory was set-up with financial support from external partners. After an initial procedure validation phase in parallel with the National TB Reference Laboratory (NTRL) and legal approvals, the laboratory registered for external quality assessment (EQA) from the NTRL, WHO, National Health Laboratories Services (NHLS), and the College of American Pathologists (CAP). The laboratory also instituted a functional quality management system (QMS). Pioneer funding ended in 2012 and the laboratory remained in self-sustainability mode. The laboratory achieved internationally acceptable standards in both structural and biosafety requirements. Of the 14 patient samples analyzed in the procedural validation phase, agreement for all tests with NTRL was 90% (P 80% in all years from NTRL, CAP, and NHLS, and culture was 100% for CAP panels and above regional average scores for all years with NHLS. Quarterly DST scores from WHO-EQA ranged from 78% to 100% in 2010, 80% to 100% in 2011, and 90 to 100% in 2012. From our experience, it is feasible to set-up a BSL-3 TB culture laboratory with acceptable quality performance standards in resource-limited countries. With the demonstrated quality of work, the laboratory attracted more research groups and post-pioneer funding, which helped to ensure sustainability. The high skilled experts in this research laboratory also continue to provide an excellent resource for the needed national discussion of the laboratory and quality management systems.

  20. Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Tsima BM

    2016-08-01

    Full Text Available Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better

  1. Scope and Limits of an anamnestic questionnaire in a control-induced low-endemicity helminthiasis setting in south-central Côte d'Ivoire.

    Science.gov (United States)

    Fürst, Thomas; Ouattara, Mamadou; Silué, Kigbafori D; N'Goran, Dje N; Adiossan, Lukas G; Bogoch, Isaac I; N'Guessan, Yao; Koné, Siaka; Utzinger, Jürg; N'Goran, Eliézer K

    2014-01-01

    Schistosomiasis and soil-transmitted helminthiasis are two high-burden neglected tropical diseases. In highly endemic areas, control efforts emphasize preventive chemotherapy. However, as morbidity, infection, and transmission begin to decrease, more targeted treatment is likely to become more cost-effective, provided that comparatively cheap diagnostic methods with reasonable accuracy are available. Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d'Ivoire. Questions pertaining to risk factors and signs and symptoms for schistosomiasis and soil-transmitted helminthiasis were included. The individuals' helminth infection status and their belonging to three different anthelmintic treatment groups were compared with the questionnaire results (i) to inform the local health authorities about the epidemiological and clinical footprint of locally prevailing helminthiases, and (ii) to explore the scope and limits of an anamnestic questionnaire as monitoring tool, which eventually could help guiding the control of neglected tropical diseases in control-induced low-endemicity settings. Our study sample consisted of 195 adults (101 males, 94 females). We found prevalences of hookworm, Trichuris trichiura, Schistosoma haematobium, and Schistosoma mansoni of 39.0%, 2.7%, 2.1%, and 2.1%, respectively. No Ascaris lumbricoides infection was found. Helminth infection intensities were generally very low. Seven, 74 and 79 participants belonged to three different treatment groups. Multivariable logistic regression models revealed statistically significant (p<0.05) associations between some risk factors, signs, and symptoms, and the different helminth infections and treatment groups. However, the risk factors, signs, and symptoms showed weak diagnostic properties. The generally low prevalence and intensity of helminth infection in this part of

  2. The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border.

    Science.gov (United States)

    Chalmers, Lauren; Cross, Jessica; Chu, Cindy S; Phyo, Aung Pyae; Trip, Margreet; Ling, Clare; Carrara, Verena; Watthanaworawit, Wanitda; Keereecharoen, Lily; Hanboonkunupakarn, Borimas; Nosten, François; McGready, Rose

    2015-10-01

    Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >10(5)  CFU/ml. In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  3. Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings.

    Science.gov (United States)

    Revell, A D; Wang, D; Wood, R; Morrow, C; Tempelman, H; Hamers, R L; Alvarez-Uria, G; Streinu-Cercel, A; Ene, L; Wensing, A M J; DeWolf, F; Nelson, M; Montaner, J S; Lane, H C; Larder, B A

    2013-06-01

    Genotypic HIV drug-resistance testing is typically 60%-65% predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART without a genotype and evaluated their potential as a treatment support tool in RLSs. Random forest models were trained to predict the probability of response to ART (≤400 copies HIV RNA/mL) using the following data from 14 891 treatment change episodes (TCEs) after virological failure, from well-resourced countries: viral load and CD4 count prior to treatment change, treatment history, drugs in the new regimen, time to follow-up and follow-up viral load. Models were assessed by cross-validation during development, with an independent set of 800 cases from well-resourced countries, plus 231 cases from Southern Africa, 206 from India and 375 from Romania. The area under the receiver operating characteristic curve (AUC) was the main outcome measure. The models achieved an AUC of 0.74-0.81 during cross-validation and 0.76-0.77 with the 800 test TCEs. They achieved AUCs of 0.58-0.65 (Southern Africa), 0.63 (India) and 0.70 (Romania). Models were more accurate for data from the well-resourced countries than for cases from Southern Africa and India (P < 0.001), but not Romania. The models identified alternative, available drug regimens predicted to result in virological response for 94% of virological failures in Southern Africa, 99% of those in India and 93% of those in Romania. We developed computational models that predict virological response to ART without a genotype with comparable accuracy to genotyping with rule-based interpretation. These models have the potential to help optimize antiretroviral therapy for patients in RLSs where genotyping is not generally available.

  4. Assessment of the impact of adherence and other predictors during HAART on various CD4 cell responses in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Abrogoua DP

    2012-03-01

    Full Text Available Danho Pascal Abrogoua1,2, Brou Jerome Kablan1, Boua Alexis Thierry Kamenan1,3, Gilles Aulagner4, Konan N'Guessan1, Christian Zohoré11Laboratoire de Pharmacie Clinique, Pharmacologie et Therapeutique – UFR Sciences Pharmaceutiques et Biologiques, 2Laboratoire de Pharmacologie Clinique, CHU de Cocody, 3Service de Pharmacie, CHU de Cocody, Abidjan, Cote d'Ivoire, 4Service Pharmaceutique Hopital Louis Pradel, Lyon, FranceObjective: The aim of this study was to quantify, by modeling, the impact of significant predictors on CD4 cell response during antiretroviral therapy in a resource-limited setting.Methods: Modeling was used to determine which antiretroviral therapy response predictors (baseline CD4 cell count, clinical state, age, and adherence significantly influence immunological response in terms of CD4 cell gain compared to a reference value at different periods of monitoring.Results: At 6 months, CD4 cell response was significantly influenced by baseline CD4 count alone. The probability of no increase in CD4 cells was 2.6 higher in patients with a baseline CD4 cell count of ≥200/mm3. At 12 months, CD4 cell response was significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was three times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.15 times lower with adherent patients. At 18 months, CD4 cell response was also significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was 5.1 times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.28 times lower with adherent patients. At 24 months, optimal CD4 cell response was significantly influenced by adherence alone. Adherence increased the probability (by 5.8 of an optimal increase in CD4 cells. Age and baseline clinical state had no significant influence on immunological response.Conclusion: The relationship between adherence and CD4

  5. Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting.

    Science.gov (United States)

    Tibaijuka, Leevan; Odongo, Robert; Welikhe, Emma; Mukisa, Wilber; Kugonza, Lilian; Busingye, Imelda; Nabukalu, Phelomena; Ngonzi, Joseph; Asiimwe, Stephen B; Bajunirwe, Francis

    2017-04-04

    Unplanned pregnancy remains a common problem in many resource-limited settings, mostly due to limited access to modern family planning (FP) services. In particular, use of the more effective long-acting reversible contraceptive (LARC) methods (i.e., intrauterine devices and hormonal implants) remains low compared to the short-acting methods (i.e., condoms, hormonal pills, injectable hormones, and spermicides). Among reproductive-age women attending FP and antenatal care clinics in Uganda, we assessed perceptions and practices regarding the use of modern contraceptive methods. We specifically aimed to evaluate factors influencing method selection. We performed a mixed-methods cross-sectional study, in which we administered structured interviews to 180 clients, and conducted 4 focus group discussions (FGDs) with 36 clients and 8 in-depth personal qualitative interviews with health service providers. We summarized quantitative data and performed latent content analysis on transcripts from the FGDs and qualitative interviews. The prevalence of ever use for LARC methods was 23%. Method characteristics (e.g., client control) appeared to drive method selection more often than structural factors (such as method availability) or individual client characteristics (such as knowledge and perceptions). The most common reasons for choosing LARC methods were: longer protection; better child-spacing; and effectiveness. The most common reasons for not choosing LARC methods included requiring a client-controlled method and desiring to conceive in the near future. The most common reasons for choosing short-acting methods were ease of access; lower cost; privacy; perceived fewer side effects; and freedom to stop using a method without involving the health provider. The personal characteristics of clients, which appeared to be important were client knowledge and number of children. The structural factor which appeared to be important was method availability. Our results suggest that

  6. Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting.

    Directory of Open Access Journals (Sweden)

    Jermaine Khumalo

    Full Text Available Accurate etiological diagnosis of meningitis is important, but difficult in resource-limited settings due to prior administration of antibiotics and lack of viral diagnostics. We aimed to develop and validate 2 real-time multiplex PCR (RT-PCR assays for the detection of common causes of community-acquired bacterial and viral meningitis in South African children.We developed 2 multiplex RT- PCRs for detection of S. pneumoniae, N. meningitidis, H. influenzae, enteroviruses, mumps virus and herpes simplex virus. We tested residual CSF samples from children presenting to a local paediatric hospital over a one-year period, whose CSF showed an abnormal cell count. Results were compared with routine diagnostic tests and the final discharge diagnosis. We calculated accuracy of the bacterial RT-PCR assay compared to CSF culture and using World Health Organisation definitions of laboratory-confirmed bacterial meningitis.From 292 samples, bacterial DNA was detected in 12 (4.1% and viral nucleic acids in 94 (32%. Compared to CSF culture, the sensitivity and specificity of the bacterial RT-PCR was 100% and 97.2% with complete agreement in organism identification. None of the cases positive by viral RT-PCR had a bacterial cause confirmed on CSF culture. Only 9/90 (10% of patients diagnosed clinically as bacterial meningitis or partially treated bacterial meningitis tested positive with the bacterial RT-PCR.In this population the use of 2 multiplex RT-PCRs targeting 6 common pathogens gave promising results. If introduced into routine diagnostic testing, these multiplex RT-PCR assays would supplement other diagnostic tests, and have the potential to limit unnecessary antibiotic therapy and hospitalisation.

  7. Linking chloride mass balance infiltration rates with chlorofluorocarbon and SF6 groundwater dating in semi-arid settings: potential and limitations.

    Science.gov (United States)

    Stadler, Susanne; Osenbruck, Karsten; Duijnisveld, Wilhelmus H M; Schwiede, Martin; Bottcher, Jurgen

    2010-09-01

    In the framework of the investigation of enrichment processes of nitrate in groundwater of the Kalahari of Botswana near Serowe, recharge processes were investigated. The thick unsaturated zone extending to up to 100 m of mostly unconsolidated sediments and very low recharge rates pose a serious challenge to study solute transport related to infiltration and recharge processes, as this extends past the conventional depths of soil scientific investigations and is difficult to describe using evidence from the groundwater due to the limitations imposed by available tracers. To determine the link between nitrate in the vadose zone and in the uppermost groundwater, sediment from the vadose zone was sampled up to a depth of 15-20 m (in one case also to 65 m) on several sites with natural vegetation in the research area. Among other parameters, sediment and water were analysed to determine chloride and nitrate concentration depth profiles. Using the chloride mass balance method, an estimation of groundwater infiltration rates produced values of 0.2-4 mm a(-1). The uncertainty of these values is, however, high. Because of the extreme thickness of the vadose zone, the travel time in the unsaturated zone might reach extreme values of up to 500 years and more. For investigations using groundwater, we applied the chlorofluorocarbons CFC-113, CFC-12, sulphur hexafluoride (SF(6)) and tritium to identify potential recharge, and found indications for some advective transport of the CFCs and SF(6), which we accounted for as constituting potential active localised recharge. In our contribution, we show the potential and limitations of the applied methods to determine groundwater recharge and coupled solute transport in semi-arid settings, and compare travel time ranges derived from soil science and groundwater investigations.

  8. Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Lawn Stephen D

    2008-07-01

    Full Text Available Abstract Background Viral load monitoring is not available for the vast majority of patients receiving antiretroviral therapy in resource-limited settings. However, the practical utility of CD4 cell count measurements as an alternative monitoring strategy has not been rigorously assessed. Methods In this study, we used a novel modelling approach that accounted for all CD4 cell count and VL values measured during follow-up from the first date that VL suppression was achieved. We determined the associations between CD4 counts (absolute values and changes during ART, VL measurements and risk of virological failure (VL > 1,000 copies/ml following initial VL suppression in 330 patients in South Africa. CD4 count changes were modelled both as the difference from baseline (ΔCD4 count and the difference between consecutive values (CD4 count slope using all 3-monthly CD4 count measurements during follow-up. Results During 7093.2 patient-months of observation 3756 paired CD4 count and VL measurements were made. In patients who developed virological failure (n = 179, VL correlated significantly with absolute CD4 counts (r = - 0.08, P = 0.003, ΔCD4 counts (r = - 0.11, P P P = 0.99, P = 0.92 and P = 0.75, respectively. Moreover, in a receiver operating characteristic (ROC curve, the association between a negative CD4 count slope and virological failure was poor (area under the curve = 0.59; sensitivity = 53.0%; specificity = 63.6%; positive predictive value = 10.9%. Conclusion CD4 count changes correlated significantly with VL at group level but had very limited utility in identifying virological failure in individual patients. CD4 count is an inadequate alternative to VL measurement for early detection of virological failure.

  9. Evaluation of a manual DNA extraction protocol and an isothermal amplification assay for detecting HIV-1 DNA from dried blood spots for use in resource-limited settings.

    Science.gov (United States)

    Jordan, Jeanne A; Ibe, Christine O; Moore, Miranda S; Host, Christel; Simon, Gary L

    2012-05-01

    In resource-limited settings (RLS) dried blood spots (DBS) are collected on infants and transported through provincial laboratories to a central facility where HIV-1 DNA PCR testing is performed using specialized equipment. Implementing a simpler approach not requiring such equipment or skilled personnel could allow the more numerous provincial laboratories to offer testing, improving turn-around-time to identify and treat infected infants sooner. Assess performances of a manual DNA extraction method and helicase-dependent amplification (HDA) assay for detecting HIV-1 DNA from DBS. 60 HIV-1 infected adults were enrolled, blood samples taken and DBS made. DBS extracts were assessed for DNA concentration and beta globin amplification using PCR and melt-curve analysis. These same extracts were then tested for HIV-1 DNA using HDA and compared to results generated by PCR and pyrosequencing. Finally, HDA limit of detection (LOD) studies were performed using DBS extracts prepared with known numbers of 8E5 cells. The manual extraction protocol consistently yielded high concentrations of amplifiable DNA from DBS. LOD assessment demonstrated HDA detected ∼470 copies/ml of HIV-1 DNA extracts in 4/4 replicates. No statistical difference was found using the McNemar's test when comparing HDA to PCR for detecting HIV-1 DNA from DBS. Using just a magnet, heat block and pipettes, the manual extraction protocol and HDA assay detected HIV-1 DNA from DBS at levels that would be useful for early infant diagnosis. Next steps will include assessing HDA for non-B HIV-1 subtypes recognition and comparison to Roche HIV-1 DNA v1.5 PCR assay. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Verification of Snapshotable Trees using Access Permissions and Typestate

    DEFF Research Database (Denmark)

    Mehnert, Hannes; Aldrich, Jonathan

    2012-01-01

    We use access permissions and typestate to specify and ver- ify a Java library that implements snapshotable search trees, as well as some client code. We formalize our approach in the Plural tool, a sound modular typestate checking tool. We describe the challenges to verify- ing snapshotable tree...

  11. 50 CFR 216.252 - Permissible methods of taking.

    Science.gov (United States)

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS REGULATIONS GOVERNING THE TAKING AND IMPORTING OF MARINE MAMMALS Taking Marine Mammals Incidental to Conducting Precision Strike Weapon Missions in the Gulf of Mexico § 216.252 Permissible methods of taking. (a) Under Letters of Authorization issued pursuant to...

  12. 50 CFR 216.213 - Permissible methods of taking.

    Science.gov (United States)

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS REGULATIONS GOVERNING THE TAKING AND IMPORTING OF MARINE MAMMALS Taking of Marine Mammals Incidental to Explosive Severance Activities Conducted During Offshore Structure Removal Operations on the Outer Continental Shelf in the U.S. Gulf of Mexico § 216.213 Permissible...

  13. Substantiation of the permissible radioactive contamination of working clothes

    International Nuclear Information System (INIS)

    Shcherbakov, V.L.; Korostin, A.S.

    1977-01-01

    A permissible level of working clothes contamination was determined on the base of the main migration routes of radioactive contaminants: permeation directly through the clothes into subclothes space on skin surface, emission into the air with amount of contaminants subsequently got by the organism of a working person through inhalation as well as transfer in the process of contacting of contaminated working clothes and surfaces of premises equipment, working person hands with amount of contaminants posteriorly got by the organism by alimentary or inhalation ways. Using the experimental and literature data available the permissible levels of working clothes contamination for the mentioned migration routes of radioactive materials have been calculated. According to the data obtained the permissible levels of working clothes contamination must not exceed 4 alpha-part/(cm 2 xmin) for contamination with high-tonic isotopes, 20 alpha-part./(cm 2 xmin) with other alpha-detine isotopes, 1000 beta-part./(cm 2 xmin) with beta-active ones. The permissible level of contamination of additional materials of the individual protection in the case of their contamination with high-tonic alpha-actine isotopes must not exceed 50 alpha-part./(cm 2 xmin), 200 alpha-part./(cm 2 xmin) for contamination th other alpha-active isotopes and 400 beta-part./(cm 2 xmin) with beta-active isotopes

  14. 26 CFR 1.422-5 - Permissible provisions.

    Science.gov (United States)

    2010-04-01

    ... of the incentive stock option are subject to a substantial risk of forfeiture and not transferable...) INCOME TAXES Certain Stock Options § 1.422-5 Permissible provisions. (a) General rule. An option that otherwise qualifies as an incentive stock option does not fail to be an incentive stock option merely...

  15. Melt-and-mold fabrication (MnM-Fab) of reconfigurable low-cost devices for use in resource-limited settings.

    Science.gov (United States)

    Li, Zhi; Tevis, Ian D; Oyola-Reynoso, Stephanie; Newcomb, Lucas B; Halbertsma-Black, Julian; Bloch, Jean-Francis; Thuo, Martin

    2015-12-01

    Interest in low-cost analytical devices (especially for diagnostics) has recently increased; however, concomitant translation to the field has been slow, in part due to personnel and supply-chain challenges in resource-limited settings. Overcoming some of these challenges require the development of a method that takes advantage of locally available resources and/or skills. We report a Melt-and-mold fabrication (MnM Fab) approach to low-cost and simple devices that has the potential to be adapted locally since it requires a single material that is recyclable and simple skills to access multiple devices. We demonstrated this potential by fabricating entry level bio-analytical devices using an affordable low-melting metal alloy, Field's metal, with molds produced from known materials such as plastic (acrylonitrile-butadiene-styrene (ABS)), glass, and paper. We fabricated optical gratings then 4×4 well plates using the same recycled piece of metal. We then reconfigured the well plates into rapid prototype microfluidic devices with which we demonstrated laminar flow, droplet generation, and bubble formation from T-shaped channels. We conclude that this MnM-Fab method is capable of addressing some challenges typically encountered with device translation, such as technical know-how or material supply, and that it can be applied to other devices, as needed in the field, using a single moldable material. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Get the Basics Right: A Description of the Key Priorities for Establishing a Neonatal Service in a Resource-Limited Setting in Cambodia.

    Science.gov (United States)

    Fox-Lewis, Shivani; Genasci Smith, Wyatt; Lor, Vary; McKellar, Gregor; Phal, Chea; Fox-Lewis, Andrew; Turner, Paul; Neou, Leakhena; Turner, Claudia

    2018-05-28

    Worldwide, reduction in under-five mortality has not sufficiently included neonates, who represent 45% of deaths in children of age under five years. The least progress has been observed in resource-limited settings. This mixed methods study conducted at a Cambodian non-governmental paediatric hospital described the key priorities of the ongoing neonatal service. Routinely collected data from the hospital and microbiology databases included the number of admissions, discharges and deaths and the number of cases of bacteraemias (2011-2016). Semi-structured interviews with the management staff explored the essential features of the service. There were 2127 neonatal admissions and 247 deaths. The incidence of facility-based neonatal mortality decreased by 81%. Bacteraemic healthcare-associated infections decreased by 68%. A dedicated area for neonatal care was perceived as crucial, allowing better infection control and delivery of staff training. In this hospital, the neonatal service prioritized basic measures, particularly, having a dedicated neonatal area. Facility-based mortality and bacteraemic healthcare-associated infections decreased.

  17. Impact of a psychoeducative intervention on adherence to HAART among low-literacy patients in a resource-limited setting: the case of an Arab country--Morocco.

    Science.gov (United States)

    Khachani, Imane; Harmouche, Hicham; Ammouri, Wafa; Rhoufrani, Fatima; Zerouali, Latifa; Abouqal, Redouane; Tazi-Mezalek, Zoubida; Adnaoui, Mohamed; Aouni, Mohamed; Maouni, Abdelaziz

    2012-01-01

    Research has demonstrated that strict adherence is necessary to maximize highly active antiretroviral therapy (HAART) benefits. This is particularly challenging for low-literacy populations in resource-limited settings like Morocco and motivated the implementation of a psychoeducative program for patients under HAART at Rabat University Hospital. The study aimed at assessing the program's impact on adherence to antiretroviral medication, knowledge of HIV/AIDS and HAART, quality of life, and biological parameters. It included patients under treatment for at least 2 months that benefited from 3 to 5 educational and psychological support sessions. Data were collected at baseline, 3 and 6 months. In all, 50 patients were included. The mean age was 38 years; 52% were illiterate and 62% unemployed. Adherence scores were high at baseline (98%) and showed no significant change throughout the study. Knowledge of HAART and HIV/AIDS, and quality of life improved significantly both at months 3 and 6. Significant increase for CD4 count rates and decrease for viral load rates were also reported. The program had no significant impact on adherence but substantively developed patients' knowledge of HIV/AIDS and HAART and improved their quality of life.

  18. Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru: a prospective evaluation

    Directory of Open Access Journals (Sweden)

    Quispe Jose A

    2009-03-01

    Full Text Available Abstract Background A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. However, current surveillance systems may not be prepared to accomplish this goal, especially in resource limited settings. As data quality and timeliness are attributes that improve outbreak detection capacity, we assessed the effect of two interventions on such attributes in Alerta, an electronic disease surveillance system in the Peruvian Navy. Methods 40 Alerta reporting units (18 clinics and 22 ships were included in a 12-week prospective evaluation project. After a short refresher course on the notification process, units were randomly assigned to either a phone, visit or control group. Phone group sites were called three hours before the biweekly reporting deadline if they had not sent their report. Visit group sites received supervision visits on weeks 4 & 8, but no phone calls. The control group sites were not contacted by phone or visited. Timeliness and data quality were assessed by calculating the percentage of reports sent on time and percentage of errors per total number of reports, respectively. Results Timeliness improved in the phone group from 64.6% to 84% in clinics (+19.4 [95% CI, +10.3 to +28.6]; p Conclusion Regular phone reminders significantly improved timeliness of reports in clinics and ships, whereas supervision visits led to improved data quality only among clinics. Further investigations are needed to establish the cost-effectiveness and optimal use of each of these strategies.

  19. Exploring the condom gap: is supply or demand the limiting factor - condom access and use in an urban and a rural setting in Kilifi district, Kenya.

    Science.gov (United States)

    Papo, Jacqueline K; Bauni, Evasius K; Sanders, Eduard J; Brocklehurst, Peter; Jaffe, Harold W

    2011-01-14

    to explore the extent of the condom gap, investigating the relative roles of supply-side and demand-side factors in determining condom use. GPS mapping of condom outlets, and population-based survey. an urban and a rural site were selected within the Epidemiological and Demographic Surveillance Site in Kilifi district, Kenya. Potential condom outlets (n = 281) were mapped and surveyed, and questionnaires on condom access and use (n = 630) were administered to a random sample of men and women aged 15-49. Multivariate logistic regression was performed to assess the relative roles of supply-side and demand-side barriers on condom use. the median straight-line distance to free condoms was 18-fold higher in the rural versus urban site. Among sexually active respondents, 42% had ever used a condom, and 23% had used a condom over the past 12 months, with lower levels among rural versus urban respondents (P supply-side or demand-side barriers, compared with individuals experiencing both types of barriers. Despite low levels of usage and the presence of supply-side and demand-side barriers, reported unmet need for condoms was low. there is an urgent need for renewed condom promotion efforts aimed at building demand, in addition to improving physical access, in resource-limited settings with generalized HIV epidemics in sub-Saharan Africa. 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  20. Utility of the heteroduplex assay (HDA) as a simple and cost-effective tool for the identification of HIV type 1 dual infections in resource-limited settings.

    Science.gov (United States)

    Powell, Rebecca L R; Urbanski, Mateusz M; Burda, Sherri; Nanfack, Aubin; Kinge, Thompson; Nyambi, Phillipe N

    2008-01-01

    The predominance of unique recombinant forms (URFs) of HIV-1 in Cameroon suggests that dual infection, the concomitant or sequential infection with genetically distinct HIV-1 strains, occurs frequently in this region; yet, identifying dual infection among large HIV cohorts in local, resource-limited settings is uncommon, since this generally relies on labor-intensive and costly sequencing methods. Consequently, there is a need to develop an effective, cost-efficient method appropriate to the developing world to identify these infections. In the present study, the heteroduplex assay (HDA) was used to verify dual or single infection status, as shown by traditional sequence analysis, for 15 longitudinally sampled study subjects from Cameroon. Heteroduplex formation, indicative of a dual infection, was identified for all five study subjects shown by sequence analysis to be dually infected. Conversely, heteroduplex formation was not detectable for all 10 HDA reactions of the singly infected study subjects. These results suggest that the HDA is a simple yet powerful and inexpensive tool for the detection of both intersubtype and intrasubtype dual infections, and that the HDA harbors significant potential for reliable, high-throughput screening for dual infection. As these infections and the recombinants they generate facilitate leaps in HIV-1 evolution, and may present major challenges for treatment and vaccine design, this assay will be critical for monitoring the continuing pandemic in regions of the world where HIV-1 viral diversity is broad.

  1. Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

    Science.gov (United States)

    Abdelaziz, Adel; Hany, Mohamed; Atwa, Hani; Talaat, Wagdy; Hosny, Somaya

    2016-01-01

    In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

  2. Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource-limited setting.

    Science.gov (United States)

    Eleje, George U; Adinma, Joseph I; Ghasi, Samuel; Ikechebelu, Joseph I; Igwegbe, Anthony O; Okonkwo, John E; Okafor, Charles I; Ezeama, Chukwuemeka O; Ezebialu, Ifeanyichukwu U; Ogbuagu, Chukwuanugo N

    2014-10-01

    To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource-limited settings. A prospective cross-sectional study was undertaken involving women with (n=105) and without (n=105) a confirmed diagnosis of PPROM admitted to Nnamdi Azikiwe University Teaching Hospital, southeast Nigeria, between January 1, 2011, and April 30, 2013. Endocervical swabs were collected from all participants and examined microbiologically. Antibiotic sensitivity testing was performed using Kirby-Bauer disk diffusion. Streptococcus spp., Staphylococcus aureus, and Escherichia coli were significantly more prevalent among women with PPROM than among those without PPROM (P<0.01). Among the antibiotics considered safe to use during pregnancy, the bacteria were most sensitive to ampicillin-sulbactam, cefixime, cefuroxime, and erythromycin. For the first 48hours, women with PPROM should receive an intravenous dose combining ampicillin-sulbactam, cefixime, cefuroxime, or erythromycin with metronidazole followed by oral administration of the chosen antibiotic combination to complete a 7-day course. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Chalya Phillipo L

    2012-03-01

    Full Text Available Abstract Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1. Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8% perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2% patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5% patients. The majority of patients (84.6% had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (P Conclusion

  4. Intra-facility linkage of HIV-positive mothers and HIV-exposed babies into HIV chronic care: rural and urban experience in a resource limited setting.

    Directory of Open Access Journals (Sweden)

    Christine Mugasha

    Full Text Available INTRODUCTION: Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID to inform strategic scale up of PMTCT programs. METHODS: A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI. HIV-infected pregnant mothers, identified through routine antenatal care (ANC and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. RESULTS: Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26% in rural and 743/1,025 (74% in urban facilities. Of these 375/1,025 (37% were linked to HIV clinics [67/267(25% rural and 308/758(41% urban]. Of 636 HIV-exposed babies, 193 (30% were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636; 8/179 (4.5%] in rural and 93/457(20.3% in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1, p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. CONCLUSION: Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to

  5. Scope and Limits of an anamnestic questionnaire in a control-induced low-endemicity helminthiasis setting in south-central Côte d'Ivoire.

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    Thomas Fürst

    Full Text Available BACKGROUND: Schistosomiasis and soil-transmitted helminthiasis are two high-burden neglected tropical diseases. In highly endemic areas, control efforts emphasize preventive chemotherapy. However, as morbidity, infection, and transmission begin to decrease, more targeted treatment is likely to become more cost-effective, provided that comparatively cheap diagnostic methods with reasonable accuracy are available. METHODOLOGY: Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d'Ivoire. Questions pertaining to risk factors and signs and symptoms for schistosomiasis and soil-transmitted helminthiasis were included. The individuals' helminth infection status and their belonging to three different anthelmintic treatment groups were compared with the questionnaire results (i to inform the local health authorities about the epidemiological and clinical footprint of locally prevailing helminthiases, and (ii to explore the scope and limits of an anamnestic questionnaire as monitoring tool, which eventually could help guiding the control of neglected tropical diseases in control-induced low-endemicity settings. PRINCIPAL FINDINGS: Our study sample consisted of 195 adults (101 males, 94 females. We found prevalences of hookworm, Trichuris trichiura, Schistosoma haematobium, and Schistosoma mansoni of 39.0%, 2.7%, 2.1%, and 2.1%, respectively. No Ascaris lumbricoides infection was found. Helminth infection intensities were generally very low. Seven, 74 and 79 participants belonged to three different treatment groups. Multivariable logistic regression models revealed statistically significant (p<0.05 associations between some risk factors, signs, and symptoms, and the different helminth infections and treatment groups. However, the risk factors, signs, and symptoms showed weak diagnostic properties. CONCLUSIONS

  6. Scope and Limits of an Anamnestic Questionnaire in a Control-Induced Low-Endemicity Helminthiasis Setting in South-Central Côte d’Ivoire

    Science.gov (United States)

    Fürst, Thomas; Ouattara, Mamadou; Silué, Kigbafori D.; N’Goran, Dje N.; Adiossan, Lukas G.; Bogoch, Isaac I.; N’Guessan, Yao; Koné, Siaka; Utzinger, Jürg; N’Goran, Eliézer K.

    2013-01-01

    Background Schistosomiasis and soil-transmitted helminthiasis are two high-burden neglected tropical diseases. In highly endemic areas, control efforts emphasize preventive chemotherapy. However, as morbidity, infection, and transmission begin to decrease, more targeted treatment is likely to become more cost-effective, provided that comparatively cheap diagnostic methods with reasonable accuracy are available. Methodology Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d’Ivoire. Questions pertaining to risk factors and signs and symptoms for schistosomiasis and soil-transmitted helminthiasis were included. The individuals’ helminth infection status and their belonging to three different anthelmintic treatment groups were compared with the questionnaire results (i) to inform the local health authorities about the epidemiological and clinical footprint of locally prevailing helminthiases, and (ii) to explore the scope and limits of an anamnestic questionnaire as monitoring tool, which eventually could help guiding the control of neglected tropical diseases in control-induced low-endemicity settings. Principal Findings Our study sample consisted of 195 adults (101 males, 94 females). We found prevalences of hookworm, Trichuris trichiura, Schistosoma haematobium, and Schistosoma mansoni of 39.0%, 2.7%, 2.1%, and 2.1%, respectively. No Ascaris lumbricoides infection was found. Helminth infection intensities were generally very low. Seven, 74 and 79 participants belonged to three different treatment groups. Multivariable logistic regression models revealed statistically significant (p<0.05) associations between some risk factors, signs, and symptoms, and the different helminth infections and treatment groups. However, the risk factors, signs, and symptoms showed weak diagnostic properties. Conclusions/Significance The generally

  7. Global health leadership training in resource-limited settings: a collaborative approach by academic institutions and local health care programs in Uganda.

    Science.gov (United States)

    Nakanjako, Damalie; Namagala, Elizabeth; Semeere, Aggrey; Kigozi, Joanitor; Sempa, Joseph; Ddamulira, John Bosco; Katamba, Achilles; Biraro, Sam; Naikoba, Sarah; Mashalla, Yohana; Farquhar, Carey; Sewankambo, Nelson

    2015-11-18

    Due to a limited health workforce, many health care providers in Africa must take on health leadership roles with minimal formal training in leadership. Hence, the need to equip health care providers with practical skills required to lead high-impact health care programs. In Uganda, the Afya Bora Global Health Leadership Fellowship is implemented through the Makerere University College of Health Sciences (MakCHS) and her partner institutions. Lessons learned from the program, presented in this paper, may guide development of in-service training opportunities to enhance leadership skills of health workers in resource-limited settings. The Afya Bora Consortium, a consortium of four African and four U.S. academic institutions, offers 1-year global health leadership-training opportunities for nurses and doctors. Applications are received and vetted internationally by members of the consortium institutions in Botswana, Kenya, Tanzania, Uganda, and the USA. Fellows have 3 months of didactic modules and 9 months of mentored field attachment with 80% time dedicated to fellowship activities. Fellows' projects and experiences, documented during weekly mentor-fellow meetings and monthly mentoring team meetings, were compiled and analyzed manually using pre-determined themes to assess the effect of the program on fellows' daily leadership opportunities. Between January 2011 and January 2015, 15 Ugandan fellows (nine doctors and six nurses) participated in the program. Each fellow received 8 weeks of didactic modules held at one of the African partner institutions and three online modules to enhance fellows' foundation in leadership, communication, monitoring and evaluation, health informatics, research methodology, grant writing, implementation science, and responsible conduct of research. In addition, fellows embarked on innovative projects that covered a wide spectrum of global health challenges including critical analysis of policy formulation and review processes

  8. Multiple-level stakeholder engagement in malaria clinical trials: addressing the challenges of conducting clinical research in resource-limited settings.

    Science.gov (United States)

    Mtove, George; Kimani, Joshua; Kisinza, William; Makenga, Geofrey; Mangesho, Peter; Duparc, Stephan; Nakalembe, Miriam; Phiri, Kamija S; Orrico, Russell; Rojo, Ricardo; Vandenbroucke, Pol

    2018-03-22

    Multinational clinical trials are logistically complex and require close coordination between various stakeholders. They must comply with global clinical standards and are accountable to multiple regulatory and ethical bodies. In resource-limited settings, it is challenging to understand how to apply global clinical standards to international, national, and local factors in clinical trials, making multiple-level stakeholder engagement an important element in the successful conduct of these clinical trials. During the planning and implementation of a large multinational clinical trial for intermittent preventive treatment of malaria in pregnancy in resource-limited areas of sub-Saharan Africa, we encountered numerous challenges, which required implementation of a range of engagement measures to ensure compliance with global clinical and regulatory standards. These challenges included coordination with ongoing global malaria efforts, heterogeneity in national regulatory structures, sub-optimal healthcare infrastructure, local practices and beliefs, and perspectives that view healthcare providers with undue trust or suspicion. In addition to engagement with international bodies, such as the World Health Organization, the Malaria in Pregnancy Consortium, the Steve Biko Centre for Bioethics, and the London School of Hygiene and Tropical Medicine, in order to address the challenges just described, Pfizer Inc. and Medicines for Malaria Venture (the "Sponsoring Entities" for these studies) and investigators liaised with national- and district-level stakeholders such as health ministers and regional/local community health workers. Community engagement measures undertaken by investigators included local meetings with community leaders to explain the research aims and answer questions and concerns voiced by the community. The investigators also engaged with family members of prospective trial participants in order to be sensitive to local practices and beliefs. Engagement

  9. PROBABILISTIC APPROACH FOR THE DETERMINATION OF CUTS PERMISSIBLE BRAKING MODES ON THE GRAVITY HUMPS

    Directory of Open Access Journals (Sweden)

    Volodymyr BOBROVSKYI

    2016-03-01

    Full Text Available The paper presents the research results of cuts braking modes on the gravity humps. The objective of this paper is developing the methods for assessment of braking modes of cuts under conditions of fuzziness of their rolling properties, as well as selecting the permissible starting speed range of cuts from retardant positions. As a criterion for assessing the modes of target control of cut rolling speed, it was proposed to use an average gap size on a classification track at the established norms of probable exceeding of permissible speed of cars collision and their stop in retarders. As a criterion for evaluating the modes of interval control of cuts rolling speed, using the risk of their non-separation on the switches was proposed. Using the simulation modeling and mathematical statistics, the configuration of the range of permissible speed of cuts coming out from retardant positions has been set. The conducted researches allow simplifying the choice of cut braking modes in systems of automatic control of cut rolling speed.

  10. Change in Vitamin D Levels Occurs Early after Antiretroviral Therapy Initiation and Depends on Treatment Regimen in Resource-Limited Settings

    Science.gov (United States)

    Havers, Fiona P.; Detrick, Barbara; Cardoso, Sandra W.; Berendes, Sima; Lama, Javier R.; Sugandhavesa, Patcharaphan; Mwelase, Noluthando H.; Campbell, Thomas B.; Gupta, Amita

    2014-01-01

    Study Background Vitamin D has wide-ranging effects on the immune system, and studies suggest that low serum vitamin D levels are associated with worse clinical outcomes in HIV. Recent studies have identified an interaction between antiretrovirals used to treat HIV and reduced serum vitamin D levels, but these studies have been done in North American and European populations. Methods Using a prospective cohort study design nested in a multinational clinical trial, we examined the effect of three combination antiretroviral (cART) regimens on serum vitamin D levels in 270 cART-naïve, HIV-infected adults in nine diverse countries, (Brazil, Haiti, Peru, Thailand, India, Malawi, South Africa, Zimbabwe and the United States). We evaluated the change between baseline serum vitamin D levels and vitamin D levels 24 and 48 weeks after cART initiation. Results Serum vitamin D levels decreased significantly from baseline to 24 weeks among those randomized to efavirenz/lamivudine/zidovudine (mean change: −7.94 [95% Confidence Interval (CI) −10.42, −5.54] ng/ml) and efavirenz/emtricitabine/tenofovir-DF (mean change: −6.66 [95% CI −9.40, −3.92] ng/ml) when compared to those randomized to atazanavir/emtricitabine/didanosine-EC (mean change: −2.29 [95% CI –4.83, 0.25] ng/ml). Vitamin D levels did not change significantly between week 24 and 48. Other factors that significantly affected serum vitamin D change included country (p<0.001), season (p<0.001) and baseline vitamin D level (p<0.001). Conclusion Efavirenz-containing cART regimens adversely affected vitamin D levels in patients from economically, geographically and racially diverse resource-limited settings. This effect was most pronounced early after cART initiation. Research is needed to define the role of Vitamin D supplementation in HIV care. PMID:24752177

  11. A Systematic Review of Non-Traumatic Spinal Cord Injuries in Sub-Saharan Africa and a Proposed Diagnostic Algorithm for Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Abdu Kisekka Musubire

    2017-12-01

    Full Text Available BackgroundNon-traumatic myelopathy is common in Africa and there are geographic differences in etiology. Clinical management is challenging due to the broad differential diagnosis and the lack of diagnostics. The objective of this systematic review is to determine the most common etiologies of non-traumatic myelopathy in sub-Saharan Africa to inform a regionally appropriate diagnostic algorithm.MethodsWe conducted a systemic review searching Medline and Embase databases using the following search terms: “Non traumatic spinal cord injury” or “myelopathy” with limitations to epidemiology or etiologies and Sub-Saharan Africa. We described the frequencies of the different etiologies and proposed a diagnostic algorithm based on the most common diagnoses.ResultsWe identified 19 studies all performed at tertiary institutions; 15 were retrospective and 13 were published in the era of the HIV epidemic. Compressive bone lesions accounted for more than 48% of the cases; a majority were Pott’s disease and metastatic disease. No diagnosis was identified in up to 30% of cases in most studies; in particular, definitive diagnoses of non-compressive lesions were rare and a majority were clinical diagnoses of transverse myelitis and HIV myelopathy. Age and HIV were major determinants of etiology.ConclusionCompressive myelopathies represent a majority of non-traumatic myelopathies in sub-Saharan Africa, and most were due to Pott’s disease. Non-compressive myelopathies have not been well defined and need further research in Africa. We recommend a standardized approach to management of non-traumatic myelopathy focused on identifying treatable conditions with tests widely available in low-resource settings.

  12. Prevalence of low bone mineral density among HIV patients on long-term suppressive antiretroviral therapy in resource limited setting of western India.

    Science.gov (United States)

    Dravid, Ameet; Kulkarni, Milind; Borkar, Amit; Dhande, Sachin

    2014-01-01

    Bone mineral density (BMD) assessment in HIV patients is sparsely done in resource limited settings. We conducted a cross-sectional study of BMD amongst HIV patients following up in our clinic from 1 June to 1 December 2013 by performing dual-energy X-ray absorptiometry scan (Lunar Prodigy Advanced DXA System, GE Healthcare) of lumbar spine and hip. Patients on long term (≥12 months), virologically suppressive antiretroviral therapy (ART) were included. Patients who were ART naïve were included as control population. Virologic failures were excluded. Low BMD was defined by WHO T-score criteria (normal: T score ≥-1;osteopenia: T score between -1 and -2.5 SD; osteoporosis: T score ≤-2.5 SD). Baseline risk factors associated with low BMD like age, low BMI, lipoatrophy, diabetes mellitus, current smoking, current alcohol intake, steroid exposure and menopause were recorded. ART-related factors associated with low BMD like ART duration, exposure to tenofovir and exposure to protease inhibitors (PI) were studied. A total of 536 patients (66% males, 496 ART experienced and 40 ART naïve) were included in this analysis. Median age was 42 years, mean BMI 23.35 kg/m(2) and median CD4 count 146 cells/mm(3). All ART experienced patients had plasma viral loadpatients in our cohort is a matter of deep concern due to its association with pathological fractures. Bone mineral loss was seen irrespective of ART used. Association of low BMD with low baseline CD4 count strengthens the case for early ART.

  13. Larval diet affects mosquito development and permissiveness to Plasmodium infection

    OpenAIRE

    Gendrin, MEM; Christophides; Linenberg, Inbar

    2016-01-01

    The larval stages of malaria vector mosquitoes develop in water pools, feeding mostly on microorganisms and environmental detritus. Richness in the nutrient supply to larvae influences the development and metabolism of larvae and adults. Here, we investigated the effects of larval diet on the development, microbiota content and permissiveness to Plasmodium of Anopheles coluzzii . We tested three fish diets often used to rear mosquitoes in the laboratory, including two pelleted diets, Dr. Clar...

  14. Account of low temperature hardening in calculation of permissible stresses

    International Nuclear Information System (INIS)

    Novikov, N.V.; Ul'yanenko, A.P.; Gorodyskij, N.I.

    1980-01-01

    Suggested is a calculation scheme of permissible stresses with the account of temperature hardening for steels and alloys, the dependences of strength, plasticity and rupture work of which on cooling temperature do not have threshold changes in a wide range of low temperatures (from 300 to 4.2 K). Application of the suggested scheme is considered on the example of 12Kh18N10T austenitic chromium-nickel steel

  15. Permissiveness toward tobacco sponsorship undermines tobacco control support in Africa.

    Science.gov (United States)

    Ayo-Yusuf, Olalekan A; Olutola, Bukola G; Agaku, Israel T

    2016-06-01

    School personnel, who are respected members of the community, may exert significant influence on policy adoption. This study assessed the impact of school personnel's permissiveness toward tobacco industry sponsorship activities on their support for complete bans on tobacco advertisements, comprehensive smoke-free laws and increased tobacco prices. Representative data were obtained from the Global School Personnel Survey for 29 African countries (n = 17 929). Adjusted prevalence ratios (aPR) were calculated using multi-variable Poisson regression models to assess the impact of permissiveness toward tobacco sponsorship activities on support for tobacco control policies (p industry should be allowed to sponsor school events were significantly less likely to support complete bans on tobacco advertisements [aPR = 0.89; 95% confidence interval (CI) 0.84-0.95] and comprehensive smoke-free laws (aPR = 0.95; 95% CI 0.92-0.98). In contrast, support for complete tobacco advertisement bans was more likely among those who believed that the tobacco industry encourages youths to smoke (aPR = 1.27; 95% CI 1.17-1.37), and among those who taught about health sometimes (aPR = 1.06; 95% CI 1.01-1.11) or a lot (aPR = 1.05; 95% CI 1.01-1.10) compared with those who did not teach about health at all. These findings underscore the need to educate school personnel on tobacco industry's strategies to undermine tobacco control policies. This may help to build school personnel support for laws intended to reduce youth susceptibility, experimentation and established use of tobacco products. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Legitimate Permissions And Specifity Of Their Enforceability In Modern Russia

    Directory of Open Access Journals (Sweden)

    Vitaly Subochev

    2014-01-01

    Full Text Available Northern Caucasus Institute of Advanced Training (branch of Krasnodar University of Ministry of Internal Affairs of Russia, 123, Malbahova Street, Nalshik, 360016, Russia. Abstract: The article investigates the basic legal permissions in Russian law - legal rights, freedoms and legitimate interests. Potential of these means of legal regulation is examined as well as their common features and essential differences. Authors argue that the effectiveness of the mechanism of legal regulation largely depends on the proper use of legal permissions. Particular attention is paid to such kind of legal mean as a legitimate interest. The article draws attention to the fact that if a legal right or freedom are such kind of permissions which are guaranteed by the law in order to sustain certain demands of subjects of law, the legitimate interest is qualitatively different mean of regulation. The authors suggest considering a legitimate interest as reflected in the objective law legal possibility of subjects of law to enjoy certain social benefits and to seek protection from the state authorities in order to meet their interests which are not contradictory to provisions of law. Qualitative difference between legitimate interest and legal right and freedom is that the legitimate interest is an opportunity, guaranteed to a lesser extent than the permitted behavior within a legal right or freedom. Legitimate interest is a mere permission, admitted by the state and to some extent supported by it. But legal right and freedom - are those means of regulation, which are directly approved and sanctioned by the state which presuppose duty of a person to a particular behavior. The author's vision of the specifity of legal enforcement of legitimate admissions is presented.

  17. LEGITIMATE PERMISSIONS AND SPECIFITY OF THEIR ENFORCEABILITY IN MODERN RUSSIA

    Directory of Open Access Journals (Sweden)

    Vitaly Subochev

    2014-01-01

    Full Text Available Northern Caucasus Institute of Advanced Training (branch of Krasnodar University of Ministry of Internal Affairs of Russia, 123, Malbahova Street, Nalshik, 360016, Russia. Abstract: The article investigates the basic legal permissions in Russian law - legal rights, freedoms and legitimate interests. Potential of these means of legal regulation is examined as well as their common features and essential differences. Authors argue that the effectiveness of the mechanism of legal regulation largely depends on the proper use of legal permissions. Particular attention is paid to such kind of legal mean as a legitimate interest. The article draws attention to the fact that if a legal right or freedom are such kind of permissions which are guaranteed by the law in order to sustain certain demands of subjects of law, the legitimate interest is qualitatively different mean of regulation. The authors suggest considering a legitimate interest as reflected in the objective law legal possibility of subjects of law to enjoy certain social benefits and to seek protection from the state authorities in order to meet their interests which are not contradictory to provisions of law. Qualitative difference between legitimate interest and legal right and freedom is that the legitimate interest is an opportunity, guaranteed to a lesser extent than the permitted behavior within a legal right or freedom. Legitimate interest is a mere permission, admitted by the state and to some extent supported by it. But legal right and freedom - are those means of regulation, which are directly approved and sanctioned by the state which presuppose duty of a person to a particular behavior. The author's vision of the specifity of legal enforcement of legitimate admissions is presented.

  18. Parental permissiveness, control, and affect and drug use among adolescents.

    Science.gov (United States)

    Becoña, Elisardo; Martínez, Úrsula; Calafat, Amador; Fernández-Hermida, José Ramón; Juan, Montse; Sumnall, Harry; Mendes, Fernando; Gabrhelík, Roman

    2013-01-01

    Parents play an important role in determining the risk of children's drug use. The aim of this study was to analyse how certain family-related variables (permissiveness toward drug use, and parental control and affect) were linked to the use of alcohol, tobacco and cannabis, based on young people's self-report of such variables. The sample was composed of 1,428 school children (51.8% males) aged between 11 and 19 from Mallorca (Spain). We found that the young people who perceived their parents as permissive and those who perceived less maternal control and higher levels of both paternal and maternal affect were more likely to use alcohol, tobacco and cannabis. Sex differences were found within this pattern. Variables of maternal affect and control were not influential among males, whereas the general pattern was maintained among females. This study highlights the importance of perceived permissiveness and the need of considering parent's and children's gender when providing control and affect, as fathers will influence male children whereas mothers will influence female children.

  19. Influence of Permissive Parenting on Youth Farm Risk Behaviors.

    Science.gov (United States)

    Jinnah, Hamida A; Stoneman, Zolinda

    2016-01-01

    Farm youth continue to experience high rates of injuries and premature deaths as a result of agricultural activities. Increased parental permissiveness is positively associated with many different types of high-risk behaviors in youth. This study explored whether permissive parenting (fathering and mothering) predicts youth unsafe behaviors on the farm. Data were analyzed for 67 youth and their parents. Families were recruited from a statewide farm publication, through youth organizations (i.e., FFA [Future Farmers of America]), local newspapers, farmer referrals, and through the Cooperative Extension Network. Hierarchical multiple regression was completed. Results revealed that fathers and mothers who practiced lax-inconsistent disciplining were more likely to have youth who indulged in unsafe farm behaviors. Key hypotheses confirmed that permissive parenting (lax-inconsistent disciplining) by parents continued to predict youth unsafe farm behaviors, even after youth age, youth gender, youth personality factor of risk-taking, and father's unsafe behaviors (a measure associated with modeling) were all taken into account. A key implication is that parents may play an important role in influencing youth farm safety behaviors. Parents (especially fathers) need to devote time to discuss farm safety with their youth. Farm safety interventions need to involve parents as well as address and respect the culture and values of families. Interventions need to focus not only on safe farm practices, but also promote positive parenting practices, including increased parent-youth communication about safety, consistent disciplining strategies, and increased monitoring and modeling of safe farm behaviors by parents.

  20. [Behavior of Orf virus in permissive and nonpermissive systems].

    Science.gov (United States)

    Büttner, M; Czerny, C P; Schumm, M

    1995-04-01

    Dogs were immunized i.m. with attenuated poxvirus vaccines (vaccinia virus, Orf-virus) and a bovine herpesvirus-1 (BHV-1) vaccine. After intradermal (i.d.) application of the vaccine viruses a specific delayed type hypersensitivity (DTH) reaction of the skin occurred only with vaccinia virus. The i.d. application of Orf-virus caused a short-term, non-specific inflammatory reaction of the skin, even in dogs not immunized with Orf-virus. Out of 30 sera from Orf-virus immunized beagles (n = 4) only eight were found reactive to Orf-virus in a competition ELISA. Three sera from dogs not Orf-virus immunized but skin-tested with the virus contained low antibody titers. Using indirect immunofluorescence (IIF) in flow cytometry, the existence of Orf-virus antigens was examined on the surface and in the cytoplasm of permissive (BFK and Vero)- and questionable permissive MDCK cells. The canine kidney MDCK cell line was found to be non-permissive for Orf-virus replication; the occurrence of an Orf-(ecthyma contagiosum) like disease in dogs is unlikely.

  1. Permission of change of limits in the vapor generators of the Atucha I Nuclear Central

    International Nuclear Information System (INIS)

    Ventura, M.

    2006-01-01

    In the mark of the modification of the Atucha-I Nuclear Central Installation (CNA-I) as consequence of the Introduction of the System 'Second Drain of Heat' (SSC), the Entity Responsible for the CNA-I (NASA) requested authorization to the Nuclear Regulatory Authority (ARN) to modify the value of the minimum level of water in the secondary side in the Steam generators (GVs) to activate the signal 'shoot of the Cut of the Reactor' (RESA-LLV). As the level in the GVs is one of those parameters that are used to shoot the Emergency Feeding System (RX), component of the SSC System, also was analyzed the change in the activation of the shoot signal of the 'Second Drain of Heat' (2SSC-LLV). The ARN uses for the study of the nuclear safety of nuclear power plants, the series of prediction programs RELAP5/MOD3.X. It participates of the evaluation and maintenance activities of these codes through specific agreements with the U.S. Nuclear Regulatory Commission (US-NRC). It is necessary to account with programs of this type since the ARN it licenses the construction and operation of Nuclear Power Plants (NPPs) and other outstanding facilities and it inquires its operation according to its own standards. With these tools its are auditing the calculations that the Responsible Entities of the operation make to guarantee the operability of the NPPs assisting the mentioned standards. The analysis with computational codes is used as a tool to achieve the best understanding in the behavior of the plant in union with the engineering approach, the manual calculations, the data analysis and the experience in the operation of the machine. (Author)

  2. Correlation Between Occurrence and Deterioration of Respiratory Diseases and Air Pollution Within the Legally Permissible Limits.

    Science.gov (United States)

    Trnjar, Kristina; Pintarić, Sanja; Mornar Jelavić, Marko; Nesek, Višnja; Ostojić, Jelena; Pleština, Sanja; Šikić, Aljoša; Pintarić, Hrvoje

    2017-06-01

    The aim of the study was to investigate the unknown effect of air pollutants on the occurrence or deterioration of respiratory diseases in the area with a humid continental climate. This retrospective study included 5868 patients with respiratory symptomatology (upper respiratory tract infection (URTI), pneumonia, acute bronchitis, chronic obstructive pulmonary disease (COPD), and asthma) admitted to emergency department (ED). The number of patients, values of meteorological parameters (mean daily values of air temperature pressure and relative humidity) and concentrations of air pollution particles (≤10 μm (PM10), ozone (O3) and nitrogen dioxide (NO2)) were collected during a two-year ( July 2008 - June 2010) period. There were 1839 (31.3%), 1712 (29.2%), 1313 (22.4%), 614 (10.5%) and 390 (6.6%) patients with pneumonia, COPD, URTI, acute bronchitis and asthma, respectively. The mean daily concentrations of NO2 (25.9 (1.7-89.7) μg/m3), O3 (47.1 (4.7-135.4) μg/m3) and PM10 particles (25.7 (4.6-146.6) μg/m3) were below the legally defined thresholds. Among other results, the occurrence of respiratory diseases showed positive Spearman's correlation with the values of air humidity (days 0-3, r=0.15 to 0.19), PM10(days 0-3, r=0.10 to 0.13) and NO2 concentrations (day 0, r=0.11), and negative correlation with the values of air temperature (days 0-3, r=-0.36 to -0.34), pressure (day 0, r=-0.10) and O3 concentrations (days 0-3, r=-0.21 to -0.22) (prespiratory diseases showed correlation with weather conditions and air pollutants despite the legally permitted values in the region with a humid continental climate.

  3. Pulse shape analysis for the GERDA experiment to set a new limit on the half-life of 0νββ decay of {sup 76}Ge

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Victoria Elisabeth

    2017-01-25

    The GERDA experiment searches for neutrinoless double beta (0νββ) decay of {sup 76}Ge using high purity germanium (HPGe) detectors operated in liquid argon (LAr). The aim is to explore half-lives of the order of 10{sup 26} yr. Therefore, GERDA relies on improved active background reduction techniques such as pulse shape discrimination (PSD) in which the time structure of the germanium signals is analyzed to discriminate signal- from background-like events. Two types of HPGe detectors are operated: semi-coaxial detectors previously used in the Heidelberg-Moscow and IGEX experiments and new Broad Energy Germanium (BEGe) detectors which feature an improved energy resolution and enhanced PSD. In Phase I of the experiment, five enriched BEGe detectors were used for the first time in the search for 0νββ decay. A PSD based on a single parameter, the ratio of the maximum current amplitude over the energy A/E is applied. 83% of the background events in a 232 keV region around Q{sub ββ} are rejected with a high signal efficiency of (92.1 ± 1.9) %. The achieved background index (BI) is (5.4{sup +4.1}{sub -3.4}) . 10{sup -3} (counts)/(keV.kg.yr). This is an improvement by a factor of 10 compared to previous germanium based 0νββ experiments. Phase II of the experiment includes a major upgrade: for further background rejection, the LAr cryostat is instrumented to detect argon scintillation light. Additional 25 BEGe detectors are installed. After PSD and LAr veto a BI of (0.7{sup +1.3}{sub -0.5}) . 10{sup -3} (counts)/(keV.kg.yr) is achieved. This is the best BI achieved in 0νββ experiments so far. A frequentist statistical analysis is performed on the combined data collected in GERDA Phase I and the first Phase II release. A new limit on the half-life of 0νββ decay of {sup 76}Ge is set to T{sup 0ν}{sub 1/2}>5.3.10{sup 25} yr at 90% C.L., with a median sensitivity of T{sup 0ν}{sub 1/2}>4.0.10{sup 25} yr at 90% C.L.

  4. Recommendation concerning maximum permissible radioactivity in animal feeds in case of a nuclear accident or other type of radiological emergency

    International Nuclear Information System (INIS)

    1988-01-01

    The SSK in its advice to the Federal Ministry of the Environment, Nature Conservation and Reactor Safety recommends to abstain from determining maximum permissible values to be applied in such cases of emergency. If, however, official limits are to be given, the following should be considered: (1) Distinction has to be made between animal feeds not subject to restrictive application with regard to time, animal species, or food chain (meat, milk, eggs), and those animal feeds whose application is subject to restrictions defined. (2) Maximum permissible activity data for animal feeds for restricted use should be ten times the value determined for non-restricted feeds. As to consultations within the EC on supplemtary tables to EC Directive No. 3954/87, the SSK presented its proposals in tables, using transfer factors from the literature concerning assessment of maximum permissible chronic intake of Cs-137, I-131, Sr-90, Pu-239, Am-241 by productive livestock (bovine, goats, sheep, swine, poultry). (HP) [de

  5. Swedish or American heterosexual college youth: who is more permissive?

    Science.gov (United States)

    Weinberg, M S; Lottes, I L; Shaver, F M

    1995-08-01

    Theories of human sexuality have proposed that two factors reduce the double standard of sexuality and lead to a convergence of male and female sexual behavior: the degree of social benefits and amount of power women have in basic societal institutions and the extent to which a society accepts permissive sexual norms. As these factors increase, the strength of the double standard will decrease and the convergence between male and female behaviors will increase. Compared to the United States, Sweden has instituted more policies to promote gender equality and has been thought to accept more permissive premarital sexual attitudes. The focus of the research reported here is to examine country and gender differences in sexual attitudes and sexual behavior for a sample of university students in the United States (N = 407) and Sweden (N = 570). Results indicate that Swedish students endorsed more similar sexual standards for women and men and reported more accepting attitudes than did American students. For sexual behavior, American men reported the most sexual experience, Swedish men the least, with the women of both countries generally in the middle category. Notwithstanding this more permissive behavior on the part of American men, gender convergence with respect to sexual behavior is stronger in Sweden on several of the dimensions examined: age of first engaging in partner-related sexual activities for those who were sexually experienced, relationship with first partner, number of partners both in the last year and in their lifetime, and affective reactions to first coitus. Gender convergence, however, is weaker in Sweden than in the United States with respect to the incidence and frequency of various sexual activities and the degree of satisfaction with current sex life. Findings are discussed with respect to the questions they raise about the current theories that framed this research and the differential amount of sex education provided in the two countries.

  6. Parental feeding practices predict authoritative, authoritarian, and permissive parenting styles.

    Science.gov (United States)

    Hubbs-Tait, Laura; Kennedy, Tay Seacord; Page, Melanie C; Topham, Glade L; Harrist, Amanda W

    2008-07-01

    Our goal was to identify how parental feeding practices from the nutrition literature link to general parenting styles from the child development literature to understand how to target parenting practices to increase effectiveness of interventions. Stand-alone parental feeding practices could be targeted independently. However, parental feeding practices linked to parenting styles require interventions treating underlying family dynamics as a whole. To predict parenting styles from feeding practices and to test three hypotheses: restriction and pressure to eat are positively related whereas responsibility, monitoring, modeling, and encouraging are negatively related to an authoritarian parenting style; responsibility, monitoring, modeling, and encouraging are positively related whereas restriction and pressure to eat are negatively related to an authoritative parenting style; a permissive parenting style is negatively linked with all six feeding practices. Baseline data of a randomized-controlled intervention study. Two hundred thirty-nine parents (93.5% mothers) of first-grade children (134 boys, 105 girls) enrolled in rural public schools. Parental responses to encouraging and modeling questionnaires and the Child Feeding Questionnaire, as well as parenting styles measured by the Parenting Styles and Dimensions Questionnaire. Correlation and regression analyses. Feeding practices explained 21%, 15%, and 8% of the variance in authoritative, authoritarian, and permissive parenting, respectively. Restriction, pressure to eat, and monitoring (negative) significantly predicted an authoritarian style (Hypothesis 1); responsibility, restriction (negative), monitoring, and modeling predicted an authoritative style (Hypothesis 2); and modeling (negative) and restriction significantly predicted a permissive style (Hypothesis 3). Parental feeding practices with young children predict general parenting styles. Interventions that fail to address underlying parenting styles

  7. Estimation of isotropic nuclear magnetic shieldings in the CCSD(T) and MP2 complete basis set limit using affordable correlation calculations

    DEFF Research Database (Denmark)

    Kupka, Teobald; Stachów, Michal; Kaminsky, Jakub

    2013-01-01

    , estimated from calculations with the family of polarizationconsistent pcS-n basis sets is reported. This dependence was also supported by inspection of profiles of deviation between CBS estimated nuclear shieldings and obtained with significantly smaller basis sets pcS-2 and aug-cc-pVTZ-J for the selected......A linear correlation between isotropic nuclear magnetic shielding constants for seven model molecules (CH2O, H2O, HF, F2, HCN, SiH4 and H2S) calculated with 37 methods (34 density functionals, RHF, MP2 and CCSD(T) ), with affordable pcS-2 basis set and corresponding complete basis set results...... set of 37 calculation methods. It was possible to formulate a practical approach of estimating the values of isotropic nuclear magnetic shielding constants at the CCSD(T)/CBS and MP2/CBS levels from affordable CCSD(T)/pcS-2, MP2/pcS-2 and DFT/CBS calculations with pcS-n basis sets. The proposed method...

  8. Cost tradeoffs in consequence management at nuclear power plants: A risk based approach to setting optimal long-term interdiction limits for regulatory analyses

    International Nuclear Information System (INIS)

    Mubayi, V.

    1995-05-01

    The consequences of severe accidents at nuclear power plants can be limited by various protective actions, including emergency responses and long-term measures, to reduce exposures of affected populations. Each of these protective actions involve costs to society. The costs of the long-term protective actions depend on the criterion adopted for the allowable level of long-term exposure. This criterion, called the ''long term interdiction limit,'' is expressed in terms of the projected dose to an individual over a certain time period from the long-term exposure pathways. The two measures of offsite consequences, latent cancers and costs, are inversely related and the choice of an interdiction limit is, in effect, a trade-off between these two measures. By monetizing the health effects (through ascribing a monetary value to life lost), the costs of the two consequence measures vary with the interdiction limit, the health effect costs increasing as the limit is relaxed and the protective action costs decreasing. The minimum of the total cost curve can be used to calculate an optimal long term interdiction limit. The calculation of such an optimal limit is presented for each of five US nuclear power plants which were analyzed for severe accident risk in the NUREG-1150 program by the Nuclear Regulatory Commission

  9. Larval diet affects mosquito development and permissiveness to Plasmodium infection.

    Science.gov (United States)

    Linenberg, Inbar; Christophides, George K; Gendrin, Mathilde

    2016-12-02

    The larval stages of malaria vector mosquitoes develop in water pools, feeding mostly on microorganisms and environmental detritus. Richness in the nutrient supply to larvae influences the development and metabolism of larvae and adults. Here, we investigated the effects of larval diet on the development, microbiota content and permissiveness to Plasmodium of Anopheles coluzzii. We tested three fish diets often used to rear mosquitoes in the laboratory, including two pelleted diets, Dr. Clarke's Pool Pellets and Nishikoi Fish Pellets, and one flaked diet, Tetramin Fish-Flakes. Larvae grow and develop faster and produce bigger adults when feeding on both types of pellets compared with flakes. This correlates with a higher microbiota load in pellet-fed larvae, in agreement with the known positive effect of the microbiota on mosquito development. Larval diet also significantly influences the prevalence and intensity of Plasmodium berghei infection in adults, whereby Nishikoi Fish Pellets-fed larvae develop into adults that are highly permissive to parasites and survive longer after infection. This correlates with a lower amount of Enterobacteriaceae in the midgut microbiota. Together, our results shed light on the influence of larval feeding on mosquito development, microbiota and vector competence; they also provide useful data for mosquito rearing.

  10. Procedures for permission of installation of nuclear power stations

    International Nuclear Information System (INIS)

    Narita, Yoriaki

    1980-01-01

    The locations of atomic power stations are first selected by electric power enterprises in consultation with the Ministry of International Trade and Industry or under the guidance of authorities concerned. The surveys of the climate, topography, water and plants in the planned sites and the influences of nuclear power generation to the surrounding areas are made by the enterprisers under the administrative guidance of the MITI. Secondly, the basic project shall be submitted to and decided by the Power Resource Development Council headed by the Prime Minister (Article 10, the Power Resource Development Law). The Council shall, if necessary, call for the attendance of the governors of prefectures concerned and hear their opinions (Article 11, the Law). As the third and most complicated phase, various procedures include; (a) permission of the changes of electrical facilities under the Electricity Enterprises Act; (b) authorization of the installation of reactors under the Nuclear Reactor Regulation Law; (c) permission or authorization under other regulations including the Agricultural Land Act, etc.; (d) additional procedures related to the indemnification to fishery and so forth. Finally the reactors are to be operated after receiving the certificates of the Minister of ITI on the inspections of construction works, nuclear fuel materials used for the reactors and welding processes of reactor containment vessels, boilers, turbines, etc. (Okada, K.)

  11. Comparison of the frequency of functional SH3 domains with different limited sets of amino acids using mRNA display.

    Directory of Open Access Journals (Sweden)

    Junko Tanaka

    Full Text Available Although modern proteins consist of 20 different amino acids, it has been proposed that primordial proteins consisted of a small set of amino acids, and additional amino acids have gradually been recruited into the genetic code. This hypothesis has recently been supported by comparative genome sequence analysis, but no direct experimental approach has been reported. Here, we utilized a novel experimental approach to test a hypothesis that native-like globular proteins might be easily simplified by a set of putative primitive amino acids with retention of its structure and function than by a set of putative new amino acids. We performed in vitro selection of a functional SH3 domain as a model from partially randomized libraries with different sets of amino acids using mRNA display. Consequently, a library rich in putative primitive amino acids included a larger number of functional SH3 sequences than a library rich in putative new amino acids. Further, the functional SH3 sequences were enriched from the primitive library slightly earlier than from a randomized library with the full set of amino acids, while the function and structure of the selected SH3 proteins with the primitive alphabet were comparable with those from the 20 amino acid alphabet. Application of this approach to various combinations of codons in protein sequences may be useful not only for clarifying the precise order of the amino acid expansion in the early stages of protein evolution but also for efficiently creating novel functional proteins in the laboratory.

  12. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru.

    Science.gov (United States)

    Jaganath, Devan; Miranda, J Jaime; Gilman, Robert H; Wise, Robert A; Diette, Gregory B; Miele, Catherine H; Bernabe-Ortiz, Antonio; Checkley, William

    2015-03-18

    It is unclear how geographic and social diversity affects the prevalence of chronic obstructive pulmonary disease (COPD). We sought to characterize the prevalence of COPD and identify risk factors across four settings in Peru with varying degrees of urbanization, altitude, and biomass fuel use. We collected sociodemographics, clinical history, and post-bronchodilator spirometry in a randomly selected, age-, sex- and site-stratified, population-based sample of 2,957 adults aged ≥35 years (median age was 54.8 years and 49.3% were men) from four resource-poor settings: Lima, Tumbes, urban and rural Puno. We defined COPD as a post-bronchodilator FEV1/FVC Peru was not uniform and, unlike other settings, was not predominantly explained by tobacco smoking. This study emphasizes the role of biomass fuel use, and highlights pulmonary tuberculosis as an often neglected risk factor in endemic areas.

  13. Maximum permissible concentration (MPC) values for spontaneously fissioning radionuclides

    International Nuclear Information System (INIS)

    Ford, M.R.; Snyder, W.S.; Dillman, L.T.; Watson, S.B.

    1976-01-01

    The radiation hazards involved in handling certain of the transuranic nuclides that exhibit spontaneous fission as a mode of decay were reaccessed using recent advances in dosimetry and metabolic modeling. Maximum permissible concentration (MPC) values in air and water for occupational exposure (168 hr/week) were calculated for 244 Pu, 246 Cm, 248 Cm, 250 Cf, 252 Cf, 254 Cf, /sup 254m/Es, 255 Es, 254 Fm, and 256 Fm. The half-lives, branching ratios, and principal modes of decay of the parent-daughter members down to a member that makes a negligible contribution to the dose are given, and all daughters that make a significant contribution to the dose to body organs following inhalation or ingestion are included in the calculations. Dose commitments for body organs are also given

  14. Setting up the Brazilian Evaluation Network: a challenging work with no boundaries Estabelecendo a Rede Brasileira de Avaliação: um trabalho desafiador sem limites

    Directory of Open Access Journals (Sweden)

    Angela Cristina Dannemann

    2005-12-01

    Full Text Available Evaluation may be a relevant tool for the practice of democracy. In order for it to occur, quality and proper utilization of its results must be assured (PATTON, 1997. Therefore, the consolidation of democratic principles in a society and the promotion of effective social interactions (FETTERMAN; WANDERSMAN, 2005 will benefit enormously from a greater and better use of evaluation in all possible formats. The Brazilian Evaluation Network was created approximately three years ago in a country with a recent history of democratic practice. Within a theoretical framework networks do not have boundaries or limits for debate. However, cultural and historical aspects create limits for the discussions and boundaries among its participants. This paper intends to shed light into some of these limits and boundaries, reflecting over how they are being overcome.Uma avaliação pode ser um importante instrumento para o exercício da democracia. Para que isso ocorra é preciso assegurar a qualidade da avaliação, bem como a utilização apropriada dos seus resultados (PATTON,1997. Desta forma, a construção de uma sociedade democrática, que busca a melhoria permanente dos seus processos sociais (FETTERMAN; WANDERSMAN, 2005, depende do aprimoramento contínuo da sua prática de avaliação, em suas variadas manifestações. No Brasil, há aproximadamente 3 anos, foi criada a Rede Brasileira de Avaliação. Uma rede que, em sua concepção teórica, não possui limites ou fronteiras de discussão. Contudo, existem aspectos culturais e históricos (envolvendo valores, que criam limites para as referidas discussões e estabelecem fronteiras entre as diferentes instâncias. Este trabalho apresenta alguns destes limites e fronteiras, refletindo sobre a forma como aqueles que encomendam e que conduzem avaliações vêm contornando os limites e ultrapassando fronteiras.

  15. Can ‘Mobile Platform’ and ‘Permission Marketing’ dance a tango to the consumers' tune? Modeling adoption of ‘SMS based Permission Advertising’

    OpenAIRE

    Prerna Bamoriya

    2015-01-01

    Many a times situation of advertising clutter is further aggrieved by the markers’ intrusive practices i.e. not asking for consumer’s explicit permission. It results in consumers’ alienation and reduced advertising effectiveness. Solution could be integration of Permission Marketing with an innovative advertising platform like Mobile. This study aimed to develop and validate a comprehensive model for understanding consumers’ adoption behavior towards SMS Based Permission Advertising (SBPA). F...

  16. Quench limits

    International Nuclear Information System (INIS)

    Sapinski, M.

    2012-01-01

    With thirteen beam induced quenches and numerous Machine Development tests, the current knowledge of LHC magnets quench limits still contains a lot of unknowns. Various approaches to determine the quench limits are reviewed and results of the tests are presented. Attempt to reconstruct a coherent picture emerging from these results is taken. The available methods of computation of the quench levels are presented together with dedicated particle shower simulations which are necessary to understand the tests. The future experiments, needed to reach better understanding of quench limits as well as limits for the machine operation are investigated. The possible strategies to set BLM (Beam Loss Monitor) thresholds are discussed. (author)

  17. Global trends in antiretroviral resistance in treatment-naive individuals with HIV after rollout of antiretroviral treatment in resource-limited settings: a global collaborative study and meta-regression analysis

    NARCIS (Netherlands)

    Gupta, Ravindra K.; Jordan, Michael R.; Sultan, Binta J.; Hill, Andrew; Davis, Daniel H. J.; Gregson, John; Sawyer, Anthony W.; Hamers, Raph L.; Ndembi, Nicaise; Pillay, Deenan; Bertagnolio, Silvia

    2012-01-01

    Background The emergence and spread of high levels of HIV-1 drug resistance in resource-limited settings where combination antiretroviral treatment has been scaled up could compromise the effectiveness of national HIV treatment programmes. We aimed to estimate changes in the prevalence of HIV-1 drug

  18. Religiosity and Premarital Sexual Permissiveness: A Response to the Reiss-Heltsley and Broderick Debate

    Science.gov (United States)

    Ruppel, Howard J., Jr.

    1970-01-01

    When religiosity among college students was measured by Faulkner and DeJong's 5-D Scale of Religiosity" and the Reiss scale was used to measure permissiveness, the expected stronger relationship between religiosity and permissiveness in groups with traditions of low sexual permissiveness than in groups with traditions of high sexual…

  19. Access to a Loaded Gun Without Adult Permission and School-Based Bullying.

    Science.gov (United States)

    Simckes, Maayan S; Simonetti, Joseph A; Moreno, Megan A; Rivara, Frederick P; Oudekerk, Barbara A; Rowhani-Rahbar, Ali

    2017-09-01

    Gun access and bullying are risk factors for sustaining or perpetrating violence among adolescents. Our knowledge of gun access among bullied students is limited. We used data on students, aged 12-18 years, from the 2011 and 2013 School Crime Supplement to the National Crime Victimization Survey to assess the association between self-reported bullying victimization (traditional and cyber) and access to a loaded gun without adult permission. Prevalence ratios (PRs) and confidence intervals (CIs) were obtained from multivariable Poisson regression using the Taylor series after controlling for student age, sex, family income, public/private school, and race. Of 10,704 participants, 4.2% (95% CI: 3.8%-4.6%) reported gun access. Compared with nonbullied students, those who reported traditional bullying (PR = 2.2; 95% CI: 1.7-2.4), cyberbullying (PR = 2.8; 95% CI: 1.6-4.9), and both (PR = 5.9; 95% CI: 4.6-7.7) were more likely to also report gun access. Adolescents who experience bullying, particularly those who report both traditional bullying and cyberbullying, are more likely to report access to a loaded gun without adult permission. These findings highlight the importance of developing interventions focused on these modifiable risk factors for preventing self-directed or interpersonal violence among youth. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  20. Maximum permissible dietary contamination after the accidental release of radioactive materials from a nuclear reactor

    Energy Technology Data Exchange (ETDEWEB)

    Pochin, E E; Rock Carling, Ernest; Court Brown, W M [Medical Research Council, Committee on Protection against Ionizing Radiations, London (United Kingdom); and others

    1960-12-01

    After the accident to No. 1 pile at Windscale on October 10, 1957 (Atomic Energy Office, 1957), the Atomic Energy Authority asked the Medical Research Council for advice on the maximum intake of certain radioactive isotopes that should be regarded as permissible, under emergency conditions, for members of the general population living in, or deriving food from, an area contaminated owing to an accident to a reactor. The Council's Committee on Protection against Ionizing Radiations, together with its Subcommittees on Internal and External Radiations, has considered this problem, and concludes that the intake of radioactive materials by ingestion of contaminated food would generally be the limiting source of hazard after any such accident. Intake by inhalation, or radiation from the exterior, would become of importance only in rather special circumstances. In the following report, therefore, the Committee proposes maximum permissible levels of dietary contamination for the relevant isotopes in the emergency conditions envisaged. In proposing these levels, the Protection Committee has used the fullest information available on the radiation doses that would be delivered to different body tissues and at different ages by the isotopes concerned, and on the ways in which these materials would enter the body.

  1. Maximum permissible dietary contamination after the accidental release of radioactive materials from a nuclear reactor

    International Nuclear Information System (INIS)

    Pochin, E.E.; Rock Carling, Ernest; Court Brown, W.M.

    1960-01-01

    After the accident to No. 1 pile at Windscale on October 10, 1957 (Atomic Energy Office, 1957), the Atomic Energy Authority asked the Medical Research Council for advice on the maximum intake of certain radioactive isotopes that should be regarded as permissible, under emergency conditions, for members of the general population living in, or deriving food from, an area contaminated owing to an accident to a reactor. The Council's Committee on Protection against Ionizing Radiations, together with its Subcommittees on Internal and External Radiations, has considered this problem, and concludes that the intake of radioactive materials by ingestion of contaminated food would generally be the limiting source of hazard after any such accident. Intake by inhalation, or radiation from the exterior, would become of importance only in rather special circumstances. In the following report, therefore, the Committee proposes maximum permissible levels of dietary contamination for the relevant isotopes in the emergency conditions envisaged. In proposing these levels, the Protection Committee has used the fullest information available on the radiation doses that would be delivered to different body tissues and at different ages by the isotopes concerned, and on the ways in which these materials would enter the body

  2. The impact of threshold language assistance programming on the accessibility of mental health services for persons with limited English proficiency in the Medi-Cal setting.

    Science.gov (United States)

    McClellan, Sean R; Wu, Frances M; Snowden, Lonnie R

    2012-06-01

    Title VI of the 1964 Civil Rights Act prohibits federal funds recipients from providing care to limited English proficiency (LEP) persons more limited in scope or lower in quality than care provided to others. In 1999, the California Department of Mental Health implemented a "threshold language access policy" to meet its Title VI obligations. Under this policy, Medi-Cal agencies must provide language assistance programming in a non-English language where a county's Medical population contains either 3000 residents or 5% speakers of that language. We examine the impact of threshold language policy-required language assistance programming on LEP persons' access to mental health services by analyzing the county-level penetration rate of services for Russian, Spanish, and Vietnamese speakers across 34 California counties, over 10 years of quarterly data. Exploiting a time series with nonequivalent control group study design, we studied this phenomena using linear regression with random county effects to account for trends over time. Threshold language policy-required assistance programming led to an immediate and significant increase in the penetration rate of mental health services for Russian (8.2, P language speaking persons. Threshold language assistance programming was effective in increasing mental health access for Russian and Vietnamese, but not for Spanish-speaking LEP persons.

  3. On the accuracy of density-functional theory exchange-correlation functionals for H bonds in small water clusters: Benchmarks approaching the complete basis set limit

    Science.gov (United States)

    Santra, Biswajit; Michaelides, Angelos; Scheffler, Matthias

    2007-11-01

    The ability of several density-functional theory (DFT) exchange-correlation functionals to describe hydrogen bonds in small water clusters (dimer to pentamer) in their global minimum energy structures is evaluated with reference to second order Møller-Plesset perturbation theory (MP2). Errors from basis set incompleteness have been minimized in both the MP2 reference data and the DFT calculations, thus enabling a consistent systematic evaluation of the true performance of the tested functionals. Among all the functionals considered, the hybrid X3LYP and PBE0 functionals offer the best performance and among the nonhybrid generalized gradient approximation functionals, mPWLYP and PBE1W perform best. The popular BLYP and B3LYP functionals consistently underbind and PBE and PW91 display rather variable performance with cluster size.

  4. Novel molecular diagnostic tools for malaria elimination: a review of options from the point of view of high-throughput and applicability in resource limited settings.

    Science.gov (United States)

    Britton, Sumudu; Cheng, Qin; McCarthy, James S

    2016-02-16

    As malaria transmission continues to decrease, an increasing number of countries will enter pre-elimination and elimination. To interrupt transmission, changes in control strategies are likely to require more accurate identification of all carriers of Plasmodium parasites, both symptomatic and asymptomatic, using diagnostic tools that are highly sensitive, high throughput and with fast turnaround times preferably performed in local health service settings. Currently available immunochromatographic lateral flow rapid diagnostic tests and field microscopy are unlikely to consistently detect infections at parasite densities less than 100 parasites/µL making them insufficiently sensitive for detecting all carriers. Molecular diagnostic platforms, such as PCR and LAMP, are currently available in reference laboratories, but at a cost both financially and in turnaround time. This review describes the recent progress in developing molecular diagnostic tools in terms of their capacity for high throughput and potential for performance in non-reference laboratories for malaria elimination.

  5. Target Product Profile for a Diagnostic Assay to Differentiate between Bacterial and Non-Bacterial Infections and Reduce Antimicrobial Overuse in Resource-Limited Settings: An Expert Consensus.

    Directory of Open Access Journals (Sweden)

    Sabine Dittrich

    Full Text Available Acute fever is one of the most common presenting symptoms globally. In order to reduce the empiric use of antimicrobial drugs and improve outcomes, it is essential to improve diagnostic capabilities. In the absence of microbiology facilities in low-income settings, an assay to distinguish bacterial from non-bacterial causes would be a critical first step. To ensure that patient and market needs are met, the requirements of such a test should be specified in a target product profile (TPP. To identify minimal/optimal characteristics for a bacterial vs. non-bacterial fever test, experts from academia and international organizations with expertise in infectious diseases, diagnostic test development, laboratory medicine, global health, and health economics were convened. Proposed TPPs were reviewed by this working group, and consensus characteristics were defined. The working group defined non-severely ill, non-malaria infected children as the target population for the desired assay. To provide access to the most patients, the test should be deployable to community health centers and informal health settings, and staff should require 90% and >80% for sensitivity and specificity, respectively. Other key characteristics, to account for the challenging environment at which the test is targeted, included: i time-to-result <10 min (but maximally <2 hrs; ii storage conditions at 0-40°C, ≤90% non-condensing humidity with a minimal shelf life of 12 months; iii operational conditions of 5-40°C, ≤90% non-condensing humidity; and iv minimal sample collection needs (50-100μL, capillary blood. This expert approach to define assay requirements for a bacterial vs. non-bacterial assay should guide product development, and enable targeted and timely efforts by industry partners and academic institutions.

  6. On a connection between the limit set of the Moebius-Klein transformation, periodic continued fractions, El Naschie's topological theory of high energy particle physics and the possibility of a new axion-like particle

    International Nuclear Information System (INIS)

    Marek-Crnjac, L.

    2004-01-01

    In the present work we first give a general representation of the derivatives of the irrational number phi, for instance ((1)/(phi)), ((1)/(phi 2 )), ((1)/(phi 3 )) etc., as periodic continued fractions. Any irrational number can then be expanded in an infinite continued fraction. The limit set of the Kleinian transformation acting on the E-infinity Cantorian spacetime turned out to be this set of periodic continued fractions, consequently the vacuum of the E-infinity is described by this limit set. As discussed by El Naschie, every particle can be interpreted geometrically as a scaling of another. This is done using the topology of hyperbolic Kleinian space of VAK, which is nothing but our limit set. Here we will present the ratios of the theoretical masses of certain elementary particles to that of some chosen particles in term of phi. Many of these masses are quite close to integer multiples of the mass of a chosen particle. Finally we discuss the possibility of new transfinite, axion-like particles as discussed recently by Krauss and El Naschie [Quintessence, Vintage, London, 1999

  7. Behavior of water gel permissibles in coal mines

    Energy Technology Data Exchange (ETDEWEB)

    Ribovich, J.; Watson, R.W.

    1979-01-01

    This paper presents an overview of the successful use of water gel permissibles, since their introduction in 1970, with an emphasis on some problems of behavior in their field application. One is the metal clip or ties used to seal the water gel package. Miners are occasionally hit by the 2.4 mm metal wire expelled from boreholes in normal shooting operations. Manufacturers have consequently reduced the mass of the metal ties by 25-50%, providing a partial solution. Another problem concerned two reported instances of misfired water gel burning after coal shooting operations. Extensive tests have offered no satisfactory solution as yet, except to point up a principal shortcoming of water gels: that of pressure desensitization. Two other factors affecting sensitivity, and possibly resulting in misfires, are low temperature and aging. There is a decline in air-gap sensitivity with prolonged storage but all approved water gels seem capable of meeting requirements for long periods under normal storage conditions. Low temperature tests indicate the majority of water gels become insensitive to a No. 6 EBC at temperatures easily attained in cold weather storage. An attempt was made to determine the minimum temperature at which a nitroglycerin-sensitized permisslbe could be initiated with a No. 8 cap; a particularly granular one was initiated as low as minus 196 C. (5 refs.) (In English)

  8. Using the Lives Saved Tool (LiST) to Model mHealth Impact on Neonatal Survival in Resource-Limited Settings

    Science.gov (United States)

    Jo, Youngji; Labrique, Alain B.; Lefevre, Amnesty E.; Mehl, Garrett; Pfaff, Teresa; Walker, Neff; Friberg, Ingrid K.

    2014-01-01

    While the importance of mHealth scale-up has been broadly emphasized in the mHealth community, it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals, not merely to expand programs. We used the Lives Saved Tool (LiST)–an evidence-based modeling software–to identify priority areas for maternal and neonatal health services, by formulating six individual and combined interventions scenarios for two countries, Bangladesh and Uganda. Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios. Although further validation of this model is desirable, tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives. PMID:25014008

  9. Using the lives saved tool (LiST to model mHealth impact on neonatal survival in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Youngji Jo

    Full Text Available While the importance of mHealth scale-up has been broadly emphasized in the mHealth community, it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals, not merely to expand programs. We used the Lives Saved Tool (LiST--an evidence-based modeling software--to identify priority areas for maternal and neonatal health services, by formulating six individual and combined interventions scenarios for two countries, Bangladesh and Uganda. Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios. Although further validation of this model is desirable, tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives.

  10. Ethics and Rationing Access to Dialysis in Resource-Limited Settings: The Consequences of Refusing a Renal Transplant in the South African State Sector.

    Science.gov (United States)

    Etheredge, Harriet; Paget, Graham

    2015-12-01

    Resource constraints in developing countries compel policy makers to ration the provision of healthcare services. This article examines one such set of Guidelines: A patient dialysing in the state sector in South Africa may not refuse renal transplantation when a kidney becomes available. Refusal of transplantation can lead to exclusion from the state-funded dialysis programme. This Guideline is legally acceptable as related to Constitutional stipulations which allow for rationing healthcare resources in South Africa. Evaluating the ethical merit of the Guideline, and exploring the ethical dilemma it poses, proves a more complex task. We examine the actions of healthcare professionals as constrained by the Guideline. From a best interests framework, we argue that in these circumstances directing patient decision making (pressurising a patient to undergo renal transplantation) is not necessarily unethical or unacceptably paternalistic. We then scrutinise the guideline itself through several different ethical 'lenses'. Here, we argue that bioethics does not provide a definitive answer as to the moral merit of rationing dialysis under these circumstances, however it can be considered just in this context. We conclude by examining a potential pitfall of the Guideline: Unwilling transplant recipients may not comply with immunosuppressive medication, which raises questions for policies based on resource management and rationing. © 2014 John Wiley & Sons Ltd.

  11. VITAL NMR: using chemical shift derived secondary structure information for a limited set of amino acids to assess homology model accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Brothers, Michael C.; Nesbitt, Anna E.; Hallock, Michael J. [University of Illinois at Urbana-Champaign, Department of Chemistry (United States); Rupasinghe, Sanjeewa G. [University of Illinois at Urbana-Champaign, Department of Cell and Developmental Biology (United States); Tang Ming [University of Illinois at Urbana-Champaign, Department of Chemistry (United States); Harris, Jason; Baudry, Jerome [University of Tennessee, Department of Biochemistry, Cellular and Molecular Biology (United States); Schuler, Mary A. [University of Illinois at Urbana-Champaign, Department of Cell and Developmental Biology (United States); Rienstra, Chad M., E-mail: rienstra@illinois.edu [University of Illinois at Urbana-Champaign, Department of Chemistry (United States)

    2012-01-15

    Homology modeling is a powerful tool for predicting protein structures, whose success depends on obtaining a reasonable alignment between a given structural template and the protein sequence being analyzed. In order to leverage greater predictive power for proteins with few structural templates, we have developed a method to rank homology models based upon their compliance to secondary structure derived from experimental solid-state NMR (SSNMR) data. Such data is obtainable in a rapid manner by simple SSNMR experiments (e.g., {sup 13}C-{sup 13}C 2D correlation spectra). To test our homology model scoring procedure for various amino acid labeling schemes, we generated a library of 7,474 homology models for 22 protein targets culled from the TALOS+/SPARTA+ training set of protein structures. Using subsets of amino acids that are plausibly assigned by SSNMR, we discovered that pairs of the residues Val, Ile, Thr, Ala and Leu (VITAL) emulate an ideal dataset where all residues are site specifically assigned. Scoring the models with a predicted VITAL site-specific dataset and calculating secondary structure with the Chemical Shift Index resulted in a Pearson correlation coefficient (-0.75) commensurate to the control (-0.77), where secondary structure was scored site specifically for all amino acids (ALL 20) using STRIDE. This method promises to accelerate structure procurement by SSNMR for proteins with unknown folds through guiding the selection of remotely homologous protein templates and assessing model quality.

  12. VITAL NMR: Using Chemical Shift Derived Secondary Structure Information for a Limited Set of Amino Acids to Assess Homology Model Accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Brothers, Michael C [University of Illinois, Urbana-Champaign; Nesbitt, Anna E [University of Illinois, Urbana-Champaign; Hallock, Michael J [University of Illinois, Urbana-Champaign; Rupasinghe, Sanjeewa [University of Illinois, Urbana-Champaign; Tang, Ming [University of Illinois, Urbana-Champaign; Harris, Jason B [ORNL; Baudry, Jerome Y [ORNL; Schuler, Mary A [University of Illinois, Urbana-Champaign; Rienstra, Chad M [University of Illinois, Urbana-Champaign

    2011-01-01

    Homology modeling is a powerful tool for predicting protein structures, whose success depends on obtaining a reasonable alignment between a given structural template and the protein sequence being analyzed. In order to leverage greater predictive power for proteins with few structural templates, we have developed a method to rank homology models based upon their compliance to secondary structure derived from experimental solid-state NMR (SSNMR) data. Such data is obtainable in a rapid manner by simple SSNMR experiments (e.g., (13)C-(13)C 2D correlation spectra). To test our homology model scoring procedure for various amino acid labeling schemes, we generated a library of 7,474 homology models for 22 protein targets culled from the TALOS+/SPARTA+ training set of protein structures. Using subsets of amino acids that are plausibly assigned by SSNMR, we discovered that pairs of the residues Val, Ile, Thr, Ala and Leu (VITAL) emulate an ideal dataset where all residues are site specifically assigned. Scoring the models with a predicted VITAL site-specific dataset and calculating secondary structure with the Chemical Shift Index resulted in a Pearson correlation coefficient (-0.75) commensurate to the control (-0.77), where secondary structure was scored site specifically for all amino acids (ALL 20) using STRIDE. This method promises to accelerate structure procurement by SSNMR for proteins with unknown folds through guiding the selection of remotely homologous protein templates and assessing model quality.

  13. Peer Mentoring at the Uganda Cancer Institute: A Novel Model for Career Development of Clinician-Scientists in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Warren Phipps

    2018-03-01

    Full Text Available Cancer centers are beginning to emerge in low- and middle-income countries despite having relatively few oncologists and specialists in related fields. Uganda, like many countries in sub-Saharan Africa, has a cadre of highly motivated clinician-scientists-in-training who are committed to developing the capacity for cancer care and research. However, potential local mentors for these trainees are burdened with uniquely high demands on their time for clinical care, teaching, institutional development, advocacy, and research. Facilitated peer mentoring helps to fill skills and confidence gaps and teaches mentoring skills so that trainees can learn to support one another and regularly access a more senior facilitator/role model. With an added consultant component, programs can engage limited senior faculty time to address specific training needs and to introduce junior investigators to advisors and even potential dyadic mentors. Two years after its inception, our facilitated peer mentoring career development program at the Uganda Cancer Institute in Kampala is successfully developing a new generation of researchers who, in turn, are now providing role models and mentors from within their group. This program provides a practical model for building the next generation of clinical scientists in developing countries.

  14. The Limited English Proficiency Patient Family Advocate Role: Fostering Respectful and Effective Care Across Language and Culture in a Pediatric Oncology Setting.

    Science.gov (United States)

    Gil, Stephanie; Hooke, Mary C; Niess, Dawn

    2016-01-01

    Patients and families with limited English proficiency (LEP) face a multitude of barriers both inside and outside the hospital walls. These barriers can contribute to difficulty accessing care and understanding/adhering to treatment recommendations, ultimately placing them at higher risk for poorer outcomes than their English-speaking counterparts. The LEP Patient Family Advocate role was created with the aim of improving access, promoting effective communication, and equalizing care for children with cancer from families with LEP. The goal of this mixed methods study was to describe the level of satisfaction and experiences of parents and health care providers who used the LEP Patient Family Advocate while receiving or providing care. Twelve parents and 15 health care providers completed quantitative surveys and an open-ended question about their experiences. High levels of satisfaction were reported. Themes about the role from qualitative responses included its positive effect on communication, trust, and connectedness between parents and staff. Continuity of care and safety were improved, and parents thought the role helped decrease their stress. The LEP Patient Family Advocate has a positive influence on family-centered cultural care. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

  15. The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting.

    Science.gov (United States)

    Busari, Jamiu O; Duits, Ashley J

    2015-01-21

    Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system. Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training. In order to achieve a VBHC system in a resource-limited environment, the standard of physicians' competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended.

  16. Challenges in Providing Treatment and Care for Viral Hepatitis among Individuals Co-Infected with HIV in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Wirach Maek-a-Nantawat

    2012-01-01

    Full Text Available Hepatitis B and C infections are prevalent among HIV-infected individuals with different epidemiologic profiles, modes of transmission, natural histories, and treatments. Southeast Asian countries are classified as “highly prevalent zones,” with a rate of hepatitis B and C coinfection in people living with HIV/AIDS of approximately 3.2–11%. Majority of hepatitis B coinfection is of genotype C. Most of the patients infected with hepatitis C in Thailand have genotype 3 which is significantly related to intravenous drug use whereas, in Vietnam, it is genotype 6. The options for antiretroviral drugs are limited and rely on global funds and research facilities. Only HBV treatment is available for free through the national health scheme. Screening tests for HBV and HCV prior to commencing antiretroviral treatment are low. Insufficient concern on hepatitis-virus-related liver malignancy and long-term hepatic morbidities is noted. Cost-effective HCV treatment can be incorporated into the national health program for those who need it by utilizing data obtained from clinical research studies. For example, patients infected with HCV genotype 2/3 with a certain IL-28B polymorphism can be treated with a shorter course of interferon and ribavirin which can also help reduce costs.

  17. Evaluating the utility of provider-recorded clinical status in the medical records of HIV-positive adults in a limited-resource setting

    Science.gov (United States)

    Stonbraker, Samantha; Befus, Montina; Nadal, Leonel Lerebours; Halpern, Mina; Larson, Elaine

    2016-01-01

    Provider-reported summaries of clinical status may assist with clinical management of HIV in resource poor settings if they reflect underlying biological processes associated with HIV disease progression. However, their ability to do so is rarely evaluated. Therefore, we aimed to assess the relationship between a provider-recorded summary of clinical status and indicators of HIV progression. Data were abstracted from 201 randomly selected medical records at a large HIV clinic in the Dominican Republic. Multivariable logistic regressions were used to examine the relationship between provider-assigned clinical status and demographic (gender, age, nationality, education) and clinical factors (reported medication adherence, CD4 cell count, viral load). The mean age of patients was 41.2 (SD = ±10.9) years and most were female (n = 115, 57%). None of the examined characteristics were significantly associated with provider-recorded clinical status. Higher CD4 cell counts were more likely for females (OR = 2.2 CI: 1.12–4.31) and less likely for those with higher viral loads (OR = 0.33 CI: 0.15–0.72). Poorer adherence and lower CD4 cell counts were significantly associated with higher viral loads (OR = 4.46 CI: 1.11–20.29 and 6.84 CI: 1.47–37.23, respectively). Clinics using provider-reported summaries of clinical status should evaluate the performance of these assessments to ensure they are associated with biologic indicators of disease progression. PMID:27495146

  18. Benefits and limitations of fine needle aspiration cytology in the diagnosis and classification of leprosy in primary and secondary healthcare settings.

    Science.gov (United States)

    Ray, R; Mondal, R K; Pathak, S

    2015-08-01

    The goal of the World Health Organization (WHO) is to eliminate leprosy as a public health problem. This will only be possible when all patients are detected and cured using multidrug therapy, which requires accurate diagnosis prior to treatment. The objective of this study was to evaluate the possibility of the diagnosis of leprosy lesions by fine needle aspiration cytology according to a modification of the Ridley-Jopling scale, as it can be used in primary and secondary healthcare centres, especially in low-resource settings in which leprosy is prevalent. A prospective study comprising 54 cases with cardinal features of leprosy was performed. Among the 54 cases, 27 patients consented to a histopathological biopsy procedure. The slides were stained with Giemsa, modified Ziehl-Neelsen, Papanicolaou and haematoxylin and eosin methods. Among the 54 cases, 34 were reported as tuberculoid leprosy, five as mid-borderline (BB), three as borderline lepromatous (BL) and eight as lepromatous leprosy (LL); four were unsatisfactory. Histopathological study was performed in 27 cases, which showed cyto-histological correlation in 21 cases (78%). Agreement between histological and cytological diagnosis was achieved in 12 of the 15 tuberculoid cases, one of the three BB cases, one of the two BL cases and all seven LL cases. With the implementation of the WHO classification based on patch counting, there is the possibility of the over-treatment of paucibacillary cases and under-treatment of multibacillary cases. Cytology in terms of cellular type morphology and bacteriological study can complement the WHO classification. © 2014 John Wiley & Sons Ltd.

  19. Local innovation for improving primary care cardiology in resource-limited African settings: an insight on the Cardio Pad(®) project in Cameroon.

    Science.gov (United States)

    Noubiap, Jean Jacques N; Jingi, Ahmadou M; Kengne, André Pascal

    2014-10-01

    Cardiovascular disease (CVD) is an emerging threat to the health of populations in Africa. With the inadequate health infrastructures, understaffed and underfunded health systems, African countries are ill-prepared to cope with the increasing demand for care for CVD, particularly for populations in remote and underserved rural areas, where 60% of the population currently reside. Task shifting and telehealth have been suggested as strategies to overcome the current health workforce shortage in African countries, and to increase access to prevention and curative services for emerging CVD. However, strategies for promoting their incorporation into the existing health systems, have yet to be developed. The Cardio Pad(®) initiative (originating from Cameroon) seeks to provide appropriate solutions to improve the application of telemedicine for CVD prevention and control in remote African settings. The Cardio Pad(®) is a tele-cardiology device which provides a number of advantages in terms of cost, ease of use, autonomy and reduced technology requirements. It is a fully touch screen medical device which enables cardiac tests such as electrocardiograms (ECG) to be performed in remote underserved areas (rural areas for instance), while the test results are transferred wirelessly via mobile phone connection, to specialist physicians who can interpret them and provide assistance with case management. While most of the current telemedicine clinical services on the African continent receive most expertise from developed countries, the Cardio Pad(®), a local invention by a 26-year-old Cameroon-trained engineer demonstrates how much innovative solutions to combat CVD and other health issues could and should be developed locally in Africa.

  20. Building operative care capacity in a resource limited setting: The Mongolian model of the expansion of sustainable laparoscopic cholecystectomy.

    Science.gov (United States)

    Wells, Katie M; Lee, Yu-Jin; Erdene, Sandag; Erdene, Sarnai; Sanchin, Urjin; Sergelen, Orgoi; Zhang, Chong; Rodriguez, Brandon P; deVries, Catherine R; Price, Raymond R

    2016-08-01

    The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic cholecystectomy throughout Mongolia. A cross-sectional, retrospective review was conducted of demographic patient data, diagnosis type, and operation performed (laparoscopic versus open cholecystectomy) from 2005-2013. Trends were analyzed from 6 of the 21 provinces (aimags) throughout Mongolia, and data were culled from 7 regional diagnostic referral and treatment centers and 2 tertiary academic medical centers. The data were analyzed by individual training center and by year before being compared between rural and urban centers. We analyzed and compared 14,522 cholecystectomies (n = 4,086 [28%] men, n = 10,436 [72%] women). Men and women were similar in age (men 52.2, standard deviation 14.8; women 49.4, standard deviation 15.7) and in the percentage undergoing laparoscopic cholecystectomy (men 39%, women 42%). By 2013, 58% of gallbladders were removed laparoscopically countrywide compared with only 2% in 2005. In 2011, laparoscopic cholecystectomy surpassed open cholecystectomy as the primary method for gallbladder removal countrywide. More than 315 Mongolian health care practitioners received laparoscopic training in 19 of the country's 21 aimags (states). By 2013, 58% of cholecystectomies countrywide were performed laparoscopically, a dramatic increase over 9 years. The expansion of laparoscopic cholecystectomy has transformed the care of biliary tract disease in Mongolia despite the country's limited resources. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. A Survey of Structural Design of Diagnostic X-ray Imaging Facilities and Compliance to Shielding Design Goals in a Limited Resource Setting

    Directory of Open Access Journals (Sweden)

    Flavious B. Nkubli

    2017-11-01

    Full Text Available Purpose: To survey structural designs of x-ray rooms and compliance to shielding design goals of three x-ray imaging facilities. Methods and Materials: The survey was conducted in three radiodiagnostic centers in South East Nigeria, labeled X, Y and Z for anonymity. A stretchable non-elastic meter rule was used to measure x-ray room dimensions. A Vernier caliper was used to measure lead thickness while a calibrated digital survey meter Radalert 100x was used for radiation survey of controlled and uncontrolled areas. Simple statistical tools such as mean and standard deviation were used for analysis with the aid of Microsoft Excel version 2007. Results: Center X had a room dimension of 2.4 m × 2.1 m, Center Y had an x-ray room dimension of 3.6 m × 3.3 m, and Center Z had two x-ray rooms with identical dimensions of 6.3 m × 3.6 m. Measured exit radiation doses for controlled areas in all the centers were: 0.00152 mSv/wk; 0.00496 mSv/wk; 0.00168 mSv/wk; 0.00224 mSv/wk respectively. Lead was the common shielding material used. Conclusion: Based on the parameters studied, Center Z had the ideal room size and layout. Relative distances from the x-ray tubes to the nearest walls were not optimized in all the centers except in Center Z. Measured exit doses were within recommended limits except in Center Y. The location of the control consoles and measured doses were appropriate and within recommended design goals.

  2. Considerations on the establishment of maximum permissible exposure of man

    International Nuclear Information System (INIS)

    Jacobi, W.

    1974-01-01

    An attempt is made in the information lecture to give a quantitative analysis of the somatic radiation risk and to illustrate a concept to fix dose limiting values. Of primary importance is the limiting values. Of primary importance is the limiting value of the radiation exposure to the whole population. By consequential application of the risk concept, the following points are considered: 1) Definition of the risk for radiation late damages (cancer, leukemia); 2) relationship between radiation dose and thus caused radiation risk; 3) radiation risk and the dose limiting values at the time; 4) criteria for the maximum acceptable radiation risk; 5) limiting value which can be expected at the time. (HP/LH) [de

  3. Recombinant pestivirus E2 glycoproteins prevent viral attachment to permissive and non permissive cells with different efficiency.

    Science.gov (United States)

    Asfor, A S; Wakeley, P R; Drew, T W; Paton, D J

    2014-08-30

    Bovine viral diarrhoea virus (BVDV) is an economically important animal pathogen, which like other pestiviruses has similar molecular biological features to hepaciviruses, including human Hepatitis C virus. The pestivirus E2 glycoproteins are the major target for virus-neutralising antibodies, as well as playing a role in receptor binding and host range restriction. In this study, recombinant E2 glycoproteins (rE2) derived from three different pestivirus species were examined for their inhibitory effects on pestivirus infectivity in cell culture. Histidine-tagged rE2 glycoproteins of BVDV type 2 strain 178003, BVDV type 1 strain Oregon C24V and CSFV strain Alfort 187 were produced in Spodoptera frugiperda insect cells and purified under native conditions. The ability of rE2 glycoprotein to inhibit the infection of permissive cells by both homologous and heterologous virus was compared, revealing that the inhibitory effects of rE2 glycoproteins correlated with the predicted similarity of the E2 structures in the recombinant protein and the test virus. This result suggests that the sequence and structure of E2 are likely to be involved in the host specificity of pestiviruses at their point of uptake into cells. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. How does organic matter occurrence set limit onto the use of Ce anomaly as a reliable proxy of redox conditions in shallow groundwaters?

    Science.gov (United States)

    Dia, A.; Gruau, G.; Davranche, M.; Vidy, A.; Henin, O.; Petitjean, P.; Le Coz-Bouhnik, M.

    2003-04-01

    This study is dedicated to the effects of organic matter on the hydrochemistry of Rare Earth Elements (REE) and the ability of using the Ce anomaly as a reliable proxy of redox conditions in surface waters when organic matter occurs. The data include a : i) two-year survey of SREE and Ce anomalies in organic-rich waters recovered from a catchment located in Brittany (western Europe) and (ii) experimental incubation of organic soils from this catchment set under controlled conditions, as well as, (iii) a REE speciation calculation in both the natural organic-rich waters from the wetlands and the experimental solutions. Field and experimental data appear to be extremely coherent, displaying good correlation between the SREE, the Dissolved Organic Carbon (DOC) contents and the redox state. The field data show a strong increase of the SREE and DOC concentrations in soil waters when the environment becomes more reducing. The onset of DOC and SREE contents is seen to be in phase with the increase of dissolved Fe and Mn. The role of Fe-, Mn-oxyhydroxides is confirmed by the experimental data as the maximum of DOC and SREE content is reached when Fe2+ reaches a maximum in the soil solution, suggesting that reductive dissolution of Fe, Mn-oxyhydroxides happens. Despite the strong redox changes and the known redox sensitive behaviour of Ce as compared to other REE, none Ce anomaly variation is observed during either, the experimental procedure, or the field survey through time. Speciation calculations were performed showing that in both such pH range and moderately oxidizing waters in DOC-rich waters, REE should have an organic speciation. Such an organic speciation prevents the formation of Ce(IV) and therefore the development of any Ce anomaly. However, since the studied waters are highly oxidizing (high nitrate contents), the nitrates impose the redox formation of Ce(IV) and a Ce anomaly should appear. Therefore, Ce(IV) is not formed in these waters either because (i) the

  5. Lutzomyia migonei is a permissive vector competent for Leishmania infantum.

    Science.gov (United States)

    Guimarães, Vanessa Cristina Fitipaldi Veloso; Pruzinova, Katerina; Sadlova, Jovana; Volfova, Vera; Myskova, Jitka; Filho, Sinval Pinto Brandão; Volf, Petr

    2016-03-17

    Leishmania infantum is the most widespread etiological agent of visceral leishmaniasis (VL) in the world, with significant mortality rates in human cases. In Latin America, this parasite is primarily transmitted by Lutzomyia longipalpis, but the role of Lutzomyia migonei as a potential vector for this protozoan has been discussed. Laboratory and field investigations have contributed to this hypothesis; however, proof of the vector competence of L. migonei has not yet been provided. In this study, we evaluate for the first time the susceptibility of L. migonei to L. infantum. Females of laboratory-reared L. migonei were fed through a chick-skin membrane on rabbit blood containing L. infantum promastigotes, dissected at 1, 5 and 8 days post-infection (PI) and checked microscopically for the presence, intensity and localisation of Leishmania infections. In addition, morphometric analysis of L. infantum promastigotes was performed. High infection rates of both L. infantum strains tested were observed in L. migonei, with colonisation of the stomodeal valve already on day 5 PI. At the late-stage infection, most L. migonei females had their cardia and stomodeal valve colonised by high numbers of parasites, and no significant differences were found compared to the development in L. longipalpis. Metacyclic forms were found in all parasite-vector combinations since day 5 PI. We propose that Lutzomyia migonei belongs to sand fly species permissive to various Leishmania spp. Here we demonstrate that L. migonei is highly susceptible to the development of L. infantum. This, together with its known anthropophily, abundance in VL foci and natural infection by L. infantum, constitute important evidence that L. migonei is another vector of this parasite in Latin America.

  6. The mothering of conduct problem and normal children in Spain and the USA: authoritarian and permissive asynchrony.

    Science.gov (United States)

    Wahler, Robert G; Cerezo, M Angeles

    2005-11-01

    Ninety-two clinic-referred and nonclinical mother-child dyads in Spain and the USA were observed in their home settings under naturalistic conditions for a total of 477 hours. Children in the clinic-referred dyads were considered troubled because of conduct problems. The observations were aimed at assessing two forms of mother-child asynchrony, either of which was expected to differentiate clinic referred from nonclinical dyads. Authoritarian asynchrony was defined as a mother's indiscriminate use of aversive reactions to her child, whereas the permissive form entailed indiscriminate positive reactions. Results showed the American mothers to generate more permissive asynchrony, whereas the Spanish mothers were inclined in the authoritarian direction. Only authoritarian asynchrony differentiated the clinical versus nonclinical dyads in each country. Discussion was centered on the greater salience of aversive as opposed to positive maternal attention, and cultural differences between countries that might have accounted for the different parenting styles.

  7. Patient engagement in the inpatient setting: a systematic review.

    Science.gov (United States)

    Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

    2014-01-01

    To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement ('self-efficacy', 'patient empowerment', 'patient activation', or 'patient engagement'), (2) involved health information technology ('technology', 'games', 'electronic health record', 'electronic medical record', or 'personal health record'), and (3) took place in the inpatient setting ('inpatient' or 'hospital'). Only English language studies were reviewed. 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Permissivity of the NCI-60 cancer cell lines to oncolytic Vaccinia Virus GLV-1h68

    International Nuclear Information System (INIS)

    Ascierto, Maria Libera; Bedognetti, Davide; Uccellini, Lorenzo; Rossano, Fabio; Ascierto, Paolo A; Stroncek, David F; Restifo, Nicholas P; Wang, Ena; Szalay, Aladar A; Marincola, Francesco M; Worschech, Andrea; Yu, Zhiya; Adams, Sharon; Reinboth, Jennifer; Chen, Nanhai G; Pos, Zoltan; Roychoudhuri, Rahul; Di Pasquale, Giovanni

    2011-01-01

    Oncolytic viral therapy represents an alternative therapeutic strategy for the treatment of cancer. We previously described GLV-1h68, a modified Vaccinia Virus with exclusive tropism for tumor cells, and we observed a cell line-specific relationship between the ability of GLV-1h68 to replicate in vitro and its ability to colonize and eliminate tumor in vivo. In the current study we surveyed the in vitro permissivity to GLV-1h68 replication of the NCI-60 panel of cell lines. Selected cell lines were also tested for permissivity to another Vaccinia Virus and a vesicular stomatitis virus (VSV) strain. In order to identify correlates of permissity to viral infection, we measured transcriptional profiles of the cell lines prior infection. We observed highly heterogeneous permissivity to VACV infection amongst the cell lines. The heterogeneity of permissivity was independent of tissue with the exception of B cell derivation. Cell lines were also tested for permissivity to another Vaccinia Virus and a vesicular stomatitis virus (VSV) strain and a significant correlation was found suggesting a common permissive phenotype. While no clear transcriptional pattern could be identified as predictor of permissivity to infection, some associations were observed suggesting multifactorial basis permissivity to viral infection. Our findings have implications for the design of oncolytic therapies for cancer and offer insights into the nature of permissivity of tumor cells to viral infection

  9. Leishmania major glycosylation mutants require phosphoglycans (lpg2- but not lipophosphoglycan (lpg1- for survival in permissive sand fly vectors.

    Directory of Open Access Journals (Sweden)

    Anna Svárovská

    2010-01-01

    Full Text Available Sand fly species able to support the survival of the protozoan parasite Leishmania have been classified as permissive or specific, based upon their ability to support a wide or limited range of strains and/or species. Studies of a limited number of fly/parasite species combinations have implicated parasite surface molecules in this process and here we provide further evidence in support of this proposal. We investigated the role of lipophosphoglycan (LPG and other phosphoglycans (PGs in sand fly survival, using Leishmania major mutants deficient in LPG (lpg1(-, and the phosphoglycan (PG-deficient mutant lpg2(-. The sand fly species used were the permissive species Phlebotomus perniciosus and P. argentipes, and the specific vector P. duboscqi, a species resistant to L. infantum development.The lpg2(- mutants did not survive well in any of the three sand fly species, suggesting that phosphoglycans and/or other LPG2-dependent molecules are required for parasite development. In vitro, all three L. major lines were equally resistant to proteolytic activity of bovine trypsin, suggesting that sand fly-specific hydrolytic proteases or other factors are the reason for the early lpg2(- parasite killing. The lpg1(- mutants developed late-stage infections in two permissive species, P. perniciosus and P. argentipes, where their infection rates and intensities of infections were comparable to the wild type (WT parasites. In contrast, in P. duboscqi the lpg1(- mutants developed significantly worse than the WT parasites.In combination with previous studies, the data establish clearly that LPG is not required for Leishmania survival in permissive species P. perniciosus and P. argentipes but plays an important role in the specific vector P. duboscqi. With regard to PGs other than LPG, the data prove the importance of LPG2-related molecules for survival of L. major in the three sand fly species tested.

  10. An Ethics of Permission: A Response to the California End of Life Option Act.

    Science.gov (United States)

    Nelson, Craig

    2016-01-01

    An ethics of permission can be helpful in framing a response to the ethical differences surrounding the California End of Life Option Act. Law does not define morality, and reaching a moral understanding demands thorough reflection. An ethics of permission examines the ethical demands of a permissive law for both clinician and patient. Serving the good of the patient, respecting professional conscience, and following the law are three ethical elements. Although developing an ethics of permission includes these three elements, these elements do not exhaust all the moral implications involved. An ethics of permission also includes the importance of exercising professional tolerance in the honoring of clinicians who choose to participate or refuse to participate. In addition, an ethics of permission also provides insight in implementing just and fair behavior among medical professionals.

  11. Medicare Current Beneficiary Survey - Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a representative national sample of the Medicare population. There are two...

  12. Is it morally permissible for hospital nurses to access prisoner-patients' criminal histories?

    Science.gov (United States)

    Neiman, Paul

    2016-01-01

    In the United States, information about a person's criminal history is accessible with a name and date of birth. Ruth Crampton has studied nurses' care for prisoner-patients in hospital settings and found care to be perfunctory and reactive. This article examines whether it is morally permissible for nurses in hospital settings to access information about prisoner-patients' criminal histories. Nurses may argue for a right to such information based on the right to personal safety at work or the obligation to provide prisoner-patients with the care that they deserve. These two arguments are considered and rejected. It is further argued that accessing information about a prisoner-patient's criminal history violates nurses' duty to care. Care, understood through Sarah Ruddick's account as work and relationship, requires nurses to be open and unbiased in order to do their part in forming a caring relationship with patients. Knowledge of a prisoner-patient's criminal history inhibits the formation of this relationship and thus violates nurses' duty to care.

  13. Testing of the permissible inventories in radioactive waste packages

    International Nuclear Information System (INIS)

    Stegmaier, W.

    1988-01-01

    The inventories of radionuclides in waste packages which are to be stored in repositories are determined in the Waste Acceptance Requirements of the repository and in the Act on Transport of Dangerous Goods. In this report limiting values of relevant radionuclides are given in such a way that it is possible to use them in a standardized manner. The limiting values apply to single radionuclides, for handling mixtures of nuclides it is necessary to use the sum formula. The minimized number of waste packages which must be produced from a given quantity of raw waste and an inventory of radionuclides keeping all parameters can be calculated with the help of the shown calculating sheet. (orig.) [de

  14. 17 CFR 230.433 - Conditions to permissible post-filing free writing prospectuses.

    Science.gov (United States)

    2010-04-01

    ... writing prospectus used at the same time as a communication in a business combination transaction subject... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Conditions to permissible post... Prospectuses § 230.433 Conditions to permissible post-filing free writing prospectuses. (a) Scope of section...

  15. 29 CFR 3.6 - Payroll deductions permissible with the approval of the Secretary of Labor.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Payroll deductions permissible with the approval of the Secretary of Labor. 3.6 Section 3.6 Labor Office of the Secretary of Labor CONTRACTORS AND SUBCONTRACTORS ON....6 Payroll deductions permissible with the approval of the Secretary of Labor. Any contractor or...

  16. 47 CFR 74.790 - Permissible service of digital TV translator and LPTV stations.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Permissible service of digital TV translator... DISTRIBUTIONAL SERVICES Low Power TV, TV Translator, and TV Booster Stations § 74.790 Permissible service of digital TV translator and LPTV stations. (a) Digital TV translator stations provide a means whereby the...

  17. Follow My Recommendations: A Personalized Privacy Assistant for Mobile App Permissions

    DEFF Research Database (Denmark)

    Andersen, Mads Schaarup; Liu, Bin; Schaub, Florian

    2016-01-01

    Modern smartphone platforms have millions of apps, many of which request permissions to access private data and resources, like user accounts or location. While these smartphone platforms provide varying degrees of control over these permissions, the sheer number of decisions that users are expec...

  18. Axiomatizations of Banzhaf Permisson Values for Games with a Hierarchical Permission Structure.

    NARCIS (Netherlands)

    van den Brink, J.R.

    2010-01-01

    In games with a permission structure it is assumed that players in a cooperative transferable utility game are hierarchically ordered in the sense that there are players that need permission from other players before they are allowed to cooperate. We provide axiomatic characterizations of Banzhaf

  19. Permissive Parenting and Mental Health in College Students: Mediating Effects of Academic Entitlement

    Science.gov (United States)

    Barton, Alison L.; Hirsch, Jameson K.

    2016-01-01

    Objective: Student mental health may suffer due to unreasonable expectations associated with academic entitlement; permissive parenting may be one source of these expectations. The authors examined the role of academic entitlement as a mediator of the relationship between permissive parenting and psychological functioning. Participants:…

  20. 36 CFR 223.12 - Permission to cut, damage, or destroy trees without advertisement.

    Science.gov (United States)

    2010-07-01

    ... destroy trees without advertisement. 223.12 Section 223.12 Parks, Forests, and Public Property FOREST... § 223.12 Permission to cut, damage, or destroy trees without advertisement. Permission may be granted to cut, damage, or destroy trees, portions of trees, or other forest products on National Forest System...

  1. 20 CFR 416.1321 - Suspension for not giving us permission to contact financial institutions.

    Science.gov (United States)

    2010-04-01

    ... contact financial institutions. 416.1321 Section 416.1321 Employees' Benefits SOCIAL SECURITY....1321 Suspension for not giving us permission to contact financial institutions. (a) If you don't give us permission to contact any financial institution and request any financial records about you when...

  2. MAK and BAT values list 2014. Maximum permissible concentrations at the place of work and biological tolerance values for working materials

    International Nuclear Information System (INIS)

    2014-01-01

    The book on the MAK (maximum permissible concentrations at the place of work) and BAT (biological tolerance values for working materials) value list 2014 includes the following chapters: (a) Maximum permissible concentrations at the place of work: definition, application and determination of MAT values, list of materials; carcinogenic working materials, sensibilizing working materials, aerosols, limiting the exposition peaks, skin resorption, MAK values during pregnancy, germ cell mutagens, specific working materials; (b) Biological tolerance values for working materials: definition and application of BAT values, list of materials, carcinogenic working materials, biological guide values, biological working material reference values.

  3. MAK and BAT values list 2015. Maximum permissible concentrations at the place of work and biological tolerance values for working materials

    International Nuclear Information System (INIS)

    2015-01-01

    The book on the MAK (maximum permissible concentrations at the place of work) and BAT (biological tolerance values for working materials) value list 2015 includes the following chapters: (a) Maximum permissible concentrations at the place of work: definition, application and determination of MAT values, list of materials; carcinogenic working materials, sensibilizing working materials, aerosols, limiting the exposition peaks, skin resorption, MAK values during pregnancy, germ cell mutagens, specific working materials; (b) Biological tolerance values for working materials: definition and application of BAT values, list of materials, carcinogenic working materials, biological guide values, biological working material reference values.

  4. The Significance of HIV ‘Blips’ in Resource-Limited Settings: Is It the Same? Analysis of the Treat Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD)

    Science.gov (United States)

    Kanapathipillai, Rupa; McManus, Hamish; Kamarulzaman, Adeeba; Lim, Poh Lian; Templeton, David J.; Law, Matthew; Woolley, Ian

    2014-01-01

    Introduction Magnitude and frequency of HIV viral load blips in resource-limited settings, has not previously been assessed. This study was undertaken in a cohort from a high income country (Australia) known as AHOD (Australian HIV Observational Database) and another cohort from a mixture of Asian countries of varying national income per capita, TAHOD (TREAT Asia HIV Observational Database). Methods Blips were defined as detectable VL (≥ 50 copies/mL) preceded and followed by undetectable VL (failure (VF) was defined as two consecutive VL ≥50 copies/ml. Cox proportional hazard models of time to first VF after entry, were developed. Results 5040 patients (AHOD n = 2597 and TAHOD n = 2521) were included; 910 (18%) of patients experienced blips. 744 (21%) and 166 (11%) of high- and middle/low-income participants, respectively, experienced blips ever. 711 (14%) experienced blips prior to virological failure. 559 (16%) and 152 (10%) of high- and middle/low-income participants, respectively, experienced blips prior to virological failure. VL testing occurred at a median frequency of 175 and 91 days in middle/low- and high-income sites, respectively. Longer time to VF occurred in middle/low income sites, compared with high-income sites (adjusted hazards ratio (AHR) 0.41; pfailure (p = 0.360 for blip 50–≤1000, p = 0.309 for blip 50–≤400 and p = 0.300 for blip 50–≤200). 209 of 866 (24%) patients were switched to an alternate regimen in the setting of a blip. Conclusion Despite a lower proportion of blips occurring in low/middle-income settings, no significant difference was found between settings. Nonetheless, a substantial number of participants were switched to alternative regimens in the setting of blips. PMID:24516527

  5. Usability of Security Management:Defining the Permissions of Guests

    Science.gov (United States)

    Johnson, Matthew; Stajano, Frank

    Within the scenario of a Smart Home, we discuss the issues involved in allowing limited interaction with the environment for unidentified principals, or guests. The challenges include identifying and authenticating guests on one hand and delegating authorization to them on the other. While the technical mechanisms for doing so in generic distributed systems have been around for decades, existing solutions are in general not applicable to the smart home because they are too complex to manage. We focus on providing both security and usability; we therefore seek simple and easy to understand approaches that can be used by a normal computer-illiterate home owner, not just by a trained system administrator. This position paper describes ongoing research and does not claim to have all the answers.

  6. Further European initiatives and regulations concerning radiation protection: drinking water guideline, maximum permissible contamination in food products and feeding stuff

    International Nuclear Information System (INIS)

    Mundigl, Stefan

    2013-01-01

    The radiation protection community has observed intensively the development of basic safety standards concerning protection against hazards of ionizing radiation. The new core part of the European radiation protection legislation is complemented by several specialized regulations relevant for radiation protection. Besides the existing regulations in the field of emergency protection the European Commission initiated a drinking water guideline that will be published in the near future. Furthermore the European commission approved a revised regulation concerning the maximum permissible contamination limits for food products and feeding stuff in case of a future nuclear accident. Together with the new radiation protection basic standards a new complete, coherent and modernized European regulation package will be accomplished.

  7. Can ‘Mobile Platform’ and ‘Permission Marketing’ dance a tango to the consumers' tune? Modeling adoption of ‘SMS based Permission Advertising’

    Directory of Open Access Journals (Sweden)

    Prerna Bamoriya

    2015-12-01

    Full Text Available Many a times situation of advertising clutter is further aggrieved by the markers’ intrusive practices i.e. not asking for consumer’s explicit permission. It results in consumers’ alienation and reduced advertising effectiveness. Solution could be integration of Permission Marketing with an innovative advertising platform like Mobile. This study aimed to develop and validate a comprehensive model for understanding consumers’ adoption behavior towards SMS Based Permission Advertising (SBPA. For this, data was collected using systematic random sampling from 524 respondents and was analyzed using Structural Equation Modeling. Study revealed some critical variables along with complex relationships among such variables, in form of an empirically validated model. At last, study made some important implications for practitioners and researchers.

  8. Assessment of a New Lower-Cost Real-Time PCR Assay for Detection of High-Risk Human Papillomavirus: Useful for Cervical Screening in Limited-Resource Settings?

    Science.gov (United States)

    Fokom Domgue, Joel; Schiffman, Mark; Wentzensen, Nicolas H; Gage, Julia C; Castle, Philip E; Raine-Bennett, Tina R; Fetterman, Barbara; Lorey, Thomas; Poitras, Nancy E; Befano, Brian; Xie, Yi; Miachon, Lais S; Dean, Michael

    2017-08-01

    Inexpensive and easy-to-perform human papillomavirus (HPV) tests are needed for primary cervical cancer screening in lower-resource regions. In a convenience sample of 516 residual exfoliative cervical specimens from the Kaiser Permanente Northern California and U.S. National Cancer Institute Persistence and Progression Study, we assessed the agreement and clinical performance of a simple, inexpensive real-time PCR assay for the detection of 13 carcinogenic HPV types (the H13 assay; Hybribio, Hong Kong) that is marketed in limited-resource settings compared to previous testing by the Hybrid Capture 2 assay (HC2; Qiagen, Germantown, MD) and the Onclarity assay (BD Diagnostics, Sparks, MD). The test set was chosen to include many HPV-positive specimens. The reference standard was a combination of HC2 and Onclarity results for HPV detection and histologic diagnosis of controls (less than cervical intraepithelial neoplasia grade 2 [limited-resource settings. Copyright © 2017 American Society for Microbiology.

  9. Covert medication in psychiatric emergencies: is it ever ethically permissible?

    Science.gov (United States)

    Hung, Erick K; McNiel, Dale E; Binder, Renée L

    2012-01-01

    Covert administration of medications to patients, defined as the administration of medication to patients without their knowledge, is a practice surrounded by clinical, legal, ethics-related, and cultural controversy. Many psychiatrists would be likely to advocate that the practice of covert medication in emergency psychiatry is not clinically, ethically, or legally acceptable. This article explores whether there may be exceptions to this stance that would be ethical. We first review the standard of emergency psychiatric care. Although we could identify no published empirical studies of covert administration of medicine in emergency departments, we review the prevalence of this practice in other clinical settings. While the courts have not ruled with respect to covert medication, we discuss the evolving legal landscape of informed consent, competency, and the right to refuse treatment. We discuss dilemmas regarding the ethics involved in this practice, including the tensions among autonomy, beneficence, and duty to protect. We explore how differences between cultures regarding the value placed on individual versus family autonomy may affect perspectives with regard to this practice. We investigate how consumers view this practice and their treatment preferences during a psychiatric emergency. Finally, we discuss psychiatric advance directives and explore how these contracts may affect the debate over the practice.

  10. Small Animal Models for Human Metapneumovirus: Cotton Rat is More Permissive than Hamster and Mouse

    Science.gov (United States)

    Zhang, Yu; Niewiesk, Stefan; Li, Jianrong

    2014-01-01

    Human metapneumovirus (hMPV) is the second most prevalent causative agent of pediatric respiratory infections worldwide. Currently, there are no vaccines or antiviral drugs against this virus. One of the major hurdles in hMPV research is the difficulty to identify a robust small animal model to accurately evaluate the efficacy and safety of vaccines and therapeutics. In this study, we compared the replication and pathogenesis of hMPV in BALB/c mice, Syrian golden hamsters, and cotton rats. It was found that BALB/c mice are not permissive for hMPV infection despite the use of a high dose (6.5 log10 PFU) of virus for intranasal inoculation. In hamsters, hMPV replicated efficiently in nasal turbinates but demonstrated only limited replication in lungs. In cotton rats, hMPV replicated efficiently in both nasal turbinate and lung when intranasally administered with three different doses (4, 5, and 6 log10 PFU) of hMPV. Lungs of cotton rats infected by hMPV developed interstitial pneumonia with mononuclear cells infiltrates and increased lumen exudation. By immunohistochemistry, viral antigens were detected at the luminal surfaces of the bronchial epithelial cells in lungs. Vaccination of cotton rats with hMPV completely protected upper and lower respiratory tract from wildtype challenge. The immunization also elicited elevated serum neutralizing antibody. Collectively, these results demonstrated that cotton rat is a robust small animal model for hMPV infection. PMID:25438015

  11. Resident alveolar macrophages are susceptible to and permissive of Coxiella burnetii infection.

    Directory of Open Access Journals (Sweden)

    Matthew Calverley

    Full Text Available Coxiella burnetii, the causative agent of Q fever, is a zoonotic disease with potentially life-threatening complications in humans. Inhalation of low doses of Coxiella bacteria can result in infection of the host alveolar macrophage (AM. However, it is not known whether a subset of AMs within the heterogeneous population of macrophages in the infected lung is particularly susceptible to infection. We have found that lower doses of both phase I and phase II Nine Mile C. burnetii multiply and are less readily cleared from the lungs of mice compared to higher infectious doses. We have additionally identified AM resident within the lung prior to and shortly following infection, opposed to newly recruited monocytes entering the lung during infection, as being most susceptible to infection. These resident cells remain infected up to twelve days after the onset of infection, serving as a permissive niche for the maintenance of bacterial infection. A subset of infected resident AMs undergo a distinguishing phenotypic change during the progression of infection exhibiting an increase in surface integrin CD11b expression and continued expression of the surface integrin CD11c. The low rate of phase I and II Nine Mile C. burnetii growth in murine lungs may be a direct result of the limited size of the susceptible resident AM cell population.

  12. A new model for deteriorating items with inflation under permissible delay in payments

    Directory of Open Access Journals (Sweden)

    R.P. Tripathi

    2014-05-01

    Full Text Available Inflation is an important factor influencing traditional economic order quality models. Marketing strategy depends on inflation due to public demand and availability of the materials. This paper presents an optimal inventory policy for deteriorating items using exponential demand rate under permissible delay in payments. Mathematical model has been derived under two cases: case I: cycle time is greater than or equal to permissible delay period, case II: cycle time is less than permissible delay period by considering holding cost as a function of time. Numerical examples and sensitivity analysis are given to reflect the numerical results. Mathematica software is used for finding optimal solutions.

  13. Eastern Caribbean Physicians' Responses to Providing HIV/AIDS Care in Resource-Limited Settings: We've Come a Long Way, but We're Not There Yet.

    Science.gov (United States)

    Reddock, Jennifer

    2016-09-01

    Physicians' ability to provide care to patients living with HIV/AIDS (PLWHA) in the Eastern Caribbean is influenced by economic constraints, sociocultural norms that govern interpersonal interactions, and the pervasive stigma linked to the disease. Although the economic environment determines national capacity to acquire various treatment and monitoring technologies, Eastern Caribbean physicians respond to practicing in a resource-limited setting by making choices that are influenced by the collectivist ethos that governs interpersonal relationships. Through qualitative interviews, the study finds that the social stigma associated with the disease requires physicians to "go the extra mile" to provide care in ways that allow PLWHA to protect their privacy in small, closely networked societies. © The Author(s) 2014.

  14. Is diabetes and hypertension screening worthwhile in resource-limited settings? An economic evaluation based on a pilot of a Package of Essential Non-communicable disease interventions in Bhutan.

    Science.gov (United States)

    Dukpa, Wangchuk; Teerawattananon, Yot; Rattanavipapong, Waranya; Srinonprasert, Varalak; Tongsri, Watsamon; Kingkaew, Pritaporn; Yothasamut, Jomkwan; Wangchuk, Dorji; Dorji, Tandin; Wangmo, Kinzang

    2015-10-01

    In response to a lack of cost-effective data on screening and early treatment of diabetes and hypertension in resource-limited settings, a model-based economic evaluation was performed on the World Health Organization (WHO)'s Package of Essential Non-communicable (PEN) disease interventions for primary health care in Bhutan. Both local and international data were applied in the model in order to derive lifetime costs and outcomes resulting from the early treatment of diabetes and hypertension. The results indicate that the current screening option (where people who are overweight, obese or aged 40 years or older who visit primary care facilities are screened for diabetes and hypertension) represents good value for money compared to 'no screening'. The study findings also indicate that expanding opportunistic screening (70% coverage of the target population) to universal screening (where 100% of the target population are screened), is likely to be even more cost-effective. From the sensitivity analysis, the value of the screening options remains the same when disease prevalence varies. Therefore, applying this model to other healthcare settings is warranted, since disease prevalence is one of the major factors in affecting the cost-effectiveness results of screening programs. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  15. Permissive parenting and mental health in college students: Mediating effects of academic entitlement.

    Science.gov (United States)

    Barton, Alison L; Hirsch, Jameson K

    2016-01-01

    Student mental health may suffer due to unreasonable expectations associated with academic entitlement; permissive parenting may be one source of these expectations. The authors examined the role of academic entitlement as a mediator of the relationship between permissive parenting and psychological functioning. Participants were 524 undergraduate students at a single institution (52% female; age range = 18-22). Data collection was completed in May 2011. Cross-sectional design. Participants completed online self-report measures of parenting styles, academic entitlement, stress, depressive symptoms, and well-being. Permissive parenting was associated with greater academic entitlement and, in turn, to more perceived stress and poorer mental health. Mother/father differences were found in some cases. Academic entitlement may partially explain why permissive parenting is detrimentally related to mental health for college students. Implications for academic affairs and counseling include helping students develop an appreciation of the role of self-regulation in college success.

  16. Exploring Permission-Induced Risk in Android Applications for Malicious Application Detection

    KAUST Repository

    Wang, Wei; Wang, Xing; Feng, Dawei; Liu, Jiqiang; Han, Zhen; Zhang, Xiangliang

    2014-01-01

    Android has been a major target of malicious applications (malapps). How to detect and keep the malapps out of the app markets is an ongoing challenge. One of the central design points of Android security mechanism is permission control

  17. Maximum permissible concentrations and negligible concentrations for antifouling substances. Irgarol 1051, dichlofluanid, ziram, chlorothalonil and TCMTB

    NARCIS (Netherlands)

    Wezel AP van; Vlaardingen P van; CSR

    2001-01-01

    This report presents maximum permissible concentrations and negligible concentrations that have been derived for various antifouling substances used as substitutes for TBT. Included here are Irgarol 1051, dichlofluanide, ziram, chlorothalonil and TCMTB.

  18. State-of-the-art literature review on permissive/protected left-turn control.

    Science.gov (United States)

    2013-06-01

    In spring 2010, the Illinois Department of Transportation initiated an areawide implementation to integrate the : flashing yellow arrow as the display for the left-turn permissive interval at more than 100 intersections operating : with protected/per...

  19. Assessment of permissible low-level releases of radionuclides into the marine environment

    International Nuclear Information System (INIS)

    Kryshev, I.I.; Sazykina, T.G.

    2002-01-01

    The subject of this paper is radio-ecological assessment of permissible low-level releases of radionuclides in sea waters ensuring the radiological protection of the human population, as well as marine biota. (author)

  20. Drug evaluation and the permissive principle: continuities and contradictions between standards and practices in antidepressant regulation.

    Science.gov (United States)

    Abraham, John; Davis, Courtney

    2009-08-01

    Pharmaceuticals are not permitted on to the market unless they are granted regulatory approval. The regulatory process is, therefore, crucial in whether or not a drug is widely prescribed. Regulatory agencies have developed standards of performance that pharmaceuticals are supposed to meet before entering the market. Regulation of technologies is often discussed by reference to the precautionary principle. In contrast, this paper develops the concept of the 'permissive principle' as a way of understanding the departure of regulators' practices from standards of drug efficacy to which regulatory agencies themselves subscribe. By taking a case study of antidepressant regulation in the UK and the USA, the mechanisms of permissive regulatory practices are examined. An STS methodology of both spatial (international) and temporal comparisons of regulatory practices with regulatory standards is employed to identify the nature and extent of the permissive regulation. It is found that the permissive principle was adopted by drug regulators in the UK and the USA, but more so by the former than the latter. Evidently, permissive regulation, which favours the commercial interests of the drug manufacturer, but is contrary to the interests of patients, may penetrate to the heart of regulatory science. On the other hand, permissive regulation of specific drugs should not be regarded as an inevitable result of marketing strategies and concomitant networks deployed by powerful pharmaceutical companies, because the extent of permissive regulation may vary according to the intra-institutional normative commitments of regulators to uphold their technical standards against the commercial interests of the manufacturer. Likely sociological factors that can account for such permissive regulatory practices are 'corporate bias', secrecy and excessive regulatory trust in the pharmaceutical industry in the UK, political expediency and ideological capture in the USA, combined in both countries

  1. Procedures for permission under atomic energy laws in the Federal Republic of Germany

    International Nuclear Information System (INIS)

    Kuhnt, D.

    1980-01-01

    The selection of proper locations by the enterprisers responsible for projects is usually accompanied in recent years by the active location policy of the state. The application for the permission of locations and projects shall be filed to one or more ministries of the province where the facilities are to be installed. The papers describing the projects, especially safety reports and summaries shall be attached to the applications. The applications shall be published on a bulletin of the government office or daily newspapers, and every person has access to the applications, the safety reports and the summaries for two months. When objections are lodged within the period, closed hearings are held to examine the protests with attendance of the objector, the enterpriser of the project and the government office which has joined the decision. Following the phase of public participation and after the confirmation of facts highly important to the decision, fact examination is carried out with cooperation of specialists by the government office authorized for permission. As a special feature of the procedures under Atomgesetz, the government office is not necessarily obliged to give permission considering the safety policy, even when the pre-requisites of permission are all fulfilled. In other respects, permission may be offered for each partial installation of the facilities and various stages of operation by particular administrative measures (partial permission). The experiences of past 20 years indicate the virtual defects of the laws applied, and the amendment is urgently required. (Okada, K.)

  2. Perceived realism moderates the relation between sexualized media consumption and permissive sexual attitudes in Dutch adolescents.

    Science.gov (United States)

    Baams, Laura; Overbeek, Geertjan; Dubas, Judith Semon; Doornwaard, Suzan M; Rommes, Els; van Aken, Marcel A G

    2015-04-01

    This study examined whether the development of sexualized media consumption and permissive sexual attitudes would be more strongly interrelated when adolescents perceived sexualized media images as highly realistic. We used data from a three-wave longitudinal sample of 444 Dutch adolescents aged 13-16 years at baseline. Results from parallel process latent growth modeling multigroup analyses showed that higher initial levels of sexualized media consumption were associated with higher initial level of permissive sexual attitudes. Moreover, increases of sexualized media consumption over time were associated with increases of permissive sexual attitudes over time. Considering the moderation by perceived realism, we found these effects only for those who perceived sexualized media as more realistic. Findings for male and female adolescents were similar except for the relations between initial levels and subsequent development. Among male adolescents who perceived sexualized media images to be realistic, higher initial levels of permissive sexual attitudes were related to subsequent less rapid development of sexualized media consumption. For male adolescents who perceived sexualized media to be less realistic, higher initial levels of sexualized media consumption were related to a subsequent less rapid development of permissive sexual attitudes. These relations were not found for female adolescents. Overall, our results suggest that, in male and female adolescents, those with a high level of perceived realism showed a correlated development of sexualized media consumption and permissive sexual attitudes. These findings point to a need for extended information on how to guide adolescents in interpreting and handling sexualized media in everyday life.

  3. Breakout Session: Fight for Your Right to Copy: How One Library Acquired the Copyright Permissions Service and Reduced Students’ Costs. Presented by Emily Riha, Copyright Permissions Coordinator, University of Minnesota.

    Directory of Open Access Journals (Sweden)

    Connie Strittmatter

    2018-02-01

    Full Text Available Emily Riha, Copyright Permissions Coordinator at the University of Minnesota, presented at the 2017 Kraemer Copyright Conference her experience when the process of securing copyright permissions moved from Printing Services to the University Libraries.

  4. Counting SET-free sets

    OpenAIRE

    Harman, Nate

    2016-01-01

    We consider the following counting problem related to the card game SET: How many $k$-element SET-free sets are there in an $n$-dimensional SET deck? Through a series of algebraic reformulations and reinterpretations, we show the answer to this question satisfies two polynomiality conditions.

  5. Decree No 90-222 of 9 March 1990 supplementing the general regulations on extractive industries set by Decree No 80-331 of 7 May 1980

    International Nuclear Information System (INIS)

    1990-03-01

    This Decree completes the transfer into national legislation of Euratom Directive No. 80-836 on radiation protection. It inserts in the General Regulations on extractive industries laid down by a Decree No. 80-331 of 1980 a Part 2 relating to environmental protection. Its provisions determine the annual permissible exposure limits to ionizing radiation during management of radioactive products, the monitoring of releases and the environment and the controls set up by the authorities [fr

  6. Suggested Safeguards and Limitations for Effective and Permissible Parenting Coordination (Facilitation or Case Management) in South Africa

    OpenAIRE

    Madelene (Leentjie) de Jong

    2015-01-01

    With the advent of the Children's Act 38 of 2005 greater emphasis was placed on the importance of both parents' involvement in their children's day-to-day lives. An unintended negative consequence of an otherwise laudable shift in social policy which supported a shared parental involvement was that the courts became the forum for co-parents to dispute a lot of day-to-day issues in respect of their children. To alleviate the negative effects of high-conflict co-parenting cases on our court sys...

  7. Wild Anopheles funestus mosquito genotypes are permissive for infection with the rodent malaria parasite, Plasmodium berghei.

    Directory of Open Access Journals (Sweden)

    Jiannong Xu

    Full Text Available Malaria parasites undergo complex developmental transitions within the mosquito vector. A commonly used laboratory model for studies of mosquito-malaria interaction is the rodent parasite, P. berghei. Anopheles funestus is a major malaria vector in sub-Saharan Africa but has received less attention than the sympatric species, Anopheles gambiae. The imminent completion of the A. funestus genome sequence will provide currently lacking molecular tools to describe malaria parasite interactions in this mosquito, but previous reports suggested that A. funestus is not permissive for P. berghei development.An A. funestus population was generated in the laboratory by capturing female wild mosquitoes in Mali, allowing them to oviposit, and rearing the eggs to adults. These F1 progeny of wild mosquitoes were allowed to feed on mice infected with a fluorescent P. berghei strain. Fluorescence microscopy was used to track parasite development inside the mosquito, salivary gland sporozoites were tested for infectivity to mice, and parasite development in A. funestus was compared to A. gambiae.P. berghei oocysts were detectable on A. funestus midguts by 7 days post-infection. By 18-20 days post-infection, sporozoites had invaded the median and distal lateral lobes of the salivary glands, and hemocoel sporozoites were observed in the hemolymph. Mosquitoes were capable of infecting mice via bite, demonstrating that A. funestus supports the complete life cycle of P. berghei. In a random sample of wild mosquito genotypes, A. funestus prevalence of infection and the characteristics of parasite development were similar to that observed in A. gambiae-P. berghei infections.The data presented in this study establish an experimental laboratory model for Plasmodium infection of A. funestus, an important vector of human malaria. Studying A. funestus-Plasmodium interactions is now feasible in a laboratory setting. This information lays the groundwork for exploitation of the

  8. The link between maternal sleep and permissive parenting during late adolescence.

    Science.gov (United States)

    Tu, Kelly M; Elmore-Staton, Lori; Buckhalt, Joseph A; El-Sheikh, Mona

    2018-03-05

    Utilizing a multi-method design, the present study examined the association between maternal sleep, assessed via actigraphy and self-reports, and permissive parenting (e.g. lax, inconsistent discipline) during adolescence, as well as the extent to which this association differed by mothers' race/ethnicity and socioeconomic status. The sample was comprised of 234 mothers (M age = 41.76 years, SD = 6.25; 67% European-American, 31% African-American, 2% other race/ethnicities) and 237 adolescents (113 boys, 124 girls; M age = 15.80 years, SD = 0.80; 66% European-American, 34% African-American). Mothers' sleep duration (actual sleep minutes) and quality (sleep efficiency, latency, long wake episodes) were assessed using actigraphy. Mothers also reported on their sleep problems and adolescents reported on mothers' permissive parenting behaviours. Results revealed that actigraphy-based longer sleep duration and shorter sleep latency were associated with lower levels of permissive parenting. Further, mothers' race/ethnicity and socioeconomic status moderated the association between actigraphy-based sleep quality (i.e. sleep efficiency, long wake episodes) and permissive parenting. Specifically, a negative association between sleep efficiency and permissive parenting was evident only for African-American mothers. In addition, a positive association between more frequent night wakings and permissive parenting was evident only for mothers from lower socioeconomic status households. The findings highlight the benefits of longer and higher-quality sleep for reducing the risk of permissive parenting, especially among ethnic minority mothers and mothers from lower socioeconomic status households. © 2018 European Sleep Research Society.

  9. A Dynamic Operation Permission Technique Based on an MFM Model and Numerical Simulation

    International Nuclear Information System (INIS)

    Akio, Gofuku; Masahiro, Yonemura

    2011-01-01

    It is important to support operator activities to an abnormal plant situation where many counter actions are taken in relatively short time. The authors proposed a technique called dynamic operation permission to decrease human errors without eliminating creative idea of operators to cope with an abnormal plant situation by checking if the counter action taken is consistent with emergency operation procedure. If the counter action is inconsistent, a dynamic operation permission system warns it to operators. It also explains how and why the counter action is inconsistent and what influence will appear on the future plant behavior by a qualitative influence inference technique based on a model by the Mf (Multilevel Flow Modeling). However, the previous dynamic operation permission is not able to explain quantitative effects on plant future behavior. Moreover, many possible influence paths are derived because a qualitative reasoning does not give a solution when positive and negative influences are propagated to the same node. This study extends the dynamic operation permission by combining the qualitative reasoning and the numerical simulation technique. The qualitative reasoning based on an Mf model of plant derives all possible influence propagation paths. Then, a numerical simulation gives a prediction of plant future behavior in the case of taking a counter action. The influence propagation that does not coincide with the simulation results is excluded from possible influence paths. The extended technique is implemented in a dynamic operation permission system for an oil refinery plant. An MFM model and a static numerical simulator are developed. The results of dynamic operation permission for some abnormal plant situations show the improvement of the accuracy of dynamic operation permission and the quality of explanation for the effects of the counter action taken

  10. The REVAMP trial to evaluate HIV resistance testing in sub-Saharan Africa: a case study in clinical trial design in resource limited settings to optimize effectiveness and cost effectiveness estimates.

    Science.gov (United States)

    Siedner, Mark J; Bwana, Mwebesa B; Moosa, Mahomed-Yunus S; Paul, Michelle; Pillay, Selvan; McCluskey, Suzanne; Aturinda, Isaac; Ard, Kevin; Muyindike, Winnie; Moodley, Pravikrishnen; Brijkumar, Jaysingh; Rautenberg, Tamlyn; George, Gavin; Johnson, Brent; Gandhi, Rajesh T; Sunpath, Henry; Marconi, Vincent C

    2017-07-01

    In sub-Saharan Africa, rates of sustained HIV virologic suppression remain below international goals. HIV resistance testing, while common in resource-rich settings, has not gained traction due to concerns about cost and sustainability. We designed a randomized clinical trial to determine the feasibility, effectiveness, and cost-effectiveness of routine HIV resistance testing in sub-Saharan Africa. We describe challenges common to intervention studies in resource-limited settings, and strategies used to address them, including: (1) optimizing generalizability and cost-effectiveness estimates to promote transition from study results to policy; (2) minimizing bias due to patient attrition; and (3) addressing ethical issues related to enrollment of pregnant women. The study randomizes people in Uganda and South Africa with virologic failure on first-line therapy to standard of care virologic monitoring or immediate resistance testing. To strengthen external validity, study procedures are conducted within publicly supported laboratory and clinical facilities using local staff. To optimize cost estimates, we collect primary data on quality of life and medical resource utilization. To minimize losses from observation, we collect locally relevant contact information, including Whatsapp account details, for field-based tracking of missing participants. Finally, pregnant women are followed with an adapted protocol which includes an increased visit frequency to minimize risk to them and their fetuses. REVAMP is a pragammatic randomized clinical trial designed to test the effectiveness and cost-effectiveness of HIV resistance testing versus standard of care in sub-Saharan Africa. We anticipate the results will directly inform HIV policy in sub-Saharan Africa to optimize care for HIV-infected patients.

  11. Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension.

    Science.gov (United States)

    Duchesne, Juan C; Kaplan, Lewis J; Balogh, Zsolt J; Malbrain, Manu L N G

    2015-01-01

    Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search. The recognition of the association between the development of ACS and resuscitation urged the need for new approach in traumatic shock management. Over a decade after wide spread application of damage control surgery damage control resuscitation was developed. DCR differs from previous resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like acidosis and hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle'. Permissive hypotension involves keeping the blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive crystalloid resuscitation have been described. Limitation of fluid intake by using colloids, hypertonic saline (HTS) or hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and electrolytes with or without protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic inflammation failing

  12. A single-blinded randomised clinical trial of permissive underfeeding in patients requiring parenteral nutrition.

    Science.gov (United States)

    Owais, Anwar Elias; Kabir, Syed Irfan; Mcnaught, Clare; Gatt, Marcel; MacFie, John

    2014-12-01

    The importance of adequate nutritional support is well established, but characterising what 'adequate nutrition' represents remains contentious. In recent years there has been increasing interest in the concept of 'permissive underfeeding' where patients are intentionally prescribed less nutrition than their calculated requirements. The aim of this study was to evaluate the effect of permissive underfeeding on septic and nutrition related morbidity in patients requiring short term parenteral nutrition (PN). This was a single-blinded randomised clinical trial of 50 consecutive patients requiring parenteral nutritional support. Patients were randomized to receive either normocaloric or hypocaloric feeding (respectively 100% vs. 60% of estimated requirements). The primary end point was septic complications. Secondary end points included the metabolic, physiological and clinical outcomes to the two feeding protocols. Permissive underfeeding was associated with fewer septic complications (3 vs. 12 patients; p = 0.003), and a lower incidence of the systemic inflammatory response syndrome (9 vs. 16 patients; p = 0.017). Permissively underfed patients had fewer feed related complications (2 vs. 9 patients; p = 0.016). Permissive underfeeding in patients requiring short term PN appears to be safe and may results in reduced septic and feed-related complications. NCT01154179 TRIAL REGISTRY: http://clinicaltrials.gov/ct2/show/NCT01154179. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  13. Evaluation of a Rapid One-step Real-time PCR Method as a High-throughput Screening for Quantification of Hepatitis B Virus DNA in a Resource-limited Setting.

    Science.gov (United States)

    Rashed-Ul Islam, S M; Jahan, Munira; Tabassum, Shahina

    2015-01-01

    Virological monitoring is the best predictor for the management of chronic hepatitis B virus (HBV) infections. Consequently, it is important to use the most efficient, rapid and cost-effective testing systems for HBV DNA quantification. The present study compared the performance characteristics of a one-step HBV polymerase chain reaction (PCR) vs the two-step HBV PCR method for quantification of HBV DNA from clinical samples. A total of 100 samples consisting of 85 randomly selected samples from patients with chronic hepatitis B (CHB) and 15 samples from apparently healthy individuals were enrolled in this study. Of the 85 CHB clinical samples tested, HBV DNA was detected from 81% samples by one-step PCR method with median HBV DNA viral load (VL) of 7.50 × 10 3 lU/ml. In contrast, 72% samples were detected by the two-step PCR system with median HBV DNA of 3.71 × 10 3 lU/ml. The one-step method showed strong linear correlation with two-step PCR method (r = 0.89; p Tabassum S. Evaluation of a Rapid One-step Real-time PCR Method as a High-throughput Screening for Quantification of Hepatitis B Virus DNA in a Resource-limited Setting. Euroasian J Hepato-Gastroenterol 2015;5(1):11-15.

  14. Rate of accumulation of thymidine analogue mutations in patients continuing to receive virologically failing regimens containing zidovudine or stavudine: implications for antiretroviral therapy programs in resource-limited settings

    DEFF Research Database (Denmark)

    Cozzi-Lepri, Alessandro; Phillips, Andrew N; Martinez-Picado, Javier

    2009-01-01

    BACKGROUND: Because changes in antiretroviral therapy in resource-limited settings (RLSs) are delayed until patients experience immunological or clinical failure, it is important to be able to estimate the consequences in terms of accumulation of thymidine analogue (TA) mutations (TAMs). METHODS...... until the second GRT. RESULTS: At the time of the first GRT in a pair (t0), 1 year after virological failure, a median of 3 TAMs were detected, mutations 41L and 215Y in 65% of pairs and 67N in 52%. Overall, 126 TAMs were accumulated during 548 person-years of follow-up (PYFUs) (1/4.3 years; 95......% confidence interval, 3.7-5.0 years). Greater predicted activity of the TA at t0, TAM profile 2 (TAM2; vs TAM profile 1 [TAM1]) profiles at t0, use of a nonnucleoside reverse-transcriptase inhibitor (NNRTI) at t0 (vs combined NNRTI and protease inhibitor), and acquisition of HIV infection through heterosexual...

  15. Diesel Engine Exhaust: Basis for Occupational Exposure Limit Value.

    Science.gov (United States)

    Taxell, Piia; Santonen, Tiina

    2017-08-01

    Diesel engines are widely used in transport and power supply, making occupational exposure to diesel exhaust common. Both human and animal studies associate exposure to diesel exhaust with inflammatory lung effects, cardiovascular effects, and an increased risk of lung cancer. The International Agency for Research on Cancer has evaluated diesel exhaust as carcinogenic to humans. Yet national or regional limit values for controlling occupational exposure to diesel exhaust are rare. In recent decades, stricter emission regulations have led to diesel technologies evolving significantly, resulting in changes in exhaust emissions and composition. These changes are also expected to influence the health effects of diesel exhaust. This review provides an overview of the current knowledge on the health effects of diesel exhaust and the influence of new diesel technologies on the health risk. It discusses the relevant exposure indicators and perspectives for setting occupational exposure limit values for diesel exhaust, and outlines directions for future research. The review is based on a collaborative evaluation report by the Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals and the Dutch Expert Committee on Occupational Safety. © The Author 2017. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  16. Automatic sets and Delone sets

    International Nuclear Information System (INIS)

    Barbe, A; Haeseler, F von

    2004-01-01

    Automatic sets D part of Z m are characterized by having a finite number of decimations. They are equivalently generated by fixed points of certain substitution systems, or by certain finite automata. As examples, two-dimensional versions of the Thue-Morse, Baum-Sweet, Rudin-Shapiro and paperfolding sequences are presented. We give a necessary and sufficient condition for an automatic set D part of Z m to be a Delone set in R m . The result is then extended to automatic sets that are defined as fixed points of certain substitutions. The morphology of automatic sets is discussed by means of examples

  17. Maternal risk factors in fetal alcohol syndrome: provocative and permissive influences.

    Science.gov (United States)

    Abel, E L; Hannigan, J H

    1995-01-01

    We present an hypothesis integrating epidemiological, clinical case, and basic biomedical research to explain why only relatively few women who drink alcohol during pregnancy give birth to children with alcohol-related birth defects (ARBDs), in particular, Fetal Alcohol Syndrome (FAS). We argue that specific sociobehavioral risk factors, e.g., low socioeconomic status, are permissive for FAS in that they provide the context for increased vulnerability. We illustrate how these permissive factors are related to biological factors, e.g., decreased antioxidant status, which in conjunction with alcohol, provoke FAS/ARBDs in vulnerable fetuses. We propose an integrative heuristic model hypothesizing that these permissive and provocative factors increase the likelihood of FAS/ARBDs because they potentiate two related mechanisms of alcohol-induced teratogenesis, specifically, maternal/fetal hypoxia and free radical formation.

  18. WifiLeaks: Underestimated Privacy Implications of the ACCESS_WIFI_STATE Android Permission

    OpenAIRE

    Achara , Jagdish Prasad; Cunche , Mathieu; Roca , Vincent; Francillon , Aurélien

    2014-01-01

    A short version has been accepted for publication in: 7th ACM Conference on Security and Privacy in Wireless and Mobile Networks (WISEC'14) Oxford, United Kingdom, July 23rd -- 25th 2014; On Android, users can choose to install an application, or not, based on the permissions it requests. These permissions are later enforced on the application by the system, e.g., when accessing sensitive user data. In this work, we focus on the access to Wi-Fi related information, which is protected by the A...

  19. Subdissociative intranasal ketamine plus standard pain therapy versus standard pain therapy in the treatment of paediatric sickle cell disease vaso-occlusive crises in resource-limited settings: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Young, James R; Sawe, Hendry Robert; Mfinanga, Juma A; Nshom, Ernest; Helm, Ethan; Moore, Charity G; Runyon, Michael S; Reynolds, Stacy L

    2017-07-10

    Pediatric sickle cell disease, highly prevalent in sub-Saharan Africa, carries great morbidity and mortality risk. Limited resources and monitoring make management of acute vaso-occlusive crises challenging. This study aims to evaluate the efficacy and safety of subdissociative intranasal ketamine as a cheap, readily available and easily administered adjunct to standard pain therapy. We hypothesise that subdissociative, intranasal ketamine may significantly augment current approaches to pain management in resource-limited settings in a safe and cost-effective manner. This is a multicentred, randomised, double-blind, placebo-controlled trial enrolling children 4-16 years of age with sickle cell disease and painful vaso-occlusive pain crises. Study sites include two sub-Saharan teaching and referral hospitals with acute intake areas. All patients receive standard analgesic therapy during evaluation. Patients randomised to the treatment arm receive 1 mg/kg intranasal ketamine at onset of therapy, while placebo arm participants receive volume-matched intranasal normal saline. All participants and clinical staff are blinded to the treatment allocation. Data will be analysed on an intention-to-treat basis. Primary endpoints are changes in self-report pain scales (Faces Pain Scale-Revised) at 30, 60 and 120 minutes and rates of adverse events. Secondary endpoints include hospital length of stay, total analgesia use and quality of life assessment 2-3 weeks postintervention. The research methods for this study have been approved by the Cameroon Baptist Convention Health Board Institutional Review Board (IRB2015-07), the Tanzanian National Institute for Medical Research (NIMR/HQ/R.8a/Vol. IX/2299), Muhimbili National Hospital IRB (MNH/IRB/I/2015/14) and the Tanzanian Food and Drugs Authority (TFDA0015/CTR/0015/9). Data reports will be provided to the Data and Safety Monitoring Board (DSMB) periodically throughout the study as well as all reports of adverse events. All

  20. Social Set Analysis

    DEFF Research Database (Denmark)

    Vatrapu, Ravi; Mukkamala, Raghava Rao; Hussain, Abid

    2016-01-01

    , conceptual and formal models of social data, and an analytical framework for combining big social data sets with organizational and societal data sets. Three empirical studies of big social data are presented to illustrate and demonstrate social set analysis in terms of fuzzy set-theoretical sentiment...... automata and agent-based modeling). However, when it comes to organizational and societal units of analysis, there exists no approach to conceptualize, model, analyze, explain, and predict social media interactions as individuals' associations with ideas, values, identities, and so on. To address...... analysis, crisp set-theoretical interaction analysis, and event-studies-oriented set-theoretical visualizations. Implications for big data analytics, current limitations of the set-theoretical approach, and future directions are outlined....

  1. Global trends in antiretroviral resistance in treatment-naive individuals with HIV after rollout of antiretroviral treatment in resource-limited settings: a global collaborative study and meta-regression analysis.

    Science.gov (United States)

    Gupta, Ravindra K; Jordan, Michael R; Sultan, Binta J; Hill, Andrew; Davis, Daniel H J; Gregson, John; Sawyer, Anthony W; Hamers, Raph L; Ndembi, Nicaise; Pillay, Deenan; Bertagnolio, Silvia

    2012-10-06

    The emergence and spread of high levels of HIV-1 drug resistance in resource-limited settings where combination antiretroviral treatment has been scaled up could compromise the effectiveness of national HIV treatment programmes. We aimed to estimate changes in the prevalence of HIV-1 drug resistance in treatment-naive individuals with HIV since initiation of rollout in resource-limited settings. We did a systematic search for studies and conference abstracts published between January, 2001, and July, 2011, and included additional data from the WHO HIV drug resistance surveillance programme. We assessed the prevalence of drug-resistance mutations in untreated individuals with respect to time since rollout in a series of random-effects meta-regression models. Study-level data were available for 26,102 patients from sub-Saharan Africa, Asia, and Latin America. We recorded no difference between chronic and recent infection on the prevalence of one or more drug-resistance mutations for any region. East Africa had the highest estimated rate of increase at 29% per year (95% CI 15 to 45; p=0·0001) since rollout, with an estimated prevalence of HIV-1 drug resistance at 8 years after rollout of 7·4% (4·3 to 12·7). We recorded an annual increase of 14% (0% to 29%; p=0·054) in southern Africa and a non-significant increase of 3% (-0·9 to 16; p=0·618) in west and central Africa. There was no change in resistance over time in Latin America, and because of much country-level heterogeneity the meta-regression analysis was not appropriate for Asia. With respect to class of antiretroviral, there were substantial increases in resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) in east Africa (36% per year [21 to 52]; pAfrica (23% per year [7 to 42]; p=0·0049). No increase was noted for the other drug classes in any region. Our findings suggest a significant increase in prevalence of drug resistance over time since antiretroviral rollout in regions of sub

  2. Permissiveness toward divorce : The influence of divorce experiences in three social contexts

    NARCIS (Netherlands)

    Sieben, I.J.P.; Verbakel, C.M.C.

    2013-01-01

    In this study, we assess whether divorce experiences in three social contexts shape individual’s permissiveness toward divorce. Using European Values Study data from 44 countries, we find that—net of personal divorce experience—parental divorce before the age of 18 (socialization context); parental

  3. Permissiveness toward divorce: The influence of divorce experiences in three social contexts

    NARCIS (Netherlands)

    Sieben, I.J.P.; Verbakel, C.M.C.

    2013-01-01

    In this study, we assess whether divorce experiences in three social contexts shape individual’s permissiveness toward divorce. Using European Values Study data from 44 countries, we find that—net of personal divorce experience—parental divorce before the age of 18 (socialization context); parental

  4. The study on the adaptation for regulation - the permission of a radioisotope

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byoung Il; Choi, Won Seok; Jung, Yong Moon [Gallup Korea, Seoul (Korea, Republic of)

    2003-08-15

    The restriction -the permission of a radioisotope keeps satisfaction with almost parts for example, awareness, observance and so on. Moreover two concepts are considered fully -too strict about certain specific control rules and needed more discriminated application standards to each organization related to KINS, it's preserved and controlled properly even if the penalties are downsized.

  5. Student Learning with Permissive and Restrictive Cell Phone Policies: A Classroom Experiment

    Science.gov (United States)

    Lancaster, Alexander L.

    2018-01-01

    Based on Finn and Ledbetter's (2013; 2014) work regarding classroom technology policies, this experimental study examined the implementation of a permissive and a restrictive cellular phone policy and the effect of these policies on students' cognitive and affective learning in two sections of a public speaking course. College students (N = 31)…

  6. 34 CFR 222.194 - Are “in-kind” contributions permissible?

    Science.gov (United States)

    2010-07-01

    .... (b) Third party in-kind contributions mean property or services that benefit this grant program and... indirect costs, the provisions of 34 CFR 80.24 govern the allowability and valuation of in-kind contributions, except that it is permissible for a third party to contribute real property to a grantee for a...

  7. Corruption and the Other(s): Scope of Superordinate Identity Matters for Corruption Permissibility.

    Science.gov (United States)

    Pisor, Anne C; Gurven, Michael

    2015-01-01

    The decision to engage in corruption-public and private corruption, nepotism, and embezzlement-is often attributed to rational actors maximizing benefits to themselves. However, the importance of reciprocal relationships in humans suggests that an actor may weigh the costs of harms of her corrupt behavior to individuals who may generate future benefits for her. We hypothesize that actors who have a larger circle of actual and potential social partners will have more individuals to consider when generating harms and will thus be less likely to find corrupt acts permissible than actors with smaller circles of valued others. Using data from the World Values Survey and European Values Study (WVS), we explore whether participants with a larger geographic identity or a greater number of group memberships (i.e. a larger scope of actual and potential social partners) are less likely to find accepting bribes permissible. We find mixed support for our hypotheses, but consistently find that WVS participants with local, country, continent, or world geographic identities are less likely to find accepting a bribe permissible than those with regional identities-that is, actors whose primary identities that encompass more than their region find corruption less permissible. We discuss the importance of considering an actor's valuation of others when modeling corruption persistence, noting that establishing scopes of positive valuation is a precursor to predicting where actors will target benefits and shunt costs.

  8. 17 CFR 240.12f-1 - Applications for permission to reinstate unlisted trading privileges.

    Science.gov (United States)

    2010-04-01

    ... reinstate unlisted trading privileges. 240.12f-1 Section 240.12f-1 Commodity and Securities Exchanges... Rules and Regulations Under the Securities Exchange Act of 1934 Unlisted Trading § 240.12f-1 Applications for permission to reinstate unlisted trading privileges. (a) An application to reinstate unlisted...

  9. 12 CFR 714.2 - What are the permissible leasing arrangements?

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false What are the permissible leasing arrangements? 714.2 Section 714.2 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING... leasing. In direct leasing, you purchase personal property from a vendor, becoming the owner of the...

  10. 30 CFR 75.504 - Permissibility of new, replacement, used, reconditioned, additional, and rebuilt electric face...

    Science.gov (United States)

    2010-07-01

    ... STANDARDS-UNDERGROUND COAL MINES Electrical Equipment-General § 75.504 Permissibility of new, replacement... new, replacement, used, reconditioned, and additional electric face equipment used in any mine..., unless in the opinion of the Secretary, such equipment or necessary replacement parts are not available...

  11. 49 CFR 350.319 - What are permissible uses of High Priority Activity Funds?

    Science.gov (United States)

    2010-10-01

    ... Activity Funds? 350.319 Section 350.319 Transportation Other Regulations Relating to Transportation... permissible uses of High Priority Activity Funds? (a) The FMCSA may generally use these funds to support, enrich, or evaluate State CMV safety programs and to accomplish the five objectives listed below: (1...

  12. Guidance document on the derivation of maximum permissible risk levels for human intake of soil contaminants

    NARCIS (Netherlands)

    Janssen PJCM; Speijers GJA; CSR

    1997-01-01

    This report contains a basic step-to-step description of the procedure followed in the derivation of the human-toxicological Maximum Permissible Risk (MPR ; in Dutch: Maximum Toelaatbaar Risico, MTR) for soil contaminants. In recent years this method has been applied for a large number of compounds

  13. Android Application Install-time Permission Validation and Run-time Malicious Pattern Detection

    OpenAIRE

    Ma, Zhongmin

    2014-01-01

    The open source structure of Android applications introduces security vulnerabilities that can be readily exploited by third-party applications. We address certain vulnerabilities at both installation and runtime using machine learning. Effective classification techniques with neural networks can be used to verify the application categories on installation. We devise a novel application category verification methodology that involves machine learning the application permissions...

  14. AN OPTIMAL REPLENISHMENT POLICY FOR DETERIORATING ITEMS WITH RAMP TYPE DEMAND UNDER PERMISSIBLE DELAY IN PAYMENTS

    Directory of Open Access Journals (Sweden)

    Dr. Sanjay Jain

    2010-10-01

    Full Text Available The aim of this paper is to develop an optimal replenishment policy for inventory models of deteriorating items with ramp type demand under permissible delay in payments. Deterioration of items begins on their arrival in stock.  An example is also presented to illustrate the application of developed model.

  15. Early alcohol use with parental permission: Psychosocial characteristics and drinking in late adolescence.

    Science.gov (United States)

    Colder, Craig R; Shyhalla, Kathleen; Frndak, Seth E

    2018-01-01

    The earliest experiences with alcohol for many children occur in the family context with parental supervision. The current study examined individual and sociocultural characteristics associated with early (prior to age 13years) sipping and tasting alcohol with parental permission in two longitudinal community samples. Early sipping/tasting was also tested as a predictor of frequency and quantity of alcohol use, and alcohol-related problems seven years later in late adolescence. Early sipping/tasting with parental permission was associated with a sociocultural context supportive of alcohol use (e.g., parental alcohol use, permissive rules about alcohol use in the home, parental attitudes about underage drinking, perceived peer norms), adolescent sensation seeking and disinhibition (e.g., surgency, externalizing behavior) and appraisals of alcohol (negative outcome expectancies and negative implicit alcohol associations). Early sipping/tasting predicted increased frequency and quantity of alcohol consumption, and increased alcohol-related problems in late adolescence, even after controlling sociocultural and individual difference variables. Findings suggest that early sipping/tasting with parental permission is not benign and is a viable target for preventive interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. A cash flow oriented EOQ model under permissible delay in payments

    African Journals Online (AJOL)

    A cash flow oriented EOQ model under permissible delay in payments. RP Tripathi, SS Misra, HS Shukla. Abstract. This study presents an inventory model to determine an optimal ordering policy for non-deteriorating items and timedependent demand rate with delay in payments permitted by the supplier under inflation and ...

  17. 77 FR 17367 - Permissible Sharing of Client Records by Customs Brokers

    Science.gov (United States)

    2012-03-26

    ...-0038] RIN 1651-AA80 Permissible Sharing of Client Records by Customs Brokers AGENCY: U.S. Customs and... would allow brokers, upon the client's consent in a written authorization, to share client information... services to the broker's clients. Although the proposed rule was prepared in response to a request from a...

  18. 75 FR 66050 - Permissible Sharing of Client Records by Customs Brokers

    Science.gov (United States)

    2010-10-27

    .... USCBP-2010-0038] RIN 1651-AA80 Permissible Sharing of Client Records by Customs Brokers AGENCIES... the Code of Federal Regulations (CFR) pertaining to the obligations of customs brokers to keep clients' information confidential. The proposed amendment would allow brokers, upon the client's consent in a written...

  19. 36 CFR 223.7 - Permission for free use of timber outside free-use areas.

    Science.gov (United States)

    2010-07-01

    ..., DEPARTMENT OF AGRICULTURE SALE AND DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER General Provisions § 223.7 Permission for free use of timber outside free-use areas. Similar material may be cut outside of a free-use area without permit in cases of emergency, but the person taking such material shall promptly notify...

  20. 26 CFR 1.414(w)-1 - Permissible withdrawals from eligible automatic contribution arrangements.

    Science.gov (United States)

    2010-04-01

    ... contribution arrangements. 1.414(w)-1 Section 1.414(w)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Plans, Etc. § 1.414(w)-1 Permissible withdrawals from eligible automatic contribution arrangements. (a) Overview. Section 414(w) provides rules under which certain employees are permitted to elect to make a...

  1. Maximum Permissible Risk Levels for Human Intake of Soil Contaminants: Fourth Series of Compounds

    NARCIS (Netherlands)

    Janssen PJCM; Apeldoorn ME van; Engelen JGM van; Schielen PCJI; Wouters MFA; CSR

    1998-01-01

    This report documents the human-toxicological risk assessment work done in 1996 and 1997 at RIVM's Centre for Substances and Risk Assessment within the scope of the RIVM project on soil intervention values for soil clean-up. The method used for derivation of the Maximum Permissible Risk, as

  2. Corruption and the Other(s: Scope of Superordinate Identity Matters for Corruption Permissibility.

    Directory of Open Access Journals (Sweden)

    Anne C Pisor

    Full Text Available The decision to engage in corruption-public and private corruption, nepotism, and embezzlement-is often attributed to rational actors maximizing benefits to themselves. However, the importance of reciprocal relationships in humans suggests that an actor may weigh the costs of harms of her corrupt behavior to individuals who may generate future benefits for her. We hypothesize that actors who have a larger circle of actual and potential social partners will have more individuals to consider when generating harms and will thus be less likely to find corrupt acts permissible than actors with smaller circles of valued others. Using data from the World Values Survey and European Values Study (WVS, we explore whether participants with a larger geographic identity or a greater number of group memberships (i.e. a larger scope of actual and potential social partners are less likely to find accepting bribes permissible. We find mixed support for our hypotheses, but consistently find that WVS participants with local, country, continent, or world geographic identities are less likely to find accepting a bribe permissible than those with regional identities-that is, actors whose primary identities that encompass more than their region find corruption less permissible. We discuss the importance of considering an actor's valuation of others when modeling corruption persistence, noting that establishing scopes of positive valuation is a precursor to predicting where actors will target benefits and shunt costs.

  3. Permissive tolerance of the patent ductus arteriosus may increase the risk of Chronic Lung Disease

    Directory of Open Access Journals (Sweden)

    Kaempf JW

    2013-03-01

    Full Text Available Joseph W Kaempf,1 Robert Huston,2 YingXing Wu,1 Andrew J Kaempf,1 Lian Wang,1 Gary Grunkemeier,1 Rebecca Mischel,2 Howard Cohen,3 Bret Freitag41Providence St Vincent Medical Center, Portland, OR, 2Randall Children’s Hospital at Legacy Emanuel, Portland, OR, 3Salem Hospital, Salem, OR, 4Legacy Salmon Creek Hospital, Vancouver, WA, USAPurpose: Because early closure therapies of the patent ductus arteriosus (PDA have not been shown to confer benefit to premature infants, the authors’ four neonatal intensive care units adopted a less aggressive PDA management protocol.Study design: A before–after investigation in infants with PDAs born 501–1500 g. Era 1 (January 2005 to December 2007 featured traditional management with indomethacin and/or surgical ligation used early to close PDAs; Era 2 (January 2008 to June 2009 featured fluid restriction and watchful waiting for PDA closure, limiting indomethacin or surgical ligation to only those infants with large PDAs needing significant respiratory support.Results: Era 2 infants (n = 129, mean ± standard deviation 27 ± 2 weeks received less and later indomethacin and less Day 1–28 total fluids as compared to Era 1 infants (n = 240, mean ± standard deviation 27 ± 2 weeks. The Chronic Lung Disease (CLD rate was higher in Era 2 (48% versus 34%, P < 0.01 as was the combined outcome of Death after Day 7 or CLD (57% versus 42%, P < 0.01. Multiple regression analysis showed Era 2 birth was a predictor of CLD. However, Poisson regression analysis determined the predictors of all seven major Vermont Oxford Network morbidities were earlier gestational age, lower birth weight, and male gender, not the era of birth. Significantly more infants were discharged home with PDAs in Era 2.Conclusion: Permissive tolerance of PDAs may increase the risk of CLD and Death after Day 7 or CLD but is not associated with significant changes in other Vermont Oxford Network morbidities.Keywords: premature infant

  4. On the substantion of permissible concentrations of plutonium isotopes in the water of fresh water and sea water NPP cooling reservoirs

    International Nuclear Information System (INIS)

    Grachev, M.I.; Gusev, D.I.; Stepanova, V.D.

    1985-01-01

    Substantiation of maximum permissible concentration (PC) of plutonium isotopes ( 238 Pu, 239 Pu, 240 Pu) in fresh and sea water cooling reservoirs of NPP with fast neutron reactors is given. The main criterion when calculating permissible plutonium content in water of surface reservoirs is the requirement not to exceed the established limits for radiation doses to persons resulted from water use. Data on coefficients of plutonium concentration in sea and fresh water hydrobionts are presented as well as on plutonium PC in water of fresh and sea water cooling reservoirs and bottom sediments of sea water cooling reservoirs. It is shown that doses to critical groups of population doesn't exceed potentially hazardous levels due to plutonium intake through food chains. But the calculation being carried out further should be corrected

  5. Permission of change of limits in the vapor generators of the Atucha I Nuclear Central; Permiso de cambio de limites en los GVs de la CNA-I

    Energy Technology Data Exchange (ETDEWEB)

    Ventura, M. [Autoridad Regulatoria Nuclear, Av. Libertador 8250 (1429), Capital Federal (Argentina)]. e-mail: mventura@sede.arn.gov.ar

    2006-07-01

    In the mark of the modification of the Atucha-I Nuclear Central Installation (CNA-I) as consequence of the Introduction of the System 'Second Drain of Heat' (SSC), the Entity Responsible for the CNA-I (NASA) requested authorization to the Nuclear Regulatory Authority (ARN) to modify the value of the minimum level of water in the secondary side in the Steam generators (GVs) to activate the signal 'shoot of the Cut of the Reactor' (RESA-LLV). As the level in the GVs is one of those parameters that are used to shoot the Emergency Feeding System (RX), component of the SSC System, also was analyzed the change in the activation of the shoot signal of the 'Second Drain of Heat' (2SSC-LLV). The ARN uses for the study of the nuclear safety of nuclear power plants, the series of prediction programs RELAP5/MOD3.X. It participates of the evaluation and maintenance activities of these codes through specific agreements with the U.S. Nuclear Regulatory Commission (US-NRC). It is necessary to account with programs of this type since the ARN it licenses the construction and operation of Nuclear Power Plants (NPPs) and other outstanding facilities and it inquires its operation according to its own standards. With these tools its are auditing the calculations that the Responsible Entities of the operation make to guarantee the operability of the NPPs assisting the mentioned standards. The analysis with computational codes is used as a tool to achieve the best understanding in the behavior of the plant in union with the engineering approach, the manual calculations, the data analysis and the experience in the operation of the machine. (Author)

  6. Acupuncture Therapy in a Group Setting for Chronic Pain.

    Science.gov (United States)

    Kligler, Benjamin; Nielsen, Arya; Kohrherr, Corinne; Schmid, Tracy; Waltermaurer, Eve; Perez, Elidania; Merrell, Woodson

    2018-02-01

    This project was designed to test the feasibility and effectiveness of acupuncture therapy given in a group setting for chronic pain. Nonrandomized, repeated measures quasi-experimental trial. Care was delivered in a primary care clinic waiting area after clinic hours. Included were primary care patients (≥18 years old) with chronic pain of the neck, back, shoulder, or osteoarthritis of any site of at least three months' duration. Subjects received eight weekly acupuncture therapy sessions in a group setting. Acupuncture therapy included a combination of palpation, acupuncture needling, Tui na, Gua sha, and auricular treatment. Baseline pain levels were established in a two- to four-week run-in; assessment of the intervention impact on pain intensity, mood, and functional status were made at the end of the treatment period (eight weeks) and 16 weeks after completion of intervention (24 weeks). Of the total 113 participants recruited for the trial, 96 completed the 24-week protocol. We found a statistically and clinically significant decrease in pain severity, pain interference, and depression in our study population. There were no serious adverse events. Acupuncture therapy offered in the group setting was effective in reducing pain severity, pain interference, and depression in patients with chronic neck, back, or shoulder pain or osteoarthritis. Benefit persisted through the 24-week measure despite no additional treatment. This finding has potentially important implications for improving access to effective acupuncture treatment for patients with limited financial resources. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  7. Maximum permissible body burdens and maximum permissible concentrations of radionuclides in air and in water for occupational exposure. Recommendations of the National Committee on Radiation Protection. Handbook 69

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1959-06-05

    The present Handbook and its predecessors stem from the Second International Congress of Radiology, held in Stockholm in 1928. At that time, under the auspices of the Congress, the International Commission on Radiological Protection (ICRP) was organized to deal initially with problems of X-ray protection and later with radioactivity protection. At that time 'permissible' doses of X-rays were estimated primarily in terms of exposures which produced erythema, the amount of exposure which would produce a defined reddening of the skin. Obviously a critical problem in establishing criteria for radiation protection was one of developing useful standards and techniques of physical measurement. For this reason two of the organizations in this country with a major concern for X-ray protection, the American Roentgen Ray Society and the Radiology Society of North America, suggested that the National Bureau of Standards assume responsibility for organizing representative experts to deal with the problem. Accordingly, early in 1929, an Advisory Committee on X-ray and Radium Protection was organized to develop recommendations on the protection problem within the United States and to formulate United States points of view for presentation to the International Commission on Radiological Protection. The organization of the U.S. Advisory Committee included experts from both the medical and physical science fields. The recommendations of this Handbook take into consideration the NCRP statement entitled 'Maximum Permissible Radiation Exposures to Man', published as an addendum to Handbook 59 on April 15, 1958. As noted above this study was carried out jointly by the ICRP and the NCRP, and the complete report is more extensive than the material contained in this Handbook.

  8. Maximum permissible body burdens and maximum permissible concentrations of radionuclides in air and in water for occupational exposure. Recommendations of the National Committee on Radiation Protection. Handbook 69

    International Nuclear Information System (INIS)

    1959-01-01

    The present Handbook and its predecessors stem from the Second International Congress of Radiology, held in Stockholm in 1928. At that time, under the auspices of the Congress, the International Commission on Radiological Protection (ICRP) was organized to deal initially with problems of X-ray protection and later with radioactivity protection. At that time 'permissible' doses of X-rays were estimated primarily in terms of exposures which produced erythema, the amount of exposure which would produce a defined reddening of the skin. Obviously a critical problem in establishing criteria for radiation protection was one of developing useful standards and techniques of physical measurement. For this reason two of the organizations in this country with a major concern for X-ray protection, the American Roentgen Ray Society and the Radiology Society of North America, suggested that the National Bureau of Standards assume responsibility for organizing representative experts to deal with the problem. Accordingly, early in 1929, an Advisory Committee on X-ray and Radium Protection was organized to develop recommendations on the protection problem within the United States and to formulate United States points of view for presentation to the International Commission on Radiological Protection. The organization of the U.S. Advisory Committee included experts from both the medical and physical science fields. The recommendations of this Handbook take into consideration the NCRP statement entitled 'Maximum Permissible Radiation Exposures to Man', published as an addendum to Handbook 59 on April 15, 1958. As noted above this study was carried out jointly by the ICRP and the NCRP, and the complete report is more extensive than the material contained in this Handbook

  9. Determination of permissible exposure doses under the provisions of the regulations on installation and operation of marine reactors

    International Nuclear Information System (INIS)

    1979-01-01

    The Ministry of Transportation defines on radioactive doses in the controlled area that exterior radioactive dose shall be 30 mili-rem for a week; concentrations of radioactive materials in the air or under the water shall be permissible concentrations otherwise specified for the employees multiplied by 0.75 in average for a week and that densities of radioactive materials on the surface of the things contaminated by such materials shall be 1/10 of permissible surface densities provided in a table attached. Permissible exposure dose outside the inspected surrounding area is 0.5 rem for a year. Permissible surface densities are included in a list attached. Permissible accumulative dose for the employees is the figure (unit rem) calculated by the formula D = 5(N-18), when D means permissible accumulative dose and N number of the age. Permissible exposure dose is 3 rem for 3 months for the employees, 1.5 rem for a year for persons other than the employees and 12 rem for the urgent work. Permissible densities for the employees, calculation of doses by interior exposure and permissible densities outside the inspected surrounding area are stipulated in detail with attached lists. (Okada, K.)

  10. In Vitro Measles Virus Infection of Human Lymphocyte Subsets Demonstrates High Susceptibility and Permissiveness of both Naive and Memory B Cells.

    Science.gov (United States)

    Laksono, Brigitta M; Grosserichter-Wagener, Christina; de Vries, Rory D; Langeveld, Simone A G; Brem, Maarten D; van Dongen, Jacques J M; Katsikis, Peter D; Koopmans, Marion P G; van Zelm, Menno C; de Swart, Rik L

    2018-04-15

    Measles is characterized by a transient immune suppression, leading to an increased risk of opportunistic infections. Measles virus (MV) infection of immune cells is mediated by the cellular receptor CD150, expressed by subsets of lymphocytes, dendritic cells, macrophages, and thymocytes. Previous studies showed that human and nonhuman primate memory T cells express higher levels of CD150 than naive cells and are more susceptible to MV infection. However, limited information is available about the CD150 expression and relative susceptibility to MV infection of B-cell subsets. In this study, we assessed the susceptibility and permissiveness of naive and memory T- and B-cell subsets from human peripheral blood or tonsils to in vitro MV infection. Our study demonstrates that naive and memory B cells express CD150, but at lower frequencies than memory T cells. Nevertheless, both naive and memory B cells proved to be highly permissive to MV infection. Furthermore, we assessed the susceptibility and permissiveness of various functionally distinct T and B cells, such as helper T (T H ) cell subsets and IgG- and IgA-positive memory B cells, in peripheral blood and tonsils. We demonstrated that T H 1T H 17 cells and plasma and germinal center B cells were the subsets most susceptible and permissive to MV infection. Our study suggests that both naive and memory B cells, along with several other antigen-experienced lymphocytes, are important target cells of MV infection. Depletion of these cells potentially contributes to the pathogenesis of measles immune suppression. IMPORTANCE Measles is associated with immune suppression and is often complicated by bacterial pneumonia, otitis media, or gastroenteritis. Measles virus infects antigen-presenting cells and T and B cells, and depletion of these cells may contribute to lymphopenia and immune suppression. Measles has been associated with follicular exhaustion in lymphoid tissues in humans and nonhuman primates, emphasizing the

  11. Permissive and instructive anterior patterning rely on mRNA localization in the wasp embryo.

    Science.gov (United States)

    Brent, Ava E; Yucel, Gozde; Small, Stephen; Desplan, Claude

    2007-03-30

    The long-germ mode of embryogenesis, in which segments arise simultaneously along the anteriorposterior axis, has evolved several times in different lineages of the holometabolous, or fully metamorphosing, insects. Drosophila's long-germ fate map is established largely by the activity of the dipteran-specific Bicoid (Bcd) morphogen gradient, which operates both instructively and permissively to accomplish anterior patterning. By contrast, all nondipteran long-germ insects must achieve anterior patterning independently of bcd. We show that bcd's permissive function is mimicked in the wasp by a maternal repression system in which anterior localization of the wasp ortholog of giant represses anterior expression of the trunk gap genes so that head and thorax can properly form.

  12. Mycobacteria exploit nitric oxide-induced transformation of macrophages into permissive giant cells.

    Science.gov (United States)

    Gharun, Kourosh; Senges, Julia; Seidl, Maximilian; Lösslein, Anne; Kolter, Julia; Lohrmann, Florens; Fliegauf, Manfred; Elgizouli, Magdeldin; Vavra, Martina; Schachtrup, Kristina; Illert, Anna L; Gilleron, Martine; Kirschning, Carsten J; Triantafyllopoulou, Antigoni; Henneke, Philipp

    2017-12-01

    Immunity to mycobacteria involves the formation of granulomas, characterized by a unique macrophage (MΦ) species, so-called multinucleated giant cells (MGC). It remains unresolved whether MGC are beneficial to the host, that is, by prevention of bacterial spread, or whether they promote mycobacterial persistence. Here, we show that the prototypical antimycobacterial molecule nitric oxide (NO), which is produced by MGC in excessive amounts, is a double-edged sword. Next to its antibacterial capacity, NO propagates the transformation of MΦ into MGC, which are relatively permissive for mycobacterial persistence. The mechanism underlying MGC formation involves NO-induced DNA damage and impairment of p53 function. Moreover, MGC have an unsurpassed potential to engulf mycobacteria-infected apoptotic cells, which adds a further burden to their antimycobacterial capacity. Accordingly, mycobacteria take paradoxical advantage of antimicrobial cellular efforts by driving effector MΦ into a permissive MGC state. © 2017 The Authors.

  13. A Rational Threshold Signature Model and Protocol Based on Different Permissions

    Directory of Open Access Journals (Sweden)

    Bojun Wang

    2014-01-01

    Full Text Available This paper develops a novel model and protocol used in some specific scenarios, in which the participants of multiple groups with different permissions can finish the signature together. We apply the secret sharing scheme based on difference equation to the private key distribution phase and secret reconstruction phrase of our threshold signature scheme. In addition, our scheme can achieve the signature success because of the punishment strategy of the repeated rational secret sharing. Besides, the bit commitment and verification method used to detect players’ cheating behavior acts as a contributing factor to prevent the internal fraud. Using bit commitments, verifiable parameters, and time sequences, this paper constructs a dynamic game model, which has the features of threshold signature management with different permissions, cheat proof, and forward security.

  14. Comparative Evaluation of Permissiveness to Dengue Virus Serotype 2 Infection in Primary Rodent Macrophages

    Directory of Open Access Journals (Sweden)

    Jeanette Prada-Arismendy

    2012-01-01

    Full Text Available Infection with dengue virus presents a broad clinical spectrum, which can range from asymptomatic cases to severe cases that are characterised by haemorrhagic syndrome and/or shock. The reason for such variability remains unknown. This work evaluated the in vitro permissiveness of mouse, rat, hamster and guinea pig macrophages to infection by dengue virus 2 (DENV2. The results established that macrophages derived from the BALB/c mouse strain showed higher permissiveness to DENV2 infection than macrophages from other rodent species, although all rodent species studied had the C820T mutation in the oligoadenylate synthetase 1b gene, indicating no relationship to the different in vitro susceptibilities of mouse cells at this locus. Other molecular mechanisms related to flavivirus susceptibility remain to be explored.

  15. A Static Android Malware Detection Based on Actual Used Permissions Combination and API Calls

    OpenAIRE

    Xiaoqing Wang; Junfeng Wang; Xiaolan Zhu

    2016-01-01

    Android operating system has been recognized by most application developers because of its good open-source and compatibility, which enriches the categories of applications greatly. However, it has become the target of malware attackers due to the lack of strict security supervision mechanisms, which leads to the rapid growth of malware, thus bringing serious safety hazards to users. Therefore, it is critical to detect Android malware effectively. Generally, the permissions declared in the An...

  16. Determination of Permissible Short-Time Emergency Overloading of Turbo-Generators and Synchronous Compensators

    Directory of Open Access Journals (Sweden)

    V. A. Anischenko

    2011-01-01

    Full Text Available The paper shows that failure to take into account variable ratio of short-time emergency overloading of turbo-generators (synchronous compensators that can lead to underestimation of overloading capacity or impermissible insulation over-heating.A method has been developed for determination of permissible duration of short-time emergency over-loading that takes into account changes of over-loading ratio in case of a failure.

  17. Permissive cytomegalovirus infection of primary villous term and first trimester trophoblasts.

    Science.gov (United States)

    Hemmings, D G; Kilani, R; Nykiforuk, C; Preiksaitis, J; Guilbert, L J

    1998-06-01

    Forty percent of women with primary cytomegalovirus (CMV) infections during pregnancy infect their fetuses with complications for the baby varying from mild to severe. How CMV crosses the syncytiotrophoblast, the barrier between maternal blood and fetal tissue in the villous placenta, is unknown. Virus may cross by infection of maternal cells that pass through physical breaches in the syncytiotrophoblast or by direct infection of the syncytiotrophoblast, with subsequent transmission to underlying fetal placental cells. In this study, we show that pure (>99.99%), long-term and healthy (>3 weeks) cultures of syncytiotrophoblasts are permissively infected with CMV. Greater than 99% of infectious progeny virus remained cell associated throughout culture periods up to 3 weeks. Infection of term trophoblasts required a higher virus inoculum, was less efficient, and progressed more slowly than parallel infections of placental and human embryonic lung fibroblasts. Three laboratory strains (AD169, Towne, and Davis) and a clinical isolate from a congenitally infected infant all permissively infected trophoblasts, although infection efficiencies varied. The infection of first trimester syncytiotrophoblasts with strain AD169 occurred at higher frequency and progressed more rapidly than infection of term cells but less efficiently and rapidly than infection of fibroblasts. These results show that villous syncytiotrophoblasts can be permissively infected by CMV but that the infection requires high virus titers and proceeds slowly and that progeny virus remains predominantly cell associated.

  18. Current limiters

    Energy Technology Data Exchange (ETDEWEB)

    Loescher, D.H. [Sandia National Labs., Albuquerque, NM (United States). Systems Surety Assessment Dept.; Noren, K. [Univ. of Idaho, Moscow, ID (United States). Dept. of Electrical Engineering

    1996-09-01

    The current that flows between the electrical test equipment and the nuclear explosive must be limited to safe levels during electrical tests conducted on nuclear explosives at the DOE Pantex facility. The safest way to limit the current is to use batteries that can provide only acceptably low current into a short circuit; unfortunately this is not always possible. When it is not possible, current limiters, along with other design features, are used to limit the current. Three types of current limiters, the fuse blower, the resistor limiter, and the MOSFET-pass-transistor limiters, are used extensively in Pantex test equipment. Detailed failure mode and effects analyses were conducted on these limiters. Two other types of limiters were also analyzed. It was found that there is no best type of limiter that should be used in all applications. The fuse blower has advantages when many circuits must be monitored, a low insertion voltage drop is important, and size and weight must be kept low. However, this limiter has many failure modes that can lead to the loss of over current protection. The resistor limiter is simple and inexpensive, but is normally usable only on circuits for which the nominal current is less than a few tens of milliamperes. The MOSFET limiter can be used on high current circuits, but it has a number of single point failure modes that can lead to a loss of protective action. Because bad component placement or poor wire routing can defeat any limiter, placement and routing must be designed carefully and documented thoroughly.

  19. Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants.

    Science.gov (United States)

    Woodgate, P G; Davies, M W

    2001-01-01

    Experimental animal data and uncontrolled, observational studies in human infants have suggested that hyperventilation and hypocapnia may be associated with increased pulmonary and neurodevelopmental morbidity. Protective ventilatory strategies allowing higher levels of arterial CO2 (permissive hypercapnia) are now widely used in adult critical care. The aggressive pursuit of normocapnia in ventilated newborn infants may contribute to the already present burden of lung disease. However, the safe or ideal range for PCO2 in this vulnerable population has not been established. To assess whether, in mechanically ventilated neonates, a strategy of permissive hypercapnia improves short and long term outcomes (esp. mortality, duration of respiratory support, incidence of chronic lung disease and neurodevelopmental outcome). Standard strategies of the Cochrane Neonatal Review Group were used. Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, CINAHL, and Current Contents. Searches were also made of previous reviews including cross-referencing, abstracts, and conference and symposia proceedings published in Pediatric Research. All randomised controlled trials in which a strategy of permissive hypercapnia was compared with conventional strategies aimed at achieving normocapnia (or lower levels of hypercapnia) in newborn infants who are mechanically ventilated were eligible. Standard methods of the Cochrane Neonatal Review Group were used. Trials identified by the search strategy were independently reviewed by each author and assessed for eligibility and trial quality. Data were extracted separately. Differences were compared and resolved. Additional information was requested from trial authors. Only published data were available for review. Results are expressed as relative risk and risk difference for dichotomous outcomes, and weighted mean difference for continuous variables. Two trials involving 269 newborn infants were included. Meta-analysis of

  20. Determination of permissible doses under the provisions of the regulations on installation and operation of reactors for power generation

    International Nuclear Information System (INIS)

    1979-01-01

    The determination is defined under the regulations on installation and operation of reactors for power generation. In the controlled area exterior radiation dose shall be 30 mili-rem for a week by the Minister of International Trade and Industry. The concentrations of radioactive materials in the air or under the water shall be permissible concentrations specified for the employees multiplied by 0.75 in average for a week. The densities of radioactive materials on the surface of the things contaminated by such materials shall be 1/10 of permissible surface densities stipulated in the table attached. Permissible exposure dose outside the inspected surrounding area is 0.5 rem for a year. Permissible surface densities are included in the table attached. Permissible accumulative dose for the employees is the figure (unit rem) calculated by the formula D = 5(N-18), when D means permissible accumulative dose and N number of the age. Permissible exposure dose is 3 rem for 3 months for the employees, 1.5 rem for a year for persons other than the employees and 12 rem for the urgent work. Permissible concentrations are defined in detail for the employees and outside the inspected surrounding area. Calculation of exposure dose in the case of interior exposure is particularly provided for. (Okada, K.)

  1. 29 CFR 3.5 - Payroll deductions permissible without application to or approval of the Secretary of Labor.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Payroll deductions permissible without application to or approval of the Secretary of Labor. 3.5 Section 3.5 Labor Office of the Secretary of Labor CONTRACTORS AND... STATES § 3.5 Payroll deductions permissible without application to or approval of the Secretary of Labor...

  2. 11 CFR 114.15 - Permissible use of corporate and labor organization funds for certain electioneering communications.

    Science.gov (United States)

    2010-01-01

    ... 11 Federal Elections 1 2010-01-01 2010-01-01 false Permissible use of corporate and labor organization funds for certain electioneering communications. 114.15 Section 114.15 Federal Elections FEDERAL ELECTION COMMISSION GENERAL CORPORATE AND LABOR ORGANIZATION ACTIVITY § 114.15 Permissible use of corporate...

  3. MAK and BAT values list 2014. Maximum permissible concentrations at the place of work and biological tolerance values for working materials; MAK- und BAT-Werte-Liste 2014. Maximale Arbeitsplatzkonzentrationen und Biologische Arbeitsstofftoleranzwerte

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2014-11-01

    The book on the MAK (maximum permissible concentrations at the place of work) and BAT (biological tolerance values for working materials) value list 2014 includes the following chapters: (a) Maximum permissible concentrations at the place of work: definition, application and determination of MAT values, list of materials; carcinogenic working materials, sensibilizing working materials, aerosols, limiting the exposition peaks, skin resorption, MAK values during pregnancy, germ cell mutagens, specific working materials; (b) Biological tolerance values for working materials: definition and application of BAT values, list of materials, carcinogenic working materials, biological guide values, biological working material reference values.

  4. MAK and BAT values list 2013. Maximum permissible concentrations at the place of work and biological tolerance values for working materials; MAK- und BAT-Werte-Liste 2013. Maximale Arbeitsplatzkonzentrationen und Biologische Arbeitsstofftoleranzwerte

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-01

    The book on the MAK (maximum permissible concentrations at the place of work) and BAT (biological tolerance values for working materials) value list 2013 includes the following chapters: (a) Maximum permissible concentrations at the place of work: definition, application and determination of MAT values, list of materials; carcinogenic working materials, sensibilizing working materials, aerosols, limiting the exposition peaks, skin resorption, MAK values during pregnancy, germ cell mutagens, specific working materials; (b) Biological tolerance values for working materials: definition and application of BAT values, list of materials, carcinogenic working materials, biological guide values, biological working material reference values.

  5. MAK and BAT values list 2015. Maximum permissible concentrations at the place of work and biological tolerance values for working materials; MAK- und BAT-Werte-Liste 2015. Maximale Arbeitsplatzkonzentrationen und Biologische Arbeitsstofftoleranzwerte

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-11-01

    The book on the MAK (maximum permissible concentrations at the place of work) and BAT (biological tolerance values for working materials) value list 2015 includes the following chapters: (a) Maximum permissible concentrations at the place of work: definition, application and determination of MAT values, list of materials; carcinogenic working materials, sensibilizing working materials, aerosols, limiting the exposition peaks, skin resorption, MAK values during pregnancy, germ cell mutagens, specific working materials; (b) Biological tolerance values for working materials: definition and application of BAT values, list of materials, carcinogenic working materials, biological guide values, biological working material reference values.

  6. Challenges to obtaining parental permission for child participation in a school-based waterpipe tobacco smoking prevention intervention in Qatar.

    Science.gov (United States)

    Nakkash, Rima T; Al Mulla, Ahmad; Torossian, Lena; Karhily, Roubina; Shuayb, Lama; Mahfoud, Ziyad R; Janahi, Ibrahim; Al Ansari, Al Anoud; Afifi, Rema A

    2014-09-30

    Involving children in research studies requires obtaining parental permission. A school-based intervention to delay/prevent waterpipe use for 7th and 8th graders in Qatar was developed, and parental permission requested. Fifty three percent (2308/4314) of the parents returned permission forms; of those 19.5% of the total (840/4314) granted permission. This paper describes the challenges to obtaining parental permission. No research to date has described such challenges in the Arab world. A random sample of 40 schools in Doha, Qatar was selected for inclusion in the original intervention. Permission forms were distributed to parents for approval of their child's participation. The permission forms requested that parents indicate their reasons for non-permission if they declined. These were categorized into themes. In order to understand reasons for non-permission, interviews with parents were conducted. Phone numbers of parents were requested from the school administration; 12 of the 40 schools (30%) agreed to provide the contact information. A random sample of 28 parents from 12 schools was interviewed to reach data saturation. Thematic analysis was used to analyze their responses. Reasons for non-permission documented in both the forms and interviews included: poor timing; lack of interest; the child not wanting to participate; and the child living in a smoke-free environment. Interviews provided information on important topics to include in the consent forms, parents' decision-making processes regarding their child's participation, and considerations for communicating with parents. Many parents also indicated that this was the first time they had been asked to give an informed consent for their child's participation in a study. Results indicate that more attention needs to be given to the informed parental consent process. Researchers should consider enhancing both the methods of communicating information as well the specific information provided. Before

  7. Peripheral Blood CCR4+CCR6+ and CXCR3+CCR6+ CD4+ T Cells Are Highly Permissive to HIV-1 Infection

    OpenAIRE

    Gosselin, Annie; Monteiro, Patricia; Chomont, Nicolas; Diaz-Griffero, Felipe; Said, Elias A.; Fonseca, Simone; Wacleche, Vanessa; El-Far, Mohamed; Boulassel, Mohamed-Rachid; Routy, Jean-Pierre; Sekaly, Rafick-Pierre; Ancuta, Petronela

    2009-01-01

    There is limited knowledge on the identity of primary CD4+ T cell subsets selectively targeted by HIV-1 in vivo. In this study, we established a link between HIV permissiveness, phenotype/homing potential, and lineage commitment in primary CD4+ T cells. CCR4+CCR6+, CCR4+CCR6−, CXCR3+CCR6+, and CXCR3+CCR6− T cells expressed cytokines and transcription factors specific for Th17, Th2, Th1Th17, and Th1 lineages, respectively. CCR4+CCR6+ and CXCR3+CCR6+ T cells expressed the HIV coreceptors CCR5 a...

  8. Dose limits

    International Nuclear Information System (INIS)

    Fitoussi, L.

    1987-12-01

    The dose limit is defined to be the level of harmfulness which must not be exceeded, so that an activity can be exercised in a regular manner without running a risk unacceptable to man and the society. The paper examines the effects of radiation categorised into stochastic and non-stochastic. Dose limits for workers and the public are discussed

  9. Permissive hypotension in the extremely low birthweight infant with signs of good perfusion.

    LENUS (Irish Health Repository)

    Dempsey, E M

    2012-01-31

    INTRODUCTION: Many practitioners routinely treat infants whose mean arterial blood pressure in mm Hg is less than their gestational age in weeks (GA). OBJECTIVE: To assess the effectiveness of utilising a combined approach of clinical signs, metabolic acidosis and absolute blood pressure (BP) values when deciding to treat hypotension in the extremely low birthweight (ELBW) infant. METHODS: Retrospective cohort study of all live born ELBW infants admitted to our neonatal intensive care unit over a 4-year period. Patients were grouped as either normotensive (BP never less than GA), hypotensive and not treated (BPpermissive hypotension) and hypotensive treated (BPpermissive hypotension had similar outcomes. Mean blood pressure in the permissive group increased from 26 mm Hg at 6 h to 31 mm Hg at 24 h. In a logistic regression model, treated hypotension is independently associated with mortality, odds ratio 8.0 (95% CI 2.3 to 28, p<0.001). CONCLUSIONS: Blood pressure spontaneously improves in ELBW infants during the first 24 h. Infants hypotensive on GA criteria but with clinical evidence of good perfusion had as good an outcome as normotensive patients. Treated low blood pressure was associated with adverse outcome.

  10. Imperfect Reworking Process Consideration in Integrated Inventory Model under Permissible Delay in Payments

    Directory of Open Access Journals (Sweden)

    Ming-Cheng Lo

    2008-01-01

    Full Text Available This study develops an improved inventory model to help the enterprises to advance their profit increasing and cost reduction in a single vendor single-buyer environment with general demand curve, adjustable production rate, and imperfect reworking process under permissible delay in payments. For advancing practical use in a real world, we are concerned with the following strategy determining, which includes the buyer's optimal selling price, order quantity, and the number of shipments per production run from the vendor to the buyer. An algorithm and numerical analysis are used to illustrate the solution procedure.

  11. Free Radical Oxidation in Rat Myocardium after Maximum Permissible Hepatic Resection.

    Science.gov (United States)

    Ermolaev, P A; Khramykh, T P; Barskaya, L O

    2016-03-01

    Free radical oxidation in rat myocardial homogenate was studied by chemiluminescent assay during the early terms after maximum permissible liver resection. During this period, activation of free radical oxidation was biphasic. The critical terms characterized by dramatic intensification of free radical oxidation in the myocardium are the first hour and the first day after surgery. The period from 3 to 12 h after surgery, in which the indices of chemiluminescence decrease, can be tentatively termed as the period of "putative wellbeing". Normalization of the free radical oxidation processes in the myocardium occurred by day 7 after surgery.

  12. Determination of the longest permissible distance between expansion compensators in gas transmission pipelines

    Energy Technology Data Exchange (ETDEWEB)

    Huening, R [Fachhochschule Muenster, Burgsteinfurt (Germany, F.R.). Fachbereich Versorgungstechnik

    1977-01-01

    In order to effectively protect long-distance gas pipelines against mountain damage in the areas in which underground mining is done, expansion compensators must be built in at certain distances. The tests to determine the slippage resistance and the highest permissible distance of expanders Lsub(max) in a transmission line NW 600 having a plastic insulation are described in this work. In addition, a way of calculating the Lsub(max) value from the existing data for pipes of varying diameter and different insulating material is shown.

  13. Studies on the establishment of maximum permissible exposure dose for reference Korean

    International Nuclear Information System (INIS)

    Kim, Y.J.; Lee, K.S.; Chun, K.C.; Kim, C.B.; Chung, K.H.; Kim, S.L.; Kim, M.J.

    1981-01-01

    In order to establish the Reference Korean and maximum permissible exposure dose of Reference Korean, for the first year a total of 9,758 males and 7,019 females were surveyed for the height, weight, a body surface area, and a total of 879 individuals of 180 households located in different 30 localities were analyzed for food consumption and a total of radioactive substances (β-ray) contained in food per capita per day. In this report the external and internal exposure dose were also estimated on the basis of data mostly published in other country as well as in Korea in part

  14. Influence of the composition of radionuclide mixtures on the maximum permissible concentration