WorldWideScience

Sample records for previous approaches needed

  1. Physician Educational Needs in Osteoporosis: An Approach to Needs Assessment.

    Science.gov (United States)

    Lockyer, Jocelyn; Hanley, David; Fidler, Herta; Toews, John; Lysholm-Andrews, Elaine

    1998-01-01

    A literature review, focus groups (n=200), and questionnaire responses from 324 family physicians identified their learning needs related to osteoporosis. The three methods identified different learning issues, suggesting the importance of triangulation to ensure currency and relevance in continuing-education needs-assessment. (SK)

  2. Sustainable development, tourism and territory. Previous elements towards a systemic approach

    Directory of Open Access Journals (Sweden)

    Pierre TORRENTE

    2009-01-01

    Full Text Available Today, tourism is one of the major challenges for many countries and territories. The balance of payments, an ever-increasing number of visitors and the significant development of the tourism offer clearly illustrate the booming trend in this sector. This macro-economic approach is often used by the organizations in charge of tourism, WTO for instance. Quantitative assessments which consider the satisfaction of customers’ needs as an end in itself have prevailed both in tourism development schemes and in prospective approaches since the sixties.

  3. Life cycle assessment of nuclear-based hydrogen production using thermochemical water decomposition: extension of previous work and future needs

    International Nuclear Information System (INIS)

    Lubis, L.I.; Dincer, I.; Rosen, M.A.

    2008-01-01

    An extension of a previous Life Cycle Assessment (LCA) of nuclear-based hydrogen production using thermochemical water decomposition is reported. The copper-chlorine thermochemical cycle is considered, and the environmental impacts of the nuclear and thermochemical plants are assessed, while future needs are identified. Environmental impacts are investigated using CML 2001 impact categories. The nuclear fuel cycle and construction of the hydrogen plant contribute significantly to total environmental impacts. The environmental impacts for the operation of the thermochemical hydrogen production plant contribute much less. Changes in the inventory of chemicals needed in the thermochemical plant do not affect significantly the total impacts. Improvement analysis suggests the development of more sustainable processes, particularly in the nuclear plant. Other important and necessary future extensions of the research reported are also provided. (author)

  4. [Investigation on the approach of delivery after previous cesarean section of Xinjiang Uyghur women].

    Science.gov (United States)

    Ding, Xin; Aimainilezi, Adalaiti; Jin, Yan; Abudula, Wuriguli; Yin, Chenghong

    2014-10-01

    To explore the appropriate approach of delivery after cesarean section of Uyghur women in primary hospitals in Xinjiang Uyghur Autonomous Region. A total of 5 154 women delivered in Luopu County People Hospital, Hetian Prefecture, Xinjiang Uyghur Autonomous Region from January 2011 to December 2012. Among them, 178 Uyghur women had cesarean section history. The interval between the previous cesarean section and this delivery varied from 1 year to 17 years. The number of cases attempting vaginal labor and the indications of the previous cesarean section were recorded. The indications for the second cesarean section were analyzed. The gestational weeks at delivery, blood loss in 2 hours after delivery, neonatal birth weight, newborn asphyxia, the rate of postpartum fever (≥ 38 °C) and hospitalization days were compared between the two approaches of delivery. (1) Among the 178 cases, 119 cases attempted vaginal labor, the rate of attempting vaginal labor was 66.9% (119/178). A total of 113 cases succeeded in vaginal delivery (the vaginal delivery group), with the successful rate of attempting vaginal delivery of 95.0% (113/119), and the successful rate of vaginal delivery was 63.5% (113/178). For those 119 women succeeded in vaginal delivery, the indications of the previous cesarean sections were as following: pregnancy complications (68.1%, 81/119), macrosomia(5.0%, 6/119), dystocia (14.3%, 17/119), pregnancies complicated with other diseases (5.0%, 6/119) and cesarean section on maternal request (7.6%, 9/119). (2) 15 cases in the cesarean section group had postpartum hemorrhage, with the incidence of 13.3% (15/113). The mean total labor time was (507 ± 182) minutes. 6 cases attempting vaginal delivery failed and turned to cesarean section. (3) 59 cases received the second cesarean section (the cesarean section group). The rate of second cesarean section was 33.1% (59/178). The indications of the second cesarean section were as following: contracted pelvis (5%, 3

  5. Accessibility patterns and community integration among previously homeless adults: a Geographic Information Systems (GIS) approach.

    Science.gov (United States)

    Chan, Dara V; Gopal, Sucharita; Helfrich, Christine A

    2014-11-01

    Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Correlation between coronary artery calcification and the need for revascularization in patients with no previous diagnosis of arterial coronary disease

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Bello, Juliana Hiromi Silva Matsumoto [Instituto do Coracao (InCor/FM/USP), Sao paulo, SP (Brazil); Magalhaes, Tiago Augusto [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil); Moreira, Valeria de Melo; Carlos Eduardo Rochitte, E-mail: rochitte@gmail.com, E-mail: crochitte@hcor.com.br [Hospital do Coracao (HCOR), Sao Paulo, SP (Brazil)

    2012-10-15

    Introduction: about half of deaths from coronary heart disease (CHD) are not preceded by cardiac symptoms or previous diagnosis. Quantification of coronary artery calcification (CAC) by computed tomography is a strong predictor of events and improves the stratification the Framingham Risk Score. Objective: to evaluate the ability of the calcium score to predict the necessity invasive treatment (bypass (CABG) or intervention coronary percutaneous (ICP)) with no previous CAD. Method: retrospective study in pts without prior CAD and with quantification of CAC during 2009. The CAC was obtained in 64 multislice CT without contrast, with synchronized ECG acquisition, 120kV, 80-100mA, radiation <1mSv, and measured by the Agatston calcium score (CS) (threshold of 130 HU). Mean, median, and diagnostic tests were used. Results: We evaluated 263 pts (171 men), 59±13 years, BMI = 27.7 kg/m2, and mean follow up of 18±3 months. The total CS was 199.5±24.39. In patients with diabetes (DM), the CS was 320.5±67.56 and 166±24.47 in non-DM. The 23 patients who underwent invasive treatment had an average CS of 692 ± 72.3 versus 134.7 ± 21.35 in patients not treated (p <0.001). Of the 47 pts with CS ≥ 400, 17 were treated (CABG or ICP). Of the 216 pts with CS <400, 6 underwent treatment. Of the treated pts, 15 without diabetes had average CS 672.7 ± 92.04 versus 728.3 ± 11 of DM (8pts). In pts without DM who not underwent invasive treatment (191 pts), only 18 pts had SC ≥ 400. Conclusion: CS ≥ 400 was a strong predictor of revascularization (CABG or ICP) with good diagnostic performance in patients without prior diagnosis of CAD in the following 18 months. (author)

  7. Treatment response in psychotic patients classified according to social and clinical needs, drug side effects, and previous treatment; a method to identify functional remission.

    Science.gov (United States)

    Alenius, Malin; Hammarlund-Udenaes, Margareta; Hartvig, Per; Sundquist, Staffan; Lindström, Leif

    2009-01-01

    Various approaches have been made over the years to classify psychotic patients according to inadequate treatment response, using terms such as treatment resistant or treatment refractory. Existing classifications have been criticized for overestimating positive symptoms; underestimating residual symptoms, negative symptoms, and side effects; or being to open for individual interpretation. The aim of this study was to present and evaluate a new method of classification according to treatment response and, thus, to identify patients in functional remission. A naturalistic, cross-sectional study was performed using patient interviews and information from patient files. The new classification method CANSEPT, which combines the Camberwell Assessment of Need rating scale, the Udvalg for Kliniske Undersøgelser side effect rating scale (SE), and the patient's previous treatment history (PT), was used to group the patients according to treatment response. CANSEPT was evaluated by comparison of expected and observed results. In the patient population (n = 123), the patients in functional remission, as defined by CANSEPT, had higher quality of life, fewer hospitalizations, fewer psychotic symptoms, and higher rate of workers than those with the worst treatment outcome. In the evaluation, CANSEPT showed validity in discriminating the patients of interest and was well tolerated by the patients. CANSEPT could secure inclusion of correct patients in the clinic or in research.

  8. Negative Measures Are Not Enough, A Constructive Approach Is Needed

    International Nuclear Information System (INIS)

    Broda, E.

    1983-01-01

    This text is Broda’s contribution to the Pugwash Symposium 1983 in Bucharest. In this document Broda analyses the paramount problem of his time: peace and especially the avoidance of atomic war. He explains further that ‘negative measures’ like the demands for an atomic freeze and disarmament are not sufficient, but a constructive approach is needed. For this constructive approach Broda assigns an important role to international organizations like IAEA a.o. (nowak)

  9. The effects of informal carers' characteristics on their information needs: The information needs state approach.

    Science.gov (United States)

    Alzougool, Basil; Chang, Shanton; Gray, Kathleen

    2017-09-01

    There has been little research that provides a comprehensive account of the nature and aspects of information needs of informal carers. The authors have previously developed and validated a framework that accounts for major underlying states of information need. This paper aims to apply this framework to explore whether there are common demographic and socioeconomic characteristics that affect the information needs states of carers. A questionnaire about the information needs states was completed by 198 carers above 18 years old. We use statistical methods to look for similarities and differences in respondents' information needs states, in terms of the demographic and socioeconomic variables. At least one information needs state varies among carers, in terms of seven demographic and socioeconomic variables: the age of the patient(s) that they are caring for; the condition(s) of the patient(s) that they are caring for; the number of patients that they are caring for; their length of time as a carer; their gender; the country that they live in; and the population of the area that they live in. The findings demonstrate the utility of the information needs state framework. We outline some practical implications of the framework.

  10. A systematic approach to training: A training needs assessment

    Science.gov (United States)

    Manning, Margaret H.

    1989-01-01

    In an effort to determine the gap between the actual performance and the necessary performance of employees for the effective and efficient accomplishment of an organization's mission and goals, an organization-wide Training Needs Assessment must be conducted. The purpose of this work was to conduct a training needs analysis and prepare a NASA Langley Catalog of On-Site Training programs. The work included developing a Training Needs Assessment Survey, implementing the survey, analyzing and researching the training needs, identifying the courses to meet the needs, and preparing and designing an On-Site Training Catalog. This needs analysis attempted to identify performance weaknesses and deficits; seek out and provide opportunities for improved performance; anticipate and avoid future problems; enhance and create new strengths. The end product is a user-friendly catalog of on-site training available. The results include: top-down approach to needs assessment; improved communication with training coordinators; 98 percent return rate of the Training Needs Assessment survey; complete, newly designed, user-friendly catalog; 167 catalog descriptions advertised; 82 new courses advertised; training logo; and request for the training application form.

  11. The neural correlates of consciousness: new experimental approaches needed?

    Science.gov (United States)

    Hohwy, Jakob

    2009-06-01

    It appears that consciousness science is progressing soundly, in particular in its search for the neural correlates of consciousness. There are two main approaches to this search, one is content-based (focusing on the contrast between conscious perception of, e.g., faces vs. houses), the other is state-based (focusing on overall conscious states, e.g., the contrast between dreamless sleep vs. the awake state). Methodological and conceptual considerations of a number of concrete studies show that both approaches are problematic: the content-based approach seems to set aside crucial aspects of consciousness; and the state-based approach seems over-inclusive in a way that is hard to rectify without losing sight of the crucial conscious-unconscious contrast. Consequently, the search for the neural correlates of consciousness is in need of new experimental paradigms.

  12. Translational research-the need of a new bioethics approach.

    Science.gov (United States)

    Hostiuc, Sorin; Moldoveanu, Alin; Dascălu, Maria-Iuliana; Unnthorsson, Runar; Jóhannesson, Ómar I; Marcus, Ioan

    2016-01-15

    Translational research tries to apply findings from basic science to enhance human health and well-being. Many phases of the translational research may include non-medical tasks (information technology, engineering, nanotechnology, biochemistry, animal research, economy, sociology, psychology, politics, and so on). Using common bioethics principles to these areas might sometimes be not feasible, or even impossible. However, the whole process must respect some fundamental, moral principles. The purpose of this paper is to argument the need for a different approach to the morality in translational bioethics, and to suggest some directions that might be followed when constructing such a bioethics. We will show that a new approach is needed and present a few ethical issues that are specific to the translational research.

  13. Complex Needs or Simplistic Approaches? Homelessness Services and People with Complex Needs in Edinburgh

    Directory of Open Access Journals (Sweden)

    Manuel Macias Balda

    2016-10-01

    Full Text Available This research addresses how homelessness services from the statutory and voluntary sector are working for people with complex needs in the City of Edinburgh. Using a qualitative approach, it analyses the service providers’ perspectives on the concept, challenges and what works when dealing with this group of people. It also explores the opinions of a sample of service users, categorised as having complex needs, regarding the accommodation and support they are receiving. After analysing the data, it is argued that homelessness agencies do not have an appropriate cognitive nor institutional framework that facilitates an effective approach to work with people with complex needs. The lack of a sophisticated understanding that recognises the relational difficulties of individuals and the presence of structural, organisational, professional and interpersonal barriers hinder the development of positive long-term relationships which is considered as the key factor of change. For this reason, it is recommended to address a set of factors that go beyond simplistic and linear approaches and move towards complex responses in order to tackle homelessness from a broader perspective and, ultimately, achieve social inclusion.

  14. Science education: the need for an interdisciplinary approach

    Directory of Open Access Journals (Sweden)

    Loredana MARCU

    2007-05-01

    Full Text Available With today's evolving science and technology, there is a desperate need for retailoring science education. Whether biology or physics, chemistry or computing, mathematics or engineering, one should seek for interaction between disciplines not only at research level but also at teaching levels. The term 'interdisciplinary' is increasingly gaining meaning for the new generation of researchers and educators as the novel approaches to all areas of science are based on multidisciplinary methods. Fields such as medical physics, biochemistry, computational biology, bioengineering, physical chemistry, just to mention some, are a valid proof of the need for interaction between sciences. Often students are confused regarding their future, as they are not aware of the applicative side of their chosen discipline. Furthermore, both undergraduate and postgraduate students encounter frequent gaps in their knowledge because of the lack of coordination and interaction between disciplines. These hiccups in the educational system could be overcome through a better organization of curriculum. An example of interdisciplinary approach in science education is medical physics. A medical physicist must have a multidisciplinary vision of physics, otherwise the goals of this developing area are not met. The aim of the present talk is to illustrate the branching science of medical physics, the need for its correlation with molecular biology, chemistry, computing, mathematics and technology, and to underline its ultimate goal: to be of service, as an adjuvant field, to the novel areas of medicine.

  15. Tailored anterior tension-free repair for the treatment of recurrent inguinal hernia previously repaired by anterior approach.

    Science.gov (United States)

    Erdas, E; Medas, F; Gordini, L; Licheri, S; Pisano, G; Nicolosi, A; Calò, P G

    2016-06-01

    The purpose of this study is to describe our policy in selecting different types of anaesthesia and anterior tension-free techniques for the repair of recurrent inguinal hernias previously treated by anterior approach and to evaluate early and late outcomes. The medical records of 111 patients who underwent recurrent inguinal hernia repair by anterior approach in the period 2000-2013 were reviewed. Fifty patients (45 %) were over 70 years old and 63 (56.7 %) had one or more co-morbidities. Hernias with large defects were the most frequently observed (59.5 %), and no-mesh techniques were the most frequent failed repair (75.7 %). Different anterior tension-free techniques and types of anaesthesia were used, depending on hernia and patient characteristics. Seventy-three patients (65.8 %) were operated on an outpatient basis. Mean follow-up period was 89 months (range 10-183). No perioperative deaths, medical events, or visceral injuries were recorded. Early postoperative complications occurred in 11 patients: 4 haematomas (3.6 %), 5 seromas (4.5 %), 1 superficial wound infection (0.9 %) and 1 ischemic orchitis (0.9 %). Late complications consisted in 3 cases of chronic moderate pain (3.2 %) and 2 re-recurrences (2.1 %). Recurrent inguinal hernia previously treated by open anterior technique can be repaired using the same approach, often on an outpatient basis, with a low rate of recurrence and postoperative complications. To be safe and effective, the repair should be performed by appropriately trained surgeons, well versed in the use of different types of anaesthesia and surgical techniques depending on patient and hernia characteristics.

  16. Diversity Management Change Projects: In Need of Alternative Conceptual Approaches?

    Directory of Open Access Journals (Sweden)

    Christina Evans

    2012-09-01

    Full Text Available Drawing on a meta-analysis of an evaluation of a European Social Fund project aimed at enhancing employment opportunities for women in Information Technology, Electronic and Computing (ITEC, this paper critically debates how effectual a diversity management approach alone is as an underpinning rationale for change in the complex area of diversity. The paper draws on the experiences of ‘partner organizations’, gathered through interviews conducted during the evaluation stage of the project. The paper discusses some of the tensions experienced by partner organizations, thus providing new insights into why such projects are not as effectual as they might be. The paper concludes by presenting a case for the need to re-conceptualise how change as part of a wider diversity management approach might best be conceptualized. We suggest that a ‘systems approach’ could prove a more fruitful way of conceptualizing change of this nature given the inter-dependences between different organizations and institutions.

  17. Ecosystem approach to inland fisheries: research needs and implementation strategies

    Science.gov (United States)

    Beard, T. Douglas; Arlinghaus, Robert; Cooke, Steven J.; McIntyre, Peter B.; De Silva, Sena; Bartley, Devin M.; Cowx, Ian G.

    2011-01-01

    Inland fisheries are a vital component in the livelihoods and food security of people throughout the world, as well as contributing huge recreational and economic benefits. These valuable assets are jeopardized by lack of research-based understanding of the impacts of fisheries on inland ecosystems, and similarly the impact of human activities associated with inland waters on fisheries and aquatic biodiversity. To explore this topic, an international workshop was organized in order to examine strategies to incorporate fisheries into ecosystem approaches for management of inland waters. To achieve this goal, a new research agenda is needed that focuses on: quantifying the ecosystem services provided by fresh waters; quantifying the economic, social and nutritional benefits of inland fisheries; improving assessments designed to evaluate fisheries exploitation potential; and examining feedbacks between fisheries, ecosystem productivity and aquatic biodiversity. Accomplishing these objectives will require merging natural and social science approaches to address coupled social–ecological system dynamics.

  18. NRC says integrated approach needed to understand, protect environment

    Science.gov (United States)

    Kolb, Charles E.; Loehr, Raymond C.; Gopnik, Morgan

    A recent study by the National Research Council (NRC) advocates a more comprehensive and integrated approach to our nation's environmental research and development (R&D) activities. Because we face environmental problems of unprecedented complexity, the study maintains that the traditional practice of studying isolated environmental problems and devising narrowly focused control or remediation strategies to manage them will no longer suffice.In the report, Building a Foundation for Sound Environmental Decisions [National Academy Press, 1997], an NRC committee highlighted the need for developing a deeper scientific understanding of ecosystems, as well as the sociological and economic aspects of human interactions with the environment. To achieve these goals, the committee recommended a core research agenda for the Environmental Protection Agency (EPA) that has three components.

  19. Designing sustainable work systems: the need for a systems approach.

    Science.gov (United States)

    Zink, Klaus J

    2014-01-01

    There is a growing discussion concerning sustainability. While this discussion was at first mainly focused on a society level--and sometimes regarding especially environmental problems, one can now see that this topic is of increasing relevance for companies worldwide and even the social dimension of this three pillar approach is gaining more and more importance. This leads to some questions: Is sustainability already a part of human factors thinking or do we have to further develop our discipline? How can we define sustainable work systems? What are the topics we have to consider? Do we need a new systems ergonomics perspective regarding whole value creation chains and a life-cycle perspective concerning products (and work systems)? How can we deal with potential contradictions about social, ecological, and economic goals? Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  20. Oral allergy syndrome--the need of a multidisciplinary approach.

    Science.gov (United States)

    Kelava, Nikolina; Lugović-Mihić, Liborija; Duvancić, Tomislav; Romić, Renata; Situm, Mirna

    2014-06-01

    Oral allergy syndrome (OAS) is one of the most common types of food allergy. The syndrome includes itching and swelling of the lips, palate and tongue, usually after consuming fresh fruits and vegetables. The underlying pathogenic mechanism is cross-reactivity between IgE antibodies specific to pollen, and antigens in food, such as fresh fruits, vegetables and nuts that are structurally similar to pollen. Both pollen and food antigens can bind to IgE and trigger type I immune reaction. Diagnosis is primarily based on the patient's history, and confirmed by skin tests, in vitro tests, and oral provocation tests. Differential diagnoses include many diseases (such as burning mouth syndrome, angioedema, hay fever, various other oral diseases, etc.), and for this reason a multidisciplinary approach is necessary, as different specialists need to be involved in the diagnostic procedure. Therapy includes avoiding, or thermal processing of, fruit and vegetables known to trigger a reaction, and antihistamine medications. If a more severe anaphylactic reaction develops, more aggressive therapy is required. The goal of this article is to present OAS, its etiopathogenesis, clinical picture, and symptoms, diagnostic approach and therapy for OAS.

  1. Treatment response in psychotic patients classified according to social and clinical needs, drug side effects, and previous treatment; a method to identify functional remission

    DEFF Research Database (Denmark)

    Alenius, Malin; Hammarlund-Udenaes, Margareta; Honoré, Per Gustaf Hartvig

    2009-01-01

    ; underestimating residual symptoms, negative symptoms, and side effects; or being to open for individual interpretation. The aim of this study was to present and evaluate a new method of classification according to treatment response and, thus, to identify patients in functional remission. METHOD: A naturalistic......, cross-sectional study was performed using patient interviews and information from patient files. The new classification method CANSEPT, which combines the Camberwell Assessment of Need rating scale, the Udvalg for Kliniske Undersøgelser side effect rating scale (SE), and the patient's previous treatment...... history (PT), was used to group the patients according to treatment response. CANSEPT was evaluated by comparison of expected and observed results. RESULTS: In the patient population (n = 123), the patients in functional remission, as defined by CANSEPT, had higher quality of life, fewer hospitalizations...

  2. Single-case effect size calculation: comparing regression and non-parametric approaches across previously published reading intervention data sets.

    Science.gov (United States)

    Ross, Sarah G; Begeny, John C

    2014-08-01

    Growing from demands for accountability and research-based practice in the field of education, there is recent focus on developing standards for the implementation and analysis of single-case designs. Effect size methods for single-case designs provide a useful way to discuss treatment magnitude in the context of individual intervention. Although a standard effect size methodology does not yet exist within single-case research, panel experts recently recommended pairing regression and non-parametric approaches when analyzing effect size data. This study compared two single-case effect size methods: the regression-based, Allison-MT method and the newer, non-parametric, Tau-U method. Using previously published research that measured the Words read Correct per Minute (WCPM) variable, these two methods were examined by comparing differences in overall effect size scores and rankings of intervention effect. Results indicated that the regression method produced significantly larger effect sizes than the non-parametric method, but the rankings of the effect size scores had a strong, positive relation. Implications of these findings for research and practice are discussed. Copyright © 2014 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  3. Distributed Electrical Energy Systems: Needs, Concepts, Approaches and Vision

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yingchen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Zhang, Jun [University of Denver; Gao, Wenzhong [University of Denver; Zheng, Xinhu [University of Minnesota; Yang, Liuqing [Colorado State University; Hao, Jun [University of Denver; Dai, Xiaoxiao [University of Denver

    2017-09-01

    Intelligent distributed electrical energy systems (IDEES) are featured by vast system components, diversifled component types, and difficulties in operation and management, which results in that the traditional centralized power system management approach no longer flts the operation. Thus, it is believed that the blockchain technology is one of the important feasible technical paths for building future large-scale distributed electrical energy systems. An IDEES is inherently with both social and technical characteristics, as a result, a distributed electrical energy system needs to be divided into multiple layers, and at each layer, a blockchain is utilized to model and manage its logic and physical functionalities. The blockchains at difierent layers coordinate with each other and achieve successful operation of the IDEES. Speciflcally, the multi-layer blockchains, named 'blockchain group', consist of distributed data access and service blockchain, intelligent property management blockchain, power system analysis blockchain, intelligent contract operation blockchain, and intelligent electricity trading blockchain. It is expected that the blockchain group can be self-organized into a complex, autonomous and distributed IDEES. In this complex system, frequent and in-depth interactions and computing will derive intelligence, and it is expected that such intelligence can bring stable, reliable and efficient electrical energy production, transmission and consumption.

  4. Computational approach in estimating the need of ditch network maintenance

    Science.gov (United States)

    Lauren, Ari; Hökkä, Hannu; Launiainen, Samuli; Palviainen, Marjo; Repo, Tapani; Leena, Finer; Piirainen, Sirpa

    2015-04-01

    Ditch network maintenance (DNM), implemented annually in 70 000 ha area in Finland, is the most controversial of all forest management practices. Nationwide, it is estimated to increase the forest growth by 1…3 million m3 per year, but simultaneously to cause 65 000 tons export of suspended solids and 71 tons of phosphorus (P) to water courses. A systematic approach that allows simultaneous quantification of the positive and negative effects of DNM is required. Excess water in the rooting zone slows the gas exchange and decreases biological activity interfering with the forest growth in boreal forested peatlands. DNM is needed when: 1) the excess water in the rooting zone restricts the forest growth before the DNM, and 2) after the DNM the growth restriction ceases or decreases, and 3) the benefits of DNM are greater than the caused adverse effects. Aeration in the rooting zone can be used as a drainage criterion. Aeration is affected by several factors such as meteorological conditions, tree stand properties, hydraulic properties of peat, ditch depth, and ditch spacing. We developed a 2-dimensional DNM simulator that allows the user to adjust these factors and to evaluate their effect on the soil aeration at different distance from the drainage ditch. DNM simulator computes hydrological processes and soil aeration along a water flowpath between two ditches. Applying daily time step it calculates evapotranspiration, snow accumulation and melt, infiltration, soil water storage, ground water level, soil water content, air-filled porosity and runoff. The model performance in hydrology has been tested against independent high frequency field monitoring data. Soil aeration at different distance from the ditch is computed under steady-state assumption using an empirical oxygen consumption model, simulated air-filled porosity, and diffusion coefficient at different depths in soil. Aeration is adequate and forest growth rate is not limited by poor aeration if the

  5. The Maasai need cows and the cows need Maasai, the use of a photovoice approach to assess animal health needs

    Directory of Open Access Journals (Sweden)

    Frank eVan Der Meer

    2015-10-01

    Full Text Available The Maasai pastoralists in sub-Saharan Africa depend on their livestock for income and food. Livestock production can be significantly improved by addressing animal health concerns. We explored the use of photovoice, a participatory action research method, to strengthen our understanding of the Maasai’s animal health needs. Nine interviewees, representing warriors, elders, and women, identified animal, social, and human health themes. The use of photography provided a new medium for Maasai to express their needs and a focus for researcher-participant communications, thereby facilitating new insights across language and cultural barriers.

  6. Collaborative Approaches Needed to Close the Big Data Skills Gap

    Directory of Open Access Journals (Sweden)

    Steven Miller

    2014-04-01

    Full Text Available The big data and analytics talent discussion has largely focused on a single role – the data scientist. However, the need is much broader than data scientists. Data has become a strategic business asset. Every professional occupation must adapt to this new mindset. Universities in partnership with industry must move quickly to ensure that the graduates they produce have the required skills for the age of big data. Existing curricula should be reviewed and adapted to ensure relevance. New curricula and degree programs are needed to meet the needs of industry.

  7. We need theoretical physics approaches to study living systems

    Science.gov (United States)

    Blagoev, Krastan B.; Shukla, Kamal; affil="3" >Herbert Levine,

    2013-08-01

    , nor collect data on the kinetics of the many complex reactions. Instead, the focus was on formulating two- or three-component reaction-diffusion equations (e.g. the Oregonator), which could explain such generic features as the existence of rotating spiral waves (and their instability), the transition to chaos, the control of the reaction by light etc. By stressing mechanism instead of meticulous detail, one could understand the system even if there were still components and interactions waiting to be cataloged and quantified. In living systems, this way of thinking is even more crucial. A leading biologist once remarked to one of us that a calculation of in vivo cytoskeletal dynamics that did not take into account the fact that the particular cell in question had more than ten isoforms of actin could not possibly be correct. We need to counter that any calculation which takes into account all these isoforms is overwhelmingly likely to be vastly under-constrained and ultimately not useful. Adding more details can often bring us further from reality. Of course, the challenge for models is then falsification, i.e., finding robust predictions which can be directly tested experimentally. The most severe criticism, to quote Pauli, remains that 'your model is not even wrong.' Is this approach proving successful? In many cases it is too early to tell, but simple models have already proved useful in understanding protein folding, directed cell motility, gene expression variability and even laboratory-scale Darwinian evolution. One could argue as well that the extremely influential Hodgkin-Huxley approach to the action potential in neurons is a vastly oversimplified description and that is why it is tractable and compelling. There are other cases, however, where the model was too simple—the simple Turing instability does not account for Drosophila segment formation [2] and the binary state relaxational dynamics of the Hopfield model may prove incapable of explaining memory

  8. A Theoretical Approach to Information Needs Across Different Healthcare Stakeholders

    Science.gov (United States)

    Raitoharju, Reetta; Aarnio, Eeva

    Increased access to medical information can lead to information overload among both the employees in the healthcare sector as well as among healthcare consumers. Moreover, medical information can be hard to understand for consumers who have no prerequisites for interpreting and understanding it. Information systems (e.g. electronic patient records) are normally designed to meet the demands of one professional group, for instance those of physicians. Therefore, the same information in the same form is presented to all the users of the systems regardless of the actual need or prerequisites. The purpose of this article is to illustrate the differences in information needs across different stakeholders in healthcare. A literature review was conducted to collect examples of these different information needs. Based on the findings the role of more user specific information systems is discussed.

  9. Transjugular Intrahepatic Portosystemic Shunt After Previous Recanalization of a Chronically Thrombosed Portal Vein via a Transmesenteric Approach

    International Nuclear Information System (INIS)

    Matsui, Osamu; Yoshikawa, Jun; Kadoya, Masumi; Gabata, Tosifumi; Takashima, Tsutomu; Urabe, Takeshi; Unoura, Masasi; Kobayashi, Kenichi

    1996-01-01

    We report a cirrhotic patient with complete occlusion of the portal vein with marked cavernous transformation due to chronic thrombosis in whom a transjugular intrahepatic portosystemic shunt (TIPS) was successfully created after direct minilaparotomy mesenteric vein catheterization, lysis and aspiration of the thrombus, and stenting in the portal vein. The methods used, we believe, provide a new technique for performing TIPS in chronically thrombosed portal veins in which previously no effective surgical therapeutic options were available

  10. On Software Certification: We Need Product-Focused Approaches

    Science.gov (United States)

    Wassyng, Alan; Maibaum, Tom; Lawford, Mark

    In this paper we begin by examining the "certification" of a consumer product, a baby walker, that is product-focused, i.e., the certification process requires the performance of precisely defined tests on the product with measurable outcomes. We then review current practices in software certification and contrast the software regime's process-oriented approach to certification with the product-oriented approach typically used in other engineering disciplines. We make the case that product-focused certification is required to produce reliable software intensive systems. These techniques will have to be domain and even product specific to succeed.

  11. Prioritizing the refactoring need for critical component using combined approach

    Directory of Open Access Journals (Sweden)

    Rajni Sehgal

    2018-10-01

    Full Text Available One of the most promising strategies that will smooth out the maintainability issues of the software is refactoring. Due to lack of proper design approach, the code often inherits some bad smells which may lead to improper functioning of the code, especially when it is subject to change and requires some maintenance. A lot of studies have been performed to optimize the refactoring strategy which is also a very expensive process. In this paper, a component based system is considered, and a Fuzzy Multi Criteria Decision Making (FMCDM model is proposed by combining subjective and objective weights to rank the components as per their urgency of refactoring. Jdeodorant tool is used to detect the code smells from the individual components of a software system. The objective method uses the Entropy approach to rank the component having the code smell. The subjective method uses the Fuzzy TOPSIS approach based on decision makers’ judgement, to identify the critically and dependency of these code smells on the overall software. The suggested approach is implemented on component-based software having 15 components. The constitute components are ranked based on refactoring requirements.

  12. Respiratory sensitization and allergy: Current research approaches and needs

    International Nuclear Information System (INIS)

    Boverhof, Darrell R.; Billington, Richard; Gollapudi, B. Bhaskar; Hotchkiss, John A.; Krieger, Shannon M.; Poole, Alan; Wiescinski, Connie M.; Woolhiser, Michael R.

    2008-01-01

    There are currently no accepted regulatory models for assessing the potential of a substance to cause respiratory sensitization and allergy. In contrast, a number of models exist for the assessment of contact sensitization and allergic contact dermatitis (ACD). Research indicates that respiratory sensitizers may be identified through contact sensitization assays such as the local lymph node assay, although only a small subset of the compounds that yield positive results in these assays are actually respiratory sensitizers. Due to the increasing health concerns associated with occupational asthma and the impending directives on the regulation of respiratory sensitizers and allergens, an approach which can identify these compounds and distinguish them from contact sensitizers is required. This report discusses some of the important contrasts between respiratory allergy and ACD, and highlights several prominent in vivo, in vitro and in silico approaches that are being applied or could be further developed to identify compounds capable of causing respiratory allergy. Although a number of animal models have been used for researching respiratory sensitization and allergy, protocols and endpoints for these approaches are often inconsistent, costly and difficult to reproduce, thereby limiting meaningful comparisons of data between laboratories and development of a consensus approach. A number of emerging in vitro and in silico models show promise for use in the characterization of contact sensitization potential and should be further explored for their ability to identify and differentiate contact and respiratory sensitizers. Ultimately, the development of a consistent, accurate and cost-effective model will likely incorporate a number of these approaches and will require effective communication, collaboration and consensus among all stakeholders

  13. THE NEED FOR STATE IN THE ECONOMY- EPISTEMOLOGICAL APPROACH

    Directory of Open Access Journals (Sweden)

    ANCA-ŞTEFANIA SAVA

    2010-01-01

    Full Text Available The aim of this paper is to discuss the need for state in the economy, in an epistemological viewpoint. It presents in a critical manner the ideas on the state of the mercantilism and physiocracy representatives, of the classical and Keynesian economists and of the so-called current „the new liberal orthodoxy”. It is noticed that the need for a minimal state, as a condition of proper functioning of the society, has been justified even by those who have criticized it (classical liberals, being recognized that a society can not be conceived anarchic and utopian. If during ’29-’33s, the philosophy of laisser-faire was replaced by the Keynesian doctrine, and ’70s have placed the welfare state in a crisis of legitimacy, starting from 2008 we can talk of a resurgence of the Keynesian paradigm, according to which government intervention is seen as a way to stimulate the economic recovery.

  14. Solving public passenger transportation problems: a need for policy reorientation. [Brokerage or consumer-oriented approach needed

    Energy Technology Data Exchange (ETDEWEB)

    Davis, F.W. Jr.; Oen, K.

    1977-01-01

    Public transportation has declined because policymakers and outdated regulations have restricted the evolution of transportation systems which more closely reflect the mobility and lifestyles of today. Public policy needs to take a consumer-oriented approach to public transportation by recognizing that all consumers do not have the same transportation needs and that one or two modes of transportation cannot satisfy these needs. This report argues that if public transportation is to become an efficient method of satisfying the transportation needs of a community, a brokerage or consumer-oriented approach should be adopted. The transportation broker will match specific individual needs with a broad array of transportation services, and overcome institutional, legal, and operational barriers to the development of new forms of transportation service. 51 references or footnotes.

  15. The Need for Integrated Approaches in Metabolic Engineering

    Energy Technology Data Exchange (ETDEWEB)

    Lechner, Anna; Brunk, Elizabeth; Keasling, Jay D.

    2016-08-15

    This review highlights state-of-the-art procedures for heterologous small-molecule biosynthesis, the associated bottlenecks, and new strategies that have the potential to accelerate future accomplishments in metabolic engineering. We emphasize that a combination of different approaches over multiple time and size scales must b e considered for successful pathway engineering in a heterologous host. We have classified these optimization procedures based on the "system" that is being manipulated: transcriptome, translatome, proteome, or reactome. By bridging multiple disciplines, including molecular biology, biochemistry, biophysics, and computational sciences, we can create an integral framework for the discovery and implementation of novel biosynthetic production routes.

  16. Why health care corruption needs a new approach.

    Science.gov (United States)

    Radin, Dagmar

    2016-07-01

    While corruption has been at the center of academic studies and on the agenda of international organizations for a couple of decades, in the health care sector corruption has not generated much interest or progress. At the centre of this issue is the lack of an interdisciplinary approach, which is warranted given the complexity of the issue and the lack of cooperation between STET scientifically rigorous academics and policy-makers, leaving room for more cooperation and progress. © The Author(s) 2015.

  17. Rheumatic fever pathogenesis: Approach in research needs change

    Directory of Open Access Journals (Sweden)

    Rajendra Tandon

    2012-01-01

    Full Text Available Despite identifying that rheumatic fever (RF is the result of an immunological reaction following group-A beta-hemolytic streptococcal infection, the pathogenesis remains elusive. RF has been incorrectly designated as causing pancarditis, since it does not cause myocarditis. Research directed toward myocarditis, targeting myosin to unravel the pathogenesis has not succeeded in more than 60 years. RF causes permanent damage to cardiac valves. The mitral valve (MV, derived from the wall of the left ventricle, is composed of a central core of connective tissue, covered on both sides by endothelium. The left ventricle does not have either myocardial or intermyocardial connective tissue involvement in RF. By exclusion, therefore, the primary site of RF damage appears to be the endothelium. Evaluation of the histopathology and immunopathology indicates that RF is a disease of the valvular and vascular endothelium. It is not a connective tissue disorder. Research to identify pathogenesis needs to be focused toward valvular endothelium.

  18. Workforce Development: A Survey of Industry Needs and Training Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Ventre, Jerry; Weissman, Jane

    2009-04-01

    This paper presents information and data collected during 2008 on PV workforce needs by the Interstate Renewable Energy Council for the U.S. Department of Energy. The data was collected from licensed contractors, PV practitioners, educators and expert instructors at training sessions, and at focus group and advisory committee meetings. Respondents were primarily from three states: Florida, New York and California. Other states were represented, but to a lesser extent. For data collection, a 12-item questionnaire was developed that addressed key workforce development issues from the perspectives of both the PV industry and training institutions. A total of 63 responses were collected, although not every respondent answered every question. Industry representatives slightly outnumbered the educators, although the difference in responses was not significant.

  19. Caseload management: an approach to making community needs visible.

    Science.gov (United States)

    McDonald, Anne; Frazer, Kate; Cowley, Dame Sarah

    2013-03-01

    To explore the process employed in the development of a population health framework and documentation for managing community nursing caseloads. No formal structure exists to validate and link local health information collected by Irish public health nurses to a wider epidemiological framework. Neglect of this bottom up information forfeits opportunities to resource and manage public health nursing services. Action research methods guided the development of the framework in one geographic area in Dublin and 34 participants engaged in Stringer's (1996) Look, Think and Act cycle. The framework identified four patient registers: family health, chronic sick/disability, older adults and acute care, which identify public health outcomes for discussion within the caseload analysis process and can predict risk factors in local populations. The use of the developed documentation identified a framework that describes caseloads in primary care and provides nurse managers with an evidence base to allocate resources, match skill mix to need, and estimate future workforce requirements.

  20. The role of a specialized approach for patients with diabetes, critical ischaemia and foot ulcers not previously considered for proactive management.

    Science.gov (United States)

    Aragón-Sánchez, J; Maynar-Moliner, M; Pulido-Duque, J M; Rabellino, M; González, G; Zander, T

    2011-10-01

    To analyse the outcome of the proactive management of patients with diabetes, critical limb ischaemia and foot ulcers using percutaneous transluminal angioplasty as the only vascular procedure and adjuvant conservative surgery when indicated. A retrospective study of patients with diabetes included in our database who sought a second opinion in our unit and met the following criteria: foot ulcer and critical limb ischaemia in patients for whom any proactive vascular treatment had not previously been considered by other teams. Twenty patients underwent endovascular procedures. Success was achieved in 19 cases (95%). No post-operative mortality (within 30 days after the procedure) was found. Additional surgery was required in eight cases (40%): one calcaneal ostectomy and seven minor amputations. The need for surgery was associated with infection (P diabetes, foot ulcers and critical limb ischaemia by means of a proactive approach including endovascular procedures in specialized settings provides a high rate of limb salvage. This may result in lowering the number of lower limb amputations in our community. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

  1. Estimating the Need for Palliative Radiation Therapy: A Benchmarking Approach

    Energy Technology Data Exchange (ETDEWEB)

    Mackillop, William J., E-mail: william.mackillop@krcc.on.ca [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Queen' s University, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Kong, Weidong [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Queen' s University, Kingston, Ontario (Canada)

    2016-01-01

    Purpose: Palliative radiation therapy (PRT) benefits many patients with incurable cancer, but the overall need for PRT is unknown. Our primary objective was to estimate the appropriate rate of use of PRT in Ontario. Methods and Materials: The Ontario Cancer Registry identified patients who died of cancer in Ontario between 2006 and 2010. Comprehensive RT records were linked to the registry. Multivariate analysis identified social and health system-related factors affecting the use of PRT, enabling us to define a benchmark population of patients with unimpeded access to PRT. The proportion of cases treated at any time (PRT{sub lifetime}), the proportion of cases treated in the last 2 years of life (PRT{sub 2y}), and number of courses of PRT per thousand cancer deaths were measured in the benchmark population. These benchmarks were standardized to the characteristics of the overall population, and province-wide PRT rates were then compared to benchmarks. Results: Cases diagnosed at hospitals with no RT on-site and residents of poorer communities and those who lived farther from an RT center, were significantly less likely than others to receive PRT. However, availability of RT at the diagnosing hospital was the dominant factor. Neither socioeconomic status nor distance from home to nearest RT center had a significant effect on the use of PRT in patients diagnosed at a hospital with RT facilities. The benchmark population therefore consisted of patients diagnosed at a hospital with RT facilities. The standardized benchmark for PRT{sub lifetime} was 33.9%, and the corresponding province-wide rate was 28.5%. The standardized benchmark for PRT{sub 2y} was 32.4%, and the corresponding province-wide rate was 27.0%. The standardized benchmark for the number of courses of PRT per thousand cancer deaths was 652, and the corresponding province-wide rate was 542. Conclusions: Approximately one-third of patients who die of cancer in Ontario need PRT, but many of them are never

  2. Innovative Approaches to Management Health Needed to Make Ecosanogenesis

    Directory of Open Access Journals (Sweden)

    Nicolae Ipate

    2015-02-01

    Full Text Available In this study we analysed the field of ecosanogenesis in correlation the health workplace, the health of consumers, and the health of the environment. Concerns of this vast area are primarily related to the implications of technology and various health products, because their effects are far more extensive and more generalized. This concept involves man to major issues, human actions and their results, nature and society, material and spiritual culture in a global relational context. If health depends on the relation human - product - nature, and promote better health will depend on optimal functionality of this relationship. Innovation as a result of research and inventions, in the service ecosanogenesis, offers a balance and sustainable development progress for sure, we could call it positive progress.Health classic resources financing, general taxes or health insurance contributions, are becoming increasingly inadequate, regardless of the type of health system, national health system or health insurance system. From increasingly many factors adversely affect the health of the population impersonal, that are not the result of human action or inaction in terms of his daily activities eg: environmental pollution, deforestation, use of non-biodegradable products etc. In conclusion we descript the innovative approaches to management health in context of ecosanogensis.

  3. Sociotechnical approaches to workplace safety: Research needs and opportunities.

    Science.gov (United States)

    Robertson, Michelle M; Hettinger, Lawrence J; Waterson, Patrick E; Noy, Y Ian; Dainoff, Marvin J; Leveson, Nancy G; Carayon, Pascale; Courtney, Theodore K

    2015-01-01

    The sociotechnical systems perspective offers intriguing and potentially valuable insights into problems associated with workplace safety. While formal sociotechnical systems thinking originated in the 1950s, its application to the analysis and design of sustainable, safe working environments has not been fully developed. To that end, a Hopkinton Conference was organised to review and summarise the state of knowledge in the area and to identify research priorities. A group of 26 international experts produced collaborative articles for this special issue of Ergonomics, and each focused on examining a key conceptual, methodological and/or theoretical issue associated with sociotechnical systems and safety. In this concluding paper, we describe the major conference themes and recommendations. These are organised into six topic areas: (1) Concepts, definitions and frameworks, (2) defining research methodologies, (3) modelling and simulation, (4) communications and decision-making, (5) sociotechnical attributes of safe and unsafe systems and (6) potential future research directions for sociotechnical systems research. Sociotechnical complexity, a characteristic of many contemporary work environments, presents potential safety risks that traditional approaches to workplace safety may not adequately address. In this paper, we summarise the investigations of a group of international researchers into questions associated with the application of sociotechnical systems thinking to improve worker safety.

  4. Sociotechnical approaches to workplace safety: Research needs and opportunities

    Science.gov (United States)

    Robertson, Michelle M.; Hettinger, Lawrence J.; Waterson, Patrick E.; Ian Noy, Y.; Dainoff, Marvin J.; Leveson, Nancy G.; Carayon, Pascale; Courtney, Theodore K.

    2015-01-01

    The sociotechnical systems perspective offers intriguing and potentially valuable insights into problems associated with workplace safety. While formal sociotechnical systems thinking originated in the 1950s, its application to the analysis and design of sustainable, safe working environments has not been fully developed. To that end, a Hopkinton Conference was organised to review and summarise the state of knowledge in the area and to identify research priorities. A group of 26 international experts produced collaborative articles for this special issue of Ergonomics, and each focused on examining a key conceptual, methodological and/or theoretical issue associated with sociotechnical systems and safety. In this concluding paper, we describe the major conference themes and recommendations. These are organised into six topic areas: (1) Concepts, definitions and frameworks, (2) defining research methodologies, (3) modelling and simulation, (4) communications and decision-making, (5) sociotechnical attributes of safe and unsafe systems and (6) potential future research directions for sociotechnical systems research. Practitioner Summary: Sociotechnical complexity, a characteristic of many contemporary work environments, presents potential safety risks that traditional approaches to workplace safety may not adequately address. In this paper, we summarise the investigations of a group of international researchers into questions associated with the application of sociotechnical systems thinking to improve worker safety. PMID:25728246

  5. Forecasting Terrorism: The Need for a More Systematic Approach

    Directory of Open Access Journals (Sweden)

    Edwin Bakker

    2012-01-01

    Full Text Available This article analyzes a unique branch of terrorism literature—terrorism futures—by academics, think tanks, and governmental agencies published between 2000 and 2012. To this end, it examines over sixty publications that attempt to discern possible futures of terrorism. In general, the track record of forecasting terrorism has not been good. This is particularly true for major changes in the modus operandi of terrorism, the attacks on 9/11 being a case in point. The analyses of the future of terrorism shows an absence of methodologies, and the lack of theoretical foundations, which lead to limited insights about the causes of changes in terrorism. Most forecasts seem to say more about the present state of terrorism than about the future. The article concludes with a call for a more systematic approach grounded in theory and methodology in order to improve the quality of foresight studies, and to enable researchers to better understand how to assess, model, forecast, and respond to the future terrorist threat.

  6. Protecting nuclear material and facilities: Is a new approach needed?

    International Nuclear Information System (INIS)

    Steinhausler, F.; Bunn, G.

    2002-01-01

    Full text: The main reason why national physical protection (PP) systems for nuclear and other radioactive material need to be strengthened further is that, after the attacks on the US on 11 September 2001, the threat of dangerous, suicidal radiological and nuclear terrorism can no longer be excluded as a possibility. Existing PP systems were not designed to deal with the threat of suicidal terrorists having the numbers, skills, training, and resources available to the commandos attacking on 11 September. Moreover, there are no mandatory international standards for domestic PP systems for nuclear or radioactive material, and this has produced great variation in protection provided from country to country. IAEA recommended standards, while useful, were not designed with the new terrorist threat in mind. Moreover, they are often not followed in practice. The result is inadequate protection against the new form of terrorism in most countries. The Director General of the IAEA expressed a similar view after 11 September, but achieving a consensus to amend the Convention on the Physical Protection of Nuclear Material (CPPNM) to require specific standards of protection for different amounts and kinds of nuclear material used or stored domestically (not in international transport) has been impossible in the year since 11 September. In the case of radiological materials, a new effort to provide required international standards for protection against the new form of terrorism has not begun. In the summer of 2001, leaders of the G-8 countries agreed to a Global Partnership to prevent the new terrorists from acquiring nuclear and radiological as well as other materials related to weapons of mass destruction. Perhaps in part because of the failure to date to achieve agreement on an effective amendment to the CPPNM, the first principle of this partnership is to strengthen 'multilateral treaties and other instruments whose aim is to prevent the proliferation or illicit

  7. Development and Initial Validation of the Need Satisfaction and Need Support at Work Scales: A Validity-Focused Approach

    Directory of Open Access Journals (Sweden)

    Susanne Tafvelin

    2018-01-01

    Full Text Available Although the relevance of employee need satisfaction and manager need support have been examined, the integration of self-determination theory (SDT into work and organizational psychology has been hampered by the lack of validated measures. The purpose of the current study was to develop and validate measures of employees’ perception of need satisfaction (NSa-WS and need support (NSu-WS at work that were grounded in SDT. We used three Swedish samples (total 'N' = 1,430 to develop and validate our scales. We used a confirmatory approach including expert panels to assess item content relevance, confirmatory factor analysis for factorial validity, and associations with theoretically warranted outcomes to assess criterion-related validity. Scale reliability was also assessed. We found evidence of content, factorial, and criterion-related validity of our two scales of need satisfaction and need support at work. Further, the scales demonstrated high internal consistency. Our newly developed scales may be used in research and practice to further our understanding regarding how satisfaction and support of employee basic needs influence employee motivation, performance, and well-being. Our study makes a contribution to the current literature by providing (1 scales that are specifically designed for the work context, (2 an example of how expert panels can be used to assess content validity, and (3 testing of theoretically derived hypotheses that, although SDT is built on them, have not been examined before.

  8. Approaches to learning, need for cognition, and strategic flexibility among university students.

    Science.gov (United States)

    Evans, Christina J; Kirby, John R; Fabrigar, Leandre R

    2003-12-01

    Considerable research has described students' deep and surface approaches to learning. Other research has described individuals' self-regulated learning and need for cognition. There is a need for research examining the relationships among these constructs. This study explored relationships among approaches to learning (deep, surface), need for cognition, and three types of control of learning (adaptive, inflexible, irresolute). Theory suggested similarities among the deep approach, need for cognition, and adaptive control (aspects of self-regulated learning); and among surface, inflexible, and irresolute control (aspects of an ineffective approach to learning). One-factor and two-factor models were proposed. Participants were 226 Canadian military college students. Participants completed the following questionnaires: the Study Process Questionnaire (Biggs, 1978), the Need for Cognition Scale (Cacioppo & Petty, 1982), and the Strategic Flexibility Questionnaire (Cantwell & Moore, 1996). Confirmatory factor analysis supported the identification of the six scale factors. Second order confirmatory factor analysis indicated three factors representing constructs underlying these factors. Neither the one- nor two-factor models accounted adequately for the data. Self-regulated learning was defined by measures of the deep approach to learning, need for cognition, and adaptive control of learning. The second factor divided into one factor consisting of irresolute control, the surface approach, and negative need for cognition; and another consisting of inflexible and negative adaptive control. Substantial relationships among scales support the need for further theory development.

  9. Assessing the Needs of Service Members and Their Families: A New Approach

    Science.gov (United States)

    2011-01-01

    rand 2011 www.rand.org Assessing the Needs of Service Members and Their Families A New Approach S ince the advent of the all-volunteer force in...programs to be responsive to the needs of service members and their families. Unfortunately, DoD does not have a systematic way to determine what those...needs are. Traditional program evaluation focuses on the use of specific programs rather than the needs of DoD families. This shortfall is remedied

  10. Social use of alcohol among adolescent offenders: a fundamental approach toward human needs

    Directory of Open Access Journals (Sweden)

    Gustavo D?Andrea

    2014-02-01

    Full Text Available This study examined some basic health care approaches toward human needs, with a particular focus on nursing. We aimed to incorporate these approaches into the discussion of the mental health of adolescent offenders who consume alcohol. We discuss specific needs of the delinquent group, critique policies that prioritize coercion of adolescent offenders, and the role that nurses could play in the sphere of juvenile delinquency.

  11. Gender-related needs and preferences in cancer care indicate the need for an individualized approach to cancer patients.

    Science.gov (United States)

    Wessels, Hester; de Graeff, Alexander; Wynia, Klaske; de Heus, Miriam; Kruitwagen, Cas L J J; Woltjer, Gerda T G J; Teunissen, Saskia C C M; Voest, Emile E

    2010-01-01

    Improving quality of care for cancer patients requires insight into their specific wishes, needs, and preferences concerning cancer care. The aim of this study was to explore the impact of gender on cancer patients' needs and preferences. Data were obtained from 386 questionnaires assessing cancer patients' preferences for health care. Multivariate regression analyses were performed with data obtained from medical oncology patients treated in seven Dutch hospitals, using the scales of the questionnaire as dependent variables. Patients rated safety, expertise, performance, and attitude of physicians and nurses highest on their list of preferences. There were significant differences between male and female patients concerning preferences in health care in 15 of the 21 scales and in two of the eight single items. Without exception, women found the care aspects mentioned in these scales and items more important than men. Multivariate regression analysis showed that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences. Gender impacts cancer patients' needs and preferences and should be taken into account for optimal cancer care. Cancer care might be tailored toward gender, for example, with regard to the means and extent of communication, manner and extent of support, counseling and rehabilitation, consultation length, and physician assignment. The results of this study may guide health care professionals and organizations to develop a gender-specific health care approach to further improve cancer patient-centered care.

  12. The TEACH Method: An Interactive Approach for Teaching the Needs-Based Theories Of Motivation

    Science.gov (United States)

    Moorer, Cleamon, Jr.

    2014-01-01

    This paper describes an interactive approach for explaining and teaching the Needs-Based Theories of Motivation. The acronym TEACH stands for Theory, Example, Application, Collaboration, and Having Discussion. This method can help business students to better understand and distinguish the implications of Maslow's Hierarchy of Needs,…

  13. Malaria Vaccine Development: The Need for Novel Approach-es: A Review Article

    Directory of Open Access Journals (Sweden)

    Shima MAHMOUDI

    2018-03-01

    Full Text Available Background: Although rigorous efforts have substantially decreased the malaria burden through decades, it still threatens the lives of millions of children. Development of an effective vaccine can provide important approach in malaria control strategies. Unfortunately, development of an effective vaccine for falciparum malaria has been hindered by the extreme complexity of malaria parasite biology, complex and diverse parasite genomes, and immune evasion by the parasites as well as the intricate nature of the parasites infection cycle. The aim of this review was to discuss the different approaches to malaria vaccine development until now.Methods: Scientific databases, including MEDLINE (via PubMed and SCOPUS were searched up to 30 Jan 2017 and the articles regarding malaria vaccine development were taken into examination.Results: Several strategies for malaria vaccine development including pre-erythrocytic vaccines, antibody-based subunit vaccines, vectored vaccines, whole sporozoite vaccines, genetically Attenuated parasites and sporozoite subunit vaccine, erythrocytic vaccines, sexual stage vaccine, transmission-blocking vaccine as well as synthetic peptides and conjugate vaccine has been introduced. However, the success has been limited thus far.Conclusion: Although development of malaria vaccine over the past 70 year has been continued, the discovery, development, and licensing of a malaria vaccine formulation, which meets safety, affordability, accessibility, applicability, and efficacy has not yet been achieved.

  14. Comparing three different approaches to the measurement of needs concerning fatigue in patients with advanced cancer

    DEFF Research Database (Denmark)

    Madsen, Ulla Riis; Groenvold, Mogens; Petersen, Morten Aagaard

    2015-01-01

    PURPOSE: To identify patients having fatigue, it is necessary to assess the patients fatigue systematically. This study investigates three different approaches to the assessment of needs concerning fatigue in patients with advanced cancer and addresses the following questions. METHODS: In a cross...... fatigue to be a problem. The QLQ-C30 item 'Were you tired' worked as a screening tool to identify patients experiencing an unmet need concerning fatigue....

  15. Bridging cancer biology and the patients' needs with nanotechnology-based approaches.

    Science.gov (United States)

    Fonseca, Nuno A; Gregório, Ana C; Valério-Fernandes, Angela; Simões, Sérgio; Moreira, João N

    2014-06-01

    Cancer remains as stressful condition and a leading cause of death in the western world. Actual cornerstone treatments of cancer disease rest as an elusive alternative, offering limited efficacy with extensive secondary effects as a result of severe cytotoxic effects in healthy tissues. The advent of nanotechnology brought the promise to revolutionize many fields including oncology, proposing advanced systems for cancer treatment. Drug delivery systems rest among the most successful examples of nanotechnology. Throughout time they have been able to evolve as a function of an increased understanding from cancer biology and the tumor microenvironment. Marketing of Doxil® unleashed a remarkable impulse in the development of drug delivery systems. Since then, several nanocarriers have been introduced, with aspirations to overrule previous technologies, demonstrating increased therapeutic efficacy besides decreased toxicity. Spatial and temporal targeting to cancer cells has been explored, as well as the use of drug combinations co-encapsulated in the same particle as a mean to take advantage of synergistic interactions in vivo. Importantly, targeted delivery of siRNA for gene silencing therapy has made its way to the clinic for a "first in man" trial using lipid-polymeric-based particles. Focusing in state-of-the-art technology, this review will provide an insightful vision on nanotechnology-based strategies for cancer treatment, approaching them from a tumor biology-driven perspective, since their early EPR-based dawn to the ones that have truly the potential to address unmet medical needs in the field of oncology, upon targeting key cell subpopulations from the tumor microenvironment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. The Relationship among Student Basic Need Satisfaction, Approaches to Learning, Reporting of Avoidance Strategies and Achievement

    Science.gov (United States)

    Betoret, Fernando Domenech; Artiga, Amparo Gomez

    2011-01-01

    Introduction: This study examines the relationship between student basic need satisfaction (autonomy, competence, relatedness and belonging), their reporting of approaches to learning (deep and surface), their reporting of avoidance strategies (avoidance of effort and challenge, avoidance of help seeking and preference to avoid novelty) and…

  17. Approaches to Study and Their Impact on the Need for Support and Guidance in Distance Learning.

    Science.gov (United States)

    Carnwell, Ros

    2000-01-01

    Discusses the results of interviews conducted with 20 women distance learners from community nursing disciplines at the University of Wolverhampton (United Kingdom) that investigated relationships between approaches to study, learning styles and strategies, and materials design, and how these impact on the need for support and guidance in distance…

  18. TwitterNEED: a hybrid approach for named entity extraction and disambiguation for tweets

    NARCIS (Netherlands)

    Habib, Mena Badieh; van Keulen, Maurice

    Twitter is a rich source of continuously and instantly updated information. Shortness and informality of tweets are challenges for Natural Language Processing tasks. In this paper, we present TwitterNEED, a hybrid approach for Named Entity Extraction and Named Entity Disambiguation for tweets. We

  19. Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach.

    Science.gov (United States)

    Timpel, P; Lang, C; Wens, J; Contel, J C; Gilis-Januszewska, A; Kemple, K; Schwarz, P E

    2017-11-13

    Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and

  20. Estimating the financial resources needed for local public health departments in Minnesota: a multimethod approach.

    Science.gov (United States)

    Riley, William; Briggs, Jill; McCullough, Mac

    2011-01-01

    This study presents a model for determining total funding needed for individual local health departments. The aim is to determine the financial resources needed to provide services for statewide local public health departments in Minnesota based on a gaps analysis done to estimate the funding needs. We used a multimethod analysis consisting of 3 approaches to estimate gaps in local public health funding consisting of (1) interviews of selected local public health leaders, (2) a Delphi panel, and (3) a Nominal Group Technique. On the basis of these 3 approaches, a consensus estimate of funding gaps was generated for statewide projections. The study includes an analysis of cost, performance, and outcomes from 2005 to 2007 for all 87 local governmental health departments in Minnesota. For each of the methods, we selected a panel to represent a profile of Minnesota health departments. The 2 main outcome measures were local-level gaps in financial resources and total resources needed to provide public health services at the local level. The total public health expenditure in Minnesota for local governmental public health departments was $302 million in 2007 ($58.92 per person). The consensus estimate of the financial gaps in local public health departments indicates that an additional $32.5 million (a 10.7% increase or $6.32 per person) is needed to adequately serve public health needs in the local communities. It is possible to make informed estimates of funding gaps for public health activities on the basis of a combination of quantitative methods. There is a wide variation in public health expenditure at the local levels, and methods are needed to establish minimum baseline expenditure levels to adequately treat a population. The gaps analysis can be used by stakeholders to inform policy makers of the need for improved funding of the public health system.

  1. Meeting water needs for sustainable development: an overview of approaches, measures and data sources

    Science.gov (United States)

    Lissner, Tabea; Reusser, Dominik E.; Sullivan, Caroline A.; Kropp, Jürgen P.

    2013-04-01

    An essential part of a global transition towards sustainability is the Millennium Development Goals (MDG), providing a blueprint of goals to meet human needs. Water is an essential resource in itself, but also a vital factor of production for food, energy and other industrial products. Access to sufficient water has only recently been recognized as a human right. One central MDG is halving the population without access to safe drinking water and sanitation. To adequately assess the state of development and the potential for a transition towards sustainability, consistent and meaningful measures of water availability and adequate access are thus fundamental. Much work has been done to identify thresholds and definitions to measure water scarcity. This includes some work on defining basic water needs of different sectors. A range of data and approaches has been made available from a variety of sources, but all of these approaches differ in their underlying assumptions, the nature of the data used, and consequently in the final results. We review and compare approaches, methods and data sources on human water use and human water needs. This data review enables identifying levels of consumption in different countries and different sectors. Further comparison is made between actual water needs (based on human and ecological requirements), and recognised levels of water abstraction. The results of our review highlight the differences between different accounts of water use and needs, and reflect the importance of standardised approaches to data definitions and measurements, making studies more comparable across space and time. The comparison of different use and allocation patterns in countries enables levels of water use to be identified which allow for an adequate level of human wellbeing to be maintained within sustainable water abstraction limits. Recommendations are provided of how data can be defined more clearly to make comparisons of water use more meaningful and

  2. Managing forests in a changing world: the need for a systemic approach. A review

    Energy Technology Data Exchange (ETDEWEB)

    Nocentini, S.; Buttoud, G.; Ciancio, O.; Corona, P.

    2017-11-01

    Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

  3. Managing forests in a changing world: the need for a systemic approach. A review

    International Nuclear Information System (INIS)

    Nocentini, S.; Buttoud, G.; Ciancio, O.; Corona, P.

    2017-01-01

    Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

  4. Managing forests in a changing world: the need for a systemic approach. A review

    Directory of Open Access Journals (Sweden)

    Susanna Nocentini

    2017-05-01

    Full Text Available Aim of study: The paper is a scientific commented discussion with the aim of defining a framework which allows both a comprehensive vision of forest dynamics, as well as an adaptive management approach and policy procedures more suited to a changing and inherently unpredictable world. Main results: We identify the main challenges facing forestry in relation to recent developments in forestry thinking, i.e. the paradox of aiming at sustainability in a changing environment, a shifting perception of the relationship between ecological and social systems, the recognition of forest ecosystems as complex adaptive systems, the need for integrating the social and ecological dimensions of forestry into a single framework, and the growing awareness of the importance of the ethical approach to the forest. We propose the concept of “systemic forestry” as a paradigm for better understanding forest dynamics and for guiding management and public actions at various levels. We compare the systemic approach with different silvicultural and forest management approaches which have been proposed in the last decades. Research highlights: Our analysis shows that a systemic approach to forestry has five main consequences: 1. forestry is viewed as a part of landscape dynamics through a multi-sectoral coordination, 2. the logic of action changes from norm to process, 3. conservation is a dynamic search for resilience, 4. multi-functionality is achieved through a multi-entries approach integrating ecological, social and economic components of sustainability, 5. forestry institutions are reframed to address the issue of changing interactions among actors, 6. a change in the ethical approach to the forest is needed.

  5. Lists and thresholds: comparing our theory of human need with Nussbaum's capabilities approach.

    OpenAIRE

    Ian Gough

    2003-01-01

    This paper compares two recent books addressing issues in human wellbeing, rights and development: A Theory of Human Need by Doyal and Gough and Women and Human Development: The Capabilities Approach by Martha Nussbaum. The first part identifies the common project which underlies both works: to clarify and defend those universal human interests which underpin an emancipatory and effective political programme for all women and men. The next two sections set out in some detail the different app...

  6. The Need for a Rights-Based Approach to the Clean Development Mechanism

    DEFF Research Database (Denmark)

    Filzmoser, Eva; Voigt, Juliane; Trunkl, Urska

    2015-01-01

    The adoption of a range of resolutions by the United Nations Human Rights Council (UNHRC) signals the introduction of a human rights-based approach into the lexicon of climate change negotiation and resulting initiatives. This development has been subsequently reinforced by the Conference of Part...... highlights the need for CDM to embrace a rights- based focus in its operation. This is followed with conclusion and recommendations....

  7. On the Brink of Shifting Paradigms, Molecular Systems Engineering Ethics Needs to Take a Proactive Approach.

    Science.gov (United States)

    Heidari, Raheleh; Elger, Bernice S; Stutzki, Ralf

    2016-01-01

    Molecular Systems Engineering (MSE) is a paradigm shift in both engineering and life sciences. While the field is still in its infancy the perspectives of MSE in revolutionising technology is promising. MSE will offer a wide range of applications in clinical, biotechnological and engineering fields while simultaneously posing serious questions on the ethical and societal aspects of such technology. The moral and societal aspects of MSE need systematic investigation from scientific and social perspectives. In a democratic setting, the societal outcomes of MSE's cutting-edge technology need to be consulted and influenced by society itself. For this purpose MSE needs inclusive public engagement strategies that bring together the public, ethicists, scientists and policy makers for optimum flow of information that maximizes the impact of public engagement. In this report we present an MSE consortium and its ethics framework for establishing a proactive approach in the study of the ethics of MSE technology.

  8. Anybody Hear Us? Attempting to Meet the Psychological Care Needs of Older People: an Ethnographic Approach

    Directory of Open Access Journals (Sweden)

    Seyed Zia Tabatabaei

    2016-07-01

    Full Text Available Older people who live in residential settings need some psychological support because of vicissitudes of life they faced with. The aim of this study is to explore psychological care needs of older people in a residential home. We used an ethnographic approach from May 2011 till January 2012. Through purposeful sampling, 14 knowledgeable participants were selected. Data were gathered from participant observations, in-depth interviews, review of related documents and field notes. Thematic analysis revealed three key themes including: (a Feelings of sadness (b Emotional desires and (c Choice and control. Findings of current study provided rich and useful information that is useful in charting new guideline for policy makers and care providers in order to support elderly residents' psychological care needs.

  9. A Toolkit Modeling Approach for Sustainable Forest Management Planning: Achieving Balance between Science and Local Needs

    Directory of Open Access Journals (Sweden)

    Brian R. Sturtevant

    2007-12-01

    Full Text Available To assist forest managers in balancing an increasing diversity of resource objectives, we developed a toolkit modeling approach for sustainable forest management (SFM. The approach inserts a meta-modeling strategy into a collaborative modeling framework grounded in adaptive management philosophy that facilitates participation among stakeholders, decision makers, and local domain experts in the meta-model building process. The modeling team works iteratively with each of these groups to define essential questions, identify data resources, and then determine whether available tools can be applied or adapted, or whether new tools can be rapidly created to fit the need. The desired goal of the process is a linked series of domain-specific models (tools that balances generalized "top-down" models (i.e., scientific models developed without input from the local system with case-specific customized "bottom-up" models that are driven primarily by local needs. Information flow between models is organized according to vertical (i.e., between scale and horizontal (i.e., within scale dimensions. We illustrate our approach within a 2.1 million hectare forest planning district in central Labrador, a forested landscape where social and ecological values receive a higher priority than economic values. However, the focus of this paper is on the process of how SFM modeling tools and concepts can be rapidly assembled and applied in new locations, balancing efficient transfer of science with adaptation to local needs. We use the Labrador case study to illustrate strengths and challenges uniquely associated with a meta-modeling approach to integrated modeling as it fits within the broader collaborative modeling framework. Principle advantages of the approach include the scientific rigor introduced by peer-reviewed models, combined with the adaptability of meta-modeling. A key challenge is the limited transparency of scientific models to different participatory groups

  10. Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach

    Directory of Open Access Journals (Sweden)

    P. Timpel

    2017-11-01

    Full Text Available Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92 of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22 of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650. Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care

  11. Health care providers and adolescents' perspectives towards adolescents' health education needs: a need assessment based on comparative approach.

    Science.gov (United States)

    Shahhosseini, Zohreh; Abedian, Kobra

    2015-02-01

    Health care providers have considerable influence on adolescents' health promotion. Thus, it is important to focus on the views of this group as one of the most reliable sources in the evaluation of teenagers' health needs. The aim of this study was to compare the attitudes of Iranian health care providers and adolescents towards the latter's health education needs. A quantitative cross-sectional survey, including 72 health care providers and 402 female students from 14 high schools in northern Iran, was carried out in 2011. Topics in a self-administrated questionnaire covered the participants' perspectives towards the educational health needs of adolescents in a five-point Likert scale. Findings revealed from health care providers' views indicate that the highest mean score was assigned to "Education about prevention of sexual high risk behavior", which was significantly different from adolescents' perspective (t=8.42, pcare providers and adolescents both emphasized on the mothers' role as the most reliable source of adolescents' education (t=1.85, p>0.05). Provision of health education programs for adolescents, which are based on integration of health care providers' perspectives and the adolescents' views, are essential in meeting adolescents' educational health needs.

  12. Policies for friendly cities: the need for a new approach by governments and the donor community

    Science.gov (United States)

    Puccioni, V.

    2018-03-01

    Since the 1990s, the major issues in the world’s cities of Developing and Emerging Economy Countries have in some few cases improved in terms of the percentage of urban population living without appropriate housing and access to essential services- but in terms of numbers such population has severely increased. The theory by which economic development would automatically produce a trickle down effect that would take care of the needs of the poor has proved ineffective, and while the middle-lower classes have seen their lot improved, the lowest income groups are more destitute then ever- and more and more vulnerable to natural disasters. The approach of Governments and the donor community needs to be radically revisited, with a new urban policy agenda that should put emphasis on support to the lowest income groups, and relying on the informal sector as the main actor in implementing such support. The impacts of Climate Change and the increased frequency and severity of natural catastrophes also call for such a revised approach. The two-step approach to interventions in disasters situations – i.e. providing temporary shelters and only subsequently reconstructing homes- is ineffective and wasteful.

  13. Critical review of forensic trace evidence analysis and the need for a new approach.

    Science.gov (United States)

    Stoney, David A; Stoney, Paul L

    2015-06-01

    The historical development, contributions and limitations of the two traditional approaches to trace evidence analysis are reviewed. The first approach was as generalist practitioner, looking broadly at an assemblage of many different particle types. The second was that of specialist practitioner, with attention focused on one specific particle type. Four factors have significantly impacted the effectiveness of these approaches: (1) increasing technological capabilities, (2) increasing complexity in the character of manufactured materials, (3) changes in forensic laboratory management, and (4) changing scientific and legal expectations. The effectiveness of each approach is assessed within the context of these changes. More recently, new technologies have been applied to some trace evidence problems, intended to address one or more limitations. This has led to a third approach founded on discrete, highly technical methods addressing specific analytical problems. After evaluating the contributions and limitations of this third approach, we consider the different ways that technologies could be developed to address unmet needs in forensic trace evidence analysis. The route toward effective use of new technologies is contrasted with how forensic science laboratories are currently choosing and employing them. The conclusion is that although new technologies are contributing, we are not on a path that will result in their most effective and appropriate use. A new approach is required. Based on an analysis of the contributions of each of the three exisiting approaches, seven characteristics of an effective trace evidence analysis capability were determined: (1) particle traces should be a major problem-solving tool, (2) there should be readily available, straightforward methods to enable their use, (3) all available and potentially useful particle types should be considered, (4) decisions to use them should be made in the context of each case, guided by what they can

  14. The role of need for closure in essentialist entitativity beliefs and prejudice: an epistemic needs approach to racial categorization.

    Science.gov (United States)

    Roets, Arne; Van Hiel, Alain

    2011-03-01

    The present research investigates how people's general epistemic motives may inspire essentialist beliefs about racial groups and racism. In three studies, we focus particularly on essentialist entitativity (EE, referring to beliefs about the uniformity, informativeness, and inherent core of racial groups), probing into its relationships with epistemic need for closure (NFC) and prejudice. In Study 1, we develop an EE scale, empirically distinguish it from the naturalness component of essentialism and non-EE beliefs, and establish its predictive utility for explaining racial prejudice. Study 2 provides experimental evidence for the causal effect of NFC on EE beliefs. Study 3 demonstrates in three different samples that EE beliefs mediate the relationship between dispositional NFC and racial prejudice. It is argued that EE beliefs about racial groups are an expression of motivated social cognition, serving people's seizing needs for quick and easy social judgment. ©2010 The British Psychological Society.

  15. Cooperative learning in 'Special Needs in Dentistry' for undergraduate students using the Jigsaw approach.

    Science.gov (United States)

    Suárez-Cunqueiro, M M; Gándara-Lorenzo, D; Mariño-Pérez, R; Piñeiro-Abalo, S; Pérez-López, D; Tomás, I

    2017-11-01

    The goals of this study were to (i) describe the use of the Jigsaw approach for the resolution of clinical cases by undergraduate students in the subject 'Special Needs in Dentistry' and (ii) assess the impact of its implementation on academic performance and the students' perception. The Jigsaw approach was applied to the fifth-year in the subject 'Special Needs in Dentistry', as part of the Dentistry degree curriculum of the University of Santiago de Compostela, during the academic years 2012/2013 and 2013/2014. A total of 109 dental students were enrolled in the study, and the final marks of the Jigsaw (n = 55) and the non-Jigsaw groups (n = 54) were compared. Students' perceptions on the Jigsaw technique were assessed using a 13-question questionnaire. Academic performance based on the final examination mark for the Jigsaw and non-Jigsaw groups was 6.45 ± 1.49 and 6.13 ± 1.50, respectively. There were not students in the Jigsaw group who failed to attend the mandatory examination (0% vs. 12.96% in the non-Jigsaw group, P = 0.006). The questionnaire's internal consistency was 0.90. The mean value for all the questionnaire items was 3.80, with the highest response score of 4.35 for the statement 'I have seen the complexity that the resolution of a clinical case can involve'. Based on the students' perceptions, the Jigsaw approach could contribute to a better understanding of the complexity of solving clinical cases in the subject 'Special Needs in Dentistry'. However, further investigations should be conducted to analyse the influence of this technique on students' academic performance in the field of clinical dentistry. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. The need to disentangle key concepts from ecosystem-approach jargon.

    Science.gov (United States)

    Waylen, K A; Hastings, E J; Banks, E A; Holstead, K L; Irvine, R J; Blackstock, K L

    2014-10-01

    The ecosystem approach--as endorsed by the Convention on Biological Diversity (CDB) in 2000-is a strategy for holistic, sustainable, and equitable natural resource management, to be implemented via the 12 Malawi Principles. These principles describe the need to manage nature in terms of dynamic ecosystems, while fully engaging with local peoples. It is an ambitious concept. Today, the term is common throughout the research and policy literature on environmental management. However, multiple meanings have been attached to the term, resulting in confusion. We reviewed references to the ecosystem approach from 1957 to 2012 and identified 3 primary uses: as an alternative to ecosystem management or ecosystem-based management; in reference to an integrated and equitable approach to resource management as per the CBD; and as a term signifying a focus on understanding and valuing ecosystem services. Although uses of this term and its variants may overlap in meaning, typically, they do not entirely reflect the ethos of the ecosystem approach as defined by the CBD. For example, there is presently an increasing emphasis on ecosystem services, but focusing on these alone does not promote decentralization of management or use of all forms of knowledge, both of which are integral to the CBD's concept. We highlight that the Malawi Principles are at risk of being forgotten. To better understand these principles, more effort to implement them is required. Such efforts should be evaluated, ideally with comparative approaches, before allowing the CBD's concept of holistic and socially engaged management to be abandoned or superseded. It is possible that attempts to implement all 12 principles together will face many challenges, but they may also offer a unique way to promote holistic and equitable governance of natural resources. Therefore, we believe that the CBD's concept of the ecosystem approach demands more attention. © 2014 Society for Conservation Biology.

  17. Taking Health Needs Seriously: Against a Luck Egalitarian Approach to Justice in Health

    DEFF Research Database (Denmark)

    Nielsen, Lasse

    2013-01-01

    handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson’s abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic...... to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck...... egalitarianism taking into account the moral requirement of meeting everyone’s basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism...

  18. Forecasting the global shortage of physicians: an economic- and needs-based approach.

    Science.gov (United States)

    Scheffler, Richard M; Liu, Jenny X; Kinfu, Yohannes; Dal Poz, Mario R

    2008-07-01

    Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country's economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected.

  19. Forecasting the global shortage of physicians: an economic- and needs-based approach

    Science.gov (United States)

    Liu, Jenny X; Kinfu, Yohannes; Dal Poz, Mario R

    2008-01-01

    Abstract Objective Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Methods Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country’s economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. Findings By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. Conclusion The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected. PMID:18670663

  20. Paediatric and perinatal postmortem imaging: the need for a subspecialty approach

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Rijn, Rick R. van [Emma Children' s Hospital - Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Taylor, Andrew M. [Great Ormond Street Hospital for Children, Cardiorespiratory Unit, London (United Kingdom); UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Sebire, Neil J. [Great Ormond Street Hospital for Children, Department of Pathology, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom)

    2015-04-01

    Paediatric postmortem imaging is distinct and different from adult postmortem imaging due to differences in disease aetiology, pathology and imaging approaches, which require a particular skill set to maximise its yield and clinical utility. Practitioners need to have expertise in several aspects of radiology, including both plain radiographs and cross-sectional imaging modalities, knowledge of specialist techniques, and familiarity with the unique range of pathologies in this patient population, including perinatal pathology. Here we outline the training requirements that should be considered to establish such a service. (orig.)

  1. Trends and needs in regulatory approaches for future reactors. Annex 16

    International Nuclear Information System (INIS)

    Kress, T.S.

    2002-01-01

    For nuclear power to be the future alternative of choice for electric generation capacity, there are two essential elements: (1) cost competitiveness, and (2) an acceptable level of safety. To meet these perhaps conflicting elements, there will need to be significant risk-informed modifications to the regulatory approaches for the licensing and oversight of reactors. This paper discusses some of the trends in the U.S. in this direction and identifies what the author believes will be technical and policy issues that stand in the way. (author)

  2. Quantitative Risk reduction estimation Tool For Control Systems, Suggested Approach and Research Needs

    Energy Technology Data Exchange (ETDEWEB)

    Miles McQueen; Wayne Boyer; Mark Flynn; Sam Alessi

    2006-03-01

    For the past year we have applied a variety of risk assessment technologies to evaluate the risk to critical infrastructure from cyber attacks on control systems. More recently, we identified the need for a stand alone control system risk reduction estimation tool to provide owners and operators of control systems with a more useable, reliable, and credible method for managing the risks from cyber attack. Risk is defined as the probability of a successful attack times the value of the resulting loss, typically measured in lives and dollars. Qualitative and ad hoc techniques for measuring risk do not provide sufficient support for cost benefit analyses associated with cyber security mitigation actions. To address the need for better quantitative risk reduction models we surveyed previous quantitative risk assessment research; evaluated currently available tools; developed new quantitative techniques [17] [18]; implemented a prototype analysis tool to demonstrate how such a tool might be used; used the prototype to test a variety of underlying risk calculational engines (e.g. attack tree, attack graph); and identified technical and research needs. We concluded that significant gaps still exist and difficult research problems remain for quantitatively assessing the risk to control system components and networks, but that a useable quantitative risk reduction estimation tool is not beyond reach.

  3. MAKING THE NEIGHBOURHOOD A BETTER PLACE TO LIVE. A SWB APPROACH IMPLEMENTING FUNDAMENTAL HUMAN NEEDS

    Directory of Open Access Journals (Sweden)

    Ioanna Anna Papachristou

    2015-10-01

    Full Text Available Subjective well-being (SWB studies have been at the centre of researchers’ attention during the last years. With the majority of people now living in cities, the necessity for a more anthropocentric approach for the study and betterment of urban environments is constantly increasing. In this sense, defining and measuring SWB in urban contexts can be of particular benefit in urban design and planning processes. In this article, a method for measuring SWB for urban places based on the accomplishment of the fundamental human needs is presented and applied at a neighbourhood of Barcelona; that of Vila de Gràcia. For the measurement, a survey was constructed based on the specific geographical and socio-economic characteristics of the study case. Retrieved from Max-Neef’s Human Scale Development Paradigm (Max-Neef et al. 1991, human needs correspond to the domains of study of the suggested method. The matching of the survey’s questions to each need is the outcome of two consecutive processes: a first qualitative one, involving the work of an expert group, and a second quantitative one, involving the definition of weights among the questions that affect the same need. Although the final result is positive (although low for this study case, results for each need show considerable differences in their level of accomplishment. At the same time people seem to truly believe that most of their feelings are affected by their living environment, with stress and calmness leading the list. In summary, the method defines and applies a simple tool to quantify and evaluate current levels of SWB at different urban scales and to determine more holistic urban indexes in order to improve decision making processes, policies and plans. The classification of the questions per need favours the identification of a potential problem at the urban grid and consequently can be used as a process for implementing related measures of improvement. The method can also be seen

  4. Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

    Science.gov (United States)

    Christensen, Leif; Karle, Hans; Nystrup, Jørgen

    2007-09-01

    An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

  5. A True Delphi Approach: Developing a Tailored Curriculum in Response to Local Agriscience Need

    Energy Technology Data Exchange (ETDEWEB)

    Rubenstein, Eric; Thoron, Andrew; Burleson, Sarah

    2012-02-07

    The Delphi approach is a structured communication technique, developed as a systematic, interactive forecasting method which relies on a panel of experts. In this specific case experts from Industry, Education and Extension fields addressed needs for educational programs in a traditional agriculturally-based community, environmentally conscious practices in order to restore environmental integrity and multi-disciplinary approach to solve sustainability problems facing the agricultural industry. The experts were divided into two main groups, (A) Secondary and (B) Post-secondary, and answered questionnaires in three rounds: • 1st Round – Participants generated a list of knowledge, skills, and competencies followed • 2nd Round – Panelists rated each item • 3rd Round – Panelists were given the opportunity to combine and add additional items As a result, top six items from both groups were not found similar, secondary panelists centralized around employment skills and post-secondary panelists focused on content areas. Implications include a need for content-based curriculum for post-secondary graduates, utilization of true-Delphi technique for future curriculum development research and further examination of students that complete secondary and post-secondary programs in biofuels/sustainable agriculture.

  6. Mental health research in the criminal justice system: The need for common approaches and international perspectives.

    Science.gov (United States)

    Roesch, R; Ogloff, J R; Eaves, D

    1995-01-01

    There is a need for researchers and policy makers in the area of mental health and law to collaborate and develop common methods of approach to research. Although we have learned a great deal about the prevalence and needs of mentally ill offenders in jails and prisons, there are a number of research questions that remain. If the "second generation" of research is to be fruitful--and useful to policy makers--we need to be sure that the methods we employ are valid and that the findings we obtain are reliable. By collaborating with colleagues in other jurisdictions, we can begin to learn whether some of the existing findings are of a general nature, or dependent upon the system in which they were found. Similarly, while the first-generation research has alerted us to the needs of mentally ill offenders in jails and prisons, second-generation research is needed to help identify factors that may help prevent the "revolving door phenomenon," which results in mentally ill people being volleyed among mental health, criminal justice, and community settings. One area that has received embarrassingly little attention has been the need for considering the relationship between substance abuse and mental disorders. In our own work, we have found an alarmingly high degree of substance abuse among offenders, including mentally ill offenders. We have come to realize the importance of considering the role that substance abuse coupled with other mental disorders may play in the criminal justice system. As a result of this concern, the Surrey Mental Health Project recently hired a full-time drug and alcohol counselor whose job it is to work with inmates with substance abuse disorders while in the jail, and to help arrange continuing treatment resources upon their release. As Wilson et al. (1995) discuss, intensive case management projects may be particularly useful at targeting the unique needs of mentally ill offenders with multiple problems. Much of the research conducted with

  7. Marketing Management Relational Approaches Focused on Consumer’s and Customer’s Needs and Desires

    Directory of Open Access Journals (Sweden)

    Gheorghe MINCULETE

    2014-12-01

    Full Text Available Currently, because of the evolution in the knowledge-based society, the marketing reveals another dimension, the one of relational marketing, which represents the special relationship established between the company and its consumers, with win-win advantages over a long period. In these circumstances, the managerial approach of marketing has new connotations for a more efficient managerial approach of the new national and international business environment. Within the marketing management process of a company, consumers or customers play a very critical role as these are the people who finally buy the goods and services of the organization, and the firm is always on the move to make them buy so as to earn revenue.This article presents the managerial approach of marketing management concept toward the strategic planning of a company and the marketing planning focused on needs and desires of consumers and customers. Therefore, consumers are the beneficiaries of the general and marketing strategy of the company while customers are those who respond to the loyalty process established by the firm. In this context, the purpose of this analysis is to highlight the strategic planning process of a company by integrating the strategic and operational marketing.In addition, we also consider important the issues related to Michael Porter’s generic strategies, which are thus presented in the context of relational knowledge within the process of marketing management. All these approaches are related to winning customers’ loyalty and obviously to customers' value that determines the company to achieve a value chain in the business process. Hence, the consumers and customers are the most important people for any organization. They are the resources which trigger the success of the business.

  8. Nematode parasite control of livestock in the tropics/subtropics: the need for novel approaches.

    Science.gov (United States)

    Waller, P J

    1997-10-01

    Because parasites are more abundant, small ruminants in the tropical/subtropical regions of the world experience much greater ravages from internal parasitic disease than those in the temperate regions. In the tropics/subtropics, the limiting ecological factor influencing the severity of parasitism is rainfall, as temperatures almost always favour hatching and development of the free-living stages. Attempts to expand sheep and goat production by replacing traditional village production systems, which rarely involve anthelmintic treatment, with large-scale intensive commercial enterprises invariably induce complete reliance on anthelmintics to control nematode parasites. This has led to the widespread development of high level, multiple anthelmintic resistance throughout the tropics/subtropics, and in certain regions this has reached the ultimate disastrous scenario of total chemotherapeutic failure. Immediate concerted efforts are needed to resolve this crisis. Significant benefits are likely to emerge from research into non-chemotherapeutic approaches to nematode parasite control, such as grazing management, worm vaccines, breed selection and biological control. However, it is likely that none, in isolation or collectively, will completely replace the need for effective anthelmintics. What is needed is the integration of all methods of parasite control as they come to hand, with the underlying aim of reducing the use and thus preserving the effectiveness of anthelmintics. Although cheap and simple procedures, based on sound epidemiological principles, can achieve dramatic benefits in worm control, they have been poorly adopted by livestock owners. Clearly then, the greatest need is for technology transfer and education programmes, but these activities are generally found to be chronically under-resourced.

  9. Oncology Education in Medical Schools: Towards an Approach that Reflects Australia's Health Care Needs.

    Science.gov (United States)

    McRae, Robert J

    2016-12-01

    Cancer has recently overtaken heart disease to become the number 1 cause of mortality both globally and in Australia. As such, adequate oncology education must be an integral component of medical school if students are to achieve learning outcomes that meet the needs of the population. The aim of this review is to evaluate the current state of undergraduate oncology education and identify how Australian medical schools can improve oncology learning outcomes for students and, by derivative, improve healthcare outcomes for Australians with cancer. The review shows that oncology is generally not well represented in medical school curricula, that few medical schools offer mandatory oncology or palliative care rotations, and that junior doctors are exhibiting declining oncology knowledge and skills. To address these issues, Australian medical schools should implement the Oncology Education Committee's Ideal Oncology Curriculum, enact mandatory oncology and palliative care clinical rotations for students, and in doing so, appreciate the importance of students' differing approaches to learning.

  10. Critical infrastructures at risk: A need for a new conceptual approach and extended analytical tools

    International Nuclear Information System (INIS)

    Kroeger, Wolfgang

    2008-01-01

    Recent decades have witnessed on the one hand a much greater and tighter integration of goods or services supply systems and growing interconnectedness as well as changing organizational and operational factors, and on the other hand an increased social vulnerability in the face of accidental or intentional disruption. The work of the International Risk Governance Council (IRGC) in the field of critical infrastructures has focused on both the risks associated with five individual infrastructures and the issues associated with the increasing interdependence between them. This paper presents a selection of system weaknesses and a number of policy options that have been identified and highlights issues for further investigation and dialogue with stakeholders. Furthermore, the need to extend current modeling and simulation techniques in order to cope with the increasing system complexity is elaborated. An object-oriented, hybrid modeling approach promising to overcome some of the shortcomings of traditional methods is presented

  11. PREVIOUS SECOND TRIMESTER ABORTION

    African Journals Online (AJOL)

    PNLC

    PREVIOUS SECOND TRIMESTER ABORTION: A risk factor for third trimester uterine rupture in three ... for accurate diagnosis of uterine rupture. KEY WORDS: Induced second trimester abortion - Previous uterine surgery - Uterine rupture. ..... scarred uterus during second trimester misoprostol- induced labour for a missed ...

  12. A comprehensive approach to handle the dynamics of customer’s needs in Quality Function Deployment based on linguistic variables

    Directory of Open Access Journals (Sweden)

    Zohreh Bostaki

    2014-04-01

    Full Text Available In the contexture of a customer-driven goods or service design process, a well-timed update of customer’s requirements may not only serve as a necessity indicator to observe how things change over time, but also it incorporates the firms a better ground to interoperate different strategies to meet the future needs of its customer. This paper proposes a systematic methodology to deal with the customer needs’ dynamics, in terms of their relative weights, in the QFD. Compared with previous research, the contribution of this paper is fourfold. First, it applies some linguistic variables to get preferences of customers and experts to determine the relative importance of customer requirements (CRs and the relationships between customer requirements and engineering characteristics (ECs. Second, it proposes the implementation of a forecasting technique. Third, it describes more comprehensively on how future uncertainty in the weights of customer’s needs could be estimated and transmitted into the design attributes. Fourth, it proposes the implementation of a quantitative approach, which takes into account the decision maker’s attitude towards risk to optimize the QFD decision making analysis. Finally, a real-world application of QFD is provided to demonstrate the practical applicability of the proposed methodology.

  13. A genomic and transcriptomic approach for a differential diagnosis between primary and secondary ovarian carcinomas in patients with a previous history of breast cancer

    International Nuclear Information System (INIS)

    Meyniel, Jean-Philippe; Alran, Séverine; Rapinat, Audrey; Gentien, David; Roman-Roman, Sergio; Mignot, Laurent; Sastre-Garau, Xavier; Cottu, Paul H; Decraene, Charles; Stern, Marc-Henri; Couturier, Jérôme; Lebigot, Ingrid; Nicolas, André; Weber, Nina; Fourchotte, Virginie

    2010-01-01

    The distinction between primary and secondary ovarian tumors may be challenging for pathologists. The purpose of the present work was to develop genomic and transcriptomic tools to further refine the pathological diagnosis of ovarian tumors after a previous history of breast cancer. Sixteen paired breast-ovary tumors from patients with a former diagnosis of breast cancer were collected. The genomic profiles of paired tumors were analyzed using the Affymetrix GeneChip ® Mapping 50 K Xba Array or Genome-Wide Human SNP Array 6.0 (for one pair), and the data were normalized with ITALICS (ITerative and Alternative normaLIzation and Copy number calling for affymetrix Snp arrays) algorithm or Partek Genomic Suite, respectively. The transcriptome of paired samples was analyzed using Affymetrix GeneChip ® Human Genome U133 Plus 2.0 Arrays, and the data were normalized with gc-Robust Multi-array Average (gcRMA) algorithm. A hierarchical clustering of these samples was performed, combined with a dataset of well-identified primary and secondary ovarian tumors. In 12 of the 16 paired tumors analyzed, the comparison of genomic profiles confirmed the pathological diagnosis of primary ovarian tumor (n = 5) or metastasis of breast cancer (n = 7). Among four cases with uncertain pathological diagnosis, genomic profiles were clearly distinct between the ovarian and breast tumors in two pairs, thus indicating primary ovarian carcinomas, and showed common patterns in the two others, indicating metastases from breast cancer. In all pairs, the result of the transcriptomic analysis was concordant with that of the genomic analysis. In patients with ovarian carcinoma and a previous history of breast cancer, SNP array analysis can be used to distinguish primary and secondary ovarian tumors. Transcriptomic analysis may be used when primary breast tissue specimen is not available

  14. A systematic approach to the training in the nuclear power industry: The need for standard

    International Nuclear Information System (INIS)

    Wilkinson, J.D.

    1995-01-01

    The five elements of a open-quotes Systematic Approach to Trainingclose quotes (SAT) are analysis, design, development, implementation and evaluation. These elements are also present in the effective application of basic process control. The fundamental negative feedback process control loop is therefore an excellent model for a successful, systematic approach to training in the nuclear power industry. Just as standards are required in today's manufacturing and service industries, eg ISO 9000, so too are control standards needed in the training industry and in particular in the training of nuclear power plant staff. The International Atomic Energy Agency (IAEA) produced its TECDOC 525 on open-quotes Training to Establish and Maintain the Qualification and Competence of Nuclear Power Plant Operations Personnelclose quotes in 1989 and the American Nuclear Society published its open-quotes Selection, Qualification, and Training of Personnel for Nuclear Power Plants, an American National Standardclose quotes in 1993. It is important that community colleges, training vendors and organizations such as the Instrument Society of America (ISA), who may be supplying basic or prerequisite training to the nuclear power industry, become aware of these and other standards relating to training in the nuclear power industry

  15. Atomic and Molecular Data Needs for Radiation Damage Modeling: Multiscale Approach

    International Nuclear Information System (INIS)

    Yakubovich, Alexander V.; Solov'yov, Andrey V.; Surdutovich, Eugene

    2011-01-01

    We present a brief overview of the multiscale approach towards understanding of the processes responsible for the radiation damage caused by energetic ions. This knowledge is very important, because it can be utilized in the ion-beam cancer therapy, which is one of the most advanced modern techniques to cure certain type of cancer. The central element of the multiscale approach is the theoretical evaluation and quantification of the DNA damage within cell environment. To achieve this goal one needs a significant amount of data on various atomic and molecular processes involved into the cascade of events starting with the ion entering and propagation in the biological medium and resulting in the DNA damage. The discussion of the follow up biological processes are beyond the scope of this brief overview. We consider different paths of the DNA damage and focus on the the illustration of the thermo-mechanical effects caused by the propagation of ions through the biological environment and in particular on the possibility of the creation of the shock waves in the vicinity of the ion tracks. We demonstrate that at the initial stages after ion's passage the shock wave is so strong that it can contribute to the DNA damage due to large pressure gradients developed at the distances of a few nanometers from the ionic tracks. This novel mechanism of the DNA damage provides an important contribution to the cumulative biodamage caused by low-energy secondary electrons, holes and free radicals.

  16. Atomic and Molecular Data Needs for Radiation Damage Modeling: Multiscale Approach

    Science.gov (United States)

    Yakubovich, Alexander V.; Surdutovich, Eugene; Solov'yov, Andrey V.

    2011-05-01

    We present a brief overview of the multiscale approach towards understanding of the processes responsible for the radiation damage caused by energetic ions. This knowledge is very important, because it can be utilized in the ion-beam cancer therapy, which is one of the most advanced modern techniques to cure certain type of cancer. The central element of the multiscale approach is the theoretical evaluation and quantification of the DNA damage within cell environment. To achieve this goal one needs a significant amount of data on various atomic and molecular processes involved into the cascade of events starting with the ion entering and propagation in the biological medium and resulting in the DNA damage. The discussion of the follow up biological processes are beyond the scope of this brief overview. We consider different paths of the DNA damage and focus on the the illustration of the thermo-mechanical effects caused by the propagation of ions through the biological environment and in particular on the possibility of the creation of the shock waves in the vicinity of the ion tracks. We demonstrate that at the initial stages after ion's passage the shock wave is so strong that it can contribute to the DNA damage due to large pressure gradients developed at the distances of a few nanometers from the ionic tracks. This novel mechanism of the DNA damage provides an important contribution to the cumulative biodamage caused by low-energy secondary electrons, holes and free radicals.

  17. Experiences of parents of children with special needs at school entry: a mixed method approach.

    Science.gov (United States)

    Siddiqua, A; Janus, M

    2017-07-01

    The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with 'special needs'). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school. Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi-structured interviews were also conducted with 10 parents to understand their experience with services. Post transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post-transition service provision. While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry. © 2017 John Wiley & Sons Ltd.

  18. [Dental pain in the previous 3 months in adolescents and Family Health Strategy: the comparison between two areas with different to oralhealth care approaches].

    Science.gov (United States)

    Carvalho, Jefferson Calixto; Rebelo, Maria Augusta Bessa; Vettore, Mario Vianna

    2011-10-01

    This study sought to compare the prevalence and intensity of dental pain in the last 3 months in adolescents living in two areas within the scope of Family Health Strategy with different to oralhealth care approaches. A cross-sectional study was conducted with 300 adolescents selected from public schools in the city of Manaus, Brazil. Adolescents living in an area with an Oral Health Team in which of health promotion is predominant (Group I, N = 150) were compared with those living in an area in which only dental treatment is offered (Group II, N = 150). Demographic and socio-economic characteristics, oral health-related behavior and use of dental services were gathered. Prevalence and intensity of dental pain in the last 3 months was assessed using a tested and validated Likert scale. The mean age of the participants was 12.9 ± 0.8 years, of which 46.7% were male. The prevalence of dental pain in the last 3 months was 33.7%, and did not differ between Groups I and II (P > 0.05). Medium to high intensity dental pain in the last 3 months was associated with Group II (OR: 2.11 [CI95 %=1.17-3.81]), after adjustment for covariates. Adolescents living in the area where only dental treatment is offered were more prone to severe dental pain compared to those living in the area where health programs are predominant.

  19. Need to use probabilistic risk approach in performance assessment of waste disposal facilities

    International Nuclear Information System (INIS)

    Bonano, E.J.; Gallegos, D.P.

    1991-01-01

    Regulations governing the disposal of radioactive, hazardous, and/or mixed wastes will likely require, either directly or indirectly, that the performance of disposal facilities be assessed quantitatively. Such analyses, commonly called ''performance assessments,'' rely on the use of predictive models to arrive at a quantitative estimate of the potential impact of disposal on the environment and the safety and health of the public. It has been recognized that a suite of uncertainties affect the results of a performance assessment. These uncertainties are conventionally categorized as (1) uncertainty in the future state of the disposal system (facility and surrounding medium), (2) uncertainty in models (including conceptual models, mathematical models, and computer codes), and (3) uncertainty in data and parameters. Decisions regarding the suitability of a waste disposal facility must be made in light of these uncertainties. Hence, an approach is needed that would allow the explicit consideration of these uncertainties so that their impact on the estimated consequences of disposal can be evaluated. While most regulations for waste disposal do not prescribe the consideration of uncertainties, it is proposed that, even in such cases, a meaningful decision regarding the suitability of a waste disposal facility cannot be made without considering the impact of the attendant uncertainties. A probabilistic risk assessment (PRA) approach provides the formalism for considering the uncertainties and the technical basis that the decision makers can use in discharging their duties. A PRA methodology developed and demonstrated for the disposal of high-level radioactive waste provides a general framework for assessing the disposal of all types of wastes (radioactive, hazardous, and mixed). 15 refs., 1 fig., 1 tab

  20. Health status transitions in community-living elderly with complex care needs: a latent class approach

    Directory of Open Access Journals (Sweden)

    Béland François

    2009-02-01

    Full Text Available Abstract Background For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164, we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical

  1. The History of Petroleum Pollution in Malaysia; Urgent Need for Integrated Prevention Approach

    Directory of Open Access Journals (Sweden)

    Mahyar Sakari

    2010-01-01

    Full Text Available Petroleum pollution is known as point and non-point source of contaminations in the environment. A major class of petroleum contaminant is groups of compounds consist of two or more fused benzene rings called polycyclic aromatic hydrocarbons (PAHs that are carcinogenic, mutagenic and toxic. Source identification of petroleum pollution is necessary to prevent pollution entry into the environment. Eight sedimentary cores were obtained from developed and developing areas around Peninsular Malaysia to investigate the historical profile of PAHs, their characteristics and its possible origins. The results showed that the PAHs concentrations varied from very minimum to 2400 ng/g d. w. in average quarter century intervals. Most of the studied locations showed high contribution of PAHs from combusted fuel, coal, biomasses and wood materials except for the southern part of Peninsular Malaysia in which revealed dominance of petroleum products. The findings indicate that PAHs are delivered from different intermediate materials such as asphalt, street dust, vehicular emission and crankcase oil. However, there has been a decline of PAHs input into the marine environment in recent years; petroleum is shown to be a significant cause of marine pollution since the second quarter of 20th century. An overview on sourced materials of petroleum pollution indicates multi-approach necessity toward pollution control, regardless of concentration and possible degradation processes. Various sectors both governmental and non-governmental are needed for prevention and control of petroleum pollution where different sources apparently contribute to the pollution generation process.

  2. New EDF approach to the mentification of NPP personnel training needs

    International Nuclear Information System (INIS)

    Hazet, Jean-Christophe

    2003-01-01

    The EDF ambition today is to be among the best electricity producers in the world. To do so, we have to take more responsibilities, to motivate and to give our employees a better level of competence, and to make them more involved in the culture and the success of our company. In order to reach these objectives a deeper analysis of the NPP training needs must be completed. Our answer, named 'Local Competencies Development System' (LCDS) consists in implementing a large decentralisation of the competencies management, done by the EDF Production Department in conjunction with the EDF Training Department. It takes place in a logical approach bound up with the historical development of our nuclear program. In addition to this LCDS a new organization of training centers instructors, in dedicated training teams, has been implemented in order to co-ordinate the different actions directly with the NPP. The purpose of this presentation is to take into account the LCDS on the operation personnel training side, a similar organization has been implemented for the maintenance side

  3. Use of a human factors approach to uncover informatics needs of nurses in documentation of care.

    Science.gov (United States)

    Rogers, Michelle L; Sockolow, Paulina S; Bowles, Kathryn H; Hand, Kristin E; George, Jessie

    2013-11-01

    The success of health information technology implementations is often tied to the impact the technical system will have on the work of the clinicians using them. Considering the role of nurses in healthcare, it is shocking that there is a lack of evaluations of nursing information systems in the literature. Here we report on how a human factors approach can be used to address barriers and facilitators to use of the nursing information system (NIS). Human factors engineering (HFE) approaches provide the theoretical and methodological underpinning to address these socio-technical issues. This study investigated the use of an NIS, a module of the electronic health record (EHR) previously implemented throughout the hospital system. The study took place in two hospitals (760 beds and 300 beds) within a three-hospital health system. Earlier in the year, the NIS was implemented throughout the health system. We applied a scenario-based evaluation technique in order to understand the barriers and facilitators to nurse use of the NIS as part of improving the healthcare delivery system. The scenarios were designed to have the nurses interact with the major components of the NIS. The research team developed the standardized scenarios to cover the major functions of the system. Twelve nurses completed the study and results show that documentation within the NIS was hindered by several aspects of the interface. This paper discusses the themes associated with the usability of the NIS interface analyzing them using usability heuristics. The team also identified facilitators to use and proposed avenues to support or enhance these facilitators. This study examined the use of an NIS to standardize care and documentation in nursing. It used scenario-based usability testing, applying the "think-aloud" protocol technique to assess the use of the NIS in documenting patient care. This method of usability evaluation exposed an understanding of how nurses use the NIS and their perspective

  4. Laparoscopy After Previous Laparotomy

    Directory of Open Access Journals (Sweden)

    Zulfo Godinjak

    2006-11-01

    Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

  5. 8 Different approaches needed to manage ED demand among different age-groups.

    Science.gov (United States)

    Rimmer, Melanie; Ablard, Suzanne; O'Keeffe, Colin; Mason, Suzanne

    2017-12-01

    including patient education, co-location of other services with ED ('ED hubs'), and extending community-based services. ED staff attribute distinctly different patterns of ED attendance to patients of different age groups, including reasons for attending ED, the route to the ED, and the rate of non-urgent attendance. Given this variation, proposed demand management interventions are likely to impact differently on different age groups, and one solution is unlikely to be optimal for all ages. Therefore a number of different approaches will be needed to manage ED demand among different age groups. © 2017, 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.

  6. Negative Emissions Technologies, the Paris Agreement, and the Need for a Human-Rights Based Approach

    Science.gov (United States)

    Burns, W. C. G.

    2016-12-01

    The new Paris Agreement under the United Nations Framework Convention on Climate Change contemplates that its prospective Parties will balance emissions and sinks by 2050 as a means to effectuate the goal of holding temperature increases to well below 2°C from pre-industrial levels, as well as the more aspirational goal of holding temperature increases to 1.5°C. Most of the IPCC's AR5 scenarios that achieve these objectives contemplate the large-scale deployment of so-called "negative emissions technologies," with an emphasis on bioenergy and carbon capture and storage (BECCS), and to a lesser degree afforestation. BECCS could assuredly help society avoid passing critical climatic thresholds, or address overshoot scenarios in this century and beyond. However, it could also profound implications for food production, the status of forests, access to lands for livelihoods by vulnerable populations, and the integrity of critical ecosystems. This, in turn could have serious ramifications for human rights of some of the world's most vulnerable populations, including the rights to food, water, livelihoods and the benefits of biodiversity. The Preamble to the Paris Agreement acknowledges the need to take into consideration the potential impact of responses to climate change, providing that "Parties should, when taking action to address climate change, respect, promote and consider their respective obligations on human rights." This presentation will outline how application of a human rights-based approach to assessing such options could help to reconcile the objectives of ameliorating potential climatic impacts while protecting the human rights of potentially affected individuals and groups. This will include the potential role of Human Rights Impacts Assessments and potential configuration of HRIAs at the national and international level. It will also briefly suggest how to operationalize this approach within the Paris Agreement framework, including institutional

  7. Do we need an integrative approach to food safety at the country level?

    International Nuclear Information System (INIS)

    Ristic, G.

    2002-01-01

    Scientific data show increasing evidence of relationship between food safety and food standards on one hand and public health concern on the other hand. In FR Yugoslavia in 1989 the system of reporting on food safety issues on federal and republic level was established. The system provides data on laboratory analysis of 22 food items (bread, milk, meat and meat products, vegetables, processed vegetables etc). Those items were and still are tested on food quality and safety parameters such as microbiological, chemical and radio nuclides. Seldom all required testing on chemical and radio nuclides are performed, so we lack exact risk assessment for those contaminants. Further, during war conflict in FR Yugoslavia and also due to industrial hazards in neighbouring countries (Rumania, Hungary) high quantities of PCBs, dioxins, heavy metals, arsenic compounds and other toxic compounds contaminated the environment. In the soil and in some food products (animal fats predominantly) radionuclides originating from Chernobyl hazard can still be detected. In order to identify the level of exposure to chemical and radio nuclide contaminants in the food chain it is essential to test intensively and systematically food from animal and from plant origin. In order to prevent entering the contaminants to the food chain new recommendations from WHO, FAO and EU suggest implementation of integrative approach to food safety and control over the whole chain of food production from 'farm to table'. This approach provides control of the contaminants in soil, water, air, control over primary food production (covering animal feed too), intensive control over processing with implementation of HACCP system, but also, over transportation, retail trade, street food and home made food too. In our country creation of the map of the polluted areas, and actions in order to treat the pollution should accompany implementation of this new food safety system. The need for assessment of the level of

  8. The need for multisectoral food chain approaches to reduce trans fat consumption in India.

    Science.gov (United States)

    Downs, Shauna M; Singh, Archna; Gupta, Vidhu; Lock, Karen; Ghosh-Jerath, Suparna

    2015-07-22

    The World Health Organization (WHO) recommends virtually eliminating trans fat from the global food supply. Although several high-income countries have successfully reduced trans fat levels in foods, low- and middle-income countries such as India face additional challenges to its removal from the food supply. This study provides a systems analysis of the Indian food chain to assess intervention options for reducing trans fat intake in low-income consumers. Data were collected at the manufacturer, retailer and consumer levels. Qualitative interviews were conducted with vanaspati manufacturers (n = 13) and local food vendors (n = 44). Laboratory analyses (n = 39) of street foods/snacks sold by the vendors were also conducted. Trans fat and snack intakes were also examined in low-income consumers in two rural villages (n = 260) and an urban slum (n = 261). Manufacturers of vanaspati described reducing trans fat levels as feasible but identified challenges in using healthier oils. The fat content of sampled oils from street vendors contained high levels of saturated fat (24.7-69.3 % of total fat) and trans fat (0.1-29.9 % of total fat). Households were consuming snacks high in trans fat as part of daily diets (31 % village and 84.3 % of slum households) and 4 % of rural and 13 % of urban households exceeded WHO recommendations for trans fat intakes. A multisectoral food chain approach to reducing trans fat is needed in India and likely in other low- and middle-income countries worldwide. This will require investment in development of competitively priced bakery shortenings and economic incentives for manufacturing foods using healthier oils. Increased production of healthier oils will also be required alongside these investments, which will become increasingly important as more and more countries begin investing in palm oil production.

  9. “Health in the Mirror”: An Unconventional Approach to Unmet Psychological Needs in Oncology

    Directory of Open Access Journals (Sweden)

    Valentina E. Di Mattei

    2017-09-01

    Full Text Available Background: The introduction of aesthetic care programs for cancer patients inside hospitals could help patients cope with the side effects of both disease and treatment. The specific objective of this study is to evaluate whether a complementary and supportive program, called “Health in the Mirror,” has a positive effect on participants by analyzing certain psychological variables.Methods: Eighty-eight female cancer patients were included in this analysis. The support program is composed of three group aesthetic interventions that address both physical and psychological aspects that accompany cancer and its treatment. Patients were asked to complete a battery of tests in order to measure the impact of the program on certain psychological variables including anxiety, depression, body image, self-esteem, and quality of life. Outcome variables were measured at three different time-points: prior to participation, on the last day of the program, and after a 3-month follow-up.Results: Participating in the psychosocial support program “Health in the Mirror” determines an improvement in the psychological variables measured. Results revealed a significant reduction in depressive symptoms, anxiety and body image issues, as well as an improvement in self-esteem levels; this suggests that participating in this program could facilitate better adjustment to disease and treatment.Discussion: This study legitimizes the importance of implementing supportive and complementary therapies together with conventional therapies; the therapeutic approach to cancer cannot be restricted solely to medical care, but it must consider the patient as a whole person with needs that are not only physical or medical, but also psychological, social, and existential.

  10. Research needs for developing a commodity-driven freight modeling approach.

    Science.gov (United States)

    2003-01-01

    It is well known that better freight forecasting models and data are needed, but the literature does not clearly indicate which components of the modeling methodology are most in need of improvement, which is a critical need in an era of limited rese...

  11. Approaching an Extended Role for Meeting Special Educational Needs in High Schools.

    Science.gov (United States)

    Mills, Keith

    1988-01-01

    The paper looks at staffing issues in meeting special educational needs in high schools in Manchester, United Kingdom. The concerns of Heads of Departments (N=26) included improved training and inservice, their extended roles within their schools, the support role of special needs staff, and the need for more planning and evaluation. (Author/DB)

  12. Effectively Serving the Needs of Today's Business Student: The Product Life Cycle Approach to Class Organization

    Science.gov (United States)

    Eastman, Jacqueline K.; Aviles, Maria; Hanna, Mark

    2012-01-01

    We illustrate a class organization process utilizing the concept of the Product Life Cycle to meet the needs of today's millennial student. In the Introduction stage of a business course, professors need to build structure to encourage commitment. In the Growth stage, professors need to promote the structure through multiple, brief activities that…

  13. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach

    DEFF Research Database (Denmark)

    Lukac, Peter; Hjortdal, Vibeke E; Pedersen, Anders K

    2006-01-01

    retrospectively evaluated. The surgeons used either the superior transseptal (group A) or left atrial approach (group B). The risk of pacemaker implantation associated with the superior transseptal approach as compared with the left atrial approach was estimated using the multivariate Cox regression analysis...... to adjust for possible confounders. RESULTS: We included 577 patients, 150 in group A and 427 in group B. Forty-four patients had a pacemaker implanted after the surgery; 17 in group A and 27 in group B (p = 0.010). The superior transseptal approach was an independent risk factor of pacemaker implantation...... in multivariate analysis (hazard ratio 2.2 [1.2 to 4.1], p = 0.014). Nineteen patients had a pacemaker implanted because of sinus node dysfunction; 9 in group A and 10 in group B (p = 0.017). Group A was an independent predictor of pacemaker implantation because of sinus node dysfunction in bivariate analyses...

  14. The Need to Disentangle Key Concepts from Ecosystem-Approach Jargon

    Science.gov (United States)

    WAYLEN, K A; HASTINGS, E J; BANKS, E A; HOLSTEAD, K L; IRVINE, R J; BLACKSTOCK, K L

    2014-01-01

    The ecosystem approach—as endorsed by the Convention on Biological Diversity (CDB) in 2000—is a strategy for holistic, sustainable, and equitable natural resource management, to be implemented via the 12 Malawi Principles. These principles describe the need to manage nature in terms of dynamic ecosystems, while fully engaging with local peoples. It is an ambitious concept. Today, the term is common throughout the research and policy literature on environmental management. However, multiple meanings have been attached to the term, resulting in confusion. We reviewed references to the ecosystem approach from 1957 to 2012 and identified 3 primary uses: as an alternative to ecosystem management or ecosystem-based management; in reference to an integrated and equitable approach to resource management as per the CBD; and as a term signifying a focus on understanding and valuing ecosystem services. Although uses of this term and its variants may overlap in meaning, typically, they do not entirely reflect the ethos of the ecosystem approach as defined by the CBD. For example, there is presently an increasing emphasis on ecosystem services, but focusing on these alone does not promote decentralization of management or use of all forms of knowledge, both of which are integral to the CBD’s concept. We highlight that the Malawi Principles are at risk of being forgotten. To better understand these principles, more effort to implement them is required. Such efforts should be evaluated, ideally with comparative approaches, before allowing the CBD’s concept of holistic and socially engaged management to be abandoned or superseded. It is possible that attempts to implement all 12 principles together will face many challenges, but they may also offer a unique way to promote holistic and equitable governance of natural resources. Therefore, we believe that the CBD’s concept of the ecosystem approach demands more attention. La Necesidad de Desenredar Conceptos Clave del

  15. Development of need for recovery from work over one year: a person-centered approach.

    Science.gov (United States)

    Siltaloppi, Marjo; Kinnunen, Ulla; Feldt, Taru; Tolvanen, Asko

    2012-01-01

    This longitudinal questionnaire study conducted among 274 Finnish employees (57% women, average age 45.9 years) in a variety of jobs aimed at identifying groups of employees who share similar mean levels and changes in need for recovery and finding out whether factors regarded as antecedents of need for recovery distinguish between the different groups of need for recovery across one year. Using mixture modeling eight groups of need for recovery were identified. The individuals identified as closely resembling each other with respect to need for recovery and its change across one year were considered to belong to the same need for recovery group. Five of these groups indicated stable (low, moderately low, average, moderately high, and high) need for recovery and three showed change (mostly decreasing) in the level of need for recovery across one year. Employees in the favorable (low and moderately low) need for recovery groups (38%) reported to have more favorable work characteristics and better functioning recovery experiences and they spent more time on physical and social off-job activities than those in the unfavorable (high and moderately high) groups (23%). Thus, the antecedents examined play a significant role in maintaining need for recovery over time.

  16. Photoemission in strongly correlated crystalline f-electron systems: A need for a new approach

    Energy Technology Data Exchange (ETDEWEB)

    Arko, A.J.; Joyce, J.J.; Sarrao, J. [and others

    1998-12-01

    The unusual properties of heavy fermion (or heavy electron) materials have sparked an avalanche of research over the last two decades in order to understand the basic phenomena responsible for these properties. Photoelectron spectroscopy (often referred to as PES in the following sections), the most direct measurement of the electronic structure of a material, should in principle be able to shed considerable light on this matter. In general the distinction between a localized and a band-like state is trivially observed in band dispersion. Much of the past work was performed on poly-crystalline samples, scraped in-situ to expose a clean surface for PES. There have since been considerable advances both in the quality of specimens as well as experimental resolution, which raise questions regarding these conclusions. Much of the past work on poly-crystalline samples has been reported in several review articles, most notably Allen et al., and it is not necessary here to review those efforts again, with the exception of subsequent work performed at high resolution. The primary focus of the present review will be on new measurements obtained on single crystals, cleaved or prepared in situ and measured at high resolution, which seem to suggest that agreement with the GS and NCA approximations is less than perfect, and that perhaps the starting models need to be modified, or that even an entirely new approach is called for. Of the promising new models the Periodic Anderson Model is most closely related to the SIM. Indeed, at high temperatures it reverts to the SIM. However, the charge polaron model of Liu (1997) as well as the two-electron band model of Sheng and Cooper (1995) cannot yet be ruled out. Inasmuch as the bulk of the single crystal work was performed by the Los Alamos group, this review will draw heavily on those results. Moreover, since the GS and NCA approximations represent the most comprehensive and widely accepted treatment of heavy fermion PES, it is only

  17. Application of Database Approaches to the Study of Earth's Aeolian Environments: Community Needs and Goals

    Science.gov (United States)

    Scuderi, Louis A.; Weissmann, Gary S.; Hartley, Adrian J.; Yang, Xiaoping; Lancaster, Nicholas

    2017-08-01

    Aeolian science is faced with significant challenges that impact its ability to benefit from recent advances in information technology. The discipline deals with high-end systems in the form of ground and satellite based sensors, computer modeling and simulation, and wind tunnel experiments. Aeolian scientists also collect field data manually with observational methods that may differ significantly between studies with little agreement on even basic morphometric parameters and terminology. Data produced from these studies, while forming the core of research papers and reports, is rarely available to the community at large. Recent advances are also superimposed on an underlying semantic structure that dates to the 1800's or earlier that is confusing, with ambiguously defined, and at times even contradictory, meanings. The aeolian "world-view" does not always fit within neat increments nor is defined by crisp objects. Instead change is continuous and features are fuzzy. Development of an ontological framework to guide spatiotemporal research is the fundamental starting point for organizing data in aeolian science. This requires a "rethinking" of how we define, collect, process, store and share data along with the development of a community-wide collaborative approach designed to bring the discipline into a data rich future. There is also a pressing need to develop efficient methods to integrate, analyze and manage spatial and temporal data and to promote data produced by aeolian scientists so it is available for preparing diagnostic studies, as input into a range of environmental models, and for advising national and international bodies that drive research agendas. This requires the establishment of working groups within the discipline to deal with content, format, processing pipelines, knowledge discovery tools and database access issues unique to aeolian science. Achieving this goal requires the development of comprehensive and highly-organized databases, tools

  18. The Need for a Participatory Approach to Soil andWater ...

    African Journals Online (AJOL)

    Soil erosion by water constitutes a threat even to maintain the subsistence livelihood of the rural population of Ethiopia. Past efforts of SWC, and environmental rehabilitation in general, did not bring about significant results, mainly because of the top-down approach pursued. Currently, replacing this approach with a ...

  19. Strengthening the Focus on Business Results: The Need for Systems Approaches in Organizational Behavior Management

    Science.gov (United States)

    Hyten, Cloyd

    2009-01-01

    Current Organizational Behavior Management (OBM) research and practice may be characterized as either behavior focused or results focused. These two approaches stem from different origins and have different characteristics. The behavior-focused approach stems from applied behavior analysis (ABA) methods and emphasizes direct observation of and…

  20. Dual Powerpoint Presentation Approach for Students with Special Educational Needs and Note-Takers

    Science.gov (United States)

    Naik, Nitin

    2017-01-01

    In higher education, supporting students with special educational needs (SEN) necessitates an understanding of these needs, additional teaching aids and innovative ideas. The teacher must be an integral part of this support process, and this is difficult for the majority of teachers, due to their lack of core understanding of SEN. However,…

  1. Need supportive teaching in practice : A narrative analysis in schools with contrasting educational approaches

    NARCIS (Netherlands)

    Stroet, Kim; Opdenakker, Marie-Christine; Minnaert, Alexander

    2015-01-01

    Research on self-determination theory (SDT) has shown that positive learning outcomes accrue in classrooms that support students’ needs for autonomy, competence, and relatedness. Studies on what need supportive teaching entails in practice are, however, scarce. In the present study, we aimed to gain

  2. Service Approaches to Young People with Complex Needs Leaving Out-of-Home Care

    Science.gov (United States)

    Malvaso, Catia; Delfabbro, Paul; Hackett, Louisa; Mills, Hayley

    2016-01-01

    Although leaving statutory out-of-home care can be a challenging time for many young people, it is recognised that young people who have multiple or complex needs find this transition particularly difficult. This study aims to gain a deeper understanding of the challenges faced by care leavers who have complex needs, as well as to identify some of…

  3. Teaching Music to Students with Special Needs: A Label-Free Approach

    Science.gov (United States)

    Hammel, Alice; Hourigan, Ryan

    2011-01-01

    A practical guide & reference manual, "Teaching Music to Students with Special Needs" addresses special needs in the broadest possible sense to equip teachers with proven, research-based curricular strategies that are grounded in both best practice and current special education law. Chapters address the full range of topics and issues music…

  4. A Needs-Driven and Responsive Approach to Supporting the Research Endeavours of Academic Librarians

    Directory of Open Access Journals (Sweden)

    Ken N. Meadows

    2013-12-01

    Full Text Available In this article, the authors describe a grassroots model for research support and explore the success and evolving directions of this model based on three iterative needs assessments administered by the Librarian and Archivist Research Support Network (LARSN Steering Committee at The University of Western Ontario. Needs assessments were identified as a critical tool to ensure that LARSN programming is relevant to librarians’ and archivists’ changing research needs. In the first four years of LARSN, three needs assessments were administered: in fall 2007, fall 2009, and spring 2011. The iterative needs assessments aimed to capture how the environment and research needs were evolving over time and the ways in which LARSN might continue to support a healthy and productive research environment. LARSN is faced with challenges that include a diversity of needs within its community, inconsistent participation levels in LARSN initiatives, and the inability to be all things to all people at all times. Still, LARSN is well received overall and rated positively by its community members. This is, in large part, because it has stayed true to its original mission to be needs-driven and responsive.

  5. Sounding the warning bells: the need for a systems approach to understanding behaviour at rail level crossings.

    Science.gov (United States)

    Read, Gemma J M; Salmon, Paul M; Lenné, Michael G

    2013-09-01

    Collisions at rail level crossings are an international safety concern and have been the subject of considerable research effort. Modern human factors practice advocates a systems approach to investigating safety issues in complex systems. This paper describes the results of a structured review of the level crossing literature to determine the extent to which a systems approach has been applied. The measures used to determine if previous research was underpinned by a systems approach were: the type of analysis method utilised, the number of component relationships considered, the number of user groups considered, the number of system levels considered and the type of model described in the research. None of research reviewed was found to be consistent with a systems approach. It is recommended that further research utilise a systems approach to the study of the level crossing system to enable the identification of effective design improvements. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  6. Identifying traffic safety needs - a systematic approach : research report and user manual.

    Science.gov (United States)

    2012-01-01

    The Indiana Department of Transportation (INDOT) manages road safety in Indiana through safety emphasis areas, identification of : safety needs within these areas, and development and implementation of transportation interventions that address the sa...

  7. FOREIGN LANGUAGES: Human Capital Approach Needed to Correct Staffing and Proficiency Shortfalls

    National Research Council Canada - National Science Library

    2002-01-01

    Although more than 70 federal agencies have foreign language needs, some of the largest programs are concentrated in the Army, the State Department, the Central Intelligence Agency, and the Federal...

  8. A systematic review of pedagogical approaches that can effectively include children with special educational needs in mainstream classrooms with a particular focus on peer group interactive approaches

    OpenAIRE

    Nind, Melanie; Wearmouth, Janice

    2005-01-01

    Background The broad background to this review is a long history of concepts of special pupils and special education and a faith in special pedagogical approaches. The rise of inclusive schools and some important critiques of special pedagogy (e.g. Hart, 1996; Norwich and Lewis, 2001; Thomas and Loxley, 2001) have raised the profile of teaching approaches that ordinary teachers can and do use to include children with special educational needs in mainstream classrooms. Inclusive education i...

  9. Measuring water affordability in developed economies. The added value of a needs-based approach.

    Science.gov (United States)

    Vanhille, Josefine; Goedemé, Tim; Penne, Tess; Van Thielen, Leen; Storms, Bérénice

    2018-04-09

    In developed countries, water affordability problems remain up on the agenda as the increasing financial costs of water services can impede the realisation of an equal access to water. More than ever, public authorities that define water tariffs face the challenge of reconciling environmental and cost recovery objectives with equity and financial accessibility for all. Indicators of water affordability can be helpful in this regard. Conventional affordability indicators often rely on the actual amount that households spend on water use. In contrast, we propose a needs-based indicator that measures the risk of being unable to afford the amount of water necessary to fulfill essential needs, i.e. needs that should be fulfilled for adequate participation in society. In this paper we set forth the methodological choices inherent to constructing a needs-based affordability indicator. Using a micro-dataset on households in Flanders (Belgium), we compare its results with the outcomes of a more common actual expenses-indicator. The paper illustrates how the constructed needs-based indicator can complement existing affordability indicators, and its capacity to reveal important risk groups. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Do we need sustainability as a new approach in human factors and ergonomics?

    Science.gov (United States)

    Zink, Klaus J; Fischer, Klaus

    2013-01-01

    The International Ergonomics Association Technical Committee 'Human Factors and Sustainable Development' was established to contribute to a broad discourse about opportunities and risks resulting from current societal 'mega-trends' and their impacts on the interactions among humans and other elements of a system, e.g. in work systems. This paper focuses on the underlying key issues: how do the sustainability paradigm and human factors/ergonomics interplay and interact, and is sustainability necessary as a new approach for our discipline? Based on a discussion of the sustainability concept, some general principles for designing new and enhancing existent approaches of human factors and ergonomics regarding their orientation towards sustainability are proposed. The increasing profile of sustainability on the international stage presents new opportunities for human factors/ergonomics. Positioning of the sustainability paradigm within human factors/ergonomics is discussed. Approaches to incorporating sustainability in the design of work systems are considered.

  11. Needs assessment in health research projects: a new approach to project management in iran.

    Science.gov (United States)

    Peykari, Niloofar; Owlia, Parviz; Malekafzali, Hossein; Ghanei, Mostafa; Babamahmoodi, Abdolreza; Djalalinia, Shirin

    2013-01-01

    The science and technology health plan has defined the outline of health research to the national vision of Iran by 2025. The aim of this study was to focus on the process of needs assessment of health research projects also health research priority setting in Iran. THE PROJECT MANAGEMENT LIFE CYCLE HAS FOUR PHASES: Initiation, Planning, Execution and Closure. Based on abovementioned points we conducted the study. Focusing on the needs assessment led to systematic implementation of needs assessment of health project in all of the medical sciences universities. Parallel with this achieved strategies health research priority setting was followed through specific process from empowerment to implementation. We should adopt with more systematic progressive methods of health project managements for both our national convenience as well as our international health research programs.

  12. Radiation protection/shield design: a need for a systems approach

    International Nuclear Information System (INIS)

    Disney, R.K.

    1977-01-01

    Radiation protection/shielding design of a nuclear facility requires a coordinated effort of many engineering disciplines to meet the requirements imposed by regulations. The system approach to Clinch River Breeder Reactor Plant (CRBRP) radiation protection is described, and the program developed to implement this approach is defined. In addition, the principal shielding design problems for LMFBR nuclear reactor systems are discussed in relation to LWR nuclear reactor system shielding designs. The methodology used to analyze these problems in the U.S. LMFBR program, the resultant design solutions, and the experimental verification of these designs and/or methods are discussed

  13. Implementing a Public Health Approach to Addressing Mental Health Needs in a University Setting: Lessons and Challenges

    Science.gov (United States)

    Parcover, Jason; Mays, Sally; McCarthy, Amy

    2015-01-01

    The mental health needs of college students are placing increasing demands on counseling center resources, and traditional outreach efforts may be outdated or incomplete. The public health model provides an approach for reaching more students, decreasing stigma, and addressing mental health concerns before they reach crisis levels. Implementing a…

  14. The crisis is homemade. Why we need a playful approach in teaching and practising strategic preparedness

    Directory of Open Access Journals (Sweden)

    Reinhard Ematinger

    2012-01-01

    Full Text Available Although the research on how to develop strategic preparedness, or resilience, has generated a great deal of interest among organizational theorists, many of the empirical studies conducted share important methodological limitations. When investigating how educational experiences boosting the participants’ capacities to learn, adapt, and apply can create sustainable value for organizations – be it non-profit-organizations or international enterprises – it becomes obvious that applied systematic creativity like playful construction, improvisation, and imagination, as well as making use of design thinking approaches, will benefit the organizations’ strategic preparedness for future scenarios.The first chapter will be on a relevant framework and the theories which fuel the value of playful and design-led approaches when it comes to corporate strategy, service development, and team identity. The framework will be illustrated in the second chapter with a proven approach designed for this very purpose. The third chapter will reflect on how to utilize this approach for teaching purposes and will elaborate on a draft for educators who want to move in this direction.

  15. The Nigerian System of Education and the Need for Pragmatic Approach

    Science.gov (United States)

    Oyebamiji, M. A.

    2011-01-01

    This paper attempted to reveal some inadequacies inherent in the Nigerian system of education and, how the pragmatic approach to education can help solve the problems of disfunctionality of the system. It does this by explaining the aims and features of the pragmatic philosophy of education. Furthermore, the paper gave answers to two basic…

  16. Towards an Agile Approach to Adapting Dynamic Collaboration Support to Student Needs

    Science.gov (United States)

    Adamson, David; Dyke, Gregory; Jang, Hyeju; Rosé, Carolyn Penstein

    2014-01-01

    This paper investigates the use of conversational agents to scaffold on-line collaborative learning discussions through an approach called Academically Productive Talk (APT). In contrast to past work on dynamic support for collaborative learning, where agents were used to elevate conceptual depth by leading students through directed lines of…

  17. Social Justice, Children's Needs and Rights: An Approach to Planning

    Science.gov (United States)

    Sims, Margaret

    2015-01-01

    Commonly, planning for children involves comparing what they know against a curriculum or learning framework which identifies what they should know. Early childhood educators are then expected to create learning opportunities to help fill the gap between these two extremes. In this paper I argue that such an approach does not honour the…

  18. The need for a Communicative Approach to improve Environmental Policy integration in urban Land Use Planning

    NARCIS (Netherlands)

    Simeonova, V.; Valk, van der A.J.J.

    2009-01-01

    The debate on sustainable development emphasizes the importance of integrating environmental policy into all policy sectors. It is increasingly recognized that this integration is needed at both the national and the local levels of governance. The Environmental Policy Integration (EPI) principle

  19. A need for non-tokamak approaches to magnetic fusion energy

    International Nuclear Information System (INIS)

    Bathke, C.G.; Krakowski, R.A.; Miller, R.L.

    1992-01-01

    Focusing exclusively on conventional tokamak physics in the quest for commercial fusion power is premature, and the options for both advanced-tokamak and non-tokamak concepts need continued investigation. The basis for this claim is developed, and promising advanced-tokamak and non-tokamak options are suggested

  20. A Needs Analysis Approach to the Evaluation of Iranian Third-Grade High School English Textbook

    Directory of Open Access Journals (Sweden)

    Nasser Rashidi

    2014-09-01

    Full Text Available Needs analysis as an integral part of evaluative review of English materials, mainly textbooks, requires giving sufficient attention in all English language learning contexts. This issue seems to be more demanding in English as a Foreign Language (EFL contexts where the textbooks are the main sources of input for the learners. However, in some cases, this important factor is excluded entirely or at least limited to the ideas of major stakeholders. This article reports on the findings of a study conducted to evaluate an English textbook (the third-grade high school English book, which is being used in all state high schools in Iran by using a needs analysis framework. First, the needs analysis questionnaires were administered among 180 third-grade female high school students for whom the textbook was designed. Having investigated the students’ perceived foreign language needs, the researcher then used it as the basis for evaluating the textbook. The results of the textbook evaluation revealed that although all language skills and components were almost important for the majority of the students, the textbook could not fully support all of them together. Finally, it was suggested that the textbook be revised or at least supplemented by other instructional materials, so that it could be more effective for the aforementioned learners.

  1. Creativity and the Transformation of Higher Education: The Need for a Black Mountain College Approach

    Science.gov (United States)

    Emanuel, Richard C.; Challons-Lipton, Siu

    2013-01-01

    The need for increased creativity in education is currently being proposed in much innovative thinking on higher education as universities are forced to recreate themselves. There are four conditions facing higher education worldwide: alignment, motivation, connection, and direction. Higher education is characterized by a hierarchy of subjects and…

  2. On the need for phylogenetic 'corrections' in functional trait-based approaches

    NARCIS (Netherlands)

    de Bello, Francesco; Berg, Matty P.; Dias, Andre T. C.; Diniz-Filho, Jose Alexandre F.; Gotzenberger, Lars; Hortal, Joaquin; Ladle, Richard J.; Leps, Jan

    2015-01-01

    There is considerable uncertainty about if, and when, phylogenetic information is needed to answer various ecological questions about trait-based ecological studies. It has been recommended that both functional and phylogenetic information should be combined, and some researchers have even suggested

  3. An Empirical Study on Business English Teaching and Development in China--A Needs Analysis Approach

    Science.gov (United States)

    Guiyu, Dai; Yang, Liu

    2016-01-01

    This paper first reviews the developmental history and status quo of Business English Program in China. Then based on the theory of needs analysis, it researches on 226 questionnaires from Business English Program students from Guangdong University of Foreign Studies to investigate the problems encountered and current situation of Business English…

  4. Enhancing periodontal health through regenerative approaches: a commentary on the need for patient-reported outcomes.

    Science.gov (United States)

    Inglehart, Marita R

    2015-02-01

    Starting in the 1970s, social scientists have discussed the importance of assessing subjective indicators of well-being and quality of life. Medical researchers followed this line of reasoning since the 1990s, emphasizing the significance of understanding how disease and its treatment affect patients' quality of life. Since the start of the 21(st) century, oral health-related quality of life (OHRQoL) received increasingly more attention. While research concerning the effects of periodontal disease and its surgical and non-surgical treatment on patients' lives has been considered in numerous studies, research including patient-reported outcomes when assessing how periodontal health can be enhanced through regenerative approaches is largely missing. This commentary proposes to consider 1) OHRQoL and 2) patients' treatment satisfaction as patient-reported outcomes in conjunction with objectively measured patient-centered factors, and discusses the value of such an approach.

  5. Political economy of Central Asia: Initial reflections on the need for a new approach

    Directory of Open Access Journals (Sweden)

    Assel Rustemova

    2011-01-01

    I argue that post-structuralist approaches and specifically, the framework of “governmentality” – a term coined by Michel Foucault, allows for more fruitful heuristic exercise. Governmentality as an analytical approach looks at the way the state positions itself in its society and determines the type of governing rationale it adopts. Particularly, it incorporates both discursive and structural-technological conditions of each state into analysis by augmenting the data before constructing the theory to argue what rationale drives government activities in the state. Governmentality speaks to both “resource curse” and the “varieties of capitalism” by enriching and complicating them while allowing identification of how rationales of governing evolve and change over time.

  6. The need and approach for characterization - U.S. air force perspectives on materials state awareness

    Science.gov (United States)

    Aldrin, John C.; Lindgren, Eric A.

    2018-04-01

    This paper expands on the objective and motivation for NDE-based characterization and includes a discussion of the current approach using model-assisted inversion being pursued within the Air Force Research Laboratory (AFRL). This includes a discussion of the multiple model-based methods that can be used, including physics-based models, deep machine learning, and heuristic approaches. The benefits and drawbacks of each method is reviewed and the potential to integrate multiple methods is discussed. Initial successes are included to highlight the ability to obtain quantitative values of damage. Additional steps remaining to realize this capability with statistical metrics of accuracy are discussed, and how these results can be used to enable probabilistic life management are addressed. The outcome of this initiative will realize the long-term desired capability of NDE methods to provide quantitative characterization to accelerate certification of new materials and enhance life management of engineered systems.

  7. Assessing basic needs in frail older persons calls for aesthetic nursing skills – an ethnographic approach

    DEFF Research Database (Denmark)

    Kollerup, Mette Geil; Angel, Sanne

    2015-01-01

    fragments together to form an understanding. Using imagination and improvisation trying out different solutions, the aesthetic nursing skills are seen prominent though related to the empiric-, ethic-, and personalskills. This enabled the nurses in enhancing the frail older persons' participation and helped...... if they are suffering from chronic diseases and complex functional impairments. A starting point for an exploration of this complexity is the identification of frail older persons' basic needs Aim: To explore the challenges in nursing assessment of basic needs when the older persons' frailty also implies impressive...... and expressive difficulties. Method: We used Spradley's theory of participant observation. Data were collected from three older persons' individual assessment meeting, followed by individual interviews with the nurse. Field notes and transcribed dialogues from the assessment meetings and interviews were analyzed...

  8. Consumers with high complex needs co-create a relationship-based approach to care

    OpenAIRE

    Sheridan, Nicolette; Kenealy, Timothy

    2016-01-01

    Introduction: People in all countries experience different social circumstances that result in avoidable differences in health. The health care system has an important role to play in creating opportunities for all populations to be as healthy as possible, especially those with high complex health and social needs. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity an...

  9. A Needs Analysis Approach to the Evaluation of Iranian Third-Grade High School English Textbook

    OpenAIRE

    Nasser Rashidi; Roghaye Kehtarfard

    2014-01-01

    Needs analysis as an integral part of evaluative review of English materials, mainly textbooks, requires giving sufficient attention in all English language learning contexts. This issue seems to be more demanding in English as a Foreign Language (EFL) contexts where the textbooks are the main sources of input for the learners. However, in some cases, this important factor is excluded entirely or at least limited to th...

  10. A CRITICAL NEEDS PLAN FOR GENERAL MOTORS: A CULTURAL PLURALISM APPROACH

    OpenAIRE

    Gregory W. Goussak; Jon K. Webber; Elliot M. Ser

    2012-01-01

    The purpose of this paper is to create a critical needs plan for General Motors Corporation in the 21st century. General Motors (GM), once the most dominant manufacturer in the automotive industry, finds itself in financial crisis with a Chapter 11 bankruptcy and a necessary government infusion of capital. The foundation of this paper applies the Supportive Model as an effective strategy for creating a new corporate culture and focusing GM as a competitive manufacturer in the global automotiv...

  11. HIV prevention, structural change and social values: the need for an explicit normative approach.

    Science.gov (United States)

    Parkhurst, Justin O

    2012-06-14

    The fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals. This paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses. HIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values. While no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well.

  12. Junk-food enhances conditioned food cup approach to a previously established food cue, but does not alter cue potentiated feeding; implications for the effects of palatable diets on incentive motivation.

    Science.gov (United States)

    Derman, Rifka C; Ferrario, Carrie R

    2018-03-16

    Efforts to stem the global rise in obesity have been minimally effective, perhaps in part because our understanding of the psychological and behavioral drivers of obesity is limited. It is well established that stimuli that are paired with palatable foods can powerfully influence food-seeking and feeding behaviors. However, how consumption of sugary, fatty "junk-foods" affects these motivational responses to food cues is poorly understood. Here, we determined the effects of short- and long-term "junk-food" consumption on the expression of cue potentiated feeding and conditioned food cup approach to Pavlovian conditioned stimuli (CS). Further, to determine the degree to which effects of "junk-food" were selective to Pavlovian motivational processes, we varied the predictive validity of the CS by including training groups conditioned with unique CS-US contingencies ranging from -1.0 to +1.0. "Junk-food" did not enhance cue potentiated feeding in any group, but expression of this potentiation effect varied with the CS-US contingency independent of diet. In contrast, "junk-food" consistently enhanced conditioned approach to the food cup; this effect was dependent on the previously established CS-US contingency. That is, consumption of "junk-food" following training enhanced approach to the food cup only in response to CSs with previously positive CS-US contingencies. This was accompanied by reduced motivation for the US itself. Together these data show that "junk-food" consumption selectively enhances incentive motivational responses to previously established food CSs, without altering cue potentiated feeding induced by these same CSs, and in the absence of enhanced motivation for food itself. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Use of comparative genomics approaches to characterize interspecies differences in response to environmental chemicals: Challenges, opportunities, and research needs

    International Nuclear Information System (INIS)

    Burgess-Herbert, Sarah L.; Euling, Susan Y.

    2013-01-01

    A critical challenge for environmental chemical risk assessment is the characterization and reduction of uncertainties introduced when extrapolating inferences from one species to another. The purpose of this article is to explore the challenges, opportunities, and research needs surrounding the issue of how genomics data and computational and systems level approaches can be applied to inform differences in response to environmental chemical exposure across species. We propose that the data, tools, and evolutionary framework of comparative genomics be adapted to inform interspecies differences in chemical mechanisms of action. We compare and contrast existing approaches, from disciplines as varied as evolutionary biology, systems biology, mathematics, and computer science, that can be used, modified, and combined in new ways to discover and characterize interspecies differences in chemical mechanism of action which, in turn, can be explored for application to risk assessment. We consider how genetic, protein, pathway, and network information can be interrogated from an evolutionary biology perspective to effectively characterize variations in biological processes of toxicological relevance among organisms. We conclude that comparative genomics approaches show promise for characterizing interspecies differences in mechanisms of action, and further, for improving our understanding of the uncertainties inherent in extrapolating inferences across species in both ecological and human health risk assessment. To achieve long-term relevance and consistent use in environmental chemical risk assessment, improved bioinformatics tools, computational methods robust to data gaps, and quantitative approaches for conducting extrapolations across species are critically needed. Specific areas ripe for research to address these needs are recommended

  14. Screening for chronic comorbid diseases in people with HIV: the need for a strategic approach.

    Science.gov (United States)

    Peters, B; Post, F; Wierzbicki, A S; Phillips, A; Power, L; Das, S; Johnson, M; Moyle, G; Hughes, L; Wilkins, E; McCloskey, E; Compston, J; Di Angelantonio, E

    2013-01-01

    Among people living with HIV, the proportion of deaths attributed to chronic noninfectious comorbid diseases has increased over the past 15 years. This is partly a result of increased longevity in the era of highly active antiretroviral therapy (HAART), and also because HIV infection is related, causally or otherwise, to several chronic conditions. These comorbidities include conditions that are strongly associated with modifiable risk factors, such as cardiovascular disease (CVD), diabetes, and renal and bone diseases, and increasingly management guidelines for HIV recommend risk evaluation for these conditions. The uptake of these screening approaches is often limited by the resources required for their application, and hence the management of risk reduction in most HIV-infected populations falls below a reasonable standard. The situation is compounded by the fact that few risk calculators have been adjusted for specific use in HIV infection. There is substantial overlap of risk factors for the four common comorbid diseases listed above that are especially relevant in HIV infection, and this offers an opportunity to develop a simple screening approach that encompasses the key risk factors for lifestyle-related chronic disease in people with HIV infection. This would identify those patients who require more in-depth investigation, and facilitate a stepwise approach to targeted management. Such a tool could improve communication between patient and clinician. A significant proportion of people with HIV are sufficiently engaged with their care to participate in health promotion and take the lead in using patient-centric screening measures. Health-based social networking offers a mechanism for dissemination of such a tool and is able to embed educational messages and support within the process. © 2012 British HIV Association.

  15. Changing physician perspectives on complementary and alternative medicine: the need for a top-down approach

    Directory of Open Access Journals (Sweden)

    MacKinnon TS

    2017-09-01

    Full Text Available Thomas S MacKinnon,1 Norbert F Banhidy,1 Daniel R Tuite21School of Medicine, Imperial College London, London, 2Faculty of Medicine, Brighton and Sussex Medical School, Brighton, UKWe read with great interest the article by Patel et al1 discussing the changing perspectives towards complementary and alternative medicine (CAM, and an impetus for additional physician knowledge of the strengths and drawbacks of CAM. These findings are indeed relevant in the UK, with an estimated 41.1% one-year prevalence of CAM use, responsible for an annual out-of-pocket expenditure of £1.6 billion.2 We agree that improved training and education in medical school and residencies – which can be thought of as a “bottom-up” approach – are fundamental in preparing the health care system for improved integration of CAM. However, we also suggest that “top-down” changes are required to optimize patient care.Authors' reply Sejal J Patel,1 Kathi J Kemper,2 Joseph P Kitzmiller31College of Public Health, The Ohio State University, 2Center for Integrative Health and Wellness, The Ohio State Wexner University Medical Center, 3Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH, USAWe agree the letter is worthy of publication but have a little to add: a top-down approach (as suggested and described by the authors of the letter certainly complements the bottom-up approach (described in our article.1View the original paper by Patel et al.

  16. Why We Need Evidence-Based, Community-Wide Approaches for Prevention of Teen Pregnancy.

    Science.gov (United States)

    Barfield, Wanda D; Warner, Lee; Kappeler, Evelyn

    2017-03-01

    Teen pregnancy and childbearing have declined over the past two decades to historic lows. The most recent declines have occurred during a time of coordinated national efforts focused on teen pregnancy. This article highlights a federal partnership to reduce teen pregnancy through the implementation of innovative, evidence-based approaches in affected communities, with a focus on reaching African-American and Latino/Hispanic youth. This initiative has the potential to transform the design and implementation of future teen pregnancy prevention efforts and provide a model that can be replicated in communities across the nation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. Systems approach to materials policy. [Role of renewable resources for energy needs

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, K C; Bhagat, N

    1976-01-01

    A comprehensive systems framework for materials policy analysis, the Reference Materials System (RMS), has been developed and is described in this paper. Specifically, the RMS provides a systematic approach to organizing engineering process-type information regarding material flows, energy requirements, costs, and environmental impacts corresponding to various materials on all processes ranging from extraction of resources through their refinement, transportation, fabrication, installation, and maintenance at the point of end use, as well as recycling. This system can be used for the assessment of material technologies, substitutions and policies, and has been applied to assess the role of renewable materials as substitutes for energy-intensive nonrenewables.

  18. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach

    Directory of Open Access Journals (Sweden)

    Sujita Kumar Kar

    2015-01-01

    Full Text Available Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its "culture-bound" status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder.

  19. Genetic approach to ambiguous genitalia and disorders of sex development: What clinicians need to know.

    Science.gov (United States)

    Yatsenko, Svetlana A; Witchel, Selma Feldman

    2017-06-01

    Genetic tools such as microarray and next-generation sequencing have initiated a new era for the diagnosis and management of patients with disorders of sex development (DSDs). These tools supplement the traditional approach to the evaluation and care of infants, children, and adolescents with DSDs. These tests can detect genetic variations known to be associated with DSDs, discover novel genetic variants, and elucidate novel mechanisms of gene regulation. Herein, we discuss these tests and their role in the management of patients with DSDs. Copyright © 2017. Published by Elsevier Inc.

  20. Europe needs to take clear, analytical approach in considering future of nuclear energy

    Energy Technology Data Exchange (ETDEWEB)

    Shepherd, John [nuclear 24, Redditch (United Kingdom)

    2016-11-15

    Europe's political leaders have been accused of failing to offer a clear and comprehensive approach to the future of nuclear power in Europe. The criticism came in an opinion adopted recently by the European Economic and Social Committee (EESC). According to the EESC, the European Commission should propose ''a clear analytical process and methodology which can offer a consistent, voluntary framework for national decision-making about the role - if any - of nuclear power in the energy mix''.

  1. Investigating the management information needs of academic Heads of Department: a Critical Success Factors approach

    Directory of Open Access Journals (Sweden)

    Francis Green

    1996-01-01

    Full Text Available This paper describes a research project in the Department of Information Studies at the University of Sheffield. With funding from the British Library Research and Development Department a critical success factors-based investigation of the management information needs of academic Heads of Department in an number of English universities was undertaken in 1994/1995, following publication of the results of a pilot study byPellow and Wilson (1993. Senior academic staff, university administrators and librarians in sixteen universities were interviewed between December, 1994 and March, 1995. Collation of data and analysis of results have been completed

  2. Update on impact effects in nuclear plants Part I--overview and need for integrated approach

    International Nuclear Information System (INIS)

    Sliter, G.E.; Ravindra, M.K.

    1984-01-01

    In this paper, an ASCE working group on impact effects in nuclear plants updates the review of this technology contained in a five-yearold ASCE report. In Part I, an overview is given of the impact conditions addressed in nuclear plant design against missiles generated by such postulated extreme events as tornados, turbine failures, pipe ruptures, aircraft crashes, and drops of heavy objects from lifting devices. The conclusion of a brief evaluation of the state of the art in predicting structural response for the various missile impact types is that two of them--pipe whip and heavy object drop--would benefit most by further development of design and analysis methods. Parts II and III of this paper review current practice and identify its limitations for these two impact types. Part I continues with a discussion of the general characteristics of impacts and the structural response they produce and concludes with a recommendation for and brief description of an ''integrated approach'' for treating impact effects. The adoption of this systematic approach in future development of impact technology would guide engineers in the use of the most appropriate and accurate available techniques for designing against a particular impact event

  3. Identifying and prioritising areas of child dental service need: a GIS-based approach.

    Science.gov (United States)

    Alsharif, A T; Kruger, E; Tennant, M

    2016-03-01

    To identify and prioritise areas of high need for dental services among the child population in metropolitan Western Australia. All children hospitalised due to an oral-condition from 2000 to 2009, at metropolitan areas of Perth were included in the analysis of a 10-year data set. QGIS tools mapped the residential location of each child and socioeconomic data in relation to existing services (School Dental Service clinics). The tables and maps provide a clear indication of specific geographical areas, where no services are located, but where high hospital-admission rates are occurring, especially among school-age children. The least-disadvantaged areas and areas of high rates of school-age child hospital-admissions were more likely to be within 2km of the clinics than not. More of high-risk-areas (socio-economically deprived areas combined with high oral-related hospital admissions rates), were found within 2km of the clinics than elsewhere. The application of GIS methodology has identified a community's current service access needs, and assisted evidence based decision making for planning and implementing changes to increase access based on risk.

  4. CADe for early detection of breast cancer-current status and why we need to continue to explore new approaches.

    Science.gov (United States)

    Nishikawa, Robert M; Gur, David

    2014-10-01

    The authors describe where we are in terms of using computer-aided detection (CADe) systems during clinical mammographic interpretations, what are the issues that we face, and why they believe that, despite disappointment in terms of verified added value when it comes to detection of soft tissue abnormalities, we need to continue to explore new approaches to improving CADe-alone performance levels and, more important perhaps, new approaches to optimal communication of CADe-generated information. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  5. Grasping the hydra: the need for a holistic and systematic approach to disaster risk reduction

    Directory of Open Access Journals (Sweden)

    Per Becker

    2009-04-01

    Full Text Available This article stresses the significance of recognising interdependencies between factors determining disaster risk in any attempts to integrate disaster risk reduction in international development cooperation. It bases its arguments on the case studies of four past projects in Sri Lanka and Tajikistan, which are scrutinised using a theoretical framework based on systems approaches. It appears that the results of ignoring interdependencies may (1cause sub-optimisation problems where the desired outcome is not reached as the factor focused on and/or the desired outcome are dependent on other factors, and (2 make it difficult or impossible to monitor and evaluate the actual effects of international development cooperation projects in disaster risk reduction.

  6. Is a Response to Intervention (RTI) Approach to Preschool Language and Early Literacy Instruction Needed?

    Science.gov (United States)

    Greenwood, Charles R; Carta, Judith J; Atwater, Jane; Goldstein, Howard; Kaminski, Ruth; McConnell, Scott

    2013-05-01

    Preschool experience plays a role in children's development. However, for programs with language and early literacy goals, the question remains whether or not preschool instructional experiences are sufficiently effective to achieve these goals for all children. In a multisite study, we conducted a process-product description of preschool instruction and children's growth and outcomes in typical programs (i.e., Pre-Kindergarten, Title 1, Head Start, Tuition-Based) using a Response to Intervention (RTI) perspective. Results indicated that (a) students in their preschool year prior to kindergarten made small gains, but students starting the year in lower Tier 2 and 3 performance levels did not close initial skills gaps, (b) variations were noted by program types with varying socio-demographics and instructional processes, and (c) the quality of instruction (Tier 1) received by all was low with room for improvement. Implications for future research on the application of the RTI approach and potential benefits are discussed.

  7. People for sale: the need for a multidisciplinary approach towards human trafficking.

    Science.gov (United States)

    Van Impe, K

    2000-01-01

    The article addresses the question of how to develop appropriate measures to tackle trafficking in women, based on the findings of a study of trafficking between the Philippines and Belgium. It argues that there is no easy or unidimensional solution to human trafficking, since it is influenced by a complex set of factors, often working in combination with one another. It concludes that control measures alone cannot stop the flow of trafficking in women and that a legal approach which relies solely on one type of legislation would be too narrow. An effective strategy must combine and balance punitive measures with protection of human rights, stricter border control and the removal of the root causes of irregular movements. Measures must be agreed and coordinated between origin, transit and receiving countries.

  8. The need for a better approach to business energy management: engaging decision makers

    International Nuclear Information System (INIS)

    Jutsen, Jonathan; Feldman, Shel

    2003-01-01

    Many programs have achieved success in stimulating companies to increase their purchase, installation, and use of energy-efficient equipment (e.g., fluorescent lighting, premium efficient motors). However, few can claim having moved companies to manage energy efficiency as an ongoing part of their practices, procedures, and culture. Recently, a program has been developed and implemented in the UK, Australia, Canada, and the U.S. that is aimed specifically at educating and motivating corporate decision-makers in this direction. This program targets senior management; it not only engages their interest and concern with energy-related issues, but also guides them to set priorities based on a structured gap analysis, and to establish and commit to a plan of action. By focusing on the business needs of the target companies and gaining executive commitment to a structured, systematic implementation plan, it motivates these companies both to seek immediate savings and to a process for continuous improvement that includes sustainable long-term energy efficiency. This paper illustrates specific aspects of the program, the way it helps drive outcomes in participating companies, and its implementation by government and utilities. In addition, the paper discusses needed changes in program evaluation methods to systematically monitor and value the cost-efficiency of this type of intervention which a) does not focus on equipment efficiencies, b) directs clients to other providers of energy efficiency services, c) helps build the infrastructure for such services, and d) motivates long-term energy reductions through the adoption of a sustainable energy-savings ethic in ongoing corporate planning and decisions

  9. Risk analysis for U.S. offshore wind farms: the need for an integrated approach.

    Science.gov (United States)

    Staid, Andrea; Guikema, Seth D

    2015-04-01

    Wind power is becoming an increasingly important part of the global energy portfolio, and there is growing interest in developing offshore wind farms in the United States to better utilize this resource. Wind farms have certain environmental benefits, notably near-zero emissions of greenhouse gases, particulates, and other contaminants of concern. However, there are significant challenges ahead in achieving large-scale integration of wind power in the United States, particularly offshore wind. Environmental impacts from wind farms are a concern, and these are subject to a number of on-going studies focused on risks to the environment. However, once a wind farm is built, the farm itself will face a number of risks from a variety of hazards, and managing these risks is critical to the ultimate achievement of long-term reductions in pollutant emissions from clean energy sources such as wind. No integrated framework currently exists for assessing risks to offshore wind farms in the United States, which poses a challenge for wind farm risk management. In this "Perspective", we provide an overview of the risks faced by an offshore wind farm, argue that an integrated framework is needed, and give a preliminary starting point for such a framework to illustrate what it might look like. This is not a final framework; substantial work remains. Our intention here is to highlight the research need in this area in the hope of spurring additional research about the risks to wind farms to complement the substantial amount of on-going research on the risks from wind farms. © 2015 Society for Risk Analysis.

  10. Quality of life, coping strategies and support needs of women seeking Traditional Chinese Medicine for infertility and viable pregnancy in Australia: a mixed methods approach.

    Science.gov (United States)

    Ried, Karin; Alfred, Ann

    2013-04-09

    Infertility affects about 15% of couples in Western-societies with most progressing to fertility clinics for treatment. Despite being common, infertility is often experienced as a lonely road for affected couples. In this paper we expand on our previously published findings of women's experiences with infertility or difficulty of viable pregnancy who had sought Traditional Chinese Medicine (TCM) therapy in Australia, and focus on women's quality of life, coping strategies, and support needs. We applied mixed methods using the Tuebingen Quality of Life and the COPE questionnaires and in-depth interviews with 25 women with primary or secondary infertility, recurrent miscarriages or unexplained stillbirth, and who had consulted a TCM practitioner. We used a thematic approach to analyse the interviews, and descriptive statistics to evaluate questionnaire responses. Women reported through both questionnaires and interviews compromised quality of life due to the high level of distress, guilt, grief, and frustration caused by infertility. However, our women represented a highly motivated sample, actively seeking alternative support. While the TCM approach to infertility management increased women's sense of personal agency and control through education and continuity of care, the need for greater understanding and support on a societal level remains. In infertility, ongoing emotional and instrumental support is pivotal to the wellbeing and quality of life of the affected. Traditional Chinese Medicine addresses some support needs in infertility not routinely available in the Western model of care. More peer-led and professional-led support groups are greatly needed for women experiencing infertility to help break isolation and raise awareness of integrative approaches to fertility management.

  11. Municipal solid waste management in Lebanon: the need for an integrated approach

    International Nuclear Information System (INIS)

    Khoury, R.; El-Fadel, M.

    2000-01-01

    Full text.This study focuses on the management of municipal solid waste (MSW) in Lebanon. It addresses the current status of MSW management in Lebanon in terms of collection, transport and disposal, infers the associated impacts of such practices and discusses mitigation measures and finally proposes basic guidelines for a national strategy for solid waste management in the country. The study is based on available previous investigations and on a field survey of 113 villages in four different countries. The study revealed the absence of an effective environmental policy and poor collection and disposal methods throughout the country, except for the Greater Beirut Area (G A), where better solid waste management practices are employed. Although collection of MSW outside GBA was found to be acceptable by local authorities, resources (labor and equipment) were not used efficiently. Furthermore, treatment of collected waste is almost not available. Waste collected is invariably open dumped and /or open burned outside GBA. The poor quality of the services were reflected by the low budgets available in the solid waste sanitation departments of most surveyed villages. Unlike the situation outside the GBA a solid waste management component can be identified in the GBA. However, until recently, nearly 90 percent of the total waste generated in the GBA is being ultimately disposed of at the landfill. This raises into question the purpose of the sorting-processing-composting facilities as well as the recycling program. Apparently, the current waste management activities, particularly source reduction and recycling have not measured up favorably with the steps outlined in an integrated solid waste management system. The study concludes with a series of policy measures that can constitute the framework for a long-term strategy in order to implement an effective solid waste master plan in Lebanon

  12. Evaluation of secretion prediction highlights differing approaches needed for oomycete and fungal effectors

    Directory of Open Access Journals (Sweden)

    Jana eSperschneider

    2015-12-01

    Full Text Available The steadily increasing number of sequenced fungal and oomycete genomes has enabled detailed studies of how these eukaryotic microbes infect plants and cause devastating losses in food crops. During infection, fungal and oomycete pathogens secrete effector molecules which manipulate host plant cell processes to the pathogen’s advantage. Proteinaceous effectors are synthesised intracellularly and must be externalised to interact with host cells. Computational prediction of secreted proteins from genomic sequences is an important technique to narrow down the candidate effector repertoire for subsequent experimental validation. In this study, we benchmark secretion prediction tools on experimentally validated fungal and oomycete effectors. We observe that for a set of fungal SwissProt protein sequences, SignalP 4 and the neural network predictors of SignalP 3 (D-score and SignalP 2 perform best. For effector prediction in particular, the use of a sensitive method can be desirable to obtain the most complete candidate effector set. We show that the neural network predictors of SignalP 2 and 3, as well as TargetP were the most sensitive tools for fungal effector secretion prediction, whereas the hidden Markov model predictors of SignalP 2 and 3 were the most sensitive tools for oomycete effectors. Thus, previous versions of SignalP retain value for oomycete effector prediction, as the current version, SignalP 4, was unable to reliably predict the signal peptide of the oomycete Crinkler effectors in the test set. Our assessment of subcellular localisation predictors shows that cytoplasmic effectors are often predicted as not extracellular. This limits the reliability of secretion predictions that depend on these tools. We present our assessment with a view to informing future pathogenomics studies and suggest revised pipelines for secretion prediction to obtain optimal effector predictions in fungi and oomycetes.

  13. Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach.

    Science.gov (United States)

    Amato, Maria Pia; Bertolotto, Antonio; Brunelli, Roberto; Cavalla, Paola; Goretti, Benedetta; Marrosu, Maria Giovanna; Patti, Francesco; Pozzilli, Carlo; Provinciali, Leandro; Rizzo, Nicola; Strobelt, Nicola; Tedeschi, Gioacchino; Trojano, Maria; Comi, Giancarlo

    2017-10-01

    Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS), most probably autoimmune in origin, usually occurring in young adults with a female/male prevalence of approximately 3:1. Women with MS in the reproductive age may face challenging issues in reconciling the desire for parenthood with their condition, owing to the possible influence both on the ongoing or planned treatment with the possible consequences on the disease course and on the potential negative effects of treatments on foetal and pregnancy outcomes. At MS diagnosis, timely counselling should promote informed parenthood, while disease evolution should be assessed before making therapeutic decisions. Current guidelines advise the discontinuation of any treatment during pregnancy, with possible exceptions for some treatments in patients with very active disease. Relapses decline during pregnancy but are more frequent during puerperium, when MS therapy should be promptly resumed in most of the cases. First-line immunomodulatory agents, such as interferon-β (IFN-β) and glatiramer acetate (GA), significantly reduce the post-partum risk of relapse. Due to substantial evidence of safety with the use of GA during pregnancy, a recent change in European marketing authorization removed the pregnancy contraindication for GA. This paper reports a consensus of Italian experts involved in MS management, including neurologists, gynaecologists and psychologists. This consensus, based on a review of the available scientific evidence, promoted an interdisciplinary approach to the management of pregnancy in MS women.

  14. Four key reasons why climate change adaptation and mitigation need a gendered approach

    Directory of Open Access Journals (Sweden)

    Carla Sarrouy

    2014-09-01

    Full Text Available Climate change is having a growing impact on every human activity, especially on agriculture with altered rainfall patterns and an increased number and intensity of extreme weather events. This article argues that efforts to mitigate and adapt to climate change must consider whole food systems – rather than the sole production of food – whilst embracing a conscious gendered approach. Women are the main victims of hunger, but they are also the main actors of global food systems, they greatly contribute to their household’s and community’s wellbeing and detain a rich and often untapped knowledge of food systems. Promoting the role of women in our global food systems enhances the inclusion of criteria mainly valued by women such as resilience, diversity and nutrition, which are paramount for climate change mitigation and adaptation.   Photo credit: By OxFam East Africa [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0], via Wikimedia Commons

  15. Humanization in healthcare arises from the need for a holistic approach to illness.

    Science.gov (United States)

    de la Fuente-Martos, C; Rojas-Amezcua, M; Gómez-Espejo, M R; Lara-Aguayo, P; Morán-Fernandez, E; Aguilar-Alonso, E

    2018-03-01

    Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  16. Need for an integrated approach towards the assessment of radon, thoron and their progeny exposures

    International Nuclear Information System (INIS)

    Mayya, Y.S.

    2008-01-01

    Recent publications dealing with epidemiological studies on North American and European populations have indicated statistically significant lung cancer risk coefficients attributable to residential radon exposures. These are essentially based on radon gas itself as the quantitative measure of exposures. However, considering that true exposures depend upon the intricate mechanisms of decay product deposition in the lung, it is necessary to go for the assessment of decay products including their size distributions and deposition velocities. This approach is essential for assessing the risks of thoron and its decay products which is of considerable importance in the public domain and in the thorium fuel cycle. The recent development of deposition based progeny concentration measurement techniques appear to be best suited for radiological risk assessments both among occupational workers and general study populations. These provide an easy to wear alternative for radon inhalation dosimetry similar to TLDs for external gamma radiations. It is urgently required to characterize their performance under a variety of residential indoor and workplace conditions. This may be achieved through an integrated multi-parametric study programme involving measurements of radon, thoron and their progeny concentrations along with fine and coarse fractions and indoor source terms. This will not only in delineate the true exposure profiles and indoor parameters (e.g. deposition velocities and air exchange rates) in the country, but also will help in establishing deposition dosimetry as a basic technique for inhalation exposure estimations for occupational workers and subjects living in high background radiation areas

  17. Biodiesel exhaust: the need for a systematic approach to health effects research.

    Science.gov (United States)

    Larcombe, Alexander N; Kicic, Anthony; Mullins, Benjamin J; Knothe, Gerhard

    2015-10-01

    Biodiesel is a generic term for fuel that can be made from virtually any plant or animal oil via transesterification of triglycerides with an alcohol (and usually a catalyst). Biodiesel has received considerable scientific attention in recent years, as it is a renewable resource that is directly able to replace mineral diesel in many engines. Additionally, some countries have mandated a minimum biodiesel content in all diesel fuel sold on environmental grounds. When combusted, biodiesel produces exhaust emissions containing particulate matter, adsorbed chemicals and a range of gases. In many cases, absolute amounts of these pollutants are lower in biodiesel exhaust compared with mineral diesel exhaust, leading to speculation that biodiesel exhaust may be less harmful to health. Additionally, engine performance studies show that the concentrations of these pollutants vary significantly depending on the renewable oil used to make the biodiesel and the ratio of biodiesel to mineral diesel in the fuel mix. Given the strategic and legislative push towards the use of biodiesel in many countries, a concerning possibility is that certain biodiesels may produce exhaust emissions that are more harmful to health than others. This variation suggests that a comprehensive, systematic and comparative approach to assessing the potential for a range of different biodiesel exhausts to affect health is urgently required. Such an assessment could inform biodiesel production priorities, drive research and development into new exhaust treatment technologies, and ultimately minimize the health impacts of biodiesel exhaust exposure. © 2015 Asian Pacific Society of Respirology.

  18. Relevance of Campylobacter to public health--the need for a One Health approach.

    Science.gov (United States)

    Gölz, Greta; Rosner, Bettina; Hofreuter, Dirk; Josenhans, Christine; Kreienbrock, Lothar; Löwenstein, Anna; Schielke, Anika; Stark, Klaus; Suerbaum, Sebastian; Wieler, Lothar H; Alter, Thomas

    2014-10-01

    Campylobacter species belong to the most important foodborne bacteria which cause gastroenteritis in humans in both developed and developing countries. With increasing reporting rates, the public awareness towards Campylobacter infections is growing continuously. This strengthens the necessity to establish intervention measures for prevention and control of thermophilic Campylobacter spp. along the food chain, as in particular poultry and poultry meat represent a major source of human infections. An interdisciplinary One Health approach and a combined effort of all stakeholders are necessary to ultimately reduce the burden of campylobacteriosis cases in humans. Numerous studies point out, however, that at present a complete elimination of Campylobacter in the food chain is not feasible. The present aim should therefore be to establish control measures and intervention strategies to minimize the occurrence of Campylobacter spp. in livestock (e.g. poultry flocks) and to reduce the quantitative Campylobacter burden in animals and foods. To this end, a combination of intervention methods at different stages of the food chain appears most promising. That has to be accompanied by targeted consumer advice and education campaigns to raise the awareness towards Campylobacter infections. Copyright © 2014 Elsevier GmbH. All rights reserved.

  19. Why the need and how to approach the functional diversity of extracellular vesicles.

    Science.gov (United States)

    Tkach, Mercedes; Kowal, Joanna; Théry, Clotilde

    2018-01-05

    In the past decade, cell-to-cell communication mediated by exosomes has attracted growing attention from biomedical scientists and physicians, leading to several recent publications in top-tier journals. Exosomes are generally defined as secreted membrane vesicles, or extracellular vesicles (EVs), corresponding to the intraluminal vesicles of late endosomal compartments, which are secreted upon fusion of multi-vesicular endosomes with the cell's plasma membrane. Cells, however, were shown to release other types of EVs, for instance, by direct budding off their plasma membrane. Some of these EVs share with exosomes major biophysical and biochemical characteristics, such as size, density and membrane orientation, which impose difficulties in their efficient separation. Despite frequent claims in the literature, whether exosomes really display more important patho/physiological functions, or are endowed with higher potential as diagnostic or therapeutic tools than other EVs, is not yet convincingly demonstrated. In this opinion article, we describe reasons for this lack of precision knowledge in the current stage of the EV field, we review recently described approaches to overcome these caveats, and we propose ways to improve our knowledge on the respective functions of distinct EVs, which will be crucial for future development of well-designed EV-based clinical applications.This article is part of the discussion meeting issue 'Extracellular vesicles and the tumour microenvironment'. © 2017 The Authors.

  20. Systems Assurance, Complexity and Emergence: The Need for a Systems Based Approach

    Science.gov (United States)

    Hessami, Ali; Karcanias, Nicos

    The complexity of modern products, systems and processes makes the task to identify, characterise and provide sufficient assurance about the desirable properties a major challenge. Stakeholders also, demand a degree of enhanced confidence about the absence of undesirable properties with a potential to cause harm or loss. The paper develops a framework of seven fundamental facets of performance as an ontology for emergent behavioural properties and a separate framework for the emergent structural properties of complex systems. The emergent behavioural aspects are explored and we develop a systems framework for assurance based on an Assessment and Management paradigm each comprising a number of principles and processes. The key argument advanced is that in the face of complexity and incessant change, enhanced confidence in the achievement of desirable and avoidance of undesirable properties requires a systems approach empowered by suitable modelling and relevant diagnostic tools explaining the nature of emergent properties. The principal focus of this paper is on safety, security and sustainability emergent behavioural (performance) aspects of complex products, systems and processes.

  1. Information Technology and the Need for Clear Communication for Effective User’s Approach

    Directory of Open Access Journals (Sweden)

    Adriane Setti

    2014-09-01

    Full Text Available The present study addresses the communication between professionals of information technology (IT and its users in the corporate environment of Curitiba (Brazil. The main aim was to analyze communication problems and implications for management and marketing. Empirical research examined responses from a sample of IT professionals with some professional experience in the area and academic level, as well as responses from a sample of IT users (making use of technology in that corporate environment. The questionnaires were available online, and the SPSS software was used for data processing. Results allow us to infer that, in the sample studied, problems in communication between IT professionals and the services’ users do exist. Data obtained reflect a need for formal training by the professionals to serve customers, manage their careers and use technology on behalf of users in order to improve business management practice. Professionals must be clear with users, to create confidence. Also, it was evident that respondent users consider technology as a basic tool, and they expect professionals to share and explain their actions toward the machine or system. This research makes some implications obvious in relation to communication processes in the IT field for management and marketing.

  2. A triangulation approach to the identification of acute sector nurses' training needs for formal nurse practitioner status.

    Science.gov (United States)

    Hicks, C; Hennessy, D

    1998-01-01

    The current confusion surrounding the definition and role function of the nurse practitioner (NP) has created a situation in which advanced clinical practice is delivered in a variety of ways and at many levels. Not surprisingly, this has led to difficulties in regulating educational provision for NPs. This study reports a survey of the perceptions of the role definitions and training needs of all nurses working at advanced clinical levels within an acute sector Trust. Although this concept is not a novel one in advanced nursing practice, the procedure adopted differed from previous studies in two fundamental ways: firstly, a unique training needs assessment instrument was used, which because of its validity and opacity, was capable of yielding a highly reliable data-base, comprising a prioritized profile of real training needs as opposed to the standard wish-list typically elicited. Secondly, it did not rely simply on the self-reported needs of the nurse sample, but also included the perceptions of the sample's immediate medical and managerial colleagues. In this way, a triangulation paradigm was adopted. The results indicated that overall, there was high agreement between the nurses and their managers, regarding both the definition of the NP role and the essential training requirements, with somewhat different opinions being offered by the medical staff. When the raw scores were standardized to correct for response bias, the data provided an operational definition of the role of the NP and a prioritized profile of training needs for nurses who wished to train to this level.

  3. Paradigm change in ocean studies: multi-platform observing and forecasting integrated approach in response to science and society needs

    Science.gov (United States)

    Tintoré, Joaquín

    2017-04-01

    -platform approach in ocean observation. Three examples from the integration capabilities of SOCIB facilities will be presented and discussed. First the quasi-continuous high frequency glider monitoring of the Ibiza Channel since 2011, an important biodiversity hot spot and a 'choke' point in the Western Mediterranean circulation, has allowed us to reveal a high frequency variability in the North-South exchanges, with very significant changes (0.8 - 0.9 Sv) occurring over periods of days to week of the same order as the previously known seasonal cycle. HF radar data and model results have also contributed more recently to better describe and understand the variability at small scales. Second, the Alborex/Perseus project multi-platform experiment (e.g., RV catamaran, 2 gliders, 25 drifters, 3 Argo type profilers & satellite data) that focused on submesoscale processes and ecosystem response and carried out in the Alborán Sea in May 2014. Glider results showed significant chlorophyll subduction in areas adjacent to the steep density front with patterns related to vertical motion. Initial dynamical interpretations will be presented. Third and final, I will discuss the key relevance of the data centre to guarantee data interoperability, quality control, availability and distribution for this new approach to ocean observation and forecasting to be really efficient in responding to key scientific state of the art priorities, enhancing technology development and responding to society needs.

  4. IAEA Inspections for Undeclared and Declared Activities: Is a More Robust Approach Needed?

    Energy Technology Data Exchange (ETDEWEB)

    Mark Schanfein

    2009-07-01

    The United States has long supported a strong international safeguards system and for many years has served as the foremost supplier of technology, equipment, and training to the International Atomic Energy Agency (IAEA). In doing so, it drew in many instances on DOE sponsored R&D and training that was directed towards domestic safeguards and then adapted for IAEA purposes. This was relatively straightforward because of the strong overlap between the development of nuclear material accountancy measures needed for both domestic and international purposes. Two factors have emerged that have made this strong reliance on domestic measures less and less able to be a source of support for the IAEA. One is the shift by the IAEA safeguards system towards detecting undeclared activities. The second is the shift of domestic attention away from nuclear material accountancy and towards physical protection. As a result, a gap in US sponsored R&D and training relevant to international safeguards has developed. The NNSA Next Generation Safeguards Initiative and the DOE NA-22 Safeguards R&D program are intended to help fill this gap and, thereby, permit the U.S. to remain as the pre-eminent supplier of technology for international safeguards purposes. In this context, IAEA challenges have been examined from the perspective of detecting the diversion of nuclear material from declared stocks; detecting undeclared production of nuclear material and activities at locations declared under INFCIRC/153; and detecting undeclared nuclear material and activities elsewhere in a state. Of these, the detection of undeclared nuclear material and activities is, perhaps, the IAEA’s most significant challenge. It is a challenge that even the international community finds difficult to meet because of the scope and the geographic scale of the problem, the technical constraints, the knowledge required, and the significant resources needed to deploy effective systems world-wide (e.g., satellite

  5. IAEA Inspections for Undeclared and Declared Activities: Is a More Robust Approach Needed?

    International Nuclear Information System (INIS)

    Schanfein, Mark

    2009-01-01

    The United States has long supported a strong international safeguards system and for many years has served as the foremost supplier of technology, equipment, and training to the International Atomic Energy Agency (IAEA). In doing so, it drew in many instances on DOE sponsored R and D and training that was directed towards domestic safeguards and then adapted for IAEA purposes. This was relatively straightforward because of the strong overlap between the development of nuclear material accountancy measures needed for both domestic and international purposes. Two factors have emerged that have made this strong reliance on domestic measures less and less able to be a source of support for the IAEA. One is the shift by the IAEA safeguards system towards detecting undeclared activities. The second is the shift of domestic attention away from nuclear material accountancy and towards physical protection. As a result, a gap in US sponsored R and D and training relevant to international safeguards has developed. The NNSA Next Generation Safeguards Initiative and the DOE NA-22 Safeguards R and D program are intended to help fill this gap and, thereby, permit the U.S. to remain as the pre-eminent supplier of technology for international safeguards purposes. In this context, IAEA challenges have been examined from the perspective of detecting the diversion of nuclear material from declared stocks; detecting undeclared production of nuclear material and activities at locations declared under INFCIRC/153; and detecting undeclared nuclear material and activities elsewhere in a state. Of these, the detection of undeclared nuclear material and activities is, perhaps, the IAEA's most significant challenge. It is a challenge that even the international community finds difficult to meet because of the scope and the geographic scale of the problem, the technical constraints, the knowledge required, and the significant resources needed to deploy effective systems world-wide (e

  6. Supporting culturally and linguistically diverse children with speech, language and communication needs: Overarching principles, individual approaches.

    Science.gov (United States)

    Verdon, Sarah; McLeod, Sharynne; Wong, Sandie

    2015-01-01

    Speech-language pathologists (SLPs) are working with an increasing number of families from culturally and linguistically diverse backgrounds as the world's population continues to become more internationally mobile. The heterogeneity of these diverse populations makes it impossible to identify and document a one size fits all strategy for working with culturally and linguistically diverse families. This paper explores approaches to practice by SLPs identified as specialising in multilingual and multicultural practice in culturally and linguistically diverse contexts from around the world. Data were obtained from ethnographic observation of 14 sites in 5 countries on 4 continents. The sites included hospital settings, university clinics, school-based settings, private practices and Indigenous community-based services. There were 652 individual artefacts collected from the sites which included interview transcripts, photographs, videos, narrative reflections, informal and formal field notes. The data were analysed using Cultural-Historical Activity Theory (Engeström, 1987). From the analysis six overarching Principles of Culturally Competent Practice (PCCP) were identified. These were: (1) identification of culturally appropriate and mutually motivating therapy goals, (2) knowledge of languages and culture, (3) use of culturally appropriate resources, (4) consideration of the cultural, social and political context, (5) consultation with families and communities, and (6) collaboration between professionals. These overarching principles align with the six position statements developed by the International Expert Panel on Multilingual Children's Speech (2012) which aim to enhance the cultural competence of speech pathologists and their practice. The international examples provided in the current study demonstrate the individualised ways that these overarching principles are enacted in a range of different organisational, social, cultural and political contexts

  7. One Health approach to identify research needs in bovine and human babesioses: workshop report

    Directory of Open Access Journals (Sweden)

    McElwain Terry F

    2010-04-01

    Full Text Available Abstract Background Babesia are emerging health threats to humans and animals in the United States. A collaborative effort of multiple disciplines to attain optimal health for people, animals and our environment, otherwise known as the One Health concept, was taken during a research workshop held in April 2009 to identify gaps in scientific knowledge regarding babesioses. The impetus for this analysis was the increased risk for outbreaks of bovine babesiosis, also known as Texas cattle fever, associated with the re-infestation of the U.S. by cattle fever ticks. Results The involvement of wildlife in the ecology of cattle fever ticks jeopardizes the ability of state and federal agencies to keep the national herd free of Texas cattle fever. Similarly, there has been a progressive increase in the number of cases of human babesiosis over the past 25 years due to an increase in the white-tailed deer population. Human babesiosis due to cattle-associated Babesia divergens and Babesia divergens-like organisms have begun to appear in residents of the United States. Research needs for human and bovine babesioses were identified and are presented herein. Conclusions The translation of this research is expected to provide veterinary and public health systems with the tools to mitigate the impact of bovine and human babesioses. However, economic, political, and social commitments are urgently required, including increased national funding for animal and human Babesia research, to prevent the re-establishment of cattle fever ticks and the increasing problem of human babesiosis in the United States.

  8. Filovirus Research: The Need for an Integrated Approach in Time and Space

    Science.gov (United States)

    Pinzon, Jorge E.

    2010-01-01

    The episodic appearance of Ebola virus (EBOV) and Marburg virus (MARV) across central Africa over the last 15 years not only underscores the importance of filoviruses as uniquely virulent agents to both human and wildlife communities but also implies a very complex transmission scenario that must be understood if we are to prevent or mitigate filovirus outbreaks in the future. Efforts of a global network of scientists and healthcare workers have expanded our knowledge of filoviruses to meet the growing threat of Ebola and Marburg hemorrhagic fevers in Africa. In recent decades, several newly emerging diseases have resulted in major threats to both affected communities and global public health. Viruses from wildlife hosts in particular, have exhibited a capability for cross-species transmission (CST), and have caused high-impact diseases in humans Such as Ebola and Marburg hemorrhagic fevers, Nipah and severe acute respiratory syndrome (SAILS). It has been estimated that about 60.3% (Jones et al. 2008) of human infectious diseases are of animal origin (zoonoses) and even some important viral diseases that are traditionally considered of human origin, for example measles and smallpox, may very well have their prehistoric origins in wildlife (Wolfe et al 2007). It maybe logical and prudent therefore, to anticipate that there are other, new filoviruses out there that will cross into humans at some point in time. If we anticipate that these will happen and wish to be prepared for and mitigate this potential, then an understanding of filoviruses as a biologic system in the environment will be essential to that process. We will need to know how the ecological dynamic of CST interacts with a 'new' viruse's evolutionary factors to overcome environmental, demographic and host-specific barriers to transmission and infectivity to humans.

  9. Pollutant fates in fluvial systems: on need of individual approach to each case study

    Science.gov (United States)

    Matys Grygar, Tomas; Elznicova, Jitka; Novakova, Tereza

    2015-04-01

    deposition in a channel belt and subsequent secondary pollution via physical mobilisation, most pollution storing in the floodplain in a surprisingly heterogeneous manner - in hotspots with a size comparable to fragments of abandoned channels (from a few to few tens of metres). The hotspots are hence best revealed by well-designed field analysis using portable instruments (gamma spectrometry or XRF). The Litavka is specific because most pollution is in its floodplain in the form of anthropogenic alluvium, a very thick vertical accretion body of "artificial" material added to the river system in the amount exceeding its normal transport capacity. That situation favours secondary pollution by chemical mobilisation of pollutants under low river discharges revealed by geochemical analysis. Our case studies show that simple "rules" such as continuous decay of pollutant concentrations downstream from the pollution source, existence of a continuous blanket of polluted overbank fines in floodplain, simple change of the pollution extent with growing distance from the river channel and as a consequence of extreme floods, or simple recipes such as low-density sampling to trace point pollution sources are too simplistic to be applicable in real polluted fluvial systems. Each river system represents a nearly unique combination of individual geomorphic processes, and each pollution has been specific by the mode how it entered the fluvial system. We will not offer "magic tools" in our contribution. In literature we can find all pieces we need for the jigsaw puzzle - pollutants fates in fluvial systems. The question is why so rarely researchers put them together. We would like to encourage them to do so.

  10. Evaluations of Factors Predicting the Need for an Extra-Cervical Approach for Intra-Thoracic Goiter

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-11-01

    Full Text Available Introduction: Intra-thoracic goiter refers to the extension of enlarged thyroid tissue into the thoracic inlet. This condition can produce symptoms of compression on adjacent organs and can sometimes be accompanied by malignant transformation. Therefore surgical treatment is almost always necessary. In order to remove the pathology with the fewest post-operative complications, selection of the appropriate surgical approach is essential. In this study we aimed to detect the criteria which help us select the best therapeutic approach.   Materials and Methods: In this retrospective study, 82 patients with intra-thoracic goiter were investigated. Their data were extracted from medical records and analyzed using SPSS software.   Results: Overall 82 patients, 18 (21% males and 64 (78% females with mean age of 56.38 years were studied. The most common clinical symptoms were mass (95% and dyspnea (73%. In most patients, the surgical approach was cervical (90.2%, while 9.8% of patients required an extra-cervical approach. Post-operation complications were observed in 17.1% of patients; the most common being transient recurrent laryngeal nerve paralysis (4.9%. Malignancy was reported in the histopathology of seven patients (8.5%. The most common malignant histopathology was papillary thyroid carcinoma (7.3%. Extension of the thyroid tissue below the uppermost level of the aortic arch was significantly correlated with the need for an extra-cervical approach to surgery (P

  11. Student identification of the need for complementary medicine education in Australian medical curricula: a constructivist grounded theory approach.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2015-04-01

    Across the Western world, including Australia, growing popularity of complementary medicines (CMs) mandates their implementation into medical education (ME). Medical students in international contexts have expressed a need to learn about CMs. In Australia, little is known about the student-specific need for CM education. The objective of this paper was to assess the self-reported need for CM education among Australian medical students. Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse data. Medical school education faculties in Australian universities. Medical students generally held favourable attitudes toward CMs but had knowledge deficits and did not feel adept at counselling patients about CMs. All students were supportive of CM education in ME, noting its importance in relation to the doctor-patient encounter, specifically with regard to interactions with medical management. As future practitioners, students recognised the need to be able to effectively communicate about CMs and advise patients regarding safe and effective CM use. Australian medical students expressed interest in, and the need for, CM education in ME regardless of their opinion of it, and were supportive of evidence-based CMs being part of their armamentarium. However, current levels of CM education in medical schools do not adequately enable this. This level of receptivity suggests the need for CM education with firm recommendations and competencies to assist CM education development required. Identifying this need may help medical educators to respond more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach.

    Science.gov (United States)

    Lyon, Aaron R; Maras, Melissa A; Pate, Christina M; Igusa, Takeru; Vander Stoep, Ann

    2016-03-01

    Although it is widely known that the occurrence of depression increases over the course of adolescence, symptoms of mood disorders frequently go undetected. While schools are viable settings for conducting universal screening to systematically identify students in need of services for common health conditions, particularly those that adversely affect school performance, few school districts routinely screen their students for depression. Among the most commonly referenced barriers are concerns that the number of students identified may exceed schools' service delivery capacities, but few studies have evaluated this concern systematically. System dynamics (SD) modeling may prove a useful approach for answering questions of this sort. The goal of the current paper is therefore to demonstrate how SD modeling can be applied to inform implementation decisions in communities. In our demonstration, we used SD modeling to estimate the additional service demand generated by universal depression screening in a typical high school. We then simulated the effects of implementing "compensatory approaches" designed to address anticipated increases in service need through (1) the allocation of additional staff time and (2) improvements in the effectiveness of mental health interventions. Results support the ability of screening to facilitate more rapid entry into services and suggest that improving the effectiveness of mental health services for students with depression via the implementation of an evidence-based treatment protocol may have a limited impact on overall recovery rates and service availability. In our example, the SD approach proved useful in informing systems' decision-making about the adoption of a new school mental health service.

  13. Computing and information services at the Jet Propulsion Laboratory - A management approach to a diversity of needs

    Science.gov (United States)

    Felberg, F. H.

    1984-01-01

    The Jet Propulsion Laboratory, a research and development organization with about 5,000 employees, presents a complicated set of requirements for an institutional system of computing and informational services. The approach taken by JPL in meeting this challenge is one of controlled flexibility. A central communications network is provided, together with selected computing facilities for common use. At the same time, staff members are given considerable discretion in choosing the mini- and microcomputers that they believe will best serve their needs. Consultation services, computer education, and other support functions are also provided.

  14. A Marketing Approach Towards the Sufficiency of Ready-Made Garments to Satisfy the Needs of Children With Autism

    Directory of Open Access Journals (Sweden)

    Mehmet Akalın

    2015-06-01

    Full Text Available Autism is a term of which we have been aware recently in our country through visual and printed media and which we have seen examples around us. Together with opening Dependent and Independent Education Centres for Children with Autism, children with autism have found the opportunity to receive education in line with their needs. With individual education programs developed by the teacher suitable for the development of the child with autism, they can acquire skills in various development areas. Dressing skill, which is one of the main skills necessary for every individual, is a mandatory skill that children with autism need to acquire to satisfy their own needs. In the first three parts of the study a conceptual frame was given and the definition, history, types, characteristics, and behaviour problems of children with autism were presented, and clothing comfort and other concepts were explained. In the fourth part, method, material, research approach, sample and population, numerals, limitations, data collection technique and data analysis technique were explained and the results were presented in tables. The study was carried out to reveal dressing problems children with autism encounter and to determine to what extent the clothes made by ready-made clothing sector satisfy the needs of children with autism and it was found that children with autism have difficulties in using ready-made clothes.

  15. Assessment of Current Process Modeling Approaches to Determine Their Limitations, Applicability and Developments Needed for Long-Fiber Thermoplastic Injection Molded Composites

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Ba Nghiep; Holbery, Jim; Smith, Mark T.; Kunc, Vlastimil; Norris, Robert E.; Phelps, Jay; Tucker III, Charles L.

    2006-11-30

    This report describes the status of the current process modeling approaches to predict the behavior and flow of fiber-filled thermoplastics under injection molding conditions. Previously, models have been developed to simulate the injection molding of short-fiber thermoplastics, and an as-formed composite part or component can then be predicted that contains a microstructure resulting from the constituents’ material properties and characteristics as well as the processing parameters. Our objective is to assess these models in order to determine their capabilities and limitations, and the developments needed for long-fiber injection-molded thermoplastics (LFTs). First, the concentration regimes are summarized to facilitate the understanding of different types of fiber-fiber interaction that can occur for a given fiber volume fraction. After the formulation of the fiber suspension flow problem and the simplification leading to the Hele-Shaw approach, the interaction mechanisms are discussed. Next, the establishment of the rheological constitutive equation is presented that reflects the coupled flow/orientation nature. The decoupled flow/orientation approach is also discussed which constitutes a good simplification for many applications involving flows in thin cavities. Finally, before outlining the necessary developments for LFTs, some applications of the current orientation model and the so-called modified Folgar-Tucker model are illustrated through the fiber orientation predictions for selected LFT samples.

  16. [Psychosocial working conditions of physician assistants: results from a qualitative study on occupational stress, resources, possible approaches to prevention and intervention needs].

    Science.gov (United States)

    Vu-Eickmann, Patricia; Loerbroks, Adrian

    2017-10-01

    Numerous studies have documented adverse psychosocial working conditions among health care staff. Working conditions may not only impair the health outcomes of this professional group, but can also affect the quality of care they deliver to patients. Previous work stress research has mainly focused on physicians and nurses. Comparable evidence remains limited, however, for physician assistants (Medizinische Fachangestellte, MFAs), who represent the largest professional group in German primary care. This study aimed to gain insights into work stressors and resources experienced by MFAs and to explore both possible approaches to prevention and intervention needs. Participants were recruited from a criterion-based sample of medical practices in and around the city of Düsseldorf (Germany) and with assistance provided by the Medical Staff Association (VMF e. V.). In total, 26 qualitative in-depth interviews were conducted (11/2015-02/2016), transcribed and content analyzed using MaxQDA. MFAs reported a high workload and unforeseeable incidents as salient occupational stressors. Additional stressors included interpersonal relationship problems with superiors and a lack of social support from colleagues. At the same time though, support from superiors and colleagues can provide a key resource for coping with work stressors. Furthermore, social interactions with patients and diversified tasks were perceived as supportive professional resources. Possible approaches to prevention were exclusively seen to operate at the organizational level. The perceived need for intervention primarily concerned adequate wages and appreciation from superiors and society. Physician assistants described their working conditions as being characterized by high demands, low job control and low rewards. We suggest basic approaches for employers to improve the working experience of MFAs, which may represent the starting point for further research efforts to develop preventive measures. Copyright

  17. Identifying tree crown delineation shapes and need for remediation on high resolution imagery using an evidence based approach

    Science.gov (United States)

    Leckie, Donald G.; Walsworth, Nicholas; Gougeon, François A.

    2016-04-01

    In order to fully realize the benefits of automated individual tree mapping for tree species, health, forest inventory attribution and forest management decision making, the tree delineations should be as good as possible. The concept of identifying poorly delineated tree crowns and suggesting likely types of remediation was investigated. Delineations (isolations or isols) were classified into shape types reflecting whether they were realistic tree shapes and the likely kind of remediation needed. Shape type was classified by an evidence based rules approach using primitives based on isol size, shape indices, morphology, the presence of local maxima, and matches with template models representing trees of different sizes. A test set containing 50,000 isols based on an automated tree delineation of 40 cm multispectral airborne imagery of a diverse temperate-boreal forest site was used. Isolations representing single trees or several trees were the focus, as opposed to cases where a tree is split into several isols. For eight shape classes from regular through to convolute, shape classification accuracy was in the order of 62%; simplifying to six classes accuracy was 83%. Shape type did give an indication of the type of remediation and there were 6% false alarms (i.e., isols classed as needing remediation but did not). Alternately, there were 5% omissions (i.e., isols of regular shape and not earmarked for remediation that did need remediation). The usefulness of the concept of identifying poor delineations in need of remediation was demonstrated and one suite of methods developed and shown to be effective.

  18. Monitoring is not enough: on the need for a model-based approach to migratory bird management

    Science.gov (United States)

    Nichols, J.D.; Bonney, Rick; Pashley, David N.; Cooper, Robert; Niles, Larry

    2000-01-01

    Informed management requires information about system state and about effects of potential management actions on system state. Population monitoring can provide the needed information about system state, as well as information that can be used to investigate effects of management actions. Three methods for investigating effects of management on bird populations are (1) retrospective analysis, (2) formal experimentation and constrained-design studies, and (3) adaptive management. Retrospective analyses provide weak inferences, regardless of the quality of the monitoring data. The active use of monitoring data in experimental or constrained-design studies or in adaptive management is recommended. Under both approaches, learning occurs via the comparison of estimates from the monitoring program with predictions from competing management models.

  19. The shrinking rainforest, and the need for accurate data a satellite radar approach to quantifying Indonesia's palm oil obsession

    Science.gov (United States)

    Trischan, John

    Rapid deforestation has been occurring in Southeast Asia for majority of the last quarter century. This is due in large by the expansion of oil palm plantations. These plantations fill the need globally for the palm oil they provide. On the other hand, they are removing some of the last remaining primary rainforests on the planet. The issue concerning the ongoing demise of rainforests in the region involves the availability of data in order to monitor the expansion of palm, at the cost of rainforest. Providing a simplified approach to mapping oil palm plantations in hopes of spreading palm analysis regionally in an effort to obtain a better grasp on the land use dynamics. Using spatial filtering techniques, the complexity of radar data are simplified in order to use for palm detection.

  20. Planning for climate change: The need for mechanistic systems-based approaches to study climate change impacts on diarrheal diseases.

    Science.gov (United States)

    Mellor, Jonathan E; Levy, Karen; Zimmerman, Julie; Elliott, Mark; Bartram, Jamie; Carlton, Elizabeth; Clasen, Thomas; Dillingham, Rebecca; Eisenberg, Joseph; Guerrant, Richard; Lantagne, Daniele; Mihelcic, James; Nelson, Kara

    2016-04-01

    Increased precipitation and temperature variability as well as extreme events related to climate change are predicted to affect the availability and quality of water globally. Already heavily burdened with diarrheal diseases due to poor access to water, sanitation and hygiene facilities, communities throughout the developing world lack the adaptive capacity to sufficiently respond to the additional adversity caused by climate change. Studies suggest that diarrhea rates are positively correlated with increased temperature, and show a complex relationship with precipitation. Although climate change will likely increase rates of diarrheal diseases on average, there is a poor mechanistic understanding of the underlying disease transmission processes and substantial uncertainty surrounding current estimates. This makes it difficult to recommend appropriate adaptation strategies. We review the relevant climate-related mechanisms behind transmission of diarrheal disease pathogens and argue that systems-based mechanistic approaches incorporating human, engineered and environmental components are urgently needed. We then review successful systems-based approaches used in other environmental health fields and detail one modeling framework to predict climate change impacts on diarrheal diseases and design adaptation strategies. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Research needs

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    Research needs were identified during working sessions for several potential separation options. These options include sequestering agents, solvent extraction, membranes, solid sorbents, novel approaches, organic separation and destruction methods, and radiation and chemical stability of separation materials

  2. An Integrated Approach Is Needed for Ecosystem Based Fisheries Management: Insights from Ecosystem-Level Management Strategy Evaluation

    Science.gov (United States)

    Fulton, Elizabeth A.; Smith, Anthony D. M.; Smith, David C.; Johnson, Penelope

    2014-01-01

    An ecosystem approach is widely seen as a desirable goal for fisheries management but there is little consensus on what strategies or measures are needed to achieve it. Management strategy evaluation (MSE) is a tool that has been widely used to develop and test single species fisheries management strategies and is now being extended to support ecosystem based fisheries management (EBFM). We describe the application of MSE to investigate alternative strategies for achieving EBFM goals for a complex multispecies fishery in southeastern Australia. The study was undertaken as part of a stakeholder driven process to review and improve the ecological, economic and social performance of the fishery. An integrated management strategy, involving combinations of measures including quotas, gear controls and spatial management, performed best against a wide range of objectives and this strategy was subsequently adopted in the fishery, leading to marked improvements in performance. Although particular to one fishery, the conclusion that an integrated package of measures outperforms single focus measures we argue is likely to apply widely in fisheries that aim to achieve EBFM goals. PMID:24454722

  3. Formal Rules Versus an Economic Approach in Dealing with Cartels: the Need for More Coherence in European Competition Law

    Directory of Open Access Journals (Sweden)

    Radu Muşetescu

    2011-12-01

    Full Text Available Cartelizing is today among the most hunted business conduct in the world. Competition authorities from the countries where these statutes were adopted embrace the wisdom that such agreements between competitors are unquestionably anti-competitive. As opposed to other business practices, cartel agreements seem to offer an undeniable proof of intent that confers comfort for those who are investigating and prosecuting them. A cartel is today qualified as per se illegal. No further proof is needed but the formal agreement and the shared intentions. They are, at least until now, the only business practice that has lead, in certain jurisdictions, to jail terms and criminal record for individuals who were engaged in their negotiation and implementation. However, cartels are business practices that do not fundamentally aggress against any property right. From a public policy perspective, the harsh attitude towards cartels is lacking a theoretical coherence. Today, when competition policies all over the world and especially in the European Union are gradually transiting towards a more economic approach to evaluating the welfare effects of business practices, reassessing cartels is a critical imperative in the effort for a more coherent and reasonable public policy.

  4. The role of duplications in the evolution of genomes highlights the need for evolutionary-based approaches in comparative genomics

    Directory of Open Access Journals (Sweden)

    Levasseur Anthony

    2011-02-01

    Full Text Available Abstract Understanding the evolutionary plasticity of the genome requires a global, comparative approach in which genetic events are considered both in a phylogenetic framework and with regard to population genetics and environmental variables. In the mechanisms that generate adaptive and non-adaptive changes in genomes, segmental duplications (duplication of individual genes or genomic regions and polyploidization (whole genome duplications are well-known driving forces. The probability of fixation and maintenance of duplicates depends on many variables, including population sizes and selection regimes experienced by the corresponding genes: a combination of stochastic and adaptive mechanisms has shaped all genomes. A survey of experimental work shows that the distinction made between fixation and maintenance of duplicates still needs to be conceptualized and mathematically modeled. Here we review the mechanisms that increase or decrease the probability of fixation or maintenance of duplicated genes, and examine the outcome of these events on the adaptation of the organisms. Reviewers This article was reviewed by Dr. Etienne Joly, Dr. Lutz Walter and Dr. W. Ford Doolittle.

  5. Too Much or Not Enough? An Examination of Special Education Provision and School District Leaders' Perceptions of Current Needs and Common Approaches

    Science.gov (United States)

    Cameron, David Lansing

    2016-01-01

    The purpose of this study was to examine the relationship between special education provision in Norway and school district leaders' perspectives regarding (a) the need for special education and (b) the importance and prevalence of integrated and segregated approaches. Findings indicate that the percentage of students perceived as being in need of…

  6. A systematic review of three approaches for constructing physical activity messages: What messages work and what improvements are needed?

    Directory of Open Access Journals (Sweden)

    Brawley Lawrence R

    2010-05-01

    Full Text Available Abstract Background To motivate individuals to adhere to a regular physical activity regime, guidelines must be supplemented with persuasive messages that are disseminated widely. While substantial research has examined effective strategies for disseminating physical activity messages, there has been no systematic effort to examine optimal message content. This paper reviews studies that evaluate the effectiveness of three approaches for constructing physical activity messages including tailoring messages to suit individual characteristics of message recipients (message tailoring, framing messages in terms of gains versus losses (message framing, and targeting messages to affect change in self-efficacy (i.e., a theoretical determinant of behavior change. Methods We searched the MEDLINE, PsycINFO, EMBASE and CINAHL databases up to July 2008. Relevant reference lists also were searched. We included intervention trials, field experiments, and laboratory-based studies that aimed to test the efficacy or effectiveness of tailored messages, framed messages and self-efficacy change messages among healthy adults. We used a descriptive approach to analyze emerging patterns in research findings. Based on this evidence we made recommendations for practice and future research. Results Twenty-two studies were identified. Twelve studies evaluated message tailoring. In 10 of these studies, tailored messages resulted in greater physical activity than a control message. Six studies evaluated framed messages. Five of these studies demonstrated that gain-framed messages lead to stronger intentions to be active compared to a control message. Moreover, a gain-frame advantage was evident in three of the four studies that assessed physical activity. Four studies evaluated self-efficacy change messages. The two studies that used an experimental design provide a clear indication that individuals' beliefs can be affected by messages that incorporate types of information

  7. A need for One Health approach – lessons learned from outbreaks of Rift Valley fever in Saudi Arabia and Sudan

    Directory of Open Access Journals (Sweden)

    Osama Ahmed Hassan

    2014-02-01

    Full Text Available Introduction: Rift Valley fever (RVF is an emerging viral zoonosis that impacts human and animal health. It is transmitted from animals to humans directly through exposure to blood, body fluids, or tissues of infected animals or via mosquito bites. The disease is endemic to Africa but has recently spread to Saudi Arabia and Yemen. Our aim was to compare two major outbreaks of RVF in Saudi Arabia (2000 and Sudan (2007 from a One Health perspective. Methods: Using the terms ‘Saudi Arabia’, ‘Sudan’, and ‘RVF’, articles were identified by searching PubMed, Google Scholar, and web pages of international organizations as well as local sources in Saudi Arabia and Sudan. Results: The outbreak in Saudi Arabia caused 883 human cases, with a case fatality rate of 14% and more than 40,000 dead sheep and goats. In Sudan, 698 human cases of RVF were recognized (case fatality, 31.5%, but no records of affected animals were available. The ecology and environment of the affected areas were similar with irrigation canals and excessive rains providing an attractive habitat for mosquito vectors to multiply. The outbreaks resulted in livestock trade bans leading to a vast economic impact on the animal market in the two countries. The surveillance system in Sudan showed a lack of data management and communication between the regional and federal health authorities, while in Saudi Arabia which is the stronger economy, better capacity and contingency plans resulted in efficient countermeasures. Studies of the epidemiology and vectors were also performed in Saudi Arabia, while in Sudan these issues were only partly studied. Conclusion: We conclude that a One Health approach is the best option to mitigate outbreaks of RVF. Collaboration between veterinary, health, and environmental authorities both on national and regional levels is needed.

  8. A Study to Identify the Training Needs of Life Insurance Sales Representatives in Taiwan Using the Delphi Approach

    Science.gov (United States)

    Fan, Chiang Ku; Cheng, Chen-Liang

    2006-01-01

    This article reports a study conducted to identify the needs for continuing professional development for life insurance sales representatives and to examine the competencies needed by those sales representatives. A modified Delphi technique was used. Most life insurance companies in the USA implement an education and training plan advocated by the…

  9. Identifying Consumer’s Needs of Health Information Technology through an Innovative Participatory Design Approach among English- and Spanish-speaking Urban Older Adults

    Science.gov (United States)

    Sheehan, B.; Yen, P.; Velez, O.; Nobile-Hernandez, D.; Tiase, V.

    2014-01-01

    Summary Objectives We describe an innovative community-centered participatory design approach, Consumer-centered Participatory Design (C2PD), and the results of applying C2PD to design and develop a web-based fall prevention system. Methods We conducted focus groups and design sessions with English- and Spanish-speaking community-dwelling older adults. Focus group data were summarized and used to inform the context of the design sessions. Descriptive content analysis methods were used to develop categorical descriptions of design session informant’s needs related to information technology. Results The C2PD approach enabled the assessment and identification of informant’s needs of health information technology (HIT) that informed the development of a falls prevention system. We learned that our informants needed a system that provides variation in functions/content; differentiates between actionable/non-actionable information/structures; and contains sensory cues that support wide-ranging and complex tasks in a varied, simple, and clear interface to facilitate self-management. Conclusions The C2PD approach provides community-based organizations, academic researchers, and commercial entities with a systematic theoretically informed approach to develop HIT innovations. Our community-centered participatory design approach focuses on consumer’s technology needs while taking into account core public health functions. PMID:25589909

  10. Identifying consumer's needs of health information technology through an innovative participatory design approach among English- and Spanish-speaking urban older adults.

    Science.gov (United States)

    Lucero, R; Sheehan, B; Yen, P; Velez, O; Nobile-Hernandez, D; Tiase, V

    2014-01-01

    We describe an innovative community-centered participatory design approach, Consumer-centered Participatory Design (C2PD), and the results of applying C2PD to design and develop a web-based fall prevention system. We conducted focus groups and design sessions with English- and Spanish-speaking community-dwelling older adults. Focus group data were summarized and used to inform the context of the design sessions. Descriptive content analysis methods were used to develop categorical descriptions of design session informant's needs related to information technology. The C2PD approach enabled the assessment and identification of informant's needs of health information technology (HIT) that informed the development of a falls prevention system. We learned that our informants needed a system that provides variation in functions/content; differentiates between actionable/non-actionable information/structures; and contains sensory cues that support wide-ranging and complex tasks in a varied, simple, and clear interface to facilitate self-management. The C2PD approach provides community-based organizations, academic researchers, and commercial entities with a systematic theoretically informed approach to develop HIT innovations. Our community-centered participatory design approach focuses on consumer's technology needs while taking into account core public health functions.

  11. Work schedule manager gap analysis : assessing the future training needs of work schedule managers using a strategic job analysis approach

    Science.gov (United States)

    2010-05-01

    This report documents the results of a strategic job analysis that examined the job tasks and knowledge, skills, abilities, and other characteristics (KSAOs) needed to perform the job of a work schedule manager. The strategic job analysis compared in...

  12. A knowledge management and need-capacity matching approach for community-based disaster management and recovery

    NARCIS (Netherlands)

    Palomares, I.; Galway, L.; Haran, M.; Neef, M.; Woods, C.; Wang, H.

    2015-01-01

    Post-crisis response and recovery necessitates the identification and prioritization of the needs and capacities of the affected community in order to provide efficient and wellcoordinated humanitarian assistance. The Community Based Comprehensive Recovery platform aims to facilitate enhanced

  13. User-driven health care - answering multidimensional information needs in individual patients utilizing post-EBM approaches: a conceptual model.

    Science.gov (United States)

    Biswas, Rakesh; Martin, Carmel M; Sturmberg, Joachim; Shanker, Ravi; Umakanth, Shashikiran; Shanker, Shiv; Kasturi, A S

    2008-10-01

    Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient-centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web-based user-driven learning solution may be a stepping-stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user-driven.

  14. What Drives Students' Loyalty-Formation in Social Media Learning within a Personal Learning Environment Approach? The Moderating Role of Need for Cognition

    Science.gov (United States)

    Arquero, José L.; del Barrio-García, Salvador; Romero-Frías, Esteban

    2017-01-01

    Our study analyzes an educational experience based on the integrated use of social media within a higher education course under a personal learning environment approach and investigates the factors that determine students' loyalty to social media learning. We examined the moderating role of need for cognition (NFC) in students' formation of…

  15. The Development of Ethnobotany Curriculum for Students in Rural Schools: An Approach that Incorporates the Needs and Insights of Local Communities

    Science.gov (United States)

    Kraipeerapun, Kittima; Thongthew, Sumlee

    2007-01-01

    In this paper, an ethnobotany curriculum is used as a case example of one approach to incorporating the insights and needs of the local community into the curriculum development process. This curriculum development was carried out in the "Kiriwong Community" in Nakornsrithammarat Province, Southern Thailand. The ethnobotany curriculum…

  16. Developmental psycholinguistics teaches us that we need multi-method, not single-method, approaches to the study of linguistic representation.

    Science.gov (United States)

    Rowland, Caroline F; Monaghan, Padraic

    2017-01-01

    In developmental psycholinguistics, we have, for many years, been generating and testing theories that propose both descriptions of adult representations and explanations of how those representations develop. We have learnt that restricting ourselves to any one methodology yields only incomplete data about the nature of linguistic representations. We argue that we need a multi-method approach to the study of representation.

  17. Anger Management Using a Cognitive-Behavioural Approach for Children with Special Education Needs: A Literature Review and Meta-Analysis

    Science.gov (United States)

    Ho, Betty P. V.; Carter, Mark; Stephenson, Jennifer

    2010-01-01

    This review examines the use of a cognitive-behavioural approach to anger management in children with special needs in community settings. Eighteen experimental studies involving a total of 408 children were located. The participants were mainly of high school age, with an IQ above 80, and with behavioural or emotional disorders. A moderate effect…

  18. Science of learning is learning of science: why we need a dialectical approach to science education research

    Science.gov (United States)

    Roth, Wolff-Michael

    2012-06-01

    Research on learning science in informal settings and the formal (sometimes experimental) study of learning in classrooms or psychological laboratories tend to be separate domains, even drawing on different theories and methods. These differences make it difficult to compare knowing and learning observed in one paradigm/context with those observed in the other. Even more interestingly, the scientists studying science learning rarely consider their own learning in relation to the phenomena they study. A dialectical, reflexive approach to learning, however, would theorize the movement of an educational science (its learning and development) as a special and general case—subject matter and method—of the phenomenon of learning (in/of) science. In the dialectical approach to the study of science learning, therefore, subject matter, method, and theory fall together. This allows for a perspective in which not only disparate fields of study—school science learning and learning in everyday life—are integrated but also where the progress in the science of science learning coincides with its topic. Following the articulation of a contradictory situation on comparing learning in different settings, I describe the dialectical approach. As a way of providing a concrete example, I then trace the historical movement of my own research group as it simultaneously and alternately studied science learning in formal and informal settings. I conclude by recommending cultural-historical, dialectical approaches to learning and interaction analysis as a context for fruitful interdisciplinary research on science learning within and across different settings.

  19. Interprofessional Work in Early Childhood Education and Care Services to Support Children with Additional Needs: Two Approaches

    Science.gov (United States)

    Wong, Sandie; Press, Frances

    2017-01-01

    In Australia, over 900,000 children attend some type of early childhood education and care service. Many of these children have learning difficulties and early childhood teachers play a significant role in identifying children's needs and working with other professionals to instigate and/or implement appropriate interventions. When educators and…

  20. Alzheimer's Disease and Other Dementias: An Organizational Approach to Identifying and Addressing Practices and Learning Needs of Family Physicians

    Science.gov (United States)

    Allen, Michael; Ferrier, Suzanne; Sargeant, Joan; Loney, Elaine; Bethune, Graeme; Murphy, Gerard

    2005-01-01

    Caring for patients with dementia is complex and demanding. Since family physicians (FPs) provide much of this care, we examined their practices, learning needs, and barriers to care concerning Alzheimer's disease and other dementias. We surveyed 392 (approximately 50%) Nova Scotia FPs and conducted focus groups and interviews with: FPs; staff of…

  1. Application of probabilistic analysis/design methods in space programs - The approaches, the status, and the needs

    Science.gov (United States)

    Ryan, Robert S.; Townsend, John S.

    1993-01-01

    The prospective improvement of probabilistic methods for space program analysis/design entails the further development of theories, codes, and tools which match specific areas of application, the drawing of lessons from previous uses of probability and statistics data bases, the enlargement of data bases (especially in the field of structural failures), and the education of engineers and managers on the advantages of these methods. An evaluation is presently made of the current limitations of probabilistic engineering methods. Recommendations are made for specific applications.

  2. Is there Needed an Industry Approach on Corporate Default Risk? Case Study on Companies Listed on Romanian Stock Exchange

    Directory of Open Access Journals (Sweden)

    Cristina Maria Triandafil

    2009-02-01

    Full Text Available This paper focuses on applying Black and Scholes structural approach on credit risk in the case of the companies listed on Romanian Stock Exchange. We conduct a case-study on 35 companies belonging to five industries (energetic, materials, chemistry, pharmaceuticals, equipments during a period of 10 years in order to highlight out default point/threshold and its essential factors evolution across industries. Research approach is concentrated also on the specific characteristics of the Romanian capital market (especially in terms of illiquidity and lack of transparency additional costs, macroeconomic environment and corporate finance decision process. We compute default point from the perspective of the arbitrage between assets and leverage; in accordance with the most recent theories on specific features corporate default within emerging countries (Galytskyy, 2006, a key element will be represented by the assets volatility which will be correlated with the country risk premium in order to highlight out a potential macroeconomic impact on corporate failure.

  3. Food science and food ingredients: the need for reliable scientific approaches and correct communication, Florence, 24 March 2015.

    Science.gov (United States)

    Ruxton, Carrie Helen

    2016-01-01

    This report summarises the proceedings of a conference organised by the Italian Association of Hospital Cardiologists. The aim was to consider the process by which dietary guidelines (DG) are developed and the quality of evidence underpinning these guidelines, as well as debating whether or not this has resulted in DG that are effective in terms of health improvement. Key points were a caution about false positives in research, the importance of holistic DG rather than single nutrient targets, the need for appropriate disease endpoints in studies and control of confounders, a plea for less reliance on observational studies which cannot address cause-and-effect relationships and a need to bear in mind unintended consequences. Options for improving the system and the quality of evidence were discussed.

  4. Taking a Regional Healthcare Coalition Approach to Mitigating Surge Capacity Needs of Mass Casualty or Pandemic Events

    Science.gov (United States)

    2012-06-01

    Hertzberg, Frederick . The Motivation to Work. http://www.netmba.com/mgmt/ob/motivation/ herzberg /. Hertzberg, Frederick . Work and the nature of man. NY...participation needs of a coalition—active involvement. In the book Work and the Nature of Man, Frederick Hertzberg details his “two-factor theory” in...59 Frederick Hertzberg; Work and the Nature of Man; 1973; Mentor Books, New York; Two-factor Theory Pp. 149-158 60 Hertzberg’s

  5. The Future of Character Education and Social-Emotional Learning: "The Need for Whole School and Community-Linked Approaches"

    Science.gov (United States)

    Elias, Maurice J.

    2014-01-01

    In an era of change, preparing our youth for an uncertain future is akin to building the airplane while it is in flight. Since we do not have the luxury of putting development on hold until we figure out the destination and the kind of plane we need to get there, we must fly anyway. This article employs an airplane analogy to illustrate the fact…

  6. Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

    Directory of Open Access Journals (Sweden)

    Brühwiler LD

    2017-09-01

    Full Text Available Background: After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists’ needs to perform these tasks are not well known. Objective: This study aims to a Identify community pharmacists’ current problems and roles at hospital discharge, b Assess their information needs, specifically the availability and usefulness of information, and c Gain insight into pharmacists’ objectives and ideas for discharge optimisation. Methods: A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies. Results: The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient's care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%. The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for “off-label” medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services. Conclusion: Surveyed Swiss community

  7. Eyeworm infections in dogs and in a human patient in Serbia: A One Health approach is needed.

    Science.gov (United States)

    Tasić-Otašević, Suzana; Gabrielli, Simona; Trenkić-Božinović, Marija; Petrović, Aleksandar; Gajić, Bojan; Colella, Vito; Momčilović, Stefan; Cancrini, Gabriella; Otranto, Domenico

    2016-04-01

    Thelazia callipaeda eyeworm has been frequently reported parasitizing humans in Asia. In Europe, the parasite is endemic in wild and domestic carnivores and only eight cases have been reported in humans so far. We describe the first case of human thelaziosis in Serbia, along with two cases in dogs from the same area. A One Health approach, based on cooperation amongst veterinarians and physicians, is strongly advised for this emerging infection in order to assess the risk for and prevent of the zoonotic infection. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The Need for an Interdisciplinary Approach to Norm Diffusion: The Case of Fair and Equitable Benefit-sharing.

    Science.gov (United States)

    Parks, Louisa; Morgera, Elisa

    2015-11-01

    No systematic study discusses the evolution of fair and equitable benefit-sharing across various areas of international law (environment, human rights, oceans), as well as at different levels of regulation (regional and national laws and guidelines, private law contracts, transboundary codes of conduct, customary laws of indigenous peoples and local communities). This article explores the usefulness of an interdisciplinary approach to the study of norm diffusion for understanding how and why fair and equitable benefit-sharing is articulated in different sites. The article discusses mechanisms, actors and frames in norm diffusion, drawing on literature from sociology, international relations and law. The article uncovers underlying similarities in scholarship on norm diffusion across the disciplines considered. It also reflects on the value of an interdisciplinary approach that encourages legal scholars to consider the implications of power structures in the diffusion of law, while the nuances of legal knowledge may lead other social scientists to revisit accepted findings on norm diffusion. These findings appear particularly useful for informing an assessment of the potential of fair and equitable benefit-sharing to promote the conservation and sustainable use of natural resources in a fair and equitable manner in the face of power asymmetries.

  9. The Need for an Interdisciplinary Approach to Norm Diffusion: The Case of Fair and Equitable Benefit‐sharing

    Science.gov (United States)

    Morgera, Elisa

    2015-01-01

    No systematic study discusses the evolution of fair and equitable benefit‐sharing across various areas of international law (environment, human rights, oceans), as well as at different levels of regulation (regional and national laws and guidelines, private law contracts, transboundary codes of conduct, customary laws of indigenous peoples and local communities). This article explores the usefulness of an interdisciplinary approach to the study of norm diffusion for understanding how and why fair and equitable benefit‐sharing is articulated in different sites. The article discusses mechanisms, actors and frames in norm diffusion, drawing on literature from sociology, international relations and law. The article uncovers underlying similarities in scholarship on norm diffusion across the disciplines considered. It also reflects on the value of an interdisciplinary approach that encourages legal scholars to consider the implications of power structures in the diffusion of law, while the nuances of legal knowledge may lead other social scientists to revisit accepted findings on norm diffusion. These findings appear particularly useful for informing an assessment of the potential of fair and equitable benefit‐sharing to promote the conservation and sustainable use of natural resources in a fair and equitable manner in the face of power asymmetries. PMID:28018594

  10. User-driven health care: answering multidimensional information needs in individual patients utilizing post-EBM approaches: an operational model.

    Science.gov (United States)

    Biswas, Rakesh; Maniam, Jayanthy; Lee, Edwin Wen Huo; Gopal, Premalatha; Umakanth, Shashikiran; Dahiya, Sumit; Ahmed, Sayeed

    2008-10-01

    The hypothesis in the conceptual model was that a user-driven innovation in presently available information and communication technology infrastructure would be able to meet patient and health professional users information needs and help them attain better health outcomes. An operational model was created to plan a trial on a sample diabetic population utilizing a randomized control trial design, assigning one randomly selected group of diabetics to receive electronic information intervention and analyse if it would improve their health outcomes in comparison with a matched diabetic population who would only receive regular medical intervention. Diabetes was chosen for this particular trial, as it is a major chronic illness in Malaysia as elsewhere in the world. It is in essence a position paper for how the study concept should be organized to stimulate wider discussion prior to beginning the study.

  11. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence.

    Science.gov (United States)

    Dara, Ravi C; Tiwari, Aseem K; Pandey, Prashant; Arora, Dinesh

    2015-01-01

    Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  12. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence

    Directory of Open Access Journals (Sweden)

    Ravi C Dara

    2015-01-01

    Full Text Available Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  13. Problems in Silverman's work indicate the need for a new approach to research on subliminal psychodynamic activation.

    Science.gov (United States)

    Fudin, R

    2001-06-01

    The basic assumption in subliminal psychodynamic activation research is that participants can unconsciously perceive the psychodynamic meaning of a complete message as it is intended by the experimenter. In attempts to account for negative findings Silverman contended that this assumption holds only under certain luminance conditions and visual field positions of a message. Paradoxically, almost all of his findings, his major evidence in support of the basic assumption, came from experiments in violation of those strictures. Further, Silverman never presented MOMMY AND I ARE ONE under a critical condition required for it to be effective. These and other considerations identify the need for an account of empirical findings other than his and for changes in his experimental method. Such research must take into account the encoding of subliminal stimuli, an area neglected almost completely by Silverman. Shevrin and his colleagues' 1996 work is outlined as a model for the use of subliminal stimuli to investigate psychoanalytically generated hypotheses.

  14. Anthropogenic pollutants affect ecosystem services of freshwater sediments. The need for a 'triad plus x' approach

    Energy Technology Data Exchange (ETDEWEB)

    Gerbersdorf, Sabine Ulrike; Wieprecht, Silke [Stuttgart Univ. (Germany). Dept. of Hydraulic Engineering and Water Resources Management; Hollert, Henner; Brinkmann, Markus [RWTH Aachen Univ. (Germany). Dept. of Ecosystem Analysis; Schuettrumpf, Holger [RWTH Aachen Univ. (Germany). Inst. of Hydraulic Engineering and Water Resources Management; Manz, Werner [Koblenz-Landau Univ., Koblenz (Germany). Inst. for Integrated Natural Sciences

    2011-09-15

    Purpose: Freshwater sediments and their attached microbial communities (biofilms) are essential features of rivers and lakes, providing valuable ecosystem services such as nutrient recycling or self-purification which extend beyond the aquatic environment. Anthropogenic pollutants, whether from the industrial era or as a result of our contemporary lifestyles, can negatively affect these functions with hitherto unknown consequences on ecology, the economy and human health. Thus far, the singular view of the involved disciplines such as ecotoxicology, environmental microbiology, hydrology and geomorphology has prevented a deeper understanding of this emerging issue. Main features: This paper discusses briefly the progressions and the state-of-the-art methods within the disciplines of concern related to contaminated sediments, ranging from ecotoxicological test systems, microbiological/molecular approaches to unravel changes of microbial ecosystems, up to the modelling of sediment transport and sorption/desorption of associated pollutants. The first bilateral research efforts on contaminated sediments include efforts to assess ecotoxicological sediment risk including sediment mobility (i.e. ecotoxicology and engineering), enhance bioremediation potential (i.e. microbiology and ecotoxicology) or to understand biostabilisation processes of sediments by microbial assemblages (i.e. microbiology and engineering). Conclusions and perspectives: In freshwater habitats, acute, chronic and mechanism-specific toxic effects on organisms, shifts in composition, structure and functionality of benthic microbial communities, as well as the obstruction of important ecosystem services by continuously discharged and long-deposited pollutants, should be related to the in situ sediment dynamics. To achieve an improved understanding of the ecology of freshwater sediments and the impairment of their important ecosystem functions by human-derived pollutants, we suggest a 'triad plus x

  15. The Value of Preoperative Volumetric Analysis by Computerised Tomography of Retrosternal Goiter to Predict the Need for an Extra-Cervical Approach.

    Science.gov (United States)

    Sormaz, İsmail Cem; Uymaz, Derya S; İşcan, Ahmet Y; Özgür, İlker; Salmaslıoğlu, Artur; Tunca, Fatih; Şenyürek, Yasemin G; Terzioğlu, Tarık

    2018-01-20

    A thyroidectomy can be performed via a cervical incision in most patients with retrosternal goiter. To investigate the correlation between the volume of the mediastinal portion of the thyroid gland and the need for an extra-cervical approach for retrosternal goiter. Diagnostic accuracy study. The measurement of craniocaudal length and the volume of the mediastinal component of the thyroid gland on computerised tomography images was performed in 47 patients with retrosternal goiter. Of these 47 patients, 8 (17%) required an extra-cervical approach and were classified as group 1, and 39 (83%) patients that required a cervical incision were classified as group 2. Receiver operating characteristic analysis was performed to determine the cut-off value for the craniocaudal length and the volume of the mediastinal thyroid mass, which significantly correlated with an extra-cervical approach for retrosternal goiter. Reoperative surgery was significantly more frequent in group 1 than in group 2 (50% vs 13%; p=0.03). The craniocaudal length of the mediastinal thyroid gland was significantly longer in group 1 than in group 2 (77±11 mm vs 31±21 mm, respectively; p=0.0001). The volume of the mediastinal component was significantly larger in group 1 compared to group 2 (264±106 cm3 vs 40±41 cm3, respectively; p=0.0001). The receiver operating characteristic curve of craniocaudal length and the volume of the mediastinal component identified ≥66 mm and ≥162 cm3 as the cut-off values with the maximum accuracy, respectively. The craniocaudal length of the thyroid mass below the thoracic inlet ≥66 mm or a volume of the mediastinal portion ≥162 cm3 were significantly associated with an extra-cervical approach (p=0.0001). For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off value for craniocaudal length was 87.5%, 64% and 97%, respectively. For predicting an extra-cervical approach, the sensitivity

  16. The Value of Preoperative Volumetric Analysis by Computerised Tomography of Retrosternal Goiter to Predict the Need for an Extra-Cervical Approach

    Directory of Open Access Journals (Sweden)

    İsmail Cem Sormaz1

    2018-02-01

    Full Text Available Background: A thyroidectomy can be performed via a cervical incision in most patients with retrosternal goiter. Aims: To investigate the correlation between the volume of the mediastinal portion of the thyroid gland and the need for an extra-cervical approach for retrosternal goiter. Study Design: Diagnostic accuracy study. Methods: The measurement of craniocaudal length and the volume of the mediastinal component of the thyroid gland on computerised tomography images was performed in 47 patients with retrosternal goiter. Of these 47 patients, 8 (17% required an extra-cervical approach and were classified as group 1, and 39 (83% patients that required a cervical incision were classified as group 2. Receiver operating characteristic analysis was performed to determine the cut-off value for the craniocaudal length and the volume of the mediastinal thyroid mass, which significantly correlated with an extra-cervical approach for retrosternal goiter. Results: Reoperative surgery was significantly more frequent in group 1 than in group 2 (50% vs 13%; p=0.03. The craniocaudal length of the mediastinal thyroid gland was significantly longer in group 1 than in group 2 (77±11 mm vs 31±21 mm, respectively; p=0.0001. The volume of the mediastinal component was significantly larger in group 1 compared to group 2 (264±106 cm3 vs 40±41 cm3, respectively; p=0.0001. The receiver operating characteristic curve of craniocaudal length and the volume of the mediastinal component identified ≥66 mm and ≥162 cm3 as the cut-off values with the maximum accuracy, respectively. The craniocaudal length of the thyroid mass below the thoracic inlet ≥66 mm or a volume of the mediastinal portion ≥162 cm3 were significantly associated with an extra-cervical approach (p=0.0001. For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off value for craniocaudal length was 87.5%, 64% and 97

  17. Using a digital story format: a contemporary approach to meeting the workforce needs of public health laboratories.

    Science.gov (United States)

    Walkner, Laurie; Fife, Dena; Bedet, Jennifer; DeMartino, Mary

    2014-01-01

    Public health laboratories are an integral partner in preparedness and emergency response. The Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC) and the State Hygienic Laboratory at the University of Iowa have a long history of working together to identify and meet the preparedness training needs of the laboratory workforce. The training, Anatomy of a Foodborne Outbreak, which uses a digital story format, provides an example of this partnership. The State Hygienic Laboratory expressed the need for training programs targeted at enhancing early detection and investigation of outbreaks. Clinical laboratory staff play a significant role in identifying patient samples that may represent the effects of foodborne illness. Given that foodborne illnesses are on the increase nationally, it is critical that laboratory staff be prepared to deal with these outbreaks. UMPERLC collaborated with State Hygienic Laboratory content experts in the design and development of a digital story, using a foodborne outbreak that focuses on testing to detect Shiga toxin-producing Escherichia coli. This narrative format was selected because seeing and hearing a story about the training content provide the learner with a deeper interaction and richer learning experience, allowing the learner to better see the bigger picture. Anatomy of a Foodborne Outbreak is available on UMPERLC's Learning Management System, Training Source (http://training-source.org). Evaluation data indicate positive learning experiences overall. The digital story format, which is a video that uses a blend of images, text, and audio narration, was an appropriate method for the content and learning outcomes of the Anatomy of a Foodborne Outbreak training. This format requires more active learning, which increases retention and transfer of knowledge. Training that is easily accessed and user-friendly is an important resource for laboratory staff. When reviewing the course completion data, the highest

  18. Information Needs of Textile Industry: Methodological Approach Tekstil Endüstrisinin Enformasyon Gereksinimleri: Metodolojik Yaklaşım

    Directory of Open Access Journals (Sweden)

    Oya Gürdal

    1998-03-01

    Full Text Available Up till now various user studies were made to show the information needs and the information use habits of the industrial firms. With the same objective, a user survey is realized in the Turkish textile industry. The research that has been done in Turkey and other world countries show that users does not know the presence of information sources and I or channels and the information needed is retrieved randomely or with difficulty. However, there is a very important relationship between the comprehension of the importance of information for the fulfilment of industrial activities and establishment and use of information sources / channels and/or information centers. Endüstriyel işletmelerin enformasyon gereksinimlerini ve bu kesimin bilgi merkezlerini kullanma alışkanlıklarını belirlemek üzere çeşitli "kullanıcı incelemeleri" (survey çalışmaları yapılmaktadır. Bu çalışmada da aynı amaçla, Türk tekstil sektörü baz alınarak endüstriyel survey araştırması gerçekleştirilmiştir. Dünyada ve bizde yapılan çalışmalar göstermektedir ki mevcut olan enformasyon kaynakları ve / veya kanallarının varlığı kullanıcılar tarafından bilinmemekte, bu nedenle de gereksinilen enformasyona güçlükle ya da rastlantısal biçimde erişilmektedir. Bununla birlikte endüstriyel aktiviteler için enformasyonun öneminin kavranması ile enformasyon kaynakları/kanalları ve / veya bilgi merkezlerinin oluşumu ve kullanımı arasında önemli bir bağ bulunmaktadır.

  19. The Assessment of Math Learning Difficulties in a Primary Grade-4 Child with High Support Needs: Mixed Methods Approach

    Directory of Open Access Journals (Sweden)

    Lawrence Mundia

    2012-03-01

    Full Text Available This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child’s major presenting difficulties. These included: inability to use the four arithmetic operations (addition, subtraction, multiplication, division efficiently; not understanding the relationship between units, tens and hundreds; using any two of the four arithmetic processes (+, - , x, ÷ in combination within one operation; treating each column as a separate problem; place value problems / wrong alignment of numbers; poor eye-hand coordination leading to dysgraphia; and memory lapses. The other problems that became apparent through this investigation and implied in the findings include possible causal factors such as dyscalculia, dyslexia, low self-esteem, low self-efficacy, and math anxiety. Further assessment, intervention and research are recommended to address problems of this vulnerable child.

  20. Controlling Eutrophication in A Mediterranean Shallow Reservoir by Phosphorus Loading Reduction: The Need for an Integrated Management Approach.

    Science.gov (United States)

    Zaragüeta, Mikel; Acebes, Pablo

    2017-04-01

    Increased nutrient enrichment in Mediterranean standing waters has enhanced the risk of being affected by cyanobacterial blooms. Because phosphorus abatement is shaped as a crucial strategy for controlling eutrophication, this study introduces a structural thinking, experiential learning laboratory with animation dynamic model elaborated for Cazalegas Reservoir (Spain) to assess the feasibility of implementing a set of internal and external control measures and hydromorphological adjustments to meet the goal of oligotrophication. This shallow reservoir is another case where recurrent eutrophication has led to reach annual mean total phosphorus concentrations (0.16 ± 0.08 mg total phosphorus/L) over the threshold of current water policies, triggering cyanobacterial growth up to undesirable levels in summer time (approximately 50,000 cells/mL). Modeling results showed that (i) after upgrading water treatment in the main tributary, (ii) applying a lanthanum-modified bentonite into the water column and sediment, and (iii) increasing reservoir water level, in-lake P concentrations and cyanobacterial abundance decreased in an 88% (below 0.01 mg total phosphorus/L) and 84% (below 6000 cells/mL), respectively in the most critical periods. However, the constraints of the proposed management strategies are associated with their costs of implementation and the time span for a stable trophic recovery of the reservoir. In that end, integrated management approaches are aimed to be adopted by water managers to reach adequate ecological status of freshwater bodies.

  1. A transnational and holistic breeding approach is needed for sustainable wheat production in the Baltic Sea region.

    Science.gov (United States)

    Chawade, Aakash; Armoniené, Rita; Berg, Gunilla; Brazauskas, Gintaras; Frostgård, Gunilla; Geleta, Mulatu; Gorash, Andrii; Henriksson, Tina; Himanen, Kristiina; Ingver, Anne; Johansson, Eva; Jørgensen, Lise Nistrup; Koppel, Mati; Koppel, Reine; Makela, Pirjo; Ortiz, Rodomiro; Podyma, Wieslaw; Roitsch, Thomas; Ronis, Antanas; Svensson, Jan T; Vallenback, Pernilla; Weih, Martin

    2018-03-14

    The Baltic Sea is one of the largest brackish water bodies in the world. Eutrophication is a major concern in the Baltic Sea due to the leakage of nutrients to the sea with agriculture being the primary source. Wheat (Triticum aestivum L.) is the most widely grown crop in the countries surrounding the Baltic Sea and thus promoting sustainable agriculture practices for wheat cultivation will have a major impact on reducing pollution in the Baltic Sea. This approach requires identifying and addressing key challenges for sustainable wheat production in the region. Implementing new technologies for climate-friendly breeding and digital farming across all surrounding countries should promote sustainable intensification of agriculture in the region. In this review, we highlight major challenges for wheat cultivation in the Baltic Sea region and discuss various solutions integrating transnational collaboration for pre-breeding and technology sharing to accelerate development of low input wheat cultivars with improved host plant resistance to pathogen and enhanced adaptability to the changing climate. © 2018 The Authors. Physiologia Plantarum published by John Wiley & Sons Ltd on behalf of Scandinavian Plant Physiology Society.

  2. The assessment of math learning difficulties in a primary grade-4 child with high support needs: Mixed methods approach

    Directory of Open Access Journals (Sweden)

    Lawrence Mundia

    2012-03-01

    Full Text Available This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child’s major presenting difficulties. These included: inability to use the four arithmetic operations (addition, subtraction, multiplication, division efficiently; not understanding the relationship between units, tens and hundreds; using any two of the four arithmetic processes (+, - , x, ÷ in combination within one operation; treating each column as a separate problem; place value problems / wrong alignment of numbers; poor eye-hand coordination leading to dysgraphia; and memory lapses. The other problems that became apparent through this investigation and implied in the findings include possible causal factors such as dyscalculia, dyslexia, low self-esteem, low self-efficacy, and math anxiety. Further assessment, intervention and research are recommended to address problems of this vulnerable child.

  3. Controlling Eutrophication in A Mediterranean Shallow Reservoir by Phosphorus Loading Reduction: The Need for an Integrated Management Approach

    Science.gov (United States)

    Zaragüeta, Mikel; Acebes, Pablo

    2017-04-01

    Increased nutrient enrichment in Mediterranean standing waters has enhanced the risk of being affected by cyanobacterial blooms. Because phosphorus abatement is shaped as a crucial strategy for controlling eutrophication, this study introduces a structural thinking, experiential learning laboratory with animation dynamic model elaborated for Cazalegas Reservoir (Spain) to assess the feasibility of implementing a set of internal and external control measures and hydromorphological adjustments to meet the goal of oligotrophication. This shallow reservoir is another case where recurrent eutrophication has led to reach annual mean total phosphorus concentrations (0.16 ± 0.08 mg total phosphorus/L) over the threshold of current water policies, triggering cyanobacterial growth up to undesirable levels in summer time (approximately 50,000 cells/mL). Modeling results showed that (i) after upgrading water treatment in the main tributary, (ii) applying a lanthanum-modified bentonite into the water column and sediment, and (iii) increasing reservoir water level, in-lake P concentrations and cyanobacterial abundance decreased in an 88% (below 0.01 mg total phosphorus/L) and 84% (below 6000 cells/mL), respectively in the most critical periods. However, the constraints of the proposed management strategies are associated with their costs of implementation and the time span for a stable trophic recovery of the reservoir. In that end, integrated management approaches are aimed to be adopted by water managers to reach adequate ecological status of freshwater bodies.

  4. Moving from theory to practice: A participatory social network mapping approach to address unmet need for family planning in Benin.

    Science.gov (United States)

    Igras, Susan; Diakité, Mariam; Lundgren, Rebecka

    2017-07-01

    In West Africa, social factors influence whether couples with unmet need for family planning act on birth-spacing desires. Tékponon Jikuagou is testing a social network-based intervention to reduce social barriers by diffusing new ideas. Individuals and groups judged socially influential by their communities provide entrée to networks. A participatory social network mapping methodology was designed to identify these diffusion actors. Analysis of monitoring data, in-depth interviews, and evaluation reports assessed the methodology's acceptability to communities and staff and whether it produced valid, reliable data to identify influential individuals and groups who diffuse new ideas through their networks. Results indicated the methodology's acceptability. Communities were actively and equitably engaged. Staff appreciated its ability to yield timely, actionable information. The mapping methodology also provided valid and reliable information by enabling communities to identify highly connected and influential network actors. Consistent with social network theory, this methodology resulted in the selection of informal groups and individuals in both informal and formal positions. In-depth interview data suggest these actors were diffusing new ideas, further confirming their influence/connectivity. The participatory methodology generated insider knowledge of who has social influence, challenging commonly held assumptions. Collecting and displaying information fostered staff and community learning, laying groundwork for social change.

  5. Promise and peril in nanomedicine: the challenges and needs for integrated systems biology approaches to define health risk.

    Science.gov (United States)

    Halappanavar, Sabina; Vogel, Ulla; Wallin, Hakan; Yauk, Carole L

    2018-01-01

    In the 1966s visionary film 'Fantastic Voyage' a submarine crew was shrunk to 100 nm in size and injected into the body of an injured scientist to repair his damaged brain. The movie (written by Harry Kleiner; directed by Richard Fleischer; novel by Isaac Asimov) drew attention to the potential power of engineered nanoscale structures and devices to construct, monitor, control, treat, and repair individual cells. Even more interesting was the fact that the film elegantly noted that the structure had to be miniaturized to a size that is not detected by the body's immune surveillance system, and highlighted the many physiological barriers that are encountered on the submarine's long journey to the target. Although the concept of miniaturizing humans remains an element of science fiction, targeted drug delivery through nanobots to treat diseases such as cancer is now a reality. The ability of nanobots to evade immune surveillance is one of the most attractive features of nanoscale materials that are exploited in the field of medicine for molecular diagnostics, targeted drug delivery, and therapy of diseases. This article will provide a concise opinion on the state-of-the-art, the challenges, and the use of systems biology-another equally revolutionary field of science-to assess the unique health hazards of nanomaterial exposures. WIREs Nanomed Nanobiotechnol 2018, 10:e1465. doi: 10.1002/wnan.1465 This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Toxicology and Regulatory Issues in Nanomedicine > Toxicology of Nanomaterials. © 2017 Her Majesty the Queen in Right of Canada. WIREs Nanomedicine and Nanobiotechnology published by Wiley Periodicals, Inc.

  6. Modeling the determinants of Medicaid home care payments for children with special health care needs: A structural equation model approach.

    Science.gov (United States)

    Adepoju, Omolola E; Zhang, Yichen; Phillips, Charles D

    2014-10-01

    The management of children with special needs can be very challenging and expensive. To examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population. We retrospectively assessed secondary data on children, ages 4-20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments. The mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures - medical conditions, intellectual disability, region, and ADL function. The most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Dabigatran - a case history demonstrating the need for comprehensive approaches to optimise the use of new drugs

    Directory of Open Access Journals (Sweden)

    Rickard eMalmstrom

    2013-05-01

    Full Text Available Background: There are potential conflicts between authorities and companies to fund new premium priced drugs especially where there are safety and/ or budget concerns. Dabigatran, a new oral anticoagulant for the prevention of stroke in patients with non-valvular AF, exemplifies this issue. Whilst new effective treatments are needed, there are issues in the elderly with dabigatran due to variable drug concentrations, no known antidote and dependence on renal elimination. Published studies have shown dabigatran to be cost-effective but there are budget concerns given the prevalence of atrial fibrillation. There are also issues with potentially re-designing anticoagulant services. This has resulted in activities across countries to better manage its use. Objective: To (i review authority activities in over 30 countries and regions, (ii use the findings to develop new models to better manage the entry of new drugs , and (iii review the implications for all major stakeholder groups. Methodology: Descriptive review and appraisal of activities regarding dabigatran and the development of guidance for groups through an iterative process. Results: There has been a plethora of activities to manage dabigatran including extensive pre-launch activities, risk sharing arrangements, prescribing restrictions and monitoring of prescribing post launch. Reimbursement has been denied in some countries due to concerns with its budget impact and/or excessive bleeding. Development of a new model and future guidance is proposed to better manage the entry of new drugs, centring on three pillars of pre-, peri- and post-launch activities. Conclusion: Models for introducing new drugs are essential to optimise their prescribing especially where there are concerns. Without such models, new drugs may be withdrawn prematurely and/ or struggle for funding.

  8. North American medical schools' experience with and approaches to the needs of students with physical and sensory disabilities.

    Science.gov (United States)

    Eickmeyer, Sarah M; Do, Kim D; Kirschner, Kristi L; Curry, Raymond H

    2012-05-01

    To determine the nature and frequency of impairments and related underlying conditions of medical students with physical and sensory disabilities (PSDs), and to assess medical schools' use of relevant publications in setting admission criteria and developing appropriate accommodations. A 25-item survey addressed schools' experiences with students known to have PSDs and their related policies and practices. The survey instrument was directed to student affairs deans at all 163 accredited American and Canadian medical schools. The authors limited the survey to consideration of PSDs, excluding psychiatric, cognitive, and learning disabilities. Eighty-six schools (52.8%) responded, representing an estimated 83,327 students enrolled between 2001 and 2010. Of these students, 0.56% had PSDs at matriculation and 0.42% at graduation. Although 81% of respondents were familiar with published guidelines for technical standards, 71% used locally derived institutional guidelines for the admission of disabled applicants. The most commonly reported accommodations for students with PSDs included extra time to complete tasks/exams (n = 62), ramps, lifts, or accessible entrances (n = 43), and dictated/audio-recorded lectures (n = 40). All responding schools required students' demonstration of physical examination skills; requirements for other technical skills, with or without accommodations, varied considerably. The matriculation and graduation rates of medical students with PSDs remain low. The most frequent accommodations reported were among those required of any academic or clinical setting by the Americans with Disabilities Act. There is a lack of consensus regarding technical standards for admission, suggesting a need to reexamine this critical issue.

  9. Immunization delivery in the second year of life in Ghana: the need for a multi-faceted approach.

    Science.gov (United States)

    Nyaku, Mawuli; Wardle, Melissa; Eng, Jodi Vanden; Ametewee, Lynnette; Bonsu, George; Larbi Opare, Joseph Kwadwo; Conklin, Laura

    2017-01-01

    68% in GAR yet less than half knew the recommended ages for receiving the vaccine, (NR: 4%, VR: 9%, GAR: 44%). Among 160 HFs participating in the survey (>50 in each region), most lacked a defaulter tracing system (NR: 94%,VR: 76%,GAR: 85%). A varying proportion of HCWs correctly indicated how to record a catch-up first dose of MCV administered to an 18-month-old child in the 12-23 month immunization register (NR: 38%, VR: 55%, GAR: 67%) and on the vaccination card (NR: 54%, VR: 53%, GAR: 76%). Although more than half of caregivers would accept text messages, (NR: 57%, VR: 78%, GAR: 96%) including reminders, related to their child's immunizations, immunization visit beyond the first year of life included knowledge gaps among caregivers, high dropout rates between MCV1 and MCV2 in all study regions, and a lack of defaulter tracing systems in most healthcare facilities providing childhood immunizations. Targeted strategies that promote behavioral, cultural, and policy changes are needed to strengthen 2YL child health service delivery and improve vaccination coverage.

  10. Immunization delivery in the second year of life in Ghana: the need for a multi-faceted approach

    Science.gov (United States)

    Nyaku, Mawuli; Wardle, Melissa; Eng, Jodi Vanden; Ametewee, Lynnette; Bonsu, George; Larbi Opare, Joseph Kwadwo; Conklin, Laura

    2017-01-01

    measles was 69% in NR, 75% in VR, and 68% in GAR yet less than half knew the recommended ages for receiving the vaccine, (NR: 4%, VR: 9%, GAR: 44%). Among 160 HFs participating in the survey (>50 in each region), most lacked a defaulter tracing system (NR: 94%,VR: 76%,GAR: 85%). A varying proportion of HCWs correctly indicated how to record a catch-up first dose of MCV administered to an 18-month-old child in the 12-23 month immunization register (NR: 38%, VR: 55%, GAR: 67%) and on the vaccination card (NR: 54%, VR: 53%, GAR: 76%). Although more than half of caregivers would accept text messages, (NR: 57%, VR: 78%, GAR: 96%) including reminders, related to their child’s immunizations, immunization visit beyond the first year of life included knowledge gaps among caregivers, high dropout rates between MCV1 and MCV2 in all study regions, and a lack of defaulter tracing systems in most healthcare facilities providing childhood immunizations. Targeted strategies that promote behavioral, cultural, and policy changes are needed to strengthen 2YL child health service delivery and improve vaccination coverage. PMID:29296139

  11. Technical Approach for Determining Key Parameters Needed for Modeling the Performance of Cast Stone for the Integrated Disposal Facility Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Yabusaki, Steven B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Serne, R. Jeffrey [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rockhold, Mark L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Wang, Guohui [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Westsik, Joseph H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-03-30

    Washington River Protection Solutions (WRPS) and its contractors at Pacific Northwest National Laboratory (PNNL) and Savannah River National Laboratory (SRNL) are conducting a development program to develop / refine the cementitious waste form for the wastes treated at the ETF and to provide the data needed to support the IDF PA. This technical approach document is intended to provide guidance to the cementitious waste form development program with respect to the waste form characterization and testing information needed to support the IDF PA. At the time of the preparation of this technical approach document, the IDF PA effort is just getting started and the approach to analyze the performance of the cementitious waste form has not been determined. Therefore, this document looks at a number of different approaches for evaluating the waste form performance and describes the testing needed to provide data for each approach. Though the approach addresses a cementitious secondary aqueous waste form, it is applicable to other waste forms such as Cast Stone for supplemental immobilization of Hanford LAW. The performance of Cast Stone as a physical and chemical barrier to the release of contaminants of concern (COCs) from solidification of Hanford liquid low activity waste (LAW) and secondary wastes processed through the Effluent Treatment Facility (ETF) is of critical importance to the Hanford Integrated Disposal Facility (IDF) total system performance assessment (TSPA). The effectiveness of cementitious waste forms as a barrier to COC release is expected to evolve with time. PA modeling must therefore anticipate and address processes, properties, and conditions that alter the physical and chemical controls on COC transport in the cementitious waste forms over time. Most organizations responsible for disposal facility operation and their regulators support an iterative hierarchical safety/performance assessment approach with a general philosophy that modeling provides

  12. Enhancing participatory approach in water resources management: development of a survey to evaluate stakeholders needs and priorities related to software capabilities

    Science.gov (United States)

    Foglia, L.; Rossetto, R.; Borsi, I.; Josef, S.; Boukalova, Z.; Triana, F.; Ghetta, M.; Sabbatini, T.; Bonari, E.; Cannata, M.; De Filippis, G.

    2016-12-01

    The EU H2020 FREEWAT project (FREE and open source software tools for WATer resource management) aims at simplifying the application of EU-water related Directives, by developing an open source and public domain, GIS-integrated platform for planning and management of ground- and surface-water resources. The FREEWAT platform is conceived as a canvas, where several distributed and physically-based simulation codes are virtually integrated. The choice of such codes was supported by the result of a survey performed by means of questionnaires distributed to 14 case study FREEWAT project partners and several stakeholders. This was performed in the first phase of the project within the WP 6 (Enhanced science and participatory approach evidence-based decision making), Task 6.1 (Definition of a "needs/tools" evaluation grid). About 30% among all the invited entities and institutions from several EU and non-EU Countries expressed their interest in contributing to the survey. Most of them were research institutions, government and geoenvironmental companies and river basin authorities.The result of the questionnaire provided a spectrum of needs and priorities of partners/stakeholders, which were addressed during the development phase of the FREEWAT platform. The main needs identified were related to ground- and surface-water quality, sustainable water management, interaction between groundwater/surface-water bodies, and design and management of Managed Aquifer Recharge schemes. Needs and priorities were then connected to the specific EU Directives and Regulations to be addressed.One of the main goals of the questionnaires was to collect information and suggestions regarding the use of existing commercial/open-source software tools to address needs and priorities, and regarding the needs to address specific water-related processes/problems.

  13. IAS 12 needs methodical approach

    NARCIS (Netherlands)

    Hafkenscheid, R.P.F.M.; Janssen, C.M.L.

    2009-01-01

    The article describes a methodology used to establish the expected value of uncertain tax positions. The Project Update on Income Taxes released by the International Accounting Standards Board (IASB) in September 2008 aims to reduce the differences between IAS 12 Income Taxes and the SFAS 109

  14. Needs assessment for adapting TB directly observed treatment intervention programme in Limpopo Province, South Africa: A community-based participatory research approach.

    Science.gov (United States)

    Mabunda, Jabu T; Khoza, Lunic B; Van den Borne, Hubertus B; Lebese, Rachel T

    2016-07-22

    Limpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours. To apply a community-based participatory research approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme. This study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts. Community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants. A total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour. Joint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community.

  15. A mixed-methods approach to conducting Internal Revenue Service-compliant community health needs assessments: a case example for nonprofit hospital leaders

    Directory of Open Access Journals (Sweden)

    Oglesby WH

    2014-10-01

    Full Text Available Willie H Oglesby, Ken Slenkovich Department of Health Policy and Management, College of Public Health, Kent State University, Kent, OH, USA Background: The Patient Protection and Affordable Care Act created new requirements for nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA at least once every 3 years, with a significant tax penalty for noncompliance. While some resources exist to help nonprofit hospital leaders conduct various aspects of a CHNA, few reflect the new Internal Revenue Service requirements. Methods: Many different models of CHNAs have emerged over the years. Although each has its unique features, the essential elements of a CHNA include engaging stakeholders, defining the community, gathering sufficient representative data, prioritizing information, and reporting results. In this paper, we expand upon this basic approach by offering a practical step-by-step guide to conducting CHNAs that meets new Internal Revenue Service regulations. Results: We developed and tested this methodology in partnership with several nonprofit hospital systems in Northeast Ohio, USA. In this paper, we discuss our use of the methodology and identify recommendations for other nonprofit hospital leaders. Conclusion: The methodology presented in this paper is a cost-effective approach to satisfying new CHNA requirements and nonprofit hospital leaders should consider using it or modifying it to fit their unique needs. Keywords: Affordable Care Act, CHNA, community benefit, community hospital

  16. Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation.

    Science.gov (United States)

    de Freitas, Cláudia; Dos Reis, Vanessa; Silva, Susana; Videira, Paula A; Morava, Eva; Jaeken, Jaak

    2017-09-26

    Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the

  17. Doll therapy: a therapeutic means to meet past attachment needs and diminish behaviours of concern in a person living with dementia--a case study approach.

    Science.gov (United States)

    Bisiani, Leah; Angus, Jocelyn

    2013-07-01

    The aim of this research study was to examine the impact of the provision of a lifelike baby doll as a therapeutic tool on the behaviour of a person living with dementia. Specifically, this single case study assessed the potential benefits, if any, of the use of doll therapy in reducing behaviours of concern such as anxiety and agitation that may be associated with observed attachment needs of a person living with dementia. A single case study of a female participant, with moderately advanced Alzheimer's disease, was the subject of this research. The case study used both qualitative and quantitative research design and methodology in data collection and analysis. Demonstrated that doll therapy was a positive intervention for the person living with dementia who was the participant in this research. The findings indicate a reduction in behaviours of concern related to the need for attachment and a considerable decline in levels of anxiety and agitation. There was extensive ongoing improvement in social interaction and communication. This research supports doll therapy as a therapeutic intervention that may be utilized within the ongoing care of some persons with dementia to meet needs for attachment and to reduce behaviours of concern. Despite some controversy on this topic, doll therapy should be considered as a therapeutic approach to further dementia care in light of this positive outcome.

  18. The Iowa K-12 Climate Science Education Initiative: a comprehensive approach to meeting in-service teachers' stated needs for teaching climate literacy with NGSS

    Science.gov (United States)

    Stanier, C. O.; Spak, S.; Neal, T. A.; Herder, S.; Malek, A.; Miller, Z.

    2017-12-01

    The Iowa Board of Education voted unanimously in 2015 to adopt NGSS performance standards. The CGRER - College of Education Iowa K-12 Climate Science Education Initiative was established in 2016 to work directly with Iowa inservice teachers to provide what teachers need most to teach climate literacy and climate science content through investigational learning aligned with NGSS. Here we present teachers' requests for teaching climate with NGSS, and an approach to provide resources for place-based authentic inquiry on climate, developed, tested, and refined in partnership with inservice and preservice teachers. A survey of inservice middle school and high school science teachers was conducted at the 2016 Iowa Council of Teachers of Mathematics/Iowa Academy of Sciences - Iowa Science Teaching Section Fall Conference and online in fall 2016. Participants (n=383) were asked about their prior experience and education, the resources they use and need, their level of comfort in teaching climate science, perceived barriers, and how they address potential controversy. Teachers indicated preference for professional development on climate content and complete curricula packaged with lessons and interactive models aligned to Iowa standards, as well as training on instructional strategies to enhance students' ability to interpret scientific evidence. We identify trends in responses by teaching experience, climate content knowledge and its source, grade level, and urban and rural districts. Less than 20% of respondents reported controversy or negativity in teaching climate to date, and a majority were comfortable teaching climate science and climate change, with equal confidence in teaching climate and other STEM content through investigational activities. We present an approach and materials to meet these stated needs, created and tested in collaboration with Iowa teachers. We combine professional development and modular curricula with bundled standards, concepts, models, data

  19. Accountable priority setting for trust in health systems--the need for research into a new approach for strengthening sustainable health action in developing countries

    DEFF Research Database (Denmark)

    Byskov, Jens; Bloch, Paul; Blystad, Astrid

    2009-01-01

    from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability...... and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed.Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must...... identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising...

  20. Energy needs

    International Nuclear Information System (INIS)

    Chateau, Bertrand

    2014-05-01

    The author first discusses the various concepts and definitions associated with energy needs, and then the difference between actual needs and energy needs by distinguishing personal needs, needs of the productive sector, energetic needs and services. In the next part, he discusses how energy needs are assessed. He discusses the relationship between energy needs and energy consumption, how energy consumptions can be analysed and interpreted. He comments how energy needs can be assessed and analysed in time and in space. He notices and explains why economy and climate are the main causes of spatial differences for energy needs per habitant, and comments the evolution of energy consumption over long periods

  1. Needs assessment for adapting TB directly observed treatment intervention programme in Limpopo Province, South Africa: A community-based participatory research approach

    Directory of Open Access Journals (Sweden)

    Jabu T. Mabunda

    2016-07-01

    Full Text Available Background: Limpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours. Aim: To apply a community-based participatory research approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme. Setting: This study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts. Methods: Community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants. Results: A total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour. Conclusion: Joint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community. Keywords: Health seeking, Adherence, Community based participatory research, Tuberculosis

  2. Needs assessment for adapting TB directly observed treatment intervention programme in Limpopo Province, South Africa: A community-based participatory research approach

    Directory of Open Access Journals (Sweden)

    Jabu T. Mabunda

    2016-03-01

    Full Text Available Background: Limpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours.Aim: To apply a community-based participatory research approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme.Setting: This study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts.Methods: Community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants.Results: A total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour.Conclusion: Joint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community.Keywords: Health seeking, Adherence, Community based participatory research, Tuberculosis

  3. Placental complications after a previous cesarean section

    OpenAIRE

    Milošević Jelena; Lilić Vekoslav; Tasić Marija; Radović-Janošević Dragana; Stefanović Milan; Antić Vladimir

    2009-01-01

    Introduction The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complic...

  4. Health professionals' views on health literacy issues for culturally and linguistically diverse women in maternity care: barriers, enablers and the need for an integrated approach.

    Science.gov (United States)

    Hughson, Jo-Anne; Marshall, Fiona; Daly, Justin Oliver; Woodward-Kron, Robyn; Hajek, John; Story, David

    2018-02-01

    Objective To identify health literacy issues when providing maternity care to culturally and linguistically diverse (CALD) women, and the strategies needed for health professionals to collaboratively address these issues. Methods A qualitative case study design was undertaken at one large metropolitan Australian hospital serving a highly CALD population. Semistructured interviews were conducted with a range of maternity healthcare staff. The data were analysed thematically. The study is informed by a framework of cultural competence education interventions for health professionals and a health literacy framework. Results Eighteen clinicians participated in the interviews (seven midwives, five obstetricians, five physiotherapists, one social worker, and one occupational therapist). Emergent themes of health literacy-related issues were: patient-based factors (communication and cultural barriers, access issues); provider-based factors (time constraints, interpreter issues); and enablers (cultural awareness among staff, technology). Conclusions There are significant health literacy and systemic issues affecting the hospital's provision of maternity care for CALD women. These findings, mapped onto the four domains of cultural competence education interventions will inform a technology-delivered health literacy intervention for CALD maternity patients. This approach may be applied to other culturally diverse healthcare settings to foster patient health literacy. What is known about the topic? There are health inequities for pregnant women of culturally and linguistically diverse (CALD) backgrounds. Low health literacy compounded by language and cultural factors contribute to these inequities and access to interpreters in pregnancy care remains an ongoing issue. Pregnancy smart phone applications are a popular source of health information for pregnant women yet these apps are not tailored for CALD women nor are they part of a regulated industry. What does this paper add

  5. Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study.

    Science.gov (United States)

    AlJaberi, Hana

    2018-04-13

    Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women's health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women's virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. ©Hana Al

  6. VET-Artdevivre Partnership Programme: Identification of market and training needs on wine, health and social aspects and innovative tools and common approaches

    Directory of Open Access Journals (Sweden)

    Filopoulos Stylianos

    2015-01-01

    Full Text Available Introduction: The VET-ArtdeVivre Partnership Programme was a two-year Partnership launched in August 2012 and funded by the EC's Leonardo da Vinci (LdV. The Partnership brought together nine different actors from seven countries of both the wider wine value chain and the Vocational Education & Training (VET field. The work focused on five different top- ics. The main objective was to identify market & training needs and to develop common approaches on wine, health & social aspects. Methods: A Market and Training Needs Analysis (MTNA Report, consisting of the respective national versions, was drafted by the Partners and reviewed by international experts. The MTNA Report provided an in depth analysis of the respective wine markets and VET, an assessment of selected key job profiles and a mapping of relevant VET offers. Results: Based on the MTNA Report, the Partnership has developed a VET framework proposal with three different training modules according to the professional needs of Sommeliers (EQF 3–5 level, Oenologists (EQF 6 level, and Physicians (EQF 6–8 level. Each module lists the expected learning hours and outcomes, the delivery and assessment methods, reading list, the trainers’ minimum formal qualifications and experience required. These proposed comprehensive training modules are linked to a database of existing training references. Considering the MTNA results and having established a concrete proposal, the Partnership has initiated the necessary dialogue to introduce and recognise these skills both at formal & informal level and national & EU level in accordance with EQF & ECVET. Conclusions: Taking into account the increasing interest on the topic and the identified gaps, professional training on wine, health and social aspects and responsible business practices should be considered by the respective stakeholders involved in defining job profiles and training programmes for professionals of the wine value chain.

  7. Preoperative screening: value of previous tests.

    Science.gov (United States)

    Macpherson, D S; Snow, R; Lofgren, R P

    1990-12-15

    To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. Retrospective cohort analysis of computerized laboratory data (complete blood count, sodium, potassium, and creatinine levels, prothrombin time, and partial thromboplastin time). Urban tertiary care Veterans Affairs Hospital. Consecutive sample of 1109 patients who had elective surgery in 1988. At admission, 7549 preoperative tests were done, 47% of which duplicated tests performed in the previous year. Of 3096 previous results that were normal as defined by hospital reference range and done closest to the time of but before admission (median interval, 2 months), 13 (0.4%; 95% CI, 0.2% to 0.7%), repeat values were outside a range considered acceptable for surgery. Most of the abnormalities were predictable from the patient's history, and most were not noted in the medical record. Of 461 previous tests that were abnormal, 78 (17%; CI, 13% to 20%) repeat values at admission were outside a range considered acceptable for surgery (P less than 0.001, frequency of clinically important abnormalities of patients with normal previous results with those with abnormal previous results). Physicians evaluating patients preoperatively could safely substitute the previous test results analyzed in this study for preoperative screening tests if the previous tests are normal and no obvious indication for retesting is present.

  8. Implant breast reconstruction after salvage mastectomy in previously irradiated patients.

    Science.gov (United States)

    Persichetti, Paolo; Cagli, Barbara; Simone, Pierfranco; Cogliandro, Annalisa; Fortunato, Lucio; Altomare, Vittorio; Trodella, Lucio

    2009-04-01

    The most common surgical approach in case of local tumor recurrence after quadrantectomy and radiotherapy is salvage mastectomy. Breast reconstruction is the subsequent phase of the treatment and the plastic surgeon has to operate on previously irradiated and manipulated tissues. The medical literature highlights that breast reconstruction with tissue expanders is not a pursuable option, considering previous radiotherapy a contraindication. The purpose of this retrospective study is to evaluate the influence of previous radiotherapy on 2-stage breast reconstruction (tissue expander/implant). Only patients with analogous timing of radiation therapy and the same demolitive and reconstructive procedures were recruited. The results of this study prove that, after salvage mastectomy in previously irradiated patients, implant reconstruction is still possible. Further comparative studies are, of course, advisable to draw any conclusion on the possibility to perform implant reconstruction in previously irradiated patients.

  9. Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: the need for a syndemic approach.

    Science.gov (United States)

    Gilbert, Louisa; Primbetova, Sholpan; Nikitin, Danil; Hunt, Timothy; Terlikbayeva, Assel; Momenghalibaf, Azzi; Ruziev, Murodali; El-Bassel, Nabila

    2013-11-01

    Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research. We conducted a comprehensive literature search of peer-reviewed publications and gray literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics. Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the co-occurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose. The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. How is shrimp aquaculture transforming coastal livelihoods and lagoons in Estero Real, Nicaragua? The need to integrate social-ecological research and ecosystem-based approaches.

    Science.gov (United States)

    Benessaiah, Karina; Sengupta, Raja

    2014-08-01

    Ecosystem-based approaches to aquaculture integrate environmental concerns into planning. Social-ecological systems research can improve this approach by explicitly relating ecological and social dynamics of change at multiple scales. Doing so requires not only addressing direct effects of aquaculture but also considering indirect factors such as changes in livelihood strategies, governance dynamics, and power relations. We selected the community of Puerto Morazán, Nicaragua as a case study to demonstrate how the introduction of small-scale aquaculture radically transformed another key livelihood activity, lagoon shrimp fishing, and the effects that these changes have had on lagoons and the people that depend on them. We find that shrimp aquaculture played a key role in the collapse, in the 1990s, of an existing lagoon common-property management. Shrimp aquaculture-related capital enabled the adoption of a new fishing technique that not only degraded lagoons but also led to their gradual privatization. The existence of social ties between small-scale shrimp farmers and other community members mitigated the impacts of privatization, illustrating the importance of social capital. Since 2008, community members are seeking to communally manage the lagoons once again, in response to degraded environmental conditions and a consolidation of the shrimp industry at the expense of smaller actors. This research shows that shrimp aquaculture intersects with a complex set of drivers, affecting not only how ecosystems are managed but also how they are perceived and valued. Understanding these social-ecological dynamics is essential to implement realistic policies and management of mangrove ecosystems and address the needs of resource-dependent people.

  11. Do we need cross border education?: A Case of Pilot Course Multi-professional Approaches to Substance Abuse Care and Working with Addicts

    Directory of Open Access Journals (Sweden)

    Tarja Orjasniemi

    2017-04-01

    Full Text Available The aim of this article is to examine studentsʼ experiences of cross-border education based on a single course carried out in collaboration between two networks, Barents Cross-Border University (BCBU and the Thematic Network of Social Work (TNSWUA, as well as the experiences of teachers in the course. The course was a part of the curriculum for the Master’s Degree Programme (BCBU in Comparative Social Work. Most of the students were studying in this Master’s Programme, some of them were exchange students at the University of Lapland (UL and the rest were social work students at UL and the University of Iceland (UI.  The course ran for two weeks in April 2015, and included lectures, discussions and workshops; parts of the course were delivered electronically, while other sections were delivered by teachers on-site. This course provided a broad multi-professional introduction to the field of addiction and substance abuse care. Students learned about screening the alcohol culture and the relationship between society, addiction, gender, family, life phases, ageing, maternity and substance use. The data for this study was collected through focus group discussion, with students reflecting on one question: ‘Do we need cross-border education?’ Data from instructors was collected through discussions during the planning and post-course discussions. Overall, the experiences of students and instructors were positive. The collaboration did not face insuperable challenges. The findings highlighted four main themes: globalization, networking, comparing theory and practice, and using technology. Globalization has set new demands for social work and its professionals. Experts in cultural diversity and international social issues, as well as people with a comparative approach to different societies, are needed the world over. Regarding implications for cross-border education, we would recommend collaboration in the particular field of social work

  12. Automatic electromagnetic valve for previous vacuum

    International Nuclear Information System (INIS)

    Granados, C. E.; Martin, F.

    1959-01-01

    A valve which permits the maintenance of an installation vacuum when electric current fails is described. It also lets the air in the previous vacuum bomb to prevent the oil ascending in the vacuum tubes. (Author)

  13. Preemie abandonment? Multidisciplinary experts consider how to best meet preemies needs at "preterm infants: a collaborative approach to specialized care" roundtable.

    Science.gov (United States)

    Als, Heidelise; Behrman, Richard; Checchia, Paul; Denne, Scott; Dennery, Phyllis; Hall, Caroline B; Martin, Richard; Panitch, Howard; Schmidt, Barbara; Stevenson, David K; Vila, Linda

    2007-06-04

    In June 2006, the Institute of Medicine (LoM), released a comprehensive study, Preterm Birth: Causes, Consequences, and Prevention. The report was a result of the IoM's efforts, in particular the Committee on Understanding Premature Birth and Assuring Healthy Outcomes, to better understand and prevent preterm birth and improve care for babies born prematurely. After its publication, a group of health care professionals came together in a roundtable session, "Preterm Infants: A Collaborative Approach to Specialized Care," to discuss the implications of the report. The following article captures the group's April 2007 discussion about the clinical and societal problems of preterm birth. It should be of interest to hospital administrators, pediatricians, third-party payers, policy makers, public health officials, academic researchers, funding agencies, allied health professionals, and others with a vested interest in curbing healthcare costs as well as what needs to be understood and done to safeguard the short- and long-term health of a most vulnerable population.

  14. Concomitant and previous osteoporotic vertebral fractures.

    Science.gov (United States)

    Lenski, Markus; Büser, Natalie; Scherer, Michael

    2017-04-01

    Background and purpose - Patients with osteoporosis who present with an acute onset of back pain often have multiple fractures on plain radiographs. Differentiation of an acute osteoporotic vertebral fracture (AOVF) from previous fractures is difficult. The aim of this study was to investigate the incidence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to identify risk factors for concomitant AOVFs. Patients and methods - This was a prospective epidemiological study based on the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA) with 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006. Concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that happen concomitantly. A previous fracture is a STIR-negative fracture at the time of initial diagnostics. Logistic regression was used to examine the influence of various variables on the incidence of concomitant fractures. Results - More than 99% of osteoporotic vertebral fractures occurred in the thoracic and lumbar spine. The incidence of concomitant fractures at the time of first patient contact was 26% and that of previous fractures was 60%. The odds ratio (OR) for concomitant fractures decreased with a higher number of previous fractures (OR =0.86; p = 0.03) and higher dual-energy X-ray absorptiometry T-score (OR =0.72; p = 0.003). Interpretation - Concomitant and previous osteoporotic vertebral fractures are common. Risk factors for concomitant fractures are a low T-score and a low number of previous vertebral fractures in cases of osteoporotic vertebral fracture. An MRI scan of the the complete thoracic and lumbar spine with STIR sequence reduces the risk of under-diagnosis and under-treatment.

  15. Uterine rupture without previous caesarean delivery

    DEFF Research Database (Denmark)

    Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone

    2015-01-01

    OBJECTIVE: To determine incidence and patient characteristics of women with uterine rupture during singleton births at term without a previous caesarean delivery. STUDY DESIGN: Population based cohort study. Women with term singleton birth, no record of previous caesarean delivery and planned...... vaginal delivery (n=611,803) were identified in the Danish Medical Birth Registry (1997-2008). Medical records from women recorded with uterine rupture during labour were reviewed to ascertain events of complete uterine rupture. Relative Risk (RR) and adjusted Relative Risk Ratio (aRR) of complete uterine...... rupture with 95% confidence intervals (95% CI) were ascertained according to characteristics of the women and of the delivery. RESULTS: We identified 20 cases with complete uterine rupture. The incidence of complete uterine rupture among women without previous caesarean delivery was about 3...

  16. INTRODUCTION Previous reports have documented a high ...

    African Journals Online (AJOL)

    pregnancy if they were married, educated, had dental insurance, previously used dental services when not pregnant, or had knowledge about the possible connection between oral health and pregnancy outcome8. The purpose of this study was to explore the factors determining good oral hygiene among pregnant women ...

  17. Empowerment perceptions of educational managers from previously ...

    African Journals Online (AJOL)

    The perceptions of educational manag ers from previously disadvantaged primary and high schools in the Nelson Mandela Metropole regarding the issue of empowerment are outlined and the perceptions of educational managers in terms of various aspects of empowerment at different levels reflected. A literature study ...

  18. Management of choledocholithiasis after previous gastrectomy.

    Science.gov (United States)

    Anwer, S; Egan, R; Cross, N; Guru Naidu, S; Somasekar, K

    2017-09-01

    Common bile duct stones in patients with a previous gastrectomy can be a technical challenge because of the altered anatomy. This paper presents the successful management of two such patients using non-traditional techniques as conventional endoscopic retrograde cholangiopancreatography was not possible.

  19. Laboratory Grouping Based on Previous Courses.

    Science.gov (United States)

    Doemling, Donald B.; Bowman, Douglas C.

    1981-01-01

    In a five-year study, second-year human physiology students were grouped for laboratory according to previous physiology and laboratory experience. No significant differences in course or board examination performance were found, though correlations were found between predental grade-point averages and grouping. (MSE)

  20. Participation in physical activity: perceptions of women with a previous history of gestational diabetes mellitus.

    Science.gov (United States)

    Graco, Marnie; Garrard, Jan; Jasper, Andrea E

    2009-04-01

    Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes mellitus (T2DM). Regular physical activity plays an important role in preventing T2DM. This study aimed to explore the perceptions of physical activity among women with previous GDM, in the context of preventing T2DM. Individual semi-structured interviews were conducted with 10 women with previous GDM who had not been diagnosed with T2DM. Data were analysed using a modified grounded theory approach. Women perceived diet to be significantly more important for the prevention of T2DM than physical activity. They underestimated the role of physical activity in preventing diabetes, which may have resulted from the lack of information they received following their pregnancy. Women consistently placed the needs of their families before their own, despite acknowledging their future health risks. The most commonly cited constraints on physical activity participation were lack of time, partner support, and appropriate childcare. They identified a need for 'family-friendly' community-based physical activity programs for mothers, more accessible childcare, and more information about the role of physical activity in diabetes prevention. Awareness of the role of physical activity for the prevention of diabetes was low. Physical activity promotion for women with previous GDM needs to be shaped around the opportunities and constraints identified by this population group.

  1. Previously unknown organomagnesium compounds in astrochemical context

    OpenAIRE

    Ruf, Alexander

    2018-01-01

    We describe the detection of dihydroxymagnesium carboxylates (CHOMg) in astrochemical context. CHOMg was detected in meteorites via ultrahigh-resolving chemical analytics and represents a novel, previously unreported chemical class. Thus, chemical stability was probed via quantum chemical computations, in combination with experimental fragmentation techniques. Results propose the putative formation of green-chemical OH-Grignard-type molecules and triggered fundamental questions within chemica...

  2. [Placental complications after a previous cesarean section].

    Science.gov (United States)

    Milosević, Jelena; Lilić, Vekoslav; Tasić, Marija; Radović-Janosević, Dragana; Stefanović, Milan; Antić, Vladimir

    2009-01-01

    The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development. The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history. The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (pcesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (pcesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (pcesarean section is an important risk factor for the development of placental complications.

  3. Previously Funded Teams | Division of Cancer Prevention

    Science.gov (United States)

    The first group of NCI-supported Tumor Glycomics Laboratories teams offered different approaches and concentrations to exploit the potential of glycomics to yield biomarkers for early cancer detection, and used various technologies to investigate complex carbohydrate biochemistry. They are listed here with links to more information about each laboratory, including publications related to their Alliance work. |

  4. INTRODUCTION Previous reports have documented a high ...

    African Journals Online (AJOL)

    Conclusion: The positive effect of education on oral hygiene practices is highlighted in this study. However there is still need for proper health enlightenment in this population with regards to use of the available oral health care facilities. Keywords: Oral hygiene, Pregnancy, Nigeria. Annals of Ibadan Postgraduate Medicine.

  5. Impact of previously disadvantaged land-users on sustainable ...

    African Journals Online (AJOL)

    There are vital farming requisites like recognition of indigenous knowledge, lack of input, capital, marketing, information and land use planning, with effect on sustainable resource use by disadvantaged land users. The need to form holistic approaches that entails all elements of sustainability is vital for the area development ...

  6. Previous Experience a Model of Practice UNAE

    OpenAIRE

    Ruiz, Ormary Barberi; Pesántez Palacios, María Dolores

    2017-01-01

    The statements presented in this article represents a preliminary version of the proposed model of pre-professional practices (PPP) of the National University of Education (UNAE) of Ecuador, an urgent institutional necessity is revealed in the descriptive analyzes conducted from technical support - administrative (reports, interviews, testimonials), pedagogical foundations of UNAE (curricular directionality, transverse axes in practice, career plan, approach and diagnostic examination as subj...

  7. Structured Approaches to Participatory Design for Children: Can Targeting the Needs of Children with Autism Provide Benefits for a Broader Child Population?

    Science.gov (United States)

    Benton, Laura; Johnson, Hilary

    2014-01-01

    In the past technology products created to overcome accessibility and usability issues experienced by individuals with special needs have also resulted in greater usability for the wider population. Technology is increasingly being seen as a key component within the education of children with special needs and recently researchers have developed…

  8. Prepositioned Stocks: DOD has Addressed Required Reporting Elements but Needs to Develop a Department-Wide Policy and Joint Service Approach

    Science.gov (United States)

    2016-04-01

    PREPOSITIONED STOCKS DOD Has Addressed Required Reporting Elements but Needs to Develop a Department-wide Policy...United States Government Accountability Office Highlights of GAO-16-418, a report to congressional committees April 2016 PREPOSITIONED STOCKS ...prepositions stocks --such as combat vehicles and repair parts--at locations around the world to prepare forces quickly for conflicts when needed

  9. [Influence of previous abdominopelvic surgery on gynecological laparoscopic operation].

    Science.gov (United States)

    Jin, Haoran; Shi, Wei; Zhou, Yingfang; Wu, Beisheng; Peng, Chao

    2014-09-01

    To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation. A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December, among them, 719 (21.90%) patients with previous abdominopelvic surgery history (study Group), 2 564 (78.10%)patients have no history of abdominopelvic surgery (control group). Study group 719 patients, previous operation times: one time in 525 cases, 194 cases were multiple; previous operation: 185 cases of gynecological surgery, 305 cases of obstetric surgery, 108 cases of general surgery, and 121 complex surgery (include at least two kinds of surgery); previous operative approach: 650 cases laparotomy and 69 cases laparoscopy. Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation, analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesion on and gynecological laparoscopic operation. The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2% (368/719), which was significantly higher than that of 8.2% (211/2 564)in patients without previous abdominopelvic surgery (P surgery (23.1%, 166/719) was significantly higher than that in the control group (3.3% , 85/2 564;P laparotomy was 0.6% (4/719) significantly more than the control groups (0.1%, 2/2 564; P = 0.023). Compared with other groups, patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P laparotomy showed no statistical difference between the two groups (P > 0.05). The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations, but the conversion rate increases, for patients with a history of multiple operation because of pelvic adhesion

  10. Spiritual and Non-spiritual Needs Among German Soldiers and Their Relation to Stress Perception, PTDS Symptoms, and Life Satisfaction: Results from a Structural Equation Modeling Approach.

    Science.gov (United States)

    Büssing, Arndt; Recchia, Daniela R

    2016-06-01

    In an anonym cross-sectional survey (using standardized questionnaires) among 1092 German soldiers, we found that 21 % regard their faith as a "strong hold in difficult times." Only a few had specific religious needs. Rather, a consistent theme from the participants was the need to communicate their own fears, worries and desire to attain states of inner peace. "Soldiers" stress perception and posttraumatic stress disorder symptoms were associated particularly with existential and Inner Peace Needs. Structural equation modeling indicated that stress perception has a negative influence on soldiers' life satisfaction, which in turn gives rise to specific unmet spiritual needs. These specific needs may indicate psycho-emotional problems which could be supported very early to prevent health affections and service failure.

  11. Books average previous decade of economic misery.

    Science.gov (United States)

    Bentley, R Alexander; Acerbi, Alberto; Ormerod, Paul; Lampos, Vasileios

    2014-01-01

    For the 20(th) century since the Depression, we find a strong correlation between a 'literary misery index' derived from English language books and a moving average of the previous decade of the annual U.S. economic misery index, which is the sum of inflation and unemployment rates. We find a peak in the goodness of fit at 11 years for the moving average. The fit between the two misery indices holds when using different techniques to measure the literary misery index, and this fit is significantly better than other possible correlations with different emotion indices. To check the robustness of the results, we also analysed books written in German language and obtained very similar correlations with the German economic misery index. The results suggest that millions of books published every year average the authors' shared economic experiences over the past decade.

  12. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

    Full Text Available Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administration of E1 prostaglandin (Misoprostol, and intravenous infusion of Oxytocin-Richter. The assessment of rediness of parturient canals was conducted by Bishop’s score; the labour course was assessed by a partogram. The effectiveness of labour induction techniques was assessed by the number of administered doses, the time of onset of regular labour, the course of labour and the postpartum period and the presence of complications, and the course of the early neonatal period, which implied the assessment of the child’s condition, described in the newborn development record. The foetus was assessed by medical ultrasound and antenatal and intranatal cardiotocography (CTG. Obtained results were analysed with SAS statistical processing software. Results The overall percentage of successful births with intravaginal administration of Misoprostol was 93 per cent (83 of cases. This percentage was higher than in the amniotomy group (relative risk (RR 11.7 and was similar to the oxytocin group (RR 0.83. Amniotomy was effective in 54 per cent (39 of cases, when it induced regular labour. Intravenous oxytocin infusion was effective in 94 per cent (89 of cases. This percentage was higher than that with amniotomy (RR 12.5. Conclusions The success of vaginal delivery after previous Caesarean section can be achieved in almost 70 per cent of cases. At that, labour induction does not decrease this indicator and remains within population boundaries.

  13. The pattern of moderate acute malnutrition in a rural area of Sri Lanka: Integrated approach is needed to address the problem

    International Nuclear Information System (INIS)

    Peiris, Dilka; Nandasena, Sumal

    2014-01-01

    8.8% have initiated the solid/semi-solid food during the first 6 months. Highest weight for age percentage of <-2SD reported from the children age 49 - 60 months (33.3% (CI = 21- 48.5)). Highest percentage of MAM was reported in the age group of 49-60 months. About 10% of children had presumed pneumonia with in the 2 weeks prior to the survey. A wide disparity was noticed in underweight proportions over the geographical localities. Majority of the children had haemoglobin levels less than 11.0 g/dl (n = 78, 65.0%). Conclusions and recommendations: Weight for age percentage of <-2SD is higher than the national average while weight for height percentage of -2SD is lesser than the National average. Multiple factors such as high levels of respiratory tract infections, poverty, lack awareness etc. may contribute to the low nutritional status of children. Integrated approach is needed to address the malnutrition in this area. A short term targeted interventions should be designed for the MAM child. (author)

  14. The Green, Amber, Red Delineation of Risk and Need (GARDIAN) management system: a pragmatic approach to optimizing heart health from primary prevention to chronic disease management.

    Science.gov (United States)

    Carrington, Melinda J; Kok, Simone; Jansen, Kiki; Stewart, Simon

    2013-08-01

    A sustained epidemic of cardiovascular disease and related risk factors is a global phenomenon contributing significantly to premature deaths and costly morbidity. Preventative strategies across the full continuum of life, from a population to individual perspective, are not optimally applied. This paper describes a simple and adaptable 'traffic-light' system we have developed to systematically perform individual risk and need delineation in order to 'titrate' the intensity and frequency of healthcare intervention in a cost-effective manner. The GARDIAN (Green Amber Red Delineation of Risk and Need) system is an individual assessment of risk and need that modulates the frequency and intensity of future healthcare intervention. Individual assessment of risk and need for ongoing intervention and support is determined with reference to three domains: (1) clinical stability, (2) gold-standard management, and (3) a broader, holistic assessment of individual circumstance. This can be applied from a primary prevention, secondary prevention, or chronic disease management perspective. Our experience with applying and validating GARDIAN to titrate healthcare resources according to need has been extensive to date, with >5000 individuals profiled in a host of clinical settings. A series of clinical randomized trials will determine the impact of the GARDIAN system on important indices of healthcare utilization and health status. The GARDIAN model to delineating risk and need for varied intensity of management shows strong potential to cost effectively improve health outcomes for both individuals at risk of heart disease and those with established heart disease.

  15. Energy needs

    International Nuclear Information System (INIS)

    Maxey, M.N.

    1982-06-01

    There seems to be a trend towards expecting energy conservation to be a panacea for the world's ills. In fact, a global perspective on energy needs shows that more, not less, energy is needed and technological innovation in energy sources is essential in order to meet the needs of more than just the developed countries. Energy-intensive technology is the amplification of our natural resources rather than their depletion. A fundamental bioethical principle must be established if we are to analyze and organize scientific evidence about hazards from currently feasible energy resources, and separate genuine from counterfeit claims to credibility. In particular, public fears about radiation hazards and radioactive waste disposal are influenced too much by rhetorical cleverness and forensic skills of a vociferous minority. Potential hazard management is ethically equitable only if it is proportioned to actual basic harm that can be identified and reduced by expenditures of human effort, time and money

  16. Tubal anastomosis after previous sterilization: a systematic review.

    Science.gov (United States)

    van Seeters, Jacoba A H; Chua, Su Jen; Mol, Ben W J; Koks, Carolien A M

    2017-05-01

    chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated. In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.

  17. Local recurrence risk after previous salvage mastectomy.

    Science.gov (United States)

    Tanabe, M; Iwase, T; Okumura, Y; Yoshida, A; Masuda, N; Nakatsukasa, K; Shien, T; Tanaka, S; Komoike, Y; Taguchi, T; Arima, N; Nishimura, R; Inaji, H; Ishitobi, M

    2016-07-01

    Breast-conserving surgery is a standard treatment for early breast cancer. For ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery, salvage mastectomy is the current standard surgical procedure. However, it is not rare for patients with IBTR who have received salvage mastectomy to develop local recurrence. In this study, we examined the risk factors of local recurrence after salvage mastectomy for IBTR. A total of 118 consecutive patients who had histologically confirmed IBTR without distant metastases and underwent salvage mastectomy without irradiation for IBTR between 1989 and 2008 were included from eight institutions in Japan. The risk factors of local recurrence were assessed. The median follow-up period from salvage mastectomy for IBTR was 4.6 years. Patients with pN2 or higher on diagnosis of the primary tumor showed significantly poorer local recurrence-free survival than those with pN0 or pN1 at primary tumor (p mastectomy for IBTR. Further research and validation studies are needed. (UMIN-CTR number UMIN000008136). Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. The risk-benefit task of research ethics committees: An evaluation of current approaches and the need to incorporate decision studies methods

    Directory of Open Access Journals (Sweden)

    Bernabe Rosemarie D L C

    2012-04-01

    Full Text Available Abstract Background Research ethics committees (RECs are tasked to assess the risks and the benefits of a trial. Currently, two procedure-level approaches are predominant, the Net Risk Test and the Component Analysis. Discussion By looking at decision studies, we see that both procedure-level approaches conflate the various risk-benefit tasks, i.e., risk-benefit assessment, risk-benefit evaluation, risk treatment, and decision making. This conflation makes the RECs’ risk-benefit task confusing, if not impossible. We further realize that RECs are not meant to do all the risk-benefit tasks; instead, RECs are meant to evaluate risks and benefits, appraise risk treatment suggestions, and make the final decision. Conclusion As such, research ethics would benefit from looking beyond the procedure-level approaches and allowing disciplines like decision studies to be involved in the discourse on RECs’ risk-benefit task.

  19. The risk-benefit task of research ethics committees: an evaluation of current approaches and the need to incorporate decision studies methods.

    Science.gov (United States)

    Bernabe, Rosemarie D L C; van Thiel, Ghislaine J M W; Raaijmakers, Jan A M; van Delden, Johannes J M

    2012-04-20

    Research ethics committees (RECs) are tasked to assess the risks and the benefits of a trial. Currently, two procedure-level approaches are predominant, the Net Risk Test and the Component Analysis. By looking at decision studies, we see that both procedure-level approaches conflate the various risk-benefit tasks, i.e., risk-benefit assessment, risk-benefit evaluation, risk treatment, and decision making. This conflation makes the RECs' risk-benefit task confusing, if not impossible. We further realize that RECs are not meant to do all the risk-benefit tasks; instead, RECs are meant to evaluate risks and benefits, appraise risk treatment suggestions, and make the final decision. As such, research ethics would benefit from looking beyond the procedure-level approaches and allowing disciplines like decision studies to be involved in the discourse on RECs' risk-benefit task.

  20. Partnering with students to explore the health needs of an ethnically diverse, low-resource school: an innovative large group assessment approach.

    Science.gov (United States)

    Vaughn, Lisa M; Jacquez, Farrah; Zhao, Juanjuan; Lang, Maria

    2011-01-01

    School-based health programs have a unique and powerful potential to meet the health needs of children because students spend more time in schools than in any other environment away from home. We conducted a participatory needs assessment called a Group Level Assessment (GLA) in collaboration with an economically disadvantaged and ethnically diverse school to facilitate the students' identification of and subsequent action toward important health needs. A total of 68 students in Kindergarten through eighth grade participated in the GLA. Four major themes emerged: the desire for more sports and after-school activities, better school lunches, enjoyment of friends and families, and overall happiness. Other health issues identified by the students included limited health/medical care, stress resulting from schoolwork and grades, positive self-image, and the desire for more art opportunities. The salient themes identified by students are consistent with many factors identified in the academic literature as important in child socioemotional functioning.

  1. Research Paper: Determination of the Needs of Mothering Handling Training for Family Caregiving of Children and Youth With Cerebral Palsy at Home Based on a Family- Centered Approach

    Directory of Open Access Journals (Sweden)

    Hamid Dalvand

    2016-11-01

    Conclusion The results showed that the highest priority of needs of mothering handling training was self-care, feeding, toileting, and functional mobility. However, the needs of mothering handling training enhanced with increasing severity of fine motor function lesions and age. The simultaneous relationships between age and MACS levels in children with CP have no effect on the priorities of mothering handling training. Organized training of families and caregivers about needs of mothering handling training and proper care of their children are facilitating steps in promoting the education of mothers of children with CP. It seems that the understanding and education of mothering handling for therapists responsible for managing children with CP and the education of their parents can open the way to effective caring and treatment.

  2. Fostering Self-Determination in Students with Intellectual Disabilities: Secondary Special Education Teachers' Self-Reported Approaches, Barriers, and Support Needs

    Science.gov (United States)

    Kemb, Paul B.

    2017-01-01

    While considerable progress is being documented in the field of special education, there is, however, a general concern about the quality of the preparation of students with disabilities transitioning from secondary school into community life. Literature indicates that the need for self-determination skills is more evident in youth with…

  3. McKinney-Vento Act: The Effectiveness of One District's Whole Child Approach to Meeting The Needs of a Vulnerable Population

    Science.gov (United States)

    Nelms, Amanda

    2017-01-01

    This study was conducted to determine if a growing, urban school district was adequately addressing the academic, social-emotional and behavioral needs of students identified as homeless under the McKinney-Vento Act. McKinney-Vento eligible students were compared to non-homeless virtual twins. Each twin was created through averaging three…

  4. Needed Computations Shortcutting Needed Steps

    DEFF Research Database (Denmark)

    Antoy, Sergio; Johannsen, Jacob; Libby, Steven

    We define a compilation scheme for a constructor-based strongly-sequential graph rewriting system which shortcuts some needed steps. The result of this compilation is another constructor-based graph rewriting system that is normalizing for the original system when using an innermost strategy. We...... then modify the resulting rewrite sytem in a way that avoids totally or partially the construction of the contracta of some needed steps of a computation. The resulting rewrite system can be easily implemented by eager functions in a variety of programming languages. When computing normal forms in this way...

  5. Response to health insurance by previously uninsured rural children.

    Science.gov (United States)

    Tilford, J M; Robbins, J M; Shema, S J; Farmer, F L

    1999-08-01

    To examine the healthcare utilization and costs of previously uninsured rural children. Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

  6. A museum-based urban teacher residency program's approach to strengthening the STEM pipeline: Channeling highly qualified Earth Science teachers into high needs schools

    Science.gov (United States)

    Ustunisik, G. K.; Zirakparvar, N. A.

    2015-12-01

    Channeling better prepared Earth Science teachers into secondary schools with low achievement rates in STEM subjects is essential to ensuring that the students attending these schools are ultimately afforded the opportunity to take advantage of projected growth in the global geoscience workforce. Here, a museum-based urban teacher residency (UTR) program's approach to building subject specific content knowledge and research experience in Earth Science teacher candidates is described. In the museum-based program, graduate-level science courses and research experiences are designed and implemented specifically for the UTR by active Earth and Space research scientists that account for almost half of the program's faculty. Because these courses and research experiences are designed specifically for the teacher candidates, they are different than many science courses and research experiences available to pre-service teachers in a university setting. At the same time, the museum-based program is the only UTR to incorporate such a rigorous science curriculum, and some possible advantages and disadvantages of the program's approach are also considered here. While the impact of the program's approach on student achievement rates has yet to be evaluated, there is promise in the well documented links between a teacher's own experience with the practice of science and that teacher's ability to leverage effective pedagogical content knowledge in the teaching of science. Because the museum-based program's science curriculum is balanced against the educational coursework and teaching residencies that necessarily form the program's backbone, the museum's approach to strengthening the teacher candidate's science background may also inform the faculty and administration of other UTRs in cases where one of their program goals is to further expand their teacher candidate's content knowledge and practical subject matter experience.

  7. Sustainable Development Goals (SDGs), and their implementation: A national global framework for health, development and equity needs a systems approach at every level.

    Science.gov (United States)

    Morton, Stephen; Pencheon, David; Squires, Neil

    2017-12-01

    The Sustainable Development Goals (SDGs) are a set of global goals for fair and sustainable health at every level: from planetary biosphere to local community. The aim is to end poverty, protect the planet and ensure that all people enjoy peace and prosperity, now and in the future. The UN has established web-sites to inform the implementation of the SDGs and an Inter-Agency and Expert Group on an Indicator Framework. We have searched for independent commentaries and analysis. The goals represent a framework that is scientifically robust, and widely intuitive intended to build upon the progress established by the Millennium Development Goals (MDGs). There is a need for system wide strategic planning to integrate the economic, social and environmental dimensions into policy and actions. Many countries have yet to understand the difference between the MDGs and the SDGs, particularly their universality, the huge potential of new data methods to help with their implementation, and the systems thinking that is needed to deliver the vision. The danger is that individual goals may be prioritized without an understanding of the potential positive interactions between goals. There is an increasing understanding that sustainable development needs a paradigm shift in our understanding of the interaction between the real economy and quality of life. There would be many social, environmental and economic benefits in changing our current model. We need to develop systems wide understanding of what supports a healthy environment and the art and science of making change. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  8. The Global Dimension of Water Governance: Why the River Basin Approach Is No Longer Sufficient and Why Cooperative Action at Global Level Is Needed

    Directory of Open Access Journals (Sweden)

    Arjen Y. Hoekstra

    2010-12-01

    Full Text Available When water problems extend beyond the borders of local communities, the river basin is generally seen as the most appropriate unit for analysis, planning, and institutional arrangements. In this paper it is argued that addressing water problems at the river basin level is not always sufficient. Many of today’s seemingly local water issues carry a (subcontinental or even global dimension, which urges for a governance approach that comprises institutional arrangements at a level beyond that of the river basin. This paper examines a number of arguments for the thesis that good water governance requires a global approach complementary to the river basin approach. Subsequently, it identifies four major issues to be addressed at global scale: Efficiency, equity, sustainability and security of water supply in a globalised world. Finally, the paper raises the question of what kind of institutional arrangements could be developed to cope with the global dimension of water issues. A few possible directions are explored, ranging from an international protocol on full-cost water pricing and a water label for water-intensive products to the implementation of water footprint quotas and the water-neutral concept.

  9. TEACHER NEEDED

    CERN Multimedia

    2002-01-01

    Part-time teacher of primary English needed from 1st December 2002 to teach English National Curriculum (KS2) and NLS to mother tongue or good second language English-speakers aged 7-10. 4 hours contact time per week, team planning, marking and meetings. Candidates should be English mother tongue qualified teachers, confident, flexible classroom practitioners and team players. For further details and how to apply: engnat@hotmail.com or 04 50 40 82 66. Apply as soon as possible, and in any case before November 20th. English National Programme - Lycée International, Ferney-Voltaire

  10. Fulminant Pneumococcal Pericarditis in a Previously Healthy Patient.

    Science.gov (United States)

    Trpkov, Cvetan; Nath, Ermin; Moon, Michael; Windram, Jonathan; Graham, Michelle M

    2017-04-01

    Purulent pericarditis is a rare acutely life-threatening condition. Initial symptoms, signs, and investigations can be nonspecific. Echocardiography is invaluable for establishing the diagnosis and initial management. We present a case of a previously healthy patient with purulent pericarditis caused by Streptococcus pneumoniae in the absence of a primary focus of infection. The patient deteriorated rapidly with cardiac tamponade and septic shock and was managed successfully by a combined medical and surgical approach. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  11. TEACHERS NEEDED

    CERN Multimedia

    2001-01-01

    The English Language Programme of the Lycée International de Ferney-Voltaire has two teaching posts available for la rentrée 2001. 1. Part-time teacher of Primary-level English Candidates for the post need to be mother-tongue English speakers. They should have a relevant degree and teaching qualification. The post involves teaching the English curriculum to pupils who are within the French educational system. Classes take place on Tuesday afternoons at the Lycée. Team spirit necessary as teachers work as a team. Induction & training are offered. 2. Part-time teacher of Secondary-level history-geography Candididates for the post need to be mother-tongue English speakers. They should have a relevant degree in history or geography and also a strong interest in the other subject. They should have a relevant teaching qualification and be confident classroom practioners. For more information on either of these posts please contact the school office on 04.50.40.82...

  12. Design of pulsed perforated-plate columns for industrial scale mass transfer applications - present experience and the need for a model based approach

    International Nuclear Information System (INIS)

    Roy, Amitava

    2010-01-01

    Mass transfer is a vital unit operation in the processing of spent nuclear fuel in the backend of closed fuel cycle and Pulsed perforated plate extraction columns are used as mass transfer device for more than five decades. The pulsed perforated plate column is an agitated differential contactor, which has wide applicability due to its simplicity, high mass transfer efficiency, high through put, suitability for maintenance free remote operation, ease of cleaning/decontamination and cost effectiveness. Design of pulsed columns are based on a model proposed to describe the hydrodynamics and mass transfer. In equilibrium stage model, the HETS values are obtained from pilot plant experiments and then scaled empirically to design columns for industrial application. The dispersion model accounts for mass transfer kinetics and back-mixing. The drop population balance model can describe complex hydrodynamics of dispersed phase, that is, drop formation, break-up and drop-to-drop interactions. In recent years, significant progress has been made to model pulsed columns using CFD, which provides complete mathematical description of hydrodynamics in terms of spatial distribution of flow fields and 3D visualization. Under the condition of pulsation, the poly-dispersed nature of turbulent droplet swarm renders modeling difficult. In the absence of industry acceptance of proposed models, the conventional chemical engineering practice is to use HETS-NTS concept or HTU-NTU approach to design extraction columns. The practicability of HTU-NTU approach has some limitations due to the lack of experimental data on individual film mass transfer coefficients. Presently, the HETS-NTS concept has been used for designing the columns, which has given satisfactory performance. The design objective is mainly to arrive at the diameter and height of the mass transfer section for a specific plate geometry, fluid properties and pulsing condition to meet the intended throughput (capacity) and mass

  13. Rates of induced abortion in Denmark according to age, previous births and previous abortions

    Directory of Open Access Journals (Sweden)

    Marie-Louise H. Hansen

    2009-11-01

    Full Text Available Background: Whereas the effects of various socio-demographic determinants on a woman's risk of having an abortion are relatively well-documented, less attention has been given to the effect of previous abortions and births. Objective: To study the effect of previous abortions and births on Danish women's risk of an abortion, in addition to a number of demographic and personal characteristics. Data and methods: From the Fertility of Women and Couples Dataset we obtained data on the number of live births and induced abortions by year (1981-2001, age (16-39, county of residence and marital status. Logistic regression analysis was used to estimate the influence of the explanatory variables on the probability of having an abortion in a relevant year. Main findings and conclusion: A woman's risk of having an abortion increases with the number of previous births and previous abortions. Some interactions were was found in the way a woman's risk of abortion varies with calendar year, age and parity. The risk of an abortion for women with no children decreases while the risk of an abortion for women with children increases over time. Furthermore, the risk of an abortion decreases with age, but relatively more so for women with children compared to childless women. Trends for teenagers are discussed in a separate section.

  14. Evolved Expendable Launch Vehicle: The Air Force Needs to Adopt an Incremental Approach to Future Acquisition Planning to Enable Incorporation of Lessons Learned

    Science.gov (United States)

    2015-08-01

    intermediate (6,000-18,000 lbs to GTO), and heavy (18,000- 28,000 lbs to GTO) classes. The Falcon 9 can lift 10,692 lbs to GTO. To launch all DOD...missions, SpaceX will need to build and have certified the Falcon Heavy vehicle. Falcon Heavy entered the Air Force certification process in April 2015 and...is expected to take place, and launch services for Delta IV Heavy missions are generally ordered three years prior to launch. Thus the Phase 1

  15. The SPICE concept - An approach to providing geometric and other ancillary information needed for interpretation of data returned from space science instruments

    Science.gov (United States)

    Acton, Charles H., Jr.

    1990-01-01

    The Navigation Ancillary Information Facility (NAIF), acting under the direction of NASA's Office of Space Science and Applications, and with substantial participation of the planetary science community, is designing and implementing an ancillary data system - called SPICE - to assist scientists in planning and interpreting scientific observations taken from spaceborne instruments. The principal objective of the implemented SPICE system is that it will hold the essential geometric and related ancillary information needed to recover the full value of science instrument data, and that it will facilitate correlations of individual instrument datasets with data obtained from other instruments on the same or other spacecraft.

  16. Path-oriented early reaction to approaching disruptions in ASDEX Upgrade and TCV in view of the future needs for ITER and DEMO

    Science.gov (United States)

    Maraschek, M.; Gude, A.; Igochine, V.; Zohm, H.; Alessi, E.; Bernert, M.; Cianfarani, C.; Coda, S.; Duval, B.; Esposito, B.; Fietz, S.; Fontana, M.; Galperti, C.; Giannone, L.; Goodman, T.; Granucci, G.; Marelli, L.; Novak, S.; Paccagnella, R.; Pautasso, G.; Piovesan, P.; Porte, L.; Potzel, S.; Rapson, C.; Reich, M.; Sauter, O.; Sheikh, U.; Sozzi, C.; Spizzo, G.; Stober, J.; Treutterer, W.; ZancaP; ASDEX Upgrade team; TCV team; the EUROfusion MST1 Team

    2018-01-01

    Routine reaction to approaching disruptions in tokamaks is currently largely limited to machine protection by mitigating an ongoing disruption, which remains a basic requirement for ITER and DEMO [1]. Nevertheless, a mitigated disruption still generates stress to the device. Additionally, in future fusion devices, high-performance discharge time itself will be very valuable. Instead of reacting only on generic features, occurring shortly before the disruption, the ultimate goal is to actively avoid approaching disruptions at an early stage, sustain the discharges whenever possible and restrict mitigated disruptions to major failures. Knowledge of the most relevant root causes and the corresponding chain of events leading to disruption, the disruption path, is a prerequisite. For each disruption path, physics-based sensors and adequate actuators must be defined and their limitations considered. Early reaction facilitates the efficiency of the actuators and enhances the probability of a full recovery. Thus, sensors that detect potential disruptions in time are to be identified. Once the entrance into a disruption path is detected, we propose a hierarchy of actions consisting of (I) recovery of the discharge to full performance or at least continuation with a less disruption-prone backup scenario, (II) complete avoidance of disruption to sustain the discharge or at least delay it for a controlled termination and, (III), only as last resort, a disruption mitigation. Based on the understanding of disruption paths, a hierarchical and path-specific handling strategy must be developed. Such schemes, testable in present devices, could serve as guidelines for ITER and DEMO operation. For some disruption paths, experiments have been performed at ASDEX Upgrade and TCV. Disruptions were provoked in TCV by impurity injection into ELMy H-mode discharges and in ASDEX Upgrade by forcing a density limit in H-mode discharges. The new approach proposed in this paper is discussed for

  17. A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management.

    Science.gov (United States)

    Bendixen, Roxanna M; Fairman, Andrea D; Karavolis, Meredith; Sullivan, Carly; Parmanto, Bambang

    2017-09-26

    Many adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program. Our objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers. Our project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA. A total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management. Our findings suggest that most individuals keep their mobile phones with them at all times and typically use

  18. Prevalence of Infraumbilical Adhesions in Women With Previous Laparoscopy

    Science.gov (United States)

    Ku, Lowell; Wong, Herb; Liu, C. Y.; Phelps, John Y.

    2007-01-01

    Background and Objectives: The aim of this study is to evaluate the prevalence of intraabdominal adhesions to the umbilicus following gynecologic laparoscopy through an umbilical incision. Methods: A retrospective review was performed of all gynecologic laparoscopic procedures in a private practice setting to identify patients with a repeat laparoscopy who had a history of a previous laparoscopy through an umbilical incision. Patients with a history of other surgeries were excluded. All repeat laparoscopies used a left upper quadrant entry technique where the abdominal cavity was surveyed for adhesions. We also reviewed adverse events attributable to the left upper quadrant entry approach. Results: We identified 151 patients who underwent a second laparoscopy and had a previous umbilical scar. Thirty-two of the 151 (21.2%) patients with a history of a laparoscopy had evidence of adhesions to the umbilical undersurface. No adverse events or injuries were attributed to the left upper quadrant entry technique. Conclusions: Adhesions to the umbilical undersurface occur in 21.2% of patients who have undergone a prior laparoscopy through an umbilical incision. For this reason, we recommend an alternate location for entry in patients with an umbilical scar from a previous laparoscopy. PMID:17651555

  19. Air pollution and detrimental effects on children’s brain. The need for a multidisciplinary approach to the issue complexity and challenges

    Directory of Open Access Journals (Sweden)

    Lilian eCalderón-Garcidueñas

    2014-08-01

    Full Text Available Millions of children in polluted cities are showing brain detrimental effects. Urban children exhibit brain structural and volumetric abnormalities, systemic inflammation, olfactory, auditory, vestibular and cognitive deficits v low-pollution controls. Neuroinflammation and blood-brain-barrier breakdown target the olfactory bulb, prefrontal cortex and brainstem, but are diffusely present throughout the brain. Urban adolescent Apolipoprotein E4 carriers significantly accelerate Alzheimer pathology. Neurocognitive effects of air pollution are permanent, apparent across all populations, and potentially clinically relevant as early evidence of evolving neurodegenerative changes. The diffuse nature of the neuroinflammation and neurodegeneration forces to employ a weight of evidence approach incorporating current clinical, cognitive, neurophysiological, radiological and epidemiological research. Pediatric air pollution research requires extensive multidisciplinary collaborations to accomplish a critical goal: to protect exposed children through multidimensional interventions having both broad impact and reach. Protecting children and teens from neural effects of air pollution should be of pressing importance for public health.

  20. The Need for an Alternative Narrative to the History of Ideas or To Pay a Debt to Women: A Feminist Approach to Ricœur's Thought

    Directory of Open Access Journals (Sweden)

    Fernanda Henriques

    2013-06-01

    Full Text Available This paper explores the thought of Paul Ricœur from a feminist point of view. My goal is to show that it is necessary to narrate differently the history of our culture – in particular, the history of philosophy – in order for wommen to attain a self-representation that is equal to that of men. I seek to show that Ricoeur’s philosophy – especially his approach to the topics of memory and history, on the one hand, and the human capacity for initiative, on the other hand– can support the idea that it is possible and legitimate to tell our history otherwise by envisioning a more accurate truth about ourselves. 

  1. Policy needs and options for a common approach towards modelling and simulation of human physiology and diseases with a focus on the virtual physiological human.

    Science.gov (United States)

    Viceconti, Marco; McCulloch, Andrew D

    2011-01-01

    Life is the result of an intricate systemic interaction between many processes occurring at radically different spatial and temporal scales. Every day, worldwide biomedical research and clinical practice produce a huge amount of information on such processes. However, this information being highly fragmented, its integration is largely left to the human actors who find this task increasingly and ever more demanding in a context where the information available continues to increase exponentially. Investments in the Virtual Physiological Human (VPH) research are largely motivated by the need for integration in healthcare. As all health information becomes digital, the complexity of health care will continue to evolve, translating into an ever increasing pressure which will result from a growing demand in parallel to limited budgets. Hence, the best way to achieve the dream of personalised, preventive, and participative medicine at sustainable costs will be through the integration of all available data, information and knowledge.

  2. STAFF NEEDED

    CERN Multimedia

    2001-01-01

    The English National Programme, part of the Lycée International de Ferney-Voltaire (France) needs the following staff for September 2001: A part-time teacher of primary English The post involves teaching the English curriculum to pupils who are within the French educational system: Classes take place on Tuesday afternoons at the Lycée, Team spirit necessary as teachers work as a team, Induction & training are offered. A part time teacher of senior secondary history-geography in English A part time teacher of secondary mathematics in English Teachers must be mother-tongue English speakers and have a relevant degree and/or teaching qualification. For the history-geography post, either history or geography degrees are acceptable. Please send your c.v. and a letter of application to Peter Woodburn, Head, English National Programme, Lycée International, 01216 Ferney-Voltaire, France. (Email: engnat@hotmail.com) Telephone 04 50 40 82 66 for further details of posts. Ple...

  3. Measuring needs

    Directory of Open Access Journals (Sweden)

    Laura Murianni

    2008-06-01

    Full Text Available The interest in measuring the health of populations, through measuring the demand and offers of health care, is deeply rooted in history. Population health indicators in use today are built upon from mortality measures from the 1500s; regular census information starting from the 1800s; civil registration records of vital statistics commencing in the 1850s; regular national surveys, which were first initiated in the 1950s; and health system and other administrative databases used widely since the 1960s. The ancient Greeks believed that the God of medicine had two daughters: Hygeia and Panacea, the first was the goddess of prevention and wellness, while the second was the goddess of treatment. Thus suggesting that people have long believed that there is more to health than health care. Today the actual concept of population health recognizes many interconnected aspects of society, the environment, and individuals all contributing to health. To increase opportunities for comparability, more valid, comprehensive and standardized ways of measuring and reporting on population health indicators are needed. The use of health indicators contributes to overall population health goals, namely improving the health populations, reducing health inequalities and measuring the performance of health care system. The objective of performance assessment is to provide governments and populations with information about the state of their health care system.

  4. Congruency sequence effects are driven by previous-trial congruency, not previous-trial response conflict

    OpenAIRE

    Weissman, Daniel H.; Carp, Joshua

    2013-01-01

    Congruency effects in distracter interference tasks are often smaller after incongruent trials than after congruent trials. However, the sources of such congruency sequence effects (CSEs) are controversial. The conflict monitoring model of cognitive control links CSEs to the detection and resolution of response conflict. In contrast, competing theories attribute CSEs to attentional or affective processes that vary with previous-trial congruency (incongruent vs. congruent). The present study s...

  5. Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy.

    Science.gov (United States)

    Spinillo, Arsenio; Beneventi, Fausta; Ramoni, Véronique; Caporali, Roberto; Locatelli, Elena; Simonetta, Margherita; Cavagnoli, Chiara; Alpini, Claudia; Albonico, Giulia; Prisco, Elena; Montecucco, Carlomaurizio

    2012-06-01

    The objective of this study was to evaluate the rates of previously undiagnosed rheumatic diseases during the first trimester of pregnancy and their impact on the pregnancy outcome. Pregnant women in their first trimester were screened using a two-step approach using a self-administered 10-item questionnaire and subsequent testing for rheumatic autoantibodies (antinuclear antibody, anti-double-stranded DNA, anti-extractable nuclear antigen, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies and lupus anticoagulant) and evaluation by a rheumatologist. Overall, the complications of pregnancy evaluated included fetal loss, pre-eclampsia, gestational diabetes, fetal growth restriction, delivery at less than 34 weeks, neonatal resuscitation and admission to the neonatal intensive care unit. Out of the 2458 women screened, the authors identified 62 (2.5%) women with previously undiagnosed undifferentiated connective tissue disease (UCTD) and 24 (0.98%) women with previously undiagnosed definite systemic rheumatic disease. The prevalences were seven (0.28%) for systemic lupus erythematosus and Sjogren's syndrome, six (0.24%) for rheumatoid arthritis, three (0.12%) for antiphospholipid syndrome and one (0.04%) for systemic sclerosis. In multiple exact logistic regression, after adjustment for potential confounders, the OR of overall complications of pregnancy were 2.81 (95% CI 1.29 to 6.18) in women with UCTD and 4.57 (95% CI 1.57 to 13.57) in those with definite diseases, respectively, compared with asymptomatic controls. In our population approximately 2.5% and 1% of first trimester pregnant women had a previously undiagnosed UCTD and definite systemic rheumatic disease, respectively. These conditions were associated with significant negative effects on the outcome of pregnancy.

  6. A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?

    Science.gov (United States)

    Claudet, Isabelle; Le Breton, Mathilde; Bréhin, Camille; Franchitto, Nicolas

    2017-04-01

    Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%). The mean age was 16.5 ± 5.2 months, and mean weight was 11.1 ± 2.1 Kg. Sixty percent of admissions occurred between 2012 and 2014. More severe presentations, based on Poisoning Severity Score, occurred over the past 2 years. Four children experienced seizures before admission. Ten children (34%) had a decreased level of consciousness (GCS cannabis consumption. This study supports the impression that accidental child poisonings with cannabis have been more serious than previously thought for 2 years. This observation may be explained by (1) the increased THC concentration in cannabis and (2) the widespread use in young adults, even after they become parents. Introducing an addiction team inside the PED could help to improve the care links with these parents. What is Known: • Cases of unintentional cannabis intoxication in children have been increasing for many years due to an increase of potency. What is New: • We highlight an increase in more severe presentations in children under the age of 3 occurring over the past 2 years, which will indicate the importance of assessing cannabis abuse in parents by a specialized addiction team.

  7. Outcomes of minimally invasive lung transplantation in a single centre: the routine approach for the future or do we still need clamshell incision?

    Science.gov (United States)

    Marczin, Nandor; Popov, Aron-Frederik; Zych, Bartlomiej; Romano, Rosalba; Kiss, Rudolf; Sabashnikov, Anton; Soresi, Simona; De Robertis, Fabio; Bahrami, Toufan; Amrani, Mohamed; Weymann, Alexander; McDermott, Grainne; Krueger, Heike; Carby, Martin; Dalal, Paras; Simon, André Ruediger

    2016-05-01

    Minimally invasive lung transplantation (MILT) via bilateral anterior thoracotomies has emerged as a novel surgical strategy with potential patient benefits when compared with transverse thoracosternotomy (clamshell incision, CS). The aim of this study is to compare MILT with CS by focusing on operative characteristics, postoperative organ function and support and mid-term clinical outcomes at Harefield Hospital. It was a retrospective observational study evaluating all bilateral sequential lung transplants between April 2010 and November 2013. CS was performed in 124 patients and MILT in 70 patients. Skin-to-skin surgical time was less in the MILT group [285 (265, 339) min] compared with CS [380 (306, 565) min] and MILT-cardiopulmonary bypass [426 (360, 478) min]. Ischaemic time was significantly longer (502 ± 116 vs 395 ± 145 min) in the MILT group compared with CS (P mechanical ventilation was shorter (26 vs 44 h, P benefits compared with our traditional approach of clamshell operations. These observations warrant larger definite studies to further evaluate the impact of MILT on physiological, clinical and patient-reported outcomes. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Does Quantitative Research in Child Maltreatment Tell the Whole Story? The Need for Mixed-Methods Approaches to Explore the Effects of Maltreatment in Infancy.

    Science.gov (United States)

    Glass, Samuel; Gajwani, Ruchika; Turner-Halliday, Fiona

    Background and Aims. Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N = 92) entering care (age 6-60 months) combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families. Methods. Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents. Results. Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p = 0.001) and between reported domestic violence and decreased DAI inhibited (p = 0.016) and disinhibited (p = 0.004) attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1) overlapping maltreatment factors occur in most cases and (2) maltreatment effects may be particularly challenging to isolate. Conclusions. Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches.

  9. Does Quantitative Research in Child Maltreatment Tell the Whole Story? The Need for Mixed-Methods Approaches to Explore the Effects of Maltreatment in Infancy

    Directory of Open Access Journals (Sweden)

    Samuel Glass

    2016-01-01

    Full Text Available Background and Aims. Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N=92 entering care (age 6–60 months combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families. Methods. Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents. Results. Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p=0.001 and between reported domestic violence and decreased DAI inhibited (p=0.016 and disinhibited (p=0.004 attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1 overlapping maltreatment factors occur in most cases and (2 maltreatment effects may be particularly challenging to isolate. Conclusions. Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches.

  10. The Influence of Adult Attachment on Patient Self-Management in Primary Care--The Need for a Personalized Approach and Patient-Centred Care.

    Directory of Open Access Journals (Sweden)

    Katja Brenk-Franz

    Full Text Available Self-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions.In the apricare study (Adult Attachment in Primary Care we used a prospective longitudinal design to examine the association between adult attachment and self-management in primary care patients with multimorbidity. The attachment dimensions avoidance and anxiety were measured using the ECR-RD. Self-management skills were measured by the FERUS (motivation to change, coping, self-efficacy, hope, social support and self-management-behaviour by the DSMQ (glucose management, dietary control, physical activity, health-care use. Clinical diagnosis and severity of disease were assessed by the patients' GPs. Multivariate analyses (GLM were used to assess the relationship between the dimensions of adult attachment and patient self-management.219 patients in primary care with multiple chronic conditions (type II diabetes, hypertension and at least one other chronic condition between the ages of 50 and 85 were included in the study. The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity. Avoidance was negatively associated with coping, self-efficacy, social support and health care use.The two attachment dimensions anxiety and avoidance are associated with different components of self-management. A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care.

  11. Using Hospital Discharge Database to Characterize Chagas Disease Evolution in Spain: There Is a Need for a Systematic Approach towards Disease Detection and Control

    Science.gov (United States)

    Gherasim, Alin; Gomez-Barroso, Diana; García, Jezabel; Benito, Agustín; Aparicio, Pilar

    2015-01-01

    After the United States, Spain comes second in the list of countries receiving migrants from Latin America, and, therefore, it is the European country with the highest expected number of infected patients of Chagas disease. We have studied the National Health System’s Hospital Discharge Records Database (CMBD) in order to describe the disease evolution from 1997 to 2011 in Spain. We performed a retrospective descriptive study using CMBD information on hospitalizations including Chagas disease. Data was divided in two periods with similar length in time: 1997-2004 and 2005-2011. Hospitalization rates were calculated and clinical characteristics were described. We used multivariable logistic regression to calculate adjusted odds-ratio (aOR) for the association between various conditions and being hospitalized with organ affectation. A total of 1729 hospitalization records were identified. Hospitalization rates for the two periods were 18 and 242.8/100000 population, respectively. The median age was 35 years (range 0-87), 74% were female and the 16-45 age-group was mostly represented (69.8%). Overall, 23.4% hospitalizations included the diagnosis of Chagas disease with organ complications. Being male [aOR: 1.3 (1.00-1.77)], aged 45 and 64 years [aOR: 2.59 (1.42-4.71)], and a median hospitalization cost above 3,065 euro [aOR: 2.03 (3.73-7.86)] were associated with hospitalizations with organ affectation. Since 2005, the number of detected infections increased in Spain. The predominant patients’ profile (asymptomatic women at fertile age) and the conditions associated with organ affectation underlines the need for increased efforts towards the early detection of T cruzi. PMID:25884198

  12. Proteomics Analysis Reveals Previously Uncharacterized Virulence Factors in Vibrio proteolyticus.

    Science.gov (United States)

    Ray, Ann; Kinch, Lisa N; de Souza Santos, Marcela; Grishin, Nick V; Orth, Kim; Salomon, Dor

    2016-07-26

    Members of the genus Vibrio include many pathogens of humans and marine animals that share genetic information via horizontal gene transfer. Hence, the Vibrio pan-genome carries the potential to establish new pathogenic strains by sharing virulence determinants, many of which have yet to be characterized. Here, we investigated the virulence properties of Vibrio proteolyticus, a Gram-negative marine bacterium previously identified as part of the Vibrio consortium isolated from diseased corals. We found that V. proteolyticus causes actin cytoskeleton rearrangements followed by cell lysis in HeLa cells in a contact-independent manner. In search of the responsible virulence factor involved, we determined the V. proteolyticus secretome. This proteomics approach revealed various putative virulence factors, including active type VI secretion systems and effectors with virulence toxin domains; however, these type VI secretion systems were not responsible for the observed cytotoxic effects. Further examination of the V. proteolyticus secretome led us to hypothesize and subsequently demonstrate that a secreted hemolysin, belonging to a previously uncharacterized clan of the leukocidin superfamily, was the toxin responsible for the V. proteolyticus-mediated cytotoxicity in both HeLa cells and macrophages. Clearly, there remains an armory of yet-to-be-discovered virulence factors in the Vibrio pan-genome that will undoubtedly provide a wealth of knowledge on how a pathogen can manipulate host cells. The pan-genome of the genus Vibrio is a potential reservoir of unidentified toxins that can provide insight into how members of this genus have successfully risen as emerging pathogens worldwide. We focused on Vibrio proteolyticus, a marine bacterium that was previously implicated in virulence toward marine animals, and characterized its interaction with eukaryotic cells. We found that this bacterium causes actin cytoskeleton rearrangements and leads to cell death. Using a

  13. Nutrition training in medical and other health professional schools in West Africa: the need to improve current approaches and enhance training effectiveness

    Directory of Open Access Journals (Sweden)

    Roger Sodjinou

    2014-07-01

    surveyed institutions had a dedicated nutrition faculty. The majority (55% of the respondents rated nutrition instruction in their institutions as insufficient. Conclusions: The results of our study reveal important gaps in current approaches to nutrition training in health professional schools in West Africa. Addressing these gaps is critical for the development of a skilled nutrition workforce in the region. Nutrition curricula that provide opportunities to obtain more insights about the basic principles of human nutrition and their application to public health and clinical practice are recommended.

  14. Assessment of radiation damage - the need for a multi-parametric and integrative approach with the help of both clinical and biological dosimetry

    International Nuclear Information System (INIS)

    Meineke, Viktor

    2008-01-01

    provide the best basis for triage and planning and providing of medical treatment after accidental radiation exposure always different and independent diagnostic procedures integrating all clinical aspects as well as different biological indicators have to be applied. Up to now this multi parametric approach is missing in medical radiation accident management. A new integrative concept is shown and discussed. (author)

  15. A Systematic Review of Changes in Marine Mammal Health in North America, 1972-2012: The Need for a Novel Integrated Approach.

    Directory of Open Access Journals (Sweden)

    Claire A Simeone

    inform indices of ocean health. A real-time, nationally centralized system for reporting marine mammal disease data is needed to be able to understand how marine mammal diseases are changing with ecosystem changes, and before these animals can truly be considered 'sentinels of ocean health'.

  16. Complicated diverticular disease of the colon, do we need to change the classical approach, a retrospective study of 110 patients in southeast England

    Directory of Open Access Journals (Sweden)

    Subhas Gokulakkrishna

    2008-01-01

    Full Text Available Abstract Background Complicated diverticular disease of the colon imposes a serious risk to patient's life, challenge to surgeons and has cost implications for health authority. The aim of this study is to evaluate the management outcome of complicated colonic diverticular disease in a district hospital and to explore the current strategies of treatment. Methods This is a retrospective study of all patients who were admitted to the surgical ward between May 2002 and November 2006 with a diagnosis of complicated diverticular disease. A proforma of patients' details, admission date, ITU admission, management outcomes and the follow up were recorded from the patients case notes and analyzed. The mean follow-up was 34 months (range 6–60 months Results The mean age of patients was 72.7 years (range 39–87 years. Thirty-one men (28.18 % and Seventy-nine women (71.81% were included in this study. Male: female ratio was 1:2.5. Sixty-eight percent of patients had one or more co-morbidities. Forty-one patients (37.27% had two or more episodes of diverticulitis while 41.8% of them had no history of diverticular disease. Eighty-six percent of patients presented with acute abdominal pain while bleeding per rectum was the main presentation in 14%. Constipation and erratic bowel habit were the commonest chronic symptoms in patients with history of diverticular disease. Generalized tenderness was reported in 64.28% while 35.71% have left iliac fossa tenderness. Leukocytosis was reported in 58 patients (52.72%. The mean time from the admission until the start of operative intervention was 20.57 hours (range 4–96 hours. Perforation was confirmed in 59.52%. Mortality was 10.90%. Another 4 (3.63% died during follow up for other reasons. Conclusion Complicated diverticular disease carries significant morbidity and mortality. These influenced by patient-related factors. Because of high mortality and morbidities, we suggest the need to target a specific group of

  17. Complicated diverticular disease of the colon, do we need to change the classical approach, a retrospective study of 110 patients in southeast England

    Science.gov (United States)

    Hussain, Abdulzahra; Mahmood, Hind; Subhas, Gokulakkrishna; EL-Hasani, Shamsi

    2008-01-01

    Background Complicated diverticular disease of the colon imposes a serious risk to patient's life, challenge to surgeons and has cost implications for health authority. The aim of this study is to evaluate the management outcome of complicated colonic diverticular disease in a district hospital and to explore the current strategies of treatment. Methods This is a retrospective study of all patients who were admitted to the surgical ward between May 2002 and November 2006 with a diagnosis of complicated diverticular disease. A proforma of patients' details, admission date, ITU admission, management outcomes and the follow up were recorded from the patients case notes and analyzed. The mean follow-up was 34 months (range 6–60 months) Results The mean age of patients was 72.7 years (range 39–87 years). Thirty-one men (28.18 %) and Seventy-nine women (71.81%) were included in this study. Male: female ratio was 1:2.5. Sixty-eight percent of patients had one or more co-morbidities. Forty-one patients (37.27%) had two or more episodes of diverticulitis while 41.8% of them had no history of diverticular disease. Eighty-six percent of patients presented with acute abdominal pain while bleeding per rectum was the main presentation in 14%. Constipation and erratic bowel habit were the commonest chronic symptoms in patients with history of diverticular disease. Generalized tenderness was reported in 64.28% while 35.71% have left iliac fossa tenderness. Leukocytosis was reported in 58 patients (52.72%). The mean time from the admission until the start of operative intervention was 20.57 hours (range 4–96 hours). Perforation was confirmed in 59.52%. Mortality was 10.90%. Another 4 (3.63%) died during follow up for other reasons. Conclusion Complicated diverticular disease carries significant morbidity and mortality. These influenced by patient-related factors. Because of high mortality and morbidities, we suggest the need to target a specific group of patients for

  18. Proteomics Analysis Reveals Previously Uncharacterized Virulence Factors in Vibrio proteolyticus

    Directory of Open Access Journals (Sweden)

    Ann Ray

    2016-07-01

    Full Text Available Members of the genus Vibrio include many pathogens of humans and marine animals that share genetic information via horizontal gene transfer. Hence, the Vibrio pan-genome carries the potential to establish new pathogenic strains by sharing virulence determinants, many of which have yet to be characterized. Here, we investigated the virulence properties of Vibrio proteolyticus, a Gram-negative marine bacterium previously identified as part of the Vibrio consortium isolated from diseased corals. We found that V. proteolyticus causes actin cytoskeleton rearrangements followed by cell lysis in HeLa cells in a contact-independent manner. In search of the responsible virulence factor involved, we determined the V. proteolyticus secretome. This proteomics approach revealed various putative virulence factors, including active type VI secretion systems and effectors with virulence toxin domains; however, these type VI secretion systems were not responsible for the observed cytotoxic effects. Further examination of the V. proteolyticus secretome led us to hypothesize and subsequently demonstrate that a secreted hemolysin, belonging to a previously uncharacterized clan of the leukocidin superfamily, was the toxin responsible for the V. proteolyticus-mediated cytotoxicity in both HeLa cells and macrophages. Clearly, there remains an armory of yet-to-be-discovered virulence factors in the Vibrio pan-genome that will undoubtedly provide a wealth of knowledge on how a pathogen can manipulate host cells.

  19. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    cited in the review may have important clinical applications, because they outline the range of problems and possible solutions in the performance of the HTx in recipients previously operated on open heart. This knowledge can facilitate the decision making process with regard to the opportunities and risks of the implementation of HTx. Given the uniqueness of each of the recipient and the donor, it is required to make a personalized approach to the question of the possible risks and to the preventive measures to reduce those risks in any given clinical situation. 

  20. Who cares for the carers at hospital discharge at the end of life? A qualitative study of current practice in discharge planning and the potential value of using The Carer Support Needs Assessment Tool (CSNAT) Approach.

    Science.gov (United States)

    Ewing, Gail; Austin, Lynn; Jones, Debra; Grande, Gunn

    2018-05-01

    Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge. To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers. Qualitative. Three National Health Service Trusts in England: focus groups with 40 hospital and community-based practitioners and 22 carer interviews about experiences of carer support during hospital discharge and views of The CSNAT Approach. Two workshops brought together 14 practitioners and five carers to discuss implementation issues. Framework analysis was conducted. Current barriers to supporting carers at hospital discharge were an organisational focus on patients' needs, what practitioners perceived as carers' often 'unrealistic expectations' of end-of-life caregiving at home and lack of awareness of patients' end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition. This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers' support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.

  1. Comprehensive Approach Training Toolkit: Training Needs Analysis

    Science.gov (United States)

    2013-03-01

    are av “Cross Cultura ppears to be a r to be any form e used the syste K). : Training Nee , social skills, m om/ er their Cros pment of flue...Michael mansystem Appr Dr. Ta Scientif ical validity of t cessarily have TY THE QUEE sented by the M TE LA REINE Défense Na uthor H. Thomso s® Incorpo...to A). al tic, at er, een n, gests A, was , to ) to- , the ive ased Page ii Résu La présen Recherche des Force exhaustiv d’exploite

  2. Typing DNA profiles from previously enhanced fingerprints using direct PCR.

    Science.gov (United States)

    Templeton, Jennifer E L; Taylor, Duncan; Handt, Oliva; Linacre, Adrian

    2017-07-01

    Fingermarks are a source of human identification both through the ridge patterns and DNA profiling. Typing nuclear STR DNA markers from previously enhanced fingermarks provides an alternative method of utilising the limited fingermark deposit that can be left behind during a criminal act. Dusting with fingerprint powders is a standard method used in classical fingermark enhancement and can affect DNA data. The ability to generate informative DNA profiles from powdered fingerprints using direct PCR swabs was investigated. Direct PCR was used as the opportunity to generate usable DNA profiles after performing any of the standard DNA extraction processes is minimal. Omitting the extraction step will, for many samples, be the key to success if there is limited sample DNA. DNA profiles were generated by direct PCR from 160 fingermarks after treatment with one of the following dactyloscopic fingerprint powders: white hadonite; silver aluminium; HiFi Volcano silk black; or black magnetic fingerprint powder. This was achieved by a combination of an optimised double-swabbing technique and swab media, omission of the extraction step to minimise loss of critical low-template DNA, and additional AmpliTaq Gold ® DNA polymerase to boost the PCR. Ninety eight out of 160 samples (61%) were considered 'up-loadable' to the Australian National Criminal Investigation DNA Database (NCIDD). The method described required a minimum of working steps, equipment and reagents, and was completed within 4h. Direct PCR allows the generation of DNA profiles from enhanced prints without the need to increase PCR cycle numbers beyond manufacturer's recommendations. Particular emphasis was placed on preventing contamination by applying strict protocols and avoiding the use of previously used fingerprint brushes. Based on this extensive survey, the data provided indicate minimal effects of any of these four powders on the chance of obtaining DNA profiles from enhanced fingermarks. Copyright © 2017

  3. Analysis Of Navy Hornet Squadron Mishap Costs With Regard To Previously Flown Flight Hours

    Science.gov (United States)

    2017-06-01

    HORNET SQUADRON MISHAP COSTS WITH REGARD TO PREVIOUSLY FLOWN FLIGHT HOURS by Jason R. Baumann June 2017 Thesis Advisor: Robert Eger Co...TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE ANALYSIS OF NAVY HORNET SQUADRON MISHAP COSTS WITH REGARD TO PREVIOUSLY FLOWN...flown flight hours with mishap costs . It uses a macro level approach by evaluating how a squadron’s previously flown flight hours affect mishap cost and

  4. Serratia liquefaciens Infection of a Previously Excluded Popliteal Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    A. Coelho

    Full Text Available : Introduction: Popliteal artery aneurysms (PAAs are rare in the general population, but they account for nearly 70% of peripheral arterial aneurysms. There are several possible surgical approaches including exclusion of the aneurysm and bypass grafting, or endoaneurysmorrhaphy and interposition of a prosthetic conduit. The outcomes following the first approach are favorable, but persistent blood flow in the aneurysm sac has been documented in up to one third of patients in the early post-operative setting. Complications from incompletely excluded aneurysms include aneurysm enlargement, local compression symptoms, and sac rupture. Notably infection of a previously excluded and bypassed PAA is rare. This is the third reported case of PAA infection after exclusion and bypass grafting and the first due to Serratia liquefaciens. Methods: Relevant medical data were collected from the hospital database. Results: This case report describes a 54 year old male patient, diagnosed with acute limb ischaemia due to a thrombosed PAA, submitted to emergency surgery with exclusion and venous bypass. A below the knee amputation was necessary 3 months later. Patient follow-up was lost until 7 years following surgical repair, when he was diagnosed with aneurysm sac infection with skin fistulisation. He had recently been diagnosed with alcoholic hepatic cirrhosis Child–Pugh Class B. The patient was successfully treated by aneurysm resection, soft tissue debridement and systemic antibiotics. Conclusion: PAA infection is a rare complication after exclusion and bypass procedures but should be considered in any patient with evidence of local or systemic infection. When a PAA infection is diagnosed, aneurysmectomy, local debridement, and intravenous antibiotic therapy are recommended. The “gold standard” method of PAA repair remains controversial. PAA excision or endoaneurysmorrhaphy avoids complications from incompletely excluded aneurysms, but is associated with

  5. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors

    Directory of Open Access Journals (Sweden)

    Ali Harlak

    2010-01-01

    Full Text Available PURPOSE: Sacrococcygeal pilonidal disease is a source of one of the most common surgical problems among young adults. While male gender, obesity, occupations requiring sitting, deep natal clefts, excessive body hair, poor body hygiene and excessive sweating are described as the main risk factors for this disease, most of these need to be verified with a clinical trial. The present study aimed to evaluate the value and effect of these factors on pilonidal disease. METHOD: Previously proposed main risk factors were evaluated in a prospective case control study that included 587 patients with pilonidal disease and 2,780 healthy control patients. RESULTS: Stiffness of body hair, number of baths and time spent seated per day were the three most predictive risk factors. Adjusted odds ratios were 9.23, 6.33 and 4.03, respectively (p<0.001. With an adjusted odds ratio of 1.3 (p<.001, body mass index was another risk factor. Family history was not statistically different between the groups and there was no specific occupation associated with the disease. CONCLUSIONS: Hairy people who sit down for more than six hours a day and those who take a bath two or less times per week are at a 219-fold increased risk for sacrococcygeal pilonidal disease than those without these risk factors. For people with a great deal of hair, there is a greater need for them to clean their intergluteal sulcus. People who engage in work that requires sitting in a seat for long periods of time should choose more comfortable seats and should also try to stand whenever possible.

  6. New Strategies for Cultivation and Detection of Previously Uncultured Microbes

    Science.gov (United States)

    Stevenson, Bradley S.; Eichorst, Stephanie A.; Wertz, John T.; Schmidt, Thomas M.; Breznak, John A.

    2004-01-01

    An integrative approach was used to obtain pure cultures of previously uncultivated members of the divisions Acidobacteria and Verrucomicrobia from agricultural soil and from the guts of wood-feeding termites. Some elements of the cultivation procedure included the following: the use of agar media with little or no added nutrients; relatively long periods of incubation (more than 30 days); protection of cells from exogenous peroxides; and inclusion of humic acids or a humic acid analogue (anthraquinone disulfonate) and quorum-signaling compounds (acyl homoserine lactones) in growth media. The bacteria were incubated in the presence of air and in hypoxic (1 to 2% O2 [vol/vol]) and anoxic atmospheres. Some bacteria were incubated with elevated concentrations of CO2 (5% [vol/vol]). Significantly more Acidobacteria were found on isolation plates that had been incubated with 5% CO2. A simple, high-throughput, PCR-based surveillance method (plate wash PCR) was developed. This method greatly facilitated detection and ultimate isolation of target bacteria from as many as 1,000 colonies of nontarget microbes growing on the same agar plates. Results illustrate the power of integrating culture methods with molecular techniques to isolate bacteria from phylogenetic groups underrepresented in culture. PMID:15294811

  7. Influence of Previous Knowledge in Torrance Tests of Creative Thinking

    Directory of Open Access Journals (Sweden)

    María Aranguren

    2015-07-01

    Full Text Available The aim of this work is to analyze the influence of study field, expertise and recreational activities participation in Torrance Tests of Creative Thinking (TTCT, 1974 performance. Several hypotheses were postulated to explore the possible effects of previous knowledge in TTCT verbal and TTCT figural university students’ outcomes. Participants in this study included 418 students from five study fields: Psychology;Philosophy and Literature, Music; Engineering; and Journalism and Advertising (Communication Sciences. Results found in this research seem to indicate that there in none influence of the study field, expertise and recreational activities participation in neither of the TTCT tests. Instead, the findings seem to suggest some kind of interaction between certain skills needed to succeed in specific studies fields and performance on creativity tests, such as the TTCT. These results imply that TTCT is a useful and valid instrument to measure creativity and that some cognitive process involved in innovative thinking can be promoted using different intervention programs in schools and universities regardless the students study field.

  8. Years of life lost due to lower extremity injury in association with dementia, and care need: a 6-year follow-up population-based study using a multi-state approach among German elderly.

    Science.gov (United States)

    Zhou, Ying; Putter, Hein; Doblhammer, Gabriele

    2016-01-12

    Dementia and care need are challenging aging populations worldwide. Lower extremity injury (LEI) in the elderly makes matters worse. Using a multi-state approach, we express the effect of LEI on dementia, care need, and mortality in terms of remaining life expectancy at age 75 (rLE) and years of life lost (YLL). A population-based random sample of beneficiaries aged 75-95 years was drawn from the largest public health insurer in Germany in 2004 and followed until 2010 (N 62,103; Mean Age ± SD 81.5 ± 4.8 years; Female 71.2%). We defined a five-state model (Healthy, Dementia, Care, Dementia & Care, Dead), and calculated transition-specific hazard ratios of LEI using Cox regression. The transition probabilities as well as the YLL due to LEI were estimated. LEI significantly increased the risk for each transition, with a maximum risk for the transition from Healthy to Care (HR: 1.70, 95% CI: 1.63-1.77) and a minimum risk for the transition from Care to Dead (HR: 1.16, 95% CI: 1.10-1.22). If the elderly had LEI-history, their age-specific mortality was generally higher and their probabilities of transient states peaked at younger ages. At age 75, initially dementia-free and care-independent elderly experiencing LEI lost about 2 years of life, of which more than 90% were life years free of dementia or care need. Dementia patients lost about one and a half year, more than 60% were free of long-term care need. LEI not only casts a large health burden on care need, but is also associated with cognitive decline and shortened rLE. LEI plus dementia extend the relative life time in need of care, despite generally shortening rLE. Using the composite measure YLL may help to better convey these results to the elderly, families, and health professionals. This may strengthen preventive measures as well as improve timely and rehabilitative treatment of LEI, not only in cognitive and physically intact elderly.

  9. 22 CFR 40.91 - Certain aliens previously removed.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Certain aliens previously removed. 40.91... IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Aliens Previously Removed § 40.91 Certain aliens previously removed. (a) 5-year bar. An alien who has been found inadmissible, whether as a result...

  10. Determining root correspondence between previously and newly detected objects

    Science.gov (United States)

    Paglieroni, David W.; Beer, N Reginald

    2014-06-17

    A system that applies attribute and topology based change detection to networks of objects that were detected on previous scans of a structure, roadway, or area of interest. The attributes capture properties or characteristics of the previously detected objects, such as location, time of detection, size, elongation, orientation, etc. The topology of the network of previously detected objects is maintained in a constellation database that stores attributes of previously detected objects and implicitly captures the geometrical structure of the network. A change detection system detects change by comparing the attributes and topology of new objects detected on the latest scan to the constellation database of previously detected objects.

  11. Critical Materials Needs

    Science.gov (United States)

    1975-08-11

    vital raw materials to consider actions such as when Jamaica increased its export tax on bauxite 700 percent in 1974. (1)* In such circumstances, the...Auxiliary power units components to meet approaches and de - lb. for aircraft. domestic U.S. needs velopment of econom- « and the consequent ical...4,1641 9,574 ^4t E S R. 3.000 12.574 6.400 18,974 2,087 7,51 4.Gt 11% Crude. 6tte.( input Vacuum trtatmtnt Rewtlting coats Credit - flor

  12. An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: the significance of patient privacy, psychological health, and social stigma to care.

    Science.gov (United States)

    Huff, Amber; Chumbler, Neale; Cherry, Colleen O'Brien; Hill, Miranda; Veguilla, Vic

    2015-04-01

    We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Accident management information needs

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R. (EG and G Idaho, Inc., Idaho Falls, ID (USA))

    1990-04-01

    In support of the US Nuclear Regulatory Commission (NRC) Accident Management Research Program, a methodology has been developed for identifying the plant information needs necessary for personnel involved in the management of an accident to diagnose that an accident is in progress, select and implement strategies to prevent or mitigate the accident, and monitor the effectiveness of these strategies. This report describes the methodology and presents an application of this methodology to a Pressurized Water Reactor (PWR) with a large dry containment. A risk-important severe accident sequence for a PWR is used to examine the capability of the existing measurements to supply the necessary information. The method includes an assessment of the effects of the sequence on the measurement availability including the effects of environmental conditions. The information needs and capabilities identified using this approach are also intended to form the basis for more comprehensive information needs assessment performed during the analyses and development of specific strategies for use in accident management prevention and mitigation. 3 refs., 16 figs., 7 tabs.

  14. Accident management information needs

    International Nuclear Information System (INIS)

    Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R.

    1990-04-01

    In support of the US Nuclear Regulatory Commission (NRC) Accident Management Research Program, a methodology has been developed for identifying the plant information needs necessary for personnel involved in the management of an accident to diagnose that an accident is in progress, select and implement strategies to prevent or mitigate the accident, and monitor the effectiveness of these strategies. This report describes the methodology and presents an application of this methodology to a Pressurized Water Reactor (PWR) with a large dry containment. A risk-important severe accident sequence for a PWR is used to examine the capability of the existing measurements to supply the necessary information. The method includes an assessment of the effects of the sequence on the measurement availability including the effects of environmental conditions. The information needs and capabilities identified using this approach are also intended to form the basis for more comprehensive information needs assessment performed during the analyses and development of specific strategies for use in accident management prevention and mitigation. 3 refs., 16 figs., 7 tabs

  15. Social and physical health of homeless adults previously treated for mental health problems.

    Science.gov (United States)

    Gelberg, L; Linn, L S

    1988-05-01

    A total of 529 homeless adults in Los Angeles County were surveyed to determine the relationship between their previous use of mental health services and their physical health status, utilization of medical services, personal habits affecting health, experience of injury and victimization, and perceived needs. Homeless adults with a previous psychiatric hospitalization were more likely to have experienced serious physical symptoms during the previous month than those who had used only outpatient mental health services or who had never used mental health services. They reported more reasons for not obtaining needed medical care, were more likely to obtained food from garbage cans, and had the least adequate personal hygiene. However, they did not differ from the other groups on most measures of nutrition, social relations, and financial status. The most frequently expressed needs of the homeless were for improved social relations, employment, shelter, and money.

  16. 2 CFR 1.215 - Relationship to previous issuances.

    Science.gov (United States)

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Relationship to previous issuances. 1.215 Section 1.215 Grants and Agreements ABOUT TITLE 2 OF THE CODE OF FEDERAL REGULATIONS AND SUBTITLE A Introduction toSubtitle A § 1.215 Relationship to previous issuances. Although some of the guidance was...

  17. 2 CFR 230.45 - Relationship to previous issuance.

    Science.gov (United States)

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Relationship to previous issuance. 230.45 Section 230.45 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET CIRCULARS AND GUIDANCE Reserved COST PRINCIPLES FOR NON-PROFIT ORGANIZATIONS (OMB CIRCULAR A-122) § 230.45 Relationship to previous issuance. (a...

  18. Research Note Effects of previous cultivation on regeneration of ...

    African Journals Online (AJOL)

    Research Note Effects of previous cultivation on regeneration of Julbernadia globiflora and Brachystegia spiciformis in grazing areas of Mupfurudzi ... Plant attributes for Julbernadia globiflora and Brachystegia spiciformis were measured in previously cultivated and uncultivated sites making up rangelands of the scheme.

  19. 49 CFR 173.23 - Previously authorized packaging.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Previously authorized packaging. 173.23 Section... REQUIREMENTS FOR SHIPMENTS AND PACKAGINGS Preparation of Hazardous Materials for Transportation § 173.23 Previously authorized packaging. (a) When the regulations specify a packaging with a specification marking...

  20. 75 FR 76056 - FEDERAL REGISTER CITATION OF PREVIOUS ANNOUNCEMENT:

    Science.gov (United States)

    2010-12-07

    ... SECURITIES AND EXCHANGE COMMISSION Sunshine Act Meeting FEDERAL REGISTER CITATION OF PREVIOUS ANNOUNCEMENT: STATUS: Closed meeting. PLACE: 100 F Street, NE., Washington, DC. DATE AND TIME OF PREVIOUSLY ANNOUNCED MEETING: Thursday, December 9, 2010 at 2 p.m. CHANGE IN THE MEETING: Time change. The closed...

  1. Triple outlet right ventricle: a previously unknown cardiac malformation.

    Science.gov (United States)

    Tingo, Jennifer E; Carroll, Sheila J; Crystal, Matthew A

    2015-03-01

    We present the case of an infant with three distinct outflow tracts from the right ventricle. Three outlets from the heart have been previously named the "Tritruncal Heart". We review the two previously reported cases of tritruncal hearts and describe the anatomy, diagnosis, surgical management, and outcome of our case. Embryologic implications are also discussed.

  2. No discrimination against previous mates in a sexually cannibalistic spider

    Science.gov (United States)

    Fromhage, Lutz; Schneider, Jutta M.

    2005-09-01

    In several animal species, females discriminate against previous mates in subsequent mating decisions, increasing the potential for multiple paternity. In spiders, female choice may take the form of selective sexual cannibalism, which has been shown to bias paternity in favor of particular males. If cannibalistic attacks function to restrict a male's paternity, females may have little interest to remate with males having survived such an attack. We therefore studied the possibility of female discrimination against previous mates in sexually cannibalistic Argiope bruennichi, where females almost always attack their mate at the onset of copulation. We compared mating latency and copulation duration of males having experienced a previous copulation either with the same or with a different female, but found no evidence for discrimination against previous mates. However, males copulated significantly shorter when inserting into a used, compared to a previously unused, genital pore of the female.

  3. Current and previous eating practices among women recovered from anorexia nervosa: a qualitative approach

    Directory of Open Access Journals (Sweden)

    Mariana Dimitrov Ulian

    2013-12-01

    Full Text Available OBJECTIVE: The aim of this study was to analyze qualitatively how women, who have recovered from anorexia nervosa, perceive and describe their current eating practices, as well as the ones developed during the eating disorder period. METHODS: Seven women were interviewed individually with the objective of investigating their eating practices, transition phases and all relevant aspects that somewhat contributed to the habit-forming; experiences, feelings and perceptions related to mealtime and the influence that food has had over the present subjects' life. The interviews were analyzed by the discourse of the collective subject method. RESULTS: The results brought up the following topics: a control; b concerns and feelings; c deprivation d beauty dictatorship; e eating competence; f importance of food; g food cacophony. CONCLUSIONS: What stands out is a multiplicity of eating practices, which during the eating disorder were similar to and characterized by restriction; however, after recovery, part of the subjects seem to have developed a higher eating competence, whereas others show a practice similar to the one acquired during the anorexia nervosa, such as the difficulty in realizing when they are satisfied and a feeling of discomfort when facing social interactions.

  4. Adolescents previously involved in Satanism experiencing mental health problems

    Directory of Open Access Journals (Sweden)

    H Heathcote

    1999-09-01

    Full Text Available No research has previously been done regarding the phenomenon of adolescents who have previously been involved in Satanism and who experience obstacles in their strive for mental health. Adolescents previously involved in Satanism present behavioral problems like aggressive outbursts, depression, “ psychosis” or suicide attempts, that could lead to suicide. In the phenomenonanalysis semi-structured, phenomenological interviews were performed with the respondents and their parents. The respondents were requested to write a naïve sketch about their life. After completion of the data-control, guidelines for nursing staff were set.

  5. A total market approach for condoms in Myanmar: the need for the private, public and socially marketed sectors to work together for a sustainable condom market for HIV prevention

    Science.gov (United States)

    Longfield, Kim; Mundy, Gary; Win, Zaw; Montagu, Dominic

    2015-01-01

    Background Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted Population Services International (PSI)/Myanmar to adopt a total market approach (TMA). This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better targeting public subsidy. Methodology Data on condom need and condom use came from PSI/Myanmar’s (PSI/M’s) behavioural surveys; data for key populations’ socioeconomic status profiles came from the same surveys and the National Tuberculosis Prevalence Survey. Data on market share, volumes, value and number of condoms were from PSI/M’s quarterly retail audits and Joint United Nations Programme on HIV/AIDS (UNAIDS). Results Between 2008 and 2010, the universal need for condoms decreased from 112.9 to 98.2 million while condom use increased from 32 to 46%. Free and socially marketed condoms dominated the market (94%) in 2009–11 with an increase in the proportion of free condoms over time. The retail price of socially marketed condoms was artificially low at 44 kyats ($0.05 USD) in 2011 while the price for commercial condoms was 119–399 kyats ($0.15–$0.49 USD). Equity analyses demonstrated an equal distribution of female sex workers across national wealth quintiles, but 54% of men who have sex with men and 55% of male clients were in the highest two quintiles. Donor subsidies for condoms increased over time; from $434 000 USD in 2009 to $577 000 USD in 2011. Conclusion The market for male condoms was stagnant in Myanmar due to: limited demand for condoms among key populations, the dominance of free and socially marketed condoms on the market and a neglected commercial sector. Subsidies for socially marketed and free condoms have prevented the growth of the private sector, an unintended consequence. A TMA is needed to grow and sustain the condom market in Myanmar, which requires close co-ordination between the

  6. A total market approach for condoms in Myanmar: the need for the private, public and socially marketed sectors to work together for a sustainable condom market for HIV prevention.

    Science.gov (United States)

    Htat, Han Win; Longfield, Kim; Mundy, Gary; Win, Zaw; Montagu, Dominic

    2015-03-01

    Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted Population Services International (PSI)/Myanmar to adopt a total market approach (TMA). This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better targeting public subsidy. Data on condom need and condom use came from PSI/Myanmar's (PSI/M's) behavioural surveys; data for key populations' socioeconomic status profiles came from the same surveys and the National Tuberculosis Prevalence Survey. Data on market share, volumes, value and number of condoms were from PSI/M's quarterly retail audits and Joint United Nations Programme on HIV/AIDS (UNAIDS). Between 2008 and 2010, the universal need for condoms decreased from 112.9 to 98.2 million while condom use increased from 32 to 46%. Free and socially marketed condoms dominated the market (94%) in 2009-11 with an increase in the proportion of free condoms over time. The retail price of socially marketed condoms was artificially low at 44 kyats ($0.05 USD) in 2011 while the price for commercial condoms was 119-399 kyats ($0.15-$0.49 USD). Equity analyses demonstrated an equal distribution of female sex workers across national wealth quintiles, but 54% of men who have sex with men and 55% of male clients were in the highest two quintiles. Donor subsidies for condoms increased over time; from $434,000 USD in 2009 to $577,000 USD in 2011. The market for male condoms was stagnant in Myanmar due to: limited demand for condoms among key populations, the dominance of free and socially marketed condoms on the market and a neglected commercial sector. Subsidies for socially marketed and free condoms have prevented the growth of the private sector, an unintended consequence. A TMA is needed to grow and sustain the condom market in Myanmar, which requires close co-ordination between the public, socially marketed and commercial sectors. Published

  7. Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings.

    Science.gov (United States)

    Speldewinde, Christopher A; Parsons, Ian

    2015-01-01

    Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia. This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues? The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia? There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

  8. Influence of previous participation in physical activity on its ...

    African Journals Online (AJOL)

    ... participation can influence perceptions of PA among the students. Physical activity promotion programmes should consider the role of these factors which should be emphasised from childhood. Keywords: physical activity, students, perceived benefits, perceived barriers, previous participation, sedentary lifestyle, Rwanda

  9. Choice of contraception after previous operative delivery at a family ...

    African Journals Online (AJOL)

    Choice of contraception after previous operative delivery at a family planning clinic in Northern Nigeria. Amina Mohammed‑Durosinlorun, Joel Adze, Stephen Bature, Caleb Mohammed, Matthew Taingson, Amina Abubakar, Austin Ojabo, Lydia Airede ...

  10. Payload specialist Reinhard Furrer show evidence of previous blood sampling

    Science.gov (United States)

    1985-01-01

    Payload specialist Reinhard Furrer shows evidence of previous blood sampling while Wubbo J. Ockels, Dutch payload specialist (only partially visible), extends his right arm after a sample has been taken. Both men show bruises on their arms.

  11. Delivery outcomes at term after one previous cesarean section.

    Science.gov (United States)

    Yamani-Zamzami, Tarik Y

    2007-12-01

    To determine the maternal and perinatal outcomes at term in women with one previous cesarean delivery and with no history of vaginal birth. This is a case-control study conducted at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, between January 1, 1999 and December 31, 2002. One hundred sixty-two women with one previous cesarean delivery and with no previous vaginal birth were compared with 324 control women. The cesarean section rate was higher in the study group 40 (24.7%) versus 23 (7.1%) in the control group and was statistically significant (phistory of vaginal delivery are considered less favorable, the vaginal birth after cesarean section success rate may be even lower if the indication for previous primary cesarean delivery was failure to progress, and may be associated with increased risk of uterine rupture. Further study is required to confirm our findings.

  12. The need for a hydromorphological approach to Chilean river management La necesidad de un enfoque hidromorfológico para la gestión de los ríos chilenos

    Directory of Open Access Journals (Sweden)

    ANDREA ANDREOLI

    2012-09-01

    Full Text Available The manuscript reflects the opinion of the authors about the need for a hydromorphological approach for the management of Chilean rivers. A brief state-of-the-art of the recent scientific advances on hydromorphological approach to river management is presented, as well as a general overview of the conditions of Chilean rivers and the mayor disturbances they suffer. Moreover, the need to take into account both direct and indirect services provided by rivers in the decision making process on river management is underlined. Hydromorphology is claimed to be a main element to be considered while assessing the ecological state of rivers. Understanding how the hydrological and morphological variables interact dynamically is indeed key to assess the presence or absence of dynamic equilibrium, a condition that, in turn, promotes both habitat diversity and self-sustainable aquatic and riparian ecosystems. The authors also emphasized the need for a change of paradigm in current Chilean rivers management practices, by developing a unified framework to assess hydromorphological and ecological river conditions. In addition, the implementation of specific legislation aimed at promoting ecological and geomorphological standards in river management practice, and the strengthening and widening of the academic teaching of fluvial ecology and geomorphology is suggested.El manuscrito refleja la opinión de los autores acerca de la necesidad de aplicar un enfoque hidromorfológico para la gestión de los ríos chilenos. Se presenta una breve reseña de los últimos avances científicos sobre el enfoque hidromorfológico en la gestión de ríos, así como una visión general de las condiciones de los ríos chilenos y sus mayores perturbaciones. Por otra parte, se hace énfasis en la necesidad de incluir en la toma de decisiones los servicios directos como los indirectos proporcionados por los ríos. Se afirma que la hidromorfología es un elemento fundamental a

  13. Secondary recurrent miscarriage is associated with previous male birth.

    LENUS (Irish Health Repository)

    Ooi, Poh Veh

    2011-01-01

    Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

  14. Secondary recurrent miscarriage is associated with previous male birth.

    LENUS (Irish Health Repository)

    Ooi, Poh Veh

    2012-01-31

    Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

  15. 76 FR 62048 - ConocoPhillips Company; Application for Blanket Authorization To Export Previously Imported...

    Science.gov (United States)

    2011-10-06

    ...Phillips Company; Application for Blanket Authorization To Export Previously Imported Liquefied Natural Gas... which trade is not prohibited by U.S. law or policy. The application was filed under section 3 of the... need for natural gas shall be the primary focus of DOE when evaluating an export application.\\4...

  16. Predicting fruit consumption: the role of habits, previous behavior and mediation effects

    NARCIS (Netherlands)

    de Vries, H.; Eggers, S.M.; Lechner, L.; van Osch, L.; van Stralen, M.M.

    2014-01-01

    Background: This study assessed the role of habits and previous behavior in predicting fruit consumption as well as their additional predictive contribution besides socio-demographic and motivational factors. In the literature, habits are proposed as a stable construct that needs to be controlled

  17. Study of some physical aspects previous to design of an exponential experiment

    International Nuclear Information System (INIS)

    Caro, R.; Francisco, J. L. de

    1961-01-01

    This report presents the theoretical study of some physical aspects previous to the design of an exponential facility. The are: Fast and slow flux distribution in the multiplicative medium and in the thermal column, slowing down in the thermal column, geometrical distribution and minimum needed intensity of sources access channels and perturbations produced by possible variations in its position and intensity. (Author) 4 refs

  18. Maternal serum screening marker levels in women with a previous aneuploidy pregnancy.

    Science.gov (United States)

    Spencer, Kevin; Staboulidou, Ismini; De Jesus Cruz, Jader; Karagiannis, George; Nicolaides, Kypros H

    2009-12-01

    To re-evaluate in a larger cohort of patients if the maternal serum biochemical markers used in first trimester aneuploidy screening have the same marker distributions in pregnancies with a previous history of aneuploidy compared with those that have no previous history. Information related to previous pregnancy history is routinely recorded as part of first trimester screening in three centres King George, Kings College and Fetal Medicine Centre, London. From the database, records were extracted for women who had a previous pregnancy diagnosed with trisomies 13, 18 or 21. For each woman with a previous aneuploidy, five unaffected pregnancies in women of the same maternal age and with no previous aneuploidy pregnancy were selected as controls. A comparison was made between the marker distributions for pregnancy associated plasma protein-A (PAPP-A) and free beta-human chronic gonadotrophin (beta-hCG) amongst the cases and controls using nonparametric statistical tests. A series of 8240 controls were compared against group of 1032 cases with a previous trisomy 21, 293 with a previous trisomy 18 and 158 with a previous trisomy 13. Cases with multiple previous trisomies were excluded. There were no significant differences in the level of free beta-hCG; however, in cases of trisomy 21 and trisomy 13 the levels of PAPP-A were increased by 5 and 16%, respectively. Risk calculation algorithms may need to take account of the increased PAPP-A levels in women with a previous trisomy 21 or trisomy 13. Copyright (c) 2009 John Wiley & Sons, Ltd.

  19. Thyroid cancer patients receiving an interdisciplinary team-based care approach (ITCA-ThyCa) appear to display better outcomes: Program evaluation results indicating a need for further integrated care and support.

    Science.gov (United States)

    Henry, Melissa; Frenkiel, Saul; Chartier, Gabrielle; MacDonald, Christina; Payne, Richard J; Black, Martin J; Mlynarek, Alex M; Zeitouni, Anthony; Kost, Karen; Loiselle, Carmen; Ehrler, Antoinette; Rosberger, Zeev; Tamilia, Michael; Chang, Yu Xin; de la Mora, Cecilia; Arbaud, Camille; Hier, Michael P

    2018-03-01

    Thyroid cancer (ThyCa) is generally associated with a favorable prognosis and excellent surgical outcomes. Consequently, its treatment is medically focused and current guidelines recommend interdisciplinary care including access to a nurse for complex cases alone. To date, no studies have evaluated the need for and impact of an Interdisciplinary Team-based Care Approach (ITCA-ThyCa) for general thyroid cancer patients, including a dedicated nurse as part of a larger interdisciplinary team, as well as patient-reported outcomes, as is recommended worldwide in cancer care. Our aim was to evaluate such a program. The ITCA-ThyCa was evaluated within a quasi-experimental design using the Centers for Disease Control Framework for Program Evaluation, including process and outcome measures. Patients eligible were adults with a biopsy indicating confirmed or highly suspicious ThyCa (TNM-Classification + Bethesda score of V/VI). The intervention group (IG) received ITCA-ThyCa and the comparison group (CG), usual care alone. In our sample comprised of 200 participants (122 IG; 78 CG), ITCA-ThyCa patients appeared to show significantly better outcomes than CG patients, namely, higher levels of overall well-being (P = .001) and fewer physical (P = .003) and practical (P = .003) issues and concerns. More satisfied with their overall care (P = .028), including care coordination (P = .049), they reported their health care provider as more approachable (P = .007), respectful (P = .005), and trustworthy (P = .077; trend) and were more likely to recommend their hospital (P = .02). Ninety-eight percent of IG patients recommended ITCA-ThyCa. Data from our program illustrates that hospital resources should not be allocated based on medical trajectory alone and challenges the idea that ThyCa is "straightforward." ThyCa patients seem to experience symptom distress at a level comparable to-or exceeding-that of general oncological patients despite their promising medical

  20. Training industry needs & Technology Industry needs

    NARCIS (Netherlands)

    Klemke, Roland; Kuula, Timo; Helin, Kaj; Wild, Fridolin

    2017-01-01

    This deliverable joins D1.1 (User Industry Needs) and D1.2 (Technology Industry Needs and Affordances) and reports on the outcomes of Tasks T1.1 (Training Industry Assessment) and T1.2 (Technology Industry Assessment). We merged the deliverables for the following reasons: For readability ease we

  1. 2 CFR 225.45 - Relationship to previous issuance.

    Science.gov (United States)

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Relationship to previous issuance. 225.45 Section 225.45 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET CIRCULARS AND GUIDANCE Reserved COST PRINCIPLES FOR STATE, LOCAL, AND INDIAN TRIBAL GOVERNMENTS (OMB CIRCULAR A-87) § 225.45 Relationship to...

  2. Cryptococcal meningitis in a previously healthy child | Chimowa ...

    African Journals Online (AJOL)

    An 8-year-old previously healthy female presented with a 3 weeks history of headache, neck stiffness, deafness, fever and vomiting and was diagnosed with cryptococcal meningitis. She had documented hearing loss and was referred to tertiary-level care after treatment with fluconazole did not improve her neurological ...

  3. Rapid fish stock depletion in previously unexploited seamounts: the ...

    African Journals Online (AJOL)

    Rapid fish stock depletion in previously unexploited seamounts: the case of Beryx splendens from the Sierra Leone Rise (Gulf of Guinea) ... A spectral analysis and red-noise spectra procedure (REDFIT) algorithm was used to identify the red-noise spectrum from the gaps in the observed time-series of catch per unit effort by ...

  4. Obstructive pulmonary disease in patients with previous tuberculosis ...

    African Journals Online (AJOL)

    Obstructive pulmonary disease in patients with previous tuberculosis: Pathophysiology of a community-based cohort. B.W. Allwood, R Gillespie, M Galperin-Aizenberg, M Bateman, H Olckers, L Taborda-Barata, G.L. Calligaro, Q Said-Hartley, R van Zyl-Smit, C.B. Cooper, E van Rikxoort, J Goldin, N Beyers, E.D. Bateman ...

  5. Balance and bilateral skills of selected previously disadvantaged ...

    African Journals Online (AJOL)

    Balance and bilateral skills of selected previously disadvantaged children aged 9 to 12 years. Eileen K Africa, Karel J Van Deventer. Abstract. The main aim of the study was to design an appropriate motor skills development programme that could be implemented in any primary school to improve the fundamental motor ...

  6. Outcome Of Pregnancy Following A Previous Lower Segment ...

    African Journals Online (AJOL)

    Background: A previous ceasarean section is an important variable that influences patient management in subsequent pregnancies. A trial of vaginal delivery in such patients is a feasible alternative to a secondary section, thus aiding to reduce the ceasarean section rate and its associated co-morbidities. Objective: To ...

  7. Suburethral sling procedures after previous surgery for urinary ...

    African Journals Online (AJOL)

    Objective. To compare the outcome of suburethral sling procedures (tension-free vaginal tape (TVT), obturator tape (Ob-tape)) for stress urinary incontinence (SUI) in women with previous surgery for SUI or pelvic organ prolapse (POP). Methods. A comparative, descriptive, retrospective study was done using information ...

  8. 5 CFR 532.405 - Use of highest previous rate.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Use of highest previous rate. 532.405 Section 532.405 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS... rate may be based upon a rate of pay received during a temporary promotion, so long as the temporary...

  9. 24 CFR 1710.552 - Previously accepted state filings.

    Science.gov (United States)

    2010-04-01

    ... of Substantially Equivalent State Law § 1710.552 Previously accepted state filings. (a) Materials... and contracts or agreements contain notice of purchaser's revocation rights. In addition see § 1715.15..., unless the developer is obligated to do so in the contract. (b) If any such filing becomes inactive or...

  10. 5 CFR 9701.352 - Use of highest previous rate.

    Science.gov (United States)

    2010-01-01

    ... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Pay Administration § 9701.352 Use of... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Use of highest previous rate. 9701.352 Section 9701.352 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT...

  11. Bilateral orbital infarction and retinal detachment in a previously ...

    African Journals Online (AJOL)

    In this report, we present a case of an 11‑year‑old previously undiagnosed sickle cell disease Nigerian girl with severe acute bilateral orbital infarction and retinal detachment to highlight that hemoglobinopathy induced orbital infarction should be considered in African children with acute onset proptosis with or without ...

  12. The effect of previous traumatic injury on homicide risk.

    Science.gov (United States)

    Griffin, Russell L; Davis, Gregory G; Levitan, Emily B; MacLennan, Paul A; Redden, David T; McGwin, Gerald

    2014-07-01

    Research has reported that a strong risk factor for traumatic injury is having a previous injury (i.e., recidivism). To date, the only study examining the relationship between recidivism and homicide reported strong associations, but was limited by possible selection bias. The current matched case-control study utilized coroner's data from 2004 to 2008. Subjects were linked to trauma registry data to determine whether the person had a previous traumatic injury. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between homicide and recidivism. Homicide risk was increased for those having a previous traumatic injury (OR 1.81, 95% CI 1.09-2.99) or a previous intentional injury (OR 2.53, 95% CI 1.24-5.17). These results suggest an association between homicide and injury recidivism, and that trauma centers may be an effective setting for screening individuals for secondary prevention efforts of homicide through violence prevention programs. © 2014 American Academy of Forensic Sciences.

  13. Control of feed intake as affected by previous treatment | Pienaar ...

    African Journals Online (AJOL)

    An experiment was conducted with eighteen rumen cannulated sheep fed on a chopped lucerne diet. Previous level of intake significantly influenced the level at which sheep initially established voluntary feed intake. This difference had disappeared after three weeks on an ad lib. intake. Perturbation analysis of the results ...

  14. "Battered Women" and Previous Victimization: Is the Question Relevant?

    Science.gov (United States)

    Gudim, Laurie, Comp.; And Others

    This report discusses battered women and the role of their previous victimization. After a literature review on family violence in general, these topics are discussed: (1) family violence and the patriarchy; (2) the historical background of family violence; (3) intergenerational cycle of violence; and (4) psychological literature's four ways…

  15. Choice of contraception after previous operative delivery at a family ...

    African Journals Online (AJOL)

    Age, education, religion, parity, prior contraception, and interval from the last delivery were significantly associated with the current choice of contraception (P 0.05). Overall, when comparing the pattern among those with a previous operative delivery and those without, ...

  16. Process cells dismantling of EUREX pant: previous activities

    International Nuclear Information System (INIS)

    Gili, M.

    1998-01-01

    In the '98-'99 period some process cells of the EUREX pant will be dismantled, in order to place there the liquid wastes conditioning plant 'CORA'. This report resumes the previous activities (plant rinsing campaigns and inactive Cell 014 dismantling), run in the past three years and the drawn experience [it

  17. The job satisfaction of principals of previously disadvantaged schools

    African Journals Online (AJOL)

    The aim of this study was to identify influences on the job satisfaction of previously disadvantaged school principals in North-West Province. Evans's theory of job satisfaction, morale and motivation was useful as a conceptual framework. A mixedmethods explanatory research design was important in discovering issues with ...

  18. Previous utilization of service does not improve timely booking in ...

    African Journals Online (AJOL)

    Previous utilization of service does not improve timely booking in antenatal care: Cross sectional study on timing of antenatal care booking at public health facilities in ... Methods: A cross sectional study was conducted to collect data from 630 pregnant women who were attending antenatal care service at 10 governmental ...

  19. Research Note Effects of previous cultivation on regeneration of ...

    African Journals Online (AJOL)

    We investigated the effects of previous cultivation on regeneration potential under miombo woodlands in a resettlement area, a spatial product of Zimbabwe's land reforms. We predicted that cultivation would affect population structure, regeneration, recruitment and potential grazing capacity of rangelands. Plant attributes ...

  20. Mondor's Disease of the Breast in a Nigerian Woman Previously ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... Case Report. How to cite this article: Olarinoye-Akorede SA, Silas BT. Mondor's disease of the breast in a Nigerian woman previously treated for invasive ductal carcinoma in the ... and the new creations are licensed under the identical terms. For reprints .... malignancy. Financial support and sponsorship.

  1. 44 CFR 402.5 - Forwarding commodities previously shipped.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Forwarding commodities... commodities previously shipped. Order T-1 applies to transportation on or discharge from ships documented... ship or aircraft, before the issuance of Order T-1, had transported restricted commodities manifested...

  2. Reoperative sentinel lymph node biopsy after previous mastectomy.

    Science.gov (United States)

    Karam, Amer; Stempel, Michelle; Cody, Hiram S; Port, Elisa R

    2008-10-01

    Sentinel lymph node (SLN) biopsy is the standard of care for axillary staging in breast cancer, but many clinical scenarios questioning the validity of SLN biopsy remain. Here we describe our experience with reoperative-SLN (re-SLN) biopsy after previous mastectomy. Review of the SLN database from September 1996 to December 2007 yielded 20 procedures done in the setting of previous mastectomy. SLN biopsy was performed using radioisotope with or without blue dye injection superior to the mastectomy incision, in the skin flap in all patients. In 17 of 20 patients (85%), re-SLN biopsy was performed for local or regional recurrence after mastectomy. Re-SLN biopsy was successful in 13 of 20 patients (65%) after previous mastectomy. Of the 13 patients, 2 had positive re-SLN, and completion axillary dissection was performed, with 1 having additional positive nodes. In the 11 patients with negative re-SLN, 2 patients underwent completion axillary dissection demonstrating additional negative nodes. One patient with a negative re-SLN experienced chest wall recurrence combined with axillary recurrence 11 months after re-SLN biopsy. All others remained free of local or axillary recurrence. Re-SLN biopsy was unsuccessful in 7 of 20 patients (35%). In three of seven patients, axillary dissection was performed, yielding positive nodes in two of the three. The remaining four of seven patients all had previous modified radical mastectomy, so underwent no additional axillary surgery. In this small series, re-SLN was successful after previous mastectomy, and this procedure may play some role when axillary staging is warranted after mastectomy.

  3. National Needs Drivers for Nanotechnology

    Energy Technology Data Exchange (ETDEWEB)

    Yonas, G.; Picraux, S.T.

    2000-10-09

    Societal needs related to demographics, resources, and human behavior will drive technological advances over the next 20 years. Nanotechnology is anticipated to be an important enabler of these advances, and thus maybe anticipated to have significant influence on new systems approaches to solving societal problems as well as on extending current science and technology-based applications. To examine the potential implications of nanotechnology a societal needs-driven approach is taken. Thus the methodology is to present the definition of the problem, and then examine system concepts, technology issues, and promising future directions. We approach the problem definition from a national and global security perspective and identify three key areas involving the condition of the planet, the human condition, and global security. In anticipating societal issues in the context of revolutionary technologies, such as maybe enabled by nanoscience, the importance of working on the entire life cycle of any technological solution is stressed.

  4. Mobility needs and wireless solutions

    DEFF Research Database (Denmark)

    Saugstrup, Dan; Henten, Anders

    The main purpose of this report is to spell out a methodological approach to the analysis of user needs with respect to mobility. Furthermore, this methodological approach is used in an exemplary analysis of the relationship between user needs and technology solutions offered by different wireless...... technologies. The report is based on a research approach, emphasizing important aspects in relation to developing more user oriented mobile services and applications in a heterogeneous network environment. As a staring point, Scandinavian research within the field of social science concerning mobility...... is described and discussed. Furthermore different wireless technologies are briefly described and discussed in relation to possible transmission capacities and coverage areas. In addition to this, a preliminary framework regarding the implications of mobility on the use and development of mobile services...

  5. Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery.

    Science.gov (United States)

    Yamamoto, Masashi; Okuda, Junji; Tanaka, Keitaro; Kondo, Keisaku; Asai, Keiko; Kayano, Hajime; Masubuchi, Shinsuke; Uchiyama, Kazuhisa

    2013-03-01

    The impact of previous abdominal surgeries on the need for conversion to open surgery and on short-term outcomes during/after laparoscopic colectomy was retrospectively investigated. This retrospective cohort study was conducted from December 1996 through December 2009. This study was conducted at Osaka Medical College Hospital. A total of 1701 consecutive patients who had undergone laparoscopic resection of the colon and rectum were classified as not having previous abdominal surgery (n = 1121) or as having previous abdominal surgery (n = 580). Short-term outcomes were recorded, and risk factors for conversion to open surgery were analyzed. There were no significant differences in operative time, blood loss, number of lymph nodes removed, or conversion rate between the groups. The rate of inadvertent enterotomy was significantly higher in the previous abdominal surgery group than in the not having previous abdominal surgery group (0.9% versus 0.1%; p = 0.03), and the postoperative recovery time was significantly longer in the previous abdominal surgery group than in the not having previous abdominal surgery group. Ileus was more frequent in the previous abdominal surgery group than in the not having previous abdominal surgery group (3.8% versus 2.1%; p = 0.04). Significant risk factors for conversion to open surgery were T stage ≥3 (OR, 2.81; 95% CI, 1.89-3.75), median incision (OR, 4.34; 95% CI, 1.23-9.41), upper median incision (OR, 2.78; 95% CI, 1.29-5.42), lower median incision (OR, 1.82; 95% CI, 1.09-3.12), and transverse colectomy (OR, 1.76; 95% CI, 1.29-2.41). The incidence of successfully completed laparoscopic colectomy after previous abdominal surgery remains high, and the short-term outcomes are acceptable.

  6. Previously unreported abnormalities in Wolfram Syndrome Type 2.

    Science.gov (United States)

    Akturk, Halis Kaan; Yasa, Seda

    2017-01-01

    Wolfram syndrome (WFS) is a rare autosomal recessive disease with non-autoimmune childhood onset insulin dependent diabetes and optic atrophy. WFS type 2 (WFS2) differs from WFS type 1 (WFS1) with upper intestinal ulcers, bleeding tendency and the lack ofdiabetes insipidus. Li-fespan is short due to related comorbidities. Only a few familieshave been reported with this syndrome with the CISD2 mutation. Here we report two siblings with a clinical diagnosis of WFS2, previously misdiagnosed with type 1 diabetes mellitus and diabetic retinopathy-related blindness. We report possible additional clinical and laboratory findings that have not been pre-viously reported, such as asymptomatic hypoparathyroidism, osteomalacia, growth hormone (GH) deficiency and hepatomegaly. Even though not a requirement for the diagnosis of WFS2 currently, our case series confirm hypogonadotropic hypogonadism to be also a feature of this syndrome, as reported before. © Polish Society for Pediatric Endocrinology and Diabetology.

  7. Nicotine Elicits Methamphetamine-Seeking in Rats Previously Administered Nicotine

    OpenAIRE

    Neugebauer, N. M.; Harrod, S. B.; Bardo, M. T.

    2009-01-01

    Research has indicated a high correlation between psychostimulant use and tobacco cigarette smoking in human substance abusers. The objective of the current study was to examine the effects of acute and repeated nicotine administration on responding for intravenous methamphetamine (0.03 mg/kg/infusion) in a rodent model of self-administration, as well as the potential of nicotine to induce reinstatement of previously extinguished drug-taking behavior in male Sprague-Dawley rats. In addition, ...

  8. Influence of previous knowledge in Torrance tests of creative thinking

    OpenAIRE

    Aranguren, María; Consejo Nacional de Investigaciones Científicas y Técnicas CONICET

    2015-01-01

    The aim of this work is to analyze the influence of study field, expertise and recreational activities participation in Torrance Tests of Creative Thinking (TTCT, 1974) performance. Several hypotheses were postulated to explore the possible effects of previous knowledge in TTCT verbal and TTCT figural university students’ outcomes. Participants in this study included 418 students from five study fields: Psychology;Philosophy and Literature, Music; Engineering; and Journalism and Advertisin...

  9. Previous climatic alterations are caused by the sun

    International Nuclear Information System (INIS)

    Groenaas, Sigbjoern

    2003-01-01

    The article surveys the scientific results of previous research into the contribution of the sun to climatic alterations. The author concludes that there is evidence of eight cold periods after the last ice age and that the alterations largely were due to climate effects from the sun. However, these effects are only causing a fraction of the registered global warming. It is assumed that the human activities are contributing to the rest of the greenhouse effect

  10. Event Sequence Variability in Healthy Swallowing: Building on Previous Findings

    OpenAIRE

    Molfenter, Sonja M.; Leigh, Chelsea; Steele, Catriona M.

    2014-01-01

    This study builds on previous work by Kendall, Leonard and McKenzie, which investigated event sequence variability for 12 paired-events during swallowing by healthy volunteers. They identified four event pairs, which always occurred in a stereotyped order as well as a most-common occurring overall order of events during swallowing. In the current study, we investigate overall event sequencing and the same four paired-events in a sample of swallows by healthy, young (under 45 years old) volunt...

  11. Previously infertile couples and the newborn intensive care unit.

    Science.gov (United States)

    Lind, R F; Pruitt, R L; Greenfeld, D

    1989-05-01

    Having a newborn child admitted to a newborn intensive care unit can be a traumatic experience for parents; however, parents who previously have been infertile face unique problems in coping with this situation. The authors discuss the difficulties parents must overcome in resolving their crises and in developing a good relationship with their child, or, in some cases, coming to terms with the child's death or ongoing disability. In addition, the authors offer suggestions for effective social work intervention.

  12. Antenatal diagnosis of Patau syndrome with previous anomalous baby

    OpenAIRE

    Keerthi Kocherla; Vasantha Kocherla

    2014-01-01

    Patau syndrome is the least common and most severe of the viable autosomal trisomies with median survival of fewer than 3 days was first identified as a cytogenetic syndrome in 1960. Patau syndrome is caused by an extra copy of chromosome 13. In this case report, we present antenatal imaging findings and gross foetal specimen correlation of foetus with Patau syndrome confirmed by karyotyping in third gravida who had significant previous obstetric history of gastrochisis in monochorionic and...

  13. Event sequence variability in healthy swallowing: building on previous findings.

    Science.gov (United States)

    Molfenter, Sonja M; Leigh, Chelsea; Steele, Catriona M

    2014-04-01

    This study builds on previous work by Kendall, Leonard, and McKenzie, which investigated event sequence variability for 12 paired events during swallowing by healthy volunteers. They identified four event pairs that always occurred in a stereotyped order and a most common occurring overall order of events during swallowing. In the current study, we investigated overall event sequencing and the same four paired events in a sample of swallows by healthy young (under 45 years old) volunteers. Data were collected during a 16-swallow lateral videofluoroscopy protocol, which included manipulations of bolus volume, barium density, bolus viscosity, and swallow cueing. Our results agreed with previous findings that variable event sequencing is found in healthy swallowing, and, in regard to obligatory sequencing of two paired events, movement of the arytenoids toward the base of the epiglottis begins prior to upper esophageal sphincter (UES) opening and maximum hyolaryngeal approximation occurs after UES opening. However, our data failed to replicate the previous findings that there is obligatory sequencing of maximum pharyngeal constriction after maximal UES distension and the UES opens before bolus arrival at the UES. The most common observed overall event sequence reported by Kendall et al. was observed in only 4/293 swallows in our dataset. Manipulations of bolus volume, bolus viscosity, barium concentration, swallow cueing, and swallow repetitions could not completely account for the differences observed between the two studies.

  14. STOCHASTIC PARAMETRIC VIBRATIONS OF ELASTIC SYSTEMS WITH REGARD TO THEIR PREVIOUS STATES

    Directory of Open Access Journals (Sweden)

    Vorona Y.V.

    2014-06-01

    Full Text Available Reduced models of stochastic parametric vibrations of elastic systems with regard to their previous states were constructed on the base of the finite element method, generalized coordinates method, asymptotic method and functional approach. Stochastic stability problem was formulated in the average for the moment functions of the first order phase coordinates. The stability of stochastic parametric vibrations of the single degree of freedom system with regard to its previous states was investigated by the 7-stages 5-order continuous Runge-Kutta method and nested formulas Dormand-Prince.

  15. Differences between Pre-School Children with and without Special Educational Needs Functioning, Participation, and Environmental Barriers at Home and in Community Settings: An International Classification of Functioning, Disability, and Health for Children and Youth Approach

    Directory of Open Access Journals (Sweden)

    Sofia Guichard

    2018-02-01

    Full Text Available The International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY; WHO, 2007 provides a framework for child functioning with an emphasis on child participation. Participation is defined as “involvement in life situations” and can be influenced by both child characteristics (health conditions, body functions, and structures and contextual factors (facilitators or barriers of the physical or social environment (WHO, 2007. This study is aimed at characterizing the functioning of pre-school-aged children, based on their frequency of participation in home and community activities and on the perception of environmental barriers to their participation by parents, using an ICF-CY approach. Differences between children with Special Educational Needs (SEN (n = 42 and children without SEN (n = 74 were analyzed. Parents of 116 children from the Porto District (Portugal completed an adapted version of the Young Children’s Participation and Environment Measure (YC-PEM; Khetani et al., 2013a. To assess child functioning, pre-school teachers completed six items of the Matrix for Assessment of Activities and Participation (Castro and Pinto, 2015, corresponding to six code sets of the ICF-CY Developmental Code Sets (Ellingsen, 2011. Children with SEN showed lower levels of functioning when compared to children without SEN, according to their pre-school teachers. Parents of children with SEN reported that their children participated less frequently in home activities. Specifically, significant differences were found in household chores, at home. Parents of children with SEN perceived more environmental factors as barriers in both settings when compared to parents of children without SEN. Differences between groups in specific environmental factors are presented with reference to the YC-PEM environmental content linked to the ICF-CY environmental domains (Khetani, 2015. Findings highlight the importance of

  16. Evaluación de indicadores programáticos: la necesidad de un enfoque social de la tuberculosis / Assessment of programmatic indicators: the need for a social approach to tuberculosis

    Directory of Open Access Journals (Sweden)

    Carlos A. García

    2014-05-01

    Full Text Available Objetivo: evaluar indicadores del Programa de Control de Tuberculosis del Municipio de Tumaco-Nariño durante el periodo comprendido entre 2010-2012. Metodología: estudio cuantitativo de alcance descriptivo y transversal retrospectivo, conforme a los procesos relacionados con la ética en investigación. Resultados: el porcentaje de curación disminuyó de 86% a 81,5%; por su parte, registraron aumentos progresivos los fracasos (2,7% a 3,7%, transferidos (8,3% a 11,2%; la incidencia aumentó de 21,4 (2010 a 26,2 (2012 cohorte a junio así como la cobertura de asesoría y oferta de prueba voluntaria de VIH (85% a 90%. Conclusiones: los resultados evidencian debilidades programáticas que pueden aumentar el riesgo de mdr y por ende el control en la cadena de transmisión. Se resalta la necesidad de fortalecer aspectos programáticos que contemplen las condiciones de vulnerabilidad social de los afectados y el desarrollo de acciones desde un enfoque social integral. Objective: to evaluate the indicators of the tuberculosis control program of the Tumaco municipality in Nariño, Colombia during the period from 2010 to 2012. Methodology: a quantitative, retrospective, cross-sectional descriptive study complying with the related processes of research ethics. Results: the cure rate decreased from 86% to 81.5%, while failures showeda progressive increase (2.7% to 3.7% as did transferred patients (8.3% to 11.2%. Similarly, incidence increased from 21.4 (2010 to 26.2 (2012 June cohort as well as the coverage of hiv counseling and the offer of voluntary HIV testing (85% to 90%.Conclusions: the results point to programmatic weaknesses which can increase the risk of mdr and thusthe control in the transmission chain. Additionally, the authors emphasize the need to strengthen programmatic aspects which take into account the social vulnerability conditions of the individuals affected as well as theimplementation of actions from acomprehensiveand social approach

  17. The prevalence of skin scars in patients previously given ...

    African Journals Online (AJOL)

    2017-02-28

    Feb 28, 2017 ... participants with confirmed scarring (Table 4) and needing medical attention had also required surgical treatment in the form of incision and drainage of an abscess. Discussion. Diclofenac is an NSAID with analgesic, antiinflammatory and antipyretic properties. NSAIDs are used to treat a wide spectrum of.

  18. Analysis of Over 10,000 Cases Finds No Association between Previously-Reported Candidate Polymorphisms and Ovarian Cancer Outcome

    Science.gov (United States)

    White, Kristin L.; Vierkant, Robert A.; Fogarty, Zachary C.; Charbonneau, Bridget; Block, Matthew S.; Pharoah, Paul D.P.; Chenevix-Trench, Georgia; Rossing, Mary Anne; Cramer, Daniel W.; Pearce, C. Leigh; Schildkraut, Joellen M.; Menon, Usha; Kjaer, Susanne Kruger; Levine, Douglas A.; Gronwald, Jacek; Culver, Hoda Anton; Whittemore, Alice S.; Karlan, Beth Y.; Lambrechts, Diether; Wentzensen, Nicolas; Kupryjanczyk, Jolanta; Chang-Claude, Jenny; Bandera, Elisa V.; Hogdall, Estrid; Heitz, Florian; Kaye, Stanley B.; Fasching, Peter A.; Campbell, Ian; Goodman, Marc T.; Pejovic, Tanja; Bean, Yukie; Lurie, Galina; Eccles, Diana; Hein, Alexander; Beckmann, Matthias W.; Ekici, Arif B.; Paul, James; Brown, Robert; Flanagan, James; Harter, Philipp; du Bois, Andreas; Schwaab, Ira; Hogdall, Claus K.; Lundvall, Lene; Olson, Sara H.; Orlow, Irene; Paddock, Lisa E.; Rudolph, Anja; Eilber, Ursula; Dansonka-Mieszkowska, Agnieszka; Rzepecka, Iwona K.; Ziolkowska-Seta, Izabela; Brinton, Louise; Yang, Hannah; Garcia-Closas, Montserrat; Despierre, Evelyn; Lambrechts, Sandrina; Vergote, Ignace; Walsh, Christine; Lester, Jenny; Sieh, Weiva; McGuire, Valerie; Rothstein, Joseph H.; Ziogas, Argyrios; Lubiński, Jan; Cybulski, Cezary; Menkiszak, Janusz; Jensen, Allan; Gayther, Simon A.; Ramus, Susan J.; Gentry-Maharaj, Aleksandra; Berchuck, Andrew; Wu, Anna H.; Pike, Malcolm C.; Van Den Berg, David; Terry, Kathryn L.; Vitonis, Allison F.; Doherty, Jennifer A.; Johnatty, Sharon; deFazio, Anna; Song, Honglin; Tyrer, Jonathan; Sellers, Thomas A.; Phelan, Catherine M.; Kalli, Kimberly R.; Cunningham, Julie M.; Fridley, Brooke L.; Goode, Ellen L.

    2013-01-01

    Background Ovarian cancer is a leading cause of cancer-related death among women. In an effort to understand contributors to disease outcome, we evaluated single-nucleotide polymorphisms (SNPs) previously associated with ovarian cancer recurrence or survival, specifically in angiogenesis, inflammation, mitosis, and drug disposition genes. Methods Twenty-seven SNPs in VHL, HGF, IL18, PRKACB, ABCB1, CYP2C8, ERCC2, and ERCC1 previously associated with ovarian cancer outcome were genotyped in 10,084 invasive cases from 28 studies from the Ovarian Cancer Association Consortium with over 37,000 observed person-years and 4,478 deaths. Cox proportional hazards models were used to examine the association between candidate SNPs and ovarian cancer recurrence or survival with and without adjustment for key covariates. Results We observed no association between genotype and ovarian cancer recurrence or survival for any of the SNPs examined. Conclusions These results refute prior associations between these SNPs and ovarian cancer outcome and underscore the importance of maximally powered genetic association studies. Impact These variants should not be used in prognostic models. Alternate approaches to uncovering inherited prognostic factors, if they exist, are needed. PMID:23513043

  19. Analysis of over 10,000 Cases finds no association between previously reported candidate polymorphisms and ovarian cancer outcome.

    Science.gov (United States)

    White, Kristin L; Vierkant, Robert A; Fogarty, Zachary C; Charbonneau, Bridget; Block, Matthew S; Pharoah, Paul D P; Chenevix-Trench, Georgia; Rossing, Mary Anne; Cramer, Daniel W; Pearce, Celeste Leigh; Schildkraut, Joellen M; Menon, Usha; Kjaer, Susanne Kruger; Levine, Douglas A; Gronwald, Jacek; Culver, Hoda Anton; Whittemore, Alice S; Karlan, Beth Y; Lambrechts, Diether; Wentzensen, Nicolas; Kupryjanczyk, Jolanta; Chang-Claude, Jenny; Bandera, Elisa V; Hogdall, Estrid; Heitz, Florian; Kaye, Stanley B; Fasching, Peter A; Campbell, Ian; Goodman, Marc T; Pejovic, Tanja; Bean, Yukie; Lurie, Galina; Eccles, Diana; Hein, Alexander; Beckmann, Matthias W; Ekici, Arif B; Paul, James; Brown, Robert; Flanagan, James M; Harter, Philipp; du Bois, Andreas; Schwaab, Ira; Hogdall, Claus K; Lundvall, Lene; Olson, Sara H; Orlow, Irene; Paddock, Lisa E; Rudolph, Anja; Eilber, Ursula; Dansonka-Mieszkowska, Agnieszka; Rzepecka, Iwona K; Ziolkowska-Seta, Izabela; Brinton, Louise; Yang, Hannah; Garcia-Closas, Montserrat; Despierre, Evelyn; Lambrechts, Sandrina; Vergote, Ignace; Walsh, Christine; Lester, Jenny; Sieh, Weiva; McGuire, Valerie; Rothstein, Joseph H; Ziogas, Argyrios; Lubinski, Jan; Cybulski, Cezary; Menkiszak, Janusz; Jensen, Allan; Gayther, Simon A; Ramus, Susan J; Gentry-Maharaj, Aleksandra; Berchuck, Andrew; Wu, Anna H; Pike, Malcolm C; Van Denberg, David; Terry, Kathryn L; Vitonis, Allison F; Doherty, Jennifer A; Johnatty, Sharon E; Defazio, Anna; Song, Honglin; Tyrer, Jonathan; Sellers, Thomas A; Phelan, Catherine M; Kalli, Kimberly R; Cunningham, Julie M; Fridley, Brooke L; Goode, Ellen L

    2013-05-01

    Ovarian cancer is a leading cause of cancer-related death among women. In an effort to understand contributors to disease outcome, we evaluated single-nucleotide polymorphisms (SNP) previously associated with ovarian cancer recurrence or survival, specifically in angiogenesis, inflammation, mitosis, and drug disposition genes. Twenty-seven SNPs in VHL, HGF, IL18, PRKACB, ABCB1, CYP2C8, ERCC2, and ERCC1 previously associated with ovarian cancer outcome were genotyped in 10,084 invasive cases from 28 studies from the Ovarian Cancer Association Consortium with over 37,000-observed person-years and 4,478 deaths. Cox proportional hazards models were used to examine the association between candidate SNPs and ovarian cancer recurrence or survival with and without adjustment for key covariates. We observed no association between genotype and ovarian cancer recurrence or survival for any of the SNPs examined. These results refute prior associations between these SNPs and ovarian cancer outcome and underscore the importance of maximally powered genetic association studies. These variants should not be used in prognostic models. Alternate approaches to uncovering inherited prognostic factors, if they exist, are needed.

  20. Optimization of hydraulic machinery by exploiting previous successful designs

    Energy Technology Data Exchange (ETDEWEB)

    Kyriacou, S A; Giannakoglou, K C [National Technical University of Athens, Parallel CFD and Optimization Unit, PO Box 64069, Athens 15710 (Greece); Weissenberger, S; Grafenberger, P, E-mail: stelios.Kyriacou@gmail.co [Andritz HYDRO, RD, Lunzerstrasse 78, 4031 Linz (Austria)

    2010-08-15

    A design-optimization method for hydraulic machinery is proposed. Optimal designs are obtained using the appropriate CFD evaluation software driven by an evolutionary algorithm which is also assisted by artificial neural networks used as surrogate evaluation models or metamodels. As shown in a previous IAHR paper by the same authors, such an optimization method substantially reduces the CPU cost, since the metamodels can discard numerous non-promising candidate solutions generated during the evolution, at almost negligible CPU cost, without evaluating them by means of the costly CFD tool. The present paper extends the optimization method of the previous paper by making it capable to accommodate and exploit pieces of useful information archived during previous relevant successful designs. So, instead of parameterizing the geometry of the hydraulic machine components, which inevitably leads to many design variables, enough to slow down the design procedure, in the proposed method all new designs are expressed as weighted combinations of the archived ones. The archived designs act as the design space bases. The role of the optimization algorithms is to find the set (or sets, for more than one objectives, where the Pareto front of non-dominated solutions is sought) of weight values, corresponding to the hydraulic machine configuration(s) with optimal performance. Since the number of weights is much less that the number of design variables of the conventional shape parameterization, the design space dimension reduces and the CPU cost of the metamodel-assisted evolutionary algorithm is much lower. The design of a Francis runner is used to demonstrate the capabilities of the proposed method.

  1. Haemophilus influenzae type f meningitis in a previously healthy boy

    DEFF Research Database (Denmark)

    Ronit, Andreas; Berg, Ronan M G; Bruunsgaard, Helle

    2013-01-01

    Non-serotype b strains of Haemophilus influenzae are extremely rare causes of acute bacterial meningitis in immunocompetent individuals. We report a case of acute bacterial meningitis in a 14-year-old boy, who was previously healthy and had been immunised against H influenzae serotype b (Hib......). The causative pathogen was identified as H influenzae serotype f (Hif), and was successfully treated with ceftriaxone. An immunological evaluation revealed transient low levels of immunoglobulins but no apparent immunodeficiency was found 2 years after the clinical insult....

  2. The long-term consequences of previous hyperthyroidism

    DEFF Research Database (Denmark)

    Hjelm Brandt Kristensen, Frans

    2015-01-01

    vascular state. While it is biologically plausible that these changes may induce long-term consequences, the insight into morbidity as well as mortality in patients with previous hyperthyroidism is limited. The reasons for this are a combination of inadequately powered studies, varying definitions......,400 non-hyperthyroid control individuals (matched for age and sex), all identified from a random 5% sample of the Danish background population (n=339,481). In the second study population, 625 same-sex twin pairs, discordant for hyperthyroidism, were included. For each individual, the degree of co...

  3. Cutaneous protothecosis in a patient with previously undiagnosed HIV infection.

    Science.gov (United States)

    Fong, Kenneth; Tee, Shang-Ian; Ho, Madeline S L; Pan, Jiun Yit

    2015-08-01

    Protothecosis is an uncommon condition resulting from infection by achlorophyllous algae of the Prototheca species. Immunocompromised individuals are generally most susceptible to protothecal infection and tend to develop severe and disseminated disease. However, the association between protothecosis and HIV-induced immunosuppression is not clear, with only a handful of cases having been described to date. Here we report a case of cutaneous protothecosis in a Chinese man with previously undiagnosed HIV infection that responded well to oral itraconazole. © 2014 The Australasian College of Dermatologists.

  4. Detection and identification of previously unrecognized microbial pathogens.

    OpenAIRE

    Relman, D. A.

    1998-01-01

    Features of a number of important but poorly explained human clinical syndromes strongly indicate a microbial etiology. In these syndromes, the failure of cultivation-dependent microbial detection methods reveals our ignorance of microbial growth requirements. Sequence-based molecular methods, however, offer alternative approaches for microbial identification directly from host specimens found in the setting of unexplained acute illnesses, chronic inflammatory disease, and from anatomic sites...

  5. Relationship of deer and moose populations to previous winters' snow

    Science.gov (United States)

    Mech, L.D.; McRoberts, R.E.; Peterson, R.O.; Page, R.E.

    1987-01-01

    (1) Linear regression was used to relate snow accumulation during single and consecutive winters with white-tailed deer (Odocoileus virginianus) fawn:doe ratios, mosse (Alces alces) twinning rates and calf:cow ratios, and annual changes in deer and moose populations. Significant relationships were found between snow accumulation during individual winters and these dependent variables during the following year. However, the strongest relationships were between the dependent variables and the sums of the snow accumulations over the previous three winters. The percentage of the variability explained was 36 to 51. (2) Significant relationships were also found between winter vulnerability of moose calves and the sum of the snow accumulations in the current, and up to seven previous, winters, with about 49% of the variability explained. (3) No relationship was found between wolf numbers and the above dependent variables. (4) These relationships imply that winter influences on maternal nutrition can accumulate for several years and that this cumulative effect strongly determines fecundity and/or calf and fawn survivability. Although wolf (Canis lupus L.) predation is the main direct mortality agent on fawns and calves, wolf density itself appears to be secondary to winter weather in influencing the deer and moose populations.

  6. Incidence of Acneform Lesions in Previously Chemically Damaged Persons-2004

    Directory of Open Access Journals (Sweden)

    N Dabiri

    2008-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Chemical gas weapons especially nitrogen mustard which was used in Iraq-Iran war against Iranian troops have several harmful effects on skin. Some other chemical agents also can cause acne form lesions on skin. The purpose of this study was to compare the incidence of acneform in previously chemically damaged soldiers and non chemically damaged persons. Materials & Methods: In this descriptive and analytical study, 180 chemically damaged soldiers, who have been referred to dermatology clinic between 2000 – 2004, and forty non-chemically damaged people, were chosen randomly and examined for acneform lesions. SPSS software was used for statistic analysis of the data. Results: The mean age of the experimental group was 37.5 ± 5.2 and that of the control group was 38.7 ± 5.9 years. The mean percentage of chemical damage in cases was 31 percent and the time after the chemical damage was 15.2 ± 1.1 years. Ninety seven cases (53.9 percent of the subjects and 19 people (47.5 percent of the control group had some degree of acne. No significant correlation was found in incidence, degree of lesions, site of lesions and age of subjects between two groups. No significant correlation was noted between percentage of chemical damage and incidence and degree of lesions in case group. Conclusion: Incidence of acneform lesions among previously chemically injured peoples was not higher than the normal cases.

  7. Intravitreal ranibizumab for diabetic macular oedema in previously vitrectomized eyes

    DEFF Research Database (Denmark)

    Laugesen, Caroline Schmidt; Ostri, Christoffer; Brynskov, Troels

    2017-01-01

    PURPOSE: There is little information about the efficacy of intravitreal vascular endothelial growth factor (VEGF) inhibition in vitrectomized eyes. This study aimed to evaluate the efficacy of anti-VEGF (ranibizumab) on diabetic macular oedema in previously vitrectomized eyes. METHODS: A nationwide...... retrospective review of medical records from 2010 to 2013. RESULTS: We identified 33 previously vitrectomized eyes in 28 patients treated with ranibizumab injections for diabetic macular oedema. Median follow-up was 323 days (interquartile range 72-1404 days). Baseline mean visual acuity was 0.57 logMAR (95% CI...... 0.13-1.01) before injections. After an average of 4.7 injections (range 1-15), mean visual acuity remained stable at 0.54 logMAR (95% CI 0.13-0.95) with a mean improvement of 0.03 (p = 0. 45, 95% CI -0.12 to 0.06). In 12 eyes (36%), visual acuity improved 0.1 logMAR or more, in 12 eyes (36%), vision...

  8. Kidnapping Detection and Recognition in Previous Unknown Environment

    Directory of Open Access Journals (Sweden)

    Yang Tian

    2017-01-01

    Full Text Available An unaware event referred to as kidnapping makes the estimation result of localization incorrect. In a previous unknown environment, incorrect localization result causes incorrect mapping result in Simultaneous Localization and Mapping (SLAM by kidnapping. In this situation, the explored area and unexplored area are divided to make the kidnapping recovery difficult. To provide sufficient information on kidnapping, a framework to judge whether kidnapping has occurred and to identify the type of kidnapping with filter-based SLAM is proposed. The framework is called double kidnapping detection and recognition (DKDR by performing two checks before and after the “update” process with different metrics in real time. To explain one of the principles of DKDR, we describe a property of filter-based SLAM that corrects the mapping result of the environment using the current observations after the “update” process. Two classical filter-based SLAM algorithms, Extend Kalman Filter (EKF SLAM and Particle Filter (PF SLAM, are modified to show that DKDR can be simply and widely applied in existing filter-based SLAM algorithms. Furthermore, a technique to determine the adapted thresholds of metrics in real time without previous data is presented. Both simulated and experimental results demonstrate the validity and accuracy of the proposed method.

  9. Efforts to promote vaginal delivery after a previous cesarean section.

    Science.gov (United States)

    Hamai, Yoko; Imanishi, Yukio

    2012-01-01

    The aim of this study was to examine the results of vaginal delivery in patients with a past history of cesarean section. The type of delivery, interventions during delivery, and the prognoses of the mothers and babies were examined in 145 women with a history of cesarean section over the 10-year period from January 2000 to December 2009. A scheduled cesarean section was performed in 27 cases. Vaginal delivery was recommended in 118 cases and the success rate was 94.9% (112/118). Uterine rupture was observed in one patient who experienced a natural rupture at home and whose previous cesarean section was an inverse T incision. No cases required a blood transfusion or hysterectomy. The prognoses of both mothers and babies were good and the vaginal delivery success rate was 94.9%. Uterine rupture was observed in one case. Vaginal delivery with previous cesarean section should be considered in cases with expectation and informed consent. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  10. Health care need

    DEFF Research Database (Denmark)

    Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter

    2006-01-01

    The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can...... be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need...

  11. Cultivation-based multiplex phenotyping of human gut microbiota allows targeted recovery of previously uncultured bacteria

    DEFF Research Database (Denmark)

    Rettedal, Elizabeth; Gumpert, Heidi; Sommer, Morten

    2014-01-01

    show that carefully designed conditions enable cultivation of a representative proportion of human gut bacteria, enabling rapid multiplex phenotypic profiling. We use this approach to determine the phylogenetic distribution of antibiotic tolerance phenotypes for 16 antibiotics in the human gut...... microbiota. Based on the phenotypic mapping, we tailor antibiotic combinations to specifically select for previously uncultivated bacteria. Utilizing this method we cultivate and sequence the genomes of four isolates, one of which apparently belongs to the genus Oscillibacter; uncultivated Oscillibacter...

  12. Relationship between the public's belief in recovery, level of mental illness stigma, and previous contact.

    Science.gov (United States)

    Barczyk, Amanda N

    2015-01-01

    Disbelief exits that individuals who have a mental health condition are able to recover and fully function in life. This study analyzed 1,437 adults from the 2006 General Social Survey. Structural equation modeling (1) examined the relationship between respondents' level of prejudicial attitudes and social distance (i.e., stigma) toward individuals who have a mental health condition and their belief in the potential of recovery (2) tested whether previous contact with an individual who received treatment was a mediator. Findings indicated that the belief in recovery led to lower levels of social distance. Prejudicial attitudes were found to be a predictor of one's level of social distance. Previous contact was not a mediator however; males, minorities and those with less education were less likely to have had previous contact. Results indicated a need to emphasize the probability of recovering from a mental health condition when developing target-specific stigma reducing strategies.

  13. Dental health in workers previously exposed to mercury vapour at a chloralkali plant.

    OpenAIRE

    Holland, R I; Ellingsen, D G; Olstad, M L; Kjuus, H

    1994-01-01

    OBJECTIVES--The dental health of 73 workers previously exposed to mercury vapour at a chloralkali plant was studied and compared with that of 51 non-exposed referents. METHODS--A record of oral, periodontal, gingival and mucosal conditions, including teeth, restorations, prostheses, and oral hygiene, was established during a 30 min examination. The participants' periodontal conditions were assessed according to the community periodontal index of treatment needs (CPITN). The results with the C...

  14. Predicting fruit consumption: the role of habits, previous behavior and mediation effects.

    Science.gov (United States)

    de Vries, Hein; Eggers, Sander M; Lechner, Lilian; van Osch, Liesbeth; van Stralen, Maartje M

    2014-07-18

    This study assessed the role of habits and previous behavior in predicting fruit consumption as well as their additional predictive contribution besides socio-demographic and motivational factors. In the literature, habits are proposed as a stable construct that needs to be controlled for in longitudinal analyses that predict behavior. The aim of this study is to provide empirical evidence for the inclusion of either previous behavior or habits. A random sample of 806 Dutch adults (>18 years) was invited by an online survey panel of a private research company to participate in an online study on fruit consumption. A longitudinal design (N = 574) was used with assessments at baseline and after one (T2) and two months (T3). Multivariate linear regression analysis was used to assess the differential value of habit and previous behavior in the prediction of fruit consumption. Eighty percent of habit strength could be explained by habit strength one month earlier, and 64% of fruit consumption could be explained by fruit consumption one month earlier. Regression analyses revealed that the model with motivational constructs explained 41% of the behavioral variance at T2 and 38% at T3. The addition of previous behavior and habit increased the explained variance up to 66% at T2 and to 59% at T3. Inclusion of these factors resulted in non-significant contributions of the motivational constructs. Furthermore, our findings showed that the effect of habit strength on future behavior was to a large extent mediated by previous behavior. Both habit and previous behavior are important as predictors of future behavior, and as educational objectives for behavior change programs. Our results revealed less stability for the constructs over time than expected. Habit strength was to a large extent mediated by previous behavior and our results do not strongly suggest a need for the inclusion of both constructs. Future research needs to assess the conditions that determine direct

  15. Health care need

    DEFF Research Database (Denmark)

    Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter

    2006-01-01

    The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can...... be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need......, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation...

  16. Incidence of previously undetected disease in routine paediatric otolaryngology admissions.

    Science.gov (United States)

    Zeitoun, H; Robinson, P

    1996-06-01

    The process of clerking routine pre-operative admissions involves the house officer taking a full medical history and performing a full physical examination. The diagnostic yield is thought to be low, and the educational value to the house officer is also small. This study addresses the question as to whether routine physical examination is always indicated. One hundred and nine children admitted for routine Otolaryngology procedures were prospectively studied to identify the importance of examination in the pre-operative assessment of patients. The results showed that 51 per cent of the children admitted had risk factors. The medical history was sufficient to identify these risk factors in all patients with the exception of one cardiac condition. This study concludes that a suitable alternative to the current process of clerking such as a standardized nurse history could be safely and efficiently undertaken. Eliminating the tiny percentage of previously unrecognized disease would be a prerequisite for such a change.

  17. Deepwater Gulf of Mexico more profitable than previously thought

    International Nuclear Information System (INIS)

    Craig, M.J.K.; Hyde, S.T.

    1997-01-01

    Economic evaluations and recent experience show that the deepwater Gulf of Mexico (GOM) is much more profitable than previously thought. Four factors contributing to the changed viewpoint are: First, deepwater reservoirs have proved to have excellent productive capacity, distribution, and continuity when compared to correlative-age shelf deltaic sands. Second, improved technologies and lower perceived risks have lowered the cost of floating production systems (FPSs). Third, projects now get on-line quicker. Fourth, a collection of other important factors are: Reduced geologic risk and associated high success rates for deepwater GOM wells due primarily to improved seismic imaging and processing tools (3D, AVO, etc.); absence of any political risk in the deepwater GOM (common overseas, and very significant in some international areas); and positive impact of deepwater federal royalty relief. This article uses hypothetical reserve distributions and price forecasts to illustrate indicative economics of deepwater prospects. Economics of Shell Oil Co.'s three deepwater projects are also discussed

  18. Percutaneous endoscopic jejunostomy in a patient with previous esophagectomy.

    Science.gov (United States)

    de la Torre, R A; Scott, J S; Unger, S W

    1991-04-01

    Establishment of a percutaneous endoscopic jejunostomy via direct jejunal puncture was accomplished in a 45-year-old woman five years after a partial esophagectomy with cervical esophagogastrostomy for adenocarcinoma of the esophagus. The patient had recurrence of the cancer at the anastomotic site with subsequent inability to eat, necessitating a feeding tube for prolonged enteral nutrition. Although percutaneous puncture of the jejunum has been previously described, it has been limited to patients who had undergone partial or complete gastrectomies with Bilroth II anastomoses. This case report of direct endoscopic jejunal tube placement in a patient after esophagectomy further establishes this procedure as a viable alternative to surgically placed feeding tubes in patients with altered gastric anatomy.

  19. Surgical treatment of breast cancer in previously augmented patients.

    Science.gov (United States)

    Karanas, Yvonne L; Leong, Darren S; Da Lio, Andrew; Waldron, Kathleen; Watson, James P; Chang, Helena; Shaw, William W

    2003-03-01

    The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated. The surgical treatment of these patients is controversial, with several questions remaining unanswered. Is breast conservation therapy feasible in this patient population and can these patients retain their implants? A retrospective review of all breast cancer patients with a history of previous augmentation mammaplasty who were treated at the Revlon/UCLA Breast Center between 1991 and 2001 was performed. During the study period, 58 patients were treated. Thirty patients (52 percent) were treated with a modified radical mastectomy with implant removal. Twenty-eight patients (48 percent) underwent breast conservation therapy, which consisted of lumpectomy, axillary lymph node dissection, and radiotherapy. Twenty-two of the patients who underwent breast conservation therapy initially retained their implants. Eleven of those 22 patients (50 percent) ultimately required completion mastectomies with implant removal because of implant complications (two patients), local recurrences (five patients), or the inability to obtain negative margins (four patients). Nine additional patients experienced complications resulting from their implants, including contracture, erosion, pain, and rupture. The data illustrate that breast conservation therapy with maintenance of the implant is not ideal for the majority of augmented patients. Breast conservation therapy with explantation and mastopexy might be appropriate for rare patients with large volumes of native breast tissue. Mastectomy with immediate reconstruction might be a more suitable choice for these patients.

  20. Effect of previous induced abortions on postabortion contraception selection.

    Science.gov (United States)

    Keene, Melissa; Roston, Alicia; Keith, Louis; Patel, Ashlesha

    2015-05-01

    The objective was to compare contraceptive method selection in women undergoing their first pregnancy termination versus women undergoing repeat pregnancy termination in an urban abortion clinic. We hypothesized that women undergoing repeat abortions will select highly effective contraceptives (intrauterine device, subdermal implant, tubal ligation) more often than patients undergoing their first abortion. We conducted a retrospective analysis of all women undergoing first-trimester surgical abortion at John H. Stroger, Jr., Hospital of Cook County from October 1, 2009, to October 31, 2011. We compared contraceptive method selection in the postabortion period after receipt of contraceptive counseling for 7466 women, stratifying women by history of no prior abortion versus one or more abortions. Of the 7466 women, 48.6% (3625) had no history of previous abortion. After controlling for age, race and number of living children, women with a history of abortion were more likely to select a highly effective method [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.06-1.33]. Most significantly, having living children was the strongest predictor of a highly effective method with an OR of 3.17 (95% CI 2.69-3.75). In women having a first-trimester abortion, the factors most predictive of selecting a highly effective method for postabortion contraception include history of previous abortion and having living children. The latter holds true independent of abortion history. This paper is unique in its ability to demonstrate the high interest in highly effective contraceptive selection in high-risk, low-income women with prior abortion history. Efforts to integrate provision of highly effective methods of contraception for postabortion care are essential for the reduction of future unintended pregnancies. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Is Previous Respiratory Disease a Risk Factor for Lung Cancer?

    Science.gov (United States)

    Denholm, Rachel; Schüz, Joachim; Straif, Kurt; Stücker, Isabelle; Jöckel, Karl-Heinz; Brenner, Darren R.; De Matteis, Sara; Boffetta, Paolo; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Landi, Maria Teresa; Caporaso, Neil; Siemiatycki, Jack; Ahrens, Wolfgang; Pohlabeln, Hermann; Zaridze, David; Field, John K.; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Dumitru, Rodica Stanescu; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Kendzia, Benjamin; Peters, Susan; Behrens, Thomas; Vermeulen, Roel; Brüning, Thomas; Kromhout, Hans

    2014-01-01

    Rationale: Previous respiratory diseases have been associated with increased risk of lung cancer. Respiratory conditions often co-occur and few studies have investigated multiple conditions simultaneously. Objectives: Investigate lung cancer risk associated with chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma. Methods: The SYNERGY project pooled information on previous respiratory diseases from 12,739 case subjects and 14,945 control subjects from 7 case–control studies conducted in Europe and Canada. Multivariate logistic regression models were used to investigate the relationship between individual diseases adjusting for co-occurring conditions, and patterns of respiratory disease diagnoses and lung cancer. Analyses were stratified by sex, and adjusted for age, center, ever-employed in a high-risk occupation, education, smoking status, cigarette pack-years, and time since quitting smoking. Measurements and Main Results: Chronic bronchitis and emphysema were positively associated with lung cancer, after accounting for other respiratory diseases and smoking (e.g., in men: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.20–1.48 and OR, 1.50; 95% CI, 1.21–1.87, respectively). A positive relationship was observed between lung cancer and pneumonia diagnosed 2 years or less before lung cancer (OR, 3.31; 95% CI, 2.33–4.70 for men), but not longer. Co-occurrence of chronic bronchitis and emphysema and/or pneumonia had a stronger positive association with lung cancer than chronic bronchitis “only.” Asthma had an inverse association with lung cancer, the association being stronger with an asthma diagnosis 5 years or more before lung cancer compared with shorter. Conclusions: Findings from this large international case–control consortium indicate that after accounting for co-occurring respiratory diseases, chronic bronchitis and emphysema continue to have a positive association with lung cancer. PMID:25054566

  2. The urgent need to change the current medical approach on tobacco cessation in Latin America Urge cambiar el abordaje de la cesación del tabaquismo por los médicos en América Latina

    Directory of Open Access Journals (Sweden)

    Guadalupe Ponciano-Rodríguez

    2010-01-01

    Full Text Available Despite of the accumulation of scientific evidence confirming the health consequences of smoking and the new paradigm of smoking as a disease where nicotine is the drug that modifies the functional and morphological characteristics of the brain in dependent smokers, tobacco smoking continues as an important public health problem in many Latin American countries. In contrast with big advances in the tobacco control area, as an example the Framework Convention on Tobacco Control signed by 168 countries, the role of health professional in the fight against tobacco is still less than ideal. In many Latin American schools of medicine, deficiencies in medical education has led to insecure physicians when they have to motivate their patients to stop smoking or to prevent young people to begin tobacco consumption. If each general practitioner or specialist during their daily medical assistance could talk to their smoker patients about the big benefits of stop smoking and support them to get free of tobacco, we would be winning a battle against smoking. Also if we could achieve generations of young non smoking doctors, who could be a real example for patients, this could also impact the prevalence of smokers. In this article we analyze the neurobiological bases of nicotine addiction, which we think are missing in the medical curriculum and could help doctors to understand tobacco smoking as a disease rather than a risk factor, and discuss the main reasons supporting an urgent change in the medical approach of tobacco cessation in Latin America as well as the need to actualize the medical curriculum in order to give physicians the skills needed to intervene successfully with their smoker patients and to be themselves non smokers.A pesar de que actualmente contamos con una gran cantidad de evidencias científicas que confirman que el tabaquismo es una enfermedad con graves consecuencias para la salud y que la nicotina es una droga o sustancia psicoactiva

  3. Microinstability of the hip: a previously unrecognized pathology

    Science.gov (United States)

    Bolia, Ioanna; Chahla, Jorge; Locks, Renato; Briggs, Karen; Philippon, Marc J.

    2016-01-01

    Summary Background Hip microinstability is an established diagnosis; however, its occurrence is still debated by many physicians. Diagnosis of hip microinstability is often challenging, due to a lack of specific signs or symptoms, and patients may remain undiagnosed for long periods. This may lead to early manifestation of degenerative joint disease. Consequently, careful patient and family history must be obtained and diagnostic imaging should follow. After a thorough clinical evaluation of the patient with suspected hip microinstability, the physician should focus on how to improve symptoms and functionality in daily and sports activities. Purpose The purpose of this review article was to give a current update regarding this diagnosis and to provide a complete diagnostic approach in order to effectively treat hip microinstability. Methods We reviewed the literature on the diagnosis, the non-operative and operative indications for the treatment of this complex and often misdiagnosed pathology. Conclusion Conservative treatment is considered the best initial approach, though, surgical intervention should be considered if symptoms persist or other hip pathology exists. Successful surgical intervention, such as hip arthroscopy, should focus on restoring the normal anatomy of the hip joint in order to regain its functionality. The role of the hip joint capsule has gained particular research interest during the last years, and its repair or reconstruction during hip arthroscopy is considered necessary in order to avoid iatrogenic hip microinstability. Various capsular closure/plication techniques have been developed towards this direction with encouraging results. Level of evidence V. PMID:28066740

  4. Mentoring to develop research selfefficacy, with particular reference to previously disadvantaged individuals

    Directory of Open Access Journals (Sweden)

    S. Schulze

    2010-07-01

    Full Text Available The development of inexperienced researchers is crucial. In response to the lack of research self-efficacy of many previously disadvantaged individuals, the article examines how mentoring can enhance the research self-efficacy of mentees. The study is grounded in the self-efficacy theory (SET – an aspect of the social cognitive theory (SCT. Insights were gained from an in-depth study of SCT, SET and mentoring, and from a completed mentoring project. This led to the formulation of three basic principles. Firstly, institutions need to provide supportive environmental conditions that facilitate research selfefficacy. This implies a supportive and efficient collective system. The possible effects of performance ratings and reward systems at the institution also need to be considered. Secondly, mentoring needs to create opportunities for young researchers to experience successful learning as a result of appropriate action. To this end, mentees need to be involved in actual research projects in small groups. At the same time the mentor needs to facilitate skills development by coaching and encouragement. Thirdly, mentors need to encourage mentees to believe in their ability to successfully complete research projects. This implies encouraging positive emotional states, stimulating self-reflection and self-comparison with others in the group, giving positive evaluative feedback and being an intentional role model.

  5. Radon anomalies prior to earthquakes (1). Review of previous studies

    International Nuclear Information System (INIS)

    Ishikawa, Tetsuo; Tokonami, Shinji; Yasuoka, Yumi; Shinogi, Masaki; Nagahama, Hiroyuki; Omori, Yasutaka; Kawada, Yusuke

    2008-01-01

    The relationship between radon anomalies and earthquakes has been studied for more than 30 years. However, most of the studies dealt with radon in soil gas or in groundwater. Before the 1995 Hyogoken-Nanbu earthquake, an anomalous increase of atmospheric radon was observed at Kobe Pharmaceutical University. The increase was well fitted with a mathematical model related to earthquake fault dynamics. This paper reports the significance of this observation, reviewing previous studies on radon anomaly before earthquakes. Groundwater/soil radon measurements for earthquake prediction began in 1970's in Japan as well as foreign countries. One of the most famous studies in Japan is groundwater radon anomaly before the 1978 Izu-Oshima-kinkai earthquake. We have recognized the significance of radon in earthquake prediction research, but recently its limitation was also pointed out. Some researchers are looking for a better indicator for precursors; simultaneous measurements of radon and other gases are new trials in recent studies. Contrary to soil/groundwater radon, we have not paid much attention to atmospheric radon before earthquakes. However, it might be possible to detect precursors in atmospheric radon before a large earthquake. In the next issues, we will discuss the details of the anomalous atmospheric radon data observed before the Hyogoken-Nanbu earthquake. (author)

  6. Cerebral Metastasis from a Previously Undiagnosed Appendiceal Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Antonio Biroli

    2012-01-01

    Full Text Available Brain metastases arise in 10%–40% of all cancer patients. Up to one third of the patients do not have previous cancer history. We report a case of a 67-years-old male patient who presented with confusion, tremor, and apraxia. A brain MRI revealed an isolated right temporal lobe lesion. A thorax-abdomen-pelvis CT scan showed no primary lesion. The patient underwent a craniotomy with gross-total resection. Histopathology revealed an intestinal-type adenocarcinoma. A colonoscopy found no primary lesion, but a PET-CT scan showed elevated FDG uptake in the appendiceal nodule. A right hemicolectomy was performed, and the specimen showed a moderately differentiated mucinous appendiceal adenocarcinoma. Whole brain radiotherapy was administrated. A subsequent thorax-abdomen CT scan revealed multiple lung and hepatic metastasis. Seven months later, the patient died of disease progression. In cases of undiagnosed primary lesions, patients present in better general condition, but overall survival does not change. Eventual identification of the primary tumor does not affect survival. PET/CT might be a helpful tool in detecting lesions of the appendiceal region. To the best of our knowledge, such a case was never reported in the literature, and an appendiceal malignancy should be suspected in patients with brain metastasis from an undiagnosed primary tumor.

  7. Measles Outbreak among Previously Immunized Adult Healthcare Workers, China, 2015

    Directory of Open Access Journals (Sweden)

    Zhengyi Zhang

    2016-01-01

    Full Text Available Measles is caused by measles virus belonging to genus Morbillivirus of the family Paramyxoviridae. Vaccination has played a critical role in controlling measles infection worldwide. However, in the recent years, outbreaks of measles infection still occur in many developing countries. Here, we report an outbreak of measles among healthcare workers and among the 60 measles infected patients 50 were healthcare workers including doctors, nurses, staff, and medics. Fifty-one patients (85% tested positive for IgM antibodies against the measles virus and 50 patients (83.3% tested positive for measles virus RNA. Surprisingly, 73.3% of the infected individuals had been previously immunized against measles. Since there is no infection division in our hospital, the fever clinics are located in the Emergency Division. In addition, the fever and rash were not recognized as measles symptoms at the beginning of the outbreak. These factors result in delay in isolation and early confirmation of the suspected patients and eventually a measles outbreak in the hospital. Our report highlights the importance of following a two-dose measles vaccine program in people including the healthcare workers. In addition, vigilant attention should be paid to medical staff with clinical fever and rash symptoms to avoid a possible nosocomial transmission of measles infection.

  8. Multispecies Coevolution Particle Swarm Optimization Based on Previous Search History

    Directory of Open Access Journals (Sweden)

    Danping Wang

    2017-01-01

    Full Text Available A hybrid coevolution particle swarm optimization algorithm with dynamic multispecies strategy based on K-means clustering and nonrevisit strategy based on Binary Space Partitioning fitness tree (called MCPSO-PSH is proposed. Previous search history memorized into the Binary Space Partitioning fitness tree can effectively restrain the individuals’ revisit phenomenon. The whole population is partitioned into several subspecies and cooperative coevolution is realized by an information communication mechanism between subspecies, which can enhance the global search ability of particles and avoid premature convergence to local optimum. To demonstrate the power of the method, comparisons between the proposed algorithm and state-of-the-art algorithms are grouped into two categories: 10 basic benchmark functions (10-dimensional and 30-dimensional, 10 CEC2005 benchmark functions (30-dimensional, and a real-world problem (multilevel image segmentation problems. Experimental results show that MCPSO-PSH displays a competitive performance compared to the other swarm-based or evolutionary algorithms in terms of solution accuracy and statistical tests.

  9. High-Grade Leiomyosarcoma Arising in a Previously Replanted Limb

    Directory of Open Access Journals (Sweden)

    Tiffany J. Pan

    2015-01-01

    Full Text Available Sarcoma development has been associated with genetics, irradiation, viral infections, and immunodeficiency. Reports of sarcomas arising in the setting of prior trauma, as in burn scars or fracture sites, are rare. We report a case of a leiomyosarcoma arising in an arm that had previously been replanted at the level of the elbow joint following traumatic amputation when the patient was eight years old. He presented twenty-four years later with a 10.8 cm mass in the replanted arm located on the volar forearm. The tumor was completely resected and pathology examination showed a high-grade, subfascial spindle cell sarcoma diagnosed as a grade 3 leiomyosarcoma with stage pT2bNxMx. The patient underwent treatment with brachytherapy, reconstruction with a free flap, and subsequently chemotherapy. To the best of our knowledge, this is the first case report of leiomyosarcoma developing in a replanted extremity. Development of leiomyosarcoma in this case could be related to revascularization, scar formation, or chronic injury after replantation. The patient remains healthy without signs of recurrence at three-year follow-up.

  10. Coronary collateral vessels in patients with previous myocardial infarction

    International Nuclear Information System (INIS)

    Nakatsuka, M.; Matsuda, Y.; Ozaki, M.

    1987-01-01

    To assess the degree of collateral vessels after myocardial infarction, coronary angiograms, left ventriculograms, and exercise thallium-201 myocardial scintigrams of 36 patients with previous myocardial infarction were reviewed. All 36 patients had total occlusion of infarct-related coronary artery and no more than 70% stenosis in other coronary arteries. In 19 of 36 patients with transient reduction of thallium-201 uptake in the infarcted area during exercise (Group A), good collaterals were observed in 10 patients, intermediate collaterals in 7 patients, and poor collaterals in 2 patients. In 17 of 36 patients without transient reduction of thallium-201 uptake in the infarcted area during exercise (Group B), good collaterals were seen in 2 patients, intermediate collaterals in 7 patients, and poor collaterals in 8 patients (p less than 0.025). Left ventricular contractions in the infarcted area were normal or hypokinetic in 10 patients and akinetic or dyskinetic in 9 patients in Group A. In Group B, 1 patient had hypokinetic contraction and 16 patients had akinetic or dyskinetic contraction (p less than 0.005). Thus, patients with transient reduction of thallium-201 uptake in the infarcted area during exercise had well developed collaterals and preserved left ventricular contraction, compared to those in patients without transient reduction of thallium-201 uptake in the infarcted area during exercise. These results suggest that the presence of viable myocardium in the infarcted area might be related to the degree of collateral vessels

  11. Motivational activities based on previous knowledge of students

    Science.gov (United States)

    García, J. A.; Gómez-Robledo, L.; Huertas, R.; Perales, F. J.

    2014-07-01

    Academic results depend strongly on the individual circumstances of students: background, motivation and aptitude. We think that academic activities conducted to increase motivation must be tuned to the special situation of the students. Main goal of this work is analyze the students in the first year of the Degree in Optics and Optometry in the University of Granada and the suitability of an activity designed for those students. Initial data were obtained from a survey inquiring about the reasons to choose this degree, their knowledge of it, and previous academic backgrounds. Results show that: 1) the group is quite heterogeneous, since students have very different background. 2) Reasons to choose the Degree in Optics and Optometry are also very different, and in many cases were selected as a second option. 3) Knowledge and motivations about the Degree are in general quite low. Trying to increase the motivation of the students we designed an academic activity in which we show different topics studied in the Degree. Results show that students that have been involved in this activity are the most motivated and most satisfied with their election of the degree.

  12. Pertussis-associated persistent cough in previously vaccinated children.

    Science.gov (United States)

    Principi, Nicola; Litt, David; Terranova, Leonardo; Picca, Marina; Malvaso, Concetta; Vitale, Cettina; Fry, Norman K; Esposito, Susanna

    2017-11-01

    To evaluate the role of Bordetella pertussis infection, 96 otherwise healthy 7- to 17-year-old subjects who were suffering from a cough lasting from 2 to 8 weeks were prospectively recruited. At enrolment, a nasopharyngeal swab and an oral fluid sample were obtained to search for pertussis infection by the detection of B. pertussis DNA and/or an elevated titre of anti-pertussis toxin IgG. Evidence of pertussis infection was found in 18 (18.7 %; 95 % confidence interval, 11.5-28.0) cases. In 15 cases, the disease occurred despite booster administration. In two cases, pertussis was diagnosed less than 2 years after the booster injection, whereas in the other cases it was diagnosed between 2 and 9 years after the booster dose. This study used non-invasive testing to show that pertussis is one of the most important causes of long-lasting cough in school-age subjects. Moreover, the protection offered by acellular pertussis vaccines currently wanes more rapidly than previously thought.

  13. Optimal temperature for malaria transmission is dramaticallylower than previously predicted

    Science.gov (United States)

    Mordecai, Eerin A.; Paaijmans, Krijin P.; Johnson, Leah R.; Balzer, Christian; Ben-Horin, Tal; de Moor, Emily; McNally, Amy; Pawar, Samraat; Ryan, Sadie J.; Smith, Thomas C.; Lafferty, Kevin D.

    2013-01-01

    The ecology of mosquito vectors and malaria parasites affect the incidence, seasonal transmission and geographical range of malaria. Most malaria models to date assume constant or linear responses of mosquito and parasite life-history traits to temperature, predicting optimal transmission at 31 °C. These models are at odds with field observations of transmission dating back nearly a century. We build a model with more realistic ecological assumptions about the thermal physiology of insects. Our model, which includes empirically derived nonlinear thermal responses, predicts optimal malaria transmission at 25 °C (6 °C lower than previous models). Moreover, the model predicts that transmission decreases dramatically at temperatures > 28 °C, altering predictions about how climate change will affect malaria. A large data set on malaria transmission risk in Africa validates both the 25 °C optimum and the decline above 28 °C. Using these more accurate nonlinear thermal-response models will aid in understanding the effects of current and future temperature regimes on disease transmission.

  14. Climbing the Needs Pyramids

    Directory of Open Access Journals (Sweden)

    J. C. Lomas

    2013-08-01

    Full Text Available Abraham Maslow’s theory of human adult motivation is often represented by a pyramid image showing two proposals: First, the five needs stages in emergent order of hierarchical ascension and second, a percentage of the adult population suggested to occupy each needs tier. Specifically, Maslow proposed that adults would be motivated to satisfy their unfilled needs until they reached the hierarchy’s apex and achieved self-transcendence. Yet how adults can purposefully ascend Maslow’s pyramid through satisfying unfilled needs remains elusive. This brief article challenges this on the theory’s 70th anniversary by presenting a new image of the needs hierarchy, based on ecological design principles to support adults’ purposeful endeavors to climb the needs pyramid.

  15. Repeat immigration: A previously unobserved source of heterogeneity?

    Science.gov (United States)

    Aradhya, Siddartha; Scott, Kirk; Smith, Christopher D

    2017-07-01

    Register data allow for nuanced analyses of heterogeneities between sub-groups which are not observable in other data sources. One heterogeneity for which register data is particularly useful is in identifying unique migration histories of immigrant populations, a group of interest across disciplines. Years since migration is a commonly used measure of integration in studies seeking to understand the outcomes of immigrants. This study constructs detailed migration histories to test whether misclassified migrations may mask important heterogeneities. In doing so, we identify a previously understudied group of migrants called repeat immigrants, and show that they differ systematically from permanent immigrants. In addition, we quantify the degree to which migration information is misreported in the registers. The analysis is carried out in two steps. First, we estimate income trajectories for repeat immigrants and permanent immigrants to understand the degree to which they differ. Second, we test data validity by cross-referencing migration information with changes in income to determine whether there are inconsistencies indicating misreporting. From the first part of the analysis, the results indicate that repeat immigrants systematically differ from permanent immigrants in terms of income trajectories. Furthermore, income trajectories differ based on the way in which years since migration is calculated. The second part of the analysis suggests that misreported migration events, while present, are negligible. Repeat immigrants differ in terms of income trajectories, and may differ in terms of other outcomes as well. Furthermore, this study underlines that Swedish registers provide a reliable data source to analyze groups which are unidentifiable in other data sources.

  16. Human stool contains a previously unrecognized diversity of novel astroviruses

    Directory of Open Access Journals (Sweden)

    Zhao Guoyan

    2009-10-01

    Full Text Available Abstract Human astroviruses are a leading cause of gastrointestinal disease. Since their discovery in 1975, 8 closely related serotypes have been described in humans, and more recently, two new astrovirus species, astrovirus MLB1 and astrovirus VA1, were identified in diarrhea patients. In this study, we used consensus astrovirus primers targeting the RNA polymerase to define the diversity of astroviruses present in pediatric patients with diarrhea on two continents. From 416 stool specimens comprising two different cohorts from Vellore, India, 35 samples were positive. These positive samples were analyzed further by either sequencing of the ~400 bp amplicon generated by the consensus PCR or by performing additional RT-PCR specific for individual astroviruses. 19 samples contained the classic human astrovirus serotypes 1-8 while 7 samples were positive for the recently described astrovirus MLB1. Strikingly, from samples that were positive in the consensus PCR screen but negative in the specific PCR assays, five samples contained sequences that were highly divergent from all previously described astroviruses. Sequence analysis suggested that three novel astroviruses, tentatively named astroviruses VA2, MLB2 and VA3, were present in these five patient specimens (AstV-VA2 in 2 patients, AstV-MLB2 in 2 patients and AstV-VA3 in one patient. Using the same RT-PCR screening strategy, 13 samples out of 466 tested stool specimens collected in St. Louis, USA were positive. Nine samples were positive for the classic human astroviruses. One sample was positive for AstV-VA2, and 3 samples were positive for AstV-MLB2 demonstrating that these two viruses are globally widespread. Collectively, these findings underscore the tremendous diversity of astroviruses present in fecal specimens from diarrhea patients. Given that a significant fraction of diarrhea etiologies is currently unknown, it is plausible that these or other yet unrecognized astroviruses may be

  17. Gastrointestinal tolerability with ibandronate after previous weekly bisphosphonate treatment

    Directory of Open Access Journals (Sweden)

    Richard Derman

    2009-09-01

    Full Text Available Richard Derman1, Joseph D Kohles2, Ann Babbitt31Department of Obstetrics and Gynecology, Christiana Hospital, Newark, DE, USA; 2Roche, Nutley, NJ, USA; 3Greater Portland Bone and Joint Specialists, Portland, ME, USAAbstract: Data from two open-label trials (PRIOR and CURRENT of women with postmenopausal osteoporosis or osteopenia were evaluated to assess whether monthly oral and quarterly intravenous (IV ibandronate dosing improved self-reported gastrointestinal (GI tolerability for patients who had previously experienced GI irritation with bisphosphonate (BP use. In PRIOR, women who had discontinued daily or weekly BP treatment due to GI intolerance received monthly oral or quarterly IV ibandronate for 12 months. The CURRENT subanalysis included women receiving weekly BP treatment who switched to monthly oral ibandronate for six months. GI symptom severity and frequency were assessed using the Osteoporosis Patient Satisfaction Questionnaire™. In PRIOR, mean GI tolerability scores increased significantly at month 1 from screening for both treatment groups (oral: 79.3 versus 54.1; IV: 84.4 versus 51.0; p < 0.001 for both. Most patients reported improvement in GI symptom severity and frequency from baseline at all post-screening assessments (>90% at Month 10. In the CURRENT subanalysis >60% of patients reported improvements in heartburn or acid reflux and >70% indicated improvement in other stomach upset at month 6. Postmenopausal women with GI irritability with daily or weekly BPs experienced improvement in symptoms with extended dosing monthly or quarterly ibandronate compared with baseline.Keywords: ibandronate, osteoporosis, bisphosphonate, gastrointestinal

  18. Information Needs/Relevance

    OpenAIRE

    Wildemuth, Barbara M.

    2009-01-01

    A user's interaction with a DL is often initiated as the result of the user experiencing an information need of some kind. Aspects of that experience and how it might affect the user's interactions with the DL are discussed in this module. In addition, users continuously make decisions about and evaluations of the materials retrieved from a DL, relative to their information needs. Relevance judgments, and their relationship to the user's information needs, are discussed in this module. Draft

  19. Climbing the Needs Pyramids

    OpenAIRE

    J. C. Lomas

    2013-01-01

    Abraham Maslow’s theory of human adult motivation is often represented by a pyramid image showing two proposals: First, the five needs stages in emergent order of hierarchical ascension and second, a percentage of the adult population suggested to occupy each needs tier. Specifically, Maslow proposed that adults would be motivated to satisfy their unfilled needs until they reached the hierarchy’s apex and achieved self...

  20. Priority knowledge needs. Summary

    International Nuclear Information System (INIS)

    2012-01-01

    This report gives an overview of the knowledge needs identified during the work on the scientific basis for the management plan. The overview includes knowledge needs identified in: the impact assessments for various sectors; the reports on the vulnerability of particularly valuable areas; proposed indicators for a monitoring system; cumulative environmental effects; conflicting interests and the need for coordination; and the report on analysis of population and, economic activity and ecosystem services. In addition, the working group has identified several additional knowledge needs. The present report summarises the 2010 status report and describes new developments since its publication.(Author)

  1. Priority knowledge needs. Summary

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    This report gives an overview of the knowledge needs identified during the work on the scientific basis for the management plan. The overview includes knowledge needs identified in: the impact assessments for various sectors; the reports on the vulnerability of particularly valuable areas; proposed indicators for a monitoring system; cumulative environmental effects; conflicting interests and the need for coordination; and the report on analysis of population and, economic activity and ecosystem services. In addition, the working group has identified several additional knowledge needs. The present report summarises the 2010 status report and describes new developments since its publication.(Author)

  2. Lung cancer in Hodgkin's disease: association with previous radiotherapy

    International Nuclear Information System (INIS)

    List, A.F.; Doll, D.C.; Greco, F.A.

    1985-01-01

    Seven cases of lung cancer were observed in patients with Hodgkin's disease (HD) since 1970. The risk ratio for the development of lung cancer among HD patients was 5.6 times that expected in the general population. The pertinent clinical data from these patients are described and compared to 28 additional patients reported from other institutions. Small-cell lung cancer represented the predominant histologic type of lung cancer encountered in both smoking and nonsmoking patients with HD, accounting for 42% of cases overall and greater than 55% of cases reported in reviews of second malignancies. Tobacco use was noted in only 53% of patients. Twenty-eight (94%) of 30 patients developing metachronous lung cancer received supradiaphragmatic irradiation as primary therapy for HD. Nineteen (68%) of these patients received subsequent chemotherapy salvage. The median age at diagnosis of HD and lung cancer was 39 and 45 years, respectively. The interval between diagnosis of HD and metachronous lung cancer averaged seven years but appeared to vary inversely with age. HD patients treated with supradiaphragmatic irradiation or combined modality therapy may be at increased risk for developing lung cancer. The high frequency of in-field malignancies that the authors observed and the prevalence of small-cell lung cancer in both smoking and nonsmoking patients suggests that chest irradiation may influence the development of metachronous lung cancer in these patients. The finding of a mean latent interval in excess of seven years emphasizes the need for close long-term observation

  3. Vaginal misoprostol for second-trimester pregnancy termination after one previous cesarean delivery.

    Science.gov (United States)

    Naguib, Ahmad H; Morsi, Hassan M; Borg, Tamer F; Fayed, Salah T; Hemeda, Hosam M

    2010-01-01

    To determine the safety and efficacy of using misoprostol vaginally for second-trimester abortion in women with a single previous cesarean delivery. This prospective observational study was carried out at a university hospital in Egypt with 50 pregnant women with 1 previous cesarean delivery; a gestation of at least 16 weeks but less than 20 weeks (group 1) or 20 or more weeks (group 2); and a need to terminate the pregnancy. The regimen was 4 doses of 200 microg of misoprostol applied vaginally every 4 hours daily, with a 12-hour nightly rest from misoprostol applications, until contractions appeared but not for more than 72 hours. The primary outcome was the induction-to-abortion interval. There were no cases of uterine rupture. Abortion within the study protocol occurred in 45 of the 50 women, for a 90% success rate. There was no significant difference in the induction-to-abortion interval between the 2 groups. Inducing abortion with lower misoprostol doses appear to be safe and effective throughout the second trimester in women with a single previous cesarean delivery. Larger randomized trials are needed to validate these results.

  4. Training Needs Identification: A Turning Point.

    Science.gov (United States)

    Thomas, Edwin A.

    1982-01-01

    Describes a systematic approach to training needs identification that is directly tied to changing organizational events and performance requirements. The discussion includes nine questions which address performance expectations. (JJD)

  5. Effect of Previous Gastrectomy on the Performance of Postoperative Colonoscopy

    Science.gov (United States)

    Kim, Sunghwan; Choi, Jeongmin; Kim, Tae Han; Suh, Yun-Suhk; Im, Jong Pil; Lee, Hyuk-Joon; Kim, Sang Gyun; Jeong, Seung-Yong; Kim, Joo Sung; Yang, Han-Kwang

    2016-01-01

    Purpose The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies. Materials and Methods Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance. Results A history of gastrectomy was associated with prolonged cecal insertion time (8.7±6.4 vs. 9.7±6.5 minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy. Conclusions History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time. PMID:27752394

  6. Additional user needs

    International Nuclear Information System (INIS)

    Rorschach, H.E.; Hayter, J.B.

    1986-01-01

    This paper summarizes the conclusions of a discussion group on users' needs held at the Workshop on an Advanced Steady-State Neutron Facility. The discussion was devoted to reactor characteristics, special facilities and siting considerations suggested by user needs. (orig.)

  7. Value, utility and needs

    DEFF Research Database (Denmark)

    Ravn, Ib

    . Objective needs for certain kinds of nutrition, like vitamins and trace minerals have been discovered by nutritional science, and researchers in SDT have identified certain psychological needs, that is, psychological nutrients required for people to enjoy psychosocial functioning and well-being. Researchers...... on every commodity. In this conceptual paper, SDTs’ mini-theory of Basic Psychological Needs is applied to solve the “paradox of value” in economics (Weisskopf, 1956): Why are some things that are practically free, such as oxygen, water and fellowship, so valuable to people, while others, often craved...... or demand jewelry in limited supply, its value increases, whether it meets human needs or not. The confusion in economics of value, price, demand, wants and needs reflects the primitive state of the human sciences in the 1800’s. Today, however, these sciences have moved on, unbeknownst to economists...

  8. Accident management information needs

    International Nuclear Information System (INIS)

    Hanson, D.J.; Ward, L.W.; Nelson, W.R.; Meyer, O.R.

    1990-04-01

    The tables contained in this Appendix A describe the information needs for a pressurized water reactor (PWR) with a large, dry containment. To identify these information needs, the branch points in the safety objective trees were examined to decide what information is necessary to (a) determine the status of the safety functions in the plant, i.e., whether the safety functions are being adequately maintained within predetermined limits, (b) identify plant behavior (mechanisms) or precursors to this behavior which indicate that a challenge to plant safety is occurring or is imminent, and (c) select strategies that will prevent or mitigate this plant behavior and monitor the implementation and effectiveness of these strategies. The information needs for the challenges to the safety functions are not examined since the summation of the information needs for all mechanisms associated with a challenge comprise the information needs for the challenge itself

  9. Poverty, Socio-Political Factors and Degradation of the Environment in Sub-Saharan Africa: The Need For a Holistic Approach to the Protection of the Environment and Realisation of the Right to Environment

    Directory of Open Access Journals (Sweden)

    Emeka Polycarp Amechi

    2009-09-01

    Full Text Available The right to environment is a recognised human right in Africa. However, despite the legal and institutional frameworks designed to respect, promote, protect and fulfil the right, its enjoyment is still a mirage to majority of African citizens as a result of environmental degradation. This article aims to proffer a holistic or integrated approach to tackling the problem of environmental degradation in sub-Saharan Africa in order to enhance the protection of the environment and the realisation of this right in the region. It recognises that the problem of environmental degradation in the region is not due to lack of regulatory frameworks, but rather due to other factors that are mainly socio-economic and political in nature. It argues that to enhance the protection of the environment and realisation of this right in sub-Saharan Africa, African governments must adopt a holistic approach towards the protection of the environment, and proposes the promotion of good governance and socio-economic reform in the region as an integral core of such approach.

  10. Long- term effects of previous experience determine nutrient discrimination abilities in birds

    Directory of Open Access Journals (Sweden)

    Spitzer Kathrin

    2008-02-01

    Full Text Available Abstract Background Foraging behaviour is an essential ecological process linking different trophic levels. A central assumption of foraging theory is that food selection maximises the fitness of the consumer. It remains unknown, however, whether animals use innate or learned behaviour to discriminate food rewards. While many studies demonstrated that previous experience is a strong determinant of complex food choices such as diet mixing, the response to simple nutritional stimuli, such as sugar concentrations, is often believed to be innate. Results Here we show that previous experience determines the ability to track changes in sugar composition in same-aged individuals of a short-lived migratory songbird, the garden warbler (Sylvia borin. Although birds received identical foods for seven months prior to the experiment, wild-caught birds achieved higher sugar intake rates than hand-raised birds when confronted with alternative, differently coloured, novel food types. Hand-raised and wild birds did not differ in their initial colour selection or overall food intake, but wild birds were quicker to adjust food choice to varying sugar intake. Conclusion Over a period of at least seven months, broader previous experience translates into a higher plasticity of food choice leading to higher nutrient intake. Our results thus highlight the need to address previous long-term experience in foraging experiments. Furthermore, they show that hand-raised animals are often poor surrogates for testing the foraging behaviour of wild animals.

  11. Down syndrome screening marker levels in women with a previous aneuploidy pregnancy.

    Science.gov (United States)

    Cuckle, Howard S; Spencer, K; Nicolaides, K H

    2005-01-01

    In Down syndrome screening programmes, women with a previous affected pregnancy are assumed to have the same marker distribution as those without a family history. This assumption needs to be tested. Information on previous aneuploidy pregnancies was routinely sought on the test request forms in three centres, Leeds, Romford and the Fetal Medicine Centre, London. For each woman with a previous aneuploidy (case), five unaffected pregnancies to women without a history were selected as controls. The markers tested included maternal serum free beta-human chorionic gonadotrophin (hCG), pregnancy-associated plasma protein A (PAPP-A), alpha-fetoprotein, unconjugated estriol and ultrasound nuchal translucency thickness. There were 375 cases: 303 with previous Down syndrome, 63 with Edwards syndrome and 9 with Patau's syndrome. There was a statistically significant difference between cases and controls, in the distribution of free beta-hCG and PAPP-A levels, adjusted for gestation. On average, free beta-hCG was increased by 10% in a subsequent pregnancy after aneuploidy (p pregnancies are available for study, it would be prudent to assume that the same increase as in unaffected pregnancies applies. Copyright (c) 2005 John Wiley & Sons, Ltd.

  12. Old-growth forest is what giant pandas really need.

    Science.gov (United States)

    Zhang, Zejun; Swaisgood, Ronald R; Zhang, Shanning; Nordstrom, Lisa A; Wang, Hongjia; Gu, Xiaodong; Hu, Jinchu; Wei, Fuwen

    2011-06-23

    Giant pandas (Ailuropoda melanoleuca) are an iconic conservation species, but despite significant research effort, do we understand what they really need? Estimating and mapping suitable habitat play a critical role in conservation planning and policy. But if assumptions about ecological needs are wrong, maps with misidentified suitable habitat will misguide conservation action. Here, we use an information-theoretic approach to analyse the largest, landscape-level dataset on panda habitat use to date, and challenge the prevailing wisdom about panda habitat needs. We show that pandas are associated with old-growth forest more than with any ecological variable other than bamboo. Other factors traditionally used in panda habitat models, such as topographic slope, are less important. We suggest that our findings are disparate from previous research in part because our research was conducted over a larger ecological scale than previous research conducted over more circumscribed areas within individual reserves. Thus, extrapolating from habitat studies on small scales to conservation planning on large scales may entail some risk. As the Chinese government is considering the renewal of its logging ban, it should take heed of the panda's dependency on old growth.

  13. Accident information needs

    International Nuclear Information System (INIS)

    Hanson, D.J.; Arcieri, W.C.; Ward, L.W.

    1992-01-01

    A Five-step methodology has been developed to evaluate information needs for nuclear power plants under accident conditions and the availability of plant instrumentation during severe accidents. Step 1 examines the credible accidents and their relationships to plant safety functions. Step 2 determines the information personnel involved in accident management will need to understand plant behavior. Step 3 determines the capability of the instrumentation to function properly under severe accident conditions. Step 4 determines the conditions expected during the identified severe accidents. Step 5 compares the instrument capabilities and the severe accident conditions to evaluate the availability of the instrumentation to supply needed plant information

  14. New study reveals twice as many asteroids as previously believed

    Science.gov (United States)

    2002-05-01

    The ISO satellite Credits: ESA ISO An artist's impression of the ISO spacecraft. The ISO Deep Asteroid Search indicates that there are between 1.1 million and 1.9 million 'space rocks' larger than 1 kilometre in diameter in the so-called 'main asteroid belt', about twice as many as previously believed. However, astronomers think it is premature to revise current assessments of the risk of the Earth being hit by an asteroid. Despite being in our own Solar System, asteroids can be more difficult to study than very distant galaxies. With sizes of up to one thousand kilometres in diameter, the brightness of these rocky objects may vary considerably in just a few minutes. They move very quickly with respect to the stars - they have been dubbed 'vermin of the sky' because they often appear as trails on long exposure images. This elusiveness explains why their actual number and size distribution remains uncertain. Most of the almost 40,000 asteroids catalogued so far (1) orbit the Sun forming the 'main asteroid belt', between Mars and Jupiter, too far to pose any threat to Earth. However, space-watchers do keep a closer eye on another category of asteroids, the 'Near Earth Asteroids' or 'NEAs', which are those whose orbits cross, or are likely to cross, that of our planet. The ISO Deep Asteroid Search (IDAS), the first systematic search for these objects performed in infrared light, focused on main belt asteroids. Because it is impossible to simply point the telescope at the whole main belt and count, astronomers choose selected regions of the belt and then use a theoretical model to extrapolate the data to the whole belt. Edward Tedesco (TerraSystems, Inc., New Hampshire, United States) and François-Xavier Desert (Observatoire de Grenoble, France) observed their main belt selected areas in 1996 and 1997 with ESA's ISO. They found that in the middle region of the belt the density of asteroids was 160 asteroids larger than 1 kilometre per square degree - an area of the

  15. Congenital costo-vertebral fibrous band and congenital kyphoscoliosis: a previously unreported combination.

    Science.gov (United States)

    Eid, Tony; Ghostine, Bachir; Kreichaty, Gaby; Daher, Paul; Ghanem, Ismat

    2013-05-01

    Congenital kyphoscoliosis (CKS) results from abnormal vertebral chondrification. Congenital fibrous bands occur in several locations with variable impact on vertebral development. We report a previously unreported case of a female infant with CKS presenting with an L2 hypoplastic vertebra and a costo-vertebral fibrous band extending to the skin in the form of a dimple. We also describe the therapeutic approach, consisting of surgical excision of the fibrous band and postoperative fulltime bracing, with a 7-year follow-up. We recommend a high index of suspicion in any unusual presentation of CKS and insist on case by case management in such cases.

  16. Why We Need Marketing.

    Science.gov (United States)

    Harper, Nancy

    1984-01-01

    An interview with Philip Kotler, the Harold T. Martin Professor of Marketing at Northwestern University, is presented. Three approaches to marketing are identified: product-oriented, hard-sell, and building satisfaction in a long-term clientele. (MLW)

  17. Is Cup Positioning Challenged in Hips Previously Treated With Periacetabular Osteotomy?

    DEFF Research Database (Denmark)

    Hartig-Andreasen, Charlotte; Stilling, Maiken; Søballe, Kjeld

    2014-01-01

    After periacetabular osteotomy (PAO), some patients develop osteoarthritis with need of a total hip arthroplasty (THA). We evaluated the outcome of THA following PAO and explored factors associated with inferior cup position and increased polyethylene wear. Follow-up were performed 4 to 10years...... after THA in 34 patients (38 hips) with previous PAO. Computer analysis evaluated cup position and wear rates. No patient had dislocations or revision surgery. Median scores were: Harris hip 96, Oxford hip 38 and WOMAC 78. Mean cup anteversion and abduction angles were 22(o) (range 7°-43°) and 45...

  18. College Information Needs.

    Science.gov (United States)

    Cibik, Margaret A.

    1982-01-01

    A survey of a sampling of college-bound high school seniors in Arizona was undertaken to determine students' information needs for college choice. Items, including institutional, student, and program characteristics, are ranked in order of perceived importance. (MSE)

  19. Human Water Needs

    National Research Council Canada - National Science Library

    Sawka, Michael N; Cheuvront, Samuel N; Carter, Robert, III

    2005-01-01

    .... Total water intake incluces drinking water, water in beverages, and water in food. Daily water needs determined from fluid balance, water turnover, or consumption studies provide similar values for a given set of conditions...

  20. Babies Need Tummy Time

    Science.gov (United States)

    ... sharing on social media links Babies Need Tummy Time! Page Content Tummy Time is not only an ... of your baby’s normal growth. What Is Tummy Time? Tummy Time describes the times when you place ...

  1. Irradiation - who needs it?

    International Nuclear Information System (INIS)

    Scoular, C.

    1994-01-01

    In this paper the public's attitudes to the irradiation of food to ensure it is bacteria free and to prolong shelf-life are considered. The need to label irradiated food and to educate the public about its implications are emphasised. The opinions of the large food retailers who maintain that high standards in food processing, hygiene and refrigeration eliminate the need for food irradiation are discussed. (UK)

  2. Analysis of current research addressing complementary use of life-cycle assessment and risk assessment for engineered nanomaterials: have lessons been learned from previous experience with chemicals?

    International Nuclear Information System (INIS)

    Grieger, Khara D.; Laurent, Alexis; Miseljic, Mirko; Christensen, Frans; Baun, Anders; Olsen, Stig I.

    2012-01-01

    While it is generally agreed that successful strategies to address the health and environmental impacts of engineered nanomaterials (NM) should consider the well-established frameworks for conducting life-cycle assessment (LCA) and risk assessment (RA), scientific research, and specific guidance on how to practically apply these methods are still very much under development. This paper evaluates how research efforts have applied LCA and RA together for NM, particularly reflecting on previous experiences with applying these methods to chemicals. Through a literature review and a separate analysis of research focused on applying LCA and RA together for NM, it appears that current research efforts have taken into account some key “lessons learned” from previous experience with chemicals while many key challenges remain for practically applying these methods to NM. We identified two main approaches for using these methods together for NM: “LC-based RA” (traditional RA applied in a life-cycle perspective) and “RA-complemented LCA” (conventional LCA supplemented by RA in specific life-cycle steps). Hence, the latter is the only identified approach which genuinely combines LC- and RA-based methods for NM-risk research efforts to date as the former is rather a continuation of normal RA according to standard assessment procedures (e.g., REACH). Both these approaches along with recommendations for using LCA and RA together for NM are similar to those made previously for chemicals, and thus, there does not appear to be much progress made specific for NM. We have identified one issue in particular that may be specific for NM when applying LCA and RA at this time: the need to establish proper dose metrics within both methods.

  3. Natural gas and bio methane in the future fuel mix. Need of action and solution approaches for an accelerated etablishment in the traffic; Erdgas und Biomethan im kuenftigen Kraftstoffmix. Handlungsbedarf und Loesungsansaetze fuer eine beschleunigte Etablierung im Verkehr

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-01-15

    The contribution under consideration reports on the need of action and on solution attempts for an accelerated establishment of natural gas and bio methane in the future fuel mix. The authors come to the following conclusions: The energy situation and climatic situation require a stronger diversification of fuels and drives. The targets for the amount of natural gas and bio methane as a fuel are not reached yet. The characteristics of natural gas speak for an accelerated establishment in the traffic sector. The admixture of bio methane can increase the climatic, environmental and resources advantages. In order to penetrate the market all participants involved must commit themselves to a concrete 'roadmap'. The contribution shows which measures must be converted by the participants involved in order to be able to utilize fully the potentials of the employment of natural gas and bio methane in the traffic sector.

  4. Low-dose computed tomography image restoration using previous normal-dose scan

    Science.gov (United States)

    Ma, Jianhua; Huang, Jing; Feng, Qianjin; Zhang, Hua; Lu, Hongbing; Liang, Zhengrong; Chen, Wufan

    2011-01-01

    the previous normal-dose scan via the presented ndiNLM algorithm is noticeable as compared to a similar approach without using the previous normal-dose scan.Conclusions: For low-dose CT image restoration, the presented ndiNLM method is robust in preserving the spatial resolution and identifying the low-contrast structure. The authors can draw the conclusion that the presented ndiNLM algorithm may be useful for some clinical applications such as in perfusion imaging, radiotherapy, tumor surveillance, etc. PMID:21992386

  5. Bearings: Technology and needs

    Science.gov (United States)

    Anderson, W. J.

    1982-01-01

    A brief status report on bearing technology and present and near-term future problems that warrant research support is presented. For rolling element bearings a material with improved fracture toughness, life data in the low Lambda region, a comprehensive failure theory verified by life data and incorporated into dynamic analyses, and an improved corrosion resistant alloy are perceived as important needs. For hydrodynamic bearings better definition of cavitation boundaries and pressure distributions for squeeze film dampers, and geometry optimization for minimum power loss in turbulent film bearings are needed. For gas film bearings, foil bearing geometries that form more nearly optimum film shapes for maximum load capacity, and more effective surface protective coatings for high temperature operation are needed.

  6. Human water needs.

    Science.gov (United States)

    Sawka, Michael N; Cheuvront, Samuel N; Carter, Robert

    2005-06-01

    Healthy humans regulate daily water balance remarkably well across their lifespan despite changes in biological development and exposure to stressors on hydration status. Acute or chronic body water deficits result when intakes are reduced or losses increase, but day-to-day hydration is generally well maintained so long as food and fluid are readily available. Total water intake includes drinking water, water in beverages, and water in food. Daily water needs determined from fluid balance, water turnover, or consumption studies provide similar values for a given set of conditions. A daily water intake of 3.7 L for adult men and 2.7 L for adult women meets the needs of the vast majority of persons. However, strenuous physical exercise and heat stress can greatly increase daily water needs, and the individual variability between athletes can be substantial.

  7. Magnetic resonance imaging detection of prostate cancer in men with previous negative prostate biopsy.

    Science.gov (United States)

    Truong, Matthew; Frye, Thomas P

    2017-06-01

    Use of transrectal ultrasound guided systematic prostate biopsy has poor diagnostic accuracy for prostate cancer (PCa) detection. Recently multiparametric MRI (mpMRI) of the prostate and MR/US fusion biopsy has been gaining popularity for men who have previously undergone a negative biopsy. We performed PubMed ® and Web of Science ® searches to identify studies on this subject, particularly focusing on studies consisting of patients who have had at least one previously negative biopsy. Across the literature, when a suspicious lesion is found on mpMRI, MR/US fusion biopsy has consistently demonstrated higher detection rate for any PCa and clinically significant PCa (csPCa) compared to the traditional repeat systematic biopsy (SB) approach. Furthermore, anteriorly located tumors are frequently identified using MR targeted biopsy (TB), suggesting that an MR guided approach allows for increased accuracy for detecting tumors commonly missed by systematic biopsies. We conclude that men with a prior negative biopsy and continued suspicion of PCa should strongly be encouraged to get a prostate mpMRI prior to a repeat biopsy.

  8. Pedagogical approaches

    DEFF Research Database (Denmark)

    Lund Larsen, Lea

    questions are: How (much) and what do teachers learn from experience? And how do teachers of adults develop their pedagogical approach? I examine the field of adult learners from the teachers’ perspective. Firstly, I identify some of the commonly described characteristics of adults as learners...... in formal settings, but in most teaching settings, the teachers act alone and develop their pedagogical approaches/- teaching strategies with no synchronous sparring from a colleague. Adult learners have particular needs and characteristics that their teachers must be able to address (cf. Knowles...

  9. Who needs intervention?

    DEFF Research Database (Denmark)

    Jørgensen, Line Dahl

    2015-01-01

    Who needs intervention? A phonological screening tool for children with cleft palate Children with cleft palate +/- cleft lip (CP) are at risk of speech and language delay. It is important to identify children with difficulties as early as possible in order to offer appropriate intervention. Conv....... Lieberman, M., & Lohmander, A. (2014). Observation is a valid way of assessing common variables in typical babbling and identifies infants who need further support. Acta Paediatrica, 103(12), 1251–1257. doi:10.1111/apa.12776...

  10. Dietary self-efficacy predicts AHEI diet quality in women with previous gestational diabetes.

    Science.gov (United States)

    Ferranti, Erin Poe; Narayan, K M Venkat; Reilly, Carolyn M; Foster, Jennifer; McCullough, Marjorie; Ziegler, Thomas R; Guo, Ying; Dunbar, Sandra B

    2014-01-01

    The purpose of this study was to examine the association of intrapersonal influences of diet quality as defined by the Health Belief Model constructs in women with recent histories of gestational diabetes. A descriptive, correlational, cross-sectional design was used to analyze relationships between diet quality and intrapersonal variables, including perceptions of threat of type 2 diabetes mellitus development, benefits and barriers of healthy eating, and dietary self-efficacy, in a convenience sample of 75 community-dwelling women (55% minority; mean age, 35.5 years; SD, 5.5 years) with previous gestational diabetes mellitus. Diet quality was defined by the Alternative Healthy Eating Index (AHEI). Multiple regression was used to identify predictors of AHEI diet quality. Women had moderate AHEI diet quality (mean score, 47.6; SD, 14.3). Only higher levels of education and self-efficacy significantly predicted better AHEI diet quality, controlling for other contributing variables. There is a significant opportunity to improve diet quality in women with previous gestational diabetes mellitus. Improving self-efficacy may be an important component to include in nutrition interventions. In addition to identifying other important individual components, future studies of diet quality in women with previous gestational diabetes mellitus are needed to investigate the scope of influence beyond the individual to potential family, social, and environmental factors. © 2014 The Author(s).

  11. Impact of vocational interests, previous academic experience, gender and age on Situational Judgement Test performance.

    Science.gov (United States)

    Schripsema, Nienke R; van Trigt, Anke M; Borleffs, Jan C C; Cohen-Schotanus, Janke

    2017-05-01

    Situational Judgement Tests (SJTs) are increasingly implemented in medical school admissions. In this paper, we investigate the effects of vocational interests, previous academic experience, gender and age on SJT performance. The SJT was part of the selection process for the Bachelor's degree programme in Medicine at University of Groningen, the Netherlands. All applicants for the academic year 2015-2016 were included and had to choose between learning communities Global Health (n = 126), Sustainable Care (n = 149), Intramural Care (n = 225), or Molecular Medicine (n = 116). This choice was used as a proxy for vocational interest. In addition, all graduate-entry applicants for academic year 2015-2016 (n = 213) were included to examine the effect of previous academic experience on performance. We used MANCOVA analyses with Bonferroni post hoc multiple comparisons tests for applicant performance on a six-scenario SJT. The MANCOVA analyses showed that for all scenarios, the independent variables were significantly related to performance (Pillai's Trace: 0.02-0.47, p performance on three scenarios (p performance on two scenarios (p performance, as was previous academic experience. Gender and age were related to performance on SJT scenarios in different settings. Especially the first effect might be helpful in selecting appropriate candidates for areas of health care in which more professionals are needed.

  12. Differences between previously married and never married 'gay' men: family background, childhood experiences and current attitudes.

    Science.gov (United States)

    Higgins, Daryl J

    2004-01-01

    Despite a large body of literature on the development of sexual orientation, little is known about why some gay men have been (or remain) married to a woman. In the current study, a self-selected sample of 43 never married gay men ('never married') and 26 gay men who were married to a woman ('previously married') completed a self-report questionnaire. Hypotheses were based on five possible explanations for gay men's marriages: (a) differences in sexual orientation (i.e., bisexuality); (b) internalized homophobia; (c) religious intolerance; (d) confusion created because of childhood/adolescent sexual experiences; and/or (e) poor psychological adjustment. Previously married described their families' religious beliefs as more fundamentalist than never married. No differences were found between married' and never married' ratings of their sexual orientation and identity, and levels of homophobia and self-depreciation. Family adaptability and family cohesion and the degree to which respondents reported having experienced child maltreatment did not distinguish between previously married and never married. The results highlight how little is understood of the reasons why gay men marry, and the need to develop an adequate theoretical model.

  13. User needs in television archive access

    DEFF Research Database (Denmark)

    Kirkegaard Lunn, Brian

    2009-01-01

    This paper presents a methodical approach for generating deep knowledge about users, as a prerequisite for design and construction of digital information access to cultural heritage information objects. We exemplify this methodical approach by reporting on an explorative study of information need...... are needed as objects of analysis in empirical research. Secondly, the needs are related to three broadcast dimensions: 1) Transmission; 2) Archive; and 3) Reception. Thirdly, four fundamental types of information needs are verified in a television broadcast context: 1) Known item; 2) Factual data; 3) Known...... research on characteristics of information needs in a television broadcast context. We demonstrate how one may go about generating knowledge which is imperative for the design and construction of future broadcast retrieval systems. Udgivelsesdato: 2009...

  14. A Need to Know

    Centers for Disease Control (CDC) Podcasts

    2009-03-16

    This podcast discusses the importance of African-American men who have sex with other men needing to know their HIV status. .  Created: 3/16/2009 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 3/19/2009.

  15. Big Brother Not Needed.

    Science.gov (United States)

    Heinen, Edward

    1983-01-01

    Cites the recent United States State Department's labeling of recent Canadian films--one on nuclear war and two on acid rain--as political propaganda as a sign of the need to review the nature of propaganda. Suggests that teaching students to intelligently evaluate propaganda is preferable to submitting to government dictum. (MM)

  16. Capabilities and Special Needs

    DEFF Research Database (Denmark)

    Kjeldsen, Christian Christrup

    thesis deals with a new Danish innovative policy (Act. no. 564 of 2007), a social work and educational intervention for mentally challenged Young people and other young people with special needs, the so-called individually arranged youth education (STU). The investigated area has lately been taken...

  17. Special Needs Education

    African Journals Online (AJOL)

    Erna Kinsey

    We (de)construct interpretive discourses in South Africa's recently published White Paper on Special Needs Education. ..... mation and advocacy campaign, targets parents and mobilises com- munity support. The passive voice arms parents with information. War is declared against social constructions averse to the vision of ...

  18. Physics and contemporary needs

    International Nuclear Information System (INIS)

    Yaldram, K.; Awais, M.M.

    1992-01-01

    The topics of emphasis in this proceeding were on two important aspects of physics: (i) computational physics and applications; and (ii) plasma physics. The lectures culminated in a very interactive discussion. The present volume of 'Physics and Contemporary Needs' covers the proceedings of this college. Some main papers in this proceedings are on neural networks, superconductors and inertial confinement fusion. (A.B.)

  19. Number Needed To… $ave?

    Science.gov (United States)

    Rocker, Graeme M; Verma, Jennifer Y; Demmons, Jillian; Mittmann, Nicole

    2015-02-06

    The 'Number Needed to Treat' (NNT) is a useful measure for estimating the number of patients that would need to receive a therapeutic intervention to avoid one of the adverse events that the treatment is designed to prevent. We explored the possibility of an adaption of NNT to estimate the 'Number Needed to $ave' (NN$) as a new, conceptual systems metric to estimate potential cost-savings to the health system from implementation of a treatment, or in this case, a program. We used the outcomes of the INSPIRED COPD Outreach ProgramTM to calculate that 26 patients would need to complete the program to avoid healthcare expenditures of $100,000, based on hospital bed days avoided. The NN$ does not translate into 'cost savings' per se, but redirection of resource expenditures for other purposes. We propose that the NN$ metric, if further developed, could help to inform system-level resource allocation decisions in a manner similar to the way that the NNT metric helps to inform individual-level treatment decisions.

  20. Your Nutritional Needs

    Science.gov (United States)

    New moms need to eat healthy foods to return to a healthy weight, keep up their energy, and adjust to changing sleep habits that come with caring for a baby around the clock. If you’re breastfeeding, it’s even more important to get lots of nutrients.